Ventilator-Associated Pneumonia and PaO2/FIO2 Diagnostic Accuracy: Changing the Paradigm?

BACKGROUND: Ventilator-associated pneumonia (VAP) is associated to longer stay and poor outcomes. Lacking definitive diagnostic criteria, worsening gas exchange assessed by PaO2/FIO2 ≤ 240 in mmHg has been proposed as one of the diagnostic criteria for VAP. We aim to assess the adequacy of PaO2/FIO2 ≤ 240 to diagnose VAP. METHODS: Prospective observational study in 255 consecutive patients with suspected VAP, clustered according to PaO2/FIO2 ≤ 240 vs. > 240 at pneumonia onset. The primary analysis was the association between PaO2/FIO2 ≤ 240 and quantitative microbiologic confirmation of pneumonia, the most reliable diagnostic gold-standard. RESULTS: Mean PaO2/FIO2 at VAP onset was 195 ± 82; 171 (67%) cases had PaO2/FIO2 ≤ 240. Patients with PaO2/FIO2 ≤ 240 had a lower APACHE-II score at ICU admission; however, at pneumonia onset they had higher CPIS, SOFA score, acute respiratory distress syndrome criteria and incidence of shock, and less microbiological confirmation of pneumonia (117, 69% vs. 71, 85%, p = 0.008), compared to patients with PaO2/FIO2 > 240. In multivariate logistic regression, PaO2/FIO2 ≤ 240 was independently associated with less microbiological confirmation (adjusted odds-ratio 0.37, 95% confidence interval 0.15-0.89, p = 0.027). The association between PaO2/FIO2 and microbiological confirmation of VAP was poor, with an area under the ROC curve 0.645. Initial non-response to treatment and length of stay were similar between both groups, while hospital mortality was higher in patients with PaO2/FIO2 ≤ 240. CONCLUSION: Adding PaO2/FIO2 ratio ≤ 240 to the clinical and radiographic criteria does not help in the diagnosis of VAP. PaO2/FIO2 ratio > 240 does not exclude this infection. Using this threshold may underestimate the incidence of VAP.info:eu-repo/semantics/publishedVersio

Kounis Syndrome Associated With Selective Anaphylaxis to Cefazolin.

info:eu-repo/semantics/publishedVersio

Preparation and characterization of Co-W alloys as anode materials for methanol fuel cells

Co-W alloys are developed by an electroplating technique using a bath solution which contains triammonium citrate (TAC) and dimethyl sulfoxide (DMSO) under suitable plating conditions. The alloys are characterized by polarization studies in order to determine their prospects as effective anode materials for methanol fuel cells in both acidic and alkaline media. Scanning electron microscopic and X-ray diffraction analysis shows that the coatings are partially amorphous. The alloys exhibit low overvoltage even on prolonged electrolysis, and have good corrosion resistance in acidic and alkaline media. Electrochemical parameters for methanol oxidation depend on the heat treatment, deposition potential and microstructure of the deposit. © 2002 Elsevier Science B.V. All rights reserved

Does a federal country need federal transfers when it has labor mobility?

JEL Classification: H77, R23, C33.The United States is recognized as a country where labor mobility between states is high. Usually, when some states experience periods of economic difficulties, people move to other states that offer better perspectives, which may alleviate depressions. In spite of this flexibility in the labor market, the Federal Budget still grants some significative amount of aid to the states. Does this help to do any good or is it even necessary when labor mobility is significative? In this paper, we assess the efficiency of having federal transfers to states when workers’ mobility is high. We use data for the 50 states of the USA and perform panel data analysis. We reach positive effects of federal transfers and migration in the relative performance of each state and also in the convergence of the states’ income to the union’s average. However, we note that the positive effect of migration is seen in lagged differences (short-run effect) and the federal transfers’ effect is seen in lagged levels (long-run effect). Moreover, quantitatively, the federal transfers have more effects than outmigration

The dynamics of the trade balance and the terms of trade in Central and Eastern European countries

In this work, we assess the existence of an S-Curve pattern in 10 Central and Eastern European countries (CEEC-10) for the relation between the trade balance and the terms of trade. Empirical results support the existence of this curve for Slovenia and Hungary. In the case of Bulgaria, the Czech Republic, and Slovakia the pattern is weaker, but it still prevails, as is the case for an aggregate of the 10 transition countries. We then document this property of business cycles in the dynamic general equilibrium trade model of Backus et al. (1994), calibrated specifically to match the CEEC-10 aggregate economy. Results support the existence of an S-Curve, except when technology shocks are absent and domestic and imported goods are perfect substitutes. Since technological shocks are determinant in explaining the S-Curve pattern and transition countries seem to be experiencing some type of technological shocks, it is not likely that this pattern will fade away in the near future and hence it is important for economic policy to be aware of this phenomenon and its consequences for these countries in terms of real convergence and the timing of euro adoption.info:eu-repo/semantics/acceptedVersio

On the welfare properties of the Lucas and Romer endogenous growth models

We present results from quantitative exercises using the Lucas and Romer endogenous growth models, from which we calculate welfare losses from the distortions presented in the Romer model. Moreover, comparing the models to data, we show that an economy governed by the Romer model would attain a higher welfare than one governed by the Lucas model, contrary to what can be interpreted from some previous theoretical contributions

Should the federal government reallocate funds within federal transfers?

It is recognized that one of the goals of federal transfers is to provide the states with some financial leverage during recessions. Federal transfers in the United States comprise such components as retirement and disability payments for individuals, other direct payments for individuals or organizations, grants, procurement contracts, and salaries and wages. Is the composition of the federal transfers’ budget having an optimal effect on the business cycle or should the federal government reallocate some expenditure? In this article, we argue that the federal government may improve its role in stabilizing the business cycle if some reallocation is made from procurement contracts and payments for other than individuals to direct payments for individuals, grants, and disability and retirement payments

Cuantificación de las distorsiones atribuibles a polución en un modelo de crecimiento endógeno con I+D

In this note we study the distortions in an endogenous growth model developed by Grimaud and Tournemaine (2007), where new pieces of knowledge are produced in a R&D sector and used to reduce pollution emissions. Using this model along with a realistic calibration, we conclude that the economy strongly underinvests in R&D, such that the policy maker would need to implement a strong tax-subsidy scheme to correct it. We suggest that a subsidy to human capital can also decrease the gap between market and optimal allocations.info:eu-repo/semantics/publishedVersio

Development and evaluation of lessons for class and group situations in grade one

Thesis (Ed.M.)--Boston Universit

Do large governments decrease happiness? New evidence of a negative effect in Europe

Until now little evidence has been found about the relationship between governments and happiness, but when cited, it has suggested a positive influence. Using micro-data from the last three waves of the European Quality of Life Survey and several measures for the weight of the government, such as structural government consumption, structural balance, and public debt, we show that government consumption and the other measures of government imbalances significantly decrease happiness in European countries. Additionally, we present robust evidence of a positive relationship between the quality of government and happiness. This evidence may lead politicians to reject the idea that bigger Governments lead to greater satisfaction. This result is consistent with people valuing (negatively) expectations for future tax increases, austerity, and possible corruption-related events.info:eu-repo/semantics/submittedVersio