366 research outputs found

    Hospitals with and without neurosurgery: a comparative study evaluating the outcome of patients with traumatic brain injury

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    Background: We leveraged the data of the international CREACTIVE consortium to investigate whether the outcome of traumatic brain injury (TBI) patients admitted to intensive care units (ICU) in hospitals without on-site neurosurgical capabilities (no-NSH) would differ had the same patients been admitted to ICUs in hospitals with neurosurgical capabilities (NSH). Methods: The CREACTIVE observational study enrolled more than 8000 patients from 83 ICUs. Adult TBI patients admitted to no-NSH ICUs within 48 h of trauma were propensity-score matched 1:3 with patients admitted to NSH ICUs. The primary outcome was the 6-month extended Glasgow Outcome Scale (GOS-E), while secondary outcomes were ICU and hospital mortality. Results: A total of 232 patients, less than 5% of the eligible cohort, were admitted to no-NSH ICUs. Each of them was matched to 3 NSH patients, leading to a study sample of 928 TBI patients where the no-NSH and NSH groups were well-balanced with respect to all of the variables included into the propensity score. Patients admitted to no-NSH ICUs experienced significantly higher ICU and in-hospital mortality. Compared to the matched NSH ICU admissions, their 6-month GOS-E scores showed a significantly higher prevalence of upper good recovery for cases with mild TBI and low expected mortality risk at admission, along with a progressively higher incidence of poor outcomes with increased TBI severity and mortality risk. Conclusions: In our study, centralization of TBI patients significantly impacted short- and long-term outcomes. For TBI patients admitted to no-NSH centers, our results suggest that the least critically ill can effectively be managed in centers without neurosurgical capabilities. Conversely, the most complex patients would benefit from being treated in high-volume, neuro-oriented ICUs

    Results on MOVPE SiGeSn deposition for the monolithic integration of III-V and IV elements in multi-junction solar cells

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    Abstract In order to produce a step forward towards the monolithic integration of III-V and IV compounds in multijunction solar cells, a first assessment of SiGeSn deposition in a metal organic vapour phase epitaxy (MOVPE) chamber also used for III-V growth has been carried out. The study brings insights on several aspects of the MOVPE SiGeSn growth in order to get a better control of SiGeSn composition and to obtain epitaxial layers with improved morphology. In particular, it is shown that the gas source Si2H6 is more influenced by the growth temperature compared to GeH4 and SnCl4, moreover, its competition with SnCl4 makes it difficult to incorporate Si in SiGeSn, as SnCl4 partial pressure is increased. SiGeSn morphology is shown to be strongly dependent on temperature, As carry-over and growth rate. A new growth model is introduced in order to explain the importance of the adatom bond lengths in inhibiting tin segregation when SiGeSn is grown at relatively high growth temperatures (>480 ¬įC). In order to investigate the photovoltaic behaviour of SiGeSn, a single-junction GaAs/InGaP/SiGeSn/Ge functional device has been manufactured and characterized by external quantum efficiency (EQE) and current-voltage measurements. The experimental and the simulated EQE show the higher absorption coefficient of SiGeSn with respect to Ge, which allows using SiGeSn layers with a thickness three times lower than Ge to produce the same photovoltaic current

    Relationship between the Clinical Frailty Scale and short-term mortality in patients ‚Č• 80¬†years old acutely admitted to the ICU: a prospective cohort study

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    Background: The Clinical Frailty Scale (CFS) is frequently used to measure frailty in critically ill adults. There is wide variation in the approach to analysing the relationship between the CFS score and mortality after admission to the ICU. This study aimed to evaluate the influence of modelling approach on the association between the CFS score and short-term mortality and quantify the prognostic value of frailty in this context. Methods: We analysed data from two multicentre prospective cohort studies which enrolled intensive care unit patients ‚Č• 80¬†years old in 26 countries. The primary outcome was mortality within 30-days from admission to the ICU. Logistic regression models for both ICU and 30-day mortality included the CFS score as either a categorical, continuous or dichotomous variable and were adjusted for patient‚Äôs age, sex, reason for admission to the ICU, and admission Sequential Organ Failure Assessment score. Results: The median age in the sample of 7487 consecutive patients was 84¬†years (IQR 81‚Äď87). The highest fraction of new prognostic information from frailty in the context of 30-day mortality was observed when the CFS score was treated as either a categorical variable using all original levels of frailty or a nonlinear continuous variable and was equal to 9% using these modelling approaches (p < 0.001). The relationship between the CFS score and mortality was nonlinear (p < 0.01). Conclusion: Knowledge about a patient‚Äôs frailty status adds a substantial amount of new prognostic information at the moment of admission to the ICU. Arbitrary simplification of the CFS score into fewer groups than originally intended leads to a loss of information and should be avoided. Trial registration NCT03134807 (VIP1), NCT03370692 (VIP2

