Conservative fluid management or deresuscitation for patients with sepsis or acute respiratory distress syndrome following the resuscitation phase of critical illness: a systematic review and meta-analysis

Background

It is unknown whether a conservative approach to fluid administration or deresuscitation (active removal of fluid using diuretics or renal replacement therapy) is beneficial following haemodynamic stabilisation of critically ill patients.

Purpose

To evaluate the efficacy and safety of conservative or deresuscitative fluid strategies in adults and children with acute respiratory distress syndrome (ARDS), sepsis or systemic inflammatory response syndrome (SIRS) in the post-resuscitation phase of critical illness.

Methods

We searched Medline, EMBASE and the Cochrane central register of controlled trials from 1980 to June 2016, and manually reviewed relevant conference proceedings from 2009 to the present. Two reviewers independently assessed search results for inclusion and undertook data extraction and quality appraisal. We included randomised trials comparing fluid regimens with differing fluid balances between groups, and observational studies investigating the relationship between fluid balance and clinical outcomes.

Results

Forty-nine studies met the inclusion criteria. Marked clinical heterogeneity was evident. In a meta-analysis of 11 randomised trials (2051 patients) using a random-effects model, we found no significant difference in mortality with conservative or deresuscitative strategies compared with a liberal strategy or usual care [pooled risk ratio (RR) 0.92, 95 % confidence interval (CI) 0.82–1.02, I2 = 0 %]. A conservative or deresuscitative strategy resulted in increased ventilator-free days (mean difference 1.82 days, 95 % CI 0.53–3.10, I2 = 9 %) and reduced length of ICU stay (mean difference −1.88 days, 95 % CI −0.12 to −3.64, I2 = 75 %) compared with a liberal strategy or standard care.

Conclusions

In adults and children with ARDS, sepsis or SIRS, a conservative or deresuscitative fluid strategy results in an increased number of ventilator-free days and a decreased length of ICU stay compared with a liberal strategy or standard care. The effect on mortality remains uncertain. Large randomised trials are needed to determine optimal fluid strategies in critical illness.

Integrability for Relativistic Spin Networks

The evaluation of relativistic spin networks plays a fundamental role in the Barrett-Crane state sum model of Lorentzian quantum gravity in 4 dimensions. A relativistic spin network is a graph labelled by unitary irreducible representations of the Lorentz group appearing in the direct integral decomposition of the space of L^2 functions on three-dimensional hyperbolic space. To `evaluate' such a spin network we must do an integral; if this integral converges we say the spin network is `integrable'. Here we show that a large class of relativistic spin networks are integrable, including any whose underlying graph is the 4-simplex (the complete graph on 5 vertices). This proves a conjecture of Barrett and Crane, whose validity is required for the convergence of their state sum model.

The Quantum Tetrahedron in 3 and 4 Dimensions

Recent work on state sum models of quantum gravity in 3 and 4 dimensions has led to interest in the `quantum tetrahedron'. Starting with a classical phase space whose points correspond to geometries of the tetrahedron in R^3, we use geometric quantization to obtain a Hilbert space of states. This Hilbert space has a basis of states labeled by the areas of the faces of the tetrahedron together with one more quantum number, e.g. the area of one of the parallelograms formed by midpoints of the tetrahedron's edges. Repeating the procedure for the tetrahedron in R^4, we obtain a Hilbert space with a basis labelled solely by the areas of the tetrahedron's faces. An analysis of this result yields a geometrical explanation of the otherwise puzzling fact that the quantum tetrahedron has more degrees of freedom in 3 dimensions than in 4 dimensions.

The OPIT system part I.

The OPIT program is briefly described. OPIT is a basis-set-optimising, self-consistent field, molecular orbital program for calculating properties of closed-shell ground states of atoms and molecules. A file handling technique is then put forward which enables core storage to be used efficiently in large FORTRAN scientific applications programs. Hashing and list processing techniques, of the type frequently used in writing system software and computer operating systems, are here applied to the creation of data files (integral label and value lists etc.). Files consist of a chained series of blocks which may exist in core or on backing store or both. Efficient use of core store is achieved and the processes of file deletion, file re-writing and garbage collection of unused blocks can be easily arranged. The scheme is exemplified with reference to the OPIT program. A subsequent paper will describe a job scheduling scheme for large programs of this sort.

No right to sext? A critical examination of media and legal debates about teenage girls' sexual agency in the digital age

Advances in digital photography and distribution technologies enable many people to produce and distribute images of their sex acts. When teenagers do this, the photos and videos they create can be legally classified as child pornography since the law makes no exception for youth who create sexually explicit images of themselves. The dominant discussions about teenage girls producing sexually explicit media (including sexting) are profoundly unproductive: (1) they blame teenage girls for creating private images that another person later maliciously distributed and (2) they fail to respect—or even discuss—teenagers’ rights to freedom of expression. Cell phones and the internet make producing and distributing images extremely easy, which provide widely accessible venues for both consensual sexual expression between partners and for sexual harassment. Dominant understandings view sexting as a troubling teenage trend created through the combination of camera phones and adolescent hormones and impulsivity, but this view often conflates consensual sexting between partners with the malicious distribution of a person’s private image as essentially equivalent behaviors. In this project, I ask: What is the role of assumptions about teen girls’ sexual agency in these problematic understandings of sexting that blame victims and deny teenagers’ rights? In contrast to the popular media panic about online predators and the familiar accusation that youth are wasting their leisure time by using digital media, some people champion the internet as a democratic space that offers young people the opportunity to explore identities and develop social and communication skills. Yet, when teen girls’ sexuality enters this conversation, all this debate and discussion narrows to a problematic consensus. The optimists about adolescents and technology fall silent, and the argument that media production is inherently empowering for girls does not seem to apply to a girl who produces a sexually explicit image of herself. Instead, feminist, popular, and legal commentaries assert that she is necessarily a victim: of a “sexualized” mass media, pressure from her male peers, digital technology, her brain structures or hormones, or her own low self-esteem and misplaced desire for attention. Why and how are teenage girls’ sexual choices produced as evidence of their failure or success in achieving Western liberal ideals of self-esteem, resistance, and agency? Since mass media and policy reactions to sexting have so far been overwhelmingly sexist and counter-productive, it is crucial to interrogate the concepts and assumptions that characterize mainstream understandings of sexting. I argue that the common sense that is co-produced by law and mass media underlies the problematic legal and policy responses to sexting. Analyzing a range of nonfiction texts including newspaper articles, talk shows, press releases, public service announcements, websites, legislative debates, and legal documents, I investigate gendered, racialized, age-based, and technologically determinist common sense assumptions about teenage girls’ sexual agency. I examine the consensus and continuities that exist between news, nonfiction mass media, policy, institutions, and law, and describe the limits of their debates. I find that this early 21st century post-feminist girl-power moment not only demands that girls live up to gendered sexual ideals but also insists that actively choosing to follow these norms is the only way to exercise sexual agency. This is the first study to date examining the relationship of conventional wisdom about digital media and teenage girls’ sexuality to both policy and mass media.

Whiteness and news: the interlocking social construction of "realities"

This dissertation examines how mainstream U.S. journalism consistently serves white racial interests and the racial status quo, or what I call white incumbency, despite its push for diversity and its stated aims to improve coverage of nonwhite communities. It is based on an in-depth ethnographic study of two daily newspapers and extensive one-on-one interviews with 61 journalists. I found that although journalists strongly identify with the need for more diverse coverage in newspapers, they emphasize individual and personal stories that avoid recognition of historical racial power imbalances, exhibiting what Ruth Frankenberg calls power-evasive race cognizance. Journalists also demonstrate a number of often contradictory identifications and self-understandings about themselves and their work, such as commitments to diversity and not taking sides, but these conflicts are almost always resolved in favor of white incumbency. Journalistic conventions and practices, such as the watchdog function and its emphasis on public institutions, routinely produce stories that replay and reinforce racial hegemony by portraying nonwhites as problems or people seeking “special privileges.” Also, journalistic repertoires about those conventions and practices avoid interrogations of journalists’ ongoing complicity in the maintenance of white incumbency.

Numerical methods for solar tomography in the STEREO era

In this thesis, we propose several advances in the numerical and computational algorithms that are used to determine tomographic estimates of physical parameters in the solar corona. We focus on methods for both global dynamic estimation of the coronal electron density and estimation of local transient phenomena, such as coronal mass ejections, from empirical observations acquired by instruments onboard the STEREO spacecraft. We present a first look at tomographic reconstructions of the solar corona from multiple points-of-view, which motivates the developments in this thesis. In particular, we propose a method for linear equality constrained state estimation that leads toward more physical global dynamic solar tomography estimates. We also present a formulation of the local static estimation problem, i.e., the tomographic estimation of local events and structures like coronal mass ejections, that couples the tomographic imaging problem to a phase field based level set method. This formulation will render feasible the 3D tomography of coronal mass ejections from limited observations. Finally, we develop a scalable algorithm for ray tracing dense meshes, which allows efficient computation of many of the tomographic projection matrices needed for the applications in this thesis.

