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- Melsen, Wilhelmina G., et al.
(författare)
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Attributable mortality of ventilator-associated pneumonia: a meta-analysis of individual patient data from randomised prevention studies
- 2013
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Ingår i: The Lancet. Infectious Diseases. - 1474-4457. ; 13:8, s. 665-671
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Tidskriftsartikel (refereegranskat)abstract
- Background Estimating attributable mortality of ventilator-associated pneumonia has been hampered by confounding factors, small sample sizes, and the difficulty of doing relevant subgroup analyses. We estimated the attributable mortality using the individual original patient data of published randomised trials of ventilator-associated pneumonia prevention. Methods We identified relevant studies through systematic review. We analysed individual patient data in a one-stage meta-analytical approach (in which we defined attributable mortality as the ratio between the relative risk reductions [RRR] of mortality and ventilator-associated pneumonia) and in competing risk analyses. Predefined subgroups included surgical, trauma, and medical patients, and patients with different categories of severity of illness scores. Findings Individual patient data were available for 6284 patients from 24 trials. The overall attributable mortality was 13%, with higher mortality rates in surgical patients and patients with mid-range severity scores at admission (ie, acute physiology and chronic health evaluation score [APACHE] 20-29 and simplified acute physiology score [SAPS 2] 35-58). Attributable mortality was close to zero in trauma, medical patients, and patients with low or high severity of illness scores. Competing risk analyses could be done for 5162 patients from 19 studies, and the overall daily hazard for intensive care unit (ICU) mortality after ventilator-associated pneumonia was 1.13 (95% CI 0.98-1.31). The overall daily risk of discharge after ventilator-associated pneumonia was 0.74 (0-68-0.80), leading to an overall cumulative risk for dying in the ICU of 2.20 (1.91-2.54). Highest cumulative risks for dying from ventilator-associated pneumonia were noted for surgical patients (2.97,95% CI 2-24-3-94) and patients with mid-range severity scores at admission (ie, cumulative risks of 2.49 [1.81-3-44] for patients with APACHE scores of 20-29 and 2.72 [1.95-3.78] for those with SAPS 2 scores of 35-58). Interpretation The overall attributable mortality of ventilator-associated pneumonia is 13%, with higher rates for surgical patients and patients with a mid-range severity score at admission. Attributable mortality is mainly caused by prolonged exposure to the risk of dying due to increased length of ICU stay.
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- Oelerich, Ole, et al.
(författare)
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Temporomandibular disorders among Ehlers-Danlos syndromes : a narrative review
- 2024
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Ingår i: Journal of international medical research. - : Sage Publications. - 0300-0605 .- 1473-2300. ; 52:4
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Tidskriftsartikel (refereegranskat)abstract
- This narrative review aims to demonstrate and summarize the complex relationship between Ehlers-Danlos syndromes (EDS) and temporomandibular disorders (TMD) by reviewing the results of observational studies and case reports. EDS are a set of hereditary connective tissue disorders, where generalized joint hypermobility (GJH), especially in the hypermobile subtype (hEDS), is a key symptom. Mutations have been identified in genes that impact the production or assembly of collagen for all subtypes except hEDS. While the correlation between GJH and TMD has been analysed in various studies, fewer studies have examined TMD in patients with EDS, with most showing an increased prevalence of TMD. In case–control studies, an elevated prevalence of myalgia, arthralgia and disc-related disorders was found in individuals with EDS. Various therapeutic interