Sepsis: time to reconsider the concept.

OBJECTIVE: To discuss the difficulty in using the concept of sepsis for clinical trials and propose new ways for designing future trials for severe infections. DESIGN: Short position statement. METHODS AND MAIN RESEARCH: Using a thorough evaluation of the recent literature in the field of severe sepsis and septic shock, the authors challenge the concept of sepsis as used in the past two decades and propose new ideas for designing future trials in this setting. The two main proposals are first to use a systematic assessment of the targeted inflammatory mediators when the study intends to counteract or replace those mediators (e.g., anti-tumor necrosis factor-alpha, activated protein C) and, second, to select more homogeneous populations, coming back to "precise infectious diseases," such as severe community-acquired pneumonia, severe peritonitis, or meningitis. CONCLUSIONS: The concept of sepsis has been useful to help clinicians to suspect and detect severe infections. Due to a considerable heterogeneity in the patients and type of infections included in the trials performed in the last two decades, it has not been useful in demonstrating the efficacy of new compounds. The authors propose a dramatic change in the design of future trials dealing with severe infections.

The night: a dangerous time to be born?

An analysis of perinatal mortality by hour of birth among 10,059 births in Canton Ticino (Switzerland) during the years 1979-1982 showed that fewer births occurred at night than during the day. The variations in number of births by hour of birth were attributed to obstetric practices. The perinatal mortality rate for night-time births was more than twice as high as that for the daytime births (+127%, P less than 0.001) and the rates for night-time births exceeded those for daytime births for 13 of the 19 causes of death examined. A higher proportion of the low and very-low-birthweight babies (less than 2500 g and less than 1500 g) were born at night between 19.00 and 06.59 hours.

Iowa guide to long-term care insurance : the time to explore your insurance options is now, 2014

This is a guide to the Senior Health Insurance Information Program (SHIIP)

Cardiovascular mechanisms of death in severe COPD exacerbation: time to think and act beyond guidelines.

Three important studies on acute exacerbations of chronic obstructive pulmonary disease (ECOPD)have been published in Thorax. Two of them, by Chang et al1(see page 764) and Hoiset et al2 (see page 775), show the importance of the cardiac biomarkers troponin T and NT-BNP (Nterminal pro-B-type natriuretic peptide) as strong predictors of the increased risk of death of patients hospitalised because of ECOPD.1 2.....

Positive Outcomes Influence the Rate and Time to Publication, but Not the Impact Factor of Publications of Clinical Trial Results

Objectives: Publication bias may affect the validity of evidence based medical decisions. The aim of this study is to assess whether research outcomes affect the dissemination of clinical trial findings, in terms of rate, time to publication, and impact factor of journal publications. Methods and Findings: All drug-evaluating clinical trials submitted to and approved by a general hospital ethics committee between 1997 and 2004 were prospectively followed to analyze their fate and publication. Published articles were identified by searching Pubmed and other electronic databases. Clinical study final reports submitted to the ethics committee, final reports synopses available online and meeting abstracts were also considered as sources of study results. Study outcomes were classified as positive (when statistical significance favoring experimental drug was achieved), negative (when no statistical significance was achieved or it favored control drug) and descriptive (for non-controlled studies). Time to publication was defined as time from study closure to publication. A survival analysis was performed using a Cox regression model to analyze time to publication. Journal impact factors of identified publications were recorded. Publication rate was 48·4% (380/785). Study results were identified for 68·9% of all completed clinical trials (541/785). Publication rate was 84·9% (180/212) for studies with results classified as positive and 68·9% (128/186) for studies with results classified as negative (p<0·001). Median time to publication was 2·09 years (IC95 1·61-2·56) for studies with results classified as positive and 3·21 years (IC95 2·69-3·70) for studies with results classified as negative (hazard ratio 1·99 (IC95 1·55-2·55). No differences were found in publication impact factor between positive (median 6·308, interquartile range: 3·141-28·409) and negative result studies (median 8·266, interquartile range: 4·135-17·157). Conclusions: Clinical trials with positive outcomes have significantly higher rates and shorter times to publication than those with negative results. However, no differences have been found in terms of impact factor.

Subjective perceptions as prognostic factors of time to fitness for work during a 4-year period after inpatient rehabilitation for orthopaedic trauma.

INTRODUCTION: Time to fitness for work (TFW) was measured as the number of days that were paid as compensation for work disability during the 4 years after discharge from the rehabilitation clinic in a population of patients hospitalised for rehabilitation after orthopaedic trauma. The aim of this study was to test whether some psychological variables can be used as potential early prognostic factors of TFW. MATERIAL AND METHODS: A Cox proportional hazards model was used to estimate the associations between predictive variables and TFW. Predictors were global health, pain at hospitalisation and pain decrease during the stay (all continuous and standardised by subtracting the mean and dividing by two standard deviations), perceived severity of the trauma and expectation of a positive evolution (both binary variables). RESULTS: Full data were available for 807 inpatients (660 men, 147 women). TFW was positively associated with better perceived health (hazard ratio [HR] 1.16, 95% confidence interval [CI] 1.13-1.19), pain decrease (HR 1.46, 95% CI 1.30-1.64) and expectation of a positive evolution (HR 1.50, 95% CI 1.32-1.70) and negatively associated with pain at hospitalisation (HR 0.67, 95% CI 0.59-0.76) and high perceived severity (HR 0.72, 95% CI 0.61-0.85). DISCUSSION: The present results provide some evidence that work disability during a four-year period after rehabilitation may be predicted by prerehabilitation perceptions of general health, pain, injury severity, as well as positive expectation of evolution.

Time to identify cardiac arrest and provide dispatch-assisted cardio-pulmonary resuscitation in a criteria-based dispatch system.

INTRODUCTION: Dispatch-assisted cardiopulmonary resuscitation (DA-CPR) plays a key role in out-of-hospital cardiac arrests. We sought to measure dispatchers' performances in a criteria-based system in recognizing cardiac arrest and delivering DA-CPR. Our secondary purpose was to identify the factors that hampered dispatchers' identification of cardiac arrests, the factors that prevented them from proposing DA-CPR, and the factors that prevented bystanders from performing CPR. METHODS AND RESULTS: We reviewed dispatch recordings for 1254 out-of-hospital cardiac arrests occurring between January 1, 2011 and December 31, 2013. Dispatchers correctly identified cardiac arrests in 71% of the reviewed cases and 84% of the cases in which they were able to assess for patient consciousness and breathing. The median time to recognition of the arrest was 60s. The median time to start chest compression was 220s. CONCLUSIONS: This study demonstrates that performances from a criteria-based dispatch system can be similar to those from a medical-priority dispatch system regarding out-of-hospital cardiac arrest (OHCA) time recognition and DA-CPR delivery. Agonal breathing recognition remains the weakest link in this sensitive task in both systems. It is of prime importance that all dispatch centers tend not only to implement DA-CPR but also to have tools to help them reach this objective, as today it should be mandatory to offer this service to the community. In order to improve benchmarking opportunities, we completed previously proposed performance standards as propositions.

A Study of African American Vernacular English in Three Novels and Colloquial Finnish in their Translations – The Dark Tower II: The Drawing of the Three, A Time to Kill and Push

Pro gradu -tutkielma käsittelee afroamerikkalaisen puhekielen (African American Vernacular English, AAVE) käyttöä kolmen englanninkielisen romaanin dialogissa ja suomen yleispuhekielen käyttöä romaanien käännöksissä. Tutkimus on pääasiassa kvantitatiivinen ja deskriptiivinen. Romaanit ovat Stephen Kingin The Dark Tower II: The Drawing of the Three (1987) (Musta torni 2, Kolme korttia pakasta 2005, suom. Kari Salminen), John Grishamin A Time to Kill (1989) (On aika tappaa 1994, suom. Kimmo Linkama) ja Sapphiren Push (1996) (Precious – harlemilaistytön tarina 2010, suom. Kristiina Drews). Alkukielisten romaanien osalta Grisham ja Sapphire suosivat lauseopillisia kielenpiirteitä, kun taas King on suosinut äänteellisiä. Sen sijaan käännöksissä piirteistä yleisimpiä ovat äänteelliset ja harvinaisimpia lauseopilliset. Vaikka käännöksissä sanastolliset piirteet ovat taajaan esiintyviä, äänteellisiä piirteitä esiintyy niitä enemmän. Poikkeuksena on On aika tappaa, jossa sanastollisia piirteitä esiintyy enemmän kuin äänteellisiä. Tulos eroaa Sampo Nevalaisen vuonna 2003 tekemästä tutkimuksesta, jossa hän sai selville, että käännöksissä käytetyt piirteet olivat enimmäkseen sanastollisia, kun taas alun perin suomeksi kirjoitetussa kaunokirjallisuudessa puhekielisyyden vaikutelma saatiin aikaan pääasiassa äänteellisin keinoin. Mahdollinen selitys tässä tutkimuksessa havaitulle erolle on se, että kahdessa romaanissa esiintyvä leimallinen AAVEn käyttö on saanut kääntäjät käyttämään samanlaisia strategioita kuin suomalaiset kirjailijat murretta kirjoittaessaan.