    Study of the cross-influence between iii-v and iv elements deposited in the same movpe growth chamber

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    We have deposited Ge, SiGe, SiGeSn, AlAs, GaAs, InGaP and InGaAs based structures in the same metalorganic vapor phase epitaxy (MOVPE) growth chamber, in order to study the effect of the cross influence between groups IV and III-V elements on the growth rate, background doping and morphology. It is shown that by adopting an innovative design of the MOVPE growth chamber and proper growth condition, the IV elements growth rate penalization due to As ‚Äúcarry over‚ÄĚ can be eliminated and the background doping level in both IV and III-V semiconductors can be drastically reduced. In the temperature range 748‚Äď888 K, Ge and SiGe morphologies do not de-grade when the semiconductors are grown in a III-V-contaminated MOVPE growth chamber. Critical morphology aspects have been identified for SiGeSn and III-Vs, when the MOVPE deposition takes place, respectively, in a As or Sn-contaminated MOVPE growth chamber. III-Vs mor-phologies are influenced by substrate type and orientation. The results are promising in view of the monolithic integration of group-IV with III-V compounds in multi-junction solar cells

    Relationship between the Clinical Frailty Scale and short-term mortality in patients‚ÄČ‚Č•‚ÄČ80¬†years old acutely admitted to the ICU: a prospective cohort study.

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    BACKGROUND: The Clinical Frailty Scale (CFS) is frequently used to measure frailty in critically ill adults. There is wide variation in the approach to analysing the relationship between the CFS score and mortality after admission to the ICU. This study aimed to evaluate the influence of modelling approach on the association between the CFS score and short-term mortality and quantify the prognostic value of frailty in this context. METHODS: We analysed data from two multicentre prospective cohort studies which enrolled intensive care unit patients‚ÄČ‚Č•‚ÄČ80¬†years old in 26 countries. The primary outcome was mortality within 30-days from admission to the ICU. Logistic regression models for both ICU and 30-day mortality included the CFS score as either a categorical, continuous or dichotomous variable and were adjusted for patient's age, sex, reason for admission to the ICU, and admission Sequential Organ Failure Assessment score. RESULTS: The median age in the sample of 7487 consecutive patients was 84¬†years (IQR 81-87). The highest fraction of new prognostic information from frailty in the context of 30-day mortality was observed when the CFS score was treated as either a categorical variable using all original levels of frailty or a nonlinear continuous variable and was equal to 9% using these modelling approaches (p‚ÄČ<‚ÄČ0.001). The relationship between the CFS score and mortality was nonlinear (p‚ÄČ<‚ÄČ0.01). CONCLUSION: Knowledge about a patient's frailty status adds a substantial amount of new prognostic information at the moment of admission to the ICU. Arbitrary simplification of the CFS score into fewer groups than originally intended leads to a loss of information and should be avoided. Trial registration NCT03134807 (VIP1), NCT03370692 (VIP2)

    Prosafe: a european endeavor to improve quality of critical care medicine in seven countries

