Science.gov

Sample records for perinatal sepsis pops

  1. Sepsis

    MedlinePlus

    ... the episode 3 , 4 . What is the economic cost of sepsis? Treatment for sepsis often involves a ... care unit and complex therapies, which incur high costs. The Agency for Healthcare Research and Quality lists ...

  2. Sepsis.

    PubMed

    Dean, Erin

    2016-09-01

    Essential facts Sepsis, a clinical syndrome caused by the body's immune and coagulation systems being switched on by an infection, is believed to cause about 44,000 deaths a year. If not recognised early and treated promptly, sepsis can lead to shock, multiple organ failure and death. Major reports (UK parliamentary and health service ombudsman enquiry in 2013 and the UK National Confidential Enquiry into Patient Outcome and Death in 2015) have highlighted sepsis as being a leading cause of avoidable death that kills more people than breast, bowel and prostate cancer combined. PMID:27581906

  3. Sepsis.

    PubMed

    Dean, Erin

    2016-09-01

    Essential facts [Figure: see text] Sepsis, a clinical syndrome caused by the body's immune and coagulation systems being switched on by an infection, is believed to cause about 44,000 deaths a year. If not recognised early and treated promptly, sepsis can lead to shock, multiple organ failure and death. Major reports (UK parliamentary and health service ombudsman enquiry in 2013 and the UK National Confidential Enquiry into Patient Outcome and Death in 2015) have highlighted sepsis as being a leading cause of avoidable death that kills more people than breast, bowel and prostate cancer combined. PMID:27615338

  4. Sepsis

    MedlinePlus

    ... oxygen. In severe cases, one or more organs fail. In the worst cases, blood pressure drops and the heart weakens, leading to septic shock. Anyone can get sepsis, but the risk is higher in People with weakened immune systems Infants and children The elderly People with chronic ...

  5. PeriStats: Perinatal Statistics

    MedlinePlus

    ... is developed by the March of Dimes Perinatal Data Center and provides access to maternal and infant health ... on PeriStats sometimes different from my health department's data? What should I do if pop-up blocker ... We acknowledge the Centers for Disease Control and Prevention for its support ...

  6. Neonatal sepsis

    MedlinePlus

    ... BE. Perinatal viral infections. In Martin RJ, Fanaroff AA, Walsh MC, eds. Fanaroff and Martin's Neonatal-Perinatal ... K. Postnatal bacterial infections. In Martin RJ, Fanaroff AA, Walsh MC, eds. Fanaroff and Martin's Neonatal-Perinatal ...

  7. Perinatal depression

    PubMed Central

    Alhusen, Jeanne L.; Alvarez, Carmen

    2016-01-01

    Abstract: Perinatal depression is a common condition with significant adverse maternal, fetal, neonatal, and early childhood outcomes. The perinatal period is an opportune time to screen, diagnose, and treat depression. Improved recognition of perinatal depression, particularly among low-income women, can lead to improved perinatal health outcomes. PMID:26934457

  8. Perinatal neuroprotection.

    PubMed

    Salmeen, Kirsten E; Jelin, Angie C; Thiet, Mari-Paule

    2014-01-01

    Fetal or neonatal brain injury can result in lifelong neurologic disability. The most significant risk factor for perinatal brain injury is prematurity; however, in absolute numbers, full-term infants represent the majority of affected children. Research on strategies to prevent or mitigate the impact of perinatal brain injury ("perinatal neuroprotection") has established the mitigating roles of magnesium sulfate administration for preterm infants and therapeutic hypothermia for term infants with suspected perinatal brain injury. Banked umbilical cord blood, erythropoietin, and a number of other agents that may improve neuronal repair show promise for improving outcomes following perinatal brain injury in animal models. Other preventative strategies include delayed umbilical cord clamping in preterm infants and progesterone in women with prior preterm birth or short cervix and avoidance of infections. Despite these advances, we have not successfully decreased the rate of preterm birth, nor are we able to predict term infants at risk of hypoxic brain injury in order to intervene prior to the hypoxic event. Further, we lack the ability to modulate the sequelae of neuronal cell insults or the ability to repair brain injury after it has been sustained. As a consequence, despite exciting advances in the field of perinatal neuroprotection, perinatal brain injury still impacts thousands of newborns each year with significant long-term morbidity and mortality. PMID:24592318

  9. [Perinatal listeriosis].

    PubMed

    Tollan, A; Sundsfjord, A; Lindal, S

    1992-04-30

    Human listeriosis is a rare disease. It may be foodborne. Listeric infection during pregnancy may give a fatal fetal outcome, caused by transplacental passage of organisms from the maternal gastrointestinal tract. We describe a case of perinatal listeriosis which resulted in preterm stillbirth. Perinatal listeriosis should be considered when flue-like symptoms are presented during pregnancy. Early diagnosis and treatment may improve the outcome.

  10. Pop in a Popper

    ERIC Educational Resources Information Center

    Reading Teacher, 2011

    2011-01-01

    This article describes Pop in a Popper, an effective lesson for teaching students how to choose and use words to give their writing fluency and flair. Pop in a Popper introduces the appositive: a group of words inserted after a noun to modify that noun. In simplest terms, writers pop this group of words into a sentence to tell more about a noun.…

  11. Jiffy Pop Volcanoes.

    ERIC Educational Resources Information Center

    Cruz, Irene

    1998-01-01

    Pans of popcorn are popped to varying degrees in order to compare them to the earth's surface with volcanic pressure building up in this demonstration. Volcanic activity is also related to bodily functions to help students make connections. For example, the release of gas through burping after drinking soda pop is related to the release of…

  12. Neutropenic sepsis.

    PubMed

    Jones, Tracie

    2016-09-28

    What was the nature of the CPD activity, practice-related feedback and/or event and/or experience in your practice? The article discussed the causes, signs and symptoms of neutropenic sepsis in adult patients after cancer treatment. It also explored the prevention and management of this condition. PMID:27682569

  13. Popping All Over

    NASA Video Gallery

    With numerous active regions populating the Sun's surface, it is no surprise that over about two days (Mar. 6-8, 2011) SDO saw flares and coronal mass ejections popping off in many directions. The ...

  14. Pop-Art Panels

    ERIC Educational Resources Information Center

    Alford, Joanna

    2012-01-01

    James Rosenquist's giant Pop-art panels included realistic renderings of well-known contemporary foods and objects, juxtaposed with famous people in the news--largely from the 1960s, '70s and '80s--and really serve as visual time capsules. In this article, eighth-graders focus on the style of James Rosenquist to create their own Pop-art panel that…

  15. Sepsis biomarkers.

    PubMed

    Prucha, Miroslav; Bellingan, Geoff; Zazula, Roman

    2015-02-01

    Sepsis is the most frequent cause of death in non-coronary intensive care units (ICUs). In the past 10 years, progress has been made in the early identification of septic patients and in their treatment and these improvements in support and therapy mean that the mortality is gradually decreasing but it still remains unacceptably high. Leaving clinical diagnosis aside, the laboratory diagnostics represent a complex range of investigations that can place significant demands on the system given the speed of response required. There are hundreds of biomarkers which could be potentially used for diagnosis and prognosis in septic patients. The main attributes of successful markers would be high sensitivity, specificity, possibility of bed-side monitoring, and financial accessibility. Only a fraction is used in routine clinical practice because many lack sufficient sensitivity or specificity. The following review gives a short overview of the current epidemiology of sepsis, its pathogenesis and state-of-the-art knowledge on the use of specific biochemical, hematological and immunological parameters in its diagnostics. Prospective approaches towards discovery of new diagnostic biomarkers have been shortly mentioned.

  16. GO, PEP, and POP!

    ERIC Educational Resources Information Center

    Baeckler, Virginia

    Here are 250 tested ideas for lively libraries, from GO (Getting Outside) to PEP (Programs, Exhibits, Projects) and POP (Positive Operating Procedures), collected by the Mercer County (New Jersey) Library at Trenton. GO ideas include public relations and outreach ideas ranging from ads at the drive-in movie to attending high school sports events…

  17. Pop Culture Peeps

    ERIC Educational Resources Information Center

    Kruszewski, Julie; Fontes, Kris

    2008-01-01

    In this article, the authors present a classroom activity called Pop Culture Peep. In this particular activity, students are required to first research famous artists and/or famous artworks to have an image to use as a reference. Students then plan out how they would decorate the Peep, deciding what materials they would use to create the Peep in…

  18. Pop Goes the Culture

    ERIC Educational Resources Information Center

    Kurlansky, Mark J.

    1977-01-01

    Popular culture is defended as a solid academic entry that is a new approach to sociology, art, and literature. The contributions and theories of three professors are discussed: Arthur Asa Berger, Leslie Fiedler, and Alan Gowans. They illustrate the range and diversity in the pop culture field. (LBH)

  19. PopGenetics.

    ERIC Educational Resources Information Center

    Johnson, David A.

    1995-01-01

    Describes new software called "PopGenetics" that is useful for conducting hands-on laboratory activities that illustrate population genetics. Users investigate the effects of selection and random drift on changes in allelic frequencies, the effect of mutation, and interactions among these three parameters. Designed for use on Macintosh computers.…

  20. Sepsis Questions and Answers

    MedlinePlus

    ... has kidney problems, sepsis can lead to kidney failure that requires lifelong dialysis. Top of Page How ... to prevent healthcare-associated infections. Recently, CDC has projects specifically focused on sepsis prevention so that we ...

  1. Perinatal rights.

    PubMed

    Munir, A E

    1984-01-01

    The history of perinatal rights is traced to determine how far the law has settled with reasonable certainty and principles can be drawn from decided cases, where the law remains uncertain. It is unlikely that there will be legislation in the near future to bring the law up to date in these matters. The right to prevent conception is accepted these day by practically all shades of opinion. Opinions on methods may differ, but the dividing line between what is contraception and what amounts to abortion is sometimes difficult to determine. The object of the offense of abortion is to protect human life. Briefly, Section 58 of the British Offences Against the Person Act 1861 makes it an offense for a pregnant woman to try unlawfully to procure her own miscarriage and for any person to try to procure unlawfully the miscarriage of a woman, whether she is pregnant or not. The precise time from which the developing ovum is protected has not been legislatively or judicially determined. In 1962 a report commissioned by the British Council of Churches suggested that for legal purposes conception should be taken to commence with implantation, i.e., about 2 weeks after fertilization. It is possible to argue that human life begins at fertilization but that is not a very convincing arugument these days. A better view seens to be that so long as the postcoital pill is taken before the fertilized egg is implanted in the womb it is contraception rather than abortion. The matter will not be totally free from question until Parliament of the courts determine the issue. The Attorney General's view that this form of postcoital treatment does not constitute a criminal offenses within either Section 58 or 59 of the Offences Against the Person Act 1860 goes a long way towards clarifying the position. Opinions begin to divide again when considering the next step after conception. Regarding abortion, the doctor should ensure that be keeps within the Abortion Act 1967 by acting with a

  2. Neonatal sepsis: progress towards improved outcomes.

    PubMed

    Shane, Andi L; Stoll, Barbara J

    2014-01-01

    Neonates are predisposed to infections during the perinatal period due to multiple exposures and a relatively compromised immune system. The burden of disease attributed to neonatal infections varies by geographic region and maternal and neonatal risk factors. Worldwide, it is estimated that more than 1.4 million neonatal deaths annually are the consequence of invasive infections. Risk factors for early-onset neonatal sepsis (EOS) include prematurity, immunologic immaturity, maternal Group B streptococcal colonization, prolonged rupture of membranes, and maternal intra-amniotic infection. Intrapartum antimicrobial prophylaxis administered to GBS-colonized women has reduced the burden of disease associated with early onset GBS invasive infections. Active surveillance has identified Gram-negative pathogens as an emerging etiology of early-onset invasive infections. Late-onset neonatal sepsis (LOS) attributable to Gram-positive organisms, including coagulase negative Staphylococci and Staphylococcus aureus, is associated with increased morbidity and mortality among premature infants. Invasive candidiasis is an emerging cause of late-onset sepsis, especially among infants who receive broad spectrum antimicrobial agents. Prophylactic fluconazole administration to very low birthweight (VLBW) neonates during the first 6 weeks of life reduces invasive candidiasis in neonatal intensive care units with high rates of fungal infection. Prevention of healthcare associated infections through antimicrobial stewardship, limited steroid use, early enteral feeding, limited use of invasive devices and standardization of catheter care practices, and meticulous hand hygiene are important and cost-effective strategies for reducing the burden of late-onset neonatal sepsis.

  3. Disturbing Pop-Tart

    NASA Technical Reports Server (NTRS)

    1997-01-01

    The Sojourner rover's front right camera imaged Pop-tart, a small rock or indurated soil material which was pushed out of the surrounding drift material by Sojourner's front left wheel during a soil mechanics experiment.

    Mars Pathfinder is the second in NASA's Discovery program of low-cost spacecraft with highly focused science goals. The Jet Propulsion Laboratory, Pasadena, CA, developed and manages the Mars Pathfinder mission for NASA's Office of Space Science, Washington, D.C. JPL is a division of the California Institute of Technology (Caltech). The Imager for Mars Pathfinder (IMP) was developed by the University of Arizona Lunar and Planetary Laboratory under contract to JPL. Peter Smith is the Principal Investigator.

  4. [Sepsis in Emergency Medicine].

    PubMed

    Christ, Michael; Geier, Felicitas; Bertsch, Thomas; Singler, Katrin

    2016-07-01

    Sepsis is defined as "life-threatening organ dysfunction caused by a dysregulated host-response to infection". Presence of organ dysfunction is associated with a mortality of 10% and higher in hospitalized sepsis patients.Introduction of standards in diagnosis and treatment of sepsis in intensive care units has not considerably reduced sepsis mortality. About 80% of patients with sepsis are transferred to intensive care units from usual care wards and emergency departments. Thus, it is tempting to speculate whether opportunities for further improvement of sepsis management exist outside of intensive care units. Performing a "quick sequential organ assessment" (qSOFA; two of following criteria have to be present: respiratory rate >22/min; sytolic blood pressure <100mmHg; altered mental status) supports to identify patients with suspicion of an infection and an increased risk of death within the hospital. Subsequent treatment according to current guidelines on sepsis management will reduce in-hospital mortality of sepsis patients. Indeed, we were able to show a substantial decrease of in-hospital mortality of about 20% in patients presenting with community acquired pneumonia to the emergency department.In summary, decision of further management of sepsis patients has to be done outside intensive care units at the time of initial presentation to professional care givers. Sepsis management in acute care settings should include a structured and standardized protocol to further improve survival in affected patients with even mild organ dysfunction.

  5. Early management of sepsis

    PubMed Central

    Vincent, Jean-Louis; Pereira, Adriano José; Gleeson, James; Backer, Daniel De

    2014-01-01

    Increased awareness of the signs and symptoms of sepsis and an emphasis on the importance of early treatment have helped to improve survival rates from this serious and frequent condition in recent years. With no specific, effective anti-sepsis therapies available, management focuses on early source control with adequate and appropriate antibiotics and removal of any source of infection, rapid resuscitation, hemodynamic stabilization and organ support. Use of dedicated teams to care for patients with sepsis can help optimize early management.

  6. Exogenous arginine in sepsis.

    PubMed

    Luiking, Yvette C; Deutz, Nicolaas E P

    2007-09-01

    Sepsis is a severe condition in critically ill patients and is considered an arginine deficiency state. The rationale for arginine deficiency in sepsis is mainly based on the reduced arginine levels in sepsis that are associated with the specific changes in arginine metabolism related to endothelial dysfunction, severe catabolism, and worse outcome. Exogenous arginine supplementation in sepsis shows controversial results with only limited data in humans and variable results in animal models of sepsis. Since in these studies the severity of sepsis varies but also the route, timing, and dose of arginine, it is difficult to draw a definitive conclusion for sepsis in general without considering the influence of these factors. Enhanced nitric oxide production in sepsis is related to suggested detrimental effects on hemodynamic instability and enhanced oxidative stress. Potential mechanisms for beneficial effects of exogenous arginine in sepsis include enhanced (protein) metabolism, improved microcirculation and organ function, effects on immune function and antibacterial effects, improved gut function, and an antioxidant role of arginine. We recently performed a study indicating that arginine can be given to septic patients without major effects on hemodynamics, suggesting that more studies can be conducted on the effects of arginine supplementation in septic patients.

  7. Numerical computation of Pop plot

    SciTech Connect

    Menikoff, Ralph

    2015-03-23

    The Pop plot — distance-of-run to detonation versus initial shock pressure — is a key characterization of shock initiation in a heterogeneous explosive. Reactive burn models for high explosives (HE) must reproduce the experimental Pop plot to have any chance of accurately predicting shock initiation phenomena. This report describes a methodology for automating the computation of a Pop plot for a specific explosive with a given HE model. Illustrative examples of the computation are shown for PBX 9502 with three burn models (SURF, WSD and Forest Fire) utilizing the xRage code, which is the Eulerian ASC hydrocode at LANL. Comparison of the numerical and experimental Pop plot can be the basis for a validation test or as an aid in calibrating the burn rate of an HE model. Issues with calibration are discussed.

  8. Perinatal depression: A clinical update.

    PubMed

    Alhusen, Jeanne L; Alvarez, Carmen

    2016-05-19

    Perinatal depression is a common condition with significant adverse maternal, fetal, neonatal, and early childhood outcomes. The perinatal period is an opportune time to screen, diagnose, and treat depression. Improved recognition of perinatal depression, particularly among low-income women, can lead to improved perinatal health outcomes. PMID:26934457

  9. Sepsis-induced myopathy

    PubMed Central

    Callahan, Leigh Ann; Supinski, Gerald S.

    2014-01-01

    Sepsis is a major cause of morbidity and mortality in critically ill patients, and despite advances in management, mortality remains high. In survivors, sepsis increases the risk for the development of persistent acquired weakness syndromes affecting both the respiratory muscles and the limb muscles. This acquired weakness results in prolonged duration of mechanical ventilation, difficulty weaning, functional impairment, exercise limitation, and poor health-related quality of life. Abundant evidence indicates that sepsis induces a myopathy characterized by reductions in muscle force-generating capacity, atrophy (loss of muscle mass), and altered bioenergetics. Sepsis elicits derangements at multiple subcellular sites involved in excitation contraction coupling, such as decreasing membrane excitability, injuring sarcolemmal membranes, altering calcium homeostasis due to effects on the sarcoplasmic reticulum, and disrupting contractile protein interactions. Muscle wasting occurs later and results from increased proteolytic degradation as well as decreased protein synthesis. In addition, sepsis produces marked abnormalities in muscle mitochondrial functional capacity and when severe, these alterations correlate with increased death. The mechanisms leading to sepsis-induced changes in skeletal muscle are linked to excessive localized elaboration of proinflammatory cytokines, marked increases in free-radical generation, and activation of proteolytic pathways that are upstream of the proteasome including caspase and calpain. Emerging data suggest that targeted inhibition of these pathways may alter the evolution and progression of sepsis-induced myopathy and potentially reduce the occurrence of sepsis-mediated acquired weakness syndromes. PMID:20046121

  10. Neurology of Sepsis.

    PubMed

    Sweis, Rochelle; Ortiz, Jorge; Biller, José

    2016-03-01

    Sepsis is a systemic inflammatory response syndrome occurring secondary to infection and labeled severe when end organ dysfunction or tissue hypoperfusion transpires. Sepsis-associated mortality remains high among critically ill patients, with chronic disease and immunosuppression being the most common risk factors. Studies demonstrate that early recognition and treatment are vital to decreasing mortality. Some of the least understood effects of sepsis are the associated neurologic complications. The peripheral nervous system (PNS) has gained most consideration and thought, largely due to dependence on mechanical ventilation. Central nervous system (CNS) complications related to sepsis have only more recently gained attention but continue to go unnoticed. Aside from the clinical examination, electroencephalography (EEG) is a sensitive tool for prognostication or uncovering non-convulsive seizures in encephalopathic patients. Further studies are needed to further define the urgency of a prevention and treatment plan for the deleterious effects of sepsis on the PNS and CNS. PMID:26820754

  11. Implementing sepsis bundles

    PubMed Central

    Jozwiak, Mathieu; Monnet, Xavier

    2016-01-01

    Sepsis bundles represent key elements of care regarding the diagnosis and treatment of patients with septic shock and allow ones to convert complex guidelines into meaningful changes in behavior. Sepsis bundles endorsed the early goal-directed therapy (EGDT) and their implementation resulted in an improved outcome of septic shock patients. They induced more consistent and timely application of evidence-based care and reduced practice variability. These benefits mainly depend on the compliance with sepsis bundles, highlighting the importance of dedicated performance improvement initiatives, such as multifaceted educational programs. Nevertheless, the interest of early goal directed therapy in septic shock patients compared to usual care has recently been questioned, leading to an update of sepsis bundles in 2015. These new sepsis bundles may also exhibit, as the previous bundles, some limits and pitfalls and the effects of their implementation still needs to be evaluated. PMID:27713890

  12. The older adult experiencing sepsis.

    PubMed

    Englert, Nadine C; Ross, Carl

    2015-01-01

    Sepsis is a potentially fatal response to infection affecting patients across the life span. Sepsis can progress from systemic inflammatory response to severe sepsis and septic shock if not recognized promptly and managed effectively. Risk factors for sepsis include age, gender, the presence of invasive devices (eg, urinary catheters), and chronic medical conditions (eg, chronic obstructive pulmonary disease). Sepsis awareness is essential and includes identification of population-focused risk factors, recognition of clinical signs and symptoms, and timely implementation of interventions. The purpose of this article was to examine sepsis in older adults, including prevalence, atypical presentation of the condition, and considerations for sepsis management in the elderly population.

  13. Lessons in Pop: Does Pop Culture Belong in the Classroom?

    ERIC Educational Resources Information Center

    Adams, Caralee

    2011-01-01

    Many teachers are finding that weaving in examples from current movies, television, music, and popular fiction makes their lessons come alive for students. A clip from "The Daily Show" or rap lyrics can be vehicles to talk about politics and poetry. Pop culture is what students talk about in the hallways, so why not harness that interest and…

  14. HUMAN HEALTH IMPACTS OF EXPOSURE TO POPS

    EPA Science Inventory

    The Stockholm Convention on persistent organic pollutants (POPs) was adopted in 2001 to protect human health and the environment from chemicals that are highly toxic, persistent, bioaccumulative and undergo long range transport. These POPs include 9 pesticides, polychlorinated d...

  15. 7 CFR 51.1239 - Pops.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 7 Agriculture 2 2010-01-01 2010-01-01 false Pops. 51.1239 Section 51.1239 Agriculture Regulations of the Department of Agriculture AGRICULTURAL MARKETING SERVICE (Standards, Inspections, Marketing... Standards for Cleaned Virginia Type Peanuts in the Shell Definitions § 51.1239 Pops. Pops means...

  16. 7 CFR 51.1239 - Pops.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 7 Agriculture 2 2014-01-01 2014-01-01 false Pops. 51.1239 Section 51.1239 Agriculture Regulations of the Department of Agriculture AGRICULTURAL MARKETING SERVICE (Standards, Inspections, Marketing... § 51.1239 Pops. Pops means fully developed shells which contain practically no kernels....

  17. 7 CFR 51.1239 - Pops.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 7 Agriculture 2 2012-01-01 2012-01-01 false Pops. 51.1239 Section 51.1239 Agriculture Regulations of the Department of Agriculture AGRICULTURAL MARKETING SERVICE (Standards, Inspections, Marketing... Standards for Cleaned Virginia Type Peanuts in the Shell Definitions § 51.1239 Pops. Pops means...

  18. 7 CFR 51.1239 - Pops.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 7 Agriculture 2 2011-01-01 2011-01-01 false Pops. 51.1239 Section 51.1239 Agriculture Regulations of the Department of Agriculture AGRICULTURAL MARKETING SERVICE (Standards, Inspections, Marketing... Standards for Cleaned Virginia Type Peanuts in the Shell Definitions § 51.1239 Pops. Pops means...

  19. 7 CFR 51.1239 - Pops.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 7 Agriculture 2 2013-01-01 2013-01-01 false Pops. 51.1239 Section 51.1239 Agriculture Regulations of the Department of Agriculture AGRICULTURAL MARKETING SERVICE (Standards, Inspections, Marketing... § 51.1239 Pops. Pops means fully developed shells which contain practically no kernels....

  20. Blacks in Pop Music: A Short Story.

    ERIC Educational Resources Information Center

    Rickelman, Melinda

    1991-01-01

    A short history of black pop music includes artists who have changed pop music or culture and highlights from the 1920s into the 1980s, from Fats Waller to Michael Jackson. In black pop music, there is a direct line of influence from the sharecropper to the current Top 40. (SLD)

  1. Pop-Art Project = Pride

    ERIC Educational Resources Information Center

    Freeman, Zachary

    2009-01-01

    In this article, the author describes a class project based on the work of contemporary American artist Red Grooms. Grooms is best known for his "sculpto-pictoramas," which are a combination of both painting and sculpture that literally pop off the page or out of the background.

  2. The Discourse of Pop Songs.

    ERIC Educational Resources Information Center

    Murphey, Tim

    1992-01-01

    The top 50 songs in English from a 1987 music chart were analyzed using a word-frequency count. For teaching English to speakers of other languages, pop songs were found to offer short, affective, simple, native texts with a lot of familiar vocabulary recycled, yet vague. (14 references) (Author/LB)

  3. Animal models of sepsis

    PubMed Central

    Fink, Mitchell P

    2014-01-01

    Sepsis remains a common, serious, and heterogeneous clinical entity that is difficult to define adequately. Despite its importance as a public health problem, efforts to develop and gain regulatory approval for a specific therapeutic agent for the adjuvant treatment of sepsis have been remarkably unsuccessful. One step in the critical pathway for the development of a new agent for adjuvant treatment of sepsis is evaluation in an appropriate animal model of the human condition. Unfortunately, the animal models that have been used for this purpose have often yielded misleading findings. It is likely that there are multiple reasons for the discrepancies between the results obtained in tests of pharmacological agents in animal models of sepsis and the outcomes of human clinical trials. One of important reason may be that the changes in gene expression, which are triggered by trauma or infection, are different in mice, a commonly used species for preclinical testing, and humans. Additionally, many species, including mice and baboons, are remarkably resistant to the toxic effects of bacterial lipopolysaccharide, whereas humans are exquisitely sensitive. New approaches toward the use of animals for sepsis research are being investigated. But, at present, results from preclinical studies of new therapeutic agents for sepsis must be viewed with a degree of skepticism. PMID:24022070

  4. Sepsis-Associated Encephalopathy

    PubMed Central

    Cotena, Simona; Piazza, Ornella

    2012-01-01

    Summary Sepsis-associated encephalopathy (SAE) is defined as a diffuse or multifocal cerebral dysfunction induced by the systemic response to the infection without clinical or laboratory evidence of direct brain infection. Its pathogenesis is multifactorial. SAE generally occurs early during severe sepsis and precedes multiple-organ failure. The most common clinical feature of SAE is the consciousness alteration which ranges from mildly reduced awareness to unresponsiveness and coma. Diagnosis of SAE is primarily clinical and depends on the exclusion of other possible causes of brain deterioration. Electroencephalography (EEG) is almost sensitive, but it is not specific for SAE. Computed Tomography (CT) head scan generally is negative in case of SAE, while Magnetic Resonance Imaging (MRI) can show brain abnormalities in case of SAE, but they are not specific for this condition. Somatosensitive Evoked Potentials (SEPs) are sensitive markers of developing cerebral dysfunction in sepsis. Cerebrospinal fluid (CBF) analysis is generally normal, a part an inconstant elevation of proteins concentration. S100B and NSE have been proposed like biomarkers for diagnosis of SAE, but the existing data are controversial. SAE is reversible even if survivors of severe sepsis have often long lasting or irreversible cognitive and behavioral sequel; however the presence of SAE can have a negative influence on survival. A specific therapy of SAE does not exist and the outcome depends on a prompt and appropriate treatment of sepsis as whole. PMID:23905041

  5. Sepsis in critical care.

    PubMed

    King, Joan E

    2007-03-01

    Sepsis is a syndrome produced by the accelerated activity of the inflammatory immune response, the clotting cascade, and endothelial damage. It is a systematic process that can progress easily into septic shock and MODS. The chemical mediators or cytokines produce a complex self-perpetuating process that impacts all body systems. It is critical for the nurse first to identify patients at risk for developing sepsis and to assess patients who have SIRS and sepsis continually for signs and symptoms of organ involvement and organ dysfunction. Once sepsis has been diagnosed, evidence-based practice indicates initiation of fluid resuscitation. Vasopressor therapy, positive inotropic support, and appropriate antibiotic therapy should be started within the first hour. Within a 6-hour timeframe the goal is stabilization of the CVP, MAP, and UOP to prevent further organ damage. The challenge for nurses caring for septic patients is to support the treatment goals, to prevent added complications including stress ulcers, DVTs, aspiration pneumonia, and the progression to MODS, and to address the patient's and the family's psychosocial needs. As complex as the pathophysiology of sepsis is, the nursing care is equally complex but also rewarding. Patients who previously might have died now recover as vigilant nursing care combines forces with new drug therapies and evidence-based practice guidelines.

  6. Essentials of sepsis management.

    PubMed

    Green, John M

    2015-04-01

    Despite remarkable advances in the knowledge of infection and human response to it, sepsis continues to be one of the most common challenges surgeons and critical care providers face. Surgeons confront the problem of infection every day, in treating established infections or reacting to a consequence of surgical intervention. Infections after surgery continue to be a problem despite massive efforts to prevent them. Patients rely on the surgeon's ability to recognize infection and treat it. Also, preventing nosocomial infection and antibiotic resistance is a primary responsibility. This article describes diagnostic and therapeutic measures for sepsis in the perioperative surgical patient.

  7. [Fatal neonatal sepsis caused by vertical transmission of Morganella morganii. Report of one case].

    PubMed

    Ovalle, Alfredo; Martínez, M Angélica; Kakarieka, Elena; García, Mirna; Salinas, Abril

    2009-09-01

    We report a term neonate who developed early-onset sepsis due to Morganella morganii. The child was vaginally delivered after a short labor, and presented signs of perinatal asphyxia. Blood cultures taken soon after birth and from mother's lochia were positive for this microorganism. The infection was unresponsive to treatment with cefotaxime, to which the microorganism was susceptible, and the infant died at 17 days of age. M morganii is an opportunistic and uncommon pathogen, causing disease mainly in patients with underlying illness or after surgery. It is a rare perinatal pathogen, causing severe disease in premature infants, in association with maternal chorioamnionitis and premature rupture of the membranes.

  8. The resuscitation package in sepsis.

    PubMed

    Demertzis, Lee M; Kollef, Marin H

    2010-09-01

    Sepsis and its attendant complications are commonly encountered in the intensive care unit. Early recognition of sepsis is critical because it allows for rapid deployment of a multifaceted resuscitation package. The cornerstones of sepsis management are antibiotic therapy, source control, and hemodynamic resuscitation. In select patients, ancillary therapies are indicated, such as activated protein C, corticosteroids, and glycemic control. Given the complexity of sepsis management, optimal care can be delivered as a bundle-a protocol encompassing the above interventions. The evidence behind the various components of sepsis management are reviewed here.

  9. Revisiting caspases in sepsis.

    PubMed

    Aziz, M; Jacob, A; Wang, P

    2014-01-01

    Sepsis is a life-threatening illness that occurs due to an abnormal host immune network which extends through the initial widespread and overwhelming inflammation, and culminates at the late stage of immunosupression. Recently, interest has been shifted toward therapies aimed at reversing the accompanying periods of immune suppression. Studies in experimental animals and critically ill patients have demonstrated that increased apoptosis of lymphoid organs and some parenchymal tissues contributes to this immune suppression, anergy and organ dysfunction. Immediate to the discoveries of the intracellular proteases, caspases for the induction of apoptosis and inflammation, and their striking roles in sepsis have been focused elaborately in a number of original and review articles. Here we revisited the different aspects of caspases in terms of apoptosis, pyroptosis, necroptosis and inflammation and focused their links in sepsis by reviewing several recent findings. In addition, we have documented striking perspectives which not only rewrite the pathophysiology, but also modernize our understanding for developing novel therapeutics against sepsis. PMID:25412304

  10. Nutrition and sepsis.

    PubMed

    Cohen, Jonathan; Chin, w Dat N

    2013-01-01

    The effect of nutritional support in critically ill patients with sepsis has received much attention in recent years. However, many of the studies have produced conflicting results. As for all critically ill patients, nutritional support, preferably via the enteral route, should be commenced once initial resuscitation and adequate perfusion pressure is achieved. Where enteral feeding is impossible or not tolerated, parenteral nutrition (either as total or complimentary therapy) may safely be administered. Most positive studies relating to nutritional support and sepsis have been in the setting of sepsis prevention. Thus, the administration of standard nutrition formulas to critically ill patients within 24 h of injury or intensive care unit admission may decrease the incidence of pneumonia. Both arginine-supplemented enteral diets, given in the perioperative period, and glutamine-supplemented parenteral nutrition have been shown to decrease infections in surgical patients. Parenteral fish oil lipid emulsions as well as probiotics given in the perioperative period may also reduce infections in patients undergoing major abdominal operations, such as liver transplantation. There is little support at the present time for the positive effect of specific pharmaconutrients, in particular fish oil, probiotics, or antioxidants, in the setting of established sepsis. More studies are clearly required on larger numbers of more homogeneous groups of patients. PMID:23075593

  11. Revisiting caspases in sepsis

    PubMed Central

    Aziz, M; Jacob, A; Wang, P

    2014-01-01

    Sepsis is a life-threatening illness that occurs due to an abnormal host immune network which extends through the initial widespread and overwhelming inflammation, and culminates at the late stage of immunosupression. Recently, interest has been shifted toward therapies aimed at reversing the accompanying periods of immune suppression. Studies in experimental animals and critically ill patients have demonstrated that increased apoptosis of lymphoid organs and some parenchymal tissues contributes to this immune suppression, anergy and organ dysfunction. Immediate to the discoveries of the intracellular proteases, caspases for the induction of apoptosis and inflammation, and their striking roles in sepsis have been focused elaborately in a number of original and review articles. Here we revisited the different aspects of caspases in terms of apoptosis, pyroptosis, necroptosis and inflammation and focused their links in sepsis by reviewing several recent findings. In addition, we have documented striking perspectives which not only rewrite the pathophysiology, but also modernize our understanding for developing novel therapeutics against sepsis. PMID:25412304

  12. Nutrition and sepsis.

    PubMed

    Cohen, Jonathan; Chin, w Dat N

    2013-01-01

    The effect of nutritional support in critically ill patients with sepsis has received much attention in recent years. However, many of the studies have produced conflicting results. As for all critically ill patients, nutritional support, preferably via the enteral route, should be commenced once initial resuscitation and adequate perfusion pressure is achieved. Where enteral feeding is impossible or not tolerated, parenteral nutrition (either as total or complimentary therapy) may safely be administered. Most positive studies relating to nutritional support and sepsis have been in the setting of sepsis prevention. Thus, the administration of standard nutrition formulas to critically ill patients within 24 h of injury or intensive care unit admission may decrease the incidence of pneumonia. Both arginine-supplemented enteral diets, given in the perioperative period, and glutamine-supplemented parenteral nutrition have been shown to decrease infections in surgical patients. Parenteral fish oil lipid emulsions as well as probiotics given in the perioperative period may also reduce infections in patients undergoing major abdominal operations, such as liver transplantation. There is little support at the present time for the positive effect of specific pharmaconutrients, in particular fish oil, probiotics, or antioxidants, in the setting of established sepsis. More studies are clearly required on larger numbers of more homogeneous groups of patients.

  13. Sepsis Associated Encephalopathy.

    PubMed

    Chaudhry, Neera; Duggal, Ashish Kumar

    2014-01-01

    Sepsis associated encephalopathy (SAE) is a common but poorly understood neurological complication of sepsis. It is characterized by diffuse brain dysfunction secondary to infection elsewhere in the body without overt CNS infection. The pathophysiology of SAE is complex and multifactorial including a number of intertwined mechanisms such as vascular damage, endothelial activation, breakdown of the blood brain barrier, altered brain signaling, brain inflammation, and apoptosis. Clinical presentation of SAE may range from mild symptoms such as malaise and concentration deficits to deep coma. The evaluation of cognitive dysfunction is made difficult by the absence of any specific investigations or biomarkers and the common use of sedation in critically ill patients. SAE thus remains diagnosis of exclusion which can only be made after ruling out other causes of altered mentation in a febrile, critically ill patient by appropriate investigations. In spite of high mortality rate, management of SAE is limited to treatment of the underlying infection and symptomatic treatment for delirium and seizures. It is important to be aware of this condition because SAE may present in early stages of sepsis, even before the diagnostic criteria for sepsis can be met. This review discusses the diagnostic approach to patients with SAE along with its epidemiology, pathophysiology, clinical presentation, and differential diagnosis.

  14. [Sepsis management -- antibiotic therapy].

    PubMed

    Welte, T

    2004-11-26

    Sepsis is one of the most frequent infectious problems at Intensive Care Units, and sepsis is associated with significant mortality. The latter could not be markedly reduced in the last years, despite a number of advances in the field of volume substitution, catecholamines, and endocrinologic therapy. The reason might be that important steps towards overcoming of sepsis are the surgical resection of infectious foci and an adequate antibiotic treatment. A critical role plays the growing resistance of pathogens against the common antibiotics. Since no major progress in the development of new antibiotics can be expected for the next years, sepsis treatment must be focused on prevention of infection, and on an optimised application of current antibiotic substances. The key factors are a broad and high dose initial treatment, a de-escalation strategy according to the clinical course, and -with exceptions- a limitation of treatment to 7 to 10 days. Rotation of antibiotics should be performed, if problems with resistances exist or no specialist for infectious diseases is available on the Intensive Care Unit.

  15. Robert Sabuda on the Art of the Pop-up; Creating Pop-ups.

    ERIC Educational Resources Information Center

    Ball, Sherry

    2003-01-01

    These two articles discuss the design and production of pop-up books, focusing on the work of Robert Sabuda. Discusses books as an art form, producing prototypes, factory production, pop-up projects for children, Web sites, and a history of pop-ups, and includes a bibliography of relevant materials. (LRW)

  16. Article "403. Toxicology of Persistent Organic Pollutants (POPs)"

    EPA Science Inventory

    Persistent Organic Pollutants (POPs) are all synthetic chemicals, either intentionally or unintentionally produced/released. Some POPs are pesticides. Others are industrial products or unintended by-products resulting from industrial processes or combustions (see figure 1). POPs ...

  17. Pop Culture Universe: Icons, Idols, Ideas

    ERIC Educational Resources Information Center

    Harper, Meghan

    2010-01-01

    This article features "Pop Culture Universe," which received the 2009 Dartmouth Medal honoring the creation of a reference work of outstanding quality. School librarians will find "Pop Culture Universe" a wonderful resource for assisting middle school and high school students with research projects on significant historical events that focus on…

  18. The encephalopathy of sepsis.

    PubMed

    Jackson, A C; Gilbert, J J; Young, G B; Bolton, C F

    1985-11-01

    Twelve fatal cases of encephalopathy associated with sepsis were examined in a ten-year retrospective study. The sources of infection and organisms isolated were variable. Six of the patients had focal neurologic signs; five had seizures. The level of consciousness varied from drowsiness to deep coma, and electroencephalograms revealed diffuse or multifocal abnormalities. Computed tomographic head scans and cerebrospinal fluid examinations were usually unremarkable. Eight patients had disseminated microabscesses in the brain at autopsy. Four patients had proliferation of astrocytes and microglia in the cerebral cortex, a feature associated with metabolic encephalopathies. Additional findings included cerebral infarcts, brain purpura, multiple small white matter hemorrhages, and central pontine myelinolysis. Although sepsis may cause encephalopathy by producing disturbances in cerebral synaptic transmission and cerebral energy production through a toxic mechanism, bacterial invasion of the brain with the formation of disseminated microabscesses is also an important cause.

  19. Sepsis-induced Cardiomyopathy

    PubMed Central

    Romero-Bermejo, Francisco J; Ruiz-Bailen, Manuel; Gil-Cebrian, Julián; Huertos-Ranchal, María J

    2011-01-01

    Myocardial dysfunction is one of the main predictors of poor outcome in septic patients, with mortality rates next to 70%. During the sepsis-induced myocardial dysfunction, both ventricles can dilate and diminish its ejection fraction, having less response to fluid resuscitation and catecholamines, but typically is assumed to be reversible within 7-10 days. In the last 30 years, It´s being subject of substantial research; however no explanation of its etiopathogenesis or effective treatment have been proved yet. The aim of this manuscript is to review on the most relevant aspects of the sepsis-induced myocardial dysfunction, discuss its clinical presentation, pathophysiology, etiopathogenesis, diagnostic tools and therapeutic strategies proposed in recent years. PMID:22758615

  20. Sepsis-associated hyperlactatemia.

    PubMed

    Garcia-Alvarez, Mercedes; Marik, Paul; Bellomo, Rinaldo

    2014-01-01

    There is overwhelming evidence that sepsis and septic shock are associated with hyperlactatemia (sepsis-associated hyperlactatemia (SAHL)). SAHL is a strong independent predictor of mortality and its presence and progression are widely appreciated by clinicians to define a very high-risk population. Until recently, the dominant paradigm has been that SAHL is a marker of tissue hypoxia. Accordingly, SAHL has been interpreted to indicate the presence of an 'oxygen debt' or 'hypoperfusion', which leads to increased lactate generation via anaerobic glycolysis. In light of such interpretation of the meaning of SAHL, maneuvers to increase oxygen delivery have been proposed as its treatment. Moreover, lactate levels have been proposed as a method to evaluate the adequacy of resuscitation and the nature of the response to the initial treatment for sepsis. However, a large body of evidence has accumulated that strongly challenges such notions. Much evidence now supports the view that SAHL is not due only to tissue hypoxia or anaerobic glycolysis. Experimental and human studies all consistently support the view that SAHL is more logically explained by increased aerobic glycolysis secondary to activation of the stress response (adrenergic stimulation). More importantly, new evidence suggests that SAHL may actually serve to facilitate bioenergetic efficiency through an increase in lactate oxidation. In this sense, the characteristics of lactate production best fit the notion of an adaptive survival response that grows in intensity as disease severity increases. Clinicians need to be aware of these developments in our understanding of SAHL in order to approach patient management according to biological principles and to interpret lactate concentrations during sepsis resuscitation according to current best knowledge. PMID:25394679

  1. Surviving Sepsis: Taming a Deadly Immune Response

    MedlinePlus

    ... disclaimer . Subscribe Surviving Sepsis Taming a Deadly Immune Response Many people have never heard of sepsis, or ... tract infection) and then a powerful and harmful response by your body’s own immune system . “With sepsis, ...

  2. How an extended perinatal audit may improve perinatal policy.

    PubMed

    Dehaene, Isabelle; Roelens, Kristien; Page, Geert

    2014-09-29

    Abstract Objective: A perinatal audit has the intention of quality of care improvement based on analysis of perinatal death, with our without analysis of maternal morbidity and/or mortality. Additional analysis of cases of intrapartum asphyxia could provide more insight into ways to improve quality of perinatal care. Methods: Analysis of cases of perinatal death and asphyxia in Jan Yperman Hospital, Ieper, Belgium, in 2012. Results: Three perinatal deaths occurred, none were preventable. Nineteen cases of proven metabolic acidosis have been identified. Three cases are considered possibly preventable, four cases are considered preventable. In three (possibly) preventable cases, foetal monitoring was absent during the active second stage of labour. In two preventable cases, intervention following a significant ST event in the second stage of labour was delayed. In one case intervention was delayed in the first stage of labour, while in another, indicated operative delivery in the second stage was not conducted. Conclusions: Integrating intrapartum asphyxia in the perinatal audit gives an opportunity to identify and eliminate weak points in the perinatal care chain, thereby optimizing quality of care. Lessons learned from our internal audit are the value of foetal monitoring and adequate action on significant ST events during second stage of labour.

  3. Postdatism -- a perinatal problem?

    PubMed

    Chhabra, S; Sood, S

    1990-01-01

    It has been traditionally accepted that maternal and fetal complications are at their lowest levels 37-42 weeks into gestation. 20% of pregnancies completed after 42 weeks gestation are thought to be affected by the postmaturity syndrome of uteroplacental insufficiency resulting in oligohydramnios, meconium passage, loss of fetal subcutaneous tissue, fetal asphyxia, and fetal death. Some workers, however, have also found that pregnancies completed between 40 and 42 weeks carry significant risk. The authors explored this question in a case-control study of 464 women seen at the Mahatma Gandhi Institute of Medical Sciences in Maharashtra, India. The cases of postdatism occurred in the absence of any other medical or obstetric problem. The operative delivery rate increased significantly among these patients compared to deliveries between 39 and 40 weeks. There was neither significant asphyxia nor perinatal loss in term completed normal patients. Asphyxia and perinatal mortality did, however, occur with postdatism. The authors note the likely role of oligohydramnios combined with placental dysfunction.

  4. Understanding pop-ins in spherical nanoindentation

    SciTech Connect

    Pathak, Siddhartha E-mail: siddharthapathak@gmail.com; Riesterer, Jessica L.; Michler, Johann; Kalidindi, Surya R.

    2014-10-20

    Pop-ins, or sudden displacement-bursts at constant load in a nanoindentation test, are typically attributed to the difficulty of setting up potent dislocation sources in the very small indentation zones in these experiments. Such displacement (and strain) bursts would intuitively indicate a sharp drop in stress during the pop-in event itself. However, spherical indentation stress-strain curves routinely exhibit a high and stable indentation stress value during the pop-in, and the indentation stresses decrease only after a further finite amount of additional indentation displacement has been applied. In order to understand this discrepancy, we utilize a combination of interrupted spherical indentation tests along with depth profiling of the residual indentation surfaces using in-situ atomic force microscopy (AFM) to study pop-ins. The AFM surface profile maps show that there is an asymmetric profile change over a limited region around the indentation contact area for a single pop-in; the asymmetry disappears upon further loading beyond the pop-in. A plausible sequence of physical processes (related to metal plasticity) occurring underneath the indenter during and immediately after the occurrence of the pop-in is proposed to explain these observations.

  5. Understanding traffic dynamics at a backbone POP

    NASA Astrophysics Data System (ADS)

    Taft, Nina; Bhattacharyya, Supratik; Jetcheva, Jorjeta; Diot, Christophe

    2001-07-01

    Spatial and temporal information about traffic dynamics is central to the design of effective traffic engineering practices for IP backbones. In this paper we study backbone traffic dynamics using data collected at a major POP on a tier-1 IP backbone. We develop a methodology that combines packet-level traces from access links in the POP and BGP routing information to build components of POP-to-POP traffic matrices. Our results show that there is wide disparity in the volume of traffic headed towards different egress POPs. At the same time, we find that current routing practices in the backbone tend to constrain traffic between ingress-egress POP pairs to a small number of paths. As a result, there is a wide variation in the utilization level of links in the backbone. Frequent capacity upgrades of the heavily used links are expensive; the need for such upgrades can be reduced by designing load balancing policies that will route more traffic over less utilized links. We identify traffic aggregates based on destination address prefixes and find that this set of criteria isolates a few aggregates that account for an overwhelmingly large portion of inter-POP traffic. We also demonstrate that these aggregates exhibit stability throughout the day on per-hour time scales, and thus they form a natural basis for splitting traffic over multiple paths in order to improve load balancing.

  6. Understanding pop-ins in spherical nanoindentation

    SciTech Connect

    Pathak, Siddhartha; Riesterer, Jessica L.; Kalidindi, Surya R.; Michler, Johann

    2014-10-24

    In this study, pop-ins, or sudden displacement-bursts at constant load in a nanoindentation test, are typically attributed to the difficulty of setting up potent dislocation sources in the very small indentation zones in these experiments. Such displacement (and strain) bursts would intuitively indicate a sharp drop in stress during the pop-in event itself. However, spherical indentation stress-strain curves routinely exhibit a high and stable indentation stress value during the pop-in, and the indentation stresses decrease only after a further finite amount of additional indentation displacement has been applied. In order to understand this discrepancy, we utilize a combination of interrupted spherical indentation tests along with depth profiling of the residual indentation surfaces using in-situ atomic force microscopy (AFM) to study pop-ins. The AFM surface profile maps show that there is an asymmetric profile change over a limited region around the indentation contact area for a single pop-in; the asymmetry disappears upon further loading beyond the pop-in. A plausible sequence of physical processes (related to metal plasticity) occurring underneath the indenter during and immediately after the occurrence of the pop-in is proposed to explain these observations.

  7. Understanding pop-ins in spherical nanoindentation

    DOE PAGESBeta

    Pathak, Siddhartha; Riesterer, Jessica L.; Kalidindi, Surya R.; Michler, Johann

    2014-10-24

    In this study, pop-ins, or sudden displacement-bursts at constant load in a nanoindentation test, are typically attributed to the difficulty of setting up potent dislocation sources in the very small indentation zones in these experiments. Such displacement (and strain) bursts would intuitively indicate a sharp drop in stress during the pop-in event itself. However, spherical indentation stress-strain curves routinely exhibit a high and stable indentation stress value during the pop-in, and the indentation stresses decrease only after a further finite amount of additional indentation displacement has been applied. In order to understand this discrepancy, we utilize a combination of interruptedmore » spherical indentation tests along with depth profiling of the residual indentation surfaces using in-situ atomic force microscopy (AFM) to study pop-ins. The AFM surface profile maps show that there is an asymmetric profile change over a limited region around the indentation contact area for a single pop-in; the asymmetry disappears upon further loading beyond the pop-in. A plausible sequence of physical processes (related to metal plasticity) occurring underneath the indenter during and immediately after the occurrence of the pop-in is proposed to explain these observations.« less

  8. Muscle regeneration after sepsis.

    PubMed

    Bouglé, Adrien; Rocheteau, Pierre; Sharshar, Tarek; Chrétien, Fabrice

    2016-01-01

    Severe critical illness is often complicated by intensive care unit-acquired weakness (ICU-AW), which is associated with increased ICU and post-ICU mortality, delayed weaning from mechanical ventilation and long-term functional disability. Several mechanisms have been implicated in the pathophysiology of ICU-AW, but muscle regeneration has not been investigated to any extent in this context, even though its involvement is suggested by the protracted functional consequences of ICU-AW. Recent data suggest that muscle regeneration could be impaired after sepsis, and that mesenchymal stem cell treatment could improve the post-injury muscle recovery. PMID:27193340

  9. Maternal and perinatal mortality.

    PubMed

    Krishna Menon, M K

    1972-01-01

    A brief analysis of data from the records of the Government Hospital for Women and Children in Madras for a 36-year period (1929-1964) is presented. India with a population of over 550 million has only 1 doctor for each 6000 population. For the 80% of the population which is rural, the doctor ratio is only 88/1 million. There is also a shortage of paramedical personnel. During the earlier years of this study period, abortions, puerperal infections; hemorrhage, and toxemia accounted for nearly 75% of all meternal deaths, while in later years deaths from these causes were 40%. Among associated factors in maternal mortality, anemia was the most frequent, it still accounts for 20% and is a contributory factor in another 20%. The mortality from postpartum hemorrhage was 9.3% but has now decreased to 2.8%. Eclampsia is a preventable disease and a marked reduction in maternal and perinatal mortality from this cause has been achieved. Maternal deaths from puerperal infections have dropped from 25% of all maternal deaths to 7%. Uterine rupture has been reduced from 75% to 9.3% due to modern facilities. Operative deliveries still have an incidence of 2.1% and a mortality rate of 1.4% of all deliveries. These rates would be further reduced by more efficient antenatal and intranatal care. Reported perinatal mortality of infants has been reduced from 182/1000 births to an average of 78/1000 in all areas, but is 60.6/1000 in the city of Madras. Socioeconomic standards play an important role in perinatal mortality, 70% of such deaths occurring in the lowest economic groups. Improvement has been noted in the past 25 years but in rural areas little progress has been made. Prematurity and low birth weights are still larger factors in India than in other countries, with acute infectious diseases, anemia, and general malnutrition among mothers the frequent causes. Problems requiring further efforts to reduce maternal and infant mortality are correct vital statistics, improved

  10. Perinatal Grief in Latino Parents

    PubMed Central

    Whitaker, Claudia; Kavanaugh, Karen; Klima, Carrie

    2013-01-01

    Extensive research exists that describes the meaning of perinatal loss to some parents, but the experience of loss from the perspective of Latino parents is not clearly understood. Additionally, current perinatal bereavement practices used often to facilitate memory-making for parents (such as viewing or holding the baby, taking photographs, or collecting mementos) are based upon research done primarily with non-Latino families. Are these common practices appropriate for this population? Because there is a paucity of research on this topic, this article describes what has been written over the past 30 years on the topic of grief and perinatal loss in Latino culture. PMID:20975393

  11. Psychological treatments for perinatal depression.

    PubMed

    Stuart, Scott; Koleva, Hristina

    2014-01-01

    Perinatal depression is prevalent and greatly affects the mother and infant. Fortunately, empirically validated psychological treatments are available for postpartum depression and depression during pregnancy. Primary among these are interpersonal psychotherapy and cognitive-behavioural therapy, which have been shown to be effective for perinatal women across the spectrum from mild to severe depression. At present, interpersonal psychotherapy is better validated than antidepressant medication for perinatal depression, and should be considered as a first-line treatment option, especially for pregnant and breast-feeding women who are depressed. More studies are needed to evaluate further the relative efficacy of psychotherapy and medication, and more thoroughly test other psychological treatments. PMID:24269903

  12. UniPOPS: Unified data reduction suite

    NASA Astrophysics Data System (ADS)

    Maddalena, Ronald J.; Garwood, Robert W.; Salter, Christopher J.; Stobie, Elizabeth B.; Cram, Thomas R.; Morgan, Lorrie; Vance, Bob; Hudson, Jerome

    2015-03-01

    UniPOPS, a suite of programs and utilities developed at the National Radio Astronomy Observatory (NRAO), reduced data from the observatory's single-dish telescopes: the Tucson 12-m, the Green Bank 140-ft, and archived data from the Green Bank 300-ft. The primary reduction programs, 'line' (for spectral-line reduction) and 'condar' (for continuum reduction), used the People-Oriented Parsing Service (POPS) as the command line interpreter. UniPOPS unified previous analysis packages and provided new capabilities; development of UniPOPS continued within the NRAO until 2004 when the 12-m was turned over to the Arizona Radio Observatory (ARO). The submitted code is version 3.5 from 2004, the last supported by the NRAO.

  13. Locating POPs Sources with Tree Bark.

    PubMed

    Peverly, Angela A; Salamova, Amina; Hites, Ronald A

    2015-12-01

    Locating sources of persistent organic pollutants (POPs) to the atmosphere can sometimes be difficult. We suggest that tree bark makes an excellent passive atmospheric sampler and that spatial analysis of tree bark POPs concentrations can often pinpoint their sources. This is an effective strategy because tree bark is lipophilic and readily adsorbs and collects POPs from the atmosphere. As such, tree bark is an ideal sampler to find POPs sources globally, regionally, or locally. This article summarizes some work on this subject with an emphasis on kriged maps and a simple power-law model, both of which have been used to locate sources. Three of the four examples led directly to the pollutant's manufacturing plant. PMID:25629888

  14. Countrywide analysis of perinatal outcome.

    PubMed

    Stembera, Z; Kravka, A; Mandys, F

    1988-01-01

    The computer laboratory of the Research Institute for the Care of Mother and Child in Prague performs annually a countrywide analysis of perinatal outcome in order to obtain a background for the preparation of the optimal strategy for improving perinatal care in CSR in the future. The total as well as weight specific perinatal mortality rate further sub-divided into early neonatal death rate and late fetal death rate and differentiated according to the birthweight, was correlated with the incidence of different factors influencing the perinatal mortality rate both countrywide and for each of the eight provinces of CSR. This way a correlation was found between some of the mentioned perinatal outcomes and e.g. instrumental equipment of obstetrical departments and neonatal intensive care units, frequency of caesarean sections, or transport of LBW newborns in incubators or "in utero" etc. The results of this analysis have proved that there still remain in some provinces opportunity for further decrease in perinatal mortality due to the incomplete observance of the two intervention strategies "Risk approach" and "New technology" which were introduced in the whole country during the last 10 years. PMID:3221298

  15. Risk factors and prognosis for neonatal sepsis in southeastern Mexico: analysis of a four-year historic cohort follow-up

    PubMed Central

    2012-01-01

    Background Neonatal sepsis is a worldwide public health issue in which, depending on the studied population, marked variations concerning its risk and prognostic factors have been reported. The aim of this study was to assess risk and prognostic factors for neonatal sepsis prevailing at a medical unit in southeastern Mexico. Thus, we used a historic cohort design to assess the association between a series of neonates and their mothers, in addition to hospital evolution features and the risk and prognosis of neonatal sepsis (defined by Pediatric Sepsis Consensus [PSC] criteria) in 11,790 newborns consecutively admitted to a Neonatology Service in Mérida, Mexico, between 2004 and 2007. Results Sepsis was found in 514 of 11,790 (4.3 %) newborns; 387 of these cases were categorized as early-onset (<72 h) (75.3 %) and 127, as late-onset (>72 h) (24.7 %). After logistic regression, risk factors for sepsis included the following: low birth weight; prematurity; abnormal amniotic fluid; premature membrane rupture (PMR) at >24 h; respiratory complications, and the requirement of assisted ventilation, O2 Inspiration fraction (IF) >60 %, or a surgical procedure. Some of these factors were differentially associated with early- or late-onset neonatal sepsis. The overall mortality rate of sepsis was 9.5 %. A marked difference in the mortality rate was found between early- and late-onset sepsis (p >0.0001). After Cox analysis, factors associated with mortality in newborns with sepsis comprised the following: prematurity; low birth weight; low Apgar score; perinatal asphyxia, and the requirement of any invasive medical or surgical procedure. Conclusions The incidence of neonatal sepsis in southeastern Mexico was 4.3 %. A different risk and prognostic profile between early- and late-onset neonatal sepsis was found. PMID:22691696

  16. A Survey on Current Practice of Management of Early Onset Neonatal Sepsis.

    PubMed

    Dey, A C; Hossain, M I; Afroze, S; Dey, S K; Mannan, M A; Shahidullah, M

    2016-04-01

    It was a survey type of cross sectional study where the participants were from different teaching/referral hospital across the country and was done to gather information regarding current practice of management of neonatal sepsis among paediatricians and neonatologists and was conducted on the spot during a national conference of Bangladesh Perinatal Society in December 2013. Specialists in neonatology, paediatrics, and some other disciplines working in different institutes across the country were requested to respond. Out of 150 physicians, 92 (61.33%) were neonatologists. Physicians suspected early onset neonatal sepsis (EONS) when there is history suggestive of prolonged rupture of membrane (74.77%), prolonged labour (9.33%), chorioamnionitis (7.33%) and maternal fever (2%). Clinical sepsis is found commonly (53.33%) which is later proved by laboratory evidences such as Hb%, TC, DC PBF (peripheral blood film), C-reactive protein, chest X-ray etc. Injection Ampicillin and Gentamycin are still the first choice of antibiotics (61.3%). Preferred route was intravenous (95.3%). Antibiotics were given for 7-10 days by most of the physicians (48.77%). However there is lack of uniformity among the participants in regard to taking decision about antibiotics, the choice of first line and the subsequent options of antibiotics. So, neonatal sepsis is the most important cause of neonatal mortality in the community. Therefore a standard protocolized approach for diagnosis and management of Early Onset Neonatal Sepsis may prove critical which is currently not in practice uniformly. PMID:27277355

  17. A Survey on Current Practice of Management of Early Onset Neonatal Sepsis.

    PubMed

    Dey, A C; Hossain, M I; Afroze, S; Dey, S K; Mannan, M A; Shahidullah, M

    2016-04-01

    It was a survey type of cross sectional study where the participants were from different teaching/referral hospital across the country and was done to gather information regarding current practice of management of neonatal sepsis among paediatricians and neonatologists and was conducted on the spot during a national conference of Bangladesh Perinatal Society in December 2013. Specialists in neonatology, paediatrics, and some other disciplines working in different institutes across the country were requested to respond. Out of 150 physicians, 92 (61.33%) were neonatologists. Physicians suspected early onset neonatal sepsis (EONS) when there is history suggestive of prolonged rupture of membrane (74.77%), prolonged labour (9.33%), chorioamnionitis (7.33%) and maternal fever (2%). Clinical sepsis is found commonly (53.33%) which is later proved by laboratory evidences such as Hb%, TC, DC PBF (peripheral blood film), C-reactive protein, chest X-ray etc. Injection Ampicillin and Gentamycin are still the first choice of antibiotics (61.3%). Preferred route was intravenous (95.3%). Antibiotics were given for 7-10 days by most of the physicians (48.77%). However there is lack of uniformity among the participants in regard to taking decision about antibiotics, the choice of first line and the subsequent options of antibiotics. So, neonatal sepsis is the most important cause of neonatal mortality in the community. Therefore a standard protocolized approach for diagnosis and management of Early Onset Neonatal Sepsis may prove critical which is currently not in practice uniformly.

  18. Perinatal lethal osteogenesis imperfecta.

    PubMed Central

    Cole, W G; Dalgleish, R

    1995-01-01

    Perinatal lethal osteogenesis imperfecta is the result of heterozygous mutations of the COL1A1 and COL1A2 genes that encode the alpha 1(I) and alpha 2(I) chains of type I collagen, respectively. Point mutations resulting in the substitution of Gly residues in Gly-X-Y amino acid triplets of the triple helical domain of the alpha 1(I) or alpha 2(I) chains are the most frequent mutations. They interrupt the repetitive Gly-X-Y structure that is mandatory for the formation of a stable triple helix. Most babies have their own private de novo mutation. However, the recurrence rate is about 7% owing to germline mosaicism in one parent. The mutations act in a dominant negative manner as the mutant pro alpha chains are incorporated into type I procollagen molecules that also contain normal pro alpha chains. The abnormal molecules are poorly secreted, more susceptible to degradation, and impair the formation of the extracellular matrix. The collagen fibres are abnormally organised and mineralisation is impaired. The severity of the clinical phenotype appears to be related to the type of mutation, its location in the alpha chain, the surrounding amino acid sequences, and the level of expression of the mutant allele. Images PMID:7643358

  19. Perinatal Mortality Magnitude, Determinants and Causes in West Gojam: Population-Based Nested Case-Control Study

    PubMed Central

    Yirgu, Robel; Molla, Mitike; Sibley, Lynn; Gebremariam, Abebe

    2016-01-01

    Introduction In Ethiopia, even if a significant reduction in child mortality is recorded recently, perinatal mortality rate is still very high. This study assessed the magnitude, determinants and causes of perinatal death in West Gojam zone, Ethiopia. Methods and materials A nested case control study was conducted on 102 cases (mothers who lost their newborns for perinatal death) and 204 controls (mothers who had live infants in the same year) among a cohort of 4097 pregnant mothers in three districts of the West Gojam zone, from Feb 2011 to Mar 2012. Logistic regression models were used to identify the independent determinant factors for perinatal mortality. The World Health Organization verbal autopsy instrument for neonatal death was used to collect mortality data and cause of death was assigned by a pediatrician and a neonatologist. Result Perinatal mortality rate was 25.1(95% CI 20.3, 29.9) per 1000 live and stillbirths. Primiparous mothers had a higher risk of losing their newborn babies for perinatal death than mothers who gave birth to five or more children (AOR = 3.15, 95% CI 1.03–9.60). Babies who were born to women who had a previous history of losing their baby to perinatal death during their last pregnancy showed higher odds of perinatal death than their counterparts (AOR = 9.55, 95% CI 4.67–19.54). Preterm newborns were more at risk for perinatal death (AOR = 9.44, 95%CI 1.81–49.22) than term babies. Newborns who were born among a household of more than two had a lesser risk of dying during the perinatal period as compared to those who were born among a member of only two. Paradoxically, home delivery was found to protect against perinatal death (AOR = 0.07 95% CI, 0.02–0.24) in comparison to institutional delivery. Bacterial sepsis, birth asphyxia and obstructed labour were among the leading causes of perinatal death. Conclusion Perinatal mortality rate remains considerably high, but proper maternal and child health care services can

  20. Recommendations for term and late preterm infants at risk for perinatal bacterial infection.

    PubMed

    Stocker, Martin; Berger, Christoph; McDougall, Jane; Giannoni, Eric

    2013-09-19

    Since publication of the initial guidelines for the prevention of group B streptococcal disease in 1996, the incidence of perinatal infection has decreased significantly. Intrapartum antibiotic prophylaxis together with appropriate management of neonates at increased risk for early-onset sepsis not only reduces morbidity and mortality, but also decreases the burden of unnecessary or prolonged antibiotic therapy. This article provides healthcare workers in Switzerland with evidence-based and best-practice derived guidelines for the assessment and management of term and late preterm infants (>34 weeks) at increased risk for perinatal bacterial infection. Management of neonates at increased risk for early-onset sepsis depends on clinical presentation and risk factors. Asymptomatic infants with risk factors for early-onset sepsis should be observed closely in an inpatient setting for the first 48 hours of life. Symptomatic neonates must be treated promptly with intravenous antibiotics. As clinical and laboratory signs of neonatal infection are nonspecific, it is mandatory to reevaluate the need for continued antibiotic therapy after 48 hours.

  1. Understanding brain dysfunction in sepsis

    PubMed Central

    2013-01-01

    Sepsis often is characterized by an acute brain dysfunction, which is associated with increased morbidity and mortality. Its pathophysiology is highly complex, resulting from both inflammatory and noninflammatory processes, which may induce significant alterations in vulnerable areas of the brain. Important mechanisms include excessive microglial activation, impaired cerebral perfusion, blood–brain-barrier dysfunction, and altered neurotransmission. Systemic insults, such as prolonged inflammation, severe hypoxemia, and persistent hyperglycemia also may contribute to aggravate sepsis-induced brain dysfunction or injury. The diagnosis of brain dysfunction in sepsis relies essentially on neurological examination and neurological tests, such as EEG and neuroimaging. A brain MRI should be considered in case of persistent brain dysfunction after control of sepsis and exclusion of major confounding factors. Recent MRI studies suggest that septic shock can be associated with acute cerebrovascular lesions and white matter abnormalities. Currently, the management of brain dysfunction mainly consists of control of sepsis and prevention of all aggravating factors, including metabolic disturbances, drug overdoses, anticholinergic medications, withdrawal syndromes, and Wernicke’s encephalopathy. Modulation of microglial activation, prevention of blood–brain-barrier alterations, and use of antioxidants represent relevant therapeutic targets that may impact significantly on neurologic outcomes. In the future, investigations in patients with sepsis should be undertaken to reduce the duration of brain dysfunction and to study the impact of this reduction on important health outcomes, including functional and cognitive status in survivors. PMID:23718252

  2. Perinatal Outcomes of Multiple Births in Southwest Nigeria

    PubMed Central

    2011-01-01

    Compared to singletons, multiple births are associated with a substantially-higher risk of maternal and perinatal mortality worldwide. However, little evidence exists on the perinatal profile and risk of neurodevelopmental disabilities among the survivors, especially in developing countries. This cross-sectional study, therefore, set out to determine the adverse perinatal outcomes that are potential markers for neurodevelopmental disabilities in infants with multiple gestations in a developing country. In total, 4,573 mothers, and their 4,718 surviving offspring in an inner-city maternity hospital in Lagos, Nigeria, from May 2005 to December 2007, were recruited. Comparisons of maternal and infant outcomes between single and multiple births were performed using multivariable logistic regression and generalized estimation equation analyses. Odds ratio (OR) and the corresponding 95% confidence interval (CI) for each marker were estimated. Of the 4,573 deliveries, there were 4,416 (96.6%) singletons and 157 (3.4%) multiples, comprising 296 twins and six triplets together (6.4% of all live 4,718 infants). After adjusting for maternal age, ethnicity, occupation, parity, and antenatal care, multiple gestations were associated with increased risks of hypertensive disorders and caesarean delivery. Similarly, after adjusting for potential maternal confounders, multiple births were associated with low five-minute Apgar score (OR: 1.47, 95% CI 1.13-1.93), neonatal sepsis (OR: 2.16, 95% CI 1.28-3.65), severe hyperbilirubinaemia (OR: 1.60, 95% CI 1.00-2.56), and admission to a special-care baby unit (OR: 1.56, 95% CI 1.12-2.17) underpinned by preterm delivery before 34 weeks (OR: 1.91, 95% CI 1.14-3.19), birthweight of less than 2,500 g (OR: 6.45, 95% CI 4.80-8.66), and intrauterine growth restriction (OR: 9.04, 95% CI 6.62-12.34). Overall, the results suggest that, in resource-poor settings, infants of multiple gestations are associated with a significantly-elevated risk of

  3. Surviving sepsis in the critical care environment.

    PubMed

    Benedict, Lara

    2015-01-01

    The management of sepsis and septic shock in the intensive care environment is a complex task requiring the cooperation of a multidisciplinary team. The Surviving Sepsis Campaign provides systematic guidelines for the recognition, early intervention, and supportive management of sepsis. Critical care nurses are instrumental in ensuring that these guidelines and other sources of evidence-based practice are used for patients with severe sepsis or septic shock. This article discusses the pathophysiologic processes in severe sepsis and septic shock and discusses the appropriate interventions as recommended by the Surviving Sepsis Campaign. Recommended early treatments are reviewed along with interventions related to hemodynamics, perfusion, and supportive care in the critical care environment.

  4. [Perinatal sources of stem cells].

    PubMed

    Piskorska-Jasiulewicz, Magdalena Maria; Witkowska-Zimny, Małgorzata

    2015-03-08

    Recently, stem cell biology has become an interesting topic. Several varieties of human stem cells have been isolated and identified in vivo and in vitro. Successful application of hematopoietic stem cells in hematology has led to the search for other sources of stem cells and expanding the scale of their application. Perinatal stem cells are a versatile cell population, and they are interesting for both scientific and practical objectives. Stem cells from perinatal tissue may be particularly useful in the clinic for autologous transplantation for fetuses and newborns, and after banking in later stages of life, as well as for in utero transplantation in the case of genetic disorders. In this review paper we focus on the extraction and therapeutic potential of stem cells derived from perinatal tissues such as the placenta, the amnion, amniotic fluid, umbilical cord blood and Wharton's jelly.

  5. Sepsis-associated encephalopathy.

    PubMed

    Gofton, Teneille E; Young, G Bryan

    2012-10-01

    Sepsis-associated encephalopathy (SAE) is a diffuse brain dysfunction that occurs secondary to infection in the body without overt CNS infection. SAE is frequently encountered in critically ill patients in intensive care units, and in up to 70% of patients with severe systemic infection. The severity of SAE can range from mild delirium to deep coma. Seizures and myoclonus are infrequent and cranial nerves are almost always spared, but most severe cases have an associated critical illness neuromyopathy. Development of SAE probably involves a number of mechanisms that are not mutually exclusive and vary from patient to patient. Substantial neurological and psychological morbidities often occur in survivors. Mortality is almost always due to multiorgan failure rather than neurological complications, and is almost 70% in patients with severe SAE. Further research into the pathophysiology, management and prevention of SAE is needed. This Review discusses the epidemiology and clinical presentation of SAE. Recent evidence for SAE pathophysiology is outlined and a diagnostic approach to patients with this syndrome is presented. Lastly, prognosis and management of SAE is discussed.

  6. Antimicrobial Peptides in Human Sepsis

    PubMed Central

    Martin, Lukas; van Meegern, Anne; Doemming, Sabine; Schuerholz, Tobias

    2015-01-01

    Nearly 100 years ago, antimicrobial peptides (AMPs) were identified as an important part of innate immunity. They exist in species from bacteria to mammals and can be isolated in body fluids and on surfaces constitutively or induced by inflammation. Defensins have anti-bacterial effects against Gram-positive and Gram-negative bacteria as well as anti-viral and anti-yeast effects. Human neutrophil peptides (HNP) 1–3 and human beta-defensins (HBDs) 1–3 are some of the most important defensins in humans. Recent studies have demonstrated higher levels of HNP 1–3 and HBD-2 in sepsis. The bactericidal/permeability-increasing protein (BPI) attenuates local inflammatory response and decreases systemic toxicity of endotoxins. Moreover, BPI might reflect the severity of organ dysfunction in sepsis. Elevated plasma lactoferrin is detected in patients with organ failure. HNP 1–3, lactoferrin, BPI, and heparin-binding protein are increased in sepsis. Human lactoferrin peptide 1–11 (hLF 1–11) possesses antimicrobial activity and modulates inflammation. The recombinant form of lactoferrin [talactoferrin alpha (TLF)] has been shown to decrease mortality in critically ill patients. A phase II/III study with TLF in sepsis did not confirm this result. The growing number of multiresistant bacteria is an ongoing problem in sepsis therapy. Furthermore, antibiotics are known to promote the liberation of pro-inflammatory cell components and thus augment the severity of sepsis. Compared to antibiotics, AMPs kill bacteria but also neutralize pathogenic factors such as lipopolysaccharide. The obstacle to applying naturally occurring AMPs is their high nephro- and neurotoxicity. Therefore, the challenge is to develop peptides to treat septic patients effectively without causing harm. This overview focuses on natural and synthetic AMPs in human and experimental sepsis and their potential to provide significant improvements in the treatment of critically ill with severe infections

  7. Cascades of popping bubbles along air/foam interfaces.

    PubMed

    Vandewalle, N; Lentz, J F

    2001-08-01

    We report image analysis of popping bubbles during the collapsing of two-dimensional (2D) and 3D aqueous foams. Although temporal and spatial correlations between successive popping bubbles within avalanches are emphasized, the breaking of a soap film at the air/foam interface seems to be independent of (i) the topology, (ii) the local curvature, and (iii) the size of the popping bubble. Possible mechanisms for cascades of pops are proposed and discussed. PMID:11497589

  8. Career Trajectories of Dutch Pop Musicians: A Longitudinal Study

    ERIC Educational Resources Information Center

    Zwaan, Koos; ter Bogt, Tom F. M.; Raaijmakers, Quinten

    2010-01-01

    Systematic studies of artistic careers are scarce and this is the first large-scale study on the career development of pop musicians. Using a prospective longitudinal approach we followed a sample of aspiring pop musicians in the Netherlands (N=369) over a three-year period. First we identified four groups of pop musicians with different career…

  9. On the Speed of Pop-Out in Feature Search

    ERIC Educational Resources Information Center

    Turatto, Massimo; Valsecchi, Matteo; Seiffert, Adriane E.; Caramazza, Alfonso

    2010-01-01

    When something unique is present in a scene, this element may become immediately visible and one has the impression that it pops out from the scene. This phenomenon, known as "pop-out" in the visual search literature, is thought to produce the fastest search possible, and response times for the detection of the pop-out target do not vary as a…

  10. POP: Publications by the Observatoire de Paris

    NASA Astrophysics Data System (ADS)

    Brocquet, C.; Henry, F.; Laurenceau, A.

    2015-04-01

    The paper presents "POP: Publications of the Observatoire de Paris," a project of the Observatoire de Paris, which was launched to keep record of its activity by indexing its publications. It also describes the aims and the challenges of the project and the features of Publesia, the software that was adopted for the project.

  11. Using Pop Culture to Teach Introductory Biology

    ERIC Educational Resources Information Center

    Pryor, Gregory S.

    2008-01-01

    Students are captivated by the characters, storylines, and gossip provided by pop culture (television, movies, magazines, books, sports, music, advertisements, and the Internet). They always seem more engaged when teachers incorporate examples and analogies from popular culture into their lectures. This seems especially true regarding non-majors…

  12. A Study of Statistics through Tootsie Pops

    ERIC Educational Resources Information Center

    Aaberg, Shelby; Vitosh, Jason; Smith, Wendy

    2016-01-01

    A classic TV commercial once asked, "How many licks does it take to get to the center of a Tootsie Roll Tootsie Pop?" The narrator claims, "The world may never know" (Tootsie Roll 2012), but an Internet search returns a multitude of answers, some of which include rigorous systematic approaches by academics to address the…

  13. Selecting Music for High School Pop Groups.

    ERIC Educational Resources Information Center

    Santy, Jeff

    1990-01-01

    Describes the criteria a high school music teacher used to select music for a new non-traditional class titled "Pop Band." Lists criteria that each song must have: playability, special feature, popular appeal, variety, artist's qualification, and appropriateness. Students took an active role in the decision-making process. (GG)

  14. Time's Up, Turkey--Pop-Up Thermometers

    ERIC Educational Resources Information Center

    Moyer, Richard; Everett, Susan

    2009-01-01

    Meat thermometers can be awkward to use in terms of placement and avoidance of bones. Because of these problems, each year 30 million Thanksgiving turkeys have a built-in thermometer that pops up when the turkey is properly cooked. Turkey timers are an example of how engineering solved a common, everyday problem. The following 5E learning cycle…

  15. Energy expenditure in rock/pop drumming.

    PubMed

    De La Rue, S E; Draper, S B; Potter, C R; Smith, M S

    2013-10-01

    Despite the vigorous nature of rock/pop drumming, there are no precise data on the energy expenditure of this activity. The aim of this study was to quantify the energy cost of rock/pop drumming. Fourteen male drummers (mean±SD; age 27±8 yrs.) completed an incremental drumming test to establish the relationship between energy expenditure and heart rate for this activity and a ramped cycle ergometer test to exhaustion as a criterion measure for peak values (oxygen uptake and heart rate). During live concert performance heart rate was continuously measured and used to estimate energy expenditure (from the energy expenditure vs. heart rate data derived from the drumming test). During concert performance, estimated energy expenditure (mean±SD) was 623±168 kcal.h⁻¹ (8.1±2.2 METs) during performances of 38.6±15.6 min, and drummers achieved a peak heart rate of 186±16 b.min⁻¹. During the drumming test participants attained 78.7±8.3% of the cycle ergometer peak oxygen uptake. Rock/pop drumming represents a relatively high-intensity form of physical activity and as such involves significant energy expenditure. Rock/pop drumming should be considered as a viable alternative to more traditional forms of physical activity.

  16. Current epidemiology of sepsis in mainland China

    PubMed Central

    Liao, Xuelian; Du, Bin; Lu, Meizhu; Wu, Minming

    2016-01-01

    The disease burden of sepsis is a global issue. Most of the large-scale epidemiological investigations on sepsis have been carried out in developed countries. The population of 1.3 billion in mainland China accounts for approximately 1/5th of the whole world population. Thus, the knowledge of the incidence and mortality of sepsis in mainland China is vital before employing measures for its improvement. However, most of the epidemiological data of sepsis in mainland China was obtained from ICU settings, and thus lacks the population-based incidence and mortality of sepsis. In the present review, we summarized the limited literature encompassing the incidence, mortality, long-term outcome, and pathogens of sepsis in mainland China. Therefore, it might provide some valuable information regarding the sepsis disease burden and current issues in the management of sepsis in mainland China. PMID:27713882

  17. Fast Action Can Prevent Sepsis Death: CDC

    MedlinePlus

    ... fullstory_160574.html Fast Action Can Prevent Sepsis Death: CDC Know the signs of extreme response to ... treated long before it causes severe illness or death, U.S. health officials report. Sepsis, or septicemia, occurs ...

  18. Severe sepsis management are we doing enough?

    PubMed

    Ahrens, Tom; Vollman, Kathleen

    2003-10-01

    For the first time in medical history, a drug has been shown to reduce the mortality associated with sepsis, the leading cause of death in many ICUs. Optimal use by appropriate selection of patients and early recognition of sepsis could save thousands of lives. Nurses play a major role in recognizing severe sepsis. By using the concepts introduced here, nurses can play a direct role in saving the lives of patients with sepsis.

  19. Sepsis caused by Flavimonas oryzihabitans.

    PubMed

    Lucas, K G; Kiehn, T E; Sobeck, K A; Armstrong, D; Brown, A E

    1994-07-01

    Previous reports of F. oryzihabitans sepsis involving central venous access devices reveal a relatively high rate of complications, including device removal, despite a course of broad-spectrum anti-microbials with compatible in vitro susceptibility results. In the present report of 22 cases of F. oryzihabitans sepsis treated at Memorial Sloan-Kettering Cancer Center from February 1986 through September 1993, the majority of CVAD-related infections with F. oryzihabitans were successfully treated with a 14-day course of antimicrobials with antipseudomonal activity, and removal of the device was usually not required. Factors that may complicate successful treatment of CVAD-related sepsis caused by F. oryzihabitans include polymicrobial infections and premature discontinuation of antibiotic therapy.

  20. Sepsis caused by Flavimonas oryzihabitans.

    PubMed

    Lucas, K G; Kiehn, T E; Sobeck, K A; Armstrong, D; Brown, A E

    1994-07-01

    Previous reports of F. oryzihabitans sepsis involving central venous access devices reveal a relatively high rate of complications, including device removal, despite a course of broad-spectrum anti-microbials with compatible in vitro susceptibility results. In the present report of 22 cases of F. oryzihabitans sepsis treated at Memorial Sloan-Kettering Cancer Center from February 1986 through September 1993, the majority of CVAD-related infections with F. oryzihabitans were successfully treated with a 14-day course of antimicrobials with antipseudomonal activity, and removal of the device was usually not required. Factors that may complicate successful treatment of CVAD-related sepsis caused by F. oryzihabitans include polymicrobial infections and premature discontinuation of antibiotic therapy. PMID:8041243

  1. Transfusion-associated bacterial sepsis.

    PubMed Central

    Wagner, S J; Friedman, L I; Dodd, R Y

    1994-01-01

    The incidence of sepsis caused by transfusion of bacterially contaminated blood components is similar to or less than that of transfusion-transmitted hepatitis C virus infection, yet significantly exceeds those currently estimated for transfusion-associated human immunodeficiency and hepatitis B viruses. Outcomes are serious and may be fatal. In addition, transfusion of sterile allogenic blood can have generalized immunosuppressive effects on recipients, resulting in increased susceptibility to postoperative infection. This review examines the frequency of occurrence of transfusion-associated sepsis, the organisms implicated, and potential sources of bacteria. Approaches to minimize the frequency of sepsis are discussed, including the benefits and disadvantages of altering the storage conditions for blood. In addition, the impact of high levels of bacteria on the gross characteristics of erythrocyte and platelet concentrates is described. The potentials and limitations of current tests for detecting bacteria in blood are also discussed. PMID:7923050

  2. Epidemiologic trends of sepsis in western countries

    PubMed Central

    Suarez De La Rica, Alejandro; Gilsanz, Fernando

    2016-01-01

    Since the American College of Chest Physicians (ACCP) and the Society of Critical care Medicine (SCCM) published the first consensus definition of syndromes related to sepsis in 1992, the knowledge of epidemiology of sepsis has clearly improved, although no prospective studies have been performed to analyse the incidence of sepsis in general population. There are differences in epidemiologic trends in sepsis between western countries and low-income and middle-income countries. In the United States (US), most of epidemiologic studies have been based on large, administrative databases, reporting an increase in the incidence of severe sepsis over years. In general, studies describing epidemiology of sepsis outside the US use clinical definitions and intensive care unit (ICU) observational cohort designs instead of administrative databases and definitions. Incidence of sepsis has increased over years, probably due to progressive aging of population, the existence of more comorbidities and maybe the liberal use of sepsis codification, by including patients with less severity. Notwithstanding, mortality due to sepsis is clearly decreasing over years, probably to improvement in ICU care, although absolute mortality is growing on account of the raise in incidence. Risk factors for sepsis are the two ends of life, male sex, US black race, presence of comorbidities and certain genetic variants. Respiratory tract infections are the most common source of sepsis, and, nowadays, Gram-positive infections are more frequent that Gram-negative sepsis in most prospective studies. PMID:27713883

  3. PopIII signatures in the spectra of PopII/I GRBs

    NASA Astrophysics Data System (ADS)

    Ma, Q.; Maio, U.; Ciardi, B.; Salvaterra, R.

    2015-05-01

    We investigate signatures of Population III (PopIII) stars in the metal-enriched environment of gamma-ray bursts (GRBs) originating from Population II-I (PopII/I) stars by using abundance ratios derived from numerical simulations that follow stellar evolution and chemical enrichment. We find that at z > 10 more than 10 per cent of PopII/I GRBs explode in a medium previously enriched by PopIII stars (we refer to them as GRBII→III). Although the formation of GRBII→III is more frequent than that of pristine PopIII GRBs (GRBIIIs), we find that the expected GRBII→III observed rate is comparable to that of GRBIIIs, due to the usually larger luminosities of the latter. GRBII→III events take place preferentially in small protogalaxies with stellar masses M⋆ ˜ 104.5-107 M⊙, star formation rates SFR ˜ 10^{-3}-10^{-1} M_{⊙} yr^{-1} and metallicities Z ˜ 10- 4-10- 2 Z⊙. On the other hand, galaxies with Z < 10- 2.8 Z⊙ are dominated by metal enrichment from PopIII stars and should preferentially host GRBII→III. Hence, measured GRB metal content below this limit could represent a strong evidence of enrichment by pristine stellar populations. We discuss how to discriminate PopIII metal enrichment on the basis of various abundance ratios observable in the spectra of GRBs' afterglows. By employing such analysis, we conclude that the currently known candidates at redshift z ≃ 6 - i.e. GRB 050904 and GRB 130606A - are likely not originated in environments pre-enriched by PopIII stars. Abundance measurements for GRBs at z ≃ 5 - such as GRB 100219A and GRB 111008A - are still poor to draw definitive conclusions, although their hosts seem to be dominated by PopII/I pollution and do not show evident signatures of massive PopIII pre-enrichment.

  4. Requirements for CEC POP machine protection system

    SciTech Connect

    Pinayev, I.

    2015-02-18

    The requirements of CEC POP machine protection system are meant to prevent damage to a vacuum chamber by a missteered electron beam. In this example, beam energy = 22 MeV, Maximal bunch charge = 5 nC, Maximal repetition rate = 78 kHz, Normalized emittance = 5 mm mrad, Minimal β-function = 1 m. From this information the requirements of the protection system can be calculated by factoring the information into equations to find beam densities and temperature excursions.

  5. Investor Outlook: After the Biotech Bubble Popped.

    PubMed

    Schimmer, Joshua; Breazzano, Steven; Yang, Jerry

    2016-03-01

    After a few torrid years of value appreciation, the biotech "bubble" has precipitously popped over the past few months. In this report, we take a look at some of the factors that drove the run-up in valuations, the triggers that led to their substantial pullback, and where the industry may be headed from here. Gene therapy/editing companies have been particularly affected by these dynamics, raising a new set of questions and challenges for the group.

  6. Do People “Pop Out”?

    PubMed Central

    Mayer, Katja M.; Vuong, Quoc C.; Thornton, Ian M.

    2015-01-01

    The human body is a highly familiar and socially very important object. Does this mean that the human body has a special status with respect to visual attention? In the current paper we tested whether people in natural scenes attract attention and “pop out” or, alternatively, are at least searched for more efficiently than targets of another category (machines). Observers in our study searched a visual array for dynamic or static scenes containing humans amidst scenes containing machines and vice versa. The arrays consisted of 2, 4, 6 or 8 scenes arranged in a circular array, with targets being present or absent. Search times increased with set size for dynamic and static human and machine targets, arguing against pop out. However, search for human targets was more efficient than for machine targets as indicated by shallower search slopes for human targets. Eye tracking further revealed that observers made more first fixations to human than to machine targets and that their on-target fixation durations were shorter for human compared to machine targets. In summary, our results suggest that searching for people in natural scenes is more efficient than searching for other categories even though people do not pop out. PMID:26441221

  7. Ethical issues in perinatal genetics.

    PubMed

    Chervenak, Frank A; McCullough, Laurence B

    2011-04-01

    Ethics is an essential dimension of perinatal genetics. This article introduces perinatologists to the ethical principles of beneficence and respect for autonomy and uses these ethical principles to articulate the ethical concept of the fetus as a patient. Together these constitute an ethical framework that we apply to risk assessment, in response to which women may be divided into four groups: prenatal genetic counseling, and the responsible management of pregnancies complicated by genetic anomalies of the fetus.

  8. Ethical issues in perinatal genetics.

    PubMed

    Chervenak, Frank A; McCullough, Laurence B

    2011-04-01

    Ethics is an essential dimension of perinatal genetics. This article introduces perinatologists to the ethical principles of beneficence and respect for autonomy and uses these ethical principles to articulate the ethical concept of the fetus as a patient. Together these constitute an ethical framework that we apply to risk assessment, in response to which women may be divided into four groups: prenatal genetic counseling, and the responsible management of pregnancies complicated by genetic anomalies of the fetus. PMID:21051301

  9. Ischemic perinatal stroke: challenge and opportunities.

    PubMed

    Raju, Tonse N K

    2008-08-01

    The second highest risk group for developing a cerebral stroke is the perinatal period, generally defined as 20 weeks of gestation through 28th postnatal day of age. In this commentary, a brief overview of ischemic perinatal strokes is presented. Ischemic perinatal stroke (IPS) occurs at a rate of 1 : 2300 to 1 : 5000 births, accounting for 30% of children with hemiplegic cerebral palsy (CP). Thus, IPS is the most common known cause for CP [1-3]. Although they occur frequently, much remains to be studied about perinatal strokes in general and the ischemic variety in particular. PMID:18705894

  10. Improving management of sepsis in the community.

    PubMed

    Culligan, Fiona

    2016-08-31

    Sepsis is a life-threatening organ dysfunction caused by a dysregulated host response to infection. Pathological changes in the circulation reduce the blood supply to major organs, causing them to fail. This may lead to death, therefore rapid recognition and treatment of sepsis is vital. Sepsis research has focused on patients in acute hospital settings. However, most cases of sepsis originate in the community, suggesting that the identification of sepsis and delivery of timely care is necessary before hospital admission. Therefore, it is essential that nurses practising in the community are provided with appropriate sepsis guidelines that can be implemented immediately. The UK Sepsis Trust has developed the General Practice Sepsis Decision Support Tool, which has been designed specifically for use in the community. This article provides an overview of how the tool is used in the community and how it works in conjunction with the 'Sepsis Six' care bundle and care bundles for hospital settings. Changes to the terminology used in relation to sepsis and recent guidelines are also explained. PMID:27577313

  11. Diagnosing sepsis - The role of laboratory medicine.

    PubMed

    Fan, Shu-Ling; Miller, Nancy S; Lee, John; Remick, Daniel G

    2016-09-01

    Sepsis is the host response to microbial pathogens resulting in significant morbidity and mortality. An accurate and timely diagnosis of sepsis allows prompt and appropriate treatment. This review discusses laboratory testing for sepsis because differentiating systemic inflammation from infection is challenging. Procalcitonin (PCT) is currently an FDA approved test to aid in the diagnosis of sepsis but with questionable efficacy. However, studies support the use of PCT for antibiotic de-escalation. Serial lactate measurements have been recommended for monitoring treatment efficacy as part of sepsis bundles. The 2016 sepsis consensus definitions include lactate concentrations >2mmol/L (>18mg/dL) as part of the definition of septic shock. Also included in the 2016 definitions are measuring bilirubin and creatinine to determine progression of organ failure indicating worse prognosis. Hematologic parameters, including a simple white blood cell count and differential, are frequently part of the initial sepsis diagnostic protocols. Several new biomarkers have been proposed to diagnose sepsis or to predict mortality, but they currently lack sufficient sensitivity and specificity to be considered as stand-alone testing. If sepsis is suspected, new technologies and microbiologic assays allow rapid and specific identification of pathogens. In 2016 there is no single laboratory test that accurately diagnoses sepsis. PMID:27387712

  12. Disseminated intravascular coagulation in sepsis.

    PubMed

    Zeerleder, Sacha; Hack, C Erik; Wuillemin, Walter A

    2005-10-01

    Disseminated intravascular coagulation is a frequent complication of sepsis. Coagulation activation, inhibition of fibrinolysis, and consumption of coagulation inhibitors lead to a procoagulant state resulting in inadequate fibrin removal and fibrin deposition in the microvasculature. As a consequence, microvascular thrombosis contributes to promotion of organ dysfunction. Recently, three randomized, double-blind, placebo-controlled trials investigated the efficacy of antithrombin, activated protein C (APC), and tissue factor pathway inhibitor, respectively, in sepsis patients. A significant reduction in mortality was demonstrated in the APC trial. In this article, we first discuss the physiology of coagulation and fibrinolysis activation. Then, the pathophysiology of coagulation activation, consumption of coagulation inhibitors, and the inhibition of fibrinolysis leading to a procoagulant state are described in more detail. Moreover, therapeutic concepts as well as the three randomized, double-blind, placebo-controlled studies are discussed.

  13. Sepsis: Medical errors in Poland.

    PubMed

    Rorat, Marta; Jurek, Tomasz

    2016-01-01

    Health, safety and medical errors are currently the subject of worldwide discussion. The authors analysed medico-legal opinions trying to determine types of medical errors and their impact on the course of sepsis. The authors carried out a retrospective analysis of 66 medico-legal opinions issued by the Wroclaw Department of Forensic Medicine between 2004 and 2013 (at the request of the prosecutor or court) in cases examined for medical errors. Medical errors were confirmed in 55 of the 66 medico-legal opinions. The age of victims varied from 2 weeks to 68 years; 49 patients died. The analysis revealed medical errors committed by 113 health-care workers: 98 physicians, 8 nurses and 8 emergency medical dispatchers. In 33 cases, an error was made before hospitalisation. Hospital errors occurred in 35 victims. Diagnostic errors were discovered in 50 patients, including 46 cases of sepsis being incorrectly recognised and insufficient diagnoses in 37 cases. Therapeutic errors occurred in 37 victims, organisational errors in 9 and technical errors in 2. In addition to sepsis, 8 patients also had a severe concomitant disease and 8 had a chronic disease. In 45 cases, the authors observed glaring errors, which could incur criminal liability. There is an urgent need to introduce a system for reporting and analysing medical errors in Poland. The development and popularisation of standards for identifying and treating sepsis across basic medical professions is essential to improve patient safety and survival rates. Procedures should be introduced to prevent health-care workers from administering incorrect treatment in cases.

  14. Early-Onset Neonatal Sepsis

    PubMed Central

    Simonsen, Kari A.; Anderson-Berry, Ann L.; Delair, Shirley F.

    2014-01-01

    SUMMARY Early-onset sepsis remains a common and serious problem for neonates, especially preterm infants. Group B streptococcus (GBS) is the most common etiologic agent, while Escherichia coli is the most common cause of mortality. Current efforts toward maternal intrapartum antimicrobial prophylaxis have significantly reduced the rates of GBS disease but have been associated with increased rates of Gram-negative infections, especially among very-low-birth-weight infants. The diagnosis of neonatal sepsis is based on a combination of clinical presentation; the use of nonspecific markers, including C-reactive protein and procalcitonin (where available); blood cultures; and the use of molecular methods, including PCR. Cytokines, including interleukin 6 (IL-6), interleukin 8 (IL-8), gamma interferon (IFN-γ), and tumor necrosis factor alpha (TNF-α), and cell surface antigens, including soluble intercellular adhesion molecule (sICAM) and CD64, are also being increasingly examined for use as nonspecific screening measures for neonatal sepsis. Viruses, in particular enteroviruses, parechoviruses, and herpes simplex virus (HSV), should be considered in the differential diagnosis. Empirical treatment should be based on local patterns of antimicrobial resistance but typically consists of the use of ampicillin and gentamicin, or ampicillin and cefotaxime if meningitis is suspected, until the etiologic agent has been identified. Current research is focused primarily on development of vaccines against GBS. PMID:24396135

  15. Biosensor of endotoxin and sepsis

    NASA Astrophysics Data System (ADS)

    Shao, Yang; Wang, Xiang; Wu, Xi; Gao, Wei; He, Qing-hua; Cai, Shaoxi

    2001-09-01

    To investigate the relation between biosensor of endotoxin and endotoxin of plasma in sepsis. Method: biosensor of endotoxin was designed with technology of quartz crystal microbalance bioaffinity sensor ligand of endotoxin were immobilized by protein A conjugate. When a sample soliton of plasma containing endotoxin 0.01, 0.03, 0.06, 0.1, 0.5, 1.0Eu, treated with perchloric acid and injected into slot of quartz crystal surface respectively, the ligand was released from the surface of quartz crystal to form a more stable complex with endotoxin in solution. The endotoxin concentration corresponded to the weight change on the crystal surface, and caused change of frequency that occurred when desorbed. The result was biosensor of endotoxin might detect endotoxin of plasma in sepsis, measurements range between 0.05Eu and 0.5Eu in the stop flow mode, measurement range between 0.1Eu and 1Eu in the flow mode. The sensor of endotoxin could detect the endotoxin of plasm rapidly, and use for detection sepsis in clinically.

  16. Early-onset neonatal sepsis.

    PubMed

    Simonsen, Kari A; Anderson-Berry, Ann L; Delair, Shirley F; Davies, H Dele

    2014-01-01

    Early-onset sepsis remains a common and serious problem for neonates, especially preterm infants. Group B streptococcus (GBS) is the most common etiologic agent, while Escherichia coli is the most common cause of mortality. Current efforts toward maternal intrapartum antimicrobial prophylaxis have significantly reduced the rates of GBS disease but have been associated with increased rates of Gram-negative infections, especially among very-low-birth-weight infants. The diagnosis of neonatal sepsis is based on a combination of clinical presentation; the use of nonspecific markers, including C-reactive protein and procalcitonin (where available); blood cultures; and the use of molecular methods, including PCR. Cytokines, including interleukin 6 (IL-6), interleukin 8 (IL-8), gamma interferon (IFN-γ), and tumor necrosis factor alpha (TNF-α), and cell surface antigens, including soluble intercellular adhesion molecule (sICAM) and CD64, are also being increasingly examined for use as nonspecific screening measures for neonatal sepsis. Viruses, in particular enteroviruses, parechoviruses, and herpes simplex virus (HSV), should be considered in the differential diagnosis. Empirical treatment should be based on local patterns of antimicrobial resistance but typically consists of the use of ampicillin and gentamicin, or ampicillin and cefotaxime if meningitis is suspected, until the etiologic agent has been identified. Current research is focused primarily on development of vaccines against GBS.

  17. Sepsis: From Bench to Bedside

    PubMed Central

    Silva, Eliézer; Passos, Rogério Da Hora; Ferri, Maurício Beller; de Figueiredo, Luiz Francisco Poli

    2008-01-01

    Sepsis is a syndrome related to severe infections. It is defined as the systemic host response to microorganisms in previously sterile tissues and is characterized by end-organ dysfunction away from the primary site of infection. The normal host response to infection is complex and aims to identify and control pathogen invasion, as well as to start immediate tissue repair. Both the cellular and humoral immune systems are activated, giving rise to both anti-inflammatory and proinflammatory responses. The chain of events that leads to sepsis is derived from the exacerbation of these mechanisms, promoting massive liberation of mediators and the progression of multiple organ dysfunction. Despite increasing knowledge about the pathophysiological pathways and processes involved in sepsis, morbidity and mortality remain unacceptably high. A large number of immunomodulatory agents have been studied in experimental and clinical settings in an attempt to find an efficacious anti-inflammatory drug that reduces mortality. Even though preclinical results had been promising, the vast majority of these trials actually showed little success in reducing the overwhelmingly high mortality rate of septic shock patients as compared with that of other critically ill intensive care unit patients. Clinical management usually begins with prompt recognition, determination of the probable infection site, early administration of antibiotics, and resuscitation protocols based on “early-goal” directed therapy. In this review, we address the research efforts that have been targeting risk factor identification, including genetics, pathophysiological mechanisms and strategies to recognize and treat these patients as early as possible. PMID:18297215

  18. Perinatal depression: implications for child mental health.

    PubMed

    Muzik, Maria; Borovska, Stefana

    2010-12-01

    Perinatal depression is common and primary care holds a crucial role for detecting, treating or, if necessary, providing referrals to mental health care for affected women. Family doctors should be aware of risk factors for peripartum depression, including previous history of depression, life events and interpersonal conflict. Perinatal depression has been associated with many poor outcomes, including maternal, child and family unit challenges. Infants and young children of perinatally depressed mothers are more likely to have a difficult temperament, as well as cognitive and emotional delays. The primary care setting is uniquely poised to be the screening and treatment site for perinatal depression; however, several obstacles, both at patient and systems level, have been identified that interfere with women's treatment engagement. Current published treatment guidelines favour psychotherapy above medicines as first line treatment for mild to moderate perinatal depression, while pharmacotherapy is first choice for severe depression, often in combination with psychosocial or integrative approaches. Among mothers who decide to stop taking their antidepressants despite ongoing depression during the perinatal period, the majority suffer from relapsing symptoms. If depression continues post-partum, there is an increased risk of poor mother-infant attachment, delayed cognitive and linguistic skills in the infant, impaired emotional development and risk for behavioural problems in later life. Complex, comprehensive and multilevel algorithms are warranted to treat perinatal depression. Primary care doctors are best suited to initiate, carry out and evaluate the effectiveness of such interventions designed to prevent adverse outcomes of maternal perinatal depression on mother and child wellbeing.

  19. Guidelines for Perinatal Care. Second Edition.

    ERIC Educational Resources Information Center

    American Coll. of Obstetricians and Gynecologists, Washington, DC.

    The basic concept emphasized in this book is that a coordinated, multidisciplinary approach within a regionalized system of perinatal care is a constant factor improving the quality of pregancy outcomes. This coordinated multidisciplinary approach has had an impact on perinatal care in three important areas: (1) improved and expanded understanding…

  20. Minimal Brain Dysfunction: Associations with Perinatal Complications.

    ERIC Educational Resources Information Center

    Nichols, Paul L.

    Examined with over 28,000 7-year-old children whose mothers registered for prenatal care was the relationship between perinatal complications and such characteristics as poor school achievement, hyperactivity, and neurological soft signs associated with the diagnosis of minimal brain dysfunction (MBD). Ten perinatal antecedents were studied:…

  1. Sepsis management in the deployed field hospital.

    PubMed

    Johnston, Andrew McD; Easby, D; Ewington, I

    2013-09-01

    Sepsis, a syndrome caused by severe infection, affects a small proportion of military casualties but has a significant effect in increasing morbidity and mortality, including causing some preventable deaths. Casualties with abdominal trauma and those with significant tissue loss appear to be at a greater risk of sepsis. In this article, the diagnosis and management of sepsis in military casualties with reference to the Surviving Sepsis Campaign guidelines are examined. We discuss the management considerations specific to military casualties in the deployed setting and also discuss factors affecting evacuation by the UK Royal Air Force Critical Care Air Support Team. PMID:24109139

  2. Systems for Paediatric Sepsis: A Global Survey

    PubMed Central

    Kang, KT; Chandler, HK; Espinosa, V; Kissoon, N

    2014-01-01

    ABSTRACT Objectives: To evaluate the resources available for early diagnosis and treatment of paediatric sepsis at hospitals in developing and developed countries. Methods: This was a voluntary online survey involving 101 hospitals from 41 countries solicited through the World Federation of Pediatric Intensive and Critical Care Societies contact list and website. The survey was designed to assess the spectrum of sepsis epidemiology, patterns of applied therapies, availability of resources and barriers to optimal sepsis treatment. Results: Ninety per cent of respondents represented a tertiary or general hospital with paediatric intensive care facilities, including 63% from developed countries. Adequate triage services were absent in more than 20% of centres. Insufficiently trained personnel and lack of a sepsis protocol was reported in 40% of all sites. While there were specific guidelines for sepsis management in 78% of centres (n = 100), protocols for assessing sepsis patients were not applied in nearly 70% of centres. Lack of parental recognition of sepsis and failure of referring centres to diagnose sepsis were identified as major barriers by more than 50% of respondents. Conclusions: Even among centres with no significant resource constraints and advanced medical systems, significant deficits in sepsis care exist. Early recognition and management remains a key issue and may be addressed through improved triage, augmented support for referring centres and public awareness. Focussed research is necessary at the institutional level to identify and address specific barriers. PMID:25867557

  3. Autophagy in sepsis: Degradation into exhaustion?

    PubMed

    Ho, Jeffery; Yu, Jun; Wong, Sunny H; Zhang, Lin; Liu, Xiaodong; Wong, Wai T; Leung, Czarina C H; Choi, Gordon; Wang, Maggie H T; Gin, Tony; Chan, Matthew T V; Wu, William K K

    2016-07-01

    Autophagy is one of the innate immune defense mechanisms against microbial challenges. Previous in vitro and in vivo models of sepsis demonstrated that autophagy was activated initially in sepsis, followed by a subsequent phase of impairment. Autophagy modulation appears to be protective against multiple organ injuries in these murine sepsis models. This is achieved in part by preventing apoptosis, maintaining a balance between the productions of pro- and anti-inflammatory cytokines, and preserving mitochondrial functions. This article aims to discuss the role of autophagy in sepsis and the therapeutic potential of autophagy enhancers.

  4. Sepsis management in the deployed field hospital.

    PubMed

    Johnston, Andrew McD; Easby, D; Ewington, I

    2013-09-01

    Sepsis, a syndrome caused by severe infection, affects a small proportion of military casualties but has a significant effect in increasing morbidity and mortality, including causing some preventable deaths. Casualties with abdominal trauma and those with significant tissue loss appear to be at a greater risk of sepsis. In this article, the diagnosis and management of sepsis in military casualties with reference to the Surviving Sepsis Campaign guidelines are examined. We discuss the management considerations specific to military casualties in the deployed setting and also discuss factors affecting evacuation by the UK Royal Air Force Critical Care Air Support Team.

  5. Perinatal loss, trauma, and dream reports.

    PubMed

    Kroth, Jerry; Garcia, Marylynne; Hallgren, Michelle; LeGrue, Emilyann; Ross, Maureen; Scalise, Juliana

    2004-06-01

    This study investigated correlations among dream characteristics and measures of trauma and perinatal bereavement as reported by women who have experienced perinatal loss. 37 women who had experienced perinatal loss were randomly selected from a perinatal support group and administered the Impact of Event Scale, the Perinatal Grief Scale, and the KJP Dream Inventory. Scores on the Impact of Events Scale (IES) correlated with Emotional Pain (.41), Despair (.37), Dreams of Death (.31), Dreams of Water (-.29), and Dreams of Being Famous (-.36). Subjects who reported higher Social Support and Emotional Expressiveness throughout their trauma showed lower scores on IES Total scores (-.52), Despair (-.62), and reported dreaming more in color (.41). Results are discussed in terms of the hypothesized role dreams may play in the grief-recovery process. PMID:15217043

  6. Perinatal Safety: From Concept to Nursing Practice

    PubMed Central

    Kennedy, Holly Powell

    2010-01-01

    Communication and teamwork problems are leading causes of documented preventable adverse outcomes in perinatal care. An essential component of perinatal safety is the organizational culture in which clinicians work. Clinicians’ individual and collective authority to question the plan of care and take action to change the direction of a clinical situation in the patient’s best interest can be viewed as their “agency for safety.” However, collective agency for safety and commitment to support nurses in their advocacy role is missing in many perinatal care settings. This paper draws from Organizational Accident Theory, High Reliability Theory, and Symbolic Interactionism to describe the nurse’s role in maintaining safety during labor and birth in acute care settings, and suggests actions for supporting the perinatal nurse at individual, group, and systems levels to achieve maximum safety in perinatal care. PMID:20147827

  7. A literature review on integrated perinatal care

    PubMed Central

    Rodríguez, Charo; des Rivières-Pigeon, Catherine

    2007-01-01

    Context The perinatal period is one during which health care services are in high demand. Like other health care sub-sectors, perinatal health care delivery has undergone significant changes in recent years, such as the integrative wave that has swept through the health care industry since the early 1990s. Purpose The present study aims at reviewing scholarly work on integrated perinatal care to provide support for policy decision-making. Results Researchers interested in integrated perinatal care have, by assessing the effectiveness of individual clinical practices and intervention programs, mainly addressed issues of continuity of care and clinical and professional integration. Conclusions Improvements in perinatal health care delivery appear related not to structurally integrated health care delivery systems, but to organizing modalities that aim to support woman-centred care and cooperative clinical practice. PMID:17786177

  8. Pop tests of storable biopropellant liquid apogee engine

    NASA Astrophysics Data System (ADS)

    Kuroda, Yukio; Tadano, Makoto; Sato, Masahiro; Kusaka, Kazuo; Kobayashi, Hideyuki; Iihara, Sigeyasu; Ban, Hiroyuki

    1994-10-01

    A pressure-fed, blowdown, hydrazine/NTO apogee propulsion system had been selected for the ETS-6. One of the problems encountered during the development of the engine was the occurrence of pops (popping) at the higher operating chamber pressures. Pops are irregular high amplitude pressure pulses. It is generally agreed that pops is a liquid spray/gas two-phase explosion triggered by a local explosion near the jet impingement region. The effects of operating parameters on pops observed in the development tests of the apogee engine for the ETS-6 were inconsistent with those reported earlier for single impingement injectors; pops with the apogee engine injectors was more likely to occur at higher chamber pressures, higher injection velocities, and higher propellant temperatures. Pops data were correlated fairly well in chamber pressures (bar-P(sub c)) vs. fuel Reynolds number (R(sub ef)) plane. However, the range of operating parameters for the above correlation were very narrow since they were obtained during injector screening tests for a particular application to the apogee engine. It was also felt that the above correlation was too simplistic to capture any effect of design parameters of multi-element injectors. In the present study, the demarcation between pops and the pops-free region was determined in broader operating ranges and design parameters. The range of bar-P(sub c) and R(sub ef) was extended by exchanging graphite nozzle throat inserts with different throat diameters. The injectors were carefully selected to obtain effects, if any, of (1) film cooling fraction, (2) secondary mixing, and (3) number of elements and/or fuel orifice diameters. It was found that there was a threshold fuel Reynolds number below which no pops were observed at any chamber pressures and that the pops region curve in the bar-P(sub c)-R(sub ef) plane had two branches: upper branches and lower branches.

  9. Phase Mixing of Popped Star Clusters

    NASA Astrophysics Data System (ADS)

    Candlish, G. N.; Smith, R.; Fellhauer, M.; Gibson, B. K.; Kroupa, P.; Assmann, P.

    2014-10-01

    As star clusters are expected to form with low star formation efficiencies, the gas in the cluster is expelled quickly and early in their development: the star cluster pops. This leads to an unbound stellar system. Previous N-body simulations have demonstrated the existence of a stepped number density distribution of cluster stars after popping, both in vertical position and vertical velocity, with a passing resemblance to a Christmas tree. Using numerical and analytical methods, we investigate the source of this structure, which arises due to the phase mixing of the out-of-equilibrium stellar system as it evolves in a background analytical potential. Considering only the vertical motions, we construct a theoretical model to describe the time evolution of the phase space distribution of stars in a Miyamoto-Nagai disk potential and a full Milky-Way type potential comprising bulge, halo and disk components, which is then compared with N- body simulations. Using our theoretical model, we investigate the possible observational signatures and the feasibility of detection.

  10. Current issues in perinatal epidemiology.

    PubMed Central

    Berendes, H. W.

    1987-01-01

    The main national data sources for perinatal epidemiology are birth and death certificates, yet routinely linked birth and death certificate data are still not available in the U.S. Completeness and quality of the reporting of perinatal events should be considered in examining trends over time and between jurisdictions. The U.S. has experienced a marked decline in its infant mortality rate, but only a very modest decline in the rate of low birth weight. Research must focus more on studies of pre-term labor, rather than low birth weight, which include children who are underground or who are born too early and who, therefore, may represent different etiologies. Sensitive hormonal tests may provide more precise estimates of the rate of very early fetal loss. Management of labor and delivery and of the high-risk newborn have undergone marked changes during the last 15 years, and yet clinical trials have not played a major role in the evaluation of these changes. The difference in reproductive outcomes between whites and blacks, especially in the rate of low birth weight, have persisted and are not understood. Data bases are becoming available for intergenerational studies to determine whether nature or nurture accounts for this difference. PMID:3660860

  11. Climate change and environmental concentrations of POPs: A review.

    PubMed

    Nadal, Martí; Marquès, Montse; Mari, Montse; Domingo, José L

    2015-11-01

    In recent years, the climate change impact on the concentrations of persistent organic pollutants (POPs) has become a topic of notable concern. Changes in environmental conditions such as the increase of the average temperature, or the UV-B radiation, are likely to influence the fate and behavior of POPs, ultimately affecting human exposure. The state of the art of the impact of climate change on environmental concentrations of POPs, as well as on human health risks, is here reviewed. Research gaps are also identified, while future studies are suggested. Climate change and POPs are a hot issue, for which wide attention should be paid not only by scientists, but also and mainly by policy makers. Most studies reported in the scientific literature are focused on legacy POPs, mainly polychlorinated dibenzo-p-dioxins and dibenzofurans (PCDD/Fs), polychlorinated biphenyls (PCBs) and pesticides. However, the number of investigations aimed at estimating the impact of climate change on the environmental levels of polycyclic aromatic hydrocarbons (PAHs) is scarce, despite of the fact that exposure to PAHs and photodegradation byproducts may result in adverse health effects. Furthermore, no data on emerging POPs are currently available in the scientific literature. In consequence, an intensification of studies to identify and mitigate the indirect effects of the climate change on POP fate is needed to minimize the human health impact. Furthermore, being this a global problem, interactions between climate change and POPs must be addressed from an international perspective. PMID:26496851

  12. Climate change and environmental concentrations of POPs: A review.

    PubMed

    Nadal, Martí; Marquès, Montse; Mari, Montse; Domingo, José L

    2015-11-01

    In recent years, the climate change impact on the concentrations of persistent organic pollutants (POPs) has become a topic of notable concern. Changes in environmental conditions such as the increase of the average temperature, or the UV-B radiation, are likely to influence the fate and behavior of POPs, ultimately affecting human exposure. The state of the art of the impact of climate change on environmental concentrations of POPs, as well as on human health risks, is here reviewed. Research gaps are also identified, while future studies are suggested. Climate change and POPs are a hot issue, for which wide attention should be paid not only by scientists, but also and mainly by policy makers. Most studies reported in the scientific literature are focused on legacy POPs, mainly polychlorinated dibenzo-p-dioxins and dibenzofurans (PCDD/Fs), polychlorinated biphenyls (PCBs) and pesticides. However, the number of investigations aimed at estimating the impact of climate change on the environmental levels of polycyclic aromatic hydrocarbons (PAHs) is scarce, despite of the fact that exposure to PAHs and photodegradation byproducts may result in adverse health effects. Furthermore, no data on emerging POPs are currently available in the scientific literature. In consequence, an intensification of studies to identify and mitigate the indirect effects of the climate change on POP fate is needed to minimize the human health impact. Furthermore, being this a global problem, interactions between climate change and POPs must be addressed from an international perspective.

  13. Terrestrial mosses as biomonitors of atmospheric POPs pollution: a review.

    PubMed

    Harmens, H; Foan, L; Simon, V; Mills, G

    2013-02-01

    Worldwide there is concern about the continuing release of persistent organic pollutants (POPs) into the environment. In this study we review the application of mosses as biomonitors of atmospheric deposition of POPs. Examples in the literature show that mosses are suitable organisms to monitor spatial patterns and temporal trends of atmospheric concentrations or deposition of POPs. These examples include polycyclic aromatic hydrocarbons (PAHs), polychlorobiphenyls (PCBs), dioxins and furans (PCDD/Fs), and polybrominated diphenyl ethers (PBDEs). The majority of studies report on PAHs concentrations in mosses and relative few studies have been conducted on other POPs. So far, many studies have focused on spatial patterns around pollution sources or the concentration in mosses in remote areas such as the polar regions, as an indication of long-range transport of POPs. Very few studies have determined temporal trends or have directly related the concentrations in mosses with measured atmospheric concentrations and/or deposition fluxes.

  14. Improving the Odds of Surviving Sepsis

    MedlinePlus

    ... Improving the Odds of Surviving Sepsis Inside Life Science View All Articles | Inside Life Science Home Page Improving the Odds of Surviving Sepsis ... Threatening Bacterial Infection Remains Mysterious This Inside Life Science article also appears on LiveScience . Learn about related ...

  15. Estrogen sulfotransferase ablation sensitizes mice to sepsis

    PubMed Central

    Chai, Xiaojuan; Guo, Yan; Jiang, Mengxi; Hu, Bingfang; Li, Zhigang; Fan, Jie; Deng, Meihong; Billiar, Timothy R.; Kucera, Heidi; Gaikwad, Nilesh W.; Xu, Meishu; Lu, Peipei; Yan, Jiong; Fu, Haiyan; Liu, Youhua; Yu, Lushan; Huang, Min; Zeng, Su; Xie, Wen

    2015-01-01

    Sepsis is the host's deleterious systemic inflammatory response to microbial infections. Here we report an essential role for the estrogen sulfotransferase (EST or SULT1E1), a conjugating enzyme that sulfonates and deactivates estrogens, in sepsis response. Both the cecal ligation and puncture (CLP) and lipopolysacharide (LPS) models of sepsis induce the expression of EST and compromise the activity of estrogen, an anti-inflammatory hormone. Surprisingly, EST ablation sensitizes mice to sepsis-induced death. Mechanistically, EST ablation attenuates sepsis-induced inflammatory responses due to compromised estrogen deactivation, leading to increased sepsis lethality. In contrast, transgenic overexpression of EST promotes estrogen deactivation and sensitizes mice to CLP-induced inflammatory response. The induction of EST by sepsis is NF-κB dependent and EST is a NF-κB target gene. The reciprocal regulation of inflammation and EST may represent a yet to be explored mechanism of endocrine regulation of inflammation, which has an impact on the clinical outcome of sepsis. PMID:26259151

  16. Pseudomonas sepsis with Noma: an association?

    PubMed

    Vaidyanathan, S; Tullu, M S; Lahiri, K R; Deshmukh, C T

    2005-08-01

    We report here a 2.5-year-old male child with community-acquired Pseudomonal sepsis showing the characteristic lesions of ecthyma gangrenosum. The child had development of gangrenous changes of the nose and face - the 'cancrum oris' or 'Noma'. We highlight the possible association of Pseudomonas sepsis and Noma, with malnutrition playing a central role in causing both the diseases.

  17. Pelvic sepsis after stapled hemorrhoidopexy

    PubMed Central

    van Wensen, Remco JA; van Leuken, Maarten H; Bosscha, Koop

    2008-01-01

    Stapled hemorrhoidopexy is a surgical procedure used worldwide for the treatment of grade III and IV hemorrhoids in all age groups. However, life-threatening complications occur occasionally. The following case report describes the development of pelvic sepsis after stapled hemorrhoidopexy. A literature review of techniques used to manage major septic complications after stapled hemorrhoidopexy was performed. There is no standardized treatment currently available. Stapled hemorrhoidopexy is a safe, effective and time-efficient procedure in the hands of experienced colorectal surgeons. PMID:18855996

  18. Perinatal Complications and Aging Indicators by Midlife

    PubMed Central

    Caspi, Avshalom; Ambler, Antony; Belsky, Daniel W.; Chapple, Simon; Cohen, Harvey Jay; Israel, Salomon; Poulton, Richie; Ramrakha, Sandhya; Rivera, Christine D.; Sugden, Karen; Williams, Benjamin; Wolke, Dieter; Moffitt, Terrie E.

    2014-01-01

    BACKGROUND: Perinatal complications predict increased risk for morbidity and early mortality. Evidence of perinatal programming of adult mortality raises the question of what mechanisms embed this long-term effect. We tested a hypothesis related to the theory of developmental origins of health and disease: that perinatal complications assessed at birth predict indicators of accelerated aging by midlife. METHODS: Perinatal complications, including both maternal and neonatal complications, were assessed in the Dunedin Multidisciplinary Health and Development Study cohort (N = 1037), a 38-year, prospective longitudinal study of a representative birth cohort. Two aging indicators were assessed at age 38 years, objectively by leukocyte telomere length (TL) and subjectively by perceived facial age. RESULTS: Perinatal complications predicted both leukocyte TL (β = −0.101; 95% confidence interval, −0.169 to −0.033; P = .004) and perceived age (β = 0.097; 95% confidence interval, 0.029 to 0.165; P = .005) by midlife. We repeated analyses with controls for measures of family history and social risk that could predispose to perinatal complications and accelerated aging, and for measures of poor health taken in between birth and the age-38 follow-up. These covariates attenuated, but did not fully explain the associations observed between perinatal complications and aging indicators. CONCLUSIONS: Our findings provide support for early-life developmental programming by linking newborns’ perinatal complications to accelerated aging at midlife. We observed indications of accelerated aging “inside,” as measured by leukocyte TL, an indicator of cellular aging, and “outside,” as measured by perceived age, an indicator of declining tissue integrity. A better understanding of mechanisms underlying perinatal programming of adult aging is needed. PMID:25349321

  19. Sepsis-induced acute kidney injury.

    PubMed

    Majumdar, Arghya

    2010-01-01

    Acute kidney injury (AKI) is a common sequel of sepsis in the intensive care unit. It is being suggested that sepsis-induced AKI may have a distinct pathophysiology and identity. Availability of biomarkers now enable us to detect AKI as early as four hours after it's inception and may even help us to delineate sepsis-induced AKI. Protective strategies such as preferential use of vasopressin or prevention of intra-abdominal hypertension may help, in addition to the other global management strategies of sepsis. Pharmacologic interventions have had limited success, may be due to their delayed usage. Newer developments in extracorporeal blood purification techniques may proffer effects beyond simple replacement of renal function, such as metabolic functions of the kidney or modulation of the sepsis cascade.

  20. Sepsis-associated encephalopathy: not just delirium

    PubMed Central

    Zampieri, Fernando Godinho; Park, Marcelo; Machado, Fabio Santana; Azevedo, Luciano Cesar Pontes

    2011-01-01

    Sepsis is a major cause of mortality and morbidity in intensive care units. Organ dysfunction is triggered by inflammatory insults and tissue hypoperfusion. The brain plays a pivotal role in sepsis, acting as both a mediator of the immune response and a target for the pathologic process. The measurement of brain dysfunction is difficult because there are no specific biomarkers of neuronal injury, and bedside evaluation of cognitive performance is difficult in an intensive care unit. Although sepsis-associated encephalopathy was described decades ago, it has only recently been subjected to scientific scrutiny and is not yet completely understood. The pathophysiology of sepsis-associated encephalopathy involves direct cellular damage to the brain, mitochondrial and endothelial dysfunction and disturbances in neurotransmission. This review describes the most recent findings in the pathophysiology, diagnosis, and management of sepsis-associated encephalopathy and focuses on its many presentations. PMID:22012058

  1. Sepsis Induced by Cecal Ligation and Puncture

    PubMed Central

    Wen, Haitao

    2014-01-01

    Summary Despite advances in intensive care unit interventions, including the use of specific antibiotics and anti-inflammation treatment, sepsis with concomitant multiple organ failure is the most common cause of death in many acute care units. In order to understand the mechanisms of clinical sepsis and develop effective therapeutic modalities, there is a need to use effective experimental models that faithfully replicate what occurs in patients with sepsis. Several models are commonly used to study sepsis, including intravenous endotoxin challenge, injection of live organisms into the peritoneal cavity, establishing abscesses in the extremities, and the induction of polymicrobial peritonitis via cecal ligation and puncture (CLP). Here, we describe the surgery procedure of CLP in mice, which has been proposed to closely replicate the nature and course of clinical sepsis in humans. PMID:23824895

  2. Hemostasis and endothelial damage during sepsis.

    PubMed

    Johansen, Maria Egede

    2015-08-01

    The sepsis syndrome represents a disease continuum, including severe sepsis and septic shock associated with high mortality. One of the main problems in severe sepsis and septic shock, resulting in organ failure and death, are disturbances in the hemostasis due to sepsis-related coagulopathy. Sepsis-related coagulopathy affects not only traditional coagulation factors, but also the platelets and endothelium. Functional testing of the hemostatic system has found application in critical illness. Thrombelastography (TEG) provides an overview of the hemostatic system allowing for an evaluation of interactions between coagulation factors and platelets. Additionally, the role of the endothelium during sepsis can be explored through testing of biomarkers of endothelial damage. The three studies comprising this PhD thesis all investigate important aspects of the disturbed hemostasis during sepsis, including endothelial damage. Together, the specific findings from the three studies improve the existing understanding of sepsis-related coagulopathy, and the possible influences of some of the treatments offered these patients. The first study investigates the occurrence of antimicrobial-induced thrombocytopenia among critically ill patients. In sepsis, thrombocytopenia is a predictor of poor outcome, and reports, of mainly casuistic nature, have previously hypothesized that specific antimicrobial agents could induce in sepsis-related thrombocytopenia. This hypothesis was tested using a randomized designed set-up, encompassing 1147 critically ill patients, and no significant difference in risk of thrombocytopenia was observed among patients receiving large amounts of antimicrobials vs. patients receiving standard-of-care. As a consequence, the risk of antimicrobial-induced thrombocytopenia in the general population of critically ill patients seemingly does not represent a substantial problem and thrombocytopenia during critical illness is most likely due to other factors such

  3. Use of early biomarkers in neonatal brain damage and sepsis: state of the art and future perspectives.

    PubMed

    Bersani, Iliana; Auriti, Cinzia; Ronchetti, Maria Paola; Prencipe, Giusi; Gazzolo, Diego; Dotta, Andrea

    2015-01-01

    The identification of early noninvasive biochemical markers of disease is a crucial issue of the current scientific research, particularly during the first period of life, since it could provide useful and precocious diagnostic information when clinical and radiological signs are still silent. The ideal biomarker should be practical and sensitive in the precocious identification of at risk patients. An earlier diagnosis may lead to a larger therapeutic window and improve neonatal outcome. Brain damage and sepsis are common causes of severe morbidity with poor outcome and mortality during the perinatal period. A large number of potential biomarkers, including neuroproteins, calcium binding proteins, enzymes, oxidative stress markers, vasoactive agents, and inflammatory mediators, have been so far investigated. The aim of the present review was to provide a brief overview of some of the more commonly investigated biomarkers used in case of neonatal brain damage and sepsis.

  4. PERISCOPE POP-IN BEAM MONITOR.

    SciTech Connect

    JOHNSON,E.D.

    1998-05-07

    We have built monitors for use as beam diagnostics in the narrow gap of an undulator for an FEL experiment. They utilize an intercepting screen of doped YAG scintillating crystal to make light that is imaged through a periscope by conventional video equipment. The absolute position can be ascertained by comparing the electron beam position with the position of a He:Ne laser that is observed by this pop-in monitor. The optical properties of the periscope and the mechanical arrangement of the system mean that beam can be spatially determined to the resolution of the camera, in this case approximately 10 micrometers. Our experience with these monitors suggests improvements for successor designs, which we also describe.

  5. Periscope pop-in beam monitor

    SciTech Connect

    Johnson, E.D.; Graves, W.S.; Robinson, K.E.

    1998-06-01

    The authors have built monitors for use as beam diagnostics in the narrow gap of an undulator for an FEL experiment. They utilize an intercepting screen of doped YAG scintillating crystal to make light that is imaged through a periscope by conventional video equipment. The absolute position can be ascertained by comparing the electron beam position with the position of a He:Ne laser that is observed by this pop-in monitor. The optical properties of the periscope and the mechanical arrangement of the system mean that beam can be spatially determined to the resolution of the camera, in this case approximately 10 micrometers. The experience with these monitors suggests improvements for successor designs, which they also describe.

  6. Five additions to the list of Sepsidae Diptera for Vietnam: Perochaeta cuirassa sp. n., Perochaeta lobo sp. n., Sepsis spura sp. n., Sepsis sepsi Ozerov, 2003 and Sepsis monostigma Thompson, 1869

    PubMed Central

    Ang, Yuchen; Meier, Rudolf

    2010-01-01

    Abstract A recent collecting trip to Vietnam yielded three new species and two new records of Sepsidae (Diptera) for the country. Here we describe two new species in the species-poor genus Perochaeta (Perochaeta cuirassa sp. n. andPerochaeta lobo sp. n.) and one to the largest sepsid genus Sepsis (Sepsis spura sp. n.) which is also found in Sumatra and Sulawesi. Two additional Sepsis species are new records for Vietnam (Sepsis sepsi Ozerov, 2003; Sepsis monostigma Thompson, 1869). We conclude with a discussion of the distribution of Perochaeta and the three Sepsis species. PMID:21594042

  7. The Surviving Sepsis Campaign: past, present and future.

    PubMed

    Schorr, Christa A; Dellinger, R Phillip

    2014-04-01

    The Surviving Sepsis Campaign (SSC) was created in 2002 and consists of severe sepsis management guidelines and a sepsis performance improvement program. The second revision of the guidelines, published in 2013, are sponsored by 30 international scientific organizations and contain changes in recommendations for fluids and vasopressor administration. The new 3- and 6-hour sepsis 'bundles' (sets of care elements) include a software program that can be downloaded free from the Surviving Sepsis Campaign website (www.survivingsepsis.org). The traditional intensive care unit and emergency department champion-driven sepsis performance improvement program continues internationally with the kick off of a new grant-funded hospital floor sepsis performance improvement initiative.

  8. Genetic and perinatal effects of abused substances

    SciTech Connect

    Brande, M.C.; Zimmerman, A.M.

    1987-01-01

    This book provides an overview of the effects of several abused drugs, including opiates, cannabinoids, alcohol, nicotine, and cocaine, with special emphasis on the actions of these substances at the molecular and cellular levels. The first half deals with genetic effects, including molecular genetics, biochemical genetics, pharmacogenetics, cytogenetics, and genetic toxicity. The second half focuses on perinatal effects and covers: drug abuse during pregnancy; biochemical aspects of marihuana on male reproduction; and long-term behavioral and neuroendocrine effects of perinatal alcohol exposure.

  9. The role of platelets in sepsis.

    PubMed

    de Stoppelaar, Sacha F; van 't Veer, Cornelis; van der Poll, Tom

    2014-10-01

    Platelets are small circulating anucleate cells that are of crucial importance in haemostasis. Over the last decade, it has become increasingly clear that platelets play an important role in inflammation and can influence both innate and adaptive immunity. Sepsis is a potentially lethal condition caused by detrimental host response to an invading pathogen. Dysbalanced immune response and activation of the coagulation system during sepsis are fundamental events leading to sepsis complications and organ failure. Platelets, being major effector cells in both haemostasis and inflammation, are involved in sepsis pathogenesis and contribute to sepsis complications. Platelets catalyse the development of hyperinflammation, disseminated intravascular coagulation and microthrombosis, and subsequently contribute to multiple organ failure. Inappropriate accumulation and activity of platelets are key events in the development of sepsis-related complications such as acute lung injury and acute kidney injury. Platelet activation readouts could serve as biomarkers for early sepsis recognition; inhibition of platelets in septic patients seems like an important target for immune-modulating therapy and appears promising based on animal models and retrospective human studies. PMID:24966015

  10. The role of platelets in sepsis.

    PubMed

    de Stoppelaar, Sacha F; van 't Veer, Cornelis; van der Poll, Tom

    2014-10-01

    Platelets are small circulating anucleate cells that are of crucial importance in haemostasis. Over the last decade, it has become increasingly clear that platelets play an important role in inflammation and can influence both innate and adaptive immunity. Sepsis is a potentially lethal condition caused by detrimental host response to an invading pathogen. Dysbalanced immune response and activation of the coagulation system during sepsis are fundamental events leading to sepsis complications and organ failure. Platelets, being major effector cells in both haemostasis and inflammation, are involved in sepsis pathogenesis and contribute to sepsis complications. Platelets catalyse the development of hyperinflammation, disseminated intravascular coagulation and microthrombosis, and subsequently contribute to multiple organ failure. Inappropriate accumulation and activity of platelets are key events in the development of sepsis-related complications such as acute lung injury and acute kidney injury. Platelet activation readouts could serve as biomarkers for early sepsis recognition; inhibition of platelets in septic patients seems like an important target for immune-modulating therapy and appears promising based on animal models and retrospective human studies.

  11. Sepsis

    MedlinePlus

    ... fluids are given through a vein. Other medical treatments include: Medicines that increase blood pressure Dialysis if there is kidney failure A breathing machine ( mechanical ventilation ) if there is lung failure

  12. Sepsis

    MedlinePlus

    ... 100.4°F [38°C] and above rectal temperature) in newborns and young infants labored or unusual breathing change in skin color (paler than usual or mildly bluish) or a rash listlessness or lethargy change in the sound of the baby's cry or excessive crying change ...

  13. The Effects of Popping Popcorn Under Reduced Pressure

    NASA Astrophysics Data System (ADS)

    Quinn, Paul; Cooper, Amanda

    2008-03-01

    In our experiments, we model the popping of popcorn as an adiabatic process and develop a process for improving the efficiency of popcorn production. By lowering the pressure of the popcorn during the popping process, we induce an increase in popcorn size, while decreasing the number of remaining unpopped kernels. In this project we run numerous experiments using three of the most common popping devices, a movie popcorn maker, a stove pot, and a microwave. We specifically examine the effects of varying the pressure on total sample size, flake size and waste. An empirical relationship is found between these variables and the pressure.

  14. Diagnostic Value of Presepsin for Sepsis

    PubMed Central

    Zhang, Jing; Hu, Zhi-De; Song, Jia; Shao, Jiang

    2015-01-01

    Abstract Several individual studies have reported the diagnostic accuracy of presepsin (sCD14-ST) for sepsis, but the results are inconsistent. The present systematic review and meta-analysis pooled data to better ascertain the value of circulatory presepsin as a biomarker for sepsis. Studies published in English before November 7, 2014 and assessing the diagnostic accuracy of presepsin for sepsis were retrieved from medical databases. The quality of eligible studies was assessed using a revised Quality Assessment for Studies of Diagnostic Accuracy (QUADAS-2). The overall diagnostic accuracy of presepsin for sepsis was pooled according to a bivariate model. Publication bias was assessed using Deek funnel plot asymmetry test. Eleven studies satisfied the inclusion criteria. The overall diagnostic sensitivity of presepsin for sepsis was 0.83 (95% CI: 0.77–0.88), and specificity was 0.78 (95% CI: 0.72–0.83). The area under the summary receiver operating characteristic curve was 0.88 (95% CI: 0.84–0.90). The pretest probability of sepsis was 0.56 among all subjects. When presepsin was introduced as the diagnostic test for sepsis, the posttest probabilities were 0.81 for a positive result and 0.19 for a negative. The major design deficits of the included studies were lack of prespecified thresholds and patient selection bias. The publication bias was negative. Presepsin is an effective adjunct biomarker for the diagnosis of sepsis, but is insufficient to detect or rule out sepsis when used alone. PMID:26632748

  15. Recurrent perinatal loss: a case study.

    PubMed

    Kavanaugh, K; Robertson, P A

    1999-01-01

    To date, investigators have not demonstrated a clear relationship between a parent's history of prior perinatal losses and intensity of grief response following a subsequent perinatal loss. Examining this relationship for low-income, African-American parents is important because they are a vulnerable population due to the high incidence of perinatal mortality in Blacks and their other life stressors that can impact on grief response and caring needs. The purpose of this case study was to examine the impact of recurrent perinatal loss on a low-income African-American parent. The research design for this study was case report, using interview data collected from a mother who had recently experienced her fourth perinatal loss, which occurred at twenty-five weeks of gestation. Transcripts from two open-ended interviews were analyzed. The theoretical framework used to guide analysis of this case study was Lazarus and Folkman's stress and coping theory. Results demonstrated that the prior perinatal losses did not appear as critical components of the way the mother responded to her most recent loss. Instead, perception of the care she received from healthcare providers and how that care related to her experiences with her one living child who was born at the same gestational age was an important determinant in how she responded to her loss. The results of this case study demonstrate the importance assessing a person's perception of their experience and those factors which contribute to the way they respond.

  16. Physiologically based pharmacokinetic modeling of POPs in Greenlanders.

    PubMed

    Sonne, Christian; Gustavson, Kim; Rigét, Frank F; Dietz, Rune; Krüger, Tanja; Bonefeld-Jørgensen, Eva C

    2014-03-01

    Human exposure to persistent organic pollutants (POPs) and the potential health impact in the Arctic far from the emission sources have been highlighted in numerous studies. As a supplement to human POP biomonitoring studies, a physiologically based pharmacokinetic (PBPK) model was set up to estimate the fate of POPs in Greenlandic Inuit's liver, blood, muscle and adipose tissue following long-term exposure to traditional Greenlandic diet. The PBPK model described metabolism, excretion and POP accumulation on the basis of their physicochemical properties and metabolic rates in the organisms. Basic correlations between chemically analyzed blood POP concentrations and calculated daily POP intake from food questionnaire of 118 middle age (18-35years) Greenlandic Inuits from four cities in West Greenland (Qaanaaq: n=40; Qeqertarsuaq: n=36; Nuuk: n=20; Narsaq: n=22) taken during 2003 to 2006 were analyzed. The dietary items included were polar bear, caribou, musk oxen, several marine species such as whales, seals, bird and fish as well as imported food. The contaminant concentrations of the dietary items as well as their chemical properties, uptake, biotransformation and excretion allowed us to estimate the POP concentration in liver, blood, muscle and adipose tissue following long-term exposure to the traditional Greenlandic diet using the PBPK model. Significant correlations were found between chemically analyzed POP blood concentrations and calculated daily intake of POPs for Qeqertarsuaq, Nuuk and Narsaq Inuit but not for the northernmost settlement Qaanaaq, probably because the highest blood POP level was found in this district which might mask the interview-based POP calculations. Despite the large variation in circulating blood POP concentrations, the PBPK model predicted blood concentrations of a factor 2-3 within the actual measured values. Moreover, the PBPK model showed that estimated blood POP concentration increased significantly after consumption of meals

  17. Dysglycemia and Glucose Control During Sepsis.

    PubMed

    Plummer, Mark P; Deane, Adam M

    2016-06-01

    Sepsis predisposes to disordered metabolism and dysglycemia; the latter is a broad term that includes hyperglycemia, hypoglycemia, and glycemic variability. Dysglycemia is a marker of illness severity. Large randomized controlled trials have provided considerable insight into the optimal blood glucose targets for critically ill patients with sepsis. However, it may be that the pathophysiologic consequences of dysglycemia are dynamic throughout the course of a septic insult and also altered by premorbid glycemia. This review highlights the relevance of hyperglycemia, hypoglycemia, and glycemic variability in patients with sepsis with an emphasis on a rational approach to management. PMID:27229647

  18. Management of neonatal sepsis in term newborns

    PubMed Central

    Du Pont-Thibodeau, Geneviève; Joyal, Jean-Sébastien

    2014-01-01

    Neonatal sepsis is a common and deadly disease. It is broadly defined as a systemic inflammatory response, occurring in the first four weeks of life, as a result of a suspected or proven infection. Yet, more reliable and consistently applied diagnostic criteria would help improve our knowledge of the disease epidemiology. Several therapeutic attempts to control systemic inflammation in sepsis were unsuccessful. Immediate empirical administration of broad-spectrum anti-microbials, aggressive fluid resuscitation, and vaso-active or inotropic support (or both) are the mainstays of the therapeutic management of neonatal sepsis. PMID:25165566

  19. Morganella morganii sepsis with massive hemolysis.

    PubMed

    Kim, Jong Hoon; Cho, Chong Rae; Um, Tae Hyun; Rhu, Ji Yoon; Kim, Eu Suk; Jeong, Jae Won; Lee, Hye Ran

    2007-12-01

    Morganella morganii is a facultative gram-negative and anaerobic rod. It may be a cause of devastating infections in neonates and immunocompromised hosts. Some bacterial infections such as Clostridium and Vibrio are associated with hemolysis. However, massive hemolysis caused by M. morganii sepsis has not yet been reported. We observed a 59-yr-old man who had chemotherapy-induced neutropenia and was found to have massive hemolysis and metabolic acidosis due to sepsis. He died 6 hr after admission in spite of aggressive treatment. Two sets of blood cultures revealed the growth of M. morganii. We report here that M. morganii sepsis can cause fatal massive hemolysis leading to death.

  20. Sepsis Resuscitation: Fluid Choice and Dose.

    PubMed

    Semler, Matthew W; Rice, Todd W

    2016-06-01

    Sepsis is a common and life-threatening inflammatory response to severe infection treated with antibiotics and fluid resuscitation. Despite the central role of intravenous fluid in sepsis management, fundamental questions regarding which fluid and in what amount remain unanswered. Recent advances in understanding the physiologic response to fluid administration, and large clinical studies examining resuscitation strategies, fluid balance after resuscitation, colloid versus crystalloid solutions, and high- versus low-chloride crystalloids, inform the current approach to sepsis fluid management and suggest areas for future research.

  1. Pop-Up Constructions Motivate and Reinforce Science Learning for Upper Elementary Students

    ERIC Educational Resources Information Center

    Olsen, Benjamin D.; Zhbanova, Ksenia S.; Parpucu, Harun; Alkouri, Zaid; Rule, Audrey C.

    2013-01-01

    Pop-up boxes and folder constructions support student inquiry while integrating art, craft, spatial, and creativity skills. Step-by-step illustrated directions for constructing pop-up boxes are provided with example images of pop-up boxes focused on ecological issues. Teachers used these pop-up constructions to assist fourth- and fifth-grade…

  2. Sepsis, venous return, and teleology.

    PubMed

    McNeilly, R G

    2014-11-01

    An understanding of heart-circulation interaction is crucial to our ability to guide our patients through an episode of septic shock. Our knowledge has advanced greatly in the last one hundred years. There are, however, certain empirical phenomena that may lead us to question the wisdom of our prevailing treatment algorithm. Three extreme but iatrogenically possible haemodynamic states exist. Firstly, inappropriately low venous return; secondly, overzealous arteriolar constriction; and finally, misguided inotropy and chronotropy. Following an unsuccessful fluid challenge, it would be logical to first set the venous tone, then set the cardiac rate and contractility, and finally set the peripheral vascular resistance. It is hypothesized that a combination of dihydroergotamine, milrinone and esmolol should be superior to a combination of noradrenaline and dobutamine for surviving sepsis. PMID:25245463

  3. [Maternal mortality and perinatal mortality].

    PubMed

    Boutaleb, Y; Mesbahi, M; Lahlou, D; Aderdour, M

    1982-01-01

    94 maternal deaths and 1546 fetal and neonatal deaths were registered among 28,706 births at the CHU Averroes in Casablanca between 1978-80. 45% of women who deliver at the clinic are very poor and only 10% are relatively well off. Obstetrical antecedents were noted in 27% of the fetal deaths. 70% of the maternal deaths occurred in women aged 20-34. 32 maternal deaths occurred among 16,232 women with 1-2 children, 30 among 6514 women with 3-5 children, and 32 among 5960 women with 6-14 children. 11,027 of the 28,706 were primaparas. Perinatal mortality was 4.46% among primaparas, 8.24% among grand multiparas, and 4.1% among secondiparas. In 58 of the 94 cases of maternal mortality the woman was hospitalized after attempting delivery at home or in a village clinic. Among women with 1 or 2 children, hemorrhage was the cause of death in 8 cases, infection in 7 cases, eclampsia in 3 cases, thromboembolism in 2 cases, uterine inversion in 2 cases, pulmonary tuberculosis in 1 case, embolism in 5 cases, and other causes 1 case each. Among women with 3-5 children hemorrhage was the cause of death in 10 cases, septicemia in 3 cases, uterine rupture in 3 cases, eclampsia in 3 cases, uterine inversion in 2 cases, viral hepatitis in 2 cases, emboli in 2 cases, and other reasons 1 case each. Among grand multiparas hemorrhage was the cause of death in 11 cases, uterine rupture in 12 cases, peritonitis in 2 cases, eclampsia in 2 cases, emboli in 2 cases, and other causes 1 case each. 19 of the maternal deaths were judged to have been avoidable with better management. Prematurity and birth weight of 1000-2500 g associated or not with other pathology were found in 714 of 1546 perinatal deaths. Of 390 cases of death in utero with retention and maceration, 68 were caused by reno-vascular syndromes, 76 by maternal infections, 33 by maternal syphilis, 26 by fetal malformation, 18 by maternal diabetes, 10 by Rh incompatability, and 159 by indeterminate causes. In 795 cases of

  4. A prospective treatment for sepsis.

    PubMed

    Shahidi Bonjar, Mohammad Rashid; Shahidi Bonjar, Leyla

    2015-01-01

    The present paper proposes a prospective auxiliary treatment for sepsis. There exists no record in the published media on the subject. As an auxiliary therapy, efficacious extracorporeal removal of sepsis-causing bacterial antigens and their toxins (BATs) from the blood of septic patients is discussed. The principal component to this approach is a bacterial polyvalent antibody-column (BPVAC), which selectively traps wide spectrum of BATs from blood in an extracorporeal circuit, and detoxified blood returns back to the patient's body. BPVAC treatment would be a device of targeted medicine. Detoxification is performed under supervision of trained personnel using simple blood-circulating machines in which blood circulates from the patient to BPVAC and back to the patient aseptically. BPVACs' reactive sites consist of carbon nanotubes on which a vast spectra of polyvalent BATs-antibodies are bond to. The devise acts as a biological filter that selectively immobilizes harmful BATs from intoxicated blood; however, no dialysis is involved. For effective neutralization, BPVAC provides large contact surface area with blood. BPVAC approach would have advantages of: 1) urgent neutralization of notorious BATs from blood of septic patients; 2) applicability in parallel with conventional treatments; 3) potential to minimize side effects of the malady; 4) applicability for a vast range of BATs; 5) potential to eliminate contact of BATs with internal tissues and organs; 6) tolerability by patients sensitive to antiserum injections; 7) capability for universal application; 8) affectivity when antibiotic-resistant bacteria are involved and the physician has no or limited access to appropriate antibiotics; and 10) being a single-use, disposable, and stand-alone device. Before using it for clinical trials in human beings, it should pass animal evaluations accurately; however, research works should optimize its implementation in human beings. For optimization, it needs appropriate

  5. A prospective treatment for sepsis

    PubMed Central

    Shahidi Bonjar, Mohammad Rashid; Shahidi Bonjar, Leyla

    2015-01-01

    The present paper proposes a prospective auxiliary treatment for sepsis. There exists no record in the published media on the subject. As an auxiliary therapy, efficacious extracorporeal removal of sepsis-causing bacterial antigens and their toxins (BATs) from the blood of septic patients is discussed. The principal component to this approach is a bacterial polyvalent antibody-column (BPVAC), which selectively traps wide spectrum of BATs from blood in an extracorporeal circuit, and detoxified blood returns back to the patient’s body. BPVAC treatment would be a device of targeted medicine. Detoxification is performed under supervision of trained personnel using simple blood-circulating machines in which blood circulates from the patient to BPVAC and back to the patient aseptically. BPVACs’ reactive sites consist of carbon nanotubes on which a vast spectra of polyvalent BATs-antibodies are bond to. The devise acts as a biological filter that selectively immobilizes harmful BATs from intoxicated blood; however, no dialysis is involved. For effective neutralization, BPVAC provides large contact surface area with blood. BPVAC approach would have advantages of: 1) urgent neutralization of notorious BATs from blood of septic patients; 2) applicability in parallel with conventional treatments; 3) potential to minimize side effects of the malady; 4) applicability for a vast range of BATs; 5) potential to eliminate contact of BATs with internal tissues and organs; 6) tolerability by patients sensitive to antiserum injections; 7) capability for universal application; 8) affectivity when antibiotic-resistant bacteria are involved and the physician has no or limited access to appropriate antibiotics; and 10) being a single-use, disposable, and stand-alone device. Before using it for clinical trials in human beings, it should pass animal evaluations accurately; however, research works should optimize its implementation in human beings. For optimization, it needs appropriate

  6. Seeking Sepsis in the Emergency Department- Identifying Barriers to Delivery of the Sepsis 6.

    PubMed

    Bentley, James; Henderson, Susan; Thakore, Shobhan; Donald, Michael; Wang, Weijie

    2016-01-01

    The Sepsis 6 is an internationally accepted management bundle that, when initiated within one hour of identifying sepsis, can reduce morbidity and mortality. This management bundle was advocated by the Scottish Patient Safety Programme as part of its Acute Adult campaign launched in 2008 and adopted by NHS Tayside in 2012. Despite this, the Emergency Department (ED) of Ninewells Hospital, a tertiary referral centre and major teaching hospital in Scotland, was displaying poor success in the Sepsis 6. We therefore set out to improve compliance by evaluating the application of all aspects of the NHS Tayside Sepsis 6 bundle within one hour of ED triage time, to identify what human factors may influence achieving the one hour The Sepsis 6 bundle. This allowed us to tailor a number of specific interventions including educational sessions, regular audit and personal feedback and check list Sepsis 6 sticker. These interventions promoted a steady increase in compliance from an initial rate of 51.0% to 74.3%. The project highlighted that undifferentiated patients create a challenge in initiating the Sepsis 6. Pyrexia is a key human factor-trigger for recognising sepsis with initial nursing assessment being vital in recognition and identifying the best area (resus) of the department to manage severely septic patients. EDs need to recognise these challenges and develop educational and feedback plans for staff and utilise available resources to maximise the Sepsis 6 compliance. PMID:27239303

  7. Seeking Sepsis in the Emergency Department- Identifying Barriers to Delivery of the Sepsis 6

    PubMed Central

    Bentley, James; Henderson, Susan; Thakore, Shobhan; Donald, Michael; Wang, Weijie

    2016-01-01

    The Sepsis 6 is an internationally accepted management bundle that, when initiated within one hour of identifying sepsis, can reduce morbidity and mortality. This management bundle was advocated by the Scottish Patient Safety Programme as part of its Acute Adult campaign launched in 2008 and adopted by NHS Tayside in 2012. Despite this, the Emergency Department (ED) of Ninewells Hospital, a tertiary referral centre and major teaching hospital in Scotland, was displaying poor success in the Sepsis 6. We therefore set out to improve compliance by evaluating the application of all aspects of the NHS Tayside Sepsis 6 bundle within one hour of ED triage time, to identify what human factors may influence achieving the one hour The Sepsis 6 bundle. This allowed us to tailor a number of specific interventions including educational sessions, regular audit and personal feedback and check list Sepsis 6 sticker. These interventions promoted a steady increase in compliance from an initial rate of 51.0% to 74.3%. The project highlighted that undifferentiated patients create a challenge in initiating the Sepsis 6. Pyrexia is a key human factor-trigger for recognising sepsis with initial nursing assessment being vital in recognition and identifying the best area (resus) of the department to manage severely septic patients. EDs need to recognise these challenges and develop educational and feedback plans for staff and utilise available resources to maximise the Sepsis 6 compliance. PMID:27239303

  8. Paradoxical pop-ups: Why are they difficult to catch?

    NASA Astrophysics Data System (ADS)

    McBeath, Michael K.; Nathan, Alan M.; Bahill, A. Terry; Baldwin, David G.

    2008-08-01

    Professional baseball players occasionally find it difficult to gracefully approach seemingly routine pop-ups. We describe a set of towering pop-ups with trajectories that exhibit cusps and loops near the apex. For a normal fly ball the horizontal velocity continuously decreases due to drag caused by air resistance. For pop-ups the Magnus force is larger than the drag force. In these cases the horizontal velocity initially decreases like a normal fly ball, but after the apex, the Magnus force accelerates the horizontal motion. We refer to this class of pop-ups as paradoxical because they appear to misinform the typically robust optical control strategies used by fielders and lead to systematic vacillation in running paths, especially when a trajectory terminates near the fielder. Former major league infielders confirm that our model agrees with their experiences.

  9. Giant pop-ins and amorphization in germanium during indentation

    NASA Astrophysics Data System (ADS)

    Oliver, David J.; Bradby, Jodie E.; Williams, Jim S.; Swain, Michael V.; Munroe, Paul

    2007-02-01

    Sudden excursions of unusually large magnitude (>1 μm), "giant pop-ins," have been observed in the force-displacement curve for high load indentation of crystalline germanium (Ge). A range of techniques including Raman microspectroscopy, focused ion-beam cross sectioning, and transmission electron microscopy, are applied to study this phenomenon. Amorphous material is observed in residual indents following the giant pop-in. The giant pop-in is shown to be a material removal event, triggered by the development of shallow lateral cracks adjacent to the indent. Enhanced depth recovery, or "elbowing," observed in the force-displacement curve following the giant pop-in is explained in terms of a compliant response of plates of material around the indent detached by lateral cracking. The possible causes of amorphization are discussed, and the implications in light of earlier indentation studies of Ge are considered.

  10. RESEARCH ON EMISSIONS AND MITIGATION OF POP'S FROM COMBUSTION SOURCES

    EPA Science Inventory

    Chapter summarizes EPA's research on emissions and control of persistent organic pollutants (POPS) from combustion sources, with emphasis on source characterization and measurement, formation and destruction mechanisms, formation prevention, and flue gas cleaning. Laboratory exp...

  11. Sepsis in Pregnancy: Identification and Management.

    PubMed

    Albright, Catherine M; Mehta, Niharika D; Rouse, Dwight J; Hughes, Brenna L

    2016-01-01

    Sepsis accounts for up to 28% of all maternal deaths. Prompt, appropriate treatment improves maternal and fetal morbidity and mortality. To date, there are no validated tools for identification of sepsis in pregnant women, and tools used in the general population tend to overestimate mortality. Once identified, management of pregnancy-associated sepsis is goal-directed, but because of the lack of studies of sepsis management in pregnancy, it must be assumed that modifications need to be made on the basis of the physiologic changes of pregnancy. Key to management is early fluid resuscitation and early initiation of appropriate antimicrobial therapy directed toward the likely source of infection or, if the source is unknown, empiric broad-spectrum therapy. Efforts directed at identifying the source of infection and appropriate source control measures are critical. Development of an illness severity scoring system and treatment algorithms validated in pregnant women needs to be a research priority.

  12. Perinatal arrhythmias -- diagnosis and treatment.

    PubMed

    Moura, Cláudia; Vieira, António; Guimarães, Hercília; Areias, José Carlos

    2002-01-01

    We did a retrospective analysis of the clinical files of 26 neonates with arrhythmia born during the period between January 1994 and February 1999. Fourteen (53.8%) of the neonates were male and 16 (61.5%) had prenatal diagnosis. Four (15.3%) had associated congenital heart disease. Twenty-one (80.7%) had abnormal rhythm and five (19.2%) had cardiac conduction disorder. Digoxin was the therapy of first choice to restore normal rhythm, used in 66.6% of the patients, followed by adenosine (16.6%) and electrical cardioversion (16.6%). An epicardial pacemaker was used in two of the three neonates with complete atrioventricular (AV) block. One neonate died due to cerebral hemorrhage. All the neonates were discharged in a clinically stable condition and 16 (88.8%) of them were medicated with digoxin. In a follow-up period that varied from 0 to 71 months (mean of 30.8 months), two patients had an episode of supraventricular tachycardia (SVT) after treatment withdrawal. Perinatal arrhythmias, although uncommon, can be life-threatening, and hence we consider our experience with these situations worth presenting.

  13. Hurricane Katrina and perinatal health.

    PubMed

    Harville, Emily W; Xiong, Xu; Buekens, Pierre

    2009-12-01

    We review the literature on the effects of Hurricane Katrina on perinatal health, and providing data from our own research on pregnant and postpartum women. After Katrina, obstetric, prenatal, and neonatal care was compromised in the short term, but increases in adverse birth outcomes such as preterm birth, low birthweight, and maternal complications were mostly limited to highly exposed women. Both pregnant and postpartum women had rates of post-traumatic stress disorder similar to, or lower than, others exposed to Katrina, and rates of depression similar to other pregnant and postpartum populations. Health behaviors, such as smoking and breastfeeding, may have been somewhat negatively affected by the disaster, whereas effects on nutrition were likely associated with limited time, money, and food choices, and indicated by both weight gain and loss. We conclude that, with a few specific exceptions, postdisaster concerns and health outcomes for pregnant and postpartum women were similar to those of other people exposed to Hurricane Katrina. In such situations, disaster planners and researchers should focus on providing care and support for the normal concerns of the peripartum period, such as breastfeeding, depression, and smoking cessation. Contraception needs to be available for those who do not want to become pregnant. Although additional physical and mental health care needs to be provided for the most severely exposed women and their babies, many women are capable of surviving and thriving in postdisaster environments.

  14. PopAlu: population-scale detection of Alu polymorphisms

    PubMed Central

    Qian, Yu; Kehr, Birte

    2015-01-01

    Alu elements are sequences of approximately 300 basepairs that together comprise more than 10% of the human genome. Due to their recent origin in primate evolution some Alu elements are polymorphic in humans, present in some individuals while absent in others. We present PopAlu, a tool to detect polymorphic Alu elements on a population scale from paired-end sequencing data. PopAlu uses read pair distance and orientation as well as split reads to identify the location and precise breakpoints of polymorphic Alus. Genotype calling enables us to differentiate between homozygous and heterozygous carriers, making the output of PopAlu suitable for use in downstream analyses such as genome-wide association studies (GWAS). We show on a simulated dataset that PopAlu calls Alu elements inserted and deleted with respect to a reference genome with high accuracy and high precision. Our analysis of real data of a human trio from the 1000 Genomes Project confirms that PopAlu is able to produce highly accurate genotype calls. To our knowledge, PopAlu is the first tool that identifies polymorphic Alu elements from multiple individuals simultaneously, pinpoints the precise breakpoints and calls genotypes with high accuracy. PMID:26417547

  15. Neonatal infectious diseases: evaluation of neonatal sepsis.

    PubMed

    Camacho-Gonzalez, Andres; Spearman, Paul W; Stoll, Barbara J

    2013-04-01

    Neonatal sepsis remains a feared cause of morbidity and mortality in the neonatal period. Maternal, neonatal, and environmental factors are associated with risk of infection, and a combination of prevention strategies, judicious neonatal evaluation, and early initiation of therapy are required to prevent adverse outcomes. This article reviews recent trends in epidemiology and provides an update on risk factors, diagnostic methods, and management of neonatal sepsis.

  16. Sepsis: From Pathophysiology to Individualized Patient Care

    PubMed Central

    László, Ildikó; Trásy, Domonkos; Molnár, Zsolt; Fazakas, János

    2015-01-01

    Sepsis has become a major health economic issue, with more patients dying in hospitals due to sepsis related complications compared to breast and colorectal cancer together. Despite extensive research in order to improve outcome in sepsis over the last few decades, results of large multicenter studies were by-and-large very disappointing. This fiasco can be explained by several factors, but one of the most important reasons is the uncertain definition of sepsis resulting in very heterogeneous patient populations, and the lack of understanding of pathophysiology, which is mainly based on the imbalance in the host-immune response. However, this heroic research work has not been in vain. Putting the results of positive and negative studies into context, we can now approach sepsis in a different concept, which may lead us to new perspectives in diagnostics and treatment. While decision making based on conventional sepsis definitions can inevitably lead to false judgment due to the heterogeneity of patients, new concepts based on currently gained knowledge in immunology may help to tailor assessment and treatment of these patients to their actual needs. Summarizing where we stand at present and what the future may hold are the purpose of this review. PMID:26258150

  17. Raftlin: a new biomarker in human sepsis.

    PubMed

    Lee, Wonhwa; Yoo, Hayoung; Ku, Sae-Kwang; Kim, Shin-Woo; Bae, Jong-Sup

    2014-06-01

    Raftlin is a major protein in lipid raft. The aim of this study was to evaluate blood levels of raftlin in septic patients. A prospective study of 82 patients with sepsis was conducted. Human umbilical vein endothelial cells (HUVECs) or mice were exposed to lipopolysaccharide (LPS, 100 ng/ml to HUVECs or 10 mg/kg to mice) or subjected to cecal ligation and puncture (CLP) surgery. Data showed that LPS induced upregulation of the synthesis and secretion of raftlin in LPS-treated HUVECs, and LPS-injected and CLP-mice. In patients admitted to the intensive care unit with sepsis, circulating levels of raftlin were significantly elevated, compared with control donors. Raftlin levels were higher in patients with septic shock, 891.6 (789.7-1,087.8, n = 30) than in patients with severe sepsis, 681.6 (480.1-819.6, n = 22) or sepsis, 496.1 (418.1-738.9, n = 30), compared with healthy volunteers 364.9 (312.1-392.4, n = 21). These results suggest that in septic patients, raftlin blood level is related to the severity of sepsis and the outcome of the patient and may represent a novel marker of endothelial cell dysfunction, and that raftlin can be used as a biomarker for determining the severity of sepsis.

  18. [Are statins a therapeutic alternative in sepsis?].

    PubMed

    Carrillo-Esper, Raúl; Rivera-Buendía, Santos; Carrillo-Córdova, Jorge Raúl; Carrillo-Córdova, Luis Daniel

    2007-01-01

    Sepsis continues to be a major cause of morbidity and mortality. Evidence is emerging from observational studies and basic science research that statins might be associated with reduced mortality in sepsis. Statins have diverse immunomodulatory and antiinflammatory properties independent of their lipid-lowering ability. The protective association between statins and sepsis persisted in high-risk subgroups including patients with diabetes mellitus, those with malignancy, and those receiving steroids. This review discusses the basis of these observations and the current place of statin therapy in patients with sepsis. This is a rapidly growing field of fascinating experimental biology. It suggests an urgent need to investigate the pharmacology of these drugs and reappraise their therapeutic indications in critically ill patients. If this finding is supported by prospective controlled trials, statins may play an important role in sepsis related mortality. By the other hand statins are significantly cheaper than other therapies that have been shown to improve outcome in sepsis, and the demonstration of mortality benefit would have enormous cost-benefit implication.

  19. Recognising early onset neonatal sepsis: an essential step in appropriate antimicrobial use.

    PubMed

    van Herk, Wendy; Stocker, Martin; van Rossum, Annemarie M C

    2016-07-01

    Early diagnosis and timely treatment of early onset neonatal sepsis (EOS) are essential to prevent life threatening complications. Subtle, nonspecific clinical presentation and low predictive values of biomarkers complicate early diagnosis. This uncertainty commonly results in unnecessary and prolonged empiric antibiotic treatment. Annually, approximately 395,000 neonates (7.9% of live term births) are treated for suspected EOS in the European Union, while the incidence of proven EOS varies between 0.01 and 0.53 per 1000 live births. Adherence to guidelines for the management of suspicion of EOS is poor. Pragmatic approaches to minimise overtreatment in neonates with suspected EOS, using combined stratified risk algorithms, based on maternal and perinatal risk factors, clinical characteristics of the neonate and sequential biomarkers are promising. PMID:27222092

  20. Plasma arginine correlations in trauma and sepsis.

    PubMed

    Chiarla, C; Giovannini, I; Siegel, J H

    2006-02-01

    Arginine (ARG) is an amino acid (AA) with unique properties and with a key-role in the metabolic, immune and reparative response to trauma and sepsis. This study has been performed to characterize the correlations between plasma levels of ARG, of other AA and of multiple metabolic variables in trauma and sepsis. Two-hundred and sixty-three plasma amino-acidograms with a large series of additional biochemical and blood variables were obtained consecutively in 9 trauma patients who developed sepsis, undergoing total parenteral nutrition with dextrose, fat and a mixed AA solution containing 10.4% arginine. ARG was low soon after trauma, then it increased with increasing distance from trauma and with the development of sepsis. ARG was also directly related to the AA infusion rate (AAIR) and for any given AAIR, was lower after trauma than after the development of sepsis. ARG was also related directly to the plasma levels of most of the other AA, the best correlation being that with lysine (r(2) = 0.81, p < 0.001). These correlations were often shifted downwards (showing lower ARG for any given level of the other AA) in measurements performed after trauma, compared to those performed after development of sepsis; this effect was more pronounced for the correlations with branched chain AA. Correlations between ARG and non-AA variables were not particularly relevant. The best simultaneous correlates of ARG, among variables involved in plasma ARG availability, were citrulline level, AAIR and urinary 3-methylhistidine excretion (accounting for the effect of endogenous proteolysis) (multiple r(2) = 0.70, p < 0.001). Plasma ornithine (ORN), the AA more specifically linked to ARG metabolism, correlated with AAIR better than ARG and, for any given AAIR, was lower after trauma than after the development of sepsis. Correlations of ORN with other AA levels were poorer than those found for ARG, however ORN was directly related to white blood cell and platelet count, fibrinogen

  1. Who should we cool after perinatal asphyxia?

    PubMed

    Thoresen, Marianne

    2015-04-01

    Three ongoing challenges have arisen after the introduction of therapeutic hypothermia (TH) as standard of care for term newborns with moderate or severe perinatal asphyxia: (i) to ensure that the correct group of infants are cooled; (ii) to optimize the delivery of TH and intensive care in relation to the severity of the encephalopathy; (iii) to systematically follow up the long-term efficacy of TH using comparable outcome data between centers and countries. This review addresses the entry criteria for TH, and discusses potential issues regarding patient selection, and management of TH: cooling mild, moderate, and very severe perinatal asphyxia, cooling longer or deeper, and/or starting with a greater delay. This includes cooling of patients outside of standard trial entry criteria, such as after postnatal collapse, premature infants, those with infection, and infants with metabolic, chromosomal or surgical diagnoses in addition to perinatal asphyxia. PMID:25667126

  2. Substance use in the perinatal period

    PubMed Central

    Forray, Ariadna; Foster, Dawn

    2015-01-01

    Perinatal substance use remains a major public health problem and is associated with a number of deleterious maternal and fetal effects. Polysubstance use in pregnancy is common, and can potentiate adverse maternal and fetal outcomes. Tobacco is the most commonly used substance in pregnancy, followed by alcohol and illicit substances. The treatments for perinatal substance use are limited and consist mostly of behavioral and psychosocial interventions. Of these contingency management has shown the most efficacy. More recently, novel interventions such as progesterone for postpartum cocaine use have shown promise. The purpose of this review is to examine the recent literature on the use of tobacco, alcohol, cannabis, stimulants, and opioids in the perinatal period, their effects on maternal and fetal health and current treatments. PMID:26386836

  3. Substance Use in the Perinatal Period.

    PubMed

    Forray, Ariadna; Foster, Dawn

    2015-11-01

    Perinatal substance use remains a major public health problem and is associated with a number of deleterious maternal and fetal effects. Polysubstance use in pregnancy is common and can potentiate adverse maternal and fetal outcomes. Tobacco is the most commonly used substance in pregnancy, followed by alcohol and illicit substances. The treatments for perinatal substance use are limited and consist mostly of behavioral and psychosocial interventions. Of these, contingency management has shown the most efficacy. More recently, novel interventions such as progesterone for postpartum cocaine use have shown promise. The purpose of this review is to examine the recent literature on the use of tobacco, alcohol, cannabis, stimulants, and opioids in the perinatal period, their effects on maternal and fetal health, and current treatments. PMID:26386836

  4. Significance, management and prevention of Streptococcus agalactiae infection during the perinatal period.

    PubMed

    Berner, Reinhard

    2004-06-01

    The highest annual death rate during the first five decades of life occurs in the first year, particularly during the perinatal period between the onset of labor and 72 h after birth. Invasive bacterial disease evoking the severe inflammatory response syndrome is a leading cause of perinatal morbidity and mortality. Group B streptococcus (Streptococcus agalactiae) is the most important pathogen in this period of life, although the concept of intrapartum antimicrobial prophylaxis has impressively reduced the rate of culture-proven invasive infection in neonates. This strategy, however, has considerable limitations since group B streptococcus-related stillbirths or prematurity and late-onset sepsis cannot be prevented. Moreover, the use of intrapartum antimicrobial prophylaxis has significantly increased the use of antibiotics during labor and therefore may select for intrapartum infections caused by other bacteria, including those resistant to antibiotics. Several advances in the development of vaccines and research on virulence factors and pathways involved in the immune response to group B streptococcus have been accomplished within the last years, including complete sequencing of the group B streptococcus genome. Development of effective vaccines and implementation of vaccination strategies will be one of the key challenges in the future for prevention of neonatal group B Streptococcus infections.

  5. Cervical insufficiency: a new issue for guidelines on prevention of perinatal group B streptococcal disease?

    PubMed

    Natale, Fabio; Brunelli, Roberto; Bizzarri, Bianca; Castronovo, Antonella; De Curtis, Mario

    2013-02-01

    The updated Guidelines on Prevention of Perinatal Group B Streptococcal Disease, issued by the Centers for Disease Control and Prevention, actually represent the mainstay in the prevention of neonatal early-onset group B streptococcal (GBS) sepsis. According to these guidelines, patients with possible preterm delivery are screened for GBS colonization and offered intrapartum prophylaxis only if they enter preterm labor or experience preterm premature rupture of the membranes. Nonetheless, the fulfillment of these recommendations seems to be suboptimal in clinical practice, as it is heavily influenced by the knowledge of the colonization status. We report here 2 cases of blood culture-proven, early-onset neonatal GBS sepsis involving preterm infants delivered by mothers who had midtrimester cervical insufficiency and bulging membranes. Midtrimester acute cervical insufficiency strongly predicts preterm delivery. These women are liable to miss intrapartum antibiotic prophylaxis because they typically have shorter labor, and the test results for GBS status are unlikely to be available before delivery. We believe that women with midtrimester cervical insufficiency and bulging membranes should be screened for GBS infection soon after hospital admittance if the gestational age is close to the threshold of fetal viability. A timely diagnosis of GBS colonization may not only increase the number of patients receiving targeted intrapartum antibiotic prophylaxis but would also allow consideration of the administration of antepartum antibiotic prophylaxis. Indeed, as further outlined in this report, GBS intraamniotic infection may dramatically occur before the onset of preterm labor or preterm premature rupture of the membranes.

  6. Perinatal care: the Kuranko context of choice.

    PubMed

    Ross, J S

    1991-01-01

    The ethnomedical aspects of childbirth and factors that influence Kuranko women in the northern Sierra Leone center of Kabala (a multiethnic town of some 15,000 inhabitants) in making decisions regarding perinatal care are the focus of this article. I found that Kuranko women develop perinatal care strategies from services available in the formal and informal health-care sectors. The discussion is situated within a context that values primary health care and health promotion and advocates the use of these frameworks in ways that are informed by Kuranko social organization and concepts of development.

  7. A blueprint for a sepsis protocol.

    PubMed

    Shapiro, Nathan I; Howell, Michael; Talmor, Daniel

    2005-04-01

    Despite numerous advances in medicine, sepsis remains an unconquered challenge. Although outcomes have improved slightly over decades, the unacceptably high mortality rate of 30%-50% for severe sepsis and septic shock continues. However, after years of unsuccessful clinical trials, several investigations over the last few years have reported survival benefit in the treatment of sepsis. Physicians now have several proven therapies to treat sepsis, but have yet to implement them on a widespread, systematic basis. This led 11 international professional societies spanning multiple specialties and continents to come together to create the Surviving Sepsis Campaign. The product of their work is an international effort organized to improve care of patients with sepsis and includes consensus, evidence-based guidelines for care that improves survival in septic patients, and an action plan for change. Given the clear role of early identification and treatment in stopping the sepsis cascade, therapy must start early in the emergency department (ED) and continue throughout the hospital course. The first of the recommendations by the Surviving Sepsis Campaign is the aggressive resuscitation strategy of early goal-directed therapy (EGDT). EGDT is reported to reduce absolute mortality by a staggering 16%. The use of recombinant activated protein C was demonstrated to confer a 6% absolute survival benefit. Steroid supplementation in adrenal insufficiency produced a 10% benefit. Additionally, early and appropriate use of antibiotics remains a cornerstone of therapy. Although no randomized trial will be performed, the effects are undisputed. Finally, although predominantly intensive care unit therapies, tight glucose control and low-tidal-volume ventilation strategies have also led to improved survival. Armed with these new therapies, the medical community must rise to this call to action. Clinicians must change the approach to this disease, as well as the way the septic patient is

  8. Mechanisms of Intestinal Barrier Dysfunction in Sepsis.

    PubMed

    Yoseph, Benyam P; Klingensmith, Nathan J; Liang, Zhe; Breed, Elise R; Burd, Eileen M; Mittal, Rohit; Dominguez, Jessica A; Petrie, Benjamin; Ford, Mandy L; Coopersmith, Craig M

    2016-07-01

    Intestinal barrier dysfunction is thought to contribute to the development of multiple organ dysfunction syndrome in sepsis. Although there are similarities in clinical course following sepsis, there are significant differences in the host response depending on the initiating organism and time course of the disease, and pathways of gut injury vary widely in different preclinical models of sepsis. The purpose of this study was to determine whether the timecourse and mechanisms of intestinal barrier dysfunction are similar in disparate mouse models of sepsis with similar mortalities. FVB/N mice were randomized to receive cecal ligation and puncture (CLP) or sham laparotomy, and permeability was measured to fluoresceinisothiocyanate conjugated-dextran (FD-4) six to 48 h later. Intestinal permeability was elevated following CLP at all timepoints measured, peaking at 6 to 12 h. Tight junction proteins claudin 1, 2, 3, 4, 5, 7, 8, 13, and 15, Junctional Adhesion Molecule-A (JAM-A), occludin, and ZO-1 were than assayed by Western blot, real-time polymerase chain reaction, and immunohistochemistry 12 h after CLP to determine potential mechanisms underlying increases in intestinal permeability. Claudin 2 and JAM-A were increased by sepsis, whereas claudin-5 and occludin were decreased by sepsis. All other tight junction proteins were unchanged. A further timecourse experiment demonstrated that alterations in claudin-2 and occludin were detectable as early as 1 h after the onset of sepsis. Similar experiments were then performed in a different group of mice subjected to Pseudomonas aeruginosa pneumonia. Mice with pneumonia had an increase in intestinal permeability similar in timecourse and magnitude to that seen in CLP. Similar changes in tight junction proteins were seen in both models of sepsis although mice subjected to pneumonia also had a marked decrease in ZO-1 not seen in CLP. These results indicate that two disparate, clinically relevant models of sepsis

  9. Bioethanol production from rice straw by popping pretreatment

    PubMed Central

    2013-01-01

    Background Rice straw has considerable potential as a raw material for bioethanol production. Popping pretreatment of rice straw prior to downstream enzymatic hydrolysis and fermentation was found to increase cellulose to glucose conversion efficiency. The aim of this study was to investigate the influence of popping pretreatment and determine the optimal enzyme loading using a surface response design. Results The optimal doses of cellulase and xylanase enzymes were 23 FPU and 62 IU/g biomass, respectively. Using the optimized enzyme condition and popping pretreatment of rice straw (15% substrate loading, w/v), a sugar recovery of 0.567 g/g biomass (glucose; 0.394 g/g) was obtained in 48 h, which was significantly higher than that from untreated rice straw (total sugar recovery; 0.270 g/g biomass). Fermentation of the hydrolyzates by Saccharomyces cerevisiae resulted in 0.172 g ethanol/g biomass after 24 h, equivalent to 80.9% of the maximum theoretical yield (based on the amount of glucose in raw material). Changes in the chemical composition and surface area of rice straw were also investigated before and after popping pretreatment. The results showed little or no difference in chemical composition between the pretreated rice straw and the control. However, the surface area of pretreated rice straw increased twofold compared to the control. Conclusion Popping pretreatment of rice straw can effectively improve downstream saccharification and fermentation, important for bioethanol production. PMID:24286244

  10. Ways to suppress click and pop for class D amplifiers

    NASA Astrophysics Data System (ADS)

    Haishi, Wang; Bo, Zhang; Jiang, Sun

    2012-08-01

    Undesirable audio click and pop may be generated in a speaker or headphone. Compared to linear (class A/B/AB) amplifiers, class D amplifiers that comprise of an input stage and a modulation stage are more prone to producing click and pop. This article analyzes sources that generate click and pop in class D amplifiers, and corresponding ways to suppress them. For a class D amplifier with a single-ended input, click and pop is likely to be due to two factors. One is from a voltage difference (VDIF) between the voltage of an input capacitance (VCIN) and a reference voltage (VREF) of the input stage, and the other one is from the non-linear switching during the setting up of the bias and feedback voltages/currents (BFVC) of the modulation stage. In this article, a fast charging loop is introduced into the input stage to charge VCIN to roughly near VREF. Then a correction loop further charges or discharges VCIN, substantially equalizing it with VREF. Dummy switches are introduced into the modulation stage to provide switching signals for setting up BFVC, and the power switches are disabled until the BFVC are set up successfully. A two channel single-ended class D amplifier with the above features is fabricated with 0.5 μm Bi-CMOS process. Road test and fast Fourier transform analysis indicate that there is no noticeable click and pop.

  11. The POP learning algorithms: reducing work in identifying fuzzy rules.

    PubMed

    Quek, C; Zhou, R W

    2001-12-01

    A novel fuzzy neural network, the Pseudo Outer-Product based Fuzzy Neural Network (POPFNN), and its two fuzzy-rule-identification algorithms are proposed in this paper. They are the Pseudo Outer-Product (POP) learning and the Lazy Pseudo Outer-Product (LazyPOP) leaning algorithms. These two learning algorithms are used in POPFNN to identify relevant fuzzy rules. In contrast with other rule-learning algorithms, the proposed algorithms have many advantages, such as being fast, reliable, efficient, and easy to understand. POP learning is a simple one-pass learning algorithm. It essentially performs rule-selection. Hence, it suffers from the shortcoming of having to consider all the possible rules. The second algorithm, the LazyPOP learning algorithm, truly identifies the fuzzy rules which are relevant and does not use a rule-selection method whereby irrelevant fuzzy rules are eliminated from an initial rule set. In addition, it is able to adjust the structure of the fuzzy neural network. The proposed LazyPOP learning algorithm is able to delete invalid feature inputs according to the fuzzy rules that have been identified. Extensive experimental results and discussions are presented for a detailed analysis of the proposed algorithms.

  12. Neonatal sepsis in Dubai, United Arab Emirates.

    PubMed

    Koutouby, A; Habibullah, J

    1995-06-01

    The case records of all neonates admitted to the neonatal unit of Al Wasl Hospital (Dubai) in a period of 60 months (May 1987-April 1992) were analysed. One-hundred-and-six neonates had confirmed sepsis. The most common causative organisms were Group B Streptococci (23 per cent), E. coli (17 per cent), Staph. epidermidis (17 per cent), and Klebsiella pneumoniae (16 per cent). Group B Streptococcus presented as the most common organism in very early (< or = 24 hours) and early onset (2-6 days) of sepsis (34 per cent, 21/61), Klebsiella pneumoniae (24 per cent), Staphylococcal epidermidis (18 per cent) and Candida (13 per cent) were most common organisms causing late onset of sepsis (7-30 days). Pseudomonas aeruginosa and Klebsiella pneumoniae had highest mortality (71 per cent, 5/7; and 59 per cent, 10/17, respectively). Lowest mortality (4 per cent, 1/25) was observed in Group B Streptococcus sepsis. Prematurity, low birth weight, and nosocomial sepsis were high risk factors associated with fatal outcome.

  13. Neuromuscular Dysfunction in Experimental Sepsis and Glutamine

    PubMed Central

    Çankayalı, İlkin; Boyacılar, Özden; Demirağ, Kubilay; Uyar, Mehmet; Moral, Ali Reşat

    2016-01-01

    Background: Electrophysiological studies show that critical illness polyneuromyopathy appears in the early stage of sepsis before the manifestation of clinical findings. The metabolic response observed during sepsis causes glutamine to become a relative essential amino acid. Aims: We aimed to assess the changes in neuromuscular transmission in the early stage of sepsis after glutamine supplementation. Study Design: Animal experimentation. Methods: Twenty male Sprague-Dawley rats were randomized into two groups. Rats in both groups were given normal feeding for one week. In the study group, 1 g/kg/day glutamine was added to normal feeding by feeding tube for one week. Cecal ligation and perforation (CLP) surgery was performed at the end of one week. Before and 24 hours after CLP, compound muscle action potentials were recorded from the gastrocnemius muscle. Results: Latency measurements before and 24 hours after CLP were 0.68±0.05 ms and 0.80±0.09 ms in the control group and 0.69±0.07 ms and 0.73±0.07 ms in the study group (p<0.05). Conclusion: Since enteral glutamine prevented compound muscle action potentials (CMAP) latency prolongation in the early phase of sepsis, it was concluded that enteral glutamine replacement might be promising in the prevention of neuromuscular dysfunction in sepsis; however, further studies are required. PMID:27308070

  14. Year in review 2008: Critical Care - sepsis

    PubMed Central

    2009-01-01

    The present report highlights the most important papers appearing in Critical Care and other major journals about severe sepsis, the systemic inflammatory response and multiorgan dysfunction over the past year. A number of these clinical and laboratory studies will have a considerable impact on the sepsis research agenda for years to come. The steroid controversy, the debate over tight glycemic control, the colloid versus crystalloid issue, the value of selective decontamination of the digestive tract, the enlarging role of biomarkers, the value of genomics and rapid diagnostic techniques have all been prominently featured in recent publications. Basic research into novel predictive assays, genetic polymorphisms, and new molecular methods to risk-stratify and to determine treatment options for sepsis have occupied much of the Critical Care publications relating to sepsis pathophysiology in 2008. We will attempt to briefly summarize what we consider to be the most significant contributions to the sepsis literature over the last year, and their likely ramifications in the future, for critical care clinicians, clinical investigators and basic researchers alike. PMID:19886974

  15. Global and cultural perinatal nursing research: improving clinical practice.

    PubMed

    Callister, Lynn Clark

    2011-01-01

    High-quality perinatal nursing care should be based on the best evidence including research findings, clinical expertise, and the preferences of women and their families. Principles of perinatal research initiatives are defined, with suggested research priorities designed to close current gaps in the micro and macro environments of perinatal nursing throughout the world. Nearly a decade ago, the following question was asked, "Where is the 'E' (evidence) in maternal child health?" Improving the quality and safety of perinatal nursing care for culturally diverse women globally is the primary goal of nurse researchers leading the future of perinatal healthcare.

  16. Endotoxins and other sepsis triggers.

    PubMed

    Opal, Steven M

    2010-01-01

    Endotoxin, or more accurately termed bacterial lipopolysaccharide (LPS), is recognized as the most potent microbial mediator implicated in the pathogenesis of sepsis and septic shock. Yet despite its discovery well over a century ago, the fundamental role of circulating endotoxin in the blood of most patients with septic shock remains enigmatic and a subject of considerable controversy. LPS is the most prominent 'alarm molecule' sensed by the host's early warning system of innate immunity presaging the threat of invasion of the internal milieu by Gram-negative bacterial pathogens. In small doses within a localized tissue space, LPS signaling is advantageous to the host in orchestrating an appropriate antimicrobial defense and bacterial clearance mechanisms. Conversely, the sudden release of large quantities of LPS into the bloodstream is clearly deleterious to the host, initiating the release of a dysregulated and potentially lethal array of inflammatory mediators and procoagulant factors in the systemic circulation. The massive host response to this single bacterial pattern recognition molecule is sufficient to generate diffuse endothelial injury, tissue hypoperfusion, disseminated intravascular coagulation and refractory shock. Numerous attempts to block endotoxin activity in clinical trials with septic patients have met with inconsistent and largely negative results. Yet the groundbreaking discoveries within the past decade into the precise molecular basis for LPS-mediated cellular activation and tissue injury has rekindled optimism that a new generation of therapies that specifically disrupt LPS signaling might succeed. Other microbial mediators found in Gram-positive bacterial and viral and fungal pathogens are now appreciated to activate many of the same host defense networks induced by LPS. This information is providing novel interventions in the continuing effots to improve the care of septic patients.

  17. Neonatal sepsis caused by Shewanella algae: A case report.

    PubMed

    Charles, Marie Victor Pravin; Srirangaraj, Sreenivasan; Kali, Arunava

    2015-01-01

    Sepsis remains a leading cause of mortality among neonates, especially in developing countries. Most cases of neonatal sepsis are attributed to Escherichia coli and other members of the Enterobacteriaceae family. Shewanella algae (S. algae) is a gram-negative saprophytic bacillus, commonly associated with the marine environment, which has been isolated from humans. Early onset neonatal sepsis caused by S. algae is uncommon. We report a case of S. algae blood stream infection in a newborn with early onset neonatal sepsis.

  18. Mitochondrial dysfunction and resuscitation in sepsis.

    PubMed

    Ruggieri, Albert J; Levy, Richard J; Deutschman, Clifford S

    2010-07-01

    Sepsis is among the most common causes of death in patients in intensive care units in North America and Europe. In the United States, it accounts for upwards of 250,000 deaths each year. Investigations into the pathobiology of sepsis have most recently focused on common cellular and subcellular processes. One possibility would be a defect in the production of energy, which translates to an abnormality in the production of adenosine triphosphate and therefore in the function of mitochondria. This article presents a clear role for mitochondrial dysfunction in the pathogenesis and pathophysiology of sepsis. What is less clear is the teleology underlying this response. Prolonged mitochondrial dysfunction and impaired biogenesis clearly are detrimental. However, early inhibition of mitochondrial function may be adaptive. PMID:20643307

  19. Host innate immune responses to sepsis

    PubMed Central

    Wiersinga, Willem Joost; Leopold, Stije J; Cranendonk, Duncan R; van der Poll, Tom

    2014-01-01

    The immune response to sepsis can be seen as a pattern recognition receptor-mediated dysregulation of the immune system following pathogen invasion in which a careful balance between inflammatory and anti-inflammatory responses is vital. Invasive infection triggers both pro-inflammatory and anti-inflammatory host responses, the magnitude of which depends on multiple factors, including pathogen virulence, site of infection, host genetics, and comorbidities. Toll-like receptors, the inflammasomes, and other pattern recognition receptors initiate the immune response after recognition of danger signals derived from microorganisms, so-called pathogen-associated molecular patterns or derived from the host, so-called danger-associated molecular patterns. Further dissection of the role of host–pathogen interactions, the cytokine response, the coagulation cascade, and their multidirectional interactions in sepsis should lead toward the development of new therapeutic strategies in sepsis. PMID:23774844

  20. Role of immunoglobulins in neonatal sepsis

    PubMed Central

    Capasso, L; Borrelli, AC; Cerullo, J; Pisanti, R; Figliuolo, C; Izzo, F; Paccone, M; Ferrara, T; Lama, S; Raimondi, F

    2015-01-01

    Neonates, especially VLBW, are at high risk for sepsis related morbidity and mortality for immaturity of their immune system and invasive NICU practices. The paucity of immunoglobulins in preterm neonates consequently to the immaturity of immune system contributes to their high risk for systemic infection. The use of intravenous IgM enriched immunoglobulins, with higher antimicrobial activity than standard IgG, has been demonstrated in a retrospective study to reduce short term mortality in VLBW infant with proven sepsis. Larger, randomized prospective trials given the enormous burden of morbidity and mortality imposed by neonatal sepsis should urgently be addressed not only to validate this results but also to tailor the optimal scheme of treatment. PMID:25674546

  1. Anticoagulant modulation of inflammation in severe sepsis.

    PubMed

    Allen, Karen S; Sawheny, Eva; Kinasewitz, Gary T

    2015-05-01

    Inflammation and coagulation are so tightly linked that the cytokine storm which accompanies the development of sepsis initiates thrombin activation and the development of an intravascular coagulopathy. This review examines the interaction between the inflammatory and coagulation cascades, as well as the role of endogenous anticoagulants in regulating this interaction and dampening the activity of both pathways. Clinical trials attempting to improve outcomes in patients with severe sepsis by inhibiting thrombin generation with heparin and or endogenous anticoagulants are reviewed. In general, these trials have failed to demonstrate that anticoagulant therapy is associated with improvement in mortality or morbidity. While it is possible that selective patients who are severely ill with a high expected mortality may be shown to benefit from such therapy, at the present time none of these anticoagulants are neither approved nor can they be recommended for the treatment of sepsis. PMID:25938026

  2. Perinatal home care: one entrepreneur's experience.

    PubMed

    Eaton, D G

    1994-10-01

    Nurses have responded to the entrepreneurial movement by entering into various nontraditional roles and starting their own businesses. This article describes the author's experience in establishing a perinatal home-care business. The characteristics of women and nurse entrepreneurs are discussed, as are the components of a business plan and how to manage a business.

  3. DRINKING WATER ARSENIC AND PERINATAL OUTCOMES

    EPA Science Inventory

    Drinking Water Arsenic and Perinatal Outcomes
    DT Lobdell, Z Ning, RK Kwok, JL Mumford, ZY Liu, P Mendola

    Many studies have documented an association between drinking water arsenic (DWA) and cancer, vascular diseases, and dermatological outcomes, but few have investigate...

  4. Perinatal mortality--an analysis of causes and strategies.

    PubMed

    Gupta, Neeru

    2011-04-01

    Perinatal mortality is the most sensitive index while imparting healthcare to mother during pregnancy and delivery and also to the baby in perinatal period. Perinatal mortality is higher in rural areas than in urban areas. Worldover perinatal or infant mortality rate is on decline. Developed countries are ahead of developing nations in giving good antenatal, intrapartal as well as neonatal care. Factors responsible for perinatal mortality in Indian context lie in sociodemographic, maternal and foetal aspects. Regional differences also are there in India while assessing perinatal mortality and delivery practices. The lacunae are to be identified while recommending strategies to be taken to lower the perinatal mortality. A community based data system should be developed so that the information should flow from down to above, from village to subcentre to primary health centre and further from district to state. Some newborns need special care. Since newborns need early recognition of danger signs and prompt treatment measures. PMID:22187796

  5. Is there an association between female circumcision and perinatal death?

    PubMed Central

    Essen, Birgitta; Bodker, Birgit; Sjoberg, N-O; Gudmundsson, Saemundur; Ostergren, P-O; Langhoff-Roos, Jens

    2002-01-01

    OBJECTIVE: In Sweden, a country with high standards of obstetric care, the high rate of perinatal mortality among children of immigrant women from the Horn of Africa raises the question of whether there is an association between female circumcision and perinatal death. METHOD: To investigate this, we examined a cohort of 63 perinatal deaths of infants born in Sweden over the period 1990-96 to circumcised women. FINDINGS: We found no evidence that female circumcision was related to perinatal death. Obstructed or prolonged labour, caused by scar tissue from circumcision, was not found to have any impact on the number of perinatal deaths. CONCLUSION: The results do not support previous conclusions that genital circumcision is related to perinatal death, regardless of other circumstances, and suggest that other, suboptimal factors contribute to perinatal death among circumcised migrant women. PMID:12219153

  6. Disseminated intravascular coagulation in meningococcal sepsis. Case 7.

    PubMed

    Zeerleder, S; Zürcher Zenklusen, R; Hack, C E; Wuillemin, W A

    2003-08-01

    We report on a man (age: 49 years), who died from severe meningococcal sepsis with disseminated intravascular coagulation (DIC), multiple organ dysfunction syndrome and extended skin necrosis. We discuss in detail the pathophysiology of the activation of coagulation and fibrinolysis during sepsis. The article discusses new therapeutic concepts in the treatment of disseminated intravascular coagulation in meningococcal sepsis, too.

  7. An Evidence Based Approach to Sepsis: Educational Program

    ERIC Educational Resources Information Center

    Perez, Dolores

    2015-01-01

    Evidence-based guidelines for recognizing and treating sepsis have been available for decades, yet healthcare providers do not adhere to the recommendations. Sepsis can progress rapidly if not recognized early. Literature reports reveal that sepsis is the leading cause of death in non-cardiac intensive care units (ICUs), and it is one of the most…

  8. Ghrelin inhibits sympathetic nervous activity in sepsis.

    PubMed

    Wu, Rongqian; Zhou, Mian; Das, Padmalaya; Dong, Weifeng; Ji, Youxin; Yang, Derek; Miksa, Michael; Zhang, Fangming; Ravikumar, Thanjavur S; Wang, Ping

    2007-12-01

    Our previous studies have shown that norepinephrine (NE) upregulates proinflammatory cytokines by activating alpha(2)-adrenoceptor. Therefore, modulation of the sympathetic nervous system represents a novel treatment for sepsis. We have also shown that a novel stomach-derived peptide, ghrelin, is downregulated in sepsis and that its intravenous administration decreases proinflammatory cytokines and mitigates organ injury. However, it remains unknown whether ghrelin inhibits sympathetic activity through central ghrelin receptors [i.e., growth hormone secretagogue receptor 1a (GHSR-la)] in sepsis. To study this, sepsis was induced in male rats by cecal ligation and puncture (CLP). Ghrelin was administered through intravenous or intracerebroventricular injection 30 min before CLP. Our results showed that intravenous administration of ghrelin significantly reduced the elevated NE and TNF-alpha levels at 2 h after CLP. NE administration partially blocked the inhibitory effect of ghrelin on TNF-alpha in sepsis. GHSR-la inhibition by the administration of a GHSR-la antagonist, [d-Arg(1),d-Phe(5), d-Trp(7,9),Leu(11)]substance P, significantly increased both NE and TNF-alpha levels even in normal animals. Markedly elevated circulating levels of NE 2 h after CLP were also significantly decreased by intracerebroventricular administration of ghrelin. Ghrelin's inhibitory effect on NE release was completely blocked by intracerebroventricular injection of the GHSR-1a antagonist or a neuropeptide Y (NPY)/Y(1) receptor antagonist. However, ghrelin's downregulatory effect on TNF-alpha release was only partially diminished by these agents. Thus ghrelin has sympathoinhibitory properties that are mediated by central ghrelin receptors involving a NPY/Y1 receptor-dependent pathway. Ghrelin's inhibitory effect on TNF-alpha production in sepsis is partially because of its modulation of the overstimulated sympathetic nerve activation.

  9. Pediatric sepsis: challenges and adjunctive therapies

    PubMed Central

    Hanna, William; Wong, Hector R.

    2012-01-01

    SYNOPSIS Sepsis remains an important challenge in pediatric critical care medicine. The current review intends to provide an appraisal of adjunctive therapies for sepsis and to highlight opportunities for meeting selected challenges in the field. Future clinical studies should address long-term and functional outcomes, as well as acute outcomes. Potential adjunctive therapies such as corticosteroids, hemofiltration, hemoadsorption, and plasmapheresis may have important roles, but still require formal and more rigorous testing by way of clinical trials. Finally, the design of future clinical trials should consider novel approaches for stratifying outcome risks as a means of improving the risk to benefit ratio of experimental therapies. PMID:23537672

  10. The Use of Fluids in Sepsis.

    PubMed

    Avila, Audrey A; Kinberg, Eliezer C; Sherwin, Nomi K; Taylor, Robinson D

    2016-03-10

    Sepsis is a systemic inflammatory response to severe infection causing significant morbidity and mortality that costs the health care system $20.3 billion annually within the United States. It is well established that fluid resuscitation is a central component of sepsis management; however, to date there is no consensus as to the ideal composition of fluid used for resuscitation. In this review, we discuss the progression of clinical research comparing various fluids, as well as the historical background behind fluid selection for volume resuscitation. We conclude that the use of balanced fluids, such as Ringer's Lactate, seems very promising but further research is needed to confirm their role.

  11. Sepsis and septic shock: a review.

    PubMed

    Chong, Josebelo; Dumont, Tiffany; Francis-Frank, Lyndave; Balaan, Marvin

    2015-01-01

    Sepsis and septic shock are a continuum of disease resulting from a complex host response to infection. They are major health issues in the United States, causing significant financial burden to the health care system in addition to multisystem morbidity and high rates of mortality. In recent decades, landmark trials in sepsis management have demonstrated improved mortality. Although the value of protocol-driven care is currently under question, it is clear that early recognition, prompt resuscitation, and timely use of antibiotics are of utmost importance.

  12. The Use of Fluids in Sepsis

    PubMed Central

    Avila, Audrey A; Sherwin, Nomi K; Taylor, Robinson D

    2016-01-01

    Sepsis is a systemic inflammatory response to severe infection causing significant morbidity and mortality that costs the health care system $20.3 billion annually within the United States. It is well established that fluid resuscitation is a central component of sepsis management; however, to date there is no consensus as to the ideal composition of fluid used for resuscitation. In this review, we discuss the progression of clinical research comparing various fluids, as well as the historical background behind fluid selection for volume resuscitation. We conclude that the use of balanced fluids, such as Ringer’s Lactate, seems very promising but further research is needed to confirm their role. PMID:27081589

  13. Strategies to reduce perinatal and neonatal mortality.

    PubMed

    Singh, M; Paul, V K

    1988-06-01

    The perinatal mortality rate in India averages 66.3/1000 live births. 60% of all infant deaths occur during the 1st month, making the neonatal mortality rate 76/1000 in rural areas and 39/1000 in urban areas. These rates have remained static since 1974. Over 90% of all deliveries occur at home and are conducted by untrained birth attendants. The major causes of perinatal deaths are immaturity/low birth weight, birth asphyxia/trauma, neonatal infections, and congenital malformations. Neonatal tetanus alone is responsible for 230,000-280,000 deaths a year. Hypoxia, low birth weight, and tetanus are preventable, if primary perinatal care is provided and high-risk pregnancies are recognized and referred to facilities where fetal monitoring and neonatal care are available. It is proposed to train all of the country's 5 million traditional birth attendants by 1990 to deliver primary perinatal care. By 1990 also there will be 1 village health guide for every 1000 people. All traditional birth attendants must know how to give mouth-to-mouth resuscitation, and the infrastructure for an adequate referral system must be established. In order to reduce the incidence of low birth weight, the Integrated Child Development Service Scheme proposes that all pregnant women receive a dietary supplement of 500 calories and 25 gm protein, and that pregnant women be given a 2-hour midday rest period. The control of malaria and intestinal infections with chloroquine and antibiotics would do much to reduce low birth weight. Simple technologies for measuring birth weight indicators, such as chest circumference or mid-arm circumference, require only a tape measure. Finally, technics of mass communication must be utilized to spread knowledge of perinatal and neonatal care. PMID:3069742

  14. Incidence and mortality of sepsis, severe sepsis, and septic shock in intensive care unit patients with candidemia.

    PubMed

    Ng, Kevin; Schorr, Christa; Reboli, Annette C; Zanotti, Sergio; Tsigrelis, Constantine

    2015-08-01

    In this incidence study, of 16 074 patients admitted to the intensive care unit (ICU) from 1/1/2003 to 7/31/2011, 161 cases of candidemia were identified. The incidence of sepsis (27%), severe sepsis (31%), and septic shock (40%) was remarkably high in these cases of candidemia, as was the all-cause in-hospital mortality for sepsis (30%), severe sepsis (44%), and septic shock (65%).

  15. [International guidelines of the Surviving Sepsis Campaign : update 2012].

    PubMed

    Briegel, J; Möhnle, P

    2013-04-01

    An update of the international guidelines for therapy of sepsis was published in February 2012 by the Surviving Sepsis Campaign (SSC). The update includes a further development of the guidelines from 2004 and 2008. The guidelines are divided into three sections, sepsis-specific therapeutic measures, recommendations on general intensive care measures for sepsis and finally special features of sepsis in pediatric intensive care medicine are presented in detail. This article discusses the most important amendments in the first two sections and delving deeper into the guidelines.

  16. Therapeutic Targets in Sepsis: Past, Present, and Future.

    PubMed

    Seeley, Eric J; Bernard, Gordon R

    2016-06-01

    Antibiotics and fluids have been standard treatment for sepsis since World War II. Many molecular mediators of septic shock have since been identified. In models of sepsis, blocking these mediators improved organ injury and decreased mortality. Clinical trials, however, have failed. The absence of new therapies has been vexing to clinicians, clinical researchers, basic scientists, and the pharmaceutical industry. This article examines the evolution of sepsis therapy and theorizes about why so many well-reasoned therapies have not worked in human trials. We review new molecular targets for sepsis and examine trial designs that might lead to successful treatments for sepsis. PMID:27229636

  17. Elucidating the role of genomics in neonatal sepsis.

    PubMed

    Srinivasan, Lakshmi; Kirpalani, Haresh; Cotten, Charles Michael

    2015-12-01

    Sepsis is a major cause of neonatal morbidity and mortality, especially in vulnerable preterm populations. Immature immune defenses, and environmental and maternal factors contribute to this risk, with as many as a third of very preterm infants experiencing sepsis during their stay in the neonatal intensive care unit (NICU). Epidemiologic and twin studies have suggested that there is a genetic contribution to sepsis predilection. Several investigators have conducted candidate gene association studies on variants of specific interest and potential functional significance in neonatal sepsis. In this review, we describe details of studies that have evaluated genetic susceptibility in neonatal sepsis, and summarize findings from a review of candidate gene association studies.

  18. Global Epidemiology of Pediatric Severe Sepsis: The Sepsis Prevalence, Outcomes, and Therapies Study

    PubMed Central

    Weiss, Scott L.; Pappachan, John; Wheeler, Derek; Jaramillo-Bustamante, Juan C.; Salloo, Asma; Singhi, Sunit C.; Erickson, Simon; Roy, Jason A.; Bush, Jenny L.; Nadkarni, Vinay M.; Thomas, Neal J.

    2015-01-01

    Rationale: Limited data exist about the international burden of severe sepsis in critically ill children. Objectives: To characterize the global prevalence, therapies, and outcomes of severe sepsis in pediatric intensive care units to better inform interventional trials. Methods: A point prevalence study was conducted on 5 days throughout 2013–2014 at 128 sites in 26 countries. Patients younger than 18 years of age with severe sepsis as defined by consensus criteria were included. Outcomes were severe sepsis point prevalence, therapies used, new or progressive multiorgan dysfunction, ventilator- and vasoactive-free days at Day 28, functional status, and mortality. Measurements and Main Results: Of 6,925 patients screened, 569 had severe sepsis (prevalence, 8.2%; 95% confidence interval, 7.6–8.9%). The patients’ median age was 3.0 (interquartile range [IQR], 0.7–11.0) years. The most frequent sites of infection were respiratory (40%) and bloodstream (19%). Common therapies included mechanical ventilation (74% of patients), vasoactive infusions (55%), and corticosteroids (45%). Hospital mortality was 25% and did not differ by age or between developed and resource-limited countries. Median ventilator-free days were 16 (IQR, 0–25), and vasoactive-free days were 23 (IQR, 12–28). Sixty-seven percent of patients had multiorgan dysfunction at sepsis recognition, with 30% subsequently developing new or progressive multiorgan dysfunction. Among survivors, 17% developed at least moderate disability. Sample sizes needed to detect a 5–10% absolute risk reduction in outcomes within interventional trials are estimated between 165 and 1,437 patients per group. Conclusions: Pediatric severe sepsis remains a burdensome public health problem, with prevalence, morbidity, and mortality rates similar to those reported in critically ill adult populations. International clinical trials targeting children with severe sepsis are warranted. PMID:25734408

  19. The Eyes Have It: Visual Pop-Out in Infants and Adults

    ERIC Educational Resources Information Center

    Adler, Scott A.; Orprecio, Jazmine

    2006-01-01

    Visual search studies with adults have shown that stimuli that contain a unique perceptual feature pop out from dissimilar distractors and are unaffected by the number of distractors. Studies with very young infants have suggested that they too might exhibit pop-out. However, infant studies have used paradigms in which pop-out is measured in…

  20. Deciding Where to Attend: Priming of Pop-Out Drives Target Selection

    ERIC Educational Resources Information Center

    Brascamp, Jan W.; Blake, Randolph; Kristjansson, Arni

    2011-01-01

    With attention and eye-movements humans orient to targets of interest. This orienting occurs faster when the same target repeats: priming of pop-out (PoP). While reaction times (RTs) can be important, PoP's real function could be to steer "where" to orient, a possibility underexposed in many current paradigms, as these predesignate a target to…

  1. Huntington II Simulation Program - POP. Student Workbook, Teacher's Guide, and Resource Handbook.

    ERIC Educational Resources Information Center

    Braun, Ludwig; Friedland, James

    Described is the population growth computer model "POP." This program is designed to allow a student with little mathematical background to explore various simple mathematical models of population growth. Student exercises revolve around the growth of a gypsy-moth population. Three variations of population modeling are included in POP: POP 1,…

  2. Prevention of perinatal group B streptococcal disease--revised guidelines from CDC, 2010.

    PubMed

    Verani, Jennifer R; McGee, Lesley; Schrag, Stephanie J

    2010-11-19

    Despite substantial progress in prevention of perinatal group B streptococcal (GBS) disease since the 1990s, GBS remains the leading cause of early-onset neonatal sepsis in the United States. In 1996, CDC, in collaboration with relevant professional societies, published guidelines for the prevention of perinatal group B streptococcal disease (CDC. Prevention of perinatal group B streptococcal disease: a public health perspective. MMWR 1996;45[No. RR-7]); those guidelines were updated and republished in 2002 (CDC. Prevention of perinatal group B streptococcal disease: revised guidelines from CDC. MMWR 2002;51[No. RR-11]). In June 2009, a meeting of clinical and public health representatives was held to reevaluate prevention strategies on the basis of data collected after the issuance of the 2002 guidelines. This report presents CDC's updated guidelines, which have been endorsed by the American College of Obstetricians and Gynecologists, the American Academy of Pediatrics, the American College of Nurse-Midwives, the American Academy of Family Physicians, and the American Society for Microbiology. The recommendations were made on the basis of available evidence when such evidence was sufficient and on expert opinion when available evidence was insufficient. The key changes in the 2010 guidelines include the following: • expanded recommendations on laboratory methods for the identification of GBS, • clarification of the colony-count threshold required for reporting GBS detected in the urine of pregnant women, • updated algorithms for GBS screening and intrapartum chemoprophylaxis for women with preterm labor or preterm premature rupture of membranes, • a change in the recommended dose of penicillin-G for chemoprophylaxis, • updated prophylaxis regimens for women with penicillin allergy, and • a revised algorithm for management of newborns with respect to risk for early-onset GBS disease. Universal screening at 35-37 weeks' gestation for maternal GBS

  3. Pathogenesis of Multiple Organ Failure in Sepsis.

    PubMed

    Rossaint, Jan; Zarbock, Alexander

    2015-01-01

    Sepsis is a severe critical illness syndrome that arises from infectious insults. While the host immune system is generally beneficial, an overshooting and unregulated immune response can cause serious organ tissue injury. During sepsis, systemic hypotension, disturbed perfusion of the microcirculation, and direct tissue-toxicity caused by inflammatory immune reaction can occur and contribute to organ failure. The failure of two or more vital organ systems is termed multi-organ dysfunction syndrome (MODS) and resembles a very critical condition associated with high morbidity and mortality. Importantly, no specific treatment strategy exists to efficiently prevent the development of MODS during sepsis. In this review, we aim to identify the relevant molecular immunological pathways involved in the pathogenesis of MODS during sepsis. We believe that a detailed understanding of this mechanism is necessary for the development of new treatment approaches for septic patients. In particular, knowledge of the endogenous regulators keeping the balance between necessary immune system activation to combat infections and prevention of host tissue damage would greatly improve the chances for the development of effective interventions.

  4. Immunomodulation during sepsis in organ transplanted children.

    PubMed

    Angele, M K; Loehe, F; Faist, E

    2005-10-01

    Newer immunosuppressive agents have dramatically reduced the rates of acute graft rejection over the last decade but may have exacerbated the problem of post-transplant infections. Causes of early mortality include graft dysfunction and sepsis. Late mortality occurs mainly due to sepsis. An excessive inflammatory response followed with a dramatic paralysis of cell-mediated immunity has been documented in septic patients. In transplanted individuals the pathophysiological changes of the immune response are further complicated by immunosuppressive agents. This article will focus on the effect of immunosuppressive agents and sepsis on cell-mediated immune responses. Moreover, potentially promising immunomodulatory approaches, i.e. human activated protein C, immunomodulatory diets containing L-arginine and fish oil, selective cytokine blockade, platelet-activating factor receptor antagonist, LPS receptor CD14 blockade and G-CSF, for the treatment of immunodysfunction in septic patients will be outlined in this review article. Most of them, however, have not been tested in the clinical arena in transplanted patients. Thus, the main part of the article, immunomodulation during sepsis in organ transplanted children is quite speculative and based on immunomodulatory strategies in other non-transplanted septic patients.

  5. Current treatment of sepsis and endotoxaemia.

    PubMed

    Periti, P

    2000-09-01

    This article reviews the new criteria for selecting the proper antimicrobial agent and dosage regimen for standard treatment of severe sepsis, with the intention of preventing septic shock. After introducing new concepts on the pathogenesis of sepsis and septic shock, the authors analyse the parameters of beta-lactam antibacterial activity, the antibiotic-induced release of bacterial endotoxin and the interrelationships between pharmacokinetics and pharmacodynamics of antibiotics in the search for an optimum dosage regimen of antimicrobial mono- or polytherapy for severely ill septic patients admitted to the intensive care unit. The mortality rate resulting from severe bacterial sepsis, particularly that associated with shock, still approaches 50% in spite of appropriate antimicrobial therapy and optimum supportive care. Bacterial endotoxins that are part of the cell wall are one of the cofactors in the pathogenesis of sepsis and septic shock and are often induced by antimicrobial chemotherapy, even if administered rationally. Not all antimicrobial agents are equally capable of inducing septic shock; this is dependent on their mechanism of action rather than on the causative pathogen species. The quantity of endotoxin released depends on the drug dose and whether filaments or spheroplast formation predominate. Some antibiotics, such as carbapenems, ceftriaxone, cefepime, glycopeptides, aminoglycosides and quinolones, do not have the propensity to provoke septic shock because their rapid bacterial activity induces mainly spheroplast or fragile spheroplast-like bacterial forms.

  6. [Pharmaconutrition with parenteral selenium in sepsis].

    PubMed

    Langlois, P L; de Oliveira Figliolino, L F; Hardy, G; Manzanares, W

    2014-04-01

    Critical illness is characterized by oxidative stress which leads to multiple organ failure, and sepsis-related organ dysfunction remains the most common cause of death in the intensive care unit. Over the last 2 decades, different antioxidant therapies have been developed to improve outcomes in septic patients. According to recent evidence, selenium therapy should be considered the cornerstone of the antioxidant strategies. Selenium given as selenious acid or sodium selenite should be considered as a drug or pharmaconutrient with prooxidant and cytotoxic effects when a loading dose in intravenous bolus form is administered, particularly in the early stage of severe sepsis/septic shock. To date, several phase ii trials have demonstrated that selenium therapy may be able to decrease mortality, improve organ dysfunction and reduce infections in critically ill septic patients. The effect of selenium therapy in sepsis syndrome must be confirmed by large, well designed phase iii clinical trials. The purpose of this review is to discuss current evidence on selenium pharmaconutrition in sepsis syndrome.

  7. [Pharmaconutrition with parenteral selenium in sepsis].

    PubMed

    Langlois, P L; de Oliveira Figliolino, L F; Hardy, G; Manzanares, W

    2014-04-01

    Critical illness is characterized by oxidative stress which leads to multiple organ failure, and sepsis-related organ dysfunction remains the most common cause of death in the intensive care unit. Over the last 2 decades, different antioxidant therapies have been developed to improve outcomes in septic patients. According to recent evidence, selenium therapy should be considered the cornerstone of the antioxidant strategies. Selenium given as selenious acid or sodium selenite should be considered as a drug or pharmaconutrient with prooxidant and cytotoxic effects when a loading dose in intravenous bolus form is administered, particularly in the early stage of severe sepsis/septic shock. To date, several phase ii trials have demonstrated that selenium therapy may be able to decrease mortality, improve organ dysfunction and reduce infections in critically ill septic patients. The effect of selenium therapy in sepsis syndrome must be confirmed by large, well designed phase iii clinical trials. The purpose of this review is to discuss current evidence on selenium pharmaconutrition in sepsis syndrome. PMID:24021703

  8. Role of biomarkers in sepsis care.

    PubMed

    Samraj, Ravi S; Zingarelli, Basilia; Wong, Hector R

    2013-11-01

    Sepsis is one of the leading causes of mortality and morbidity, even with the current availability of extended-spectrum antibiotics and advanced medical care. Biomarkers offer a tool in facilitating early diagnosis, in identifying patient populations at high risk of complications, and in monitoring progression of the disease, which are critical assessments for appropriate therapy and improvement in patient outcomes. Several biomarkers are already available for clinical use in sepsis; however, their effectiveness in many instances is limited by the lack of specificity and sensitivity to characterize the presence of an infection and the complexity of the inflammatory and immune processes and to stratify patients into homogenous groups for specific treatments. Current advances in molecular techniques have provided new tools facilitating the discovery of novel biomarkers, which can vary from metabolites and chemical products present in body fluids to genes and proteins in circulating blood cells. The purpose of this review was to examine the current status of sepsis biomarkers, with special emphasis on emerging markers, which are undergoing validation and may transition into clinical practice for their informative value in diagnosis, prognosis, or response to therapy. We will also discuss the new concept of combination biomarkers and biomarker risk models, their existing challenges, and their potential use in the daily management of patients with sepsis.

  9. Overview of the south Bethlehem works as seen fro pop's ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    Overview of the south Bethlehem works as seen fro pop's rock; The works is on the left side of the river and the Lehigh Canal parallels the river to the right; looking west - Bethlehem Steel Corporation, South Bethlehem Works, Along Lehigh River, North of Fourth Street, West of Minsi Trail Bridge, Bethlehem, Northampton County, PA

  10. Popping the Kernel Modeling the States of Matter

    ERIC Educational Resources Information Center

    Hitt, Austin; White, Orvil; Hanson, Debbie

    2005-01-01

    This article discusses how to use popcorn to engage students in model building and to teach them about the nature of matter. Popping kernels is a simple and effective method to connect the concepts of heat, motion, and volume with the different phases of matter. Before proceeding with the activity the class should discuss the nature of scientific…

  11. Plugging into Pop at the Junior High Level.

    ERIC Educational Resources Information Center

    Thompson, Dick

    1979-01-01

    Describes a junior high music program in Ridgewood, New Jersey, which capitalizes on student interest in popular music through courses in rock music history, pop music choral concerts, and facilities offering modern music production and performance equipment. This article is part of a theme issue on popular music. (SJL)

  12. Avengers Assemble! Using Pop-Culture Icons to Communicate Science

    ERIC Educational Resources Information Center

    Zehr, E. Paul

    2014-01-01

    Engaging communication of complex scientific concepts with the general public requires more than simplification. Compelling, relevant, and timely points of linkage between scientific concepts and the experiences and interests of the general public are needed. Pop-culture icons such as superheroes can represent excellent opportunities for exploring…

  13. Structure for Storing Properties of Particles (PoP)

    SciTech Connect

    Patel, N. R.; Mattoon, C. M.; Beck, B. R.; Summers, N. C.; Brown, D. A.

    2014-06-01

    Some evaluated nuclear databases are critical for applications such as nuclear energy, nuclear medicine, homeland security, and stockpile stewardship. Particle masses, nuclear excitation levels, and other “Properties of Particles” are essential for making evaluated nuclear databases. Currently, these properties are obtained from various databases that are stored in outdated formats. Moreover, the “Properties of Particles” (PoP) structure is being designed that will allow storing all information for one or more particles in a single place, so that each evaluation, simulation, model calculation, etc. can link to the same data. Information provided in PoP will include properties of nuclei, gammas and electrons (along with other particles such as pions, as evaluations extend to higher energies). Presently, PoP includes masses from the Atomic Mass Evaluation version 2003 (AME2003), and level schemes and gamma decays from the Reference Input Parameter Library (RIPL-3). The data are stored in a hierarchical structure. An example of how PoP stores nuclear masses and energy levels will be presented here.

  14. Some Professors Pop Pills for an Intellectual Edge

    ERIC Educational Resources Information Center

    Monastersky, Richard

    2008-01-01

    Professors know that some of their students pop Ritalin and other stimulants to give themselves a mental edge, but an informal survey suggests that some faculty members are also taking drugs for the express purpose of helping their careers. In an online survey of 1,400 readers published this month, the journal "Nature" found that 20 percent had…

  15. Cool Giant Atlases in the CRIRES-POP Library

    NASA Astrophysics Data System (ADS)

    Nicholls, C.; Lebzelter, T.; Crires-Pop Team

    2015-08-01

    The CRIRES-POP project will provide a public database of high resolution, high signal/noise near-infrared spectra of stars spanning the HR diagram. A relevant part of this library for the AGB community will be high quality reference spectra of several cool evolved giants.

  16. Factors Influencing Pop Music Preferences of Young Persons.

    ERIC Educational Resources Information Center

    Boyle, J. David; And Others

    1981-01-01

    Examined and compared self-reported reasons for pop music preferences of 397 students in grades five, seven, nine, eleven, and college. Results revealed that characteristics such as melody, mood, rhythm, and lyrics were the most important reasons for selection. Differences in response by age and background characteristics were noted. (Author/SJL)

  17. Structure for Storing Properties of Particles (PoP)

    SciTech Connect

    Patel, N.R.; Mattoon, C.M.; Beck, B.R.; Summers, N.C.; Brown, D.A.

    2014-06-15

    Evaluated nuclear databases are critical for applications such as nuclear energy, nuclear medicine, homeland security, and stockpile stewardship. Particle masses, nuclear excitation levels, and other “Properties of Particles” are essential for making evaluated nuclear databases. Currently, these properties are obtained from various databases that are stored in outdated formats. A “Properties of Particles” (PoP) structure is being designed that will allow storing all information for one or more particles in a single place, so that each evaluation, simulation, model calculation, etc. can link to the same data. Information provided in PoP will include properties of nuclei, gammas and electrons (along with other particles such as pions, as evaluations extend to higher energies). Presently, PoP includes masses from the Atomic Mass Evaluation version 2003 (AME2003), and level schemes and gamma decays from the Reference Input Parameter Library (RIPL-3). The data are stored in a hierarchical structure. An example of how PoP stores nuclear masses and energy levels will be presented here.

  18. Getting to the Center of a Tootsie Roll Pop

    ERIC Educational Resources Information Center

    Lien, Brian

    2007-01-01

    In this article, the author describes an activity he introduced to his engineering drafting students that involved a Tootsie Roll product. In this particular activity, he assigned his students to find out how many licks are needed to get to the center of a Tootsie Roll Pop. He first asked his students to do some research if an answer exists for…

  19. Clinical analysis of cases of neonatal Streptococcus agalactiae sepsis.

    PubMed

    Zeng, S J; Tang, X S; Zhao, W L; Qiu, H X; Wang, H; Feng, Z C

    2016-01-01

    With the advent of antibiotic resistance, pathogenic bacteria have become a major threat in cases of neonatal sepsis; however, guidelines for treatment have not yet been standardized. In this study, 15 cases of neonatal Streptococcus agalactiae sepsis from our hospital were retrospectively analyzed. Of these, nine cases showed early-onset and six cases showed late-onset sepsis. Pathogens were characterized by genotyping and antibiotic sensitivity tests on blood cultures. Results demonstrated that in cases with early-onset sepsis, clinical manifestations affected mainly the respiratory tract, while late-onset sepsis was accompanied by intracranial infection. Therefore, we suggest including a cerebrospinal fluid examination when diagnosing neonatal sepsis. Bacterial genotyping indicated the bacteria were mainly type Ib, Ia, and III S. agalactiae. We recommend treatment with penicillin or ampicillin, since bacteria were resistant to clindamycin and tetracycline. In conclusion, our results provide valuable information for the clinical treatment of S. agalactiae sepsis in neonatal infants.

  20. Translational research and biomarkers in neonatal sepsis.

    PubMed

    Delanghe, Joris R; Speeckaert, Marijn M

    2015-12-01

    As neonatal sepsis is a severe condition, there is a call for reliable biomarkers to differentiate between infected and noninfected newborns. Although blood culture has been considered as the gold standard, this analysis is still too slow and limited by false negative results. Use of CRP is hampered by a physiological 3-day increase, resulting in a low sensitivity to detect sepsis at an early stage. A moderate diagnostic accuracy of other acute phase proteins has been demonstrated (serum amyloid A, procalcitonin, lipopolysaccharide binding protein, mannose binding lectin and hepcidin). In neonatal sepsis, changed chemokine/cytokine levels are observed before those of acute phase reactants. High IL-6, IL-8, IL-10 and TNF-α concentrations are detected in infected infants. Soluble interleukin-2 receptor has been used to identify bacteremia, whereas low plasma RANTES concentrations are characteristic for septicemia. Several cell adhesion molecules contribute to the pathogenesis of sepsis. As an upregulated CD64 expression on granulocytes is found within 1-6h after bacterial invasion, serial CD64 measurements could guide antibiotic therapy. An increased CD11b/CD18 density can improve the diagnosis, and a positive correlation between CD11b and the severity of systemic inflammation has been reported. An early increase in sCD14-ST presepsin is also observed during sepsis, whereas high sTREM-1 values in early-onset neonatal sepsis (EOS) have been associated with mortality. Biomarkers resulting from proteomics are also promising. A 4-biomarker 'mass restricted' score has been validated as diagnostic for intra-amniotic infection and/or inflammation. S100A8 in amniotic fluid is a strong predictor of an increased incidence of EOS. Proteomic analysis of cord blood has revealed altered protein expression patterns. The ApoSAA score is useful for identifying sepsis and could guide prescription of antibiotics. (1)H-NMR and GC-MS metabolomics allow to diagnose septic shock, which is

  1. The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3)

    PubMed Central

    Singer, Mervyn; Deutschman, Clifford S.; Seymour, Christopher Warren; Shankar-Hari, Manu; Annane, Djillali; Bauer, Michael; Bellomo, Rinaldo; Bernard, Gordon R.; Chiche, Jean-Daniel; Coopersmith, Craig M.; Hotchkiss, Richard S.; Levy, Mitchell M.; Marshall, John C.; Martin, Greg S.; Opal, Steven M.; Rubenfeld, Gordon D.; van der Poll, Tom; Vincent, Jean-Louis; Angus, Derek C.

    2016-01-01

    IMPORTANCE Definitions of sepsis and septic shock were last revised in 2001. Considerable advances have since been made into the pathobiology (changes in organ function, morphology, cell biology, biochemistry, immunology, and circulation), management, and epidemiology of sepsis, suggesting the need for reexamination. OBJECTIVE To evaluate and, as needed, update definitions for sepsis and septic shock. PROCESS A task force (n = 19) with expertise in sepsis pathobiology, clinical trials, and epidemiology was convened by the Society of Critical Care Medicine and the European Society of Intensive Care Medicine. Definitions and clinical criteria were generated through meetings, Delphi processes, analysis of electronic health record databases, and voting, followed by circulation to international professional societies, requesting peer review and endorsement (by 31 societies listed in the Acknowledgment). KEY FINDINGS FROMEVIDENCE SYNTHESIS Limitations of previous definitions included an excessive focus on inflammation, the misleading model that sepsis follows a continuum through severe sepsis to shock, and inadequate specificity and sensitivity of the systemic inflammatory response syndrome (SIRS) criteria. Multiple definitions and terminologies are currently in use for sepsis, septic shock, and organ dysfunction, leading to discrepancies in reported incidence and observed mortality. The task force concluded the term severe sepsis was redundant. RECOMMENDATIONS Sepsis should be defined as life-threatening organ dysfunction caused by a dysregulated host response to infection. For clinical operationalization, organ dysfunction can be represented by an increase in the Sequential [Sepsis-related] Organ Failure Assessment (SOFA) score of 2 points or more, which is associated with an in-hospital mortality greater than 10%. Septic shock should be defined as a subset of sepsis in which particularly profound circulatory, cellular, and metabolic abnormalities are associated with a

  2. Potentially Inadvertent Immunomodulation: Norepinephrine Use in Sepsis.

    PubMed

    Stolk, Roeland F; van der Poll, Tom; Angus, Derek C; van der Hoeven, Johannes G; Pickkers, Peter; Kox, Matthijs

    2016-09-01

    Septic shock is a major cause of death worldwide and a considerable healthcare burden in the twenty-first century. Attention has shifted from damaging effects of the proinflammatory response to the detrimental role of antiinflammation, a phenomenon known as sepsis-induced immunoparalysis. Sepsis-induced immunoparalysis may render patients vulnerable to secondary infections and is associated with impaired outcome. The immunoparalysis hypothesis compels us to reevaluate the current management of septic shock and to assess whether we are inadvertently compromising or altering the host immune response. In this perspective, we discuss the potential detrimental role of norepinephrine, the cornerstone treatment for septic shock, in sepsis-induced immunoparalysis. We provide a short overview of the current understanding of the immunologic pathophysiology of sepsis, followed by a detailed description of the immunomodulatory effects of norepinephrine and alternative vasopressors. We conclude that although the development of novel therapies aimed at reversing immunoparalysis is underway, the use of norepinephrine may aggravate the development, extent, and duration of sepsis-induced immunoparalysis. Current in vitro and animal data indicate that norepinephrine treatment exerts immunosuppressive and bacterial growth-promoting effects and may increase susceptibility toward infections. However, evidence in humans is circumstantial, as immunologic effects of norepinephrine have not been investigated properly in experimental or clinical studies. Alternatives such as vasopressin/selepressin, angiotensin II, and phenylephrine could have a fundamental advantage over norepinephrine with respect to their immunologic properties. However, also for these agents, in vivo immunologic data in humans are largely lacking. As such, human studies on the immunomodulatory properties of norepinephrine and viable alternatives are highly warranted. PMID:27398737

  3. Hospitalization Type and Subsequent Severe Sepsis

    PubMed Central

    Dickson, Robert P.; Rogers, Mary A. M.; Langa, Kenneth M.; Iwashyna, Theodore J.

    2015-01-01

    Rationale: Hospitalization is associated with microbiome perturbation (dysbiosis), and this perturbation is more severe in patients treated with antimicrobials. Objectives: To evaluate whether hospitalizations known to be associated with periods of microbiome perturbation are associated with increased risk of severe sepsis after hospital discharge. Methods: We studied participants in the U.S. Health and Retirement Study with linked Medicare claims (1998–2010). We measured whether three hospitalization types associated with increasing severity of probable dysbiosis (non–infection-related hospitalization, infection-related hospitalization, and hospitalization with Clostridium difficile infection [CDI]) were associated with increasing risk for severe sepsis in the 90 days after hospital discharge. We used two study designs: the first was a longitudinal design with between-person comparisons and the second was a self-controlled case series design using within-person comparison. Measurements and Main Results: We identified 43,095 hospitalizations among 10,996 Health and Retirement Study–Medicare participants. In the 90 days following non–infection-related hospitalization, infection-related hospitalization, and hospitalization with CDI, adjusted probabilities of subsequent admission for severe sepsis were 4.1% (95% confidence interval [CI], 3.8–4.4%), 7.1% (95% CI, 6.6–7.6%), and 10.7% (95% CI, 7.7–13.8%), respectively. The incidence rate ratio (IRR) of severe sepsis was 3.3-fold greater during the 90 days after hospitalizations than during other observation periods. The IRR was 30% greater after an infection-related hospitalization versus a non–infection-related hospitalization. The IRR was 70% greater after a hospitalization with CDI than an infection-related hospitalization without CDI. Conclusions: There is a strong dose–response relationship between events known to result in dysbiosis and subsequent severe sepsis hospitalization that is not present

  4. Plasma soluble Tim-3 emerges as an inhibitor in sepsis: sepsis contrary to membrane Tim-3 on monocytes.

    PubMed

    Ren, F; Li, J; Jiang, X; Xiao, K; Zhang, D; Zhao, Z; Ai, J; Hou, C; Jia, Y; Han, G; Xie, L

    2015-11-01

    Immune dysfunction is the main characteristic of sepsis. T cell Ig and mucin domain protein 3 (Tim-3) on the monocytes has been reported to promote immune homeostasis during sepsis, but the influences of plasm soluble Tim-3 (sTim-3) on the immune system during sepsis remain unknown. Here, 100 patients with different severities of sepsis (40 sepsis, 42 severe sepsis, and 18 septic shock) were enrolled in this study. The Tim-3 and human leukocyte antigen-DR (HLA-DR) on the circulating monocytes were detected using flow cytometry. Plasma sTim-3 was detected by enzyme-linked immunosorbent assay. Inflammatory factors and two kinds of A disintegrin and metalloprotease (ADAM) - ADAM10 and ADAM17 were assessed. The Tim-3 and HLA-DR on the monocytes decreased with increasing sepsis severity. The sTim-3 was reduced in the sepsis and severe sepsis patients but was elevated in the septic shock patients who exhibited significant immunosuppression as predicted by HLA-DR. sTim-3 levels were negatively correlated with IL-12 and TNF-α. ADAM10 and ADAM17, sheddases of Tim-3, exhibited trends toward elevations in the septic shock group. In conclusion, sTim-3 was involved in the development of sepsis. The homeostasis-promoting role of the Tim-3 on the monocytes was disrupted, while the inhibitory role of sTim-3 emerged during sepsis-induced immunosuppression.

  5. Etiological analysis of presumed perinatal stroke.

    PubMed

    Kocaman, Canan; Yilmaz, Yuksel

    2012-02-01

    This study aimed to investigate the maternal, pre- and perinatal, and prothrombotic factors with congenital hemiparesis due to presumed perinatal stroke (PPS). Prothrombotic risk factors including protein C and S, antithrombin III, lipoprotein (a), homocystein, factor VIII levels; anticardiolipin antibodies and lupus anticoagulant; methylenetetrahydrofolate reductase mutations, factor V Leiden, prothrombin G20210A mutations were investigated. Arterial ischemic stroke was detected in 60% and periventricular venous infarction in 40%. At least one prothrombotic risk factor was present in 69%, two in 17%, and three or more in 8.5% of cases. The most common combination was methylenetetrahydrofolate reductase C677T and factor V Leiden heterozygosity. The etiology and pathogenesis of PPS is still unclear. According to this study, most of the patients with PPS might have one or more prothrombotic risk factors and certain prenatal risk factors including intrauterine growth retardation, twin gestation and preeclampsia might be related to PPS. PMID:21561729

  6. Perinatal nurses' perceptions of competency assessments.

    PubMed

    Maddox, Brenda L; Waller-Wise, Renece; Weed, Latricia D

    2014-10-01

    Competency assessment should be a changing and continuing process. In addition, it should be appropriate for the organization and the nursing staff. Nursing educators are challenged to provide a competency assessment process that is relevant and meaningful. This qualitative research study describes perinatal nurses' perceptions of a change from a traditional testing competency assessment to a hands-on competency assessment. The setting was a medical center in southeastern Alabama. Thirteen nurses participated in the study. Focus groups were used to explore the new assessment method. Three themes were identified: I am learning, multidimensional learning together, and increasing professional confidence. As the medical center perinatal nursing competency assessment program continues to improve, the expectation is for other departments to assess and revise their competency assessment program.

  7. Perinatal mortality in Matlab, Bangladesh: a community-based study.

    PubMed

    Fauveau, V; Wojtyniak, B; Mostafa, G; Sarder, A M; Chakraborty, J

    1990-09-01

    Perinatal deaths, comprising stillbirths and deaths during the first week of life, were monitored over the eight-year period 1979 to 1986 in a rural Bangladeshi population of 196,000. The perinatal mortality rate was 75 per 1000 total births. The rate was 13% higher in males than females. Stillbirth and early neonatal mortality rates were 37 and 38 per 1000 total births, respectively. The major causes of perinatal deaths are presented, as well as some of the maternal determinants. During the period under study, perinatal mortality declined regularly and significantly over time in an area covered by an intensive Family Planning and Health Services programme, but not in the adjacent control area. This raises the issue of the impact of such a programme upon perinatal mortality, and the need to include a strong maternity care component into primary healthcare strategies if further reductions of perinatal mortality are to be achieved. PMID:2262255

  8. Perinatal mortality attributable to complications of childbirth in Matlab, Bangladesh.

    PubMed Central

    Kusiako, T.; Ronsmans, C.; Van der Paal, L.

    2000-01-01

    Very few population-based studies of perinatal mortality in developing countries have examined the role of intrapartum risk factors. In the present study, the proportion of perinatal deaths that are attributable to complications during childbirth in Matlab, Bangladesh, was assessed using community-based data from a home-based programme led by professional midwives between 1987 and 1993. Complications during labour and delivery--such as prolonged or obstructed labour, abnormal fetal position, and hypertensive diseases of pregnancy--increased the risk of perinatal mortality fivefold and accounted for 30% of perinatal deaths. Premature labour, which occurred in 20% of pregnancies, accounted for 27% of perinatal mortality. Better care by qualified staff during delivery and improved care of newborns should substantially reduce perinatal mortality in this study population. PMID:10859856

  9. Perinatal Risk Factors for Mild Motor Disability

    ERIC Educational Resources Information Center

    Hands, Beth; Kendall, Garth; Larkin, Dawne; Parker, Helen

    2009-01-01

    The aetiology of mild motor disability (MMD) is a complex issue and as yet is poorly understood. The aim of this study was to identify the prevalence of perinatal risk factors in a cohort of 10-year-old boys and girls with (n = 362) and without (n = 1193) MMD. Among the males with MMD there was a higher prevalence of postpartum haemorrhage,…

  10. Specific ultrasonographic features of perinatal lethal hypophosphatasia.

    PubMed

    Zankl, Andreas; Mornet, Etienne; Wong, Shell

    2008-05-01

    Prenatal diagnosis of perinatal lethal hypophosphatasia (PL-HPH) by ultrasonography is difficult as PL-HPH must be differentiated from other skeletal dysplasias with short long bones and poor mineralization of the skeleton, such as osteogenesis imperfecta type II and achondrogenesis/hypochondrogenesis. Here we present a case of molecularly confirmed PL-HPH and illustrate specific ultrasonographic findings that help to distinguish PL-HPH from similar conditions. PMID:18386808

  11. Mechanisms of perinatal arterial ischemic stroke

    PubMed Central

    Fernández-López, David; Natarajan, Niranjana; Ashwal, Stephen; Vexler, Zinaida S

    2014-01-01

    The incidence of perinatal stroke is high, similar to that in the elderly, and produces a significant morbidity and severe long-term neurologic and cognitive deficits, including cerebral palsy, epilepsy, neuropsychological impairments, and behavioral disorders. Emerging clinical data and data from experimental models of cerebral ischemia in neonatal rodents have shown that the pathophysiology of perinatal brain damage is multifactorial. These studies have revealed that, far from just being a smaller version of the adult brain, the neonatal brain is unique with a very particular and age-dependent responsiveness to hypoxia–ischemia and focal arterial stroke. In this review, we discuss fundamental clinical aspects of perinatal stroke as well as some of the most recent and relevant findings regarding the susceptibility of specific brain cell populations to injury, the dynamics and the mechanisms of neuronal cell death in injured neonates, the responses of neonatal blood–brain barrier to stroke in relation to systemic and local inflammation, and the long-term effects of stroke on angiogenesis and neurogenesis. Finally, we address translational strategies currently being considered for neonatal stroke as well as treatments that might effectively enhance repair later after injury. PMID:24667913

  12. Action plan to reduce perinatal mortality.

    PubMed

    Bhakoo, O N; Kumar, R

    1990-01-01

    The government of India has set a goal of reducing perinatal mortality from its current rate of 48/1000 to 30-35/1000 by the year 2000. Perinatal deaths result from maternal malnutrition, inadequate prenatal care, complications of delivery, and infections in the postpartum period. Since reductions in perinatal mortality require attention to social, economic, and behavioral factors, as well as improvements in the health care delivery system, a comprehensive strategy is required. Social measures, such as raising the age at marriage to 18 years for females, improving the nutritional status of adolescent girls, reducing the strenuousness of work during pregnancy, improving female literacy, raising women's status in the society and thus in the family, and poverty alleviation programs, would all help eliminate the extent of complications of pregnancy. Measures required to enhance infant survival include improved prenatal care, prenatal tetanus toxoid immunization, use of sterile disposable cord care kits, the provision of mucus extractors and resuscitation materials to birth attendants, the creation of neonatal care units in health facilities, and more efficient referral of high-risk newborns and mothers. Since 90% of births in rural India take place at home priority must be given to training traditional birth attendants in the identification of high risk factors during pregnancy, delivery, and the newborn period. PMID:12316585

  13. Blood Biomarkers for Evaluation of Perinatal Encephalopathy

    PubMed Central

    Graham, Ernest M.; Burd, Irina; Everett, Allen D.; Northington, Frances J.

    2016-01-01

    Recent research in identification of brain injury after trauma shows many possible blood biomarkers that may help identify the fetus and neonate with encephalopathy. Traumatic brain injury shares many common features with perinatal hypoxic-ischemic encephalopathy. Trauma has a hypoxic component, and one of the 1st physiologic consequences of moderate-severe traumatic brain injury is apnea. Trauma and hypoxia-ischemia initiate an excitotoxic cascade and free radical injury followed by the inflammatory cascade, producing injury in neurons, glial cells and white matter. Increased excitatory amino acids, lipid peroxidation products, and alteration in microRNAs and inflammatory markers are common to both traumatic brain injury and perinatal encephalopathy. The blood-brain barrier is disrupted in both leading to egress of substances normally only found in the central nervous system. Brain exosomes may represent ideal biomarker containers, as RNA and protein transported within the vesicles are protected from enzymatic degradation. Evaluation of fetal or neonatal brain derived exosomes that cross the blood-brain barrier and circulate peripherally has been referred to as the “liquid brain biopsy.” A multiplex of serum biomarkers could improve upon the current imprecise methods of identifying fetal and neonatal brain injury such as fetal heart rate abnormalities, meconium, cord gases at delivery, and Apgar scores. Quantitative biomarker measurements of perinatal brain injury and recovery could lead to operative delivery only in the presence of significant fetal risk, triage to appropriate therapy after birth and measure the effectiveness of treatment. PMID:27468268

  14. Ethics in perinatal medicine: A global perspective.

    PubMed

    Chervenak, Frank A; McCullough, Laurence B

    2015-10-01

    This article describes the professional responsibility model of perinatal ethics, which requires the perinatologist in all cases to identify and balance beneficence-based and autonomy-based obligations to the pregnant patient, beneficence-based obligations to the fetal patient, and beneficence-based obligations to the neonatal patient. We explain how this model avoids the clinical failure of both fetal and maternal rights-based reductionism, i.e., insistence either on unlimited fetal rights or on unlimited maternal rights, respectively. The professional responsibility model of perinatal ethics provides the basis for the transnational clinical ethical concept of healthcare justice, which requires that beneficence-based obligations to all patients be routinely fulfilled by providing them with an evidence-based standard of care. We then show how healthcare justice can be used to identify and address ethically unacceptable allocation of healthcare resources. The professional responsibility model of perinatal ethics creates an important role for the perinatologist as responsible advocate for pregnant, fetal, and neonatal patients. PMID:26049210

  15. Behavioural outcomes of perinatal maternal fluoxetine treatment.

    PubMed

    McAllister, B B; Kiryanova, V; Dyck, R H

    2012-12-13

    During and following pregnancy, women are at considerable risk of experiencing depression. For treatment, selective serotonin reuptake inhibitor drugs, such as fluoxetine, are commonly prescribed, yet the potential effects of perinatal exposure to these drugs on the brain and behaviour have not been examined in humans beyond childhood. This is despite abundant evidence from studies using rodents indicating that altered serotonin levels early in life affect neurodevelopment and behavioural outcomes. These reported effects on behaviour are inconsistent, however, and the testing of females has often been overlooked. In the present study, the behavioural outcomes of female mice perinatally (embryonic day 15 to postnatal day 12) treated with fluoxetine (25mg/kg/day) via a non-stressful method of maternal administration were assessed using a battery of tests. Maternal treatment resulted in subtle alterations in anxiety-like and depression-like behaviour in early adulthood, with a decrease in both types of behaviour as well as body weight. Though altered anxiety and depression have previously been reported in this area of research, decreased anxiety is a novel finding. While there was little effect of perinatal maternal fluoxetine treatment on many of the behaviours assessed, the capacity to alter "emotional" behaviours in mice has implications with regard to research on human infant fluoxetine exposure.

  16. Perinatal nicotine-induced transgenerational asthma.

    PubMed

    Rehan, Virender K; Liu, Jie; Sakurai, Reiko; Torday, John S

    2013-10-01

    Asthma is a major public health hazard worldwide. Its transgenerational inheritance has been inferred from epidemiological studies. More recently, using nicotine as a proxy for maternal smoking, we have demonstrated that an asthma-like phenotype can be inherited by rat offspring for up to two generations, i.e., multigenerationally, after the initial intrauterine exposure. We hypothesized that asthma transmission to offspring following perinatal nicotine exposure is not restricted up to F2 generation, but it also extends to subsequent generations. To test this hypothesis, using a well-established rat model of nicotine exposure-induced childhood asthma, we determined if perinatal nicotine exposure of F0 gestating dams would transmit asthma transgenerationally to F3 offspring. We now extend our findings to third-generation offspring, including abnormal pulmonary function, particularly as it relates to the occurrence in the upper airway exclusively in males, and to its effects on molecular functional markers (fibronectin and peroxisome proliferator-activated receptor γ), previously shown to be consistent with the asthma phenotype, herein expressed in fibroblasts isolated from the lung. These data, for the first time, demonstrate the transgenerational transmission of the asthma phenotype to F3 offspring following perinatal nicotine exposure of F0 dams. PMID:23911437

  17. Sirtuin-2 Regulates Sepsis Inflammation in ob/ob Mice

    PubMed Central

    Wang, Xianfeng; Buechler, Nancy L.; Martin, Ayana; Wells, Jonathan; Yoza, Barbara; McCall, Charles E.; Vachharajani, Vidula

    2016-01-01

    Objective Obesity increases morbidity and resource utilization in sepsis patients. Sepsis transitions from early/hyper-inflammatory to late/hypo-inflammatory phase. Majority of sepsis-mortality occurs during the late sepsis; no therapies exist to treat late sepsis. In lean mice, we have shown that sirtuins (SIRTs) modulate this transition. Here, we investigated the role of sirtuins, especially the adipose-tissue abundant SIRT-2 on transition from early to late sepsis in obese with sepsis. Methods Sepsis was induced using cecal ligation and puncture (CLP) in ob/ob mice. We measured microvascular inflammation in response to lipopolysaccharide/normal saline re-stimulation as a “second-hit” (marker of immune function) at different time points to track phases of sepsis in ob/ob mice. We determined SIRT-2 expression during different phases of sepsis. We studied the effect of SIRT-2 inhibition during the hypo-inflammatory phase on immune function and 7-day survival. We used a RAW264.7 (RAW) cell model of sepsis for mechanistic studies. We confirmed key findings in diet induced obese (DIO) mice with sepsis. Results We observed that the ob/ob-septic mice showed an enhanced early inflammation and a persistent and prolonged hypo-inflammatory phase when compared to WT mice. Unlike WT mice that showed increased SIRT1 expression, we found that SIRT2 levels were increased in ob/ob mice during hypo-inflammation. SIRT-2 inhibition in ob/ob mice during the hypo-inflammatory phase of sepsis reversed the repressed microvascular inflammation in vivo via activation of endothelial cells and circulating leukocytes and significantly improved survival. We confirmed the key finding of the role of SIRT2 during hypo-inflammatory phase of sepsis in this project in DIO-sepsis mice. Mechanistically, in the sepsis cell model, SIRT-2 expression modulated inflammatory response by deacetylation of NFκBp65. Conclusion SIRT-2 regulates microvascular inflammation in obese mice with sepsis and may

  18. Post–Acute Care Use and Hospital Readmission after Sepsis

    PubMed Central

    Jones, Tiffanie K.; Fuchs, Barry D.; Small, Dylan S.; Halpern, Scott D.; Hanish, Asaf; Umscheid, Craig A.; Baillie, Charles A.; Kerlin, Meeta Prasad; Gaieski, David F.

    2015-01-01

    Rationale: The epidemiology of post–acute care use and hospital readmission after sepsis remains largely unknown. Objectives: To examine the rate of post–acute care use and hospital readmission after sepsis and to examine risk factors and outcomes for hospital readmissions after sepsis. Methods: In an observational cohort study conducted in an academic health care system (2010–2012), we compared post–acute care use at discharge and hospital readmission after 3,620 sepsis hospitalizations with 108,958 nonsepsis hospitalizations. We used three validated, claims-based approaches to identify sepsis and severe sepsis. Measurements and Main Results: Post–acute care use at discharge was more likely after sepsis, driven by skilled care facility placement (35.4% after sepsis vs. 15.8%; P < 0.001), with the highest rate observed after severe sepsis. Readmission rates at 7, 30, and 90 days were higher postsepsis (P < 0.001). Compared with nonsepsis hospitalizations (15.6% readmitted within 30 d), the increased readmission risk was present regardless of sepsis severity (27.3% after sepsis and 26.0–26.2% after severe sepsis). After controlling for presepsis characteristics, the readmission risk was found to be 1.51 times greater (95% CI, 1.38–1.66) than nonsepsis hospitalizations. Readmissions after sepsis were more likely to result in death or transition to hospice care (6.1% vs. 13.3% after sepsis; P < 0.001). Independent risk factors associated with 30-day readmissions after sepsis hospitalizations included age, malignancy diagnosis, hospitalizations in the year prior to the index hospitalization, nonelective index admission type, one or more procedures during the index hospitalization, and low hemoglobin and high red cell distribution width at discharge. Conclusions: Post–acute care use and hospital readmissions were common after sepsis. The increased readmission risk after sepsis was observed regardless of sepsis severity and was associated with

  19. Improving the management of sepsis in a district general hospital by implementing the 'Sepsis Six' recommendations.

    PubMed

    Kumar, Prashant; Jordan, Mark; Caesar, Jenny; Miller, Sarah

    2015-01-01

    Sepsis is a common condition with a major global impact on healthcare resources and expenditure. The Surviving Sepsis Campaign has been vigorous in promoting internationally recognised pathways to improve the management of septic patients and decrease mortality. However, translating recommendations into practice is a challenging and complex task that requires a multi-faceted approach with sustained engagement from local stakeholders. Whilst working at a district general hospital in New Zealand, we were concerned by the seemingly inconsistent management of septic patients, often leading to long delays in the initiation of life-saving measures such as antibiotic, fluid, and oxygen administration. In our hospital there were no clear systems, protocols or guidelines in place for identifying and managing septic patients. We therefore launched the Sepsis Six resuscitation bundle of care in our hospital in an attempt to raise awareness amongst staff and improve the management of septic patients. We introduced a number of simple low-cost interventions that included educational sessions for junior doctors and nursing staff, as well as posters and modifications to phlebotomy trolleys that acted as visual reminders to implement the Sepsis Six bundle. Overall, we found there to a be a steady improvement in the delivery of the Sepsis Six bundle in septic patients with 63% of patients receiving appropriate care within one hour, compared to 29% prior to our interventions. However this did not translate to an improvement in patient mortality. This project forms part of an on going process to instigate a fundamental culture change among local healthcare professionals regarding the management of sepsis. Whilst we have demonstrated improved implementation of the Sepsis Six bundle, the key challenge remains to ensure that momentum of this project continues and forms a platform for sustainable clinical improvement in the long term. PMID:26734403

  20. Characterization and quantification of unintentional POP emissions from primary and secondary copper metallurgical processes in China

    NASA Astrophysics Data System (ADS)

    Nie, Zhiqiang; Liu, Guorui; Liu, Wenbin; Zhang, Bing; Zheng, Minghui

    2012-09-01

    Field monitoring was conducted to update and develop unintentional persistent organic pollutant (unintentional POP) emission inventories for the copper metallurgy industry in China. In this study, emissions of six unintentional POPs comprised of polychlorinated dibenzo-p-dioxin and dibenzofuran (PCDD/PCDF), polychlorinated biphenyls (PCBs), polychlorinated naphthalenes (PCNs), hexachlorobenzene (HxCBz) and pentachlorobenzene (PeCBz) in stack gas and fly ash samples from primary and secondary copper smelters using different raw materials and technologies were measured and compared. Different concentrations, congener patterns and emission factors of unintentional POPs among four copper smelters were observed. Variations in unintentional POP emissions from several areas of a primary copper smelter were also investigated. The total emissions of unintentional POPs from primary and secondary copper production in 2010 in China were estimated respectively. These results provide a useful reference for the establishment of unintentional POP emission inventories and for policymakers to formulate control strategies to reduce unintentional POPs resulting from copper metallurgy.

  1. Dual role of astrocytes in perinatal asphyxia injury and neuroprotection.

    PubMed

    Romero, J; Muñiz, J; Logica Tornatore, T; Holubiec, M; González, J; Barreto, G E; Guelman, L; Lillig, C H; Blanco, E; Capani, F

    2014-04-17

    Perinatal asphyxia represents an important cause of severe neurological deficits including delayed mental and motor development, epilepsy, major cognitive deficits and blindness. However, at the moment, most of the therapeutic strategies were not well targeted toward the processes that induced the brain injury during perinatal asphyxia. Traditionally, experimental research focused on neurons, whereas astrocytes have been more related with the damage mechanisms of perinatal asphyxia. In this work, we propose to review possible protective as well as deleterious roles of astrocytes in the asphyctic brain with the aim to stimulate further research in this area of perinatal asphyxia still not well studied. PMID:24172702

  2. Dual role of astrocytes in perinatal asphyxia injury and neuroprotection.

    PubMed

    Romero, J; Muñiz, J; Logica Tornatore, T; Holubiec, M; González, J; Barreto, G E; Guelman, L; Lillig, C H; Blanco, E; Capani, F

    2014-04-17

    Perinatal asphyxia represents an important cause of severe neurological deficits including delayed mental and motor development, epilepsy, major cognitive deficits and blindness. However, at the moment, most of the therapeutic strategies were not well targeted toward the processes that induced the brain injury during perinatal asphyxia. Traditionally, experimental research focused on neurons, whereas astrocytes have been more related with the damage mechanisms of perinatal asphyxia. In this work, we propose to review possible protective as well as deleterious roles of astrocytes in the asphyctic brain with the aim to stimulate further research in this area of perinatal asphyxia still not well studied.

  3. New uses of legacy systems: examples in perinatal care.

    PubMed

    Margolis, A; Vázquez, R; Mendoza, G; Zignago, A; López, A; Lucián, H

    1999-01-01

    In this article, new uses of the Perinatal Information System at the Uruguayan Social Security health care facilities are described. The perinatal information system has been in place for over 13 years, with about 40 thousand clinical records on electronic files. A newly created Web interface allows a distributed access to existing perinatal information within the National Social Security Wide Area a Network. Perinatal data is also exported to a management information system, allowing to dynamically answer questions and make managerial decisions, and eventually link these data with other sources. Future steps regarding clinical information systems are outlined.

  4. New uses of legacy systems: examples in perinatal care.

    PubMed Central

    Margolis, A.; Vázquez, R.; Mendoza, G.; Zignago, A.; López, A.; Lucián, H.

    1999-01-01

    In this article, new uses of the Perinatal Information System at the Uruguayan Social Security health care facilities are described. The perinatal information system has been in place for over 13 years, with about 40 thousand clinical records on electronic files. A newly created Web interface allows a distributed access to existing perinatal information within the National Social Security Wide Area a Network. Perinatal data is also exported to a management information system, allowing to dynamically answer questions and make managerial decisions, and eventually link these data with other sources. Future steps regarding clinical information systems are outlined. Images Figure 1 Figure 2 PMID:10566481

  5. The neuropathology of acquired pre- and perinatal brain injuries.

    PubMed

    Folkerth, Rebecca D

    2007-02-01

    Acquired pre- and perinatal brain injuries comprise a significant proportion of perinatal neuropathology. They are associated with placental abnormalities, maternal factors, multiple gestations, and preterm labor, as well as with the later development of cerebral palsy and developmental delay. The patterns of perinatal brain injury depend on the etiology (often hypoxic-ischemic) and the timing relative to the development of the fetal nervous system, since the vulnerabilities of gray and white matter differ across postconceptional age and by neuroanatomic site. Nevertheless, characteristic features allow determination of the approximate age and cause of each pattern of injury in the perinatal brain. PMID:17455862

  6. The perinatal safety nurse: exemplar of transformational leadership.

    PubMed

    Raab, Cheryl; Palmer-Byfield, Renée

    2011-01-01

    There is increased attention to the issue of patient safety in the care of pregnant women and their infants. The Joint Commission has issued sentinel event alerts regarding infant and maternal morbidity and mortality. Hospitals and healthcare systems are implementing perinatal patient safety programs to minimize the risk of preventable patient harm. This article describes the role of the perinatal patient safety nurse as one aspect of a comprehensive initiative to promote patient safety for women who give birth. Nurses and organizations offering perinatal care are encouraged to incorporate the role of perinatal patient safety nurse in their patient safety efforts. PMID:21743356

  7. Severe sepsis and septic shock: defining the clinical problem.

    PubMed

    Opal, Steven M

    2003-01-01

    It is generally acknowledged that severe sepsis/septic shock is a major problem in clinical medicine, yet the extent of the problem and its basic immunology remain poorly defined. The generation of accurate statistics about sepsis is confounded by the imprecise and highly variable terminology used to describe sepsis by clinicians around the world. The problem of sepsis is further complicated by the remarkably diverse spectrum of illness encompassed under the term 'sepsis'. Sepsis may range in severity from mild systemic inflammation without significant clinical consequences to multisystem failure in septic shock with an exceedingly high mortality rate. Sepsis connotes a clinical syndrome that may occur in any age group, in markedly different patient populations, and in response to a multitude of microbial pathogens from multiple different anatomical sites within the human body. A concerted effort has been made to standardize definitions of sepsis by the use of international committees and consensus opinions from panels of experts in sepsis research. While consensus definitions of sepsis have proven to be of value, the lack of uniformity in interpretation of these definitions continues to be problematic by clinicians and basic researchers alike. Recently, a new conceptual framework for understanding sepsis has been developed, called the PIRO concept (predisposition, infection, response and organ dysfunction). This has been conceptually modeled from the TNM classification (tumor size, nodal spread, metastases) which has been successfully used in defining treatment and prognostic indicators in clinical oncology. Further refinements in the definitions and predisposing factors of severe sepsis should improve the understanding and management of severe sepsis and septic shock in the near future.

  8. POP emission inventories on different scales and their future trends

    NASA Astrophysics Data System (ADS)

    Theloke, Jochen; Breivik, Knut; Denier van der Gon, Hugo; Kugler, Ulrike; Li, Yi-Fan; Pacyna, Jozef; Panasiuk, Damian; Sundseth, Kyrre; Sweetman, Andy; Tao, Shu

    2010-05-01

    Persistent organic pollutants (POPs) are defined as organic substances that possess toxic characteristics; are persistent; bioaccumulate; are prone to long-range transboundary atmospheric transport and deposition; and are likely to cause significant adverse human health or environmental effects near to and distant from their sources. To reduce these adverse effects and for monitoring the effectiveness of existing international agreements, esp. UNECE-POP and UNEP protocols, concerning POPs the compilation of emission inventories is required. This presentation addresses emission inventories for POPs which are covered by existing protocols as well as candidate substances which are in focus for the revision of the international protocols. The following substances will be taken into account in this presentation: Dioxins and Furans (PCDD/F), PAHs, PCBs, Hexachlorbenzene (HCB), Pesticides (e.g. HCH, Dicofol and Endosulfan), Perfluoroctansulfonate (PFOS) and Polybrominated Diphenylethers (PBDEs), Hexachlorobutadiene (HCBD), Pentachlorobenzene (PeCB), Polychlorinated Naphthalenes (PCN), and Pentachlorophenols (PCPs). For all considered substances emission inventories exist with different qualities, from preliminary estimates to more complete inventories. These inventories are based on different methodologies (measurements, modelling, mass balance approaches, etc.), cover different regions (Europe, North America, Asia, China) and different spatial scales (regional, global) with different spatial resolutions. An overview will be given of the current state of the knowledge through a description of the main sources for the specific pollutants, the recent emission levels, a description of historical emission (incl. time series) and gridded data bases, if available. Furthermore, recommendations to improve POP emission inventories as well as major obstacles to achieve these improvements will be given. A further focus of this presentation will be an overview of future trends of

  9. Sepsis in the severely immunocompromised patient.

    PubMed

    Kalil, Andre C; Opal, Steven M

    2015-06-01

    The prevention and treatment of sepsis in the immunocompromised host present a challenging array of diagnostic and management issues. The neutropenic patient has a primary defect in innate immune responses and is susceptible to conventional and opportunistic pathogens. The solid organ transplant patient has a primary defect in adaptive immunity and is susceptible to a myriad of pathogens that require an effective cellular immune response. Risk for infections in organ transplant recipients is further complicated by mechanical, vascular, and rejection of the transplanted organ itself. The immune suppressed state can modify the cardinal signs of inflammation, making accurate and rapid diagnosis of infection and sepsis difficult. Empiric antimicrobial agents can be lifesaving in these patients, but managing therapy in an era of progressive antibiotic resistance has become a real issue. This review discusses the challenges faced when treating severe infections in these high-risk patients.

  10. Sepsis in the severely immunocompromised patient.

    PubMed

    Kalil, Andre C; Opal, Steven M

    2015-06-01

    The prevention and treatment of sepsis in the immunocompromised host present a challenging array of diagnostic and management issues. The neutropenic patient has a primary defect in innate immune responses and is susceptible to conventional and opportunistic pathogens. The solid organ transplant patient has a primary defect in adaptive immunity and is susceptible to a myriad of pathogens that require an effective cellular immune response. Risk for infections in organ transplant recipients is further complicated by mechanical, vascular, and rejection of the transplanted organ itself. The immune suppressed state can modify the cardinal signs of inflammation, making accurate and rapid diagnosis of infection and sepsis difficult. Empiric antimicrobial agents can be lifesaving in these patients, but managing therapy in an era of progressive antibiotic resistance has become a real issue. This review discusses the challenges faced when treating severe infections in these high-risk patients. PMID:25939918

  11. Carbon monoxide in the treatment of sepsis.

    PubMed

    Nakahira, Kiichi; Choi, Augustine M K

    2015-12-15

    Carbon monoxide (CO), a low-molecular-weight gas, is endogenously produced in the body as a product of heme degradation catalyzed by heme oxygenase (HO) enzymes. As the beneficial roles of HO system have been elucidated in vitro and in vivo, CO itself has also been reported as a potent cytoprotective molecule. Whereas CO represents a toxic inhalation hazard at high concentration, low-dose exogenous CO treatment (~250-500 parts per million) demonstrates protective functions including but not limited to the anti-inflammatory and antiapoptotic effects in preclinical models of human diseases. Of note, CO exposure confers protection in animal models of sepsis by inhibiting inflammatory responses and also enhancing bacterial phagocytosis in leukocytes. These unique functions of CO including both dampening inflammation and promoting host defense mechanism are mediated by multiple pathways such as autophagy induction or biosynthesis of specialized proresolving lipid mediators. We suggest that CO gas may represent a novel therapy for patients with sepsis.

  12. Sepsis management: An evidence-based approach.

    PubMed

    Baig, Muhammad Akbar; Shahzad, Hira; Jamil, Bushra; Hussain, Erfan

    2016-03-01

    The Surviving Sepsis Campaign (SSC) guidelines have outlined an early goal directed therapy (EGDT) which demonstrates a standardized approach to ensure prompt and effective management of sepsis. Having said that, there are barriers associated with the application of evidence-based practice, which often lead to an overall poorer adherence to guidelines. Considering the global burden of disease, data from low- to middle-income countries is scarce. Asia is the largest continent but most Asian countries do not have a well-developed healthcare system and compliance rates to resuscitation and management bundles are as low as 7.6% and 3.5%, respectively. Intensive care units are not adequately equipped and financial concerns limit implementation of expensive treatment strategies. Healthcare policy-makers should be notified in order to alleviate financial restrictions and ensure delivery of standard care to septic patients.

  13. Haemophilus influenzae sepsis resulting from pneumonia.

    PubMed

    Marinella, M A

    1997-01-01

    Haemophilus influenzae is a pleomorphic gram-negative bacterium that causes a myriad of infections in both adults and children. The organism frequently causes respiratory infections in patients with obstructive lung disease but may on occasion cause invasive infections including pneumonia with bacteremia. We report the case of a patient with underlying lung disease and metastatic malignancy in whom sepsis related to pneumonia caused by H. influenzae developed.

  14. Leaching behavior of persistent organic pollutants (POPs) in shredder residues.

    PubMed

    Sakai, S; Urano, S; Takatsuki, H

    1998-01-01

    It is well known that some kinds of waste contain persistent organic pollutants (POPs) such as PCDD/DFs and PCBs. Leaching behaviors of these chemicals, however, have not been focused so much because of their low leachability. On the other hand, shredder residues originated from automobiles and electric appliances consist mainly of plastics, such as PVC, which contain additives including DEHP. In this study, contents analyses and leaching tests with and without surfactant-like substances for shredder residues were conducted. As a result, shredder residues from automobile and electric appliance contained PCBs in ppm level and a quantity of PCDD/DFs. Surfactant-like substances increase the leaching concentration of POPs. DEHP also leached out considerably even though using distilled water. PMID:9828329

  15. THE EPITHELIUM AS A TARGET IN SEPSIS.

    PubMed

    Chawla, Lakhmir S; Fink, Mitchell; Goldstein, Stuart L; Opal, Steven; Gómez, Alonso; Murray, Patrick; Gómez, Hernando; Kellum, John A

    2016-03-01

    Organ dysfunction induced by sepsis has been consistently associated with worse outcome and death. Regardless of the organ compromised, epithelial dysfunction is present throughout the body, affecting those organs that contain epithelia like the skin, lungs, liver, gut, and kidneys. Despite their obvious differences, sepsis seems to alter common features of all epithelia, such as barrier function and vectorial ion transport. Such alterations in the lung, the gut, and the kidney have direct implications that may explain the profound organ functional impairments in the absence of overt cell death. Epithelial injury in this context is not only an explanatory real pathophysiologic event, but also represents a source of biomarkers that have been explored to identify organ compromise earlier, predict outcome, and even to test novel therapeutic interventions such as blood purification. However, this remains largely experimental, and despite promising results, work is still required to better understand the response of the epithelial cells to sepsis, to define their role in adaptation to insults, to comprehend the interorgan cross-talk that occurs in these circumstances, and to exploit these aspects in pursuit of targeted therapies like blood purification, which may improve outcome for these patients in the future. PMID:26863125

  16. Reduction in maternal mortality due to sepsis.

    PubMed

    Chhabra, S; Kaipa, A; Kakani, A

    2005-02-01

    The present study was undertaken at a rural medical institute in India to analyse the trends in maternal mortality due to sepsis and the factors associated with change, if any. During the study period of 20 years, a total of 37,155 women delivered, 192 deaths occurred and forty deaths (20.83%) were due to sepsis and it's sequlae. It was revealed that there is a definite decrease in the proportion of deaths due to sepsis, to 10% in the last five years from 35% in earlier years. The change seems to be due to the advocacy of clean deliveries and reduction in case fatality because of alterations in medication and earlier surgical intervention. However the percentage contribution of septic abortion has remained the same. Septic abortion continues to exist inspite of all the current laws and discussion about the availability of a liberal law, which permits abortion almost on request. Most of the women who had died due to septic abortion were married (65%). Deaths due to septic abortion, are persisting even in married women and it is a matter of concern for health providers, policy makers and governments. PMID:15814392

  17. Sepsis and Meningitis due to Listeria Monocytogenes

    PubMed Central

    Aygen, Bilgehan; Esel, Duygu; Kayabas, Uner; Alp, Emine; Sumerkan, Bulent; Doganay, Mehmet

    2007-01-01

    Purpose This study focused on the effect of immuno-compromising conditions on the clinical presentation of severe listerial infection. Patients and Methods Nine human listeriosis cases seen from 1991-2002 were reviewed. All adult patients, from whose blood, peritoneal fluid or cerebrospinal fluid (CSF) the L. monocytogenes was isolated, were included in this retrospective study. Results Listeriosis presented as primary sepsis with positive blood cultures in 5 cases and meningitis with positive CSF cultures in 4 cases. All of these patients had at least one underlying disease, most commonly, hematologic malignancy, diabetes mellitus, amyloidosis and hepatic cirrhosis; 55.6% had received immunosuppressive or corticosteroid therapy within a week before the onset of listeriosis. The patients were adults with a mean age of 60 years. Fever, night sweats, chills and lethargy were the most common symptoms; high temperature (> 38℃), tachycardia, meningeal signs and poor conditions in general were the most common findings on admission. The mortality rate was 33.3% and was strictly associated with the severity of the underlying disease. Mortality differences were significant between sepsis (20%) and meningitis (50%) patients. Conclusion Listeriosis as an uncommon infection in our region and that immuno-suppressive therapy is an important pre-disposing factor of listeriosis. Sepsis and meningitis were more common in this group of patients and had the highest case-fatality rate for food-borne illnesses. PMID:17594151

  18. Coagulation in patients with severe sepsis.

    PubMed

    Levi, Marcel; Poll, Tom van der

    2015-02-01

    In the majority of patients with severe sepsis, systemic activation of coagulation is present. Increasing evidence points to an extensive cross-talk between coagulation and inflammation that may play an important role in the pathogenesis of sepsis. Inflammation not only leads to activation of coagulation, but coagulation also considerably affects inflammatory activity. Molecular pathways that contribute to inflammation-induced activation of coagulation have been precisely identified. Proinflammatory cytokines and other mediators are capable of activating the coagulation system and downregulating important physiological anticoagulant pathways. Activation of the coagulation system and ensuing thrombin generation is dependent on expression of tissue factor on activated mononuclear cells and endothelial cells, and is insufficiently counteracted by TFPI. Simultaneously, endothelial-bound anticoagulant mechanism, in particular the protein C system, is shutoff by proinflammatory cytokines. In addition, fibrin removal is severely inhibited, because of inactivation of the fibrinolytic system, caused by an upregulation of its main inhibitor, plasminogen activator inhibitor type 1 (PAI-1). Increased fibrin formation and impaired removal lead to (micro)vascular thrombosis, which may result in tissue ischemia and subsequent organ damage. The cornerstone of the management of coagulation in sepsis is the specific and vigorous treatment of the underlying disorder. Strategies aimed at the inhibition of coagulation activation may theoretically be justified and have been found beneficial in experimental and initial clinical studies. Heparin may be an effective anticoagulant approach and alternative strategies comprise restoration of physiological anticoagulant pathways. PMID:25590524

  19. Leading-Edge "Pop-Up" Spoiler For Airfoil

    NASA Technical Reports Server (NTRS)

    Wilson, John C.; Lance, Michael B.

    1991-01-01

    New concept places spoiler in leading edge of airfoil, hinged along its trailing edge, so airflow helps to deploy it and force it against mechanical stop. Deployed "pop-up" spoiler quickly eliminates almost all aerodynamic lift of stabilator. Designed to be added to leading edge of existing stabilator, without major rework. Though initial application to be on helicopter stabilators, equally applicable to wings or winglike components.

  20. Boron in the extreme Pop II star HD 140283

    NASA Astrophysics Data System (ADS)

    Edvardsson, Bengt

    1997-07-01

    Using the HST and ground-based observations we have determined abundances of boron and beryllium in the extreme Pop II dwarf HD140283. These are very useful since different scenarios for the origins of Be and B in the Early Galaxy suggest different abundance ratios between the two elements. From the 2497 Angstrom B I line the boron abundance was found to be log epsilon{B} {=12 + log{N{B}/N{H}}} =0.34 +/- 0.20 {Edvardsson et al. 1994, A&A 290, 176}. Our abundance ratio N{B}/N{Be} 17 and similar results for other stars indicate that these elements were formed by cosmic ray spallation in the Early Galaxy. Other suggested mechanisms include inhomogeneous Big Bang nucleosynthesis, supernova boron production or photoerosion in active galactic nuclei. These mechanisms would give other abundance ratios. We now want to confirm these results by observing the 2089 Angstrom B I line. The line is expected to give an independent check of the boron abundances as well as an opportunity to examine the suitability of the line for future investigations of the ratio between the isotopes 11B/10B in Pop II stars. This isotopic ratio has never been measured in Pop II objects and provides further important information concerning the mechanism of 11B production and the conditions in the Early Galaxy. For comparison, the solar system {meteoritic} 11B/10B suggests that about 40% of the 11B in Pop I objects is not formed by ISM spallation, but probably in Supernovae of Type II.

  1. Popping of graphite oxide: application in preparing metal nanoparticle catalysts.

    PubMed

    Gao, Yongjun; Chen, Xi; Zhang, Jiaguang; Asakura, Hiroyuki; Tanaka, Tsunehiro; Teramura, Kentaro; Ma, Ding; Yan, Ning

    2015-08-26

    A popcorn-like transformation of graphite oxide (GO) is reported and used to synthesize metal nanoparticle catalysts. The popping step is unique and essential, not only generating a high-surface-area support but also partially decomposing the metal precursors to form well-separated metal oxide nuclei, which would further evolve into highly dispersed and uniform-sized nanoparticles in the subsequent reduction. PMID:26179983

  2. The pediatric sepsis biomarker risk model: potential implications for sepsis therapy and biology.

    PubMed

    Alder, Matthew N; Lindsell, Christopher J; Wong, Hector R

    2014-07-01

    Sepsis remains a major cause of morbidity and mortality in adult and pediatric intensive care units. Heterogeneity of demographics, comorbidities, biological mechanisms, and severity of illness leads to difficulty in determining which patients are at highest risk of mortality. Determining mortality risk is important for weighing the potential benefits of more aggressive interventions and for deciding whom to enroll in clinical trials. Biomarkers can be used to parse patients into different risk categories and can outperform current methods of patient risk stratification based on physiologic parameters. Here we review the Pediatric Sepsis Biomarker Risk Model that has also been modified and applied to estimate mortality risk in adult patients. We compare the two models and speculate on the biological implications of the biomarkers in patients with sepsis.

  3. Inhibition of Intestinal Thiamin Transport in Rat Model of Sepsis

    PubMed Central

    Sassoon, Catherine S.; Zhu, Ercheng; Fang, Liwei; Subramanian, Veedamali S.; Said, Hamid M.

    2016-01-01

    Objective Thiamin deficiency is highly prevalent in patients with sepsis, but the mechanism by which sepsis induces thiamin deficiency is unknown. This study aimed to determine the influence of various severity of sepsis on carrier-mediated intestinal thiamin uptake, level of expressions of thiamin transporters (thiamin transporter-1 (THTR-1) and thiamin transporter-2 (THTR-2)), and mitochondrial thiamin pyrophosphate transporter (MTPPT). Design Randomized, controlled study Setting Research laboratory at a Veterans Affairs Medical Center Subjects Twenty-four Sprague-Dawley rats were randomized into controls, mild, moderate and severe sepsis with equal number of animals in each group. Measurements and Main Results Sepsis was induced by cecal ligation and puncture with the cecum ligated below the cecal valve at 25 %, 50 % and 75 % of cecal length, defined as severe, moderate and mild sepsis, respectively. Control animals underwent laparotomy only. After 2 days of induced sepsis, carrier-mediated intestinal thiamin uptake was measured using [3H]thiamin. Expressions of THTR-1, THTR-2, and MTPPT proteins and mRNA were measured. Proinflammatory cytokines (IL-1β and IL-6), and adenosine triphosphate (ATP) were also measured. Sepsis inhibited [3H]thiamin uptake and the inhibition was a function of sepsis severity. Both cell membranes thiamin transporters and MTPPT expression levels were suppressed; also levels of ATP in the intestine of animals with moderate and severe sepsis were significantly lower than that of sham operated controls. Conclusions For the first time we demonstrated that sepsis inhibited carrier-mediated intestinal thiamin uptake as a function of sepsis severity, suppressed thiamin transporters and MTPPT, leading to ATP depletion. PMID:27065466

  4. Levels and Trends of Historic POPs (PCDD/Fs and PCBs) and Newer POPs (PBDEs) in U.S. Meat and Poultry and Implications for Human Exposure

    Technology Transfer Automated Retrieval System (TEKTRAN)

    The concentrations of several historic POPs, i.e. polychlorinated dibenzo p dioxins, polychlorinated dibenzofurans, and polychlorinated biphenyls, along with a newer class of POPs, the polybrominated diphenyl ethers (PBDEs), were measured in domestic meat and poultry samples from 2002 and 2008. The ...

  5. Avengers Assemble! Using pop-culture icons to communicate science

    PubMed Central

    2014-01-01

    Engaging communication of complex scientific concepts with the general public requires more than simplification. Compelling, relevant, and timely points of linkage between scientific concepts and the experiences and interests of the general public are needed. Pop-culture icons such as superheroes can represent excellent opportunities for exploring scientific concepts in a mental “landscape” that is comfortable and familiar. Using an established icon as a familiar frame of reference, complex scientific concepts can then be discussed in a more accessible manner. In this framework, scientists and the general public use the cultural icon to occupy a commonly known performance characteristic. For example, Batman represents a globally recognized icon who represents the ultimate response to exercise and training. The physiology that underlies Batman's abilities can then be discussed and explored using real scientific examples that highlight truths and fallacies contained in the presentation of pop-culture icons. Critically, it is not important whether the popular representation of the icon shows correct science because the real science can be revealed in discussing the character through this lens. Scientists and educators can then use these icons as foils for exploring complex ideas in a context that is less threatening and more comfortable for the target audience. A “middle-ground hypothesis” for science communication is proposed in which pop-culture icons are used to exploring scientific concepts in a bridging mental landscape that is comfortable and familiar. This approach is encouraged for communication with all nonscientists regardless of age. PMID:25039082

  6. Teachers are students in ZPG program called 'Pop Ed.'.

    PubMed

    Schline, S

    1977-01-01

    Zero Population Growth's Population Education (Pop Ed) program began in 1975 as an ongoing effort to bring the "real world" into the classroom by demonstrating the relationships among population trends, food and energy resources, and environmental and economic problems. The training workshops which last for a day or 2 have the following goals: 1) to offer a brief demographic overview for teachers, 2) to provide lesson plans and techniques readily usable in the classroom, 3) to alert teachers to the best written and audiovisual materials available, 4) to identify local resources for teaching Pop Ed, and 5) to provide sample materials. In the 1st year of program operation 10 workshops were held. These workshops are credited, at least partly, with the subsequent population instruction that reached over 10,400 students and 1600 teachers. Another 15 workshops were held in the 2nd year of operation. Obstacles to the program are the assumption on the part of some teachers that Pop Ed belongs in disciplines other than their own and the belief on the part of many teachers that they will require extensive training. PMID:12308748

  7. Single versus successive pop-in modes in nanoindentation tests of single crystals

    DOE PAGESBeta

    Xia, Yuzhi; Gao, Yanfei; Pharr, George M.; Bei, Hongbin

    2016-05-24

    From recent nanoindentation experiments, two types of pop-in modes have been identified: a single pop-in with a large displacement excursion, or a number of pop-ins with comparable and small displacement excursions. Theoretical analyses are developed here to study the roles played by indenter tip radius, pre-existing defect density, heterogeneous nucleation source type, and lattice resistance on the pop-in modes. The evolution of dislocation structures in earlier pop-ins provides input to modeling a stochastic, heterogeneous mechanism that may be responsible for the subsequent pop-ins. It is found that when the first pop-in occurs near theoretical shear stress, the pop-in mode ismore » determined by the lattice resistance and tip radius. When the first pop-in occurs at low shear stress, whether the successive pop-in mode occurs depends on how the heterogeneous dislocation nucleation source density increases as compared to the increase of the total dislocation density. Lastly, the above transitions are found to correlate well with the ratio of indenter tip radius to the mean spacing of dislocation nucleation sources.« less

  8. TRPV1 and SP: key elements for sepsis outcome?

    PubMed Central

    Bodkin, Jennifer Victoria; Fernandes, Elizabeth Soares

    2013-01-01

    Sensory neurons play important roles in many disorders, including inflammatory diseases, such as sepsis. Sepsis is a potentially lethal systemic inflammatory reaction to a local bacterial infection, affecting thousands of patients annually. Although associated with a high mortality rate, sepsis outcome depends on the severity of systemic inflammation, which can be directly influenced by several factors, including the immune response of the patient. Currently, there is a lack of effective drugs to treat sepsis, and thus there is a need to develop new drugs to improve sepsis outcome. Several mediators involved in the formation of sepsis have now been identified, but the mechanisms underlying the pathology remain poorly understood. The transient receptor potential vanilloid 1 (TRPV1) receptor and the neuropeptide substance P (SP) have recently been demonstrated as important targets for sepsis and are located on sensory neurones and non-neuronal cells. Herein, we highlight and review the importance of sensory neurones for the modulation of sepsis, with specific focus on recent findings relating to TRPV1 and SP, with their distinct abilities to alter the transition from local to systemic inflammation and also modify the overall sepsis outcome. We also emphasize the protective role of TRPV1 in this context. LINKED ARTICLES This article is part of a themed section on Neuropeptides. To view the other articles in this section visit http://dx.doi.org/10.1111/bph.2013.170.issue-7 PMID:23145480

  9. Factor v Leiden mutation in severe infection and sepsis.

    PubMed

    Levi, Marcel; Schouten, Marcel; van't Veer, Cees; van der Poll, Tom

    2011-11-01

    In severe infection and sepsis, activation of coagulation frequently occurs, which contributes to the development of multiple organ dysfunction. Factor V Leiden is a relatively common mutation resulting in a mild prohemostatic state and consequently with an increased tendency to develop thrombosis. Hypothetically, patients with factor V Leiden may suffer from more severe coagulopathy in cases of severe infection or sepsis. Aggravation of the procoagulant state in sepsis may subsequently result in more severe organ dysfunction and an increased risk of death. In this article we review the experimental and clinical evidence regarding the relationship between the presence of a factor V Leiden mutation and the incidence and outcome of sepsis.

  10. Experimental treatments for mitochondrial dysfunction in sepsis: A narrative review

    PubMed Central

    Zheng, Guilang; Lyu, Juanjuan; Huang, Jingda; Xiang, Dan; Xie, Meiyan; Zeng, Qiyi

    2015-01-01

    Sepsis is a systemic inflammatory response to infection. Sepsis, which can lead to severe sepsis, septic shock, and multiple organ dysfunction syndrome, is an important cause of mortality. Pathogenesis is extremely complex. In recent years, cell hypoxia caused by mitochondrial dysfunction has become a hot research field. Sepsis damages the structure and function of mitochondria, conversely, mitochondrial dysfunction aggravated sepsis. The treatment of sepsis lacks effective specific drugs. The aim of this paper is to undertake a narrative review of the current experimental treatment for mitochondrial dysfunction in sepsis. The search was conducted in PubMed databases and Web of Science databases from 1950 to January 2014. A total of 1,090 references were retrieved by the search, of which 121 researches met all the inclusion criteria were included. Articles on the relationship between sepsis and mitochondria, and drugs used for mitochondrial dysfunction in sepsis were reviewed retrospectively. The drugs were divided into four categories: (1) Drug related to mitochondrial matrix and respiratory chain, (2) drugs of mitochondrial antioxidant and free radical scavengers, (3) drugs related to mitochondrial membrane stability, (4) hormone therapy for septic mitochondria. In animal experiments, many drugs show good results. However, clinical research lacks. In future studies, the urgent need is to develop promising drugs in clinical trials. PMID:25983774

  11. Sepsis and Acute Respiratory Distress Syndrome: Recent Update.

    PubMed

    Kim, Won-Young; Hong, Sang-Bum

    2016-04-01

    Severe sepsis or septic shock is characterized by an excessive inflammatory response to infectious pathogens. Acute respiratory distress syndrome (ARDS) is a devastating complication of severe sepsis, from which patients have high mortality. Advances in treatment modalities including lung protective ventilation, prone positioning, use of neuromuscular blockade, and extracorporeal membrane oxygenation, have improved the outcome over recent decades, nevertheless, the mortality rate still remains high. Timely treatment of underlying sepsis and early identification of patients at risk of ARDS can help to decrease its development. In addition, further studies are needed regarding pathogenesis and novel therapies in order to show promising future treatments of sepsis-induced ARDS. PMID:27066082

  12. Cortical Reorganization of Language Functioning Following Perinatal Left MCA Stroke

    ERIC Educational Resources Information Center

    Tillema, Jan-Mendelt; Byars, Anna W.; Jacola, Lisa M.; Schapiro, Mark B.; Schmithorst, Vince J.; Szaflarski, Jerzy P.; Holland, Scott K.

    2008-01-01

    Objective: Functional MRI was used to determine differences in patterns of cortical activation between children who suffered perinatal left middle cerebral artery (MCA) stroke and healthy children performing a silent verb generation task. Methods: Ten children with prior perinatal left MCA stroke (age 6-16 years) and ten healthy age matched…

  13. 21 CFR 884.2740 - Perinatal monitoring system and accessories.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Perinatal monitoring system and accessories. 884.2740 Section 884.2740 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN... Monitoring Devices § 884.2740 Perinatal monitoring system and accessories. (a) Identification. A...

  14. Modifying CBT for Perinatal Depression: What Do Women Want?

    ERIC Educational Resources Information Center

    O'Mahen, Heather; Fedock, Gina; Henshaw, Erin; Himle, Joseph A.; Forman, Jane; Flynn, Heather A.

    2012-01-01

    The evidence for the efficacy of CBT for depression during the perinatal period is mixed. This was a qualitative study that aimed to understand the perinatal-specific needs of depressed women in an effort to inform treatment modifications that may increase the relevance and acceptability of CBT during this period. Stratified purposeful sampling…

  15. A Primer for Nurses on Perinatal/Neonatal Stroke.

    PubMed

    Becker, Jill S

    2015-01-01

    Perinatal or neonatal stroke is not uncommon, but diagnosis is often missed. Perinatal nurses are often the first health professionals in the position to observe the most typical symptom of stroke in a newborn, which is focal seizure. Etiology, symptoms and outcomes are reviewed and discussed through the context of the author's personal story.

  16. Perinatal Generalized Anxiety Disorder: Assessment and Treatment.

    PubMed

    Misri, Shaila; Abizadeh, Jasmin; Sanders, Shawn; Swift, Elena

    2015-09-01

    Perinatal generalized anxiety disorder (GAD) has a high prevalence of 8.5%-10.5% during pregnancy and 4.4%-10.8% postpartum. Despite its attendant dysfunction in the patient, this potentially debilitating mental health condition is often underdiagnosed. This overview will provide guidance for clinicians in making timely diagnosis and managing symptoms appropriately. A significant barrier to the diagnosis of GAD in the perinatal population is difficulty in distinguishing normal versus pathological worry. Because a perinatal-specific screening tool for GAD is nonexistent, early identification, diagnosis and treatment is often compromised. The resultant maternal dysfunction can potentially impact mother-infant bonding and influence neurodevelopmental outcomes in the children. Comorbid occurrence of GAD and major depressive disorder changes the illness course and its treatment outcome. Psychoeducation is a key component in overcoming denial/stigma and facilitating successful intervention. Treatment strategies are contingent upon illness severity. Cognitive behavior therapy (CBT), relaxation, and mindfulness therapy are indicated for mild GAD. Moderate/severe illness requires pharmacotherapy and CBT, individually or in combination. No psychotropic medications are approved by the FDA or Health Canada in pregnancy or the postpartum; off-label pharmacological treatment is instituted only if the benefit of therapy outweighs its risk. SSRIs/SNRIs are the first-line treatment for anxiety disorders due to data supporting their efficacy and overall favorable side effect profile. Benzodiazepines are an option for short-term treatment. While research on atypical antipsychotics is evolving, some can be considered for severe manifestations where the response to antidepressants or benzodiazepines has been insufficient. A case example will illustrate the onset, clinical course, and treatment strategies of GAD through pregnancy and the postpartum. PMID:26125602

  17. Perinatal risk factors for acute myeloid leukemia.

    PubMed

    Crump, Casey; Sundquist, Jan; Sieh, Weiva; Winkleby, Marilyn A; Sundquist, Kristina

    2015-12-01

    Infectious etiologies have been hypothesized for acute leukemias because of their high incidence in early childhood, but have seldom been examined for acute myeloid leukemia (AML). We conducted the first large cohort study to examine perinatal factors including season of birth, a proxy for perinatal infectious exposures, and risk of AML in childhood through young adulthood. A national cohort of 3,569,333 persons without Down syndrome who were born in Sweden in 1973-2008 were followed up for AML incidence through 2010 (maximum age 38 years). There were 315 AML cases in 69.7 million person-years of follow-up. We found a sinusoidal pattern in AML risk by season of birth (P < 0.001), with peak risk among persons born in winter. Relative to persons born in summer (June-August), incidence rate ratios for AML were 1.72 (95 % CI 1.25-2.38; P = 0.001) for winter (December-February), 1.37 (95 % CI 0.99-1.90; P = 0.06) for spring (March-May), and 1.27 (95 % CI 0.90-1.80; P = 0.17) for fall (September-November). Other risk factors for AML included high fetal growth, high gestational age at birth, and low maternal education level. These findings did not vary by sex or age at diagnosis. Sex, birth order, parental age, and parental country of birth were not associated with AML. In this large cohort study, birth in winter was associated with increased risk of AML in childhood through young adulthood, possibly related to immunologic effects of early infectious exposures compared with summer birth. These findings warrant further investigation of the role of seasonally varying perinatal exposures in the etiology of AML.

  18. Incarceration, Maternal Hardship, and Perinatal Health Behaviors

    PubMed Central

    Dumont, Dora M.; Wildeman, Christopher; Lee, Hedwig; Gjelsvik, Annie; Valera, Pamela A.; Clarke, Jennifer G.

    2014-01-01

    Background Parental incarceration is associated with mental and physical health problems in children, yet little research directly tests mechanisms through which parental incarceration could imperil child health. We hypothesized that the incarceration of a woman or her romantic partner in the year before birth constituted an additional hardship for already-disadvantaged women, and that these additionally vulnerable women were less likely to engage in positive perinatal health behaviors important to infant and early childhood development. Methods We analyzed 2006-2010 data from the Pregnancy Risk Assessment and Monitoring System (PRAMS) to assess the association between incarceration in the year prior to the birth of a child and perinatal maternal hardships and behaviors. Results Women reporting incarceration of themselves or their partners in the year before birth of a child had 0.86 the odds (95% CI .78-.95) of beginning prenatal care in the first trimester compared to women not reporting incarceration. They were nearly twice as likely to report partner abuse and were significantly more likely to rely on WIC and/or Medicaid for assistance during pregnancy. These associations persist after controlling for socioeconomic measures and other stressors, including homelessness and job loss. Conclusions Incarceration of a woman or her partner in the year before birth is associated with higher odds of maternal hardship and poorer perinatal health behaviors. The unprecedented scale of incarceration in the U.S. simultaneously presents an underutilized public health opportunity and constitutes a social determinant of health that may contribute to disparities in early childhood development. PMID:24615355

  19. Perinatal Generalized Anxiety Disorder: Assessment and Treatment

    PubMed Central

    Abizadeh, Jasmin; Sanders, Shawn; Swift, Elena

    2015-01-01

    Abstract Perinatal generalized anxiety disorder (GAD) has a high prevalence of 8.5%–10.5% during pregnancy and 4.4%–10.8% postpartum. Despite its attendant dysfunction in the patient, this potentially debilitating mental health condition is often underdiagnosed. This overview will provide guidance for clinicians in making timely diagnosis and managing symptoms appropriately. A significant barrier to the diagnosis of GAD in the perinatal population is difficulty in distinguishing normal versus pathological worry. Because a perinatal-specific screening tool for GAD is nonexistent, early identification, diagnosis and treatment is often compromised. The resultant maternal dysfunction can potentially impact mother–infant bonding and influence neurodevelopmental outcomes in the children. Comorbid occurrence of GAD and major depressive disorder changes the illness course and its treatment outcome. Psychoeducation is a key component in overcoming denial/stigma and facilitating successful intervention. Treatment strategies are contingent upon illness severity. Cognitive behavior therapy (CBT), relaxation, and mindfulness therapy are indicated for mild GAD. Moderate/severe illness requires pharmacotherapy and CBT, individually or in combination. No psychotropic medications are approved by the FDA or Health Canada in pregnancy or the postpartum; off-label pharmacological treatment is instituted only if the benefit of therapy outweighs its risk. SSRIs/SNRIs are the first-line treatment for anxiety disorders due to data supporting their efficacy and overall favorable side effect profile. Benzodiazepines are an option for short-term treatment. While research on atypical antipsychotics is evolving, some can be considered for severe manifestations where the response to antidepressants or benzodiazepines has been insufficient. A case example will illustrate the onset, clinical course, and treatment strategies of GAD through pregnancy and the postpartum. PMID:26125602

  20. Perinatal Generalized Anxiety Disorder: Assessment and Treatment.

    PubMed

    Misri, Shaila; Abizadeh, Jasmin; Sanders, Shawn; Swift, Elena

    2015-09-01

    Perinatal generalized anxiety disorder (GAD) has a high prevalence of 8.5%-10.5% during pregnancy and 4.4%-10.8% postpartum. Despite its attendant dysfunction in the patient, this potentially debilitating mental health condition is often underdiagnosed. This overview will provide guidance for clinicians in making timely diagnosis and managing symptoms appropriately. A significant barrier to the diagnosis of GAD in the perinatal population is difficulty in distinguishing normal versus pathological worry. Because a perinatal-specific screening tool for GAD is nonexistent, early identification, diagnosis and treatment is often compromised. The resultant maternal dysfunction can potentially impact mother-infant bonding and influence neurodevelopmental outcomes in the children. Comorbid occurrence of GAD and major depressive disorder changes the illness course and its treatment outcome. Psychoeducation is a key component in overcoming denial/stigma and facilitating successful intervention. Treatment strategies are contingent upon illness severity. Cognitive behavior therapy (CBT), relaxation, and mindfulness therapy are indicated for mild GAD. Moderate/severe illness requires pharmacotherapy and CBT, individually or in combination. No psychotropic medications are approved by the FDA or Health Canada in pregnancy or the postpartum; off-label pharmacological treatment is instituted only if the benefit of therapy outweighs its risk. SSRIs/SNRIs are the first-line treatment for anxiety disorders due to data supporting their efficacy and overall favorable side effect profile. Benzodiazepines are an option for short-term treatment. While research on atypical antipsychotics is evolving, some can be considered for severe manifestations where the response to antidepressants or benzodiazepines has been insufficient. A case example will illustrate the onset, clinical course, and treatment strategies of GAD through pregnancy and the postpartum.

  1. Perinatal lung function and invasive antenatal procedures

    PubMed Central

    Yuksel, B.; Greenough, A.; Naik, S.; Cheeseman, P.; Nicolaides, K. H.

    1997-01-01

    BACKGROUND: Second trimester amniocentesis has been associated with an excess of perinatal lung function abnormalities. Early amniocentesis might have a similar adverse effect, as could other invasive investigations carried out in the first trimester. METHODS: Plethysmographic measurements of thoracic gas volume (TGV) and airway resistance (Raw), from which specific conductance (sGaw) was calculated, were made in the perinatal period in non-sedated infants. In addition, functional residual capacity (FRC) was measured using a helium gas dilution technique. Measurements were made in 47 infants whose mothers had undergone early amniocentesis, 19 whose mothers had undergone chorion villus sampling, and 25 controls whose mothers had undergone no invasive antenatal procedures. RESULTS: The infants of mothers who had undergone early amniocentesis had higher TGV (95% CI - 6.3 to 1.1 ml/kg) and Raw values (95% CI -10.68 to -5.23 cm H2O/l/s) and lower sGaw (0.11 to 0.84 l/cm H2O.s) and FRC (-5.17 to - 0.87 ml/kg) values than the controls. Infants whose mothers had undergone chorion villus sampling also differed significantly from the controls with higher Raw (-7.59 to -1.99 cm H2O/l/s) and lower sGaw values (0.11 to 0.24 l/cm H2O.s), and had lower Raw values than those in the early amniocentesis group (not significant). Logistic regression analysis, taking into account possible risk factors for abnormal lung function, showed that the procedures performed in the first trimester were independently associated with a high airways resistance. CONCLUSION: These results suggest that invasive procedures performed in the first trimester of pregnancy have an adverse effect on perinatal lung function. 


 PMID:9059482

  2. Preventing Workplace Injuries Among Perinatal Nurses.

    PubMed

    Harolds, Laura; Hurst, Helen

    2016-01-01

    Many aspects of perinatal nursing put nurses at risk for injuries, including frequent repetitive bending, lifting of clients, and exposure to potentially large amounts of body fluids such as blood and amniotic fluid. Violence is also a potential risk with stressful family situations that may arise around childbirth. Workplace injuries put a health care facility at risk for staff turnover, decreases in the number of skilled nurses, client dissatisfaction, workers' compensation payouts, and employee lawsuits. Through the use of safety equipment, improved safety and violence training programs, "no manual lift" policies, reinforcement of personal protective equipment usage, and diligent staff training to improve awareness, these risks can be minimized.

  3. Preventing Workplace Injuries Among Perinatal Nurses.

    PubMed

    Harolds, Laura; Hurst, Helen

    2016-01-01

    Many aspects of perinatal nursing put nurses at risk for injuries, including frequent repetitive bending, lifting of clients, and exposure to potentially large amounts of body fluids such as blood and amniotic fluid. Violence is also a potential risk with stressful family situations that may arise around childbirth. Workplace injuries put a health care facility at risk for staff turnover, decreases in the number of skilled nurses, client dissatisfaction, workers' compensation payouts, and employee lawsuits. Through the use of safety equipment, improved safety and violence training programs, "no manual lift" policies, reinforcement of personal protective equipment usage, and diligent staff training to improve awareness, these risks can be minimized. PMID:26902445

  4. Prenatal and perinatal risk factors of schizophrenia.

    PubMed

    Meli, Giampiero; Ottl, Birgit; Paladini, Angela; Cataldi, Luigi

    2012-12-01

    Schizophrenia could be considered the most severe of all psychiatric disorders. It shows a heterogeneous clinical picture and presents an etiopathogenesis that is not cleared sufficiently. Even if the etiopathogenesis remains a puzzle, there is a scientific consensus that it is an expression of interaction between genotype and environmental factors. In the present article, following a study of literature and the accumulated evidence, the role of prenatal and perinatal factors in the development of schizophrenia will be revised and synthesized. We think that better knowledge of the risk factors could be helpful not only for better comprehension of the pathogenesis but especially to optimize interventions for prevention of the disorder. PMID:22646662

  5. Global monitoring plan for persistent organic pollutants (POPs) under the Stockholm Convention: Triggering, streamlining and catalyzing global POPs monitoring.

    PubMed

    Magulova, Katarina; Priceputu, Ana

    2016-10-01

    The Stockholm Convention on Persistent Organic Pollutants (POPs) aims to protect human health and the environment from POPs through a range of measures aimed at reducing and ultimately eliminating their releases into the environment and subsequent human exposure. Article 16 of the Convention sets the basis for a mechanism to assess the success of the activities undertaken worldwide to implement the Convention. One of major pillars for the evaluation of the effectiveness of the Convention is monitoring data obtained through the Global Monitoring Plan (GMP) for POPs. The implementation of the GMP over the last eleven years, since the entry into force of the Convention, shows how a global treaty such as the Stockholm Convention streamlined existing monitoring efforts and triggered harmonization and further development of a global monitoring network. In its initial stages, long term POPs monitoring programmes were available only in some parts of the globe. Over more than a decade of generation of harmonized, comparable monitoring data on 23 chemicals of global concern, a rich and extremely valuable dataset has been generated in the frame of the GMP. Long-term monitoring programmes have enlarged the scope of their activities to cover newly listed chemicals, and new programmes have emerged. Monitoring data are broadly shared through the GMP data warehouse, the Convention's clearing-house mechanism, and through other appropriate global tools. Through its global reach, the GMP contributes to the global chemicals and waste policy agenda, supports and triggers further research initiatives, and provides information to the general public at large. PMID:26794340

  6. Some observations on perinatal mortality in rural health centre.

    PubMed

    Damodar; Mathur, H N; Sharma, P N

    1983-01-01

    A 4-year study of perinatal mortality in Rural Health Training Centre, Vallabhnagar, affiliated to R.N.T. Medical College, Udaipur was conducted. The chief objective of the study was to analyze underlying causes of perinatal deaths. The perinatal mortality rate was calculated to be 74.19/100 births. Age and parity of mother and sex of the child did not affect perinatal mortality significantly. Antenatal care of mother had a significant role in determining fetal outcome and 1st week survival. Fate of the newborn was substantially affected by birth weight less than 2 kg. Training of "dais" in view of identification of "at risk" cases and nutrition education, better facilities in terms of personnel and equipment, and improvement in referral services emerged as necessary steps needed to plan strategy for lowering perinatal mortaltiy in rural areas. PMID:6680112

  7. Perinatal mortality in a rural district of south India.

    PubMed

    Chandrashekar, S; Rao, R S; Chakladar, B K; Krishnan, L; Nair, N S

    1998-01-01

    Perinatal mortality is one of the most sensitive indices of maternal and child health. The perinatal mortality rate is an indicator of the extent of pregnancy wastage as well as of the quality and quantity of health care available to the mother and the newborn. A community based prospective study carried out on 13,214 births in South Kanara district between Oct. 1991-Sept. 1992 revealed a perinatal mortality rate (PNMR) of 44.65/1000 births. Among the various factors influencing perinatal mortality, breech deliveries and babies of multiple pregnancies had a very high perinatal mortality rate of 180.81/1000 births (adjusted odd's ratio: 4.90) and 128/1000 births (adjusted odd's ratio: 2.64). The previous bad obstetric history of the mother, parity and sex of the newborn were among the other important factors influencing the PNMR. PMID:10773926

  8. Perinatal depression: a review of US legislation and law.

    PubMed

    Rhodes, Ann M; Segre, Lisa S

    2013-08-01

    Accumulating research documenting the prevalence and negative effects of perinatal depression, together with highly publicized tragic critical incidents of suicide and filicide by mothers with postpartum psychosis, have fueled a continuum of legislation. Specialists in perinatal mental health should recognize how their work influences legislative initiatives and penal codes, and take this into consideration when developing perinatal services and research. Yet, without legal expertise, the status of legislative initiatives can be confusing. To address this shortfall, we assembled an interdisciplinary team of academics specializing in law, as well as perinatal mental health, to summarize these issues. This review presents the relevant federal and state legislation and summarizes the criminal codes that governed the court decisions on cases in which a mother committed filicide because of postpartum psychosis. Moreover, the review aims to help researchers and providers who specialize in perinatal depression understand their role in this legal landscape. PMID:23740222

  9. Different regulation of Toll-like receptor 4 expression on blood CD14+ monocytes by simvastatin in patients with sepsis and severe sepsis

    PubMed Central

    Shao, Huanzhang; Wang, Cunzhen; Zhu, Wenliang; Huang, Xiaopei; Guo, Zhisong; Zhang, Huifeng; Qin, Bingyu

    2015-01-01

    We have demonstrated that regulation of Toll-like receptor 4 (TLR4) surface expression levels on blood CD14+ monocytes by simvastatin treatment in patient with sepsis is different from that in patients with severe sepsis. In patients with sepsis simvastatin treatment statistically significantly decreased TLR4 surface expression level on blood CD14+ monocytes, while in patients with severe sepsis simvastatin treatment had no significant influence on TLR4 surface expression level on blood CD14+ monocytes. The changes of plasma interleukin-6 (IL-6) induced by simvastatin in patients with sepsis and severe sepsis were similar with that of TLR4. Our results indicated simvastatin treatment differently influenced inflammation process in patients with sepsis and severe sepsis, which might partially explain the discrepancy, presented by previous trials, about the therapeutic effects of simvastatin treatment in patients with sepsis and severe sepsis. PMID:26550333

  10. Perinatal testicular torsion and medicolegal considerations.

    PubMed

    Massoni, F; Troili, G M; Pelosi, M; Ricci, S

    2014-06-01

    Perinatal testicular torsion (PTT) is a very complex condition because of rarity of presentation and diagnostic and therapeutic difficulties. In presence of perinatal testicular torsion, the involvement of contralateral testis can be present also in absence of other indications which suggest the bilateral involvement; therefore, occurrences supported by literature do not exclude the use of surgery to avoid the risk of omitted or delayed diagnosis. The data on possible recovery of these testicles are not satisfactory, and treatment consists of an observational approach ("wait-and-see") or an interventional approach. The hypothesis of randomized clinical trials seems impracticable because of rarity of disease. The authors present a case of PTT, analyzing injuries due to clinical and surgical management of these patients, according to medicolegal profile. The delayed diagnosis and the choice of an incorrect therapeutic approach can compromise the position of healthcare professionals, defective in terms of skill, prudence and diligence. Endocrine insufficiency is an unfortunate event. The analysis of literature seems to support, because of high risk, a surgical approach aimed not only at resolution of unilateral pathology or prevention of a relapse, but also at prevention of contralateral testicular torsion. PMID:24826979

  11. Neutrophil apoptosis: a marker of disease severity in sepsis and sepsis-induced acute respiratory distress syndrome

    PubMed Central

    Fialkow, Léa; Fochesatto Filho, Luciano; Bozzetti, Mary C; Milani, Adriana R; Rodrigues Filho, Edison M; Ladniuk, Roberta M; Pierozan, Paula; de Moura, Rafaela M; Prolla, João C; Vachon, Eric; Downey, Gregory P

    2006-01-01

    Introduction Apoptosis of neutrophils (polymorphonuclear neutrophils [PMNs]) may limit inflammatory injury in sepsis and acute respiratory distress syndrome (ARDS), but the relationship between the severity of sepsis and extent of PMN apoptosis and the effect of superimposed ARDS is unknown. The objective of this study was to correlate neutrophil apoptosis with the severity of sepsis and sepsis-induced ARDS. Methods A prospective cohort study was conducted in intensive care units of three tertiary hospitals in Porto Alegre, southern Brazil. Fifty-seven patients with sepsis (uncomplicated sepsis, septic shock, and sepsis-induced ARDS) and 64 controls were enrolled. Venous peripheral blood was collected from patients with sepsis within 24 hours of diagnosis. All surgical groups, including controls, had their blood drawn 24 hours after surgery. Control patients on mechanical ventilation had blood collected within 24 hours of initiation of mechanical ventilation. Healthy controls were blood donors. Neutrophils were isolated, and incubated ex vivo, and apoptosis was determined by light microscopy on cytospun preparations. The differences among groups were assessed by analysis of variance with Tukeys. Results In medical patients, the mean percentage of neutrophil apoptosis (± standard error of the mean [SEM]) was lower in sepsis-induced ARDS (28% ± 3.3%; n = 9) when compared with uncomplicated sepsis (57% ± 3.2%; n = 8; p < 0.001), mechanical ventilation without infection, sepsis, or ARDS (53% ± 3.0%; n = 11; p < 0.001) and healthy controls (69% ± 1.1%; n = 33; p < 0.001) but did not differ from septic shock (38% ± 3.7%; n = 12; p = 0.13). In surgical patients with sepsis, the percentage of neutrophil apoptosis was lower for all groups when compared with surgical controls (52% ± 3.6%; n = 11; p < 0.001). Conclusion In medical patients with sepsis, neutrophil apoptosis is inversely proportional to the severity of sepsis and thus may be a marker of the severity of

  12. New perspectives on immunomodulatory therapy for bacteraemia and sepsis.

    PubMed

    Opal, Steven M

    2010-12-01

    Systemic immune dysregulation is generally acknowledged to be the fundamental molecular mechanism that underlies the pathophysiology of severe sepsis and septic shock. In the presence of a systemic infection, microbial pathogens and their soluble mediators induce generalised immune activation and coagulation activation, leading to severe sepsis and septic shock. For decades, immune-based therapies have been devised with the specific intent of inhibiting the pro-inflammatory events that are thought to precipitate the septic process. Despite a clear therapeutic rationale based upon the available experimental evidence, anti-inflammatory therapies targeting the innate or acquired immune response have largely been unsuccessful in clinical trials of sepsis. Compelling evidence now exists that a prolonged state of sepsis-induced immune suppression follows the initial period of stabilisation and resuscitation in many critically ill patients. Sepsis-related immune suppression is evidenced by histological findings of markedly enhanced lymphocytic and monocytic apoptosis, poor response to neoantigens and recall antigens, and increased incidence of infections by opportunistic pathogens. Candidiasis, cytomegalovirus activation and secondary infections by relatively avirulent bacterial pathogens such as Stenotrophomonas and Acinetobacter spp. are commonplace in septic patients during prolonged Intensive Care Unit stays. Immunological tools to detect sepsis-induced immunosuppression are now available, and novel immunoadjuvants are in development to re-establish immune competence in sepsis patients. The intelligent use of immunomodulatory agents in sepsis will necessitate a personalised medicine approach to treat each patient at the appropriate time and with the optimal therapy.

  13. The Endothelial Glycocalyx: New Diagnostic and Therapeutic Approaches in Sepsis

    PubMed Central

    Koczera, Patrick

    2016-01-01

    Sepsis is defined as a life-threatening organ dysfunction caused by a dysregulated host response to infection. The endothelial glycocalyx is one of the earliest sites involved during sepsis. This fragile layer is a complex network of cell-bound proteoglycans, glycosaminoglycan side chains, and sialoproteins lining the luminal side of endothelial cells with a thickness of about 1 to 3 μm. Sepsis-associated alterations of its structure affect endothelial permeability and result in the liberation of endogenous damage-associated molecular patterns (DAMPs). Once liberated in the circulatory system, DAMPs trigger the devastating consequences of the proinflammatory cascades in sepsis and septic shock. In this way, the injury to the glycocalyx with the consecutive release of DAMPs contributes to a number of specific clinical effects of sepsis, including acute kidney injury, respiratory failure, and septic cardiomyopathy. Moreover, the extent of glycocalyx degradation serves as a marker of endothelial dysfunction and sepsis severity. In this review, we highlight the crucial role of the glycocalyx in sepsis as a diagnostic tool and discuss the potential of members of the endothelial glycocalyx serving as hopeful therapeutic targets in sepsis-associated multiple organ failures. PMID:27699168

  14. Late mortality after sepsis: propensity matched cohort study

    PubMed Central

    Osterholzer, John J; Langa, Kenneth M; Angus, Derek C; Iwashyna, Theodore J

    2016-01-01

    Objectives To determine whether late mortality after sepsis is driven predominantly by pre-existing comorbid disease or is the result of sepsis itself. Deign Observational cohort study. Setting US Health and Retirement Study. Participants 960 patients aged ≥65 (1998-2010) with fee-for-service Medicare coverage who were admitted to hospital with sepsis. Patients were matched to 777 adults not currently in hospital, 788 patients admitted with non-sepsis infection, and 504 patients admitted with acute sterile inflammatory conditions. Main outcome measures Late (31 days to two years) mortality and odds of death at various intervals. Results Sepsis was associated with a 22.1% (95% confidence interval 17.5% to 26.7%) absolute increase in late mortality relative to adults not in hospital, a 10.4% (5.4% to 15.4%) absolute increase relative to patients admitted with non-sepsis infection, and a 16.2% (10.2% to 22.2%) absolute increase relative to patients admitted with sterile inflammatory conditions (P<0.001 for each comparison). Mortality remained higher for at least two years relative to adults not in hospital. Conclusions More than one in five patients who survives sepsis has a late death not explained by health status before sepsis. PMID:27189000

  15. The Endothelial Glycocalyx: New Diagnostic and Therapeutic Approaches in Sepsis

    PubMed Central

    Koczera, Patrick

    2016-01-01

    Sepsis is defined as a life-threatening organ dysfunction caused by a dysregulated host response to infection. The endothelial glycocalyx is one of the earliest sites involved during sepsis. This fragile layer is a complex network of cell-bound proteoglycans, glycosaminoglycan side chains, and sialoproteins lining the luminal side of endothelial cells with a thickness of about 1 to 3 μm. Sepsis-associated alterations of its structure affect endothelial permeability and result in the liberation of endogenous damage-associated molecular patterns (DAMPs). Once liberated in the circulatory system, DAMPs trigger the devastating consequences of the proinflammatory cascades in sepsis and septic shock. In this way, the injury to the glycocalyx with the consecutive release of DAMPs contributes to a number of specific clinical effects of sepsis, including acute kidney injury, respiratory failure, and septic cardiomyopathy. Moreover, the extent of glycocalyx degradation serves as a marker of endothelial dysfunction and sepsis severity. In this review, we highlight the crucial role of the glycocalyx in sepsis as a diagnostic tool and discuss the potential of members of the endothelial glycocalyx serving as hopeful therapeutic targets in sepsis-associated multiple organ failures.

  16. Severe sepsis and septic shock in the elderly: An overview.

    PubMed

    Nasa, Prashant; Juneja, Deven; Singh, Omender

    2012-02-01

    The incidence of severe sepsis and septic shock is increasing in the older population leading to increased admissions to the intensive care units (ICUs). The elderly are predisposed to sepsis due to co-existing co-morbidities, repeated and prolonged hospitalizations, reduced immunity, functional limitations and above all due to the effects of aging itself. A lower threshold and a higher index of suspicion is required to diagnose sepsis in this patient population because the initial clinical picture may be ambiguous, and aging increases the risk of a sudden deterioration in sepsis to severe sepsis and septic shock. Management is largely based on standard international guidelines with a few modifications. Age itself is an independent risk factor for death in patients with severe sepsis, however, many patients respond well to timely and appropriate interventions. The treatment should not be limited or deferred in elderly patients with severe sepsis only on the grounds of physician prejudice, but patient and family preferences should also be taken into account as the outcomes are not dismal. Future investigations in the management of sepsis should not only target good functional recovery but also ensure social independence and quality of life after ICU discharge. PMID:24701398

  17. Cardiac Function and Dysfunction in Sepsis.

    PubMed

    Fenton, Kimberly E; Parker, Margaret M

    2016-06-01

    Cardiac function and dysfunction are important in the clinical outcomes of sepsis and septic shock. Cardiac dysfunction is not a single entity, but is a broad spectrum of syndromes that result in biventricular cardiac dysfunction manifested by both systolic and diastolic dysfunction and is influenced by cardiac loading conditions (ie, preload and afterload). Elucidating the underlying pathophysiology has proved to be complex. This article emphasizes the underlying pathophysiology of cardiac dysfunction and explores recent evidence related to diagnosis, including the utility of biomarkers, the role of echocardiography, and management goals and treatment. PMID:27229645

  18. A Perinatal Health Framework for Women with Physical Disabilities

    PubMed Central

    Mitra, Monika; Long-Bellil, Linda M.; Smeltzer, Suzanne C.; Iezzoni, Lisa I.

    2015-01-01

    Background Studies suggest that women with disabilities experience health and health care disparities before, during, and after pregnancy. However, existing perinatal health and health care frameworks do not address the needs and barriers faced by women with physical disabilities around the time of pregnancy. A new framework that addresses the perinatal disparities among women with physical disabilities is needed. Objective To propose a framework for examining perinatal health and health care disparities among women with physical disabilities. Methods We developed a perinatal health framework guided by the International Classification of Functioning, Disability and Health (ICF) and the integrated perinatal health framework by Misra et al. Results The proposed framework uses a life span perspective in a manner that directly addresses the multiple determinants specific to women with physical disabilities around the time of pregnancy. The framework is based on longitudinal and integrated perspectives that take into account women's functional status and environment over their life course. Conclusion The perinatal health framework for women with physical disabilities was developed to inform the way researchers and health care professionals address disparities in perinatal health and health care among women with physical disabilities. PMID:26189010

  19. Science review: The brain in sepsis – culprit and victim

    PubMed Central

    Sharshar, Tarek; Hopkinson, Nicholas S; Orlikowski, David; Annane, Djillali

    2005-01-01

    On one side, brain dysfunction is a poorly explored complication of sepsis. On the other side, brain dysfunction may actively contribute to the pathogenesis of sepsis. The current review aimed at summarizing the current knowledge about the reciprocal interaction between the immune and central nervous systems during sepsis. The immune-brain cross talk takes part in circumventricular organs that, being free from blood-brain-barrier, interface between brain and bloodstream, in autonomic nuclei including the vagus nerve, and finally through the damaged endothelium. Recent observations have confirmed that sepsis is associated with excessive brain inflammation and neuronal apoptosis which clinical relevance remains to be explored. In parallel, damage within autonomic nervous and neuroendocrine systems may contribute to sepsis induced organ dysfunction. PMID:15693982

  20. How Can the Microbiologist Help in Diagnosing Neonatal Sepsis?

    PubMed Central

    Paolucci, Michela; Landini, Maria Paola; Sambri, Vittorio

    2012-01-01

    Neonatal sepsis can be classified into two subtypes depending upon whether the onset of symptoms is before 72 hours of life (early-onset neonatal sepsis—EONS) or later (late-onset neonatal sepsis—LONS). These definitions have contributed greatly to diagnosis and treatment by identifying which microorganisms are likely to be responsible for sepsis during these periods and the expected outcomes of infection. This paper focuses on the tools that microbiologist can offer to diagnose and eventually prevent neonatal sepsis. Here, we discuss the advantages and limitation of the blood culture, the actual gold standard for sepsis diagnosis. In addition, we examine the utility of molecular techniques in the diagnosis and management of neonatal sepsis. PMID:22319539

  1. Targeting HMGB1 in the treatment of sepsis

    PubMed Central

    Wang, Haichao; Ward, Mary F.; Sama, Andrew E.

    2013-01-01

    Introduction Sepsis refers to the host’s deleterious and non-resolving systemic inflammatory response to microbial infections, and represents the leading cause of death in the intensive care unit. The pathogenesis of sepsis is complex, but partly mediated by a newly identified alarmin molecule, the high mobility group box 1 (HMGB1). Areas covered Here we review the evidence that support extracellular HMGB1 as a late mediator of experimental sepsis with a wider therapeutic window, and discuss the therapeutic potential of HMGB1-neutralizing antibodies and small molecule inhibitors (herbal components) in experimental sepsis. Expert opinion It will be important to evaluate the efficacy of HMGB1-targeting strategies for the clinical management of human sepsis in the future. PMID:24392842

  2. Fabrication of Pop-up Detector Arrays on Si Wafers

    NASA Technical Reports Server (NTRS)

    Li, Mary J.; Allen, Christine A.; Gordon, Scott A.; Kuhn, Jonathan L.; Mott, David B.; Stahle, Caroline K.; Wang, Liqin L.

    1999-01-01

    High sensitivity is a basic requirement for a new generation of thermal detectors. To meet the requirement, close-packed, two-dimensional silicon detector arrays have been developed in NASA Goddard Space Flight Center. The goal of the task is to fabricate detector arrays configured with thermal detectors such as infrared bolometers and x-ray calorimeters to use in space fliGht missions. This paper focuses on the fabrication and the mechanical testing of detector arrays in a 0.2 mm pixel size, the smallest pop-up detectors being developed so far. These array structures, nicknamed "PUDS" for "Pop-Up Detectors", are fabricated on I pm thick, single-crystal, silicon membranes. Their designs have been refined so we can utilize the flexibility of thin silicon films by actually folding the silicon membranes to 90 degrees in order to obtain close-packed two-dimensional arrays. The PUD elements consist of a detector platform and two legs for mechanical support while also serving as electrical and thermal paths. Torsion bars and cantilevers connecting the detector platform to the legs provide additional flexures for strain relief. Using micro-electromechanical structure (MEMS) fabrication techniques, including photolithography, anisotropic chemical etching, reactive-ion etching, and laser dicing, we have fabricated PLTD detector arrays of fourteen designs with a variation of four parameters including cantilever length, torsion bar length and width, and leg length. Folding tests were conducted to test mechanical stress distribution for the array structures. We obtained folding yields and selected optimum design parameters to reach minimal stress levels. Computer simulation was also employed to verify mechanical behaviors of PUDs in the folding process. In addition, scanning electron microscopy was utilized to examine the flatness of detectors and the alignment of detector pixels in arrays. The fabrication of thermistors and heaters on the pop-up detectors is under way

  3. The CASSIOPE/e-POP Suprathermal Electron Imager (SEI)

    NASA Astrophysics Data System (ADS)

    Knudsen, D. J.; Burchill, J. K.; Cameron, T. G.; Enno, G. A.; Howarth, A.; Yau, A. W.

    2015-06-01

    The Suprathermal Electron Imager (SEI) on the Enhanced Polar Outflow Probe (e-POP) experiment uses a microchannel-plate-intensified charge-coupled device (CCD) detector to record two-dimensional, energy-angle images of electron distributions for energies up to 350 eV. Alternatively, the SEI can be biased to measure positive ions at energies that include the ambient ionospheric population (<1 eV) and extending to 350 eV. At the highest measurement resolution, distribution images are 64 pixels in diameter and are read out at a rate of 100 images per second. The SEI's field of view is 360∘×±4∘, and includes viewing of the nadir and ram directions, nominally. At high latitude the nominal orientation allows coverage of most pitch angles. The SEI is included on e-POP to address the mission's principal scientific objectives, the first being to characterize polar ion outflow and its drivers including ambipolar electric fields generated by suprathermal electron populations, and direct energization of ions by plasma waves or through frictional heating. In addition, the SEI's focus on low energies and high time resolution allows a unique view of suprathermal particle populations and their role in wave-particle interactions, in support of e-POP's second scientific objective: to study plasma waves and wave propagation in the high-latitude ionosphere. Observations taken within geophysically quiet regions indicate that the instrument can track bulk ion flow velocity with a resolution of order 25 m/s or better.

  4. The Greek National Perinatal Survey. II: Socioeconomic factors and perinatal mortality in Greece.

    PubMed

    Tzoumaka-Bakoula, C; Lekea-Karanika, V; Matsaniotis, N S; Golding, J

    1989-01-01

    Information concerning all 10,859 singleton deliveries in Greece in April 1983, were analysed to assess the contribution of socioeconomic factors to the perinatal mortality rate. Statistically significant associations were initially found with parental education, parental ages, duration of marriage, paternal occupation and parity. There was no association with maternal smoking habit, maternal occupation during pregnancy, type of health insurance or housing conditions. Once logistic regression analyses had taken account of the strong parity effect (P less than 0.0001), only a moderate association with maternal age (P less than 0.05) remained statistically significant, together with a marginally significant (P less than 0.05) association with maternal education level. Mothers who were moderately well educated had the lowest risk of loosing their baby. It is concluded that traditional measures of social deprivation appeared to have little effect on perinatal mortality in Greece in 1983. PMID:2710679

  5. Improving Sepsis Management in the Acute Admissions Unit.

    PubMed

    Adcroft, Laura

    2014-01-01

    Sepsis is a common condition with a major impact on healthcare resources and expenditure. We therefore wanted to investigate and improve how the acute admission unit (AAU) at the Great Western Hospital (GWH) is managing patients who present directly to the unit with sepsis. In order to obtain this information, an audit was undertaken against the College of Emergency Medicine standards used by the emergency department within GWH and across the UK. Data was retrospectively collected for 30 patients with a diagnosis of severe sepsis or septic shock. The notes were scrutinized with regard to the implementation of College of Emergency Medicine standards for the management of sepsis. This meant that performance in the AAU was compared against the emergency department at GWH and national figures. The data collected shows performance is below national standards with regard to documentation of high flow oxygen use (AAU: 24%, ED 100%; national median: 50%; CEM standard 95%), crystalloid fluid boluses (AAU: 52%; ED: 90%; national median: 83%; CEM standard 100%), lactate measurements (AAU: 66%, ED: 93%; national median: 80%; CEM standard 95%), and obtainment of blood cultures (AAU: 52%; ED 73%; national median: 77%; CEM standard: 95%). Only 3% of patients received all six parts of the sepsis bundle. Since auditing in 2012/2013 we have introduced a sepsis proforma based on a current proforma being used within Severn Deanery. This proforma uses the 'Sepsis Six' bundle appropriate to ward based care. We have raised awareness of sepsis implications and management through the creation of a 'sepsis working group' to educate both junior doctors and nurses. In turn, this has led to education through the use of posters, pocket reference cards, and teaching sessions. Re-audit shows significant improvement in administering all parts of the Sepsis Six bundle and an 8% improvement in patients receiving all six of the bundle.

  6. Immunotherapy: A promising approach to reverse sepsis-induced immunosuppression.

    PubMed

    Patil, Naeem K; Bohannon, Julia K; Sherwood, Edward R

    2016-09-01

    Sepsis is defined as life-threatening organ dysfunction caused by dysregulated host responses to infection (Third International Consensus definition for Sepsis and septic shock). Despite decades of research, sepsis remains the leading cause of death in intensive care units. More than 40 clinical trials, most of which have targeted the sepsis-associated pro-inflammatory response, have failed. Thus, antibiotics and fluid resuscitation remain the mainstays of supportive care and there is intense need to discover and develop novel, targeted therapies to treat sepsis. Both pre-clinical and clinical studies over the past decade demonstrate unequivocally that sepsis not only causes hyper-inflammation, but also leads to simultaneous adaptive immune system dysfunction and impaired antimicrobial immunity. Evidences for immunosuppression include immune cell depletion (T cells most affected), compromised T cell effector functions, T cell exhaustion, impaired antigen presentation, increased susceptibility to opportunistic nosocomial infections, dysregulated cytokine secretion, and reactivation of latent viruses. Therefore, targeting immunosuppression provides a logical approach to treat protracted sepsis. Numerous pre-clinical studies using immunomodulatory agents such as interleukin-7, anti-programmed cell death 1 antibody (anti-PD-1), anti-programmed cell death 1 ligand antibody (anti-PD-L1), and others have demonstrated reversal of T cell dysfunction and improved survival. Therefore, identifying immunosuppressed patients with the help of specific biomarkers and administering specific immunomodulators holds significant potential for sepsis therapy in the future. This review focusses on T cell dysfunction during sepsis and discusses the potential immunotherapeutic agents to boost T cell function during sepsis and improve host resistance to infection. PMID:27468649

  7. Sepsis-induced alterations in sleep of rats.

    PubMed

    Baracchi, Francesca; Ingiosi, Ashley M; Raymond, Richard M; Opp, Mark R

    2011-11-01

    Sepsis is a systemic immune response to infection that may result in multiple organ failure and death. Polymicrobial infections remain a serious clinical problem, and in the hospital, sepsis is the number-one noncardiac killer. Although the central nervous system may be one of the first systems affected, relatively little effort has been made to determine the impact of sepsis on the brain. In this study, we used the cecal ligation and puncture (CLP) model to determine the extent to which sepsis alters sleep, the EEG, and brain temperature (Tbr) of rats. Sepsis increases the amount of time rats spend in non-rapid eye movement sleep (NREMS) during the dark period, but not during the light period. Rapid eye movements sleep (REMS) of septic rats is suppressed for about 24 h following CLP surgery, after which REMS increases during dark periods for at least three nights. The EEG is dramatically altered shortly after sepsis induction, as evidenced by reductions in slow-frequency components. Furthermore, sleep is fragmented, indicating that the quality of sleep is diminished. Effects on sleep, the EEG, and Tbr persist for at least 84 h after sepsis induction, the duration of our recording period. Immunohistochemical assays focused on brain stem mechanisms responsible for alterations in REMS, as little information is available concerning infection-induced suppression of this sleep stage. Our immunohistochemical data suggest that REMS suppression after sepsis onset may be mediated, in part, by the brain stem GABAergic system. This study demonstrates for the first time that sleep and EEG patterns are altered during CLP-induced sepsis. These data suggest that the EEG may serve as a biomarker for sepsis onset. These data also contribute to our knowledge of potential mechanisms, whereby infections alter sleep and other central nervous system functions.

  8. [Perinatal Information System. Incorporation latency and impact on perinatal clinical registry].

    PubMed

    Simini, F; Fernández, A; Sosa, C; Díaz Rossello, J L

    2001-10-01

    The Perinatal Information System (SIP) is a clinical record, local management and quality assurance software standard in Latin America and the Caribbean. The time to implement SIP in a Maternity Hospital is evaluated as well as the effect of statistics on perinatal health indicators in subsequent years. In the sample of 20 Maternity Hospitals (5 Countries, 40% Private and 60% Public) 85% had a reliable information system by the third year of use of SIP. 15% of hospitals still had problems at that time that were already clear during the second year, a time corrective measures can still be taken. The evaluation of the impact of yearly reports shows that 58% of recommendations were fulfilled, specially those regarding the complete filling-in of clinical records (62%) and to a lesser extent variables that reflect clinical practices and organization of services (52%). The conclusion is that Maternity Hospitals in Latin America and the Caribbean have the capacity to adopt a complex tool of computerized clinical records for quality assurance of perinatal care and monitoring of health indicators.

  9. [Perinatal Information System. Incorporation latency and impact on perinatal clinical registry].

    PubMed

    Simini, F; Fernández, A; Sosa, C; Díaz Rossello, J L

    2001-10-01

    The Perinatal Information System (SIP) is a clinical record, local management and quality assurance software standard in Latin America and the Caribbean. The time to implement SIP in a Maternity Hospital is evaluated as well as the effect of statistics on perinatal health indicators in subsequent years. In the sample of 20 Maternity Hospitals (5 Countries, 40% Private and 60% Public) 85% had a reliable information system by the third year of use of SIP. 15% of hospitals still had problems at that time that were already clear during the second year, a time corrective measures can still be taken. The evaluation of the impact of yearly reports shows that 58% of recommendations were fulfilled, specially those regarding the complete filling-in of clinical records (62%) and to a lesser extent variables that reflect clinical practices and organization of services (52%). The conclusion is that Maternity Hospitals in Latin America and the Caribbean have the capacity to adopt a complex tool of computerized clinical records for quality assurance of perinatal care and monitoring of health indicators. PMID:11816526

  10. Vasopressin in sepsis and septic shock.

    PubMed

    Kampmeier, T G; Rehberg, S; Westphal, M; Lange, M

    2010-10-01

    Arginine vasopressin (AVP) and its synthetic, long-acting analog terlipressin (TP) are potent alternative vasoconstrictors in the treatment of septic patients with catecholamine-refractive vasodilatatory shock. The results from one large randomized clinical trial suggest that AVP plus norepinephrine (NE) infusion is as safe and effective as treatment with NE alone in patients with septic shock. Because the desired effects of vasopressin analogs are basically related to their vasopressinergic effects via the V1a receptor, more selective V1 agonists, such as TP, may be more potent in reversing sepsis-related arterial hypotension. In this regard, recent evidence from small-scale studies suggests that continuous low-dose infusion rather than intermittent bolus injection of TP is associated with fewer side effects, such as depression of cardiac output and rebound arterial hypotension. However, because clinical data on the administration of TP in patients with sepsis are limited, it should not currently be used beyond the scope of controlled trials. The optimal time point for the initiation of therapy with vasopressin analogs has yet to be determined. While AVP and TP are commonly used as last-resort therapies in severe septic shock, some evidence supports the initiation of treatment in a less severe state of the disease.

  11. Intestinal radiation syndrome: sepsis and endotoxin

    SciTech Connect

    Geraci, J.P.; Jackson, K.L.; Mariano, M.S.

    1985-03-01

    Rats were whole-body irradiated with 8-MeV cyclotron-produced neutrons and /sup 137/Cs ..gamma.. rays to study the role of enteric bacteria and endotoxin in the intestinal radiation syndrome. Decrease in intestinal weight was used as an index of radiation-induced breakdown of the mucosa. Neutron and ..gamma..-ray doses that were sublethal for intestinal death resulted in a dose-dependent decrease in intestinal weight, reaching minimal values 2 to 3 days after exposure, followed by recovery within 5 days after irradiation. Neutron and photon doses that caused intestinal death resulted in greater mucosal breakdown with little or no evidence of mucosal recovery. The presence of fluid in the intestine and diarrhea, but not bacteremia or endotoxemia, were related to mucosal breakdown and recovery. Neither sepsis nor endotoxin could be detected in liver samples taken at autopsy from animals which died a short time earlier from intestinal injury. These results suggest that overt sepsis and endotoxemia do not play a significant role in the intestinal radiation syndrome.

  12. Hypomagnesemia in Critically Ill Sepsis Patients

    PubMed Central

    Velissaris, Dimitrios; Karamouzos, Vassilios; Pierrakos, Charalampos; Aretha, Diamanto; Karanikolas, Menelaos

    2015-01-01

    Magnesium (Mg), also known as “the forgotten electrolyte”, is the fourth most abundant cation overall and the second most abundant intracellular cation in the body. Mg deficiency has been implicated in the pathophysiology of many diseases. This article is a review of the literature regarding Mg abnormalities with emphasis on the implications of hypomagnesemia in critical illness and on treatment options for hypomagnesemia in critically ill patients with sepsis. Hypomagnesemia is common in critically ill patients, and there is strong, consistent clinical evidence, largely from observational studies, showing that hypomagnesemia is significantly associated with increased need for mechanical ventilation, prolonged ICU stay and increased mortality. Although the mechanism linking hypomagnesemia with poor clinical outcomes is not known, experimental data suggest mechanisms contributing to such outcomes. However, at the present time, there is no clear evidence that magnesium supplementation improves outcomes in critically ill patients with hypomagnesemia. Large, well-designed clinical trials are needed to evaluate the role of magnesium therapy for improving outcomes in critically ill patients with sepsis. PMID:26566403

  13. Mass balance for POPs in hazardous and municipal solid waste incinerators.

    PubMed

    Van Caneghem, J; Block, C; Van Brecht, A; Wauters, G; Vandecasteele, C

    2010-02-01

    The amount of different persistent organic pollutants (POPs) in the input of waste incinerators was compared to that in the output. Three cases were considered: a rotary kiln incinerating hazardous waste, a grate furnace incinerating municipal solid waste (MSW) and the same grate furnace co-incinerating plastics of waste of electrical and electronic equipment (WEEE) and automotive shredder residue (ASR) with MSW. The mass balance for PCBs in the rotary kiln indicates that these POPs are destroyed effectively during incineration. The grate furnace can be a sink or source of PCDD/Fs and PCBs depending on the concentrations in the incinerated waste. In order to compare the total amount of POPs in input and output, a methodology was developed whereby the amount of POPs was weighed according to minimal risk doses (MRDs) or cancer potency factors. For both incinerators the PCDD/Fs, PCBs and polyaromatic hydrocarbons (PAHs) are the main contributors to total weighed POP output. In MSW, the PCDD/Fs, PBDD/Fs and polybrominated diphenylethers (PBDEs) are the main contributors to the weighed POP input. The ratios of the weighed POP-input over -output clearly indicate that the rotary kiln incinerating hazardous waste is a weighed POP sink. The grate furnace incinerating MSW is a weighed POP sink or source depending on the POP-concentrations in the waste, but the difference between output and input is rather limited. When e.g. ASR and plastics of WEEE, containing high concentrations of PBDEs and PCBs, are co-incinerated in the grate furnace, it is clearly a weighed POP sink.

  14. Neonatal thyroid function: influence of perinatal factors.

    PubMed Central

    Franklin, R C; Carpenter, L M; O'Grady, C M

    1985-01-01

    Indices of thyroid function were measured in 229 healthy term neonates at birth and at 5, 10, and 15 days of age. Results were analysed to assess whether maternal diabetes mellitus, toxaemia of pregnancy, intrapartum fetal distress, duration of labour, method of delivery, asphyxia at birth, race, sex, birthweight, birth length, head circumference, or method of feeding influenced any index. Thyroxine, the free thyroxine index, and free thyroxine concentrations at birth correlated with birthweight. Method of delivery influenced mean thyroxine and free thyroxine index values at birth and at age 5 days. Mean values of triiodothyronine, reverse triiodothyronine, thyroxine binding globulin, and thyroid stimulating hormone were not affected by any of the perinatal factors studied. Birthweight and perhaps method of delivery should be taken into account when interpreting neonatal thyroxine parameters but determination of thyroid stimulating hormone as a screen for congenital hypothyroidism in healthy term neonates circumvents these considerations. PMID:3977386

  15. Perinatal mortality at pre-Columbian Teotihuacan.

    PubMed

    Storey, R

    1986-04-01

    The skeletal population of 166 individuals from a low-status apartment compound of the pre-Columbian city of Teotihuacan contained 52 perinatal individuals. The most perilous time of the lifespan was around birth, as revealed by life table analysis. Femur length was not increasing during the last month of gestation, and individuals were probably shorter somatically at birth than modern standards or historic-period Arikara skeletal controls. The possibility of intrauterine growth retardation is investigated through paleo-pathological indicators of prenatal growth arrest. The evidence of prenatal stress and the high rate of mortality at birth seem to indicate that this New World preindustrial urban population faced similar health and nutritional stresses as Old World preindustrial cities.

  16. Cytomegalovirus myelitis in perinatally acquired HIV.

    PubMed Central

    Güngör, T; Funk, M; Linde, R; Jacobi, G; Horn, M; Kreuz, W

    1993-01-01

    A 7 year old child perinatally infected with HIV who died from progressive muscular paralysis and central nervous respiratory failure is described. Cytomegalovirus (CMV) prophylaxis with a special intravenous CMV hyper-immunoglobulin had been successfully conducted for more than four years. Macroscopic and microscopic immunohistochemical examination of the spinal cord revealed a diffuse CMV infiltration of the entire myelon. CMV infected cells were identified as astrocytes, oligodendrocytes, neurons, macrophages, ependymal, endothelial, and Schwann cells. Other organs had no signs of CMV infection. Central nervous spinal CMV infection was most probably due to insufficient penetration of the blood-brain barrier by the CMV hyper-immunoglobulin. In suspicious cases early spinal magnetic resonance imaging (1.5 tesla) combined with an examination of urine and cerebrospinal fluid for CMV is recommended. Images Figure 1 Figure 2 Figure 3 PMID:8385439

  17. Collagen defects in lethal perinatal osteogenesis imperfecta.

    PubMed

    Bateman, J F; Chan, D; Mascara, T; Rogers, J G; Cole, W G

    1986-12-15

    Quantitative and qualitative abnormalities of collagen were observed in tissues and fibroblast cultures from 17 consecutive cases of lethal perinatal osteogenesis imperfecta (OI). The content of type I collagen was reduced in OI dermis and bone and the content of type III collagen was also reduced in the dermis. Normal bone contained 99.3% type I and 0.7% type V collagen whereas OI bone contained a lower proportion of type I, a greater proportion of type V and a significant amount of type III collagen. The type III and V collagens appeared to be structurally normal. In contrast, abnormal type I collagen chains, which migrated slowly on electrophoresis, were observed in all babies with OI. Cultured fibroblasts from five babies produced a mixture of normal and abnormal type I collagens; the abnormal collagen was not secreted in two cases and was slowly secreted in the others. Fibroblasts from 12 babies produced only abnormal type I collagens and they were also secreted slowly. The slower electrophoretic migration of the abnormal chains was due to enzymic overmodification of the lysine residues. The distribution of the cyanogen bromide peptides containing the overmodified residues was used to localize the underlying structural abnormalities to three regions of the type I procollagen chains. These regions included the carboxy-propeptide of the pro alpha 1(I)-chain, the helical alpha 1(I) CB7 peptide and the helical alpha 1(I) CB8 and CB3 peptides. In one baby a basic charge mutation was observed in the alpha 1(I) CB7 peptide and in another baby a basic charge mutation was observed in the alpha 1(I) CB8 peptide. The primary defects in lethal perinatal OI appear to reside in the type I collagen chains. Type III and V collagens did not appear to compensate for the deficiency of type I collagen in the tissues.

  18. Ethical issues in perinatal mental health.

    PubMed

    Miller, Laura J

    2009-06-01

    The principles of autonomy, beneficence, nonmaleficence, and justice can guide clinicians in finding ethical approaches to the treatment of women who have psychiatric disorders during preconception, pregnancy, and postpartum. Table 1 summarizes some clinical dilemmas in perinatal mental health care, the ethical conundrums posed by these situations, and guiding principles or tools that can help clinicians resolve ethical conflicts. The concept of relational ethics helps resolve apparent mother-offspring ethical conflicts, and the practice of preventive ethics helps anticipate and reduce the risk of ethical dilemmas and adverse clinical outcomes. These central principles suggest the following guidelines in caring for perinatal women: In situations that seem to pit the needs of a pregnant or postpartum woman against the needs of her fetus or baby, reframe the problem to find a solution that most benefits the mother-baby dyad while posing the least risk to the dyad. In evaluating a pregnant woman's ability to make autonomous, informed decisions about medical care, assess her ability to decide on behalf of both herself and her fetus. When explaining the risks of treatments such as psychotropic medication during pregnancy, avoid errors of omission by also explaining the risks of withholding the treatments. Apply the principle of justice to ensure that women are not stigmatized by having psychiatric disorders or by being pregnant. When screening for maternal psychiatric symptoms, ensure that the benefits of screening outweigh the ethical costs by designing effective follow-up systems for helping women who have positive screens. When treating women of reproductive age for psychiatric disorders, proactively discuss family planning and, when appropriate, the anticipated risks of the illness and the treatment during future pregnancies. Offer preventive interventions to reduce these risks. PMID:19486812

  19. e-POP Radio Science Using Amateur Radio Transmissions

    NASA Astrophysics Data System (ADS)

    Frissell, N. A.; Perry, G. W.; Miller, E. S.; Shovkoplyas, A.; Moses, M. L.; James, H. G.; Yau, A. W.

    2015-12-01

    A major component of the enhanced Polar Outflow Probe (e-POP) Radio Receiver Instrument (RRI) mission is to utilize artificially generated radio emissions to study High Frequency (HF) radio wave propagation in the ionosphere. In the North American and European sectors, communications between amateur radio operators are a persistent and abundant source source of HF transmissions. We present the results of HF radio wave propagation experiments using amateur radio transmissions as an HF source for e-POP RRI. We detail how a distributed and autonomously operated amateur radio network can be leveraged to study HF radio wave propagation as well as the structuring and dynamics of the ionosphere over a large geographic region. In one case, the sudden disappearance of nearly two-dozen amateur radio HF sources located in the midwestern United States was used to detect a enhancement in foF2 in that same region. We compare our results to those from other more conventional radio instruments and models of the ionosphere to demonstrate the scientific merit of incorporating amateur radio networks for radio science at HF.

  20. Avengers Assemble! Using pop-culture icons to communicate science.

    PubMed

    Zehr, E Paul

    2014-06-01

    Engaging communication of complex scientific concepts with the general public requires more than simplification. Compelling, relevant, and timely points of linkage between scientific concepts and the experiences and interests of the general public are needed. Pop-culture icons such as superheroes can represent excellent opportunities for exploring scientific concepts in a mental “landscape” that is comfortable and familiar. Using an established icon as a familiar frame of reference, complex scientific concepts can then be discussed in a more accessible manner. In this framework, scientists and the general public use the cultural icon to occupy a commonly known performance characteristic. For example, Batman represents a globally recognized icon who represents the ultimate response to exercise and training. The physiology that underlies Batman’s abilities can then be discussed and explored using real scientific examples that highlight truths and fallacies contained in the presentation of pop-culture icons. Critically, it is not important whether the popular representation of the icon shows correct science because the real science can be revealed in discussing the character through this lens. Scientists and educators can then use these icons as foils for exploring complex ideas in a context that is less threatening and more comfortable for the target audience. A “middle-ground hypothesis” for science communication is proposed in which popculture icons are used to exploring scientific concepts in a bridging mental landscape that is comfortable and familiar. This approach is encouraged for communication with all nonscientists regardless of age.

  1. Risk of Remote Seizures After Perinatal Ischemic Stroke.

    PubMed

    Ritacco, David G

    2016-08-01

    Investigators from the University of California San Francisco and Kaiser Permanente Medical Centers in Oakland report outcome of perinatal arterial ischemic stroke (PAIS) in a population-based cohort, with particular attention to the incidence of seizures. PMID:27649623

  2. High-tech, high-touch perinatal home care.

    PubMed

    Dahlberg, N L; Blazek, D; Wikoff, B; Tuckwell, B L; Koloroutis, M

    1995-05-01

    Perinatal home care for women experiencing a high-risk pregnancy often requires the use of technologies for safe home management. Home care professionals need to integrate high technology with high touch to ensure the best results.

  3. Contribution of congenital malformation to perinatal mortality in Lagos, Nigeria.

    PubMed

    Abudu, O O; Uguru, V; Olude, O

    1988-08-01

    Over a 17-month period we prospectively recorded identifiable congenital malformations at delivery in singleton births in our hospital. Despite the prevailing religious and cultural belief we carried out autopsies in 41% of the perinatal deaths that occurred during the study period. Out of a total of 63 (21/1000 singleton births) congenital malformations discovered, 21 (33%) were identified at autopsy only. About 16% of total perinatal deaths were due to congenital malformation. Cardiovascular malformations accounted for about 40% of perinatal deaths from congenital malformations followed by central nervous system malformation (23.3%), gastrointestinal malformations (20%), musculo-skeletal malformations (6.7%); renal malformations (3.3%) and others (6.7%). No relationship between maternal age, parity and congenital malformation was found. The results from this study suggest that with the use of autopsy, teratology may contribute significantly to the prevailing high perinatal mortality in Lagos more than was previously thought. PMID:2905300

  4. Optimizing the treatment of mood disorders in the perinatal period.

    PubMed

    Meltzer-Brody, Samantha; Jones, Ian

    2015-06-01

    The perinatal period is a time of high risk for women with unipolar and bipolar mood disorders. We discuss treatment considerations for perinatal mood disorders, including unipolar and bipolar depression as well as postpartum psychosis. We further explore the unique issues faced by women and their families across the full trajectory of the perinatal period from preconception planning through pregnancy and following childbirth. Treatment of perinatal mood disorders requires a collaborative care approach between obstetrics practitioners and mental health providers, to ensure that a thoughtful risk : benefit analysis is conducted. It is vital to consider the risks of the underlying illness versus risks of medication exposure during pregnancy or lactation. When considering medication treatment, attention must be paid to prior medication trials that were most efficacious and best tolerated. Lastly, it is important to assess the impact of individual psychosocial stressors and lifestyle factors on treatment response.

  5. Prevention of perinatal transmission of human immunodeficiency virus.

    PubMed

    Chappell, Catherine A; Cohn, Susan E

    2014-12-01

    The reproductive health needs of all women of childbearing age should routinely address effective and appropriate contraception, safer sex practices, and elimination of alcohol, illicit drugs and tobacco should pregnancy occur. Combined antepartum, intrapartum, and infant antiretroviral (ARV) prophylaxis are recommended because ARV drugs reduce perinatal transmission by several mechanisms, including lowering maternal viral load and providing infant pre- and post-exposure prophylaxis. Scheduled cesarean delivery at 38 weeks with IV AZT decreases the risk of perinatal transmission if the HIV RNA is greater than 1000 copies/mL or if HIV levels are unknown near the time of delivery. Oral AZT should generally be given for at least 6 weeks to all infants perinatally exposed to HIV to reduce perinatal transmission of HIV. PMID:25455313

  6. Genetics of perinatal brain injury in the preterm infant.

    PubMed

    Baier, Ronald John

    2006-05-01

    Due to developmental immaturity of the central nervous system, effects of an adverse intrauterine environment and need for intensive care postnatally, preterm infants are at high risk of sustaining brain injury in the perinatal period. Infants who suffer brain injury in the perinatal period are at risk for long-term neurodevelopmental sequelae. Clinical and experimental data supports a significant role for inflammatory mediators in the pathophysiology of perinatal brain injury. Abnormalities in coagulation proteins in the sick preterm newborn may accentuate the risk for intraventricular hemorrhage. Polymorphisms in TNF alpha , IL-1 beta , IL-4, IL-6 and IL-10 as well as mutations in coagulation proteins have been investigated as potential candidate genes to modify risk and or severity of perinatal brain injury. Preliminary evidence suggests a role for cytokine genes as risk modifiers for IVH and PVL.

  7. 46 CFR 162.018-5 - Blow-down adjustment and popping tolerance.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 46 Shipping 6 2011-10-01 2011-10-01 false Blow-down adjustment and popping tolerance. 162.018-5... Compressed Gas § 162.018-5 Blow-down adjustment and popping tolerance. (a) Safety relief valves shall be so... adjustible blow-down construction shall be adjusted to close after blowing down not more than 5 percent...

  8. 46 CFR 162.018-5 - Blow-down adjustment and popping tolerance.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 46 Shipping 6 2010-10-01 2010-10-01 false Blow-down adjustment and popping tolerance. 162.018-5... Compressed Gas § 162.018-5 Blow-down adjustment and popping tolerance. (a) Safety relief valves shall be so... adjustible blow-down construction shall be adjusted to close after blowing down not more than 5 percent...

  9. 46 CFR 162.018-5 - Blow-down adjustment and popping tolerance.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 46 Shipping 6 2012-10-01 2012-10-01 false Blow-down adjustment and popping tolerance. 162.018-5... Compressed Gas § 162.018-5 Blow-down adjustment and popping tolerance. (a) Safety relief valves shall be so... adjustible blow-down construction shall be adjusted to close after blowing down not more than 5 percent...

  10. 46 CFR 162.018-5 - Blow-down adjustment and popping tolerance.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 46 Shipping 6 2014-10-01 2014-10-01 false Blow-down adjustment and popping tolerance. 162.018-5... Compressed Gas § 162.018-5 Blow-down adjustment and popping tolerance. (a) Safety relief valves shall be so... adjustable blow-down construction shall be adjusted to close after blowing down not more than 5 percent...

  11. 46 CFR 162.018-5 - Blow-down adjustment and popping tolerance.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 46 Shipping 6 2013-10-01 2013-10-01 false Blow-down adjustment and popping tolerance. 162.018-5... Compressed Gas § 162.018-5 Blow-down adjustment and popping tolerance. (a) Safety relief valves shall be so... adjustible blow-down construction shall be adjusted to close after blowing down not more than 5 percent...

  12. Contextual Distinctiveness Produces Long-Lasting Priming of Pop-Out

    ERIC Educational Resources Information Center

    Thomson, David R.; Milliken, Bruce

    2013-01-01

    Maljkovic and Nakayama have demonstrated memory influences in singleton search from one trial to the next, an effect they termed "priming of pop-out" (PoP). This effect was described as resulting from the persistence of an implicit memory trace, the influence of which could be observed for around 5-8 subsequent trials. Thomson and Milliken (2012)…

  13. Strategies for Using Pop Culture in Sport Psychology and Coaching Education

    ERIC Educational Resources Information Center

    Collins, Karen

    2012-01-01

    The use of pop culture as a tool for learning and instruction is paramount. Therefore, it is imperative for teachers to be aware of, and incorporate, trends that are popular and reflect the student experience. This article addresses the pop culture trends that can positively affect teaching, coaching education, and sport psychology practice.…

  14. Understanding the potential impact of milk processing on the distribution of POPs residues in milk products

    Technology Transfer Automated Retrieval System (TEKTRAN)

    It has long been acknowledged that human exposure to persistent organic pollutants (POPs) occurs principally through our food. Therefore, market basket surveys of the food supply have been valuable tools to provide estimates of human exposures to POPs and the risks associated with these exposures. ...

  15. Late Pop III Star Formation During the Epoch of Reionization: Results from the Renaissance Simulations

    NASA Astrophysics Data System (ADS)

    Xu, Hao; Norman, Michael L.; O’Shea, Brian W.; Wise, John H.

    2016-06-01

    We present results on the formation of Population III (Pop III) stars at redshift 7.6 from the Renaissance Simulations, a suite of extremely high-resolution and physics-rich radiation transport hydrodynamics cosmological adaptive-mesh refinement simulations of high-redshift galaxy formation performed on the Blue Waters supercomputer. In a survey volume of about 220 comoving Mpc3, we found 14 Pop III galaxies with recent star formation. The surprisingly late formation of Pop III stars is possible due to two factors: (i) the metal enrichment process is local and slow, leaving plenty of pristine gas to exist in the vast volume; and (ii) strong Lyman–Werner radiation from vigorous metal-enriched star formation in early galaxies suppresses Pop III formation in (“not so”) small primordial halos with mass less than ˜3 × 107 M ⊙. We quantify the properties of these Pop III galaxies and their Pop III star formation environments. We look for analogs to the recently discovered luminous Ly α emitter CR7, which has been interpreted as a Pop III star cluster within or near a metal-enriched star-forming galaxy. We find and discuss a system similar to this in some respects, however, the Pop III star cluster is far less massive and luminous than CR7 is inferred to be.

  16. Noncanonical Wnt signaling pathways in C. elegans converge on POP-1/TCF and control cell polarity.

    PubMed

    Herman, Michael A; Wu, Mingfu

    2004-05-01

    In the nematode Caenorhabditis elegans, a canonical Wnt signaling pathway controls a cell migration whereas noncanonical Wnt pathways control the polarities of individual cells. Despite the differences in the identities and interactions among canonical and noncanonical Wnt pathway components, as well as the processes they regulate, almost all C. elegans Wnt pathways involve the sole Tcf homolog, POP-1. Intriguingly, POP-1 is asymmetrically distributed between the daughters of an asymmetric cell division, with the anterior sister cell usually having a higher level of nuclear POP-1 than its posterior sister. At some divisions, asymmetric distribution of POP-1 is controlled by noncanonical Wnt signaling, but at others the asymmetry is generated independently. Recent experiments suggest that despite this elaborate anterior-posterior POP-1 asymmetry, the quantity of POP-1 protein may have less to do with the subsequent determination of fate than does the quality of the POP-1 protein in the cell. In this review, we will embark on a quest to understand Quality (1), at least from the standpoint of the effect POP/Tcf quality has on the control of cell polarity in C. elegans. PMID:14977564

  17. Late Pop III Star Formation During the Epoch of Reionization: Results from the Renaissance Simulations

    NASA Astrophysics Data System (ADS)

    Xu, Hao; Norman, Michael L.; O'Shea, Brian W.; Wise, John H.

    2016-06-01

    We present results on the formation of Population III (Pop III) stars at redshift 7.6 from the Renaissance Simulations, a suite of extremely high-resolution and physics-rich radiation transport hydrodynamics cosmological adaptive-mesh refinement simulations of high-redshift galaxy formation performed on the Blue Waters supercomputer. In a survey volume of about 220 comoving Mpc3, we found 14 Pop III galaxies with recent star formation. The surprisingly late formation of Pop III stars is possible due to two factors: (i) the metal enrichment process is local and slow, leaving plenty of pristine gas to exist in the vast volume; and (ii) strong Lyman-Werner radiation from vigorous metal-enriched star formation in early galaxies suppresses Pop III formation in (“not so”) small primordial halos with mass less than ˜3 × 107 M ⊙. We quantify the properties of these Pop III galaxies and their Pop III star formation environments. We look for analogs to the recently discovered luminous Ly α emitter CR7, which has been interpreted as a Pop III star cluster within or near a metal-enriched star-forming galaxy. We find and discuss a system similar to this in some respects, however, the Pop III star cluster is far less massive and luminous than CR7 is inferred to be.

  18. Supporting Social Studies Reading Comprehension with an Electronic Pop-Up Dictionary

    ERIC Educational Resources Information Center

    Fry, Sara Winstead; Gosky, Ross

    2008-01-01

    This study investigated how middle school students' comprehension was impacted by reading social studies texts online with a pop-up dictionary function for every word in the text. A quantitative counterbalance design was used to determine how 129 middle school students' reading comprehension test scores for the pop-up dictionary reading differed…

  19. 76 FR 45693 - Safety Zone; San Diego POPS Fireworks, San Diego, CA

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-08-01

    ... SECURITY Coast Guard 33 CFR Part 165 RIN 1625-AA00 Safety Zone; San Diego POPS Fireworks, San Diego, CA... temporary safety zone on the navigable waters of San Diego Bay in support of the San Diego POPS Fireworks... rule, call or e-mail Petty Officer Shane Jackson, Waterways Management, U.S. Coast Guard Sector...

  20. 75 FR 38412 - Safety Zone; San Diego POPS Fireworks, San Diego, CA

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-07-02

    ... SECURITY Coast Guard 33 CFR Part 165 RIN 1625-AA00 Safety Zone; San Diego POPS Fireworks, San Diego, CA... zone on the ] navigable waters of San Diego Bay in support of the San Diego POPS Fireworks. This safety.... Coast Guard Sector San Diego, CA; telephone 619-278- 7262, e-mail Shane.E.Jackson@uscg.mil . If you...

  1. Mast Cell Stabilization Improves Survival by Preventing Apoptosis in Sepsis

    PubMed Central

    Ramos, Laura; Peña, Geber; Cai, Bolin; Deitch, E. A.; Ulloa, Luis

    2011-01-01

    Inhibiting single cytokines produced modest effects in clinical trials, in part because the cytokines werenot specific for sepsis, and sepsis may require cellular strategies. Previous studies reported that mast cells (MCs) fight infections in early sepsis. In this study, we report that MC stabilizers restrain serum TNF levels and improve survival in wild-type but not in MC-deficient mice. Yet, MC depletion in knockout mice attenuates serum TNF but does not improve survival in sepsis. Serum HMGB1 was the only factor correlating with survival. MC stabilizers inhibit systemic HMGB1 levels and rescue mice from established peritonitis. MC stabilizers fail to inhibit HMGB1 secretion from macrophages, but they prevent apoptosis and caspase-3 activation in sepsis. These results suggest that MC stabilization provides therapeutic benefits in sepsis by inhibiting extracellular release of HMGB1 from apoptotic cells. Our study provides the first evidence that MCs have major immunological implications regulating cell death in sepsis and represent a pharmacological target for infectious disorders in a clinically realistic time frame. PMID:20519642

  2. Angiopoietin-2 associations with the underlying infection and sepsis severity.

    PubMed

    Lymperopoulou, Korina; Velissaris, Dimitrios; Kotsaki, Antigone; Antypa, Elli; Georgiadou, Sara; Tsaganos, Thomas; Koulenti, Despina; Paggalou, Evgenia; Damoraki, Georgia; Karagiannidis, Napoleon; Orfanos, Stylianos E

    2015-05-01

    Angiopoietin-2 (Ang-2) is an important mediator in sepsis. We have previously shown that endotoxemia levels are related to the underlying infection and affect septic patients' outcome. Based on this background we now investigated if circulating Ang-2 (cAng-2) and monocyte Ang-2 expression in septic patients are associated with the underlying infection and organ failure. We measured cAng-2 in 288 septic patients (121 with sepsis, 167 with severe sepsis/septic shock) at less than 24h post study inclusion (day 1) and on days 3 and 7. Peripheral blood mononuclear cells (PBMCs) were additionally isolated; Ang-2 gene expression was estimated by means of real-time PCR. Levels of cAng-2 were higher under severe sepsis and septic shock, as compared to uncomplicated sepsis; PBMC Ang-2 copies were higher in severe sepsis. On day 1, cAng-2 and Ang-2 gene copies were greater under severe sepsis/septic shock in sufferers from all types of infections with the exception of community-acquired pneumonia and ventilator-associated pneumonia. cAng-2 increased proportionally to the number of failing organs, and was higher under metabolic acidosis and acute coagulopathy as compared to no failing organ. On day 1, copies of Ang-2 were higher in survivors, whereas cAng-2 was higher in non-survivors. In a large cohort of septic patients, cAng-2 kinetics appears associated with the underlying infection and organ failure type.

  3. The role of arginine in infection and sepsis.

    PubMed

    Luiking, Yvette C; Poeze, Martijn; Ramsay, Graham; Deutz, Nicolaas E P

    2005-01-01

    Sepsis is a systemic response to an infection, with high morbidity and mortality rates. Metabolic changes during infection and sepsis could be related to changes in metabolism of the amino acid L-arginine. In sepsis, protein breakdown is increased, which is a key process to maintain arginine delivery because both endogenous de novo arginine production from citrulline and food intake are reduced. Arginine catabolism, on the other hand, is markedly increased by enhanced use of arginine via the arginase and nitric oxide pathways. As a result, lowered plasma arginine levels are usually found. Arginine may therefore be considered as an essential amino acid in sepsis, and supplementation could be beneficial in sepsis by improving microcirculation and protein anabolism. L-Arginine supplementation in a hyperdynamic pig model of sepsis prohibits the increase in pulmonary arterial blood pressure, improves muscle and liver protein metabolism, and restores the intestinal motility pattern. Arguments raised against arginine supplementation are mainly pointed at stimulating nitric oxide (NO) production, with concerns about toxicity of increased NO and hemodynamic instability with refractory hypotension. NO synthase inhibition, however, increased mortality. Arginine supplementation in septic patients has transient effects on hemodynamics when supplied as a bolus but seems without hemodynamic side effects when supplied continuously. In conclusion, arginine could have an essential role in infection and sepsis.

  4. Challenges in the diagnosis and management of neonatal sepsis.

    PubMed

    Zea-Vera, Alonso; Ochoa, Theresa J

    2015-02-01

    Neonatal sepsis is the third leading cause of neonatal mortality and a major public health problem, especially in developing countries. Although recent medical advances have improved neonatal care, many challenges remain in the diagnosis and management of neonatal infections. The diagnosis of neonatal sepsis is complicated by the frequent presence of noninfectious conditions that resemble sepsis, especially in preterm infants, and by the absence of optimal diagnostic tests. Since neonatal sepsis is a high-risk disease, especially in preterm infants, clinicians are compelled to empirically administer antibiotics to infants with risk factors and/or signs of suspected sepsis. Unfortunately, both broad-spectrum antibiotics and prolonged treatment with empirical antibiotics are associated with adverse outcomes and increase antimicrobial resistance rates. Given the high incidence and mortality of sepsis in preterm infants and its long-term consequences on growth and development, efforts to reduce the rates of infection in this vulnerable population are one of the most important interventions in neonatal care. In this review, we discuss the most common questions and challenges in the diagnosis and management of neonatal sepsis, with a focus on developing countries.

  5. Neonatal sepsis: an old problem with new insights.

    PubMed

    Shah, Birju A; Padbury, James F

    2014-01-01

    Neonatal sepsis continues to be a common and significant health care burden, especially in very-low-birth-weight infants (VLBW<1500 g). Though intrapartum antibiotic prophylaxis has decreased the incidence of early-onset group B streptococcal infection dramatically, it still remains a major cause of neonatal sepsis. Moreover, some studies among VLBW preterm infants have shown an increase in early-onset sepsis caused by Escherichia coli. As the signs and symptoms of neonatal sepsis are nonspecific, early diagnosis and prompt treatment remains a challenge. There have been a myriad of studies on various diagnostic markers like hematological indices, acute phase reactants, C-reactive protein, procalcitonin, cytokines, and cell surface markers among others. Nonetheless, further research is needed to identify a biomarker with high diagnostic accuracy and validity. Some of the newer markers like inter α inhibitor proteins have shown promising results thereby potentially aiding in early detection of neonates with sepsis. In order to decrease the widespread, prolonged use of unnecessary antibiotics and improve the outcome of the infants with sepsis, reliable identification of sepsis at an earlier stage is paramount.

  6. Mortality in Sepsis and its relationship with Gender

    PubMed Central

    Nasir, Nosheen; Jamil, Bushra; Siddiqui, Shahla; Talat, Najeeha; Khan, Fauzia A.; Hussain, Rabia

    2015-01-01

    Background and Objective: Sepsis remains a leading cause of death across the world, carrying a mortality rate of 20–50%. Women have been reported to be less likely to suffer from sepsis and to have a lower risk of mortality from sepsis compared to men. The objective of this study was to determine the relationship between gender and mortality in sepsis, and compare cytokine profiles of male and female patients. Methods: This was a prospective case series on 97 patients admitted with sepsis. Clinical and microbiological data was gathered, blood samples were collected for cytokine (IL-10, IL-6 and TNFα) levels and patients were followed up for clinical outcome. Results: There were 54% males and 46% females, with no significant difference of age or comorbids between genders. Respiratory tract infection was the commonest source of sepsis, and was more common in females (60%) compared to males (39%) (p=0.034). Males had a higher mortality (p=0.048, RR 1.73) and plasma IL-6 level(p=0.040) compared to females. Mean IL-6 plasma level was significantly (p<0.01) higher in patients who died vs. who recovered. Conclusion: Our study shows that males with sepsis have a 70% greater mortality rate, and mortality is associated with a higher IL-6 plasma level. PMID:26649014

  7. Colloids in sepsis: evenly distributed molecules surrounded by uneven questions.

    PubMed

    Zampieri, Fernando Godinho; Park, Marcelo; Azevedo, Luciano Cesar Pontes

    2013-05-01

    Colloids are frequently used for fluid expansion in the intensive care unit, although its use on several clinical scenarios remains unproven of any relevant clinical benefit. The purpose of this article was to carry out a narrative review regarding the safety and efficacy of colloids in patients with sepsis and septic shock, with emphasis on the most commonly used colloids, albumin and starches. Colloids are effective fluid expanders and are able to restore the hemodynamic profile with less total volume than crystalloids. These properties appear to be preserved even in patients with sepsis with increased capillary permeability. However, some colloids are associated with renal impairment and coagulation abnormalities. Starch use was associated with increased mortality in two large clinical trials. Also, starches probably have significant renal adverse effects and may be related to more need for renal replacement therapy in severe sepsis. Albumin is the only colloid that has been shown safe in patients with sepsis and that may be associated with improved outcomes on specific subpopulations. No trial so far found any robust clinical end point favoring colloid use in patients with sepsis. Because there is no proven benefit of the use of most colloids in patients with sepsis, its use should not be encouraged outside clinical trials. Albumin is the only colloid solution that has proven to be safe, and its use may be considered on hypoalbuminemic patients with sepsis. Nevertheless, there are no robust data to recommend routine albumin administration in sepsis. Starch use should be avoided in patients with sepsis because of the recent findings of a multicenter randomized study until further evidence is available.

  8. Epigenetics and fetal adaptation to perinatal events: diversity through fidelity.

    PubMed

    Joss-Moore, L A; Metcalfe, D B; Albertine, K H; McKnight, R A; Lane, R H

    2010-04-01

    Perinatal insults, including fetal undernutrition and hypoxia, are associated with an increased susceptibility to several adult-onset metabolic disorders. These include cardiovascular disease, insulin resistance, and obesity. However, the mechanisms driving the long-term phenotypic consequences have only recently begun to be elucidated. A primary mechanism accounting for perinatal adaptation is the epigenetic modification of chromatin. In this context, epigenetic modifications to chromatin are thought to arise in response to a perinatal insult in an effort to modulate gene expression and maximize fetal survival. In this symposium report, we discuss epigenetics as a mechanism by which perinatal adaptations can be made by the developing fetus. We examine the benefits of using multiple in vivo models to understand the interrelation of signals that come together and result in perinatal adaptation. Epigenetic effects on IGF-1 arising from a perinatal insult are discussed, as are the difficulties and challenges associated with this complex field. In conclusion, epigenetics provides a means of modulating gene transcription, thus allowing fetal adaptation to a broad variety of conditions. PMID:19854998

  9. Update on the management of neonatal sepsis in horses.

    PubMed

    Palmer, Jon

    2014-08-01

    Despite advances in neonatal intensive care sepsis, severe sepsis and septic shock remain the biggest killers of neonatal foals. Management of this severe syndrome remains difficult, requiring intensive intervention. Key aspects of management include infection control, hemodynamic support, immunomodulatory interventions, and metabolic/endocrine support. Infection control largely consists of early antimicrobial therapy, plasma transfusions, and local therapy for the infected focus. In cases with severe sepsis or septic shock, hemodynamic support with fluids, vasoactive agents, and respiratory support insuring oxygen delivery to vital organs is important. Nutritional support is important, but close monitoring is needed to avoid hyperglycemia and hypoglycemia.

  10. Potential of surface acoustic wave biosensors for early sepsis diagnosis.

    PubMed

    Csete, Marie; Hunt, William D

    2013-08-01

    Early diagnosis of sepsis is a difficult problem for intensivists and new biomarkers for early diagnosis have been difficult to come by. Here we discuss the potential of adapting a technology from the electronics industry, surface acoustic wave (SAW) sensors, for diagnosis of multiple markers of sepsis in real time, using non-invasive assays of exhaled breath condensate. The principles and advantages of the SAW technology are reviewed as well as a proposed plan for adapting this flexible technology to early sepsis detection. PMID:23471596

  11. Challenges with Diagnosing and Managing Sepsis in Older Adults.

    PubMed

    Clifford, Kalin M; Dy-Boarman, Eliza A; Haase, Krystal K; Maxvill, Kristen; Pass, Steven E; Alvarez, Carlos A

    2016-01-01

    Sepsis in older adults has many challenges that affect rate of septic diagnosis, treatment, and monitoring parameters. Numerous age-related changes and comorbidities contribute to increased risk of infections in older adults, but also atypical symptomatology that delays diagnosis. Due to various pharmacokinetic/pharmacodynamic changes in the older adult, medications are absorbed, metabolized, and eliminated at different rates as compared to younger adults, which increases risk of adverse drug reactions due to use of drug therapy needed for sepsis management. This review provides information to aid in diagnosis and offers recommendations for monitoring and treating sepsis in the older adult population.

  12. Metabolism, Metabolomics, and Nutritional Support of Patients with Sepsis.

    PubMed

    Englert, Joshua A; Rogers, Angela J

    2016-06-01

    Sepsis is characterized by profound changes in systemic and cellular metabolism that disrupt normal metabolic homeostasis. These metabolic changes can serve as biomarkers for disease severity. Lactate, a metabolite of anaerobic metabolism, is the most widely used ICU biomarker and it is incorporated into multiple management algorithms. Technological advances now make broader metabolic profiling possible, with early studies identifying metabolic changes associated with sepsis mortality. Finally, given the marked changes in metabolism in sepsis and the association of worse prognosis in patients with severe metabolic derangements, we summarize the seminal trials conducted to optimize nutrition in the ICU. PMID:27229648

  13. Vasoactive agents for the treatment of sepsis

    PubMed Central

    Chen, Kun

    2016-01-01

    The article describes some commonly used vasoactive agents in patients with septic shock. Depending on their distinct pharmacological properties, their effects on vascular bed and cardiac function are different. For example, dopamine has equivalent effect on heart and vasculature, which can result in increases in cardiac output, mean arterial pressure and heart rate. Dobutamine is considered as inodilator because it has potent effect on cardiac systole and vasculature. Patients with sepsis and septic shock sometimes have coexisting cardiac dysfunction that justifies the use of dobutamine. Levosimendan is a relatively new agent exerting its inodilator effect by increasing sensitivity of myocardium to calcium. Some preliminary studies showed a promising result of levosimendan on reducing mortality. PMID:27713891

  14. Time course of cytokine levels in sepsis.

    PubMed

    Thijs, L G; Hack, C E

    1995-11-01

    In severe sepsis, a network of proinflammatory cytokines (TNF, IL-1 beta, IL-6, IL-8) is activated and blood levels of these cytokines are elevated, albeit inconsistently and with large individual variations. In addition, elevated blood levels of anti-inflammatory cytokines (IL-10), as well as of soluble cytokine receptors (sTNF-RI and II, IL-1ra), have been found. They seem to have a regulatory function in the host response. Levels of TNF and IL-6 are usually highest at the time of admission, whereas the time course of IL-1 beta levels (when detectable) can vary considerably. Limited data on IL-8 levels suggest that they may remain elevated for longer periods. Elevated levels of sTNFR and IL-1ra may also persist for a prolonged period of time. The pathogenetic significance of these observations is still unclear, but persistingly high levels of proinflammatory cytokines may be associated with organ failure and mortality.

  15. Sepsis: From Pattern to Mechanism and Back

    PubMed Central

    An, Gary; Namas, Rami A.; Vodovotz, Yoram

    2013-01-01

    Sepsis is a clinical entity in which complex inflammatory and physiological processes are mobilized, not only across a range of cellular and molecular interactions, but also in clinically relevant physiological signals accessible at the bedside. There is a need for a mechanistic understanding that links the clinical phenomenon of physiologic variability with the underlying patterns of the biology of inflammation, and we assert that this can be facilitated through the use of dynamic mathematical and computational modeling. An iterative approach of laboratory experimentation and mathematical/computational modeling has the potential to integrate cellular biology, physiology, control theory, and systems engineering across biological scales, yielding insights into the control structures that govern mechanisms by which phenomena, detected as biological patterns, are produced. This approach can represent hypotheses in the formal language of mathematics and computation, and link behaviors that cross scales and domains, thereby offering the opportunity to better explain, diagnose, and intervene in the care of the septic patient. PMID:23140124

  16. [Community acquired sepsis by Serratia rubidaea].

    PubMed

    Okada, Takanori; Yokota, Eisuke; Matsumoto, Isao

    2002-02-01

    A 48-year-old male who had a past history of alcoholic pancreatitis and diabetes mellitus was admitted to our hospital due to chills and vomiting, on August 13, 1998. His body temperature was 38.0 degrees C, and he had the disturbance of consciousness, tachypnea, tachycardia and hepatomegaly with tenderness. Laboratory findings showed highly inflammatory reactions, DIC and hepatorenal dysfunction. Abdominal CT and US revealed multiple liver abscess with portal vein thrombus. Serratia rubidaea was detected in the blood culture. SBT/CPZ and TOB were administered and he recovered. This is a rare case of Serratia rubidaea sepsis. It is also necessary to pay attention to Serratia infections as well as S. marcescens.

  17. Sepsis, parenteral vaccination and skin disinfection

    PubMed Central

    Cook, Ian F.

    2016-01-01

    ASBSTRACT Disinfection should be required for all skin penetrative procedures including parenteral administration of vaccines. This review analyses medically attended infectious events following parenteral vaccination in terms of their microbiological aetiology and pathogenesis. Like ‘clean’ surgical site infections, the major pathogens responsible for these events were Staphylococcal species, implicating endogenous con-tamination as a significant source of infection. As 70% isopropyl alcohol swabbing has been shown to effectively disinfect the skin, it would be medico-legally difficult to defend a case of sepsis with the omission of skin disinfection unless the very low risk of this event was adequately explained to the patient and documented prior to vaccination. There was a significant cost-benefit for skin disinfection and cellulitis. Skin disinfection in the context of parenteral vaccination represents a new paradigm of medical practice; the use of a low cost intervention to prevent an event of very low prevalence but of significant cost. PMID:27295449

  18. Interprofessional sepsis education module: a pilot study.

    PubMed

    Chung, Han-Oh; Medina, Damien; Fox-Robichaud, Alison

    2016-03-01

    Although there is an increasing emphasis on interprofessional collaboration for safer health care systems, there remains a paucity of opportunities for postgraduate trainees to engage in formal interprofessional education (IPE). Current opportunities for interprofessional learning, such as simulation sessions, typically do not provide true IPE because they often utilize actors or confederates as support staff, making residents the only stakeholders in the education experience. Here, we describe a flexible educational module designed to provide genuine IPE for physicians, nurses, and respiratory therapists. We outline how simulation, feedback, and group discussions can be used to teach interprofessional team communication, collaboration, and crew resource management skills-while, at the same time, also teaching a highly relevant medical topic (sepsis management) and thus resulting in learner engagement and motivation.

  19. A latent class approach for sepsis diagnosis supports use of procalcitonin in the emergency room for diagnosis of severe sepsis

    PubMed Central

    2013-01-01

    Background Given the acknowledged problems in sepsis diagnosis, we use a novel way with the application of the latent class analysis (LCA) to determine the operative characteristics of C-reactive protein (CRP), D-dimer (DD) and Procalcitonin (PCT) as diagnostic tests for sepsis in patients admitted to hospital care with a presumptive infection. Methods Cross-sectional study to determine the diagnostic accuracy of three biological markers against the gold standard of clinical definition of sepsis provided by an expert committee, and also against the likelihood of sepsis according to LCA. Patients were recruited in the emergency room within 24 hours of hospitalization and were follow-up daily until discharge. Results Among 765 patients, the expert committee classified 505 patients (66%) with sepsis, 112 (15%) with infection but without sepsis and 148 (19%) without infection. The best cut-offs points for CRP, DD, and PCT were 7.8 mg/dl, 1616 ng/ml and 0.3 ng/ml, respectively; but, neither sensitivity nor specificity reach 70% for any biomarker. The LCA analysis with the same three tests identified a “cluster” of 187 patients with several characteristics suggesting a more severe condition as well as better microbiological confirmation. Assuming this subset of patients as the new prevalence of sepsis, the ROC curve analysis identified new cut-off points for the tests and suggesting a better discriminatory ability for PCT with a value of 2 ng/ml. Conclusions Under a “classical” definition of sepsis three typical biomarkers (CRP, PCT and DD) are not capable enough to differentiate septic from non-septic patients in the ER. However, a higher level of PCT discriminates a selected group of patients with severe sepsis. PMID:24050481

  20. Sphingosine 1-phosphate and its carrier apolipoprotein M in human sepsis and in Escherichia coli sepsis in baboons.

    PubMed

    Frej, Cecilia; Linder, Adam; Happonen, Kaisa E; Taylor, Fletcher B; Lupu, Florea; Dahlbäck, Björn

    2016-06-01

    Sphingosine 1-phosphate (S1P) is an important regulator of vascular integrity and immune cell migration, carried in plasma by high-density lipoprotein (HDL)-associated apolipoprotein M (apoM) and by albumin. In sepsis, the protein and lipid composition of HDL changes dramatically. The aim of this study was to evaluate changes in S1P and its carrier protein apoM during sepsis. For this purpose, plasma samples from both human sepsis patients and from an experimental Escherichia coli sepsis model in baboons were used. In the human sepsis cohort, previously studied for apoM, plasma demonstrated disease-severity correlated decreased S1P levels, the profile mimicking that of plasma apoM. In the baboons, a similar disease-severity dependent decrease in plasma levels of S1P and apoM was observed. In the lethal E. coli baboon sepsis, S1P decreased already within 6-8 hrs, whereas the apoM decrease was seen later at 12-24 hrs. Gel filtration chromatography of plasma from severe human or baboon sepsis on Superose 6 demonstrated an almost complete loss of S1P and apoM in the HDL fractions. S1P plasma concentrations correlated with the platelet count but not with erythrocytes or white blood cells. The liver mRNA levels of apoM and apoA1 decreased strongly upon sepsis induction and after 12 hr both were almost completely lost. In conclusion, during septic challenge, the plasma levels of S1P drop to very low levels. Moreover, the liver synthesis of apoM decreases severely and the plasma levels of apoM are reduced. Possibly, the decrease in S1P contributes to the decreased endothelial barrier function observed in sepsis. PMID:26990127

  1. In-111 WBC imaging in musculoskeletal sepsis

    SciTech Connect

    Thompson, L.; Ouzounian, T.J.; Webber, M.M.; Amstutz, H.C.

    1984-01-01

    This study evaluated the accuracy and utility of the In-111 labeled WBC imaging in a series of patients who were suspected of having musculoskeletal sepsis. The labeling of the WBCs was patterned after a method previously described, in which the WBCs are labeled with In-111 oxine in plasma. The WBCs from 100 ml of blood are separated and incubated with In-111 oxine complex, and then 500 ..mu..Ci. of the labeled cells were reinjected into the patient. Images of the areas in question were obtained at 24 hrs. In some instances, 48 hour images were also obtained. Images were interpreted using consistent criteria. Forty imaging procedures were done on 39 patients. These included 39 total joint protheses, and 17 other images to evaluate possible osteomyelitis, septic arthritis or deep abscesses. Of these studies, 15 were positive, and 42 negative. The findings were then correlated with operative culture and pathology in 21, aspiration cultures and gram stains in 14, and with clinical findings in the remaining 21. This correlation showed 41 true negatives, 12 true positives, 1 false negative, and 2 false positives. The sensitivity was 92.9% and the specificity was 95.2%l. The false negative occurred in a patient on chronic suppressive antibiotic therapy for an infected total hip replacement. The false positive images occurred in a patient with active rheumatoid arthritis and in a patient imaged one month post operative placement of the prosthesis. These images were very useful in several septic patients who had many possible sites of infection. The authors conclude that In-III imaging is an accurate and useful non-invasive method of evaluating musculoskeletal sepsis.

  2. Popping a Hole in High-Speed Pursuits

    NASA Technical Reports Server (NTRS)

    2005-01-01

    NASA s Plum Brook Station, a 6,400-acre, remote test installation site for Glenn Research Center, houses unique, world-class test facilities, including the world s largest space environment simulation chamber and the world s only laboratory capable of full-scale rocket engine firings and launch vehicle system level tests at high-altitude conditions. Plum Brook Station performs complex and innovative ground tests for the U.S. Government (civilian and military), the international aerospace community, as well as the private sector. Popping a Hole in High-Speed Pursuits Recently, Plum Brook Station s test facilities and NASA s engineering experience were combined to improve a family of tire deflating devices (TDDs) that helps law enforcement agents safely, simply, and successfully stop fleeing vehicles in high-speed pursuit

  3. A plethora of angiopoietin-2 effects during clinical sepsis

    PubMed Central

    2010-01-01

    The interesting study by Davis and colleagues in the current issue of Critical Care expands on the increasingly recognized role of angiopoietins in human sepsis but raises a number of questions, which are discussed in this commentary. The authors describe an association between elevated angiopoietin (ang)-2 levels and impaired vascular reactivity, measured by the partly nitric oxide-dependent finger hyperemic response to forearm vascular occlusion, in patients with sepsis. This suggests that the ang-1/2-Tie2 system is involved in a number of pathophysiologic, phenotypic and perhaps prognostic alterations in human sepsis, on top of the effect on pulmonary endothelial barrier function. The novel inflammatory route may be a target for future therapeutic studies in human sepsis and acute lung injury, including those with activated protein C. PMID:20587077

  4. Paradoxical Roles of the Neutrophil in Sepsis: Protective and Deleterious

    PubMed Central

    Sônego, Fabiane; Castanheira, Fernanda Vargas e Silva; Ferreira, Raphael Gomes; Kanashiro, Alexandre; Leite, Caio Abner Vitorino Gonçalves; Nascimento, Daniele Carvalho; Colón, David Fernando; Borges, Vanessa de Fátima; Alves-Filho, José Carlos; Cunha, Fernando Queiróz

    2016-01-01

    Sepsis, an overwhelming inflammatory response syndrome secondary to infection, is one of the costliest and deadliest medical conditions worldwide. Neutrophils are classically considered to be essential players in the host defense against invading pathogens. However, several investigations have shown that impairment of neutrophil migration to the site of infection, also referred to as neutrophil paralysis, occurs during severe sepsis, resulting in an inability of the host to contain and eliminate the infection. On the other hand, the neutrophil antibacterial arsenal contributes to tissue damage and the development of organ dysfunction during sepsis. In this review, we provide an overview of the main events in which neutrophils play a beneficial or deleterious role in the outcome of sepsis. PMID:27199981

  5. Clinical Decision Support for Early Recognition of Sepsis.

    PubMed

    Amland, Robert C; Hahn-Cover, Kristin E

    2016-01-01

    Sepsis is an inflammatory response triggered by infection, with a high in-hospital mortality rate. Early recognition and treatment can reverse the inflammatory response, with evidence of improved patient outcomes. One challenge clinicians face is identifying the inflammatory syndrome against the background of the patient's infectious illness and comorbidities. An approach to this problem is implementation of computerized early warning tools for sepsis. This multicenter retrospective study sought to determine clinimetric performance of a cloud-based computerized sepsis clinical decision support system (CDS), understand the epidemiology of sepsis, and identify opportunities for quality improvement. Data encompassed 6200 adult hospitalizations from 2012 through 2013. Of 13% patients screened-in, 51% were already suspected to have an infection when the system activated. This study focused on a patient cohort screened-in before infection was suspected; median time from arrival to CDS activation was 3.5 hours, and system activation to diagnostic collect was another 8.6 hours. PMID:25385815

  6. Development of an e-learning package for sepsis care.

    PubMed

    Davis, Anna; Henderson, James; Langmack, Gill

    Severe sepsis is a major cause of morbidity and mortality in the UK. This article describes the collaborative development and implementation of an interactive online learning package to understand the key role nurses have in recognising and then starting to apply the Sepsis Six care bundle in clinical practice. The e-learning package, developed in a UK teaching hospital, uses a case study approach to address the knowledge that is required to be able to recognise sepsis, to understand the processes that occur and the ongoing care and treatment required. The package is relevant to final-year student nurses, newly registered nurses in preceptorship and other health professionals involved in assessing and treating patients who may be developing sepsis.

  7. Molecular Hydrogen Therapy Ameliorates Organ Damage Induced by Sepsis.

    PubMed

    Zheng, Yijun; Zhu, Duming

    2016-01-01

    Since it was proposed in 2007, molecular hydrogen therapy has been widely concerned and researched. Many animal experiments were carried out in a variety of disease fields, such as cerebral infarction, ischemia reperfusion injury, Parkinson syndrome, type 2 diabetes mellitus, metabolic syndrome, chronic kidney disease, radiation injury, chronic hepatitis, rheumatoid arthritis, stress ulcer, acute sports injuries, mitochondrial and inflammatory disease, and acute erythema skin disease and other pathological processes or diseases. Molecular hydrogen therapy is pointed out as there is protective effect for sepsis patients, too. The impact of molecular hydrogen therapy against sepsis is shown from the aspects of basic vital signs, organ functions (brain, lung, liver, kidney, small intestine, etc.), survival rate, and so forth. Molecular hydrogen therapy is able to significantly reduce the release of inflammatory factors and oxidative stress injury. Thereby it can reduce damage of various organ functions from sepsis and improve survival rate. Molecular hydrogen therapy is a prospective method against sepsis. PMID:27413421

  8. Biomarkers for sepsis: a review with special attention to India.

    PubMed

    Nelson, George E; Mave, Vidya; Gupta, Amita

    2014-01-01

    Sepsis is a serious infection and still a common cause of morbidity and mortality in resource-limited settings such as India. Even when microbiologic diagnostics are available, bacteremia is only identified in a proportion of patients who present with sepsis and bloodstream infections. Biomarkers have been used in a variety of disease processes and can help aid in diagnosing bacterial infections. There have been numerous biomarkers investigated to aid with diagnosis and prognostication in sepsis with the majority suffering from lack of sensitivity or specificity. Procalcitonin has been heralded as the biomarker that holds the most promise for bloodstream infections. Data are emerging in India, and in this review, we focus on the current data of biomarkers in sepsis with particular attention to how biomarkers could be used to augment diagnosis and treatment in India.

  9. Biomarkers for Sepsis: What Is and What Might Be?

    PubMed Central

    Biron, Bethany M.; Ayala, Alfred; Lomas-Neira, Joanne L.

    2015-01-01

    Every year numerous individuals develop the morbid condition of sepsis. Therefore, novel biomarkers that might better inform clinicians treating such patients are sorely needed. Difficulty in identifying such markers is in part due to the complex heterogeneity of sepsis, resulting from the broad and vague definition of this state/condition based on numerous possible clinical signs and symptoms as well as an incomplete understanding of the underlying pathobiology of this complex condition. This review considers some of the attempts that have been made so far, looking at both the pro- and anti-inflammatory response to sepsis, as well as genomic analysis, as sources of potential biomarkers. Irrespective, for functional biomarker(s) of sepsis to successfully translate from the laboratory to a clinical setting, the biomarker must be target specific and sensitive as well as easy to implement/interpret, and be cost effective, such that they can be utilized routinely in patient diagnosis and treatment. PMID:26417200

  10. Heart Rate Variability in Porcine Progressive Peritonitis-Induced Sepsis

    PubMed Central

    Jarkovska, Dagmar; Valesova, Lenka; Chvojka, Jiri; Benes, Jan; Sviglerova, Jitka; Florova, Blanka; Nalos, Lukas; Matejovic, Martin; Stengl, Milan

    2016-01-01

    Accumulating evidence suggests that heart rate variability (HRV) alterations could serve as an indicator of sepsis progression and outcome, however, the relationships of HRV and major pathophysiological processes of sepsis remain unclear. Therefore, in this experimental study HRV was investigated in a clinically relevant long-term porcine model of severe sepsis/septic shock. HRV was analyzed by several methods and the parameters were correlated with pathophysiological processes of sepsis. In 16 anesthetized, mechanically ventilated, and instrumented domestic pigs of either gender, sepsis was induced by fecal peritonitis. Experimental subjects were screened up to the refractory shock development or death. ECG was continuously recorded throughout the experiment, afterwards RR intervals were detected and HRV parameters computed automatically using custom made measurement and analysis MATLAB routines. In all septic animals, progressive hyperdynamic septic shock developed. The statistical measures of HRV, geometrical measures of HRV and Poincaré plot analysis revealed a pronounced reduction of HRV that developed quickly upon the onset of sepsis and was maintained throughout the experiment. The frequency domain analysis demonstrated a decrease in the high frequency component and increase in the low frequency component together with an increase of the low/high frequency component ratio. The reduction of HRV parameters preceded sepsis-associated hemodynamic changes including heart rate increase or shock progression. In a clinically relevant porcine model of peritonitis-induced progressive septic shock, reduction of HRV parameters heralded sepsis development. HRV reduction was associated with a pronounced parasympathetic inhibition and a shift of sympathovagal balance. Early reduction of HRV may serve as a non-invasive and sensitive marker of systemic inflammatory syndrome, thereby widening the therapeutic window for early interventions. PMID:26779039

  11. Anti-inflammatory effect of Momordica charantia in sepsis mice.

    PubMed

    Chao, Che-Yi; Sung, Ping-Jyun; Wang, Wei-Hsien; Kuo, Yueh-Hsiung

    2014-01-01

    Wild bitter gourd (Momordica charantia L. var. abbreviate Seringe), a common vegetable in Asia, is used in traditional medicine to treat various diseases, including inflammation. Extant literature indicates that wild bitter gourds have components that activate PPARα and PPARγ. This research probed the influence of adding wild bitter gourd to diets on inflammation responses in mice with sepsis induced by intraperitoneal injection of LPS. Male BALB/c mice were divided normal, sepsis, positive control, and three experimental groups. The latter ate diets with low (1%), moderate (2%), and high (10%) ratios of wild bitter gourd lyophilized powder. Before mice were sacrificed, with the exception of the normal group, intraperitoneal injection of LPS induced sepsis in each group; positive control group was injected with LPS after PDTC. This experiment revealed starkly lower weights in groups with added wild bitter gourd than those of the remaining groups. Blood lipids (TG, cholesterol, and NEFA) were also lower in comparison to the sepsis group, and blood glucose concentrations recovered and approached normal levels. Blood biochemistry values related to inflammation reactions indicated GOT, GPT, C-RP, and NO concentrations of groups with added wild bitter gourd were all lower than those of the sepsis group. Secretion levels of the spleen pro-inflammatory cytokines IL-1, IL-6, and TNF-α tallied significantly lower in comparison to the sepsis group, whereas secretion levels of IL-10 anti-inflammatory cytokine increased. Expression level of proteins NF-κB, iNOS, and COX-2 were significantly inhibited. Results indicate wild bitter gourd in diets promoted lipid metabolism, reducing fat accumulation, and improving low blood glucose in sepsis. Addition of wild bitter gourd can reduce inflammation biochemical markers or indicators and pro-inflammatory cytokines in the body, hence improving the inflammation responses in mice with sepsis. PMID:25153878

  12. A Review of GM-CSF Therapy in Sepsis.

    PubMed

    Mathias, Brittany; Szpila, Benjamin E; Moore, Frederick A; Efron, Philip A; Moldawer, Lyle L

    2015-12-01

    Determine what clinical role, if any, GM-CSF may have in the clinical treatment of sepsis in the adult patient. Advancements in the management of sepsis have led to significant decreases in early mortality; however, sepsis remains a significant source of long-term mortality and disability which places strain on healthcare resources with a substantial growing economic impact. Historically, early multiple organ failure (MOF) and death in patients with severe sepsis was thought to result from an exaggerated proinflammatory response called the systemic inflammatory response syndrome (SIRS). Numerous prospective randomized controlled trials (PRCTs) tested therapies aimed at decreasing the organ injury associated with an exaggerated inflammatory response. With few exceptions, the results from these PRCTs have been disappointing, and currently no specific therapeutic agent is approved to counteract the early SIRS response in patients with severe sepsis. It has long been recognized that there is a delayed immunosuppressive state that contributes to long-term morbidity. However, recent findings now support a concurrent proinflammatory and anti-inflammatory response present throughout sepsis. Multiple immunomodulating agents have been studied to combat the immunosuppressive phase of sepsis with the goal of decreasing secondary infection, reducing organ dysfunction, decreasing ICU stays, and improving survival. Granulocyte-macrophage colony stimulating factor (GM-CSF), a myelopoietic growth factor currently used in patients with neutropenia secondary to chemotherapy-induced myelosuppression, has been studied as a potential immune-activating agent. The applicability of GM-CSF as a standard therapy for generalized sepsis is still largely understudied; however, small-scale studies available have demonstrated some improved recovery from infection, decreased hospital length of stay, decreased days requiring mechanical ventilation, and decreased medical costs. PMID:26683913

  13. A Review of GM-CSF Therapy in Sepsis

    PubMed Central

    Mathias, Brittany; Szpila, Benjamin E.; Moore, Frederick A.; Efron, Philip A.; Moldawer, Lyle L.

    2015-01-01

    Abstract Determine what clinical role, if any, GM-CSF may have in the clinical treatment of sepsis in the adult patient. Advancements in the management of sepsis have led to significant decreases in early mortality; however, sepsis remains a significant source of long-term mortality and disability which places strain on healthcare resources with a substantial growing economic impact. Historically, early multiple organ failure (MOF) and death in patients with severe sepsis was thought to result from an exaggerated proinflammatory response called the systemic inflammatory response syndrome (SIRS). Numerous prospective randomized controlled trials (PRCTs) tested therapies aimed at decreasing the organ injury associated with an exaggerated inflammatory response. With few exceptions, the results from these PRCTs have been disappointing, and currently no specific therapeutic agent is approved to counteract the early SIRS response in patients with severe sepsis. It has long been recognized that there is a delayed immunosuppressive state that contributes to long-term morbidity. However, recent findings now support a concurrent proinflammatory and anti-inflammatory response present throughout sepsis. Multiple immunomodulating agents have been studied to combat the immunosuppressive phase of sepsis with the goal of decreasing secondary infection, reducing organ dysfunction, decreasing ICU stays, and improving survival. Granulocyte-macrophage colony stimulating factor (GM-CSF), a myelopoietic growth factor currently used in patients with neutropenia secondary to chemotherapy-induced myelosuppression, has been studied as a potential immune-activating agent. The applicability of GM-CSF as a standard therapy for generalized sepsis is still largely understudied; however, small-scale studies available have demonstrated some improved recovery from infection, decreased hospital length of stay, decreased days requiring mechanical ventilation, and decreased medical costs. PMID

  14. Opsonic Fibronectin Deficiency and Sepsis: Cause or Effect?

    PubMed Central

    Lanser, Marc E.; Saba, Thomas M.

    1982-01-01

    Opsonic fibronectin is known to modulate macrophage (RE cell) and neutrophil Phagocytic function. Its depletion has been documented following trauma, burn, and operation in patients with rapid restoration of normal levels unless bacteremia and/or wound sepsis intervenes. Sepsis is associated with a secondary phase of opsonic fibronectin deficiency. We have observed in burn patients that this secondary phase of opsonic fibronectin depletion following trauma and burn is seen two to three days prior to the onset of clinical sepsis, raising the question of whether this deficiency sensitized the host to the subsequent development of sepsis or whether its deplection was merely an unsuspected sensitive indication of preclinical sepsis. To address the possibility that opsonic fibronectin deficiency might lower resistance to sepsis, Sprague-Dawley rats (200 gm) were partially depleted (35%) of their opsonic fibronectin prior to intraperitoneal inoculation with Staphylococcus aureus. Mortality to S. aureus peritonitis was significantly (p < 0.05) increased in animals with fibronectin deficiency. Furthermore, in control animals, nonsurvival was also associated with significantly (p < 0.05) lower initial fibronectin levels than survival. However, peritonitis itself also resulted in an early (within one hour) depletion of opsonic fibronectin followed by a marked “hyperopsonemia” within 12 hours in both groups. Thus, opsonic fibronectin depletion decreases resistance to sepsis, and the development of sepsis itself will initiate opsonic fibronectin deficiency. Host defense against infection may depend on early restoration and maintenance of normal opsonic fibronectin levels following trauma, burn, and operation, as well as the ability of the host to mount an appropriate hyperopsonemic elevation of fibronectin levels in response to infection. PMID:7059244

  15. Development and Validation of an Automated Sepsis Risk Assessment System.

    PubMed

    Back, Ji-Sun; Jin, Yinji; Jin, Taixian; Lee, Sun-Mi

    2016-10-01

    Aggressive resuscitation can decrease sepsis mortality, but its success depends on early detection of sepsis. The purpose of this study was to develop and verify an Automated Sepsis Risk Assessment System (Auto-SepRAS), which would automatically assess the sepsis risk of inpatients by applying data mining techniques to electronic health records (EHR) data and provide daily updates. The seven predictors included in the Auto-SepRAS after initial analysis were admission via the emergency department, which had the highest odds ratio; diastolic blood pressure; length of stay; respiratory rate; heart rate; and age. Auto-SepRAS classifies inpatients into three risk levels (high, moderate, and low) based on the predictive values from the sepsis risk-scoring algorithm. The sepsis risk for each patient is presented on the nursing screen of the EHR. The AutoSepRAS was implemented retrospectively in several stages using EHR data and its cut-off scores adjusted. Overall discrimination power was moderate (AUC>.80). The Auto-SepRAS should be verified or updated continuously or intermittently to maintain high predictive performance, but it does not require invasive tests or data input by nurses that would require additional time. Nurses are able to provide patients with nursing care appropriate to their risk levels by using the sepsis risk information provided by the Auto-SepRAS. In particular, with early detection of changes related to sepsis, nurses should be able to help in providing rapid initial resuscitation of high-risk patients. © 2016 Wiley Periodicals, Inc.

  16. Functional outcomes of general medical patients with severe sepsis

    PubMed Central

    2013-01-01

    Background Severe sepsis is a common cause for admission to the general medical ward. Previous work has demonstrated substantial new long-term disability in patients with severe sepsis, but the short-term functional outcomes of patients admitted to the general medical floor -- where the majority of severe sepsis is treated -- are largely unknown. Methods A retrospective cohort study was performed of patients initially admitted to non-ICU medical wards at a tertiary care academic medical center. Severe sepsis was confirmed by three physician reviewers, using the International Consensus Conference definition of sepsis. Baseline functional status, disposition location, and receipt of post-acute skilled care were recorded using a structured abstraction instrument. Results 3,146 discharges had severe sepsis by coding algorithm; from a random sample of 111 patients, 64 had the diagnosis of severe sepsis confirmed by reviewers. The mean age of the 64 patients was 63.5 years +/- 18.0. Prior to admission, 80% of patients lived at home and 50.8% of patients were functionally independent. Inpatient mortality was 12.5% and 37.5% of patients were discharged to a nursing facility. Of all patients in the cohort, 50.0% were discharged home, and 66.7% of patients who were functionally independent at baseline were discharged to home. Conclusions New physical debility is a common feature of severe sepsis in patients initially cared for on the general medical floor. Debility occurs even in those with good baseline physical function. Interventions to improve the poor functional outcomes of this population are urgently needed. PMID:24330544

  17. Manatí Medical Center Sepsis Management Epidemiological Study.

    PubMed

    Morales Serrano, Tamara; Ramos, Shirley; Lara Gonzalez, Yanira; Torres Colberg, Heileene; Vera Quiñones, Alexis; Miranda Santiago, Roberto; Amill, Samuel; Otero, Marielys; Cintron, Vielka; Villarreal Morales, Martha Lissete

    2015-01-01

    Sepsis is the combination of infection and physiological changes known as the systemic inflammatory response syndrome. There have been improvements in mortality rates and outcomes of septic patients based on "Surviving Sepsis Campaign" guidelines. Current management of sepsis at our Institution follows no specific mandatory protocols. This study aimed to verify the incidence and outcome of sepsis in Manati Medical Center, Puerto Rico. An observational retrospective study was conducted. All the Emergency Department admissions from May 1/ to October 31/ 2013 were screened for sepsis per ICD-9 code. For all included patients, demographic and clinical data at ED admission were collected. During this period 8931 patients were admitted and 148 met criteria for sepsis and related conditions. The overall mortality rate was 43.91%. Mortality increased with age, from 10.52% among ≤ 44 years old to 68.75% in those ≥ 85 years old. The main infection sources were respiratory (32.66%) and urinary tract (24.62%). Mean age among non-survivors was 10.8 years higher than the survivor group (95% Cl 5.2-1 6.5, p < 0.05). Multivariate analysis showed an increased fatality rate associated to severity of sepsis (HR 1.33; 95% Cl; 1.03-1.72, p = 0.02) and the APACHE2 score (HR 1.05; 95% Cl, 1.01-1.09 p = 0.03). Our data suggests that sepsis is an important problem to consider. We strongly encourage an institutional standardized protocol to diminish the mortality impact. Our results will allow adequate preventive strategies to improve early diagnosis, mortality rates and outcomes of septic patients.

  18. Molecular diagnosis of sepsis: New aspects and recent developments

    PubMed Central

    Lehman, L.; Hunfeld, K.-P.; Kost, G.

    2014-01-01

    By shortening the time to pathogen identification and allowing for detection of organisms missed by blood culture, new molecular methods may provide clinical benefits for the management of patients with sepsis. While a number of reviews on the diagnosis of sepsis have recently been published we here present up-to-date new developments including multiplex PCR, mass spectrometry and array techniques. We focus on those techniques that are commercially available and for which clinical studies have been performed and published. PMID:24678402

  19. Perinatal epidemiological risk factors for preeclampsia.

    PubMed

    Bobić, Mirna Vuković; Habek, Dubravko; Habek, Jasna Čerkez

    2015-03-01

    In the present study, the impact of the potential perinatal epidemiological factors on preeclampsia development was assessed. This clinical study included 55 pregnant women with preeclampsia and control group of 50 healthy pregnant women. Positive family history of cardiovascular disease, diabetes mellitus or thromboembolic disease was recorded in 50% of women with preeclampsia versus 28% of control group women. Positive personal history of this disease was recorded in 15% of women with preeclampsia, whereas all control group women had negative personal history of preeclampsia. Dietary habits, i.e. the intake of meat and meat products, fruit and vegetables, coffee and alcohol drinks were similar in the two groups, without statistically significant differences. The women with preeclampsia and control women reported comparable habits; there was no difference in the consumption of meat, fruit, vegetables, coffee and alcohol, smoking, use of folate and oral hormonal contraception before pregnancy, or in physical activity as the potential risk factors for preeclampsia in current pregnancy. However, personal and family history of vascular disease proved to be significant risk factors for the occurrence of preeclampsia, emphasizing the need of lifestyle and dietary modifications with healthy dietary habits, while avoiding adverse habits in pregnancy.

  20. Ethical issues of perinatal human gene therapy.

    PubMed

    Fletcher, J C; Richter, G

    1996-01-01

    This paper examines some key ethical issues raised by trials of human gene therapy in the perinatal period--i.e., in infants, young children, and the human fetus. It describes five resources in ethics for researchers' considerations prior to such trials: (1) the history of ethical debate about gene therapy, (2) a literature on the relevance of major ethical principles for clinical research, (3) a body of widely accepted norms and practices, (4) knowledge of paradigm cases, and (5) researchers' own professional integrity. The paper also examines ethical concerns that must be met prior to any trial: benefits to and safety of subjects, informed assent of children and informed parental permission, informed consent of pregnant women in fetal gene therapy, protection of privacy, and concerns about fairness in the selection of subjects. The paper criticizes the position that cases of fetal gene therapy should be restricted only to those where the pregnant woman has explicitly refused abortion. Additional topics include concerns about genetic enhancement and germ-line gene therapy.

  1. Perinatal induction of Cre recombination with tamoxifen.

    PubMed

    Lizen, Benoit; Claus, Melissa; Jeannotte, Lucie; Rijli, Filippo M; Gofflot, Françoise

    2015-12-01

    Temporal control of site-specific recombination is commonly achieved by using a tamoxifen-inducible form of Cre or Flp recombinases. Although powerful protocols of induction have been developed for gene inactivation at adult stages or during embryonic development, induction of recombination at late gestational or early postnatal stages is still difficult to achieve. In this context, using the ubiquitous CMV-CreER(T2) transgenic mice, we have tested and validated two procedures to achieve recombination just before and just after birth. The efficiency of recombination was evaluated in the brain, which is known to be more problematic to target. For the late gestation treatment with tamoxifen, different protocols of complementary administration of progesterone and estrogen were tested. However, delayed delivery and/or mortality of pups due to difficult delivery were always observed. To circumvent this problem, pups were collected from tamoxifen-treated pregnant dams by caesarian section at E18.5 and given to foster mothers. For postnatal treatment, different dosages of tamoxifen were administered by intragastric injection to the pups during 3 or 4 days after birth. The efficiency of these treatments was analyzed at P7 using a transgenic reporter line. They were also validated with the Hoxa5 conditional allele. In conclusion, we have developed efficient procedures that allow achieving efficient recombination of floxed alleles at perinatal stages. These protocols will allow investigating the late/adult functions of many developmental genes, whose characterization has been so far restricted to embryonic development. PMID:26395370

  2. Inter-annual variation of persistent organic pollutants (POPS) in an Antarctic top predator Arctocephalus gazella.

    PubMed

    Brault, Emily K; Goebel, Michael E; Geisz, Heidi N; Canuel, Elizabeth A; Dickhut, Rebecca M

    2013-11-19

    Persistent organic pollutants (POPs), contaminants that may bioaccumulate in upper trophic level organisms, were detected in the milk of a top predator, the Antarctic fur seal (Arctocephalus gazella). Multiparous females had significantly lower concentrations of certain POPs (trans-nonachlor, p,p'-DDE, and several PCBs) in their milk than primiparous females, likely due to the annual lactational transfer of the POP burden from mother to pup. Furthermore, there were significant interannual differences in POP concentrations in multiparous females' milk from five breeding seasons between 2000 and 2011. Decreasing trends in concentrations of certain POPs over the recent decade coincide with declining global emissions, yet atmospheric concentrations in the Antarctic are not always consistent with global trends, suggesting that additional factors may contribute to temporal trends of POPs in fur seals. Climate shifts and corresponding availability of krill over the past decade were not consistent with trends observed in POP concentrations in fur seal milk, suggesting that climate may not be a key factor. Additional mechanisms, such as variability in the geographic ranges of individual seals during overwintering migrations are discussed and should be explored further. PMID:24138491

  3. New Approaches to Sepsis: Molecular Diagnostics and Biomarkers

    PubMed Central

    Bauer, Michael; Riedemann, Niels C.; Hartog, Christiane S.

    2012-01-01

    Summary: Sepsis is among the most common causes of death in hospitals. It arises from the host response to infection. Currently, diagnosis relies on nonspecific physiological criteria and culture-based pathogen detection. This results in diagnostic uncertainty, therapeutic delays, the mis- and overuse of antibiotics, and the failure to identify patients who might benefit from immunomodulatory therapies. There is a need for new sepsis biomarkers that can aid in therapeutic decision making and add information about screening, diagnosis, risk stratification, and monitoring of the response to therapy. The host response involves hundreds of mediators and single molecules, many of which have been proposed as biomarkers. It is, however, unlikely that one single biomarker is able to satisfy all the needs and expectations for sepsis research and management. Among biomarkers that are measurable by assays approved for clinical use, procalcitonin (PCT) has shown some usefulness as an infection marker and for antibiotic stewardship. Other possible new approaches consist of molecular strategies to improve pathogen detection and molecular diagnostics and prognostics based on transcriptomic, proteomic, or metabolic profiling. Novel approaches to sepsis promise to transform sepsis from a physiologic syndrome into a group of distinct biochemical disorders and help in the development of better diagnostic tools and effective adjunctive sepsis therapies. PMID:23034322

  4. Sepsis-induced elevation in plasma serotonin facilitates endothelial hyperpermeability

    PubMed Central

    Li, Yicong; Hadden, Coedy; Cooper, Anthonya; Ahmed, Asli; Wu, Hong; Lupashin, Vladimir V.; Mayeux, Philip R.; Kilic, Fusun

    2016-01-01

    Hyperpermeability of the endothelial barrier and resulting microvascular leakage are a hallmark of sepsis. Our studies describe the mechanism by which serotonin (5-HT) regulates the microvascular permeability during sepsis. The plasma 5-HT levels are significantly elevated in mice made septic by cecal ligation and puncture (CLP). 5-HT-induced permeability of endothelial cells was associated with the phosphorylation of p21 activating kinase (PAK1), PAK1-dependent phosphorylation of vimentin (P-vimentin) filaments, and a strong association between P-vimentin and ve-cadherin. These findings were in good agreement with the findings with the endothelial cells incubated in serum from CLP mice. In vivo, reducing the 5-HT uptake rates with the 5-HT transporter (SERT) inhibitor, paroxetine blocked renal microvascular leakage and the decline in microvascular perfusion. Importantly, mice that lack SERT showed significantly less microvascular dysfunction after CLP. Based on these data, we propose that the increased endothelial 5-HT uptake together with 5-HT signaling disrupts the endothelial barrier function in sepsis. Therefore, regulating intracellular 5-HT levels in endothelial cells represents a novel approach in improving sepsis-associated microvascular dysfunction and leakage. These new findings advance our understanding of the mechanisms underlying cellular responses to intracellular/extracellular 5-HT ratio in sepsis and refine current views of these signaling processes during sepsis. PMID:26956613

  5. Sepsis-induced elevation in plasma serotonin facilitates endothelial hyperpermeability.

    PubMed

    Li, Yicong; Hadden, Coedy; Cooper, Anthonya; Ahmed, Asli; Wu, Hong; Lupashin, Vladimir V; Mayeux, Philip R; Kilic, Fusun

    2016-01-01

    Hyperpermeability of the endothelial barrier and resulting microvascular leakage are a hallmark of sepsis. Our studies describe the mechanism by which serotonin (5-HT) regulates the microvascular permeability during sepsis. The plasma 5-HT levels are significantly elevated in mice made septic by cecal ligation and puncture (CLP). 5-HT-induced permeability of endothelial cells was associated with the phosphorylation of p21 activating kinase (PAK1), PAK1-dependent phosphorylation of vimentin (P-vimentin) filaments, and a strong association between P-vimentin and ve-cadherin. These findings were in good agreement with the findings with the endothelial cells incubated in serum from CLP mice. In vivo, reducing the 5-HT uptake rates with the 5-HT transporter (SERT) inhibitor, paroxetine blocked renal microvascular leakage and the decline in microvascular perfusion. Importantly, mice that lack SERT showed significantly less microvascular dysfunction after CLP. Based on these data, we propose that the increased endothelial 5-HT uptake together with 5-HT signaling disrupts the endothelial barrier function in sepsis. Therefore, regulating intracellular 5-HT levels in endothelial cells represents a novel approach in improving sepsis-associated microvascular dysfunction and leakage. These new findings advance our understanding of the mechanisms underlying cellular responses to intracellular/extracellular 5-HT ratio in sepsis and refine current views of these signaling processes during sepsis.

  6. Predictive values for procalcitonin in the diagnosis of neonatal sepsis

    PubMed Central

    Mohsen, Abdel Hakeem Abdel; Kamel, Bothina Ahmed

    2015-01-01

    Background: Early diagnosis of neonatal sepsis followed by appropriate treatment decreases mortality and morbidity in infants. The aim of this study is to assess the role of procalcitonin (PCT) as a marker in the early diagnosis of neonatal sepsis. Methods: We present a cross sectional study where 35 neonates with early onset sepsis (admitted to the Neonatal Intensive Care Units at El-Minia Children University Hospital from August 2012 to August 2013) were included in the study. Another 35 healthy neonates with no clinical or biological data of infection were included as a control group. Subjects were subjected to a thorough history taking and routine laboratory investigations. Serum PCT and C-reactive protein (CRP) levels were determined by enzyme-linked immunosorbent assay (ELISA). Results: Mean levels of PCT and CRP in neonates with sepsis were significantly higher than in the control group (p=0.0001). There was a moderate, but significant, positive correlation between PCT and C-reactive protein (p=0.001, r=0.55) and an insignificant correlation between procalcitonin and total leukocytic count among the neonates with sepsis (p=0.2, r=0.2). In addition, procalcitonin had high sensitivity, specificity, a high positive predictive value, and a high negative predictive value (80%, 85.7%, 84.8%, and 81.1% respectively). Procalcitonin showed higher sensitivity when compared to CRP. Conclusion: Procalcitonin is a sensitive, independent, and useful biomarker in comparison to CRP in early diagnosis of neonatal sepsis. PMID:26396733

  7. Circulating MicroRNAs as Biomarkers for Sepsis.

    PubMed

    Benz, Fabian; Roy, Sanchari; Trautwein, Christian; Roderburg, Christoph; Luedde, Tom

    2016-01-09

    Sepsis represents a major cause of lethality during intensive care unit (ICU) treatment. Pharmacological treatment strategies for sepsis are still limited and mainly based on the early initiation of antibiotic and supportive treatment. In this context, numerous clinical and serum based markers have been evaluated for the diagnosis, the severity, and the etiology of sepsis. However until now, few of these factors could be translated into clinical use. MicroRNAs (miRNAs) do not encode for proteins but regulate gene expression by inhibiting the translation or transcription of their target mRNAs. Recently it was demonstrated that miRNAs are released into the circulation and that the spectrum of circulating miRNAs might be altered during various pathologic conditions, such as inflammation, infection, and sepsis. By using array- and single PCR-based methods, a variety of deregulated miRNAs, including miR-25, miR-133a, miR-146, miR-150, and miR-223, were described in the context of sepsis. Some of the miRNAs correlated with the disease stage, as well as patients' short and long term prognosis. Here, we summarize the current findings on the role of circulating miRNAs in the diagnosis and staging of sepsis in critically ill patients. We compare data from patients with findings from animal models and, finally, highlight the challenges and drawbacks that currently prevent the use of circulating miRNAs as biomarkers in clinical routine.

  8. HMGB1 Mediates Anemia of Inflammation in Murine Sepsis Survivors

    PubMed Central

    Valdés-Ferrer, Sergio I; Papoin, Julien; Dancho, Meghan E; Olofsson, Peder S; Li, Jianhua; Lipton, Jeffrey M; Avancena, Patricia; Yang, Huan; Zou, Yong-Rui; Chavan, Sangeeta S; Volpe, Bruce T; Gardenghi, Sara; Rivella, Stefano; Diamond, Betty; Andersson, Ulf; Steinberg, Bettie M; Blanc, Lionel; Tracey, Kevin J

    2015-01-01

    Patients surviving sepsis develop anemia, but the molecular mechanism is unknown. Here we observed that mice surviving polymicrobial gram-negative sepsis develop hypochromic, microcytic anemia with reticulocytosis. The bone marrow of sepsis survivors accumulates polychromatophilic and orthochromatic erythroblasts. Compensatory extramedullary erythropoiesis in the spleen is defective during terminal differentiation. Circulating tumor necrosis factor (TNF) and interleukin (IL)-6 are elevated for 5 d after the onset of sepsis, and serum high-mobility group box 1 (HMGB1) levels are increased from d 7 until at least d 28. Administration of recombinant HMGB1 to healthy mice mediates anemia with extramedullary erythropoiesis and significantly elevated reticulocyte counts. Moreover, administration of anti-HMGB1 monoclonal antibodies after sepsis significantly ameliorates the development of anemia (hematocrit 48.5 ± 9.0% versus 37.4 ± 6.1%, p < 0.01; hemoglobin 14.0 ± 1.7 versus 11.7 ± 1.2 g/dL, p < 0.01). Together, these results indicate that HMGB1 mediates anemia by interfering with erythropoiesis, suggesting a potential therapeutic strategy for anemia in sepsis. PMID:26736178

  9. Improving time to antibiotics and implementing the "Sepsis 6".

    PubMed

    McGregor, Calum

    2014-01-01

    It has been shown that completion of the "Sepsis 6" within 1 hour reduces mortality (1). This project aims to assess compliance with this standard and evaluate the effectiveness of a sepsis improvement plan in a district general hospital in the UK. A baseline audit was performed, examining case notes of "septic patients" retrospectively (those on intravenous antibiotics). Compliance with each element of the sepsis six plus time to first antibiotic (TTFA) was assessed. A sepsis improvement plan was introduced consisting of staff education, reinforcing vigilance, regular multidisciplinary meetings and incorporating a standardised approach through the use of a sepsis proforma. Following the introduction of this, and after some refinement, the average time to antibiotic fell from 6 hours to 1.4 hours. In conclusion, an educational drive along with a systematic change in processes has seen reduced TTFA along with enhanced compliance with most elements of the sepsis 6. Through continued assessment and further improving upon systematic processes with continued education we would anticipate consistent improvement in the management of septic patients.

  10. A Systems Biology Approach Reveals Converging Molecular Mechanisms that Link Different POPs to Common Metabolic Diseases

    PubMed Central

    Ruiz, Patricia; Perlina, Ally; Mumtaz, Moiz; Fowler, Bruce A.

    2015-01-01

    Background: A number of epidemiological studies have identified statistical associations between persistent organic pollutants (POPs) and metabolic diseases, but testable hypotheses regarding underlying molecular mechanisms to explain these linkages have not been published. Objectives: We assessed the underlying mechanisms of POPs that have been associated with metabolic diseases; three well-known POPs [2,3,7,8-tetrachlorodibenzodioxin (TCDD), 2,2´,4,4´,5,5´-hexachlorobiphenyl (PCB 153), and 4,4´-dichlorodiphenyldichloroethylene (p,p´-DDE)] were studied. We used advanced database search tools to delineate testable hypotheses and to guide laboratory-based research studies into underlying mechanisms by which this POP mixture could produce or exacerbate metabolic diseases. Methods: For our searches, we used proprietary systems biology software (MetaCore™/MetaDrug™) to conduct advanced search queries for the underlying interactions database, followed by directional network construction to identify common mechanisms for these POPs within two or fewer interaction steps downstream of their primary targets. These common downstream pathways belong to various cytokine and chemokine families with experimentally well-documented causal associations with type 2 diabetes. Conclusions: Our systems biology approach allowed identification of converging pathways leading to activation of common downstream targets. To our knowledge, this is the first study to propose an integrated global set of step-by-step molecular mechanisms for a combination of three common POPs using a systems biology approach, which may link POP exposure to diseases. Experimental evaluation of the proposed pathways may lead to development of predictive biomarkers of the effects of POPs, which could translate into disease prevention and effective clinical treatment strategies. Citation: Ruiz P, Perlina A, Mumtaz M, Fowler BA. 2016. A systems biology approach reveals converging molecular mechanisms that

  11. [Simulation of long-range transport potential of POPs in Poyang Lake].

    PubMed

    Gong, Xiao-Feng; Xiang, Hong-Rui; Chen, Chun-Li; Zhou, Wen-Bin; Wang, Jia-Jia; Liu, Chun-Ying; Zeng, Yan

    2014-06-01

    The long-range transport potential (LRTP) and overall persistence (Pov) of 5 typical persisitent organic pollutants (POPs) through air and water in Poyang Lake were estimated by the TaPL3 model. The characteristic travel distance (CTD) and Pov of different POPs were compared. In addition, the key parameters were examined by the sensitivity analysis method using p, p'-DDT as an example. The results showed that the CTD(Air) of p, p'-DDT, gamma-HCH, HCB, PCP and 2, 3, 7, 8-TCDD ranged from 432 km (2, 3, 7, 8-TCDD) to 86 479 km (HCB), and the value of Pov(Air) ranged from 85.6 d (PCP) to 2 231 d (HCB), when POPs were emitted to the atmosphere. Soil phase was the main fate of these typical POPs, and it was about 72.0% percent of the total phase. Meanwhile, the CTD(Water) was from 4 207 km (PCP) to 1.19 x 10(5) km (gamma-HCH), and Pov(Water) was from 103 d (PCP) to 2 890 d (HCB), when POPs were emitted to the water. Sediment phase was the main fate of these typical POPs, and it was about 52.5% percent of the total phase. Half-life in the environment and octanol-water partition coefficient logarithm of POPs were the two main physical-chemical parameters that affected CTD and Pov. When compared with other similar studies in China, the CTD(Air) of related POPs in Poyang Lake is in the middle level. While the CTD(Water) was a little higher than other areas, which was due to the higher water depth and water flow velocity of Poyang Lake. Therefore, the higher water depth and water flow velocity were two significantly-affected parameters of CTD(Water). The results could provide a scientific basis to studies of environmental process and risks of POPs in Poyang Lake.

  12. Perinatally infected adolescents living with human immunodeficiency virus (perinatally human immunodeficiency virus)

    PubMed Central

    Cruz, Maria Leticia S; Cardoso, Claudete A

    2015-01-01

    The availability of highly potent antiretroviral treatment during the last decades has transformed human immunodeficiency virus (HIV) infection into a chronic disease. Children that were diagnosed during the first months or years of life and received treatment, are living longer and better and are presently reaching adolescence and adulthood. Perinatally HIV-infected adolescents (PHIV) and young adults may present specific clinical, behavior and social characteristics and demands. We have performed a literature review about different aspects that have to be considered in the care and follow-up of PHIV. The search included papers in the MEDLINE database via PubMed, located using the keywords “perinatally HIV-infected” AND “adolescents”. Only articles published in English or Portuguese from 2003 to 2014 were selected. The types of articles included original research, systematic reviews, and quantitative or qualitative studies; case reports and case series were excluded. Results are presented in the following topics: “Puberal development and sexual maturation”, “Growth in weight and height”, “Bone metabolism during adolescence”, “Metabolic complications”, “Brain development, cognition and mental health”, “Reproductive health”, “Viral drug resistance” and “Transition to adult outpatient care”. We hope that this review will support the work of pediatricians, clinicians and infectious diseases specialists that are receiving these subjects to continue treatment. PMID:26279988

  13. [Perinatal Depression: The Meaning of the Paradigm Shift from "Postnatal" to "Perinatal"].

    PubMed

    Kamo, Toshiko

    2015-01-01

    Psychiatry regarding pregnancy, childbirth, and child-rearing is changing rapidly. In this paper, the meaning of the paradigm shift from postnantal to perinatal depression along with the changing treatment are discussed. Since the late 20 century, several large-scale epidemiological surveys on the incidence and outcomes of postnatal depression have concluded not only that postpartum depression is likely to occur at a high frequency, such as 10-15%, but that the subsequent maternal mortality rate as the number of deaths from suicide is higher than deaths due to obstetric medical conditions. Additionally, evidence of the negative impact of a mother's depression on the physical and mental development of children has been accumulated as well. Several studies regarding depression during pregnancy, such as on the relatively high frequency of prenatal depression or negative consequence of interrupted pharmacological treatment, should also be highlighted. These movements seemed to reflect the change in special attributes of depressive disorders and bipolar disorders, in that the term perinatal onset came to be preferred instead of postnatal, used in DSM-IV. Comprehensive treatment guidelines for depression applicable for all women with the potential for pregnancy, delivery, and lactation are needed as the next step.

  14. Identification of adults with sepsis in the prehospital environment: a systematic review

    PubMed Central

    Smyth, Michael A; Brace-McDonnell, Samantha J; Perkins, Gavin D

    2016-01-01

    Objective Early identification of sepsis could enable prompt delivery of key interventions such as fluid resuscitation and antibiotic administration which, in turn, may lead to improved patient outcomes. Limited data indicate that recognition of sepsis by paramedics is often poor. We systematically reviewed the literature on prehospital sepsis screening tools to determine whether they improved sepsis recognition. Design Systematic review. The electronic databases MEDLINE, EMBASE, CINAHL, the Cochrane Library and PubMed were systematically searched up to June 2015. In addition, subject experts were contacted. Setting Prehospital/emergency medical services (EMS). Study selection All studies addressing identification of sepsis (including severe sepsis and septic shock) among adult patients managed by EMS. Outcome measures Recognition of sepsis by EMS clinicians. Results Owing to considerable variation in the methodological approach adopted and outcome measures reported, a narrative approach to data synthesis was adopted. Three studies addressed development of prehospital sepsis screening tools. Six studies addressed paramedic diagnosis of sepsis with or without use of a prehospital sepsis screening tool. Conclusions Recognition of sepsis by ambulance clinicians is poor. The use of screening tools, based on the Surviving Sepsis Campaign diagnostic criteria, improves prehospital sepsis recognition. Screening tools derived from EMS data have been developed, but they have not yet been validated in clinical practice. There is a need to undertake validation studies to determine whether prehospital sepsis screening tools confer any clinical benefit. PMID:27496231

  15. Emission of dioxins/furans and other U-POPs from test burns of non-POP pesticides in a hazardous waste incinerator.

    PubMed

    Khumsaeng, Thipsukon; Oanh, Nguyen Thi Kim; Kare, Karstensen H; Polprasert, Chongrak

    2013-04-01

    This paper presents the results of test burns for obsolete pesticides (OPs) of the permethrin group in a high temperature incinerator (HTI) in Southeast Asia. Three test burn runs were conducted, a baseline run when no OP was fed to the incinerator, and two test runs with different mixtures of OP compounds (formula 1 and 2, refer to Table 1 for detail) containing chlorine in the feeding wastes. The unintentional formed persistent organic pollutants (U-POPs) including 17 dioxins/furans, 12 dioxin-like PCBs and 12 chlorobenzenes (CBs) were monitored in all input materials and all discharges (flue gas, scrubbing liquid and solid residues). The results show relatively high levels of the U-POPs in the flue gas emission with total dioxins/furans of 4.4, 3.4, and 8.4 ng I-TEQ/m(3) in the baseline, test run 1 and test run 2, respectively, which are above international acceptable emission levels. The PCB levels in flue gas were, respectively, 0.01, 0.3 and 0.4 ng I-TEQ/m(3). The baseline thus had similar U-POPs levels with the OP test runs. In stack emission, approximately 90% of the U-POPs and 100% of CBs were present in gas phase. The emission factors, mass of pollutants per metric ton (tonne) of input waste, of U-POPs associated with fly ash (from bag house) were the highest, followed by flue gas and bottom ash while those associated with scrubbing liquid were relatively low. Among the waste input material only the black toner power contained U-POPs, but at low levels. The profiles of the dioxins/furans and PCBs in the toner waste were significantly different from that in the discharges. Despite the overall good destruction and removal efficiency of permethrin (better than 90%) the high emission of U-POPs and CBs from the test burn is of another more serious concern. To our best knowledge the findings of this study are the first of this kind for the Southeast Asia. The findings emphasize that if not properly conducted a standard destruction technology of a non-POP

  16. Mapping Perinatal Nursing Process Measurement Concepts to Standard Terminologies.

    PubMed

    Ivory, Catherine H

    2016-07-01

    The use of standard terminologies is an essential component for using data to inform practice and conduct research; perinatal nursing data standardization is needed. This study explored whether 76 distinct process elements important for perinatal nursing were present in four American Nurses Association-recognized standard terminologies. The 76 process elements were taken from a valid paper-based perinatal nursing process measurement tool. Using terminology-supported browsers, the elements were manually mapped to the selected terminologies by the researcher. A five-member expert panel validated 100% of the mapping findings. The majority of the process elements (n = 63, 83%) were present in SNOMED-CT, 28% (n = 21) in LOINC, 34% (n = 26) in ICNP, and 15% (n = 11) in CCC. SNOMED-CT and LOINC are terminologies currently recommended for use to facilitate interoperability in the capture of assessment and problem data in certified electronic medical records. Study results suggest that SNOMED-CT and LOINC contain perinatal nursing process elements and are useful standard terminologies to support perinatal nursing practice in electronic health records. Terminology mapping is the first step toward incorporating traditional paper-based tools into electronic systems. PMID:27081756

  17. Mapping Perinatal Nursing Process Measurement Concepts to Standard Terminologies.

    PubMed

    Ivory, Catherine H

    2016-07-01

    The use of standard terminologies is an essential component for using data to inform practice and conduct research; perinatal nursing data standardization is needed. This study explored whether 76 distinct process elements important for perinatal nursing were present in four American Nurses Association-recognized standard terminologies. The 76 process elements were taken from a valid paper-based perinatal nursing process measurement tool. Using terminology-supported browsers, the elements were manually mapped to the selected terminologies by the researcher. A five-member expert panel validated 100% of the mapping findings. The majority of the process elements (n = 63, 83%) were present in SNOMED-CT, 28% (n = 21) in LOINC, 34% (n = 26) in ICNP, and 15% (n = 11) in CCC. SNOMED-CT and LOINC are terminologies currently recommended for use to facilitate interoperability in the capture of assessment and problem data in certified electronic medical records. Study results suggest that SNOMED-CT and LOINC contain perinatal nursing process elements and are useful standard terminologies to support perinatal nursing practice in electronic health records. Terminology mapping is the first step toward incorporating traditional paper-based tools into electronic systems.

  18. Perinatal 192 IgG-Saporin as Neuroteratogen.

    PubMed

    Petrosini, Laura; De Bartolo, Paola; Cutuli, Debora; Gelfo, Francesca

    2016-01-01

    The immunotoxin 192 IgG-saporin selectively destroys basal forebrain cholinergic neurons that provide cholinergic input to the hippocampus, entire cortical mantle, amygdala, and olfactory bulb. Perinatal immunotoxic lesions by 192 IgG-saporin induce long-lasting cholinergic depletion mimicking a number of developmental disorders reported in humans. The perinatal injection of 192 IgG-saporin induces several brain modifications, which are observed in neocortex and hippocampus at short and long term. These plastic changes involve both structural (alterations in brain volume, neuronal morphology, and neurogenesis) and molecular (modulations of the levels of neurotransmitters and other proteins related to neurodegeneration) levels. Moreover, the perinatal injection of 192 IgG-saporin may interact with the brain plastic capacity to react to other injuries. Perinatal 192 IgG-saporin lesions allowed investigating the role of the basal forebrain cholinergic system in modulating behavioral functions in developing as well as adult rats. After perinatal cholinergic depletion, rats display reduced ultrasonic vocalizations as neonates, learning and exploratory deficits as juveniles, altered discriminative abilities, impulsive and perseverative behaviors, and memory deficits as adults. Overall, these findings underline the importance of cholinergic system integrity for the development of specific structural and functional features. PMID:26695170

  19. Low perinatal autopsy rate in Malaysia: time for a change.

    PubMed

    Tan, Geok Chin; Hayati, Abdul Rahman; Khong, Teck Yee

    2010-01-01

    Our objectives were to determine the perinatal autopsy rate in a tertiary hospital in Malaysia and to quantify the value of the perinatal autopsy. All stillbirths, miscarriages, therapeutic abortions, and neonatal deaths between January 1, 2004, and August 31, 2009, were identified from the archives. The autopsy findings were compared with the clinical diagnoses. The autopsy reports were also reviewed to determine if it would be possible to improve the quality of the autopsies. There were 807 perinatal deaths, of which 36 (4.5%) included an autopsy. There were ethnic differences in the rate of autopsy, with the lowest rate among the Malays. The autopsy provided the diagnosis, changed the clinical diagnosis, or revealed additional findings in 58.3% of cases. Ancillary testing, such as microbiology, chromosomal analysis, and biochemistry, could improve the quality of the autopsy. This study provides further data on the perinatal autopsy rate from an emerging and developing country. It reaffirms the value of the perinatal autopsy. Attempts must be made to improve on the low autopsy rate while recognizing that the performance of autopsies can be enhanced through the use of ancillary testing.

  20. Endophenotypes in Schizophrenia for the Perinatal Period: Criteria for Validation

    PubMed Central

    Ross, Randal G.; Freedman, Robert

    2015-01-01

    Endophenotypes are disease-associated phenotypes that are thought to reflect the neurobiological or other mechanisms that underlie the more overt symptoms of a psychiatric illness. Endophenotypes have been critical in understanding the genetics, neurobiology, and treatment of schizophrenia. Because psychiatric illnesses have multiple causes, including both genetic and nongenetic risk factors, an endophenotype linked to one of the mechanisms may be expressed more frequently than the disease itself. However, in schizophrenia research, endophenotypes have almost exclusively been studied in older adolescents or adults who have entered or passed through the age of risk for the disorder. Yet, schizophrenia is a neurodevelopmental disorder where prenatal development starts a cascade of brain changes across the lifespan. Endophenotypes have only minimally been utilized to explore the perinatal development of vulnerability. One major impediment to the development of perinatally-useful endophenotypes has been the established validity criteria. For example, the criterion that the endophenotype be more frequently present in those with disease than those without is difficult to demonstrate when there can be a decades-long period between endophenotype measurement and the age of greatest risk for onset of the disorder. This article proposes changes to the endophenotype validity criteria appropriate to perinatal research and reviews how application of these modified criteria helped identify a perinatally-usable phenotype of risk for schizophrenia, P50 sensory gating, which was then used to propose a novel perinatal primary prevention intervention. PMID:25943124

  1. Late-onset neonatal sepsis: recent developments

    PubMed Central

    Dong, Ying; Speer, Christian P

    2015-01-01

    The incidence of neonatal late-onset sepsis (LOS) is inversely related to the degree of maturity and varies geographically from 0.61% to 14.2% among hospitalised newborns. Epidemiological data on very low birth weight infants shows that the predominant pathogens of neonatal LOS are coagulase-negative staphylococci, followed by Gram-negative bacilli and fungi. Due to the difficulties in a prompt diagnosis of LOS and LOS-associated high risk of mortality and long-term neurodevelopmental sequelae, empirical antibiotic treatment is initiated on suspicion of LOS. However, empirical therapy is often inappropriately used with unnecessary broad-spectrum antibiotics and a prolonged duration of treatment. The increasing number of multidrug-resistant Gram-negative micro-organisms in neonatal intensive care units (NICU) worldwide is a serious concern, which requires thorough and efficient surveillance strategies and appropriate treatment regimens. Immunological strategies for preventing neonatal LOS are not supported by current evidence, and approaches, such as a strict hygiene protocol and the minimisation of invasive procedures in NICUs represent the cornerstone to reduce the burden of neonatal LOS. PMID:25425653

  2. [Immunology and sepsis syndrome in burn trauma].

    PubMed

    Ipaktchi, K; Vogt, P M

    2009-05-01

    Despite significant advances in burn surgery and critical care, severe burn trauma defined as injuries covering more than 25% of the total body surface area, is still associated with high mortality and morbidity. Burn trauma is a whole body injury where peripheral dermal injury rapidly results in systemic inflammation and inflammatory core organ damage. The severe disturbance of internal homeostasis involves all vital organ systems and obligates early referral to specialized burn centers. Treatment of severely burned patients is a multifaceted challenge directed by pathophysiologic events which progress from local skin destruction, disruption of physicochemical and microvascular barriers to breakdown of peripheral and central circulation, organ failure and ultimately death. While early intensive care focuses on maintenance of tissue oxygenation and perfusion, surgical treatment deals with management of the burn wounds as a source of inflammation and infection. Here wound debridement and coverage is essential to abrogate systemic effects of inflammation and limit pathogen invasion. While control of early burn stages minimizes mortality due to burn shock, subsequent burn sepsis continues to be a formidable challenge for physicians and the main cause of burn mortality.

  3. Late-onset neonatal sepsis: recent developments.

    PubMed

    Dong, Ying; Speer, Christian P

    2015-05-01

    The incidence of neonatal late-onset sepsis (LOS) is inversely related to the degree of maturity and varies geographically from 0.61% to 14.2% among hospitalised newborns. Epidemiological data on very low birth weight infants shows that the predominant pathogens of neonatal LOS are coagulase-negative staphylococci, followed by Gram-negative bacilli and fungi. Due to the difficulties in a prompt diagnosis of LOS and LOS-associated high risk of mortality and long-term neurodevelopmental sequelae, empirical antibiotic treatment is initiated on suspicion of LOS. However, empirical therapy is often inappropriately used with unnecessary broad-spectrum antibiotics and a prolonged duration of treatment. The increasing number of multidrug-resistant Gram-negative micro-organisms in neonatal intensive care units (NICU) worldwide is a serious concern, which requires thorough and efficient surveillance strategies and appropriate treatment regimens. Immunological strategies for preventing neonatal LOS are not supported by current evidence, and approaches, such as a strict hygiene protocol and the minimisation of invasive procedures in NICUs represent the cornerstone to reduce the burden of neonatal LOS.

  4. Model for predicting short-term mortality of severe sepsis

    PubMed Central

    Adrie, Christophe; Francais, Adrien; Alvarez-Gonzalez, Antonio; Mounier, Roman; Azoulay, Elie; Zahar, Jean-Ralph; Clec'h, Christophe; Goldgran-Toledano, Dany; Hammer, Laure; Descorps-Declere, Adrien; Jamali, Samir; Timsit, Jean-Francois

    2009-01-01

    Introduction To establish a prognostic model for predicting 14-day mortality in ICU patients with severe sepsis overall and according to place of infection acquisition and to sepsis episode number. Methods In this prospective multicentre observational study on a multicentre database (OUTCOMEREA) including data from 12 ICUs, 2268 patients with 2737 episodes of severe sepsis were randomly divided into a training cohort (n = 1458) and a validation cohort (n = 810). Up to four consecutive severe sepsis episodes per patient occurring within the first 28 ICU days were included. We developed a prognostic model for predicting death within 14 days after each episode, based on patient data available at sepsis onset. Results Independent predictors of death were logistic organ dysfunction (odds ratio (OR), 1.22 per point, P < 10-4), septic shock (OR, 1.40; P = 0.01), rank of severe sepsis episode (1 reference, 2: OR, 1.26; P = 0.10 ≥ 3: OR, 2.64; P < 10-3), multiple sources of infection (OR; 1.45, P = 0.03), simplified acute physiology score II (OR, 1.02 per point; P < 10-4), McCabe score ([greater than or equal to]2) (OR, 1.96; P < 10-4), and number of chronic co-morbidities (1: OR, 1.75; P < 10-3, ≥ 2: OR, 2.24, P < 10-3). Validity of the model was good in whole cohorts (AUC-ROC, 0.76; 95%CI, 0.74 to 0.79; and HL Chi-square: 15.3 (P = 0.06) for all episodes pooled). Conclusions In ICU patients, a prognostic model based on a few easily obtained variables is effective in predicting death within 14 days after the first to fourth episode of severe sepsis complicating community-, hospital-, or ICU-acquired infection. PMID:19454002

  5. Serum Procalcitonine Levels as an Early Diagnostic Indicator of Sepsis

    PubMed Central

    Beqja-Lika, Anila; Bulo-Kasneci, Anyla; Refatllari, Etleva; Heta-Alliu, Nevila; Rucaj-Barbullushi, Alma; Mone, Iris; Mitre, Anila

    2013-01-01

    Introduction: Prompt and accurate diagnosis of sepsis is of high importance for clinicians. Procalcitonine (PCT) and C-reactive protein (CRP) have been proposed as markers for this purpose. Our aim was to evaluate the levels of PCT and CRP in early sepsis and its correlation with severity of sepsis. Methods: Levels of PCT and CRP were taken from 60 patients with sepsis criteria and 39 patients with SIRS symptoms from the University Hospital Center “Mother Teresa” in Tirana, Albania during 2010-2012. Sensitivity, specificity and predictive values for PCT and CRP were calculated. Results: PCT and CRP levels increased in parallel with the severity of the clinical conditions of the patients. The mean PCT level in patients with sepsis was 11.28 ng/ml versus 0.272 ng/ml in patients with SIRS symptoms, with a sensitivity of 97.4% and a specificity of 96.6% for PCT >0.5ng/ml. The mean CRP level in septic patients was 146.58 mg/l vs. 34.4 mg/l in patients with SIRS, with a sensitivity of 98.6% for sepsis and a specificity of 75 % for CRP >11mg/l. Conclusion: PCT and CRP values are useful markers to determine early diagnosis and severity of an infection. In the present study, PCT was found to be a more accurate diagnostic parameter for differentiating SIRS from sepsis and may be helpful in the follow-up of critically ill patients. PMID:23687457

  6. Impact of sepsis on CD4 T cell immunity

    PubMed Central

    Cabrera-Perez, Javier; Condotta, Stephanie A.; Badovinac, Vladimir P.; Griffith, Thomas S.

    2014-01-01

    Sepsis remains the primary cause of death from infection in hospital patients, despite improvements in antibiotics and intensive-care practices. Patients who survive severe sepsis can display suppressed immune function, often manifested as an increased susceptibility to (and mortality from) nosocomial infections. Not only is there a significant reduction in the number of various immune cell populations during sepsis, but there is also decreased function in the remaining lymphocytes. Within the immune system, CD4 T cells are important players in the proper development of numerous cellular and humoral immune responses. Despite sufficient clinical evidence of CD4 T cell loss in septic patients of all ages, the impact of sepsis on CD4 T cell responses is not well understood. Recent findings suggest that CD4 T cell impairment is a multipronged problem that results from initial sepsis-induced cell loss. However, the subsequent lymphopenia-induced numerical recovery of the CD4 T cell compartment leads to intrinsic alterations in phenotype and effector function, reduced repertoire diversity, changes in the composition of naive antigen-specific CD4 T cell pools, and changes in the representation of different CD4 T cell subpopulations (e.g., increases in Treg frequency). This review focuses on sepsis-induced alterations within the CD4 T cell compartment that influence the ability of the immune system to control secondary heterologous infections. The understanding of how sepsis affects CD4 T cells through their numerical loss and recovery, as well as function, is important in the development of future treatments designed to restore CD4 T cells to their presepsis state. PMID:24791959

  7. Assessment of Fibrinolysis in Sepsis Patients with Urokinase Modified Thromboelastography

    PubMed Central

    Panigada, Mauro; Zacchetti, Lucia; L’Acqua, Camilla; Cressoni, Massimo; Anzoletti, Massimo Boscolo; Bader, Rossella; Protti, Alessandro; Consonni, Dario; D’Angelo, Armando; Gattinoni, Luciano

    2015-01-01

    Introduction Impairment of fibrinolysis during sepsis is associated with worse outcome. Early identification of this condition could be of interest. The aim of this study was to evaluate whether a modified point-of-care viscoelastic hemostatic assay can detect sepsis-induced impairment of fibrinolysis and to correlate impaired fibrinolysis with morbidity and mortality. Methods This single center observational prospective pilot study was performed in an adult Intensive Care Unit (ICU) of a tertiary academic hospital. Forty consecutive patients admitted to the ICU with severe sepsis or septic shock were included. Forty healthy individuals served as controls. We modified conventional kaolin activated thromboelastography (TEG) adding urokinase to improve assessment of fibrinolysis in real time (UK-TEG). TEG, UK-TEG, plasminogen activator inhibitor (PAI)-1, thrombin-activatable fibrinolysis inhibitor (TAFI), d-dimer, DIC scores and morbidity (rated with the SOFA score) were measured upon ICU admission. Logistic regression was used to calculate odds ratios (ORs) and 95% confidence intervals (95% CIs) of mortality at ICU discharge. Results UK-TEG revealed a greater impairment of fibrinolysis in sepsis patients compared to healthy individuals confirmed by PAI-1. TAFI was not different between sepsis patients and healthy individuals. 18/40 sepsis patients had fibrinolysis impaired according to UK-TEG and showed higher SOFA score (8 (6–13) vs 5 (4–7), p = 0.03), higher mortality (39% vs 5%, p = 0.01) and greater markers of cellular damage (lactate levels, LDH and bilirubin). Mortality at ICU discharge was predicted by the degree of fibrinolysis impairment measured by UK-TEG Ly30 (%) parameter (OR 0.95, 95% CI 0.93–0.98, p = 0.003). Conclusions Sepsis-induced impairment of fibrinolysis detected at UK-TEG was associated with increased markers of cellular damage, morbidity and mortality. PMID:26308340

  8. Complementary and alternative medicine therapies for perinatal depression.

    PubMed

    Deligiannidis, Kristina M; Freeman, Marlene P

    2014-01-01

    Complementary and alternative medicine therapies are increasingly sought out by people with psychiatric disorders. In this chapter, we review the evidence for several commonly used CAM therapies (i.e. omega-3 fatty acids, folate, S-adenosyl-methionine, St John's Wort, bright light therapy, exercise, massage, and acupuncture) in the treatment of perinatal depression. A number of these treatments may be reasonable to consider for women during pregnancy or postpartum, but the safety and efficacy of these relative to standard treatments must still be systematically determined. Evidence-based use of complementary and alternative medicine therapies treatments for perinatal depression is discussed. Adequately powered systematic studies are necessary to determine the role of complementary and alternative medicine therapies in the treatment of perinatal depression.

  9. Perinatal Programming of Asthma: The Role of Gut Microbiota

    PubMed Central

    Azad, Meghan B.; Kozyrskyj, Anita L.

    2012-01-01

    Perinatal programming, a dominant theory for the origins of cardiovascular disease, proposes that environmental stimuli influence developmental pathways during critical periods of prenatal and postnatal development, inducing permanent changes in metabolism. In this paper, we present evidence for the perinatal programming of asthma via the intestinal microbiome. While epigenetic mechanisms continue to provide new explanations for the programming hypothesis of asthma development, it is increasingly apparent that the intestinal microbiota plays an independent and potentially interactive role. Commensal gut bacteria are essential to immune system development, and exposures disrupting the infant gut microbiota have been linked to asthma. This paper summarizes the recent findings that implicate caesarean delivery, breastfeeding, perinatal stress, probiotics, and antibiotics as modifiers of infant gut microbiota in the development of asthma. PMID:22110540

  10. Improving the care of sepsis: Between system redesign and professional responsibility: A roundtable discussion in the world sepsis day, September 25, 2013, Riyadh, Saudi Arabia.

    PubMed

    Arabi, Yaseen; Alamry, Ahmed; Levy, Mitchell M; Taher, Saadi; Marini, Abdellatif M

    2014-07-01

    This paper summarizes the roundtable discussion in September 25, 2013, Riyadh, Saudi Arabia as part of the World Sepsis Day held in King Abdulaziz Medical City, Riyadh. The objectives of the roundtable discussion were to (1) review the chasm between the current management of sepsis and best practice, (2) discuss system redesign and role of the microsystem in sepsis management, (3) emphasize the multidisciplinary nature of the care of sepsis and that improvement of the care of sepsis is the responsibility of all, (4) discuss the bundle concept in sepsis management, and (5) reflect on the individual responsibility of the health care team toward sepsis with a focus on accountability and the moral agent.

  11. 76 FR 60842 - Announcement of Requirements and Registration for “popHealth Tools Development Challenge”

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-09-30

    ... from such an activity. Participants must be teams of at least two people. All participants are required...://www.challenge.gov Web site and search for the ``popHealth Tools Development Challenge''. Access...

  12. Demonstrating Classical Conditioning in Introductory Psychology: Needles Do Not Always Make Balloons Pop!

    ERIC Educational Resources Information Center

    Vernoy, Mark W.

    1987-01-01

    Describes a method of teaching classical conditioning to an introductory psychology class which involves demonstrating the conditioned response that occurs when a needle pierces, but does not pop, a balloon. (GEA)

  13. Global fibrinolytic capacity in pediatric patients with sepsis and disseminated intravascular coagulation.

    PubMed

    Bay, Ali; Oner, Ahmet Faik; Kose, Dogan; Dogan, Murat

    2006-10-01

    There are many complex pathophysiologic changes of the coagulation system in sepsis. The fibrinolytic system was evaluated in septic children using the global fibrinolytic capacity (GFC), a new technique reflecting the overall fibrinolytic activity. The study consisted of 24 children with sepsis, 36 children with sepsis plus disseminated intravascular coagulation (DIC), and 20 healthy age-matched control individuals. Compared with controls, 86% of sepsis patients and 87% of sepsis plus DIC patients had decreased GFC levels. Between the sepsis plus DIC and sepsis groups there was no significant difference in terms of GFC levels. While 19 patients (52.7%) died in the sepsis plus DIC group, only three patients (12.5%) died in the sepsis group. When survivors and nonsurvivors were compared in terms of coagulation tests, there were significant differences for protein C, antithrombin, platelet, fibrinogen, aspartate aminotransferase, alanine aminotransferase, prothrombin time, and white blood cell values. In conclusion, the level of GFC reduced in most of the pediatric sepsis patients but no difference was observed between patients with sepsis and patients with sepsis plus DIC. While inhibition of fibrinolysis is an important finding in sepsis, the mortality is mainly associated with the presence of end-organ damage and the status of coagulation parameters.

  14. PopGenome: an efficient Swiss army knife for population genomic analyses in R.

    PubMed

    Pfeifer, Bastian; Wittelsbürger, Ulrich; Ramos-Onsins, Sebastian E; Lercher, Martin J

    2014-07-01

    Although many computer programs can perform population genetics calculations, they are typically limited in the analyses and data input formats they offer; few applications can process the large data sets produced by whole-genome resequencing projects. Furthermore, there is no coherent framework for the easy integration of new statistics into existing pipelines, hindering the development and application of new population genetics and genomics approaches. Here, we present PopGenome, a population genomics package for the R software environment (a de facto standard for statistical analyses). PopGenome can efficiently process genome-scale data as well as large sets of individual loci. It reads DNA alignments and single-nucleotide polymorphism (SNP) data sets in most common formats, including those used by the HapMap, 1000 human genomes, and 1001 Arabidopsis genomes projects. PopGenome also reads associated annotation files in GFF format, enabling users to easily define regions or classify SNPs based on their annotation; all analyses can also be applied to sliding windows. PopGenome offers a wide range of diverse population genetics analyses, including neutrality tests as well as statistics for population differentiation, linkage disequilibrium, and recombination. PopGenome is linked to Hudson's MS and Ewing's MSMS programs to assess statistical significance based on coalescent simulations. PopGenome's integration in R facilitates effortless and reproducible downstream analyses as well as the production of publication-quality graphics. Developers can easily incorporate new analyses methods into the PopGenome framework. PopGenome and R are freely available from CRAN (http://cran.r-project.org/) for all major operating systems under the GNU General Public License. PMID:24739305

  15. PopGenome: An Efficient Swiss Army Knife for Population Genomic Analyses in R

    PubMed Central

    Pfeifer, Bastian; Wittelsbürger, Ulrich; Ramos-Onsins, Sebastian E.; Lercher, Martin J.

    2014-01-01

    Although many computer programs can perform population genetics calculations, they are typically limited in the analyses and data input formats they offer; few applications can process the large data sets produced by whole-genome resequencing projects. Furthermore, there is no coherent framework for the easy integration of new statistics into existing pipelines, hindering the development and application of new population genetics and genomics approaches. Here, we present PopGenome, a population genomics package for the R software environment (a de facto standard for statistical analyses). PopGenome can efficiently process genome-scale data as well as large sets of individual loci. It reads DNA alignments and single-nucleotide polymorphism (SNP) data sets in most common formats, including those used by the HapMap, 1000 human genomes, and 1001 Arabidopsis genomes projects. PopGenome also reads associated annotation files in GFF format, enabling users to easily define regions or classify SNPs based on their annotation; all analyses can also be applied to sliding windows. PopGenome offers a wide range of diverse population genetics analyses, including neutrality tests as well as statistics for population differentiation, linkage disequilibrium, and recombination. PopGenome is linked to Hudson’s MS and Ewing’s MSMS programs to assess statistical significance based on coalescent simulations. PopGenome’s integration in R facilitates effortless and reproducible downstream analyses as well as the production of publication-quality graphics. Developers can easily incorporate new analyses methods into the PopGenome framework. PopGenome and R are freely available from CRAN (http://cran.r-project.org/) for all major operating systems under the GNU General Public License. PMID:24739305

  16. Perinatal Asphyxia from the Obstetric Standpoint: Diagnosis and Interventions.

    PubMed

    Herrera, Christina A; Silver, Robert M

    2016-09-01

    Perinatal asphyxia is a general term referring to neonatal encephalopathy related to events during birth. Asphyxia refers to a deprivation of oxygen for a duration sufficient to cause neurologic injury. Most cases of perinatal asphyxia are not necessarily caused by intrapartum events but rather associated with underlying chronic maternal or fetal conditions. Of intrapartum causes, obstetric emergencies are the most common and are not always preventable. Screening high-risk pregnancies with ultrasound, Doppler velocimetry, and antenatal testing can aid in identifying fetuses at risk. Interventions such as intrauterine resuscitation or operative delivery may decrease the risk of severe hypoxia from intrauterine insults and improve long-term neurologic outcomes. PMID:27524445

  17. Interrelationship of carcinogen and glucocorticoid in perinatal enzyme induction.

    PubMed

    Leakey, J E; Wishart, G J; Dutton, G J

    1982-01-01

    Polycyclic aromatic hydrocarbons such as 3-methylcholanthrene can interrelate certain of their effects with those of glucocorticoid in the fetomaternal unit and the infant. We describe the induction by both classes of compounds in perinatal rat liver of enzymes that modify their biologic activity, and present further evidence for glucocorticoid-mimetic effects of 3-methylcholanthrene. We suggest that some degree of fetal teratogenicity and imprinting of postnatal events can arise from these mimetic effects, which should be taken into consideration along with the more direct perinatal toxicity of these mutagens.

  18. The experience of the implementation of perinatal audit in Moldova.

    PubMed

    Stratulat, P; Curteanu, A; Caraus, T; Petrov, V; Gardosi, J

    2014-09-01

    The Beyond the Numbers project in Moldova implemented perinatal mortality audit as a means to improve maternity and newborn care. Key activities for this project included training in audit, the setting up of audit committees, implementation of the review of cases and dissemination of information. During the project, a significant reduction was noted of perinatal deaths at term (from 37 weeks gestation and birthweight of ≥2500 g) by 1.5 per 1000; from 5.1 per 1000 in 2006 to 3.6 per 1000 in 2013.

  19. Early intervention after perinatal stroke: Opportunities and challenges

    PubMed Central

    Basu, Anna P

    2014-01-01

    Perinatal stroke is the commonest cause of hemiplegic cerebral palsy. No standardised early intervention exists despite evidence for a critical time window for activity-dependent plasticity to mould corticospinal tract development in the first few years of life. Intervention during this unique period of plasticity could mitigate the consequences of perinatal stroke to an extent not possible with later intervention, by preserving the normal pattern of development of descending motor pathways. This article outlines the broad range of approaches currently under investigation. Improved early detection and outcome prediction remain important goals, despite significant progress in this area. PMID:24528276

  20. Biomarkers of endothelial cell activation in early sepsis

    PubMed Central

    Skibsted, Simon; Jones, Alan E; Puskarich, Michael A.; Arnold, Ryan; Sherwin, Robert; Trzeciak, Stephen; Schuetz, Philipp; Aird, William C.; Shapiro, Nathan I

    2013-01-01

    PURPOSE To investigate the association of endothelial-related markers with organ dysfunction and in-hospital mortality to validate our earlier findings in a multicenter study. We hypothesize that: 1) endothelial biomarkers will be associated with organ dysfunction and mortality in sepsis; and, that sFlt-1, holds promise as novel prognostic markers in sepsis. METHODS A prospective, multicenter, observational study of a convenience sample of Emergency Department (ED) patients with a suspected infection presenting to one of four urban, academic medical center EDs between January 2009 and January 2010. We collected plasma while the patients were in the ED, and subsequently assayed endothelial-related biomarkers, namely sFlt-1, sE-Selectin, sICAM-1, sVCAM-1, and PAI-1. Outcomes were organ dysfunction and in-hospital mortality. RESULTS We enrolled at a total of 166 patients: 63 with sepsis (38%), 61 with severe sepsis (37%) and 42 with septic shock (25%). All endothelial biomarkers were significantly associated with sepsis severity, P < 0.002. We found a significant inter-correlation between all biomarkers, strongest between sFlt1 and PAI-1 (r=0.61, P < 0.001) and PAI-1 and sE-selectin and sICAM-1 (r=0.49, P < 0.001). Among the endothelial biomarkers, sFlt-1 had the strongest association with SOFA score (r=0.58, P < 0.001). sFlt-1 and PAI-1 had the highest area under the operating receiver characteristic curve for mortality of 0.87. CONCLUSIONS This multi-center validation study confirms that markers of endothelial activation are associated with sepsis severity, organ dysfunction and mortality in sepsis. This supports the hypothesis that the endothelium plays a central role in the pathophysiology of sepsis and may serve as a more accurate prediction tool and a target for therapies aimed at ameliorating endothelial cell dysfunction. Additionally, sFLT-1 holds promise as a novel sepsis severity biomarker. PMID:23524845

  1. Blood Culture Proven Early Onset Sepsis and Late Onset Sepsis in Very-Low-Birth-Weight Infants in Korea.

    PubMed

    Lee, Soon Min; Chang, Meayoung; Kim, Ki-Soo

    2015-10-01

    Neonatal sepsis remains one of the most important causes of death and co-morbidity in very-low-birth-weight (VLBW) infants. The aim of this study was to determine the current incidences of early-onset sepsis (EOS) and late-onset sepsis (LOS), the distribution of pathogens, and the impact of infection on co-morbidities in VLBW infants. We analyzed the data including sepsis episode from 2,386 VLBW infants enrolled in Korean Neonatal Network from January 2013 to June 2014. We defined EOS as a positive blood culture occurring between birth and 7 days of life and LOS after 7 days of life. Sepsis was found in 21.1% of VLBW infants. The risk of sepsis was inversely related to birth weight and gestational age. EOS was found in only 3.6% of VLBW infants, however the mortality rate was as high as 34.1%. EOS was associated with the increased odds for bronchopulmonary dysplasia and intraventricular hemorrhage. The vast majority of EOS was caused by Gram-positive organisms, particularly coagulase-negative staphylococci (30.6%). LOS developed in 19.4% of VLBW infants with a 16.1% mortality rate. Pathogens in LOS were dominated by coagulase-negative staphylococci (38.3%). Twenty-five percent and fifty percent of first LOS episode occurred after 12 days and 20 days from birth, respectively. Younger and smaller VLBW infants showed the earlier occurrence day for the 25% of first LOS episode. This study provides a recent nationwide epidemiology of sepsis in VLBW infants in Korea. Based on this study, successful strategies to reduce infections would improve survival and reduce morbidity.

  2. Improving the management of sepsis in a district general hospital by implementing the ‘Sepsis Six’ recommendations

    PubMed Central

    Kumar, Prashant; Jordan, Mark; Caesar, Jenny; Miller, Sarah

    2015-01-01

    Sepsis is a common condition with a major global impact on healthcare resources and expenditure. The Surviving Sepsis Campaign has been vigorous in promoting internationally recognised pathways to improve the management of septic patients and decrease mortality. However, translating recommendations into practice is a challenging and complex task that requires a multi-faceted approach with sustained engagement from local stakeholders. Whilst working at a district general hospital in New Zealand, we were concerned by the seemingly inconsistent management of septic patients, often leading to long delays in the initiation of life-saving measures such as antibiotic, fluid, and oxygen administration. In our hospital there were no clear systems, protocols or guidelines in place for identifying and managing septic patients. We therefore launched the Sepsis Six resuscitation bundle of care in our hospital in an attempt to raise awareness amongst staff and improve the management of septic patients. We introduced a number of simple low-cost interventions that included educational sessions for junior doctors and nursing staff, as well as posters and modifications to phlebotomy trolleys that acted as visual reminders to implement the Sepsis Six bundle. Overall, we found there to a be a steady improvement in the delivery of the Sepsis Six bundle in septic patients with 63% of patients receiving appropriate care within one hour, compared to 29% prior to our interventions. However this did not translate to an improvement in patient mortality. This project forms part of an on going process to instigate a fundamental culture change among local healthcare professionals regarding the management of sepsis. Whilst we have demonstrated improved implementation of the Sepsis Six bundle, the key challenge remains to ensure that momentum of this project continues and forms a platform for sustainable clinical improvement in the long term. PMID:26734403

  3. From mind-pops to hallucinations? A study of involuntary semantic memories in schizophrenia.

    PubMed

    Elua, Ia; Laws, Keith R; Kvavilashvili, Lia

    2012-04-30

    Involuntary semantic memories or mind-pops consist of isolated fragments of one's semantic knowledge (e.g., a word or a sentence, proper name, image or a melody) that come to mind unexpectedly, without any deliberate attempt to recall them. They can be experienced as alien and uncontrollable, and may share some phenomenological similarities with hallucinations. The aim of the present study was to investigate the nature and frequency of mind-pops in people with schizophrenia (N=37), as well as clinically depressed (N=31) and non-clinical controls (N=31). Results showed that schizophrenia patients reported experiencing mind-pops more frequently than both depressed and non-clinical controls. Schizophrenia patients also reported a wider range of different types of mind-pops than non-clinical controls. The depressed group did not differ from non-clinical controls in the frequency and range of mind-pops, indicating that mind-pops are not characteristic of clinical populations in general, but may be particularly prevalent in patients with schizophrenia. The possible implications of this finding to current models of auditory verbal hallucinations are discussed and the need for future research in this area is emphasized. PMID:22424894

  4. Plastic as a carrier of POPs to aquatic organisms: a model analysis.

    PubMed

    Koelmans, Albert A; Besseling, Ellen; Wegner, Anna; Foekema, Edwin M

    2013-07-16

    It has been hypothesized that persistent organic pollutants (POPs) in microplastic may pose a risk to aquatic organisms. Here we develop and analyze a conceptual model that simulates the effects of plastic on bioaccumulation of POPs. The model accounts for dilution of exposure concentration by sorption of POPs to plastic (POP "dilution"), increased bioaccumulation by ingestion of plastic-containing POPs ("carrier"), and decreased bioaccumulation by ingestion of clean plastic ("cleaning"). The model is parametrized for the lugworm Arenicola marina and evaluated against recently published bioaccumulation data for this species from laboratory bioassays with polystyrene microplastic. Further scenarios include polyethylene microplastic, nanosized plastic, and open marine systems. Model analysis shows that plastic with low affinity for POPs such as polystyrene will have a marginal decreasing effect on bioaccumulation, governed by dilution. For stronger sorbents such as polyethylene, the dilution, carrier, and cleaning mechanism are more substantial. In closed laboratory bioassay systems, dilution and cleaning dominate, leading to decreased bioaccumulation. Also in open marine systems a decrease is predicted due to a cleaning mechanism that counteracts biomagnification. However, the differences are considered too small to be relevant from a risk assessment perspective.