”What an awesome time to be a fan!” ‒ Kokemuksellisuuden muodostuminen Batman: Yön Ritari -elokuvan markkinointiin kehitetyssä ARG-pelissä

Tutkimukseni käsittelee kokemuksellisuuden muodostumista Batman: Yön Ritari -elokuvan markkinointiin kehitetyssä ARG-pelissä. ARG-peli eli vaihtoehtotodellisuuspeli on pervasiivinen peli, joka välittyy osallistujille reaaliaikaisesti erilaisten arkipäiväisten viestimien kautta immersiivisyyttä ja yhteisöllisyyttä korostaen. Vuorovaikutukseen perustuva ARG-peli on kokemus, joka muodostuu yhteistyössä pelintekijöiden ja osallistujien välillä. Tutkimuksen keskeisenä tavoitteena on tarkastella Why So Serious? -pelin kokemuksellisuutta luovia elementtejä sekä pelintekijöiden että pelaajien näkökulmasta. Tutkimusaineistoni koostuu verkkoaineistosta. Käsittelen tutkimuksessani kahta peliyhteisön kannalta merkittävää keskustelufoorumia, joissa osallistujat kokivat ja pelasivat peliä yhteisönä ja yksilöinä. Tutkimusmetodini pohjautuu fenomenologis-hermeneuttiseen metodiin: tarkastelen ARG-pelin kokemuksellisuutta tulkitsemalla osallistujien kirjallisia ilmaisuja ilmiöön liittyvä teoriatausta tukenani. Tutkimukseni on aineistolähtöinen ja etenee kronologisesti. Pelin kokonaiskuvan muodostamisessa olen hyödyntänyt osallistujien luomaa wikisivustoa, mikä toimi pelin aikana sekä informaatiokanavana että peliä dokumentoivana mediana. Vaikka käsittelemäni ARG-peli ei edustanut perinteistä ARG-peliä muun muassa heikon tarinallisuutensa vuoksi, se muodosti osallistujilleen hyvin voimakkaan kokemuksen. Why So Serious? -pelin kokemuksellisuus pohjautui hyvin pitkälti Batman-brändin tunnettuuteen ja populaarikulttuuriseen arvoon sekä nimekkäisiin fiktiivisiin hahmoihin, jotka yhdessä houkuttelivat osallistujia uppoutumaan pelin vaihtoehtotodellisuuteen. Keskinäisestä kilpailustaan huolimatta peliyhteisöt muodostivat jäsenilleen kollektiivisen identiteetin tunteen, minkä lisäksi muun muassa pelin dokumentointi ja spekulointi laajensivat osallistujien kokemusta. Yksilötasolla ensikertalaisuus vaikutti vahvasti pelin muodostamaan kokemukseen: kokemus oli voimakkaampi niille pelaajille, jotka osallistuivat ARG-peliin ensimmäistä kertaa. Why So Serious? -pelistä tuli ainutkertaisuudessaan osa Batman-brändin historiaa, mikä vahvisti pelin osallistujilleen tuottamaa kokemusta. 2000-luvun kuluttaja etsii elämyksiä ja myös markkinoinnin on mukauduttava – sekä uudistuttava – kuluttajien kasvavien vaatimuksien mukaan. Tutkimukseni on yksi esimerkki onnistuneesta, 2000-luvun kuluttajille suunnatusta markkinointikampanjasta.