Assessment of candidemia-attributable mortality in critically ill patients using propensity score matching analysis

[EN] Introduction: Candidemia in critically ill patients is usually a severe and life-threatening condition with a high crude mortality. Very few studies have focused on the impact of candidemia on ICU patient outcome and attributable mortality still remains controversial. This study was carried out to determine the attributable mortality of ICU-acquired candidemia in critically ill patients using propensity score matching analysis. Methods: A prospective observational study was conducted of all consecutive non-neutropenic adult patients admitted for at least seven days to 36 ICUs in Spain, France, and Argentina between April 2006 and June 2007. The probability of developing candidemia was estimated using a multivariate logistic regression model. Each patient with ICU-acquired candidemia was matched with two control patients with the nearest available Mahalanobis metric matching within the calipers defined by the propensity score. Standardized differences tests (SDT) for each variable before and after matching were calculated. Attributable mortality was determined by a modified Poisson regression model adjusted by those variables that still presented certain misalignments defined as a SDT > 10%. Results: Thirty-eight candidemias were diagnosed in 1,107 patients (34.3 episodes/1,000 ICU patients). Patients with and without candidemia had an ICU crude mortality of 52.6% versus 20.6% (P < 0.001) and a crude hospital mortality of 55.3% versus 29.6% (P = 0.01), respectively. In the propensity matched analysis, the corresponding figures were 51.4% versus 37.1% (P = 0.222) and 54.3% versus 50% (P = 0.680). After controlling residual confusion by the Poisson regression model, the relative risk (RR) of ICU- and hospital-attributable mortality from candidemia was RR 1.298 (95% confidence interval (CI) 0.88 to 1.98) and RR 1.096 (95% CI 0.68 to 1.69), respectively. Conclusions: ICU-acquired candidemia in critically ill patients is not associated with an increase in either ICU or hospital mortality.

Modal hedges in para-pharmaceutical product instructions: some examples from English and Serbian

[EN] The paper investigates how modal hedges (Coates 1983) understood as expressions of procedural meaning , i.e. expressions which instruct the addressee/reader how to process the propositional content of an utterance/statement (Watts 2004) are used in product descriptions, advertisements and consumer instructions leaflets for a number of products belonging to the Consumer Health Care category for the purposes of complying with consumer protection laws on the one hand and serving as an implicit disclaimer of manufacturer’s responsibility on the other. The analysis is carried out contrastively for two languages, English and Serbian. The results obtained are discussed and viewed as a matter of cultural variety and difference, especially taking into consideration the fact that consumer protection laws seem to be equally strict in US, UK and Commonwealth, Europe and Serbia.

A contrastive analysis of epistemic modality in scientific English

[ES] This paper investigates the use of epistemic expressions in scientific English. The main aim of this research is to analyse if native speakers of English use epistemic modality in the same way than non-native speakers of English and to detect the most outstanding cognitive implications of this fact. The corpus used in this research contains 50 research papers written by native English speakers and 50 scientific papers written by Spanish researchers who use English to communicate internationally. As epistemic modals are used to indicate the possibility of some piece of knowledge, this paper focuses on epistemic modal verbs in order to detect if native speakers of English and non-native speakers of English communicate modality in the same way, or if there are differences in frequency and use. The results obtained in this analysis indicated that there are differences in the frequency of use of epistemic expressions, even if the intention of the writers is the same.

Analysis of preferences for freight transport using advanced choice models

Programa de doctorado: Perspectivas científicas sobre el turismo y la dirección de empresas turísticas