What procalcitonin brings to management of sepsis in the ICU

In inflammatory states, particularly in response to infectious stimuli, local procalcitonin (PCT) production rises, and because these tissues cannot further process PCT into calcitonin, serum levels increase. In the critical care setting, PCT should be considered a useful tool to help physicians in some specific, although frequent, situations. Serial measurements of PCT levels may indicate the effectiveness of medical decisions such as the appropriateness of antibiotic therapy, the detection of new infections, and the exclusion of a diagnosis of sepsis. PCT-guided algorithms may also help to decrease the duration of antimicrobial therapy. However, the role of PCT as a prognostic marker in critically ill patients is controversial. In a study by Karlsson and colleagues, PCT concentrations did not differ between hospital survivors and nonsurvivors, but the outcome was better in patients whose PCT concentrations decreased more than 50%. The study of PCT kinetics thus could offer an individual risk assessment in patients with severe sepsis

Exploring design principles for data literacy activities to support children’s inquiries from complex data

Data literacy is gaining importance as a general skill that all citizens should possess in an increasingly data-driven society. As such there is interest in how it can be taught in schools. However, the majority of teaching focuses on small, personally collected data which is easier for students to relate to. This does not give the students the breadth of experience they need for dealing with the larger, complex data that is collected at scale and used to drive the intelligent systems that people engage with during work and leisure time. Neither does it prepare them for future jobs, which increasingly require skills for critically querying and deriving insights from data. This paper addresses this gap by trialling a method for teaching from complex data, collected through a smart city project. The main contribution is to show that existing data principles from the literature can be adapted to design data literacy activities that help pupils understand complex data collected by others and form interesting questions and hypotheses about it. It also demonstrates how smart city ideas and concepts can be brought to life in the classroom. The Urban Data School study was carried out over two years in three primary and secondary schools in England, using smart city datasets. Three teachers took part, providing access to different age groups, subject areas, and class types. This resulted in four distinctive field studies, with 67 stu- dents aged between 10-14 years, each lasting a few weeks within the two year period. The studies provide evidence that when engaging with data that has not been personally collected, activities designed to give the experience of collecting the data can help in critiquing it

Some future scenarios for ‘in the wild’ visualisations

Migration from desktop-based to alternative out of the desk visualisations, could help to overcome some of the issues that are related to traditional screen representation problems. But simultaneously, it represents a challenge in which many technical and ethical questions have yet to be answered. In the following sections some thoughts about how visualisation outside the desktop could be applied are presented through three different categories: common objects, large scale augmented reality and natural devices

Phase transitions at surfaces, edges, and corners

Results of large-scale Monte Carlo simulations of three-dimensional Ising models with edges and corners are reviewed. At the ordinary transition, angle dependent critical exponents are observed, whereas at the surface transition edge and corner critical exponents are non-universal and depend on the details of the model. The results obtained at the surface transition are compared to exact findings on critical two-dimensional Ising models with different types of defect lines.Comment: 6 pages, 5 figure

Management of neurological complications of infective endocarditis in ICU patients

Patients with infective endocarditis (IE) are generally referred to the intensive care unit (ICU) for one or more organ dysfunctions caused by complications of IE. Neurologic events are frequent causes of ICU admission in patients with IE. They can arise through various mechanisms consisting of stroke or transient ischemic attack, cerebral hemorrhage, mycotic aneurysm, meningitis, cerebral abscess, or encephalopathy. Most complications occur early during the course of IE and are a hallmark of left-sided abnormalities of native or prosthetic valves. Occlusion of cerebral arteries, with stroke or transient ischemic attack, accounts for 40% to 50% of the central nervous system complications of IE. CT scan is the most easily feasible neuroimaging in critically unstable patients. However, magnetic resonance imaging is more sensitive and when performed should follow a standardized protocol. In patients with ischemic stroke who are already receiving oral anticoagulant therapy, this treatment should be replaced by unfractionated heparin for at least 2 weeks with a close monitoring of coagulation tests. Mounting evidence shows that, for both complicated left-sided native valve endocarditis and Staphylococcus aureus prosthetic valve endocarditis, valve replacement combined with medical therapy is associated with a better outcome than medical treatment alone. In a recent series, approximately 50% of patients underwent valve replacement during the acute phase of IE before completion of antibiotic treatment. After a neurological event, most patients have at least one indication for cardiac surgery. Recent data from literature suggest that after a stroke, surgery indicated for heart failure, uncontrolled infection, abscess, or persisting high emboli risk should not be delayed, provided that the patient is not comatose or has no severe deficit. Neurologic complications of IE contribute to a severe prognosis in ICU patients. However, patients with only silent or transient stroke had a better prognosis than patients with symptomatic events. In addition, more than neurologic event per se, a better predictor of mortality is neurologic dysfunction, which is associated with location and extension of brain damage. Patients with severe neurological impairment and those with brain hemorrhage have the worse outcome

Sexual and Reproductive Health Behaviors of Undocumented Migrants in Geneva: A Cross Sectional Study

