Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016.

OBJECTIVE: To provide an update to "Surviving Sepsis Campaign Guidelines for Management of Sepsis and Septic Shock: 2012." DESIGN: A consensus committee of 55 international experts representing 25 international organizations was convened. Nominal groups were assembled at key international meetings (for those committee members attending the conference). A formal conflict-of-interest (COI) policy was developed at the onset of the process and enforced throughout. A stand-alone meeting was held for all panel members in December 2015. Teleconferences and electronic-based discussion among subgroups and among the entire committee served as an integral part of the development. METHODS: The panel consisted of five sections: hemodynamics, infection, adjunctive therapies, metabolic, and ventilation. Population, intervention, comparison, and outcomes (PICO) questions were reviewed and updated as needed, and evidence profiles were generated. Each subgroup generated a list of questions, searched for best available evidence, and then followed the principles of the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system to assess the quality of evidence from high to very low, and to formulate recommendations as strong or weak, or best practice statement when applicable. RESULTS: The Surviving Sepsis Guideline panel provided 93 statements on early management and resuscitation of patients with sepsis or septic shock. Overall, 32 were strong recommendations, 39 were weak recommendations, and 18 were best-practice statements. No recommendation was provided for four questions. CONCLUSIONS: Substantial agreement exists among a large cohort of international experts regarding many strong recommendations for the best care of patients with sepsis. Although a significant number of aspects of care have relatively weak support, evidence-based recommendations regarding the acute management of sepsis and septic shock are the foundation of improved outcomes for these critically ill patients with high mortality

The p53 pathway in breast cancer

p53 mutation remains the most common genetic change identified in human neoplasia. In breast cancer, p53 mutation is associated with more aggressive disease and worse overall survival. The frequency of mutation in p53 is, however, lower in breast cancer than in other solid tumours. Changes, both genetic and epigenetic, have been identified in regulators of p53 activity and in some downstream transcriptional targets of p53 in breast cancers that express wild-type p53. Molecular pathological analysis of the structure and expression of constituents of the p53 pathway is likely to have value in diagnosis, in prognostic assessment and, ultimately, in treatment of breast cancer

Predicting youth participation in urban agriculture in Malaysia: insights from the theory of planned behavior and the functional approach to volunteer motivation

This study examines factors associated with the decision of Malaysian youth to participate in a voluntary urban agriculture program. Urban agriculture has generated significant interest in developing countries to address concerns over food security, growing urbanization and employment. While an abundance of data shows attracting the participation of young people in traditional agriculture has become a challenge for many countries, few empirical studies have been conducted on youth motivation to participate in urban agriculture programs, particularly in non-Western settings. Drawing on the theories of planned behavior and the functional approach to volunteer motivation, we surveyed 890 students from a public university in Malaysia about their intention to join a new urban agriculture program. Hierarchical regression findings indicated that the strongest predictor of participation was students’ attitude toward urban agriculture, followed by subjective norms, career motives and perceived barriers to participation. The findings from this study may provide useful information to the university program planners in Malaysia in identifying mechanisms for future students’ involvement in the program

Synergies between centralized and federated approaches to data quality: a report from the national COVID cohort collaborative

Objective In response to COVID-19, the informatics community united to aggregate as much clinical data as possible to characterize this new disease and reduce its impact through collaborative analytics. The National COVID Cohort Collaborative (N3C) is now the largest publicly available HIPAA limited dataset in US history with over 6.4 million patients and is a testament to a partnership of over 100 organizations. Materials and Methods We developed a pipeline for ingesting, harmonizing, and centralizing data from 56 contributing data partners using 4 federated Common Data Models. N3C data quality (DQ) review involves both automated and manual procedures. In the process, several DQ heuristics were discovered in our centralized context, both within the pipeline and during downstream project-based analysis. Feedback to the sites led to many local and centralized DQ improvements. Results Beyond well-recognized DQ findings, we discovered 15 heuristics relating to source Common Data Model conformance, demographics, COVID tests, conditions, encounters, measurements, observations, coding completeness, and fitness for use. Of 56 sites, 37 sites (66%) demonstrated issues through these heuristics. These 37 sites demonstrated improvement after receiving feedback. Discussion We encountered site-to-site differences in DQ which would have been challenging to discover using federated checks alone. We have demonstrated that centralized DQ benchmarking reveals unique opportunities for DQ improvement that will support improved research analytics locally and in aggregate. Conclusion By combining rapid, continual assessment of DQ with a large volume of multisite data, it is possible to support more nuanced scientific questions with the scale and rigor that they require

The InFACT Global H1N1 Collaboration. InFACT: a global critical care research response to H1N1.

An international collaboration for clinical research during pandemic viral infection

Oceanization starts at depth during continental rupturing in the Northern Red Sea

We present here 3D seismic reflection and gravity data obtained from an off-axis area of the NW Red Sea, as well as results of a study of gabbroic rocks recovered in the same area both from an oil well below a thick evaporitic-sedimentary sequence, and from a layered mafic complex exposed on the Brothers Islets. These new data provide constraints on the composition, depth of emplacement and age of early syn-rift magma intrusions into the deep crust. The Brothers are part of a series of sub-parallel NW-striking topographic highs associated with SW-dipping extensional fault blocks with significant footwall uplift during rifting that brought early syn-rift deep crustal rocks up to the seafloor. Assuming an important role played by magmatism in the evolution of narrow rifts helps to solve the controversy on the nature of the crust in the northern/central Red Sea (i.e., the crust outside the axial oceanic cells is either oceanic or it consists of melt-intruded extended continental crust). Gabbros show petrologic and geochemical signatures similar to those of MORB-type gabbroic cumulates and are compatible with their having been emplaced either in a continental or in an oceanic context. We explored the different hypotheses proposed to explain the lack of magnetic anomalies in the presence of oceanic crust in the northern Red Sea. Our results, combined with a review of all the geophysical and geological data in the area, suggest a stretched and thinned continental crust with few isolated sites of basaltic injections, in line with a model whereby asthenospheric melt intrusions contribute to weaken the lower crust enabling some decoupling between upper and lower crust, protracting upper crust extension and delaying crustal breakup. Our findings show that continental rupture in the northern Red Sea is preceded by intrusion of basaltic melts with MORB-type elemental and isotopic signature, that cooled forming gabbros at progressively shallower crustal depths as rifting progressed toward continental separation