  5. Software-Enabled Distributed Network Governance: The PopMedNet Experience

    PubMed Central

    Davies, Melanie; Erickson, Kyle; Wyner, Zachary; Malenfant, Jessica; Rosen, Rob; Brown, Jeffrey

    2016-01-01

    Introduction: The expanded availability of electronic health information has led to increased interest in distributed health data research networks. Distributed Research Network Model: The distributed research network model leaves data with and under the control of the data holder. Data holders, network coordinating centers, and researchers have distinct needs and challenges within this model. Software Enabled Governance: PopMedNet: The concerns of network stakeholders are addressed in the design and governance models of the PopMedNet software platform. PopMedNet features include distributed querying, customizable workflows, and auditing and search capabilities. Its flexible role-based access control system enables the enforcement of varying governance policies. Selected Case Studies: Four case studies describe how PopMedNet is used to enforce network governance models. Issues and Challenges: Trust is an essential component of a distributed research network and must be built before data partners may be willing to participate further. The complexity of the PopMedNet system must be managed as networks grow and new data, analytic methods, and querying approaches are developed. Conclusions: The PopMedNet software platform supports a variety of network structures, governance models, and research activities through customizable features designed to meet the needs of network stakeholders. PMID:27141522

  6. A clinical perspective of sepsis-associated delirium.

    PubMed

    Tsuruta, Ryosuke; Oda, Yasutaka

    2016-01-01

    The term sepsis-associated encephalopathy (SAE) has been applied to animal models, postmortem studies in patients, and severe cases of sepsis. SAE is considered to include all types of brain dysfunction, including delirium, coma, seizure, and focal neurological signs. Clinical data for sepsis-associated delirium (SAD) have been accumulating since the establishment of definitions of coma or delirium and the introduction of validated screening tools. Some preliminary studies have examined the etiology of SAD. Neuroinflammation, abnormal cerebral perfusion, and neurotransmitter imbalances are the main mechanisms underlying the development of SAD. However, there are still no specific diagnostic blood, electrophysiological, or imaging tests or treatments specific for SAD. The duration of delirium in intensive care patients is associated with long-term functional disability and cognitive impairment, although this syndrome usually reverses after the successful treatment of sepsis. Once the respiratory and hemodynamic states are stabilized, patients with severe sepsis or septic shock should receive rehabilitation as soon as possible because early initiation of rehabilitation can reduce the duration of delirium. We expect to see further pathophysiological data and the development of novel treatments for SAD now that reliable and consistent definitions of SAD have been established. PMID:27011789

  7. Endocrine dysfunction in sepsis: a beneficial or deleterious host response?

    PubMed

    Gheorghiţă, Valeriu; Barbu, Alina Elena; Gheorghiu, Monica Livia; Căruntu, Florin Alexandru

    2015-03-01

    Sepsis is a systemic, deleterious inflammatory host response triggered by an infective agent leading to severe sepsis, septic shock and multi-organ failure. The host response to infection involves a complex, organized and coherent interaction between immune, autonomic, neuroendocrine and behavioral systems. Recent data have confirmed that disturbances of the autonomic nervous and neuroendocrine systems could contribute to sepsis-induced organ dysfunction. Through this review, we aimed to summarize the current knowledge about the endocrine dysfunction as response to sepsis, specifically addressed to vasopressin, copeptin, cortisol, insulin and leptin. We searched the following readily accessible, clinically relevant databases: PubMed, UpToDate, BioMed Central. The immune system could be regarded as a "diffuse sensory organ" that signals the presence of pathogens to the brain through different pathways, such as the vagus nerve, endothelial activation/dysfunction, cytokines and neurotoxic mediators and the circumventricular organs, especially the neurohypophysis. The hormonal profile changes substantially as a consequence of inflammatory mediators and microorganism products leading to inappropriately low levels of vasopressin, sick euthyroid syndrome, reduced adrenal responsiveness to ACTH, insulin resistance, hyperglycemia as well as hyperleptinemia. In conclusion, clinical diagnosis of this "pan-endocrine illness" is frequently challenging due to the many limiting factors. The most important benefits of endocrine markers in the management of sepsis may be reflected by their potential to be used as biomarkers in different scoring systems to estimate the severity of the disease and the risk of death.

  8. Interleukin-8 in sepsis: relation to shock and inflammatory mediators.

    PubMed

    Hack, C E; Hart, M; van Schijndel, R J; Eerenberg, A J; Nuijens, J H; Thijs, L G; Aarden, L A

    1992-07-01

    Because of its neutrophil-activating properties, interleukin-8 (IL-8) may play an important role in the pathophysiology of sepsis. We measured circulating IL-8 levels in 47 patients with clinical sepsis. Levels on admission were elevated in 42 of the 47 patients (89%) and were comparable in patients with gram-positive or gram-negative infections. Patients with shock had significantly higher IL-8 levels than normotensive patients (P = 0.0014, Wilcoxon-Mann-Whitney test), whereas no differences in IL-8 levels were found between patients with or without adult respiratory distress syndrome. Patients who died had higher IL-8 levels on admission than the patients who survived. The largest differences in IL-8 levels between survivors and nonsurvivors was found when only patients with positive cultures were considered (P = 0.0342). IL-8 levels appeared to correlate significantly with lactate levels and inversely with leukocyte and platelet numbers and mean arterial pressure. In addition, the IL-8 level in the sepsis patients was found to correlate significantly with levels of IL-6, elastase-alpha 1-antitrypsin, and C3a. Serial observations revealed that in most patients IL-8 levels decreased, irrespective of the outcome. Thus, our results demonstrate that IL-8 levels are increased in most patients with sepsis and correlate with some important clinical, biochemical, and inflammatory parameters. These findings suggest a role for IL-8 in the pathophysiology of sepsis.

  9. The role of MBL2 gene polymorphism in sepsis incidence

    PubMed Central

    Liu, Lei; Ning, Bo

    2015-01-01

    Aim: This case-control study was aimed to explore the role of mannose-binding lectin 2 (MBL2) gene rs1800450 polymorphism (codon 54 A/B, G230A) in the development of sepsis in Han Chinese. Methods: MBL2 rs1800450 polymorphism was genotyped by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP). MBL serum level was detected by enzyme-linked immunosorbent assay (ELISA). Associations between rs1800450 and sepsis susceptibility was detected by Chi-square test and represented by odds ratios (ORs) and 95% confidence intervals (CIs). Correlation of rs1800450 genotypes and MBL serum level was assessed using t test. Result: Variant A allele frequency was significantly observed in cases than that in controls, indicating a significant association with the susceptibility of sepsis (OR = 1.979, 95% CI = 1.200-3.262). GA genotype also relate to the onset of sepsis (OR = 2.090, 95% CI = 1.163-3.753). MBL serum concentrations were significantly different between case and control groups (P<0.001). Meanwhile, variant allele carriers had lower serum level compared with wild homozygous (P<0.001). Conclusion: Variant A allele in MBL2 gene rs1800450 polymorphism might increase the risk of sepsis via decrease the MBL serum level. PMID:26823854

  10. Impaired Granuloma Formation in Sepsis: Impact of Monocytopenia

    PubMed Central

    Alingrin, Julie; Coiffard, Benjamin; Textoris, Julien; Belenotti, Pauline; Daumas, Aurélie; Leone, Marc; Mege, Jean-Louis

    2016-01-01

    Granulomas are a collection of immune cells considered to be protective in infectious diseases. The in vitro generation of granulomas is an interesting substitution to invasive approaches of granuloma study. The monitoring of immune response through the determination of in vitro granuloma formation in patients with severe sepsis may be critical to individualize treatments. We compared the in vitro generation of granulomas by co-culturing circulating mononuclear cells from 19 patients with severe sepsis, 9 patients cured from Q fever and 12 healthy subjects as controls, and Sepharose beads coated either with BCG or Coxiella burnetii extracts to analyze both immune and innate granulomas, respectively. We showed that the great majority of patients with severe sepsis were unable to form granulomas in response to BCG and C. burnetii extracts whereas more than 80% of healthy controls and patients cured from Q fever formed granulomas. We also found that monocytopenia and defective production of tumor necrosis factor were associated with reduced formation of granulomas in patients with severe sepsis even if TNF did not seem to be involved in the defective granuloma formation. Taken together, these results suggest that the deficiency of granuloma formation may be a measurement of altered recruitment and activation of monocytes and lymphocytes in patients with severe sepsis. PMID:27441846

  11. Multi-analytical Approaches Informing the Risk of Sepsis

    NASA Astrophysics Data System (ADS)

    Gwadry-Sridhar, Femida; Lewden, Benoit; Mequanint, Selam; Bauer, Michael

    Sepsis is a significant cause of mortality and morbidity and is often associated with increased hospital resource utilization, prolonged intensive care unit (ICU) and hospital stay. The economic burden associated with sepsis is huge. With advances in medicine, there are now aggressive goal oriented treatments that can be used to help these patients. If we were able to predict which patients may be at risk for sepsis we could start treatment early and potentially reduce the risk of mortality and morbidity. Analytic methods currently used in clinical research to determine the risk of a patient developing sepsis may be further enhanced by using multi-modal analytic methods that together could be used to provide greater precision. Researchers commonly use univariate and multivariate regressions to develop predictive models. We hypothesized that such models could be enhanced by using multiple analytic methods that together could be used to provide greater insight. In this paper, we analyze data about patients with and without sepsis using a decision tree approach and a cluster analysis approach. A comparison with a regression approach shows strong similarity among variables identified, though not an exact match. We compare the variables identified by the different approaches and draw conclusions about the respective predictive capabilities,while considering their clinical significance.

  12. Glycocalyx and sepsis-induced alterations in vascular permeability.

    PubMed

    Chelazzi, Cosimo; Villa, Gianluca; Mancinelli, Paola; De Gaudio, A Raffaele; Adembri, Chiara

    2015-01-28

    Endothelial cells line the inner portion of the heart, blood vessels, and lymphatic vessels; a basal membrane of extracellular matrix lines the extraluminal side of endothelial cells. The apical side of endothelial cells is the site for the glycocalyx, which is a complex network of macromolecules, including cell-bound proteoglycans and sialoproteins. Sepsis-associated alterations of this structure may compromise endothelial permeability with associated interstitial fluid shift and generalized edema. Indeed, in sepsis, the glycocalyx acts as a target for inflammatory mediators and leukocytes, and its ubiquitous nature explains the damage of tissues that occurs distant from the original site of infection. Inflammatory-mediated injury to glycocalyx can be responsible for a number of specific clinical effects of sepsis, including acute kidney injury, respiratory failure, and hepatic dysfunction. Moreover, some markers of glycocalyx degradation, such as circulating levels of syndecan or selectins, may be used as markers of endothelial dysfunction and sepsis severity. Although a great deal of experimental evidence shows that alteration of glycocalyx is widely involved in endothelial damage caused by sepsis, therapeutic strategies aiming at preserving its integrity did not significantly improve the outcome of these patients.

  13. Use of miRNAs as biomarkers in sepsis.

    PubMed

    Dumache, Raluca; Rogobete, Alexandru Florin; Bedreag, Ovidiu Horea; Sarandan, Mirela; Cradigati, Alina Carmen; Papurica, Marius; Dumbuleu, Corina Maria; Nartita, Radu; Sandesc, Dorel

    2015-01-01

    Sepsis is one of the most common causes of death in critical patients. Severe generalized inflammation, infections, and severe physiological imbalances significantly decrease the survival rate with more than 50%. Moreover, monitoring, evaluation, and therapy management often become extremely difficult for the clinician in this type of patients. Current methods of diagnosing sepsis vary based especially on the determination of biochemical-humoral markers, such as cytokines, components of the complement, and proinflammatory and anti-inflammatory compounds. Recent studies highlight the use of new biomarkers for sepsis, namely, miRNAs. miRNAs belong to a class of small, noncoding RNAs with an approximate content of 19-23 nucleotides. Following biochemical and physiological imbalances, the expression of miRNAs in blood or other body fluids changes significantly. Moreover, its stability, specificity, and selectivity make miRNAs ideal candidates for sepsis biomarkers. In conclusion, we can affirm that stable species of circulating miRNAs represent potential biomarkers for monitoring the evolution of sepsis.

  14. [Usefulness of Presepsin Measurement: A New Biomarker for Sepsis].

    PubMed

    Okamura, Yoshikazu

    2015-01-01

    Sepsis is a systemic inflammatory response syndrome (SIRS) caused by infection, and it is one of the major causes of mortality of critical care patients. Since it has been reported that early, optimal treatment of patients is important to reduce mortality from sepsis, a sepsis marker with a high sensitivity and specificity is required. Presepsin (P-SEP) was discovered as a new marker whose levels elevated specifically in the blood of patients with sepsis in Japan in 2002. Presepsin is a 13-kDa glycoprotein that is a truncated N-terminal fragment of CD14. Since one of the production mechanisms of presepsin is related to the phagocytosis of bacteria, the biological characteristics of presepsin are different from those of other inflammatory markers. Presepsin has three features in comparison with procalcitonin(PCT), C-reactive protein(CRP), and interleukin-6 (IL-6): 1) Presepsin can be detected earlier after the onset of infection; 2) Presepsin is not affected by severe trauma, severe burn, or invasive surgical procedures, which lead to SIRS, more than PCT, CRP, or IL-6; 3) Presepsin levels reflect the clinical condition of septic patients. Although clinical evidence is not sufficient at present, presepsin may be a strong tool for the development of novel treatment strategies for sepsis.

  15. Impaired Granuloma Formation in Sepsis: Impact of Monocytopenia.

    PubMed

    Alingrin, Julie; Coiffard, Benjamin; Textoris, Julien; Belenotti, Pauline; Daumas, Aurélie; Leone, Marc; Mege, Jean-Louis

    2016-01-01

    Granulomas are a collection of immune cells considered to be protective in infectious diseases. The in vitro generation of granulomas is an interesting substitution to invasive approaches of granuloma study. The monitoring of immune response through the determination of in vitro granuloma formation in patients with severe sepsis may be critical to individualize treatments. We compared the in vitro generation of granulomas by co-culturing circulating mononuclear cells from 19 patients with severe sepsis, 9 patients cured from Q fever and 12 healthy subjects as controls, and Sepharose beads coated either with BCG or Coxiella burnetii extracts to analyze both immune and innate granulomas, respectively. We showed that the great majority of patients with severe sepsis were unable to form granulomas in response to BCG and C. burnetii extracts whereas more than 80% of healthy controls and patients cured from Q fever formed granulomas. We also found that monocytopenia and defective production of tumor necrosis factor were associated with reduced formation of granulomas in patients with severe sepsis even if TNF did not seem to be involved in the defective granuloma formation. Taken together, these results suggest that the deficiency of granuloma formation may be a measurement of altered recruitment and activation of monocytes and lymphocytes in patients with severe sepsis. PMID:27441846

  16. Sepsis: Multiple Abnormalities, Heterogeneous Responses, and Evolving Understanding

    PubMed Central

    Iskander, Kendra N.; Osuchowski, Marcin F.; Stearns-Kurosawa, Deborah J.; Kurosawa, Shinichiro; Stepien, David; Valentine, Catherine

    2013-01-01

    Sepsis represents the host's systemic inflammatory response to a severe infection. It causes substantial human morbidity resulting in hundreds of thousands of deaths each year. Despite decades of intense research, the basic mechanisms still remain elusive. In either experimental animal models of sepsis or human patients, there are substantial physiological changes, many of which may result in subsequent organ injury. Variations in age, gender, and medical comorbidities including diabetes and renal failure create additional complexity that influence the outcomes in septic patients. Specific system-based alterations, such as the coagulopathy observed in sepsis, offer both potential insight and possible therapeutic targets. Intracellular stress induces changes in the endoplasmic reticulum yielding misfolded proteins that contribute to the underlying pathophysiological changes. With these multiple changes it is difficult to precisely classify an individual's response in sepsis as proinflammatory or immunosuppressed. This heterogeneity also may explain why most therapeutic interventions have not improved survival. Given the complexity of sepsis, biomarkers and mathematical models offer potential guidance once they have been carefully validated. This review discusses each of these important factors to provide a framework for understanding the complex and current challenges of managing the septic patient. Clinical trial failures and the therapeutic interventions that have proven successful are also discussed. PMID:23899564

  17. The CASSIOPE/e-POP Magnetic Field Instrument (MGF)

    NASA Astrophysics Data System (ADS)

    Wallis, D. D.; Miles, D. M.; Narod, B. B.; Bennest, J. R.; Murphy, K. R.; Mann, I. R.; Yau, A. W.

    2015-06-01

    Field-aligned currents couple energy between the Earth's magnetosphere and ionosphere and are responsible for driving both micro and macro motions of plasma and neutral atoms in both regimes. These currents are believed to be a contributing energy source for ion acceleration in the polar ionosphere and may be detected via measurements of magnetic gradients along the track of a polar orbiting spacecraft, usually the north-south gradients of the east-west field component. The detection of such gradients does not require observatory class measurements of the geomagnetic field. The Magnetic Field instrument (MGF) measures the local magnetic field onboard the Enhanced Polar Outflow Probe (e-POP) satellite by using two ring-core fluxgate sensors to characterize and remove the stray spacecraft field. The fluxgate sensors have their heritage in the MAGSAT design, are double wound for reduced mass and cross-field dependence, and are mounted on a modest 0.9 m carbon-fiber boom. The MGF samples the magnetic field 160 times per sec (˜50 meters) to a resolution of 0.0625 nT and outputs data at 1952 bytes per second including temperature measurements. Its power consumption is 2.2 watts, and its noise level is 7 pT per root Hz at 1 Hz.

  18. Suitable reverberation times for halls for rock and pop music.

    PubMed

    Adelman-Larsen, Niels Werner; Thompson, Eric R; Gade, Anders C

    2010-01-01

    The existing body of literature regarding the acoustic design of concert halls has focused almost exclusively on classical music, although there are many more performances of popular music, including rock and pop. Objective measurements were made of the acoustics of 20 rock music venues in Denmark and a questionnaire was used in a subjective assessment of those venues with professional rock musicians and sound engineers as expert listeners. Correlations between the measurements show that clarity, including bass frequencies down to 63 Hz, is important for the general impression of the acoustics of the hall. The best-rated halls in the study have reverberation times that are approximately frequency independent from 0.6 to 1.2 s for hall volumes from 1000 to 6000 m(3). The worst rated halls in the study had significantly higher reverberation times in the 63 and 125 Hz bands. Since most audiences at rock concerts are standing, absorption coefficients were measured with a standing audience from 63 Hz to 4 kHz. These measurements showed that a standing audience absorbs about five times as much energy in mid-/high-frequency bands as in low-frequency bands.

  19. No emotional "pop-out" effect in natural scene viewing.

    PubMed

    Acunzo, David J; Henderson, John M

    2011-10-01

    It has been shown that attention is drawn toward emotional stimuli. In particular, eye movement research suggests that gaze is attracted toward emotional stimuli in an unconscious, automated manner. We addressed whether this effect remains when emotional targets are embedded within complex real-world scenes. Eye movements were recorded while participants memorized natural images. Each image contained an item that was either neutral, such as a bag, or emotional, such as a snake or a couple hugging. We found no latency difference for the first target fixation between the emotional and neutral conditions, suggesting no extrafoveal "pop-out" effect of emotional targets. However, once detected, emotional targets held attention for a longer time than neutral targets. The failure of emotional items to attract attention seems to contradict previous eye-movement research using emotional stimuli. However, our results are consistent with studies examining semantic drive of overt attention in natural scenes. Interpretations of the results in terms of perceptual and attentional load are provided. PMID:21787079

  20. Plateau `pop-up' in the great 1897 Assam earthquake

    NASA Astrophysics Data System (ADS)

    Bilham, Roger; England, Philip

    2001-04-01

    The great Assam earthquake of 12 June 1897 reduced to rubble all masonry buildings within a region of northeastern India roughly the size of England, and was felt over an area exceeding that of the great 1755 Lisbon earthquake. Hitherto it was believed that rupture occurred on a north-dipping Himalayan thrust fault propagating south of Bhutan. But here we show that the northern edge of the Shillong plateau rose violently by at least 11m during the Assam earthquake, and that this was due to the rupture of a buried reverse fault approximately 110km in length and dipping steeply away from the Himalaya. The stress drop implied by the rupture geometry and the prodigious fault slip of 18 +/- 7m explains epicentral accelerations observed to exceed 1g vertically and surface velocities exceeding 3ms-1 (ref. 1). This quantitative observation of active deformation of a `pop-up' structure confirms that faults bounding such structures can penetrate the whole crust. Plateau uplift in the past 2-5 million years has caused the Indian plate to contract locally by 4 +/- 2mmyr-1, reducing seismic risk in Bhutan but increasing the risk in northern Bangladesh.

  1. Neonatal Enterovirus Infection: Case Series of Clinical Sepsis and Positive Cerebrospinal Fluid Polymerase Chain Reaction Test with Myocarditis and Cerebral White Matter Injury Complications

    PubMed Central

    Morriss, Frank H.; Lindower, Julie B.; Bartlett, Heather L.; Atkins, Dianne L.; Kim, Jean O.; Klein, Jonathan M.; Ford, Bradley A.

    2016-01-01

    Objective We describe five neonates with enteroviral (EV) infection to demonstrate central nervous system (CNS) and cardiac complications and report successful treatment of myocarditis with immunoglobulin intravenous (IVIG) in two. Study Design Case series identified during three enteroviral seasons in one neonatal intensive care unit (NICU) by cerebral spinal fluid (CSF) reverse transcriptase polymerase chain reaction (PCR) testing for EV in neonates suspected to have sepsis, but with sterile bacterial cultures. Results Cases were identified in each of three sequential years in a NICU with 800 to 900 admissions/year. Two cases were likely acquired perinatally; all were symptomatic with lethargy and poor feeding by age 5 to 10 days. All had signs of sepsis and/or meningitis; one progressed to periventricular leukomalacia and encephalomalacia. Two recovered from myocarditis after treatment that included IVIG 3 to 5 g/kg. Conclusion Neonates who appear septic without bacterial etiology may have EV CNS infections that can be diagnosed rapidly by CSF PCR testing. Cases may be underdiagnosed in the early neonatal period if specific testing is not performed. Neonates with EV infection should be investigated for evidence of periventricular leukomalacia, screened for myocarditis, and considered for IVIG treatment. PMID:27695644

  2. Neonatal Enterovirus Infection: Case Series of Clinical Sepsis and Positive Cerebrospinal Fluid Polymerase Chain Reaction Test with Myocarditis and Cerebral White Matter Injury Complications

    PubMed Central

    Morriss, Frank H.; Lindower, Julie B.; Bartlett, Heather L.; Atkins, Dianne L.; Kim, Jean O.; Klein, Jonathan M.; Ford, Bradley A.

    2016-01-01

    Objective We describe five neonates with enteroviral (EV) infection to demonstrate central nervous system (CNS) and cardiac complications and report successful treatment of myocarditis with immunoglobulin intravenous (IVIG) in two. Study Design Case series identified during three enteroviral seasons in one neonatal intensive care unit (NICU) by cerebral spinal fluid (CSF) reverse transcriptase polymerase chain reaction (PCR) testing for EV in neonates suspected to have sepsis, but with sterile bacterial cultures. Results Cases were identified in each of three sequential years in a NICU with 800 to 900 admissions/year. Two cases were likely acquired perinatally; all were symptomatic with lethargy and poor feeding by age 5 to 10 days. All had signs of sepsis and/or meningitis; one progressed to periventricular leukomalacia and encephalomalacia. Two recovered from myocarditis after treatment that included IVIG 3 to 5 g/kg. Conclusion Neonates who appear septic without bacterial etiology may have EV CNS infections that can be diagnosed rapidly by CSF PCR testing. Cases may be underdiagnosed in the early neonatal period if specific testing is not performed. Neonates with EV infection should be investigated for evidence of periventricular leukomalacia, screened for myocarditis, and considered for IVIG treatment.

  3. Prevention of Sepsis in Children: A New Paradigm for Public Policy

    PubMed Central

    Riley, Carley; Wheeler, Derek S.

    2012-01-01

    Sepsis is one of the leading causes of death worldwide. While the management of critically ill patients with sepsis is certainly better now compared to 20 years ago, sepsis-associated mortality remains unacceptably high. Annual deaths from sepsis in both children and adults far surpass the number of deaths from acute myocardial infarction (AMI), stroke, or cancer. Given the substantial toll that sepsis takes worldwide, prevention of sepsis remains a global priority. Multiple effective prevention strategies exist. Antibiotic prophylaxis, immunizations, and healthcare quality improvement initiatives are important means through which we may reduce the morbidity and mortality from sepsis around the world. Inclusion of these strategies in a coordinated and thoughtful campaign to reduce the global burden of sepsis is necessary for the improvement of pediatric health worldwide. PMID:22216408

  4. Source, Managemnt and Quantification of Unintentional POPs (PCDDD/Fs) in Nepal

    NASA Astrophysics Data System (ADS)

    Charitra Sah, Ram

    2010-05-01

    The aim to prepare and present this paper is to highlight the source, management and quantification of the unintentional POPs in an unindustrialized least developing landlocked small country Nepal. The methodology adopted for this is the review of the relevant research documents and national initiative towards addressing this issues complemented with sharing of the first hand experience from the implementation of the POPs management activities undertaken by our organization. Nepal is a small country of size 147181 sq.km but having large sources of POPs including unintentional POPs (PCDD/Fs) mainly because of weak enforcement of the existing environment related laws, standards and international commitment including POPs Convention. Country became homes to about 75 tons of Obsolete Pesticide since last 30 years including about 44 percent (33 tons out of 75) are of known POPs. These obsolete pesticides including identified POPs have been poorly stored in some about 25 locations throughout the country. The major warehouse accommodating about 50 tons at Amlekhgunj has been located just in front of a high school where about 1000 children are being studying and found to have some health related problem due to the gasses emission from the warehouse as well as school playground field contaminated with these POPs pesticides. The playground soil contamination has been found from routine examination of the soil samples. In addition to pesticides including POPs were used in the agriculture and public health field in the past, there are several other practices as well as anthropogenic activities producing PCDD/Fs. The annual inventory of countrywide emission of unintentional POPs was estimated to be 312.55 g TEQ for Nepal (MOE 2004). This is very high for a country like Nepal least developing in terms of industrial and economy. This estimation was based on the UNEP Toolkit which has included the broad categories of waste such as waste incineration, ferrous and non ferrous metal

  5. Australian Enterococcal Sepsis Outcome Progamme, 2011.

    PubMed

    Coombs, Geoffrey W; Pearson, Julie C; Le, Tam; Daly, Denise A; Robinson, James O; Gottlieb, Thomas; Howden, Benjamin P; Johnson, Paul D R; Bennett, Catherine M; Stinear, Timothy P; Turnidge, John D

    2014-09-01

    From 1 January to 31 December 2011, 29 institutions around Australia participated in the Australian Enterococcal Sepsis Outcome Programme (AESOP). The aim of AESOP 2011 was to determine the proportion of enterococcal bacteraemia isolates in Australia that are antimicrobial resistant, with particular emphasis on susceptibility to ampicillin and the glycopeptides, and to characterise the molecular epidemiology of the Enterococcus faecalis and E. faecium isolates. Of the 1,079 unique episodes of bacteraemia investigated, 95.8% were caused by either E. faecalis (61.0%) or E. faecium (34.8%). Ampicillin resistance was detected in 90.4% of E. faecium but not detected in E. faecalis. Using Clinical and Laboratory Standards Institute breakpoints (CLSI), vancomycin non-susceptibility was reported in 0.6% and 31.4% of E. faecalis and E. faecium respectively and was predominately due to the acquisition of the vanB operon. Approximately 1 in 6 vanB E. faecium isolates however, had an minimum inhibitory concentration at or below the CLSI vancomycin susceptible breakpoint of ≤ 4 mg/L. Overall, 37% of E. faecium harboured vanA or vanB genes. Although molecular typing identified 126 E. faecalis pulsed-field gel electrophoresis (PFGE) pulsotypes, more than 50% belonged to 2 pulsotypes that were isolated across Australia. E. faecium consisted of 73 PFGE pulsotypes from which 43 multilocus sequence types were identified. Almost 90% of the E. faecium were identified as clonal complex 17 clones, of which approximately half were characterised as sequence type 203, which was isolated Australia-wide. In conclusion, the AESOP 2011 has shown that although polyclonal, enterococcal bacteraemias in Australia are frequently caused by ampicillin-resistant vanB E. faecium. PMID:25391408

  6. Functional and histopathologic changes in the liver during sepsis.

    PubMed

    Caruana, J A; Montes, M; Camara, D S; Ummer, A; Potmesil, S H; Gage, A A

    1982-05-01

    Although liver failure from sepsis is a frequent occurrence in serious ill, hospitalized patients, little information is available on the histologic changes of the liver. We examined the histopathology of the liver of 19 patients who died of clinical sepsis and attempted to relate certain features of the illness or treatment to the observed histopathologic changes. The most striking finding was midzonal and peripheral necrosis of a moderate to marked degree in 11 of 19 patients. Other important changes were acute inflammation and cholestasis. The severity of hepatocellular necrosis did not appear to be influenced by the premortem circulating pathogen, by the nutritional support administered or by the arterial blood pressure. It is suggested that hepatocellular necrosis is characteristic of sepsis and may be caused by loss of specific factors which normally maintain liver function and structure. PMID:6803371

  7. [Reinstating cloxacilin for empiric antibiotic in late-onset sepsis].

    PubMed

    Sandoval, Alejandra; Cofré, Fernanda; Delpiano, Luis; Izquierdo, Giannina; Labraña, Yenis; Reyes, Alejandra

    2015-04-01

    Vancomycin has been used for more than 50 years in neonatal intensive care units (NICUs) as the therapy of choice for late-onset sepsis, mainly because Coagulase negative Staphylococci (CoNS) are common and mostly resistant to oxacyllin despitelow virulence and unusual association with fulminant sepsis. CUs due to several factors including its high pharmacokinetic variability, difficulty in reaching therapeutic plasmatic drug concentrations and progressively increasing minimum inhibitory concentrations (MIC). The increase of CoNS with higher MICs as well as the rise of infections caused by resistant gram-negative bacilli and candida should move to reconsider Vancomycin as first line treatment. Infections in neonates have a different behavior than in other populations and we consoder of utmost importance to consider the use of oxacyllin as first line antimicrobial therapy for late-onset sepsis. PMID:26065451

  8. Hydrogen Gas Presents a Promising Therapeutic Strategy for Sepsis

    PubMed Central

    Liu, Lingling; Yu, Yonghao; Wang, Guolin

    2014-01-01

    Sepsis is characterized by a severe inflammatory response to infection. It remains a major cause of morbidity and mortality in critically ill patients despite developments in monitoring devices, diagnostic tools, and new therapeutic options. Recently, some studies have found that molecular hydrogen is a new therapeutic gas. Our studies have found that hydrogen gas can improve the survival and organ damage in mice and rats with cecal ligation and puncture, zymosan, and lipopolysaccharide-induced sepsis. The mechanisms are associated with the regulation of oxidative stress, inflammatory response, and apoptosis, which might be through NF-κB and Nrf2/HO-1 signaling pathway. In this paper, we summarized the progress of hydrogen treatment in sepsis. PMID:24829918

  9. Host response biomarkers in sepsis: the role of procalcitonin.

    PubMed

    Vincent, Jean-Louis; Van Nuffelen, Marc; Lelubre, Christophe

    2015-01-01

    Procalcitonin is the prohormone of calcitonin and present in minute quantities in health. However, during infection, its levels rise considerably and are correlated with the severity of the infection. Several assays have been developed for measurement of procalcitonin levels; in this article, we will briefly present the PCT-sensitive Kryptor(®) test (Brahms, Hennigsdorf, Germany), one of the most widely used assays for procalcitonin in recent studies. Many studies have demonstrated the value of procalcitonin levels for diagnosing sepsis and assessing disease severity. Procalcitonin levels have also been successfully used to guide antibiotic administration. However, procalcitonin is not specific for sepsis, and values need to be interpreted in the context of a full clinical examination and the presence of other signs and symptoms of sepsis.

  10. Presepsin (Soluble CD14 Subtype): Reference Ranges of a New Sepsis Marker in Term and Preterm Neonates

    PubMed Central

    Pugni, Lorenza; Pietrasanta, Carlo; Milani, Silvano; Vener, Claudia; Ronchi, Andrea; Falbo, Mariella; Arghittu, Milena; Mosca, Fabio

    2015-01-01

    Objective Presepsin (soluble CD14 subtype) has been shown to be beneficial as a sepsis marker in adults. Nevertheless, very few data are available in neonates. The aim of the present study was to determine reference ranges of presepsin in term and preterm neonates. Methods Healthy term neonates and preterm neonates without clinical signs of infection admitted to the Neonatal Unit were consecutively enrolled. Presepsin concentrations in whole blood were measured using a point-of-care assay system located in the Unit. Demographic data, antenatal and perinatal variables commonly affecting C-reactive protein and procalcitonin values were considered. Results Of the 684 neonates enrolled in the study, 484 (70.8%) were born at term and 200 (29.2%) were preterm (24–36 weeks’ gestation). In term infants, presepsin median value was 603.5 pg/mL (interquartile range: 466.5–791 pg/mL; 5th and 95th centiles: 315 and 1178 pg/mL respectively). In preterm infants, presepsin median value was slightly higher, equal to 620 pg/mL (interquartile range: 503–864 pg/mL; 5th and 95th centiles: 352 and 1370 pg/mL respectively). The reference ranges of presepsin we determined were much higher than those seen in healthy adults. No correlation between presepsin levels and postnatal age was observed, as well as no significant difference was demonstrated in preterm neonates at different gestational ages. None of the variables analyzed affected presepsin levels at a clinical significant extent. Conclusion For the first time, this study provides reference ranges of presepsin in term and preterm neonates. Having reliable reference values is crucial for obtaining an adequate diagnostic accuracy. Based on our results, most variables commonly affecting C-reactive protein and procalcitonin values do not affect presepsin levels, which suggests that presepsin could be an effective sepsis marker. Further investigations in large groups of neonates with sepsis are needed to determine the diagnostic

  11. Fatal sepsis caused by an unusual Klebsiella species that was misidentified by an automated identification system.

    PubMed

    Seki, Masafumi; Gotoh, Kazuyoshi; Nakamura, Shota; Akeda, Yukihiro; Yoshii, Tadashi; Miyaguchi, Shinichi; Inohara, Hidenori; Horii, Toshihiro; Oishi, Kazunori; Iida, Tetsuya; Tomono, Kazunori

    2013-05-01

    This is a description of fatal sepsis caused by infection with Klebsiella variicola, which is an isolate genetically related to Klebsiella pneumoniae. The patient's condition was incorrectly diagnosed as common sepsis caused by K. pneumoniae, which was identified using an automated identification system, but next-generation sequencing and the non-fermentation of adonitol finally identified the cause of sepsis as K. variicola.

  12. Proteolytic inactivation of plasma C1- inhibitor in sepsis.

    PubMed

    Nuijens, J H; Eerenberg-Belmer, A J; Huijbregts, C C; Schreuder, W O; Felt-Bersma, R J; Abbink, J J; Thijs, L G; Hack, C E

    1989-08-01

    Activation of both the complement system and the contact system of intrinsic coagulation is implicated in the pathophysiology of sepsis. Because C1 inhibitor (C1-Inh) regulates the activation of both cascade systems, we studied the characteristics of plasma C1-Inh in 48 patients with severe sepsis on admission to the Intensive Care Unit at the Free University of Amsterdam. The ratio between the level of functional and antigenic C1-Inh (functional index) was significantly reduced in the patients with sepsis compared with healthy volunteers (P = 0.004). The assessment of modified (cleaved), inactive C1-Inh (iC1-Inh), and complexed forms of C1-Inh (nonfunctional C1-Inh species) revealed that the reduced functional index was mainly due to the presence of iC1-Inh. On SDS-PAGE, iC1-Inh species migrated with a lower apparent molecular weight (Mr 98,000, 91,000, and 86,000) than native C1-Inh (Mr 110,000). Elevated iC1-Inh levels (greater than or equal to 0.13 microM) were found in 81% of all patients, sometimes up to 1.6 microM. Levels of iC1-Inh on admission appeared to be of prognostic value: iC1-Inh was higher in 27 patients who died than in 21 patients who survived (P = 0.003). The mortality in 15 patients with iC1-Inh levels up to 0.2 microM was 27%, but in 12 patients with plasma iC1-Inh exceeding 0.44 microM, the mortality was 83%. The overall mortality in the patients with sepsis was 56%. We propose that the cleavage of C1-Inh in patients with sepsis reflects processes that play a major role in the development of fatal complications during sepsis.

  13. Diagnostic and prognostic biomarkers of sepsis in critical care.

    PubMed

    Kibe, Savitri; Adams, Kate; Barlow, Gavin

    2011-04-01

    Sepsis is a leading cause of mortality in critically ill patients. Delay in diagnosis and initiation of antibiotics have been shown to increase mortality in this cohort. However, differentiating sepsis from non-infectious triggers of the systemic inflammatory response syndrome (SIRS) is difficult, especially in critically ill patients who may have SIRS for other reasons. It is this conundrum that predominantly drives broad-spectrum antimicrobial use and the associated evolution of antibiotic resistance in critical care environments. It is perhaps unsurprising, therefore, that the search for a highly accurate biomarker of sepsis has become one of the holy grails of medicine. Procalcitonin (PCT) has emerged as the most studied and promising sepsis biomarker. For diagnostic and prognostic purposes in critical care, PCT is an advance on C-reactive protein and other traditional markers of sepsis, but is not accurate enough for clinicians to dispense with clinical judgement. There is stronger evidence, however, that measurement of PCT has a role in reducing the antibiotic exposure of critical care patients. For units intending to incorporate PCT assays into routine clinical practice, the cost-effectiveness of this is likely to depend on the pre-implementation length of an average antibiotic course and the subsequent impact of implementation on emerging antibiotic resistance. In most of the trials to date, the average baseline duration of the antibiotic course was longer than is currently standard practice in many UK critical care units. Many other biomarkers are currently being investigated. To be highly useful in clinical practice, it may be necessary to combine these with other novel biomarkers and/or traditional markers of sepsis.

  14. Arginine, citrulline and nitric oxide metabolism in sepsis.

    PubMed

    Kao, Christina C; Bandi, Venkata; Guntupalli, Kalpalatha K; Wu, Manhong; Castillo, Leticia; Jahoor, Farook

    2009-06-02

    Arginine has vasodilatory effects, via its conversion by NO synthase into NO, and immunomodulatory actions which play important roles in sepsis. Protein breakdown affects arginine availability and the release of asymmetric dimethylarginine, an inhibitor of NO synthase, may therefore affect NO synthesis in patients with sepsis. The objective of the present study was to investigate whole-body in vivo arginine and citrulline metabolism and NO synthesis rates, and their relationship to protein breakdown in patients with sepsis or septic shock and in healthy volunteers. Endogenous leucine flux, an index of whole-body protein breakdown rate, was measured in 13 critically ill patients with sepsis or septic shock and seven healthy controls using an intravenous infusion of [1-13C]leucine. Arginine flux, citrulline flux and the rate of conversion of arginine into citrulline (an index of NO synthesis) were measured with intravenous infusions of [15N2]guanidino-arginine and [5,5-2H2]citrulline. Plasma concentrations of nitrite plus nitrate, arginine, citrulline and asymmetric dimethylarginine were measured. Compared with controls, patients had a higher leucine flux and higher NO metabolites, but arginine flux, plasma asymmetric dimethylarginine concentration and the rate of NO synthesis were not different. Citrulline flux and plasma arginine and citrulline were lower in patients than in controls. Arginine production was positively correlated with the protein breakdown rate. Whole-body arginine production and NO synthesis were similar in patients with sepsis and septic shock and healthy controls. Despite increased proteolysis in sepsis, there is a decreased arginine plasma concentration, suggesting inadequate de novo synthesis secondary to decreased citrulline production.

  15. Heparanase mediates renal dysfunction during early sepsis in mice

    PubMed Central

    Lygizos, Melissa I; Yang, Yimu; Altmann, Christopher J; Okamura, Kayo; Hernando, Ana Andres; Perez, Mario J; Smith, Lynelle P; Koyanagi, Daniel E; Gandjeva, Aneta; Bhargava, Rhea; Tuder, Rubin M; Faubel, Sarah; Schmidt, Eric P

    2013-01-01

    Heparanase, a heparan sulfate-specific glucuronidase, mediates the onset of pulmonary neutrophil adhesion and inflammatory lung injury during early sepsis. We hypothesized that glomerular heparanase is similarly activated during sepsis and contributes to septic acute kidney injury (AKI). We induced polymicrobial sepsis in mice using cecal ligation and puncture (CLP) in the presence or absence of competitive heparanase inhibitors (heparin or nonanticoagulant N-desulfated re-N-acetylated heparin [NAH]). Four hours after surgery, we collected serum and urine for measurement of renal function and systemic inflammation, invasively determined systemic hemodynamics, harvested kidneys for histology/protein/mRNA, and/or measured glomerular filtration by inulin clearance. CLP-treated mice demonstrated early activation of glomerular heparanase with coincident loss of glomerular filtration, as indicated by a >twofold increase in blood urea nitrogen (BUN) and a >50% decrease in inulin clearance (P < 0.05) in comparison to sham mice. Administration of heparanase inhibitors 2 h prior to CLP attenuated sepsis-induced loss of glomerular filtration rate, demonstrating that heparanase activation contributes to early septic renal dysfunction. Glomerular heparanase activation was not associated with renal neutrophil influx or altered vascular permeability, in marked contrast to previously described effects of pulmonary heparanase on neutrophilic lung injury during sepsis. CLP induction of renal inflammatory gene (IL-6, TNF-α, IL-1β) expression was attenuated by NAH pretreatment. While serum inflammatory indices (KC, IL-6, TNF-α, IL-1β) were not impacted by NAH pretreatment, heparanase inhibition attenuated the CLP-induced increase in serum IL-10. These findings demonstrate that glomerular heparanase is active during sepsis and contributes to septic renal dysfunction via mechanisms disparate from heparanase-mediated lung injury. PMID:24400155

  16. Optical detection of sepsis markers using liquid crystal based biosensors

    NASA Astrophysics Data System (ADS)

    McCamley, Maureen K.; Artenstein, Andrew W.; Opal, Steven M.; Crawford, Gregory P.

    2007-02-01

    A liquid crystal based biosensor for the detection and diagnosis of sepsis is currently in development. Sepsis, a major clinical syndrome with a significant public health burden in the US due to a large elderly population, is the systemic response of the body to a localized infection and is defined as the combination of pathologic infection and physiological changes. Bacterial infections are responsible for 90% of cases of sepsis in the US. Currently there is no bedside diagnostic available to positively identify sepsis. The basic detection scheme employed in a liquid crystal biosensor contains attributes that would find value in a clinical setting, especially for the early detection of sepsis. Utilizing the unique properties of liquid crystals, such as birefringence, a bedside diagnostic is in development which will optically report the presence of biomolecules. In a septic patient, an endotoxin known as lipopolysaccharide (LPS) is released from the outer membrane of Gram-negative bacteria and can be found in the blood stream. It is hypothesized that this long chained molecule will cause local disruptions to the open surface of a sensor containing aligned liquid crystal. The bulk liquid crystal ampli.es these local changes at the surface due to the presence of the sepsis marker, providing an optical readout through polarizing microscopy images. Liquid crystal sensors consisting of both square and circular grids, 100-200 μm in size, have been fabricated and filled with a common liquid crystal material, 5CB. Homeotropic alignment was confirmed using polarizing microscopy. The grids were then contacted with either saline only (control), or saline with varying concentrations of LPS. Changes in the con.guration of the nematic director of the liquid crystal were observed through the range of concentrations tested (5mg/mL - 1pg/mL) which have been confirmed by a consulting physician as clinically relevant levels.

  17. Development of an anti-endotoxin vaccine for sepsis.

    PubMed

    Cross, Alan S

    2010-01-01

    Gram-negative bacterial lipopolysaccharide (LPS, endotoxin) is an important initiator of sepsis, a clinical syndrome that is a leading cause of death in intensive care units. Vaccines directed against core LPS structures that are widely conserved among Gram-negative bacteria (GNB) have been developed for the treatment and/or prevention of sepsis. Killed whole bacterial vaccines (E. coli O111:B4, J5 [Rc chemotype] mutant and S. minnesota, Re chemotype) protected mice against experimental sepsis. Human J5 immune antisera reduced the mortality from GNB sepsis in a large controlled clinical trial; however, subsequent clinical studies with antiendotoxin antibodies did not demonstrate protective efficacy in sepsis. Multiple clinical studies have since demonstrated a correlation between the level of circulating antibodies to LPS core and morbidity and mortality in different clinical settings. We therefore developed a subunit vaccine by combining detoxified J5 LPS (J5 dLPS) with the outer membrane protein (OMP) from group B N. meningitidis. This vaccine was highly efficacious in experimental models of sepsis and progressed to phase 1 clinical trial. While well-tolerated, this vaccine induced only 3-4-fold increases in anti-J5 dLPS antibody. Addition of the TLR9 agonist, oligodeoxynucleotide with a CpG motif, as adjuvant to the vaccine increased antibody levels in mice and the vaccine/CpG combination will progress to phase 1 human study. Additional vaccines in which the core glycolipid was either conjugated to carrier protein or incorporated into liposomes have been developed, but have not progressed to clinical trial. Should an antiendotoxin vaccine become available, a new immunization strategy directed towards distinct populations at risk will be required. PMID:20593272

  18. Perinatal antidepressant use: understanding women's preferences and concerns.

    PubMed

    Battle, Cynthia L; Salisbury, Amy L; Schofield, Casey A; Ortiz-Hernandez, Samia

    2013-11-01

    Perinatal depression is prevalent and linked with a host of adverse consequences for women and newborns. Rates of engagement in depression treatment are, however, strikingly low among pregnant and postpartum women, with the majority of affected women receiving no mental health treatment. Research indicates that perinatal women are extremely reluctant to take antidepressant medications, yet the nature of women's concerns and treatment decision- making patterns have not been well documented. Developing a clearer understanding of women's treatment preferences and behaviors may help identify solutions to the under-treatment of perinatal depression. In this mixed methods study, we conducted in-depth interviews with 61 pregnant women, approximately half of whom were experiencing clinical levels of depression. In addition to assessing psychiatric diagnoses, symptoms, and functional impairment, we conducted qualitative interviews addressing women's preferences for depression treatment, concerns, and decision-making patterns. Consistent with prior reports, women were significantly more likely to voice a preference for non-pharmacologic depression treatments, as opposed to antidepressant medications. Many depressed women reported a great degree of uncertainty regarding how to treat their depression, and those with more severe depression symptoms were more likely to endorse decisional conflict. Analysis of qualitative comments yielded detailed information about the nature of women's concerns and preferences related to use of antidepressant medications and other aspects of treatment engagement. We discuss findings in the context of improving patient-centered care for perinatal depression.

  19. Perinatal Antidepressant Use: Understanding Women’s Preferences and Concerns

    PubMed Central

    BATTLE, CYNTHIA L.; SALISBURY, AMY L.; SCHOFIELD, CASEY A.; ORTIZ-HERNANDEZ, SAMIA

    2014-01-01

    Perinatal depression is prevalent and linked with a host of adverse consequences for women and newborns. Rates of engagement in depression treatment are, however, strikingly low among pregnant and postpartum women, with the majority of affected women receiving no mental health treatment. Research indicates that perinatal women are extremely reluctant to take antidepressant medications, yet the nature of women’s concerns and treatment decisionmaking patterns have not been well documented. Developing a clearer understanding of women’s treatment preferences and behaviors may help identify solutions to the under-treatment of perinatal depression. In this mixed methods study, we conducted in-depth interviews with 61 pregnant women, approximately half of whom were experiencing clinical levels of depression. In addition to assessing psychiatric diagnoses, symptoms, and functional impairment, we conducted qualitative interviews addressing women’s preferences for depression treatment, concerns, and decision-making patterns. Consistent with prior reports, women were significantly more likely to voice a preference for non-pharmacologic depression treatments, as opposed to antidepressant medications. Many depressed women reported a great degree of uncertainty regarding how to treat their depression, and those with more severe depression symptoms were more likely to endorse decisional conflict. Analysis of qualitative comments yielded detailed information about the nature of women’s concerns and preferences related to use of antidepressant medications and other aspects of treatment engagement. We discuss findings in the context of improving patient-centered care for perinatal depression. PMID:24241498

  20. Perinatal Mortality Counseling Program For Families Who Experience a Stillbirth.

    ERIC Educational Resources Information Center

    Kellner, Kenneth R.; And Others

    1981-01-01

    Discusses the emotional impact of a stillbirth on a family. The Perinatal Mortality Counseling Program (PMCP) at Shands Teaching Hospital, Gainesville, Florida, provides crisis intervention and support for these families, as well as serving a research function. Outlines the program, including its history, composition, procedures, and research.…

  1. Impaired Lung Mitochondrial Respiration Following Perinatal Nicotine Exposure in Rats.

    PubMed

    Cannon, Daniel T; Liu, Jie; Sakurai, Reiko; Rossiter, Harry B; Rehan, Virender K

    2016-04-01

    Perinatal smoke/nicotine exposure predisposes to chronic lung disease and morbidity. Mitochondrial abnormalities may contribute as the PPARγ pathway is involved in structural and functional airway deficits after perinatal nicotine exposure. We hypothesized perinatal nicotine exposure results in lung mitochondrial dysfunction that can be rescued by rosiglitazone (RGZ; PPARγ receptor agonist). Sprague-Dawley dams received placebo (CON), nicotine (NIC, 1 mg kg(-1)), or NIC + RGZ (3 mg kg(-1)) daily from embryonic day 6 to postnatal day 21. Parenchymal lung (~10 mg) was taken from adult male offspring for mitochondrial assessment in situ. ADP-stimulated O2 consumption was less in NIC and NIC + RGZ compared to CON (F[2,14] = 17.8; 4.5 ± 0.8 and 4.1 ± 1.4 vs. 8.8 ± 2.5 pmol s mg(-1); p < 0.05). The respiratory control ratio for ADP, an index of mitochondrial coupling, was reduced in NIC and remediated in NIC + RGZ (F[2,14] = 3.8; p < 0.05). Reduced mitochondrial oxidative capacity and abnormal coupling were evident after perinatal nicotine exposure. RGZ improved mitochondrial function through tighter coupling of oxidative phosphorylation.

  2. Visual Deficits and Improvements in Children after Perinatal Hypoxia.

    ERIC Educational Resources Information Center

    Groenendaal, F.; Van Hof-Van Duin, J.

    1992-01-01

    Study of the visual development of 38 infants, children, and youths who were neurologically impaired following perinatal hypoxia found that all children showed impairments of 1 or more visual functions, though visual development continued and visual improvements were demonstrated up to age 16. (Author/JDD)

  3. Perinatal mortality with particular reference to the Singapore situation.

    PubMed

    Tan, K L

    1984-04-01

    Perinatal mortality rates have been gradually declining in all countries. The initial decline mainly resulted from improvements in the late foetal mortality rates. Later with improvements in neonatal care, early neonatal mortality rates also improved. The developed countries have consistently shown better results than the developing countries, an indication of the higher standard of living, general health as well as the delivery of health care in these countries. In the Singapore situation, a rapid improvement in perinatal mortality was initially observed due to improvements in the late foetal mortality, followed later by reduction in the early neonatal mortality due to upgrading of neonatal intensive care. The perinatal mortality rate is lowest in the Chinese compared to the Indians and Malays, most likely due to the dietary practices of the three ethnic groups in Singapore; while the Chinese encourage extra nutrition in the pregnant female, the Malays and Indians tend to practise dietary restriction during this period. The improved nutrition of the pregnant mother is a factor in improving the perinatal mortality.

  4. Perinatal Mental Health: Supporting New Families through Vulnerability and Change.

    ERIC Educational Resources Information Center

    Fenichel, Emily, Ed.

    2002-01-01

    "Zero to Three is a single focus bulletin of the National Center for Infants, Toddlers, and Families providing insight from multiple disciplines on the development of infants, toddlers, and their families. Noting that because the perinatal periodfrom the later stages of pregnancy through the first 6 months of the infants lifeis a period of…

  5. 21 CFR 884.2740 - Perinatal monitoring system and accessories.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Perinatal monitoring system and accessories. 884.2740 Section 884.2740 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN... heart rate by means of combining and coordinating uterine contraction and fetal heart monitors...

  6. 21 CFR 884.2740 - Perinatal monitoring system and accessories.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Perinatal monitoring system and accessories. 884.2740 Section 884.2740 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN... heart rate by means of combining and coordinating uterine contraction and fetal heart monitors...

  7. 21 CFR 884.2740 - Perinatal monitoring system and accessories.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Perinatal monitoring system and accessories. 884.2740 Section 884.2740 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN... heart rate by means of combining and coordinating uterine contraction and fetal heart monitors...

  8. Impaired Lung Mitochondrial Respiration Following Perinatal Nicotine Exposure in Rats.

    PubMed

    Cannon, Daniel T; Liu, Jie; Sakurai, Reiko; Rossiter, Harry B; Rehan, Virender K

    2016-04-01

    Perinatal smoke/nicotine exposure predisposes to chronic lung disease and morbidity. Mitochondrial abnormalities may contribute as the PPARγ pathway is involved in structural and functional airway deficits after perinatal nicotine exposure. We hypothesized perinatal nicotine exposure results in lung mitochondrial dysfunction that can be rescued by rosiglitazone (RGZ; PPARγ receptor agonist). Sprague-Dawley dams received placebo (CON), nicotine (NIC, 1 mg kg(-1)), or NIC + RGZ (3 mg kg(-1)) daily from embryonic day 6 to postnatal day 21. Parenchymal lung (~10 mg) was taken from adult male offspring for mitochondrial assessment in situ. ADP-stimulated O2 consumption was less in NIC and NIC + RGZ compared to CON (F[2,14] = 17.8; 4.5 ± 0.8 and 4.1 ± 1.4 vs. 8.8 ± 2.5 pmol s mg(-1); p < 0.05). The respiratory control ratio for ADP, an index of mitochondrial coupling, was reduced in NIC and remediated in NIC + RGZ (F[2,14] = 3.8; p < 0.05). Reduced mitochondrial oxidative capacity and abnormal coupling were evident after perinatal nicotine exposure. RGZ improved mitochondrial function through tighter coupling of oxidative phosphorylation. PMID:26899624

  9. Perinatal Staff Nurse Medical Device Use and Education.

    ERIC Educational Resources Information Center

    McConnell, Edwina A.

    1998-01-01

    Survey responses from 48 perinatal nurses found that most learned about medical devices by reading manuals; 75% had received inservice training; and 95% learned from other staff. Inadequate knowledge was related to fear of causing patient harm. Initial learning method influenced what was learned, and hands-on experience was considered efficacious.…

  10. PREGNANCY AND PERINATAL HEALTH, BAMEN, INNER MONGOLIA, CHINA

    EPA Science Inventory

    For developing countries, especially in remote rural areas, measures of maternal and perinatal health may be difficult to obtain because it is not systematically collected and/or electronic data is not available. We assisted the public health officials of Bayingnormen (BaMen), In...

  11. Trends in Perinatal Care and Implications for Frontline Nurse Leaders.

    PubMed

    Crenshaw, Jeannette T; Adams, Ellise D; Amis, Debby

    2016-01-01

    The perinatal trends presented in this article are based on recent topics from conferences, journals, the media, as well as from input from perinatal nurses. Trends in patient care are influenced by evidence known for decades, new research, emerging and innovative concepts in healthcare, patient and family preferences, and the media. Trends discussed in this article are rethinking the due date, birth outside the hospital setting, obstetric hospitalists as birth attendants, nitrous oxide for pain in childbirth, hydrotherapy and waterbirth in the hospital setting, delayed cord clamping, disrupters of an optimal infant microbiome, skin-to-skin care during cesarean surgery, and breast-sleeping and the breast-feeding dyad. In addition, the authors developed implications for perinatal nurses related to each trend. The goal is to stimulate reflection on evidence that supports or does not support current practice and to stimulate future research by discussing some of the current trends that may influence the care that perinatal nurses provide during the birthing year. PMID:27465460

  12. Perinatal Pitocin as an Early ADHD Biomarker: Neurodevelopmental Risk?

    ERIC Educational Resources Information Center

    Kurth, Lisa; Haussmann, Robert

    2011-01-01

    Objective: To investigate a potential relationship between coincidental increases in perinatal Pitocin usage and subsequent childhood ADHD onset in an attempt to isolate a specific risk factor as an early biomarker of this neurodevelopmental disorder. Method: Maternal labor/delivery and corresponding childbirth records of 172 regionally diverse,…

  13. An Endangered Generation: Impact of Perinatal Drug Use.

    ERIC Educational Resources Information Center

    Jones, Melanie M.

    This article reviews some of the literature on educational approaches for drug-exposed children. Common effects of prenatal and perinatal drug use on the female user, the developing fetus, and the neonate are reviewed. It is noted that female drug users have an increased incidence of medical complications during pregnancy; that the specific…

  14. Assessing the knowledge of perinatal mental illness among student midwives.

    PubMed

    Phillips, Louise

    2015-11-01

    The experience of perinatal mental illness (mental illness occurring around the time of pregnancy) currently affect 1 in 10 women and can have adverse effects on the mother and her child (Massie and Szajnberg, 2002; O'Connor et al., 2002). The care and effective management of women experiencing perinatal mental illness is therefore an important issue for health care staff, managers, psychiatrists, commissioners and campaigners. Midwives play a significant part in caring for women throughout their pregnancies, during labour and up to the first month after birth. Midwives are in a unique position to assess a woman's well-being and to offer appropriate support. However, previous research has revealed that midwives often have poor understanding and knowledge of perinatal mental health issues and require improved training (Ross-Davie et al, 2006; McCann and Clark, 2010). This research project aims to systematically assess student midwives awareness of perinatal mental illness. The findings of this study will inform curriculum development for graduate and post-graduate midwifery students therefore improving the care and support women with mental illness receive from antenatal services. The findings from this study will also be used for the formation of an educational web-based programme for student and qualified midwives.

  15. Prenatal and Perinatal Risk Factors for Autism in China

    ERIC Educational Resources Information Center

    Zhang, Xin; Lv, Cong-Chao; Tian, Jiang; Miao, Ru-Juan; Xi, Wei; Hertz-Picciotto, Irva; Qi, Lihong

    2010-01-01

    We conducted a case-control study using 190 Han children with and without autism to investigate prenatal and perinatal risk factors for autism in China. Cases were recruited through public special education schools and controls from regular public schools in the same region (Tianjin), with frequency matching on sex and birth year. Unadjusted…

  16. Prenatal and Perinatal Factors Associated with Intellectual Disability

    ERIC Educational Resources Information Center

    Bilder, Deborah A.; Pinborough-Zimmerman, Judith; Bakian, Amanda V.; Miller, Judith S.; Dorius, Josette T.; Nangle, Barry; McMahon, William M.

    2013-01-01

    Prenatal and perinatal risk factors associated with intellectual disability (ID) were studied in 8-year-old Utah children from a 1994 birth cohort (N = 26,108) using broad ascertainment methods and birth records following the most current recording guidelines. Risk factor analyses were performed inclusive and exclusive of children with a known or…

  17. Sepsis attenuates the anabolic response to skeletal muscle contraction

    PubMed Central

    Steiner, Jennifer L.; Lang, Charles H.

    2014-01-01

    Electrically stimulated muscle contraction is a potential clinical therapy to treat sepsis-induced myopathy; however, whether sepsis alters contraction-induced anabolic signaling is unknown. Polymicrobial peritonitis was produced by cecal ligation and puncture (CLP) in male C57BL/6 mice and time-matched, pair-fed controls (CON). At ~24 h post-CLP, the right hindlimb was electrically stimulated via the sciatic nerve to evoke maximal muscle contractions and the gastrocnemius was collected 2 h later. Protein synthesis was increased by muscle contraction in CON mice. Sepsis suppressed the rate of synthesis in both the non-stimulated (31%) and stimulated (57%) muscle versus CON. Contraction of muscle in CON mice increased the phosphorylation of mTORC1 substrates S6K1 Thr389 (8-fold), S6K1 Thr421/Ser424 (7-fold) and 4E-BP1 Ser65 (11-fold). Sepsis blunted the contraction-induced phosphorylation of S6K1 Thr389 (67%), S6K1 Thr421/Ser424 (46%) and 4E-BP1 Ser65 (85%). Conversely, sepsis did not appear to modulate protein elongation as eEF2 Thr56 phosphorylation was decreased similarly by muscle contraction in both groups. MAPK signaling was discordant following muscle contraction in septic muscle; phosphorylation of ERK Thr202/Tyr204 and p38 Thr180/Tyr182 was increased similarly in both CON and CLP mice while sepsis prevented the contraction-induced phosphorylation of JNK Thr183/Tyr185 and c-JUN Ser63. The expression of IL-6 and TNF-α mRNA in muscle was increased by sepsis, and contraction increased TNF-α to a greater extent in muscle from septic than CON mice. Injection of the mTOR inhibitor Torin2 in separate mice confirmed that contraction-induced increases in S6K1 and 4E-BP1 were mTOR-mediated. These findings demonstrate that resistance to contraction-induced anabolic signaling occurs during sepsis and is predominantly mTORC1-dependent. PMID:25423127

  18. Cold agglutinin disease in sepsis: A rare entity

    PubMed Central

    Garg, Ravinder; Kukar, Neetu; Bajwa, Sukhminder Jit Singh; Kaur, Shaminder

    2015-01-01

    Cold agglutinin disease (CAgD) is a type of autoimmune hemolytic anemia which generally occurs in adults and is characterized by the presence of IgM antibodies directed against polysaccharide antigens on red blood cell surface. A 16-year-old male, having clinical picture of sepsis and anemia, presented to the Emergency Department of our Institute in an Hemodynamically unstable condition. Investigation profile revealed hemolysis due to CAgD, which responded to corticosteroids, antibiotics and supportive treatment. This case highlights the importance of recognizing this entity in such type of cases presenting with sepsis and anemia. PMID:26229347

  19. Endothelial and Microcirculatory Function and Dysfunction in Sepsis.

    PubMed

    Colbert, James F; Schmidt, Eric P

    2016-06-01

    The microcirculation is a series of arterioles, capillaries, and venules that performs essential functions of oxygen and nutrient delivery, customized to the unique physiologic needs of the supplied organ. The homeostatic microcirculatory response to infection can become harmful if overactive and/or dysregulated. Pathologic microcirculatory dysfunction can be directly visualized by intravital microscopy or indirectly measured via detection of circulating biomarkers. Although several treatments have been shown to protect the microcirculation during sepsis, they have not improved patient outcomes when applied indiscriminately. Future outcomes-oriented studies are needed to test sepsis therapeutics when personalized to a patient's microcirculatory dysfunction. PMID:27229643

  20. Neuroanatomy and Physiology of Brain Dysfunction in Sepsis.

    PubMed

    Mazeraud, Aurelien; Pascal, Quentin; Verdonk, Franck; Heming, Nicholas; Chrétien, Fabrice; Sharshar, Tarek

    2016-06-01

    Sepsis-associated encephalopathy (SAE), a complication of sepsis, is often complicated by acute and long-term brain dysfunction. SAE is associated with electroencephalogram pattern changes and abnormal neuroimaging findings. The major processes involved are neuroinflammation, circulatory dysfunction, and excitotoxicity. Neuroinflammation and microcirculatory alterations are diffuse, whereas excitotoxicity might occur in more specific structures involved in the response to stress and the control of vital functions. A dysfunction of the brainstem, amygdala, and hippocampus might account for the increased mortality, psychological disorders, and cognitive impairment. This review summarizes clinical and paraclinical features of SAE and describes its mechanisms at cellular and structural levels. PMID:27229649