Undocumented migrants face major barriers in accessing prevention and health care. Whereas the association between low socioeconomic status and poor health is well documented only few studies have addressed specific health issues in undocumented migrants. The aim of the present study is to describe sexual and reproductive health behaviors of undocumented migrants in Geneva. This descriptive cross sectional study included consecutive undocumented migrants presenting from November 2007 to February 2008 to a health facility offering free access to health care to this population. Following informed consent, they completed a self administered questionnaire about their socio-demographic profile and sexual and reproductive health behaviors. A total of 384 patients were eligible for the study. 313 (82%) agreed to participate of which 77% (241 patients) completed the survey. Participants were mainly young, Latino-American, single, well-educated and currently working women. They had multiple partners and reported frequently engaging in sexual intercourse. Use of contraceptive methods and strategies of prevention against sexually transmitted infections (STI) were rare. Nearly half of the women had had at least one induced abortion and 40% had had an unplanned pregnancy. One in four participants reported a current or past STI or other genital infection. The results of our study suggest that undocumented migrants engage in frequent and high risk sexual intercourse with insufficient use of contraceptive methods and suboptimal strategies of prevention against STI. Our study underlines the real need for specific sexual and reproductive educational programs targeting this hard to reach populatio

L’émergence de l’espace public a la Réunion. Un contexte socio-historique singulier

L’éclairage socio-historique proposé dans cet article n’a pas pour objet de construire un décor illustratif de la situation réunionnaise : la mise en perspective diachronique de la transformation de la société réunionnaise vise ici à inscrire l’émergence d’un espace public à la Réunion dans un processus historique, l’histoire constituant une variable endogène du contexte présent. Signifiante pour les acteurs locaux, elle est une catégorie en tant que telle et s’impose de façon incontournable pour la compréhension de ce qui se joue « ici et maintenant ». De ce point de vue, l’espace public ne constitue ni un type idéal universalisé ni une catégorie normative.Selon ces principes, la forme spécifique que prend l’espace public réunionnais est appréhendée d’abord au regard de l’évolution socio-historique de la société locale et des profondes transformations qui la parcourent depuis une trentaine d’années. Dans un second temps, l’émergence de l’espace public réunionnais est examiné au travers de la mutation du paysage médiatique local.The socio-historical approach proposed in this article is not aimed at building an illustrative setting for the situation in Reunion Island: the purpose of putting the transformation of the Reunion society into a diachronic perspective is to place the emergence of a public sphere in Reunion Island within a historical process, history being an endogenous variable of the present context. Being meaningful to the local actors, it is a category in itself and imposes itself in an unavoidable way for the understanding of what is being enacted « here and now ». From this point of view, public sphere makes up neither a universalised ideal type nor a normative category.According to these principles, the specific form taken up by the public sphere in Reunion Island is first analysed from the angle of the socio-historical evolution of the local society and of the deep transformations which have been running through it in the past thirty years. Secondly, the emergence of public space in Reunion Island is examined though the changes in the local media scenery

Year-round records of bulk and size-segregated aerosol composition in central Antarctica (Concordia site) Part 1: Fractionation of sea-salt particles

Abstract. Multiple year-round records of bulk and size-segregated composition of aerosol were obtained at the inland site of Concordia located at Dome C in East Antarctica. In parallel, sampling of acidic gases on denuder tubes was carried out to quantify the concentrations of HCl and HNO3 present in the gas phase. These time-series are used to examine aerosol present over central Antarctica in terms of chloride depletion relative to sodium with respect to freshly emitted sea-salt aerosol as well as depletion of sulfate relative to sodium with respect to the composition of seawater. A depletion of chloride relative to sodium is observed over most of the year, reaching a maximum of ~ 20 ng m−3 in spring when there are still large sea-salt amounts and acidic components start to recover. The role of acidic sulfur aerosol and nitric acid in replacing chloride from sea-salt particles is here discussed. HCl is found to be around twice more abundant than the amount of chloride lost by sea-salt aerosol, suggesting that either HCl is more efficiently transported to Concordia than sea-salt aerosol or reemission from the snow pack over the Antarctic plateau represents an additional significant HCl source. The size-segregated composition of aerosol collected in winter (from 2006 to 2011) indicates a mean sulfate to sodium ratio of sea-salt aerosol present over central Antarctica of 0.16 ± 0.05, suggesting that, on average, the sea-ice and open ocean emissions equally contribute to sea-salt aerosol load of the inland Antarctic atmosphere. The temporal variability of the sulfate depletion relative to sodium was examined at the light of air mass backward trajectories, showing an overall decreasing trend of the ratio (i.e. a stronger sulfate depletion relative to sodium) when air masses arriving at Dome C had travelled a longer time over sea-ice than over open-ocean. The findings are shown to be useful to discuss sea-salt ice records extracted at deep drilling sites located inland Antarctica. </jats:p

Zero-variance principle for Monte Carlo algorithms

We present a general approach to greatly increase at little cost the efficiency of Monte Carlo algorithms. To each observable to be computed we associate a renormalized observable (improved estimator) having the same average but a different variance. By writing down the zero-variance condition a fundamental equation determining the optimal choice for the renormalized observable is derived (zero-variance principle for each observable separately). We show, with several examples including classical and quantum Monte Carlo calculations, that the method can be very powerful.Comment: 9 pages, Latex, to appear in Phys. Rev. Let