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    BACKGROUND: long-lasting shared research databases are an important source of epidemiological information and can promote comparison between different healthcare services. Here we present ProsaFe, an advanced international research network in intensive care medicine, with the focus on assessing and improving the quality of care. the project involved 343 icUs in seven countries. all patients admitted to the icU were eligible for data collection. MetHoDs: the ProsaFe network collected data using the same electronic case report form translated into the corresponding languages. a complex, multidimensional validation system was implemented to ensure maximum data quality. individual and aggregate reports by country, region, and icU type were prepared annually. a web-based data-sharing system allowed participants to autonomously perform different analyses on both own data and the entire database. RESULTS: The final analysis was restricted to 262 general ICUs and 432,223 adult patients, mostly admitted to Italian units, where a research network had been active since 1991. organization of critical care medicine in the seven countries was relatively similar, in terms of staffing, case mix and procedures, suggesting a common understanding of the role of critical care medicine. conversely, icU equipment differed, and patient outcomes showed wide variations among countries. coNclUsioNs: ProsaFe is a permanent, stable, open access, multilingual database for clinical benchmarking, icU self-evaluation and research within and across countries, which offers a unique opportunity to improve the quality of critical care. its entry into routine clinical practice on a voluntary basis is testimony to the success and viability of the endeavor

    Sepsis at ICU admission does not decrease 30-day survival in very old patients: a post-hoc analysis of the VIP1 multinational cohort study

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    Background: The number of intensive care patients aged ‚Č• 80 years (Very old Intensive Care Patients; VIPs) is growing. VIPs have high mortality and morbidity and the benefits of ICU admission are frequently questioned. Sepsis incidence has risen in recent years and identification of outcomes is of considerable public importance. We aimed to determine whether VIPs admitted for sepsis had different outcomes than those admitted for other acute reasons and identify potential prognostic factors for 30-day survival. Results: This prospective study included VIPs with Sequential Organ Failure Assessment (SOFA) scores ‚Č• 2 acutely admitted to 307 ICUs in 21 European countries. Of 3869 acutely admitted VIPs, 493 (12.7%) [53.8% male, median age 83 (81-86) years] were admitted for sepsis. Sepsis was defined according to clinical criteria; suspected or demonstrated focus of infection and SOFA score ‚Č• 2 points. Compared to VIPs admitted for other acute reasons, VIPs admitted for sepsis were younger, had a higher SOFA score (9 vs. 7, p &lt; 0.0001), required more vasoactive drugs [82.2% vs. 55.1%, p &lt; 0.0001] and renal replacement therapies [17.4% vs. 9.9%; p &lt; 0.0001], and had more life-sustaining treatment limitations [37.3% vs. 32.1%; p = 0.02]. Frailty was similar in both groups. Unadjusted 30-day survival was not significantly different between the two groups. After adjustment for age, gender, frailty, and SOFA score, sepsis had no impact on 30-day survival [HR 0.99 (95% CI 0.86-1.15), p = 0.917]. Inverse-probability weight (IPW)-adjusted survival curves for the first 30 days after ICU admission were similar for acute septic and non-septic patients [HR: 1.00 (95% CI 0.87-1.17), p = 0.95]. A matched-pair analysis in which patients with sepsis were matched with two control patients of the same gender with the same age, SOFA score, and level of frailty was also performed. A Cox proportional hazard regression model stratified on the matched pairs showed that 30-day survival was similar in both groups [57.2% (95% CI 52.7-60.7) vs. 57.1% (95% CI 53.7-60.1), p = 0.85]. Conclusions: After adjusting for organ dysfunction, sepsis at admission was not independently associated with decreased 30-day survival in this multinational study of 3869 VIPs. Age, frailty, and SOFA score were independently associated with survival

    Intronic determinants coordinate charme lncRNA nuclear activity through the interaction with MATR3 and PTBP1

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    Chromatin architect of muscle expression (Charme) is a muscle-restricted long noncoding RNA (lncRNA) that plays an important role in myogenesis. Earlier evidence indicates that the nuclear Charme isoform, named pCharme, acts on the chromatin by assisting the formation of chromatin domains where myogenic transcription occurs. By combining RNA antisense purification (RAP) with mass spectrometry and loss-of-function analyses, we have now identified the proteins that assist these chromatin activities. These proteins‚ÄĒwhich include a sub-set of splicing regulators, principally PTBP1 and the multifunctional RNA/DNA binding protein MATR3‚ÄĒbind to sequences located within the alternatively spliced intron-1 to form nuclear aggregates. Consistent with the functional importance of pCharme interactome in vivo, a targeted deletion of the intron-1 by a CRISPR-Cas9 approach in mouse causes the release of pCharme from the chromatin and results in cardiac defects similar to what was observed upon knockout of the full-length transcript

    Sepsis at ICU admission does not decrease 30-day survival in very old patients: a post-hoc analysis of the VIP1 multinational cohort study.

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    BACKGROUND: The number of intensive care patients aged‚ÄČ‚Č•‚ÄČ80¬†years (Very old Intensive Care Patients; VIPs) is growing. VIPs have high mortality and morbidity and the benefits of ICU admission are frequently questioned. Sepsis incidence has risen in recent years and identification of outcomes is of considerable public importance. We aimed to determine whether VIPs admitted for sepsis had different outcomes than those admitted for other acute reasons and identify potential prognostic factors for 30-day survival. RESULTS: This prospective study included VIPs with Sequential Organ Failure Assessment (SOFA) scores‚ÄČ‚Č•‚ÄČ2 acutely admitted to 307 ICUs in 21 European countries. Of 3869 acutely admitted VIPs, 493 (12.7%) [53.8% male, median age 83 (81-86) years] were admitted for sepsis. Sepsis was defined according to clinical criteria; suspected or demonstrated focus of infection and SOFA score‚ÄČ‚Č•‚ÄČ2 points. Compared to VIPs admitted for other acute reasons, VIPs admitted for sepsis were younger, had a higher SOFA score (9 vs. 7, p‚ÄČ<‚ÄČ0.0001), required more vasoactive drugs [82.2% vs. 55.1%, p‚ÄČ<‚ÄČ0.0001] and renal replacement therapies [17.4% vs. 9.9%; p‚ÄČ<‚ÄČ0.0001], and had more life-sustaining treatment limitations [37.3% vs. 32.1%; p‚ÄČ=‚ÄČ0.02]. Frailty was similar in both groups. Unadjusted 30-day survival was not significantly different between the two groups. After adjustment for age, gender, frailty, and SOFA score, sepsis had no impact on 30-day survival [HR 0.99 (95% CI 0.86-1.15), p‚ÄČ=‚ÄČ0.917]. Inverse-probability weight (IPW)-adjusted survival curves for the first 30¬†days after ICU admission were similar for acute septic and non-septic patients [HR: 1.00 (95% CI 0.87-1.17), p‚ÄČ=‚ÄČ0.95]. A matched-pair analysis in which patients with sepsis were matched with two control patients of the same gender with the same age, SOFA score, and level of frailty was also performed. A Cox proportional hazard regression model stratified on the matched pairs showed that 30-day survival was similar in both groups [57.2% (95% CI 52.7-60.7) vs. 57.1% (95% CI 53.7-60.1), p‚ÄČ=‚ÄČ0.85]. CONCLUSIONS: After adjusting for organ dysfunction, sepsis at admission was not independently associated with decreased 30-day survival in this multinational study of 3869 VIPs. Age, frailty, and SOFA score were independently associated with survival

    High energy cosmic ray physics with underground muons in MACRO. I. Analysis methods and experimental results

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    In this paper, the first of a two-part work, we present the reconstruction and measurement of muon events detected underground by the MACRO experiment at Gran Sasso (E —É 1.3 TeV in atmosphereÕí. The main aim of this work is to discuss the muon multiplicity distribution as measured in the detector. The data sample analyzed consists of 4.4Ōę10 6 muon events, of which Ō≥ 263 000 are multiple muons, corresponding to a total live time of 5850 h. In this sample, the observed multiplicities extend above N Ō≠35, with intermuon separations up to 50 m and beyond. Additional complementing measurements, such as the inclusive muon flux, the angular distribution, and the muon separation distribution ÕĎdecoherenceÕí, are also included. The physical interpretation of the results presented here is reported in the following companion paper. ÕďS0556-2821ÕĎ97Õí00615-2ÕĒ PACS numberÕĎsÕí: 13.85. Tp, 96.40.De, 96.40.Tv, 98.70.S
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