Formulação e vida de prateleira de Pseudomonas chlororaphis 63- 28 em fibra de coco, talco e turfa.

2009

The Proceedings of the South Carolina Historical Association

Annually, the association publishes a journal, The Proceedings, which consists of papers presented at the annual meeting. James H. Hammond and the Southern Convention by Robert C. Tucker The Nesbitt Manufacturing Company’s Debt to the Bank of the State of South Carolina by J. M. Lesesne The Southern Movement to Reopen the African Slave Trade, 1854-1860: A Factor in Secession by Jack K. Williams Richard Yeadon, Confederate Patriot by John C. Ellen, Jr.

Síntomas musculoesqueléticos de la región dorsolumbar y hábitos de vida en trabajadores de una empresa de construcción, Bogotá, 2016: estudio de corte transversal

RESUMEN El dolor dorso lumbar es un síntoma que afecta a gran cantidad de personas y población trabajadora en el mundo y comprende un importante problema de salud. La prevalencia de dolor de espalda baja en población trabajadora se estima en un 60% a un 85%, mientras que la prevalencia anual en la población general varía entre un 15% al 45%. La incidencia anual de dolor de espalda en la población general se estima entre 10% y 15%. Objetivo Determinar la prevalencia de síntomas musculoesqueléticos de la región dorso lumbar y los hábitos de vida de trabajadores en una empresa de construcción en la ciudad de Bogotá. Metodología Se realizó un estudio de corte transversal. Se analizaron datos secundarios procedentes de una base de datos de una empresa de construcción ubicada en la ciudad de Bogotá, con 282 trabajadores. Se incluyeron variables sociodemográficas, laborales, hábitos de vida y síntomas musculoesqueléticos. Se hizo un análisis descriptivo considerando las medidas de tendencia central para las variables cuantitativas y distribución de frecuencias para variables cualitativas. Resultados Se incluyeron a 282 trabajadores con un promedio de edad de 33.4 años (DE=10.2). El 93% correspondió al sexo masculino. La prevalencia de síntomas musculoesqueléticos en región dorsal fue de 26% y región lumbar 31.2%. La mayoría de trabajadores se encuentra en el área operativa con un 87,9% en la tercera década de la vida y con un tiempo en la empresa de 11 a 18 años (42.8%). Otros factores que se asociaron con la presencia de síntomas en la región dorsolumbar fueron: realizar oficios domésticos, el sedentarismo y dormir menos de 6 horas. Conclusiones Los síntomas musculoesqueléticos derivados de la actividad laboral en la construcción constituyen un problema significativo influenciado por los factores de riesgo relacionados con el trabajo, las características sociodemográficas y hábitos de vida que pueden jugar un papel fundamental para la aparición de sintomatología. Por lo tanto, se requiere que los trabajadores sean incluidos en programas de vigilancia epidemiológica, con el fin de establecer acciones de prevención que permitan disminuir la aparición de dichos síntomas.

The last of the Arctic voyages; being a narrative of the expedition in H. M. S. Assistance, under the command of Captian Sir Edward Belcher, C. B., in search of Sir John Franklin, during the years 1852-53-54. With notes on the natural history, by Sir John Richardson, Professor Owen, Thomas Bell, J. W. Salter and Lovell Reeve.

1

The last of the Arctic voyages; being a narrative of the expedition in H. M. S. Assistance, under the command of Captian Sir Edward Belcher, C. B., in search of Sir John Franklin, during the years 1852-53-54. With notes on the natural history, by Sir John Richardson, Professor Owen, Thomas Bell, J. W. Salter and Lovell Reeve.

2

Pteridophyta of Peru. Rolla M. Tryon, Robert G. Stolze ; with the collaboration of John T. Mickel, Robbin C. Moran.

n.s. no.27(1991)

Phosphatic microfossils from the Ordovician of the United States / Matthew H. Nitecki --, Raymond C. Gutschick --, John E. Repetski --.

v.35:no.1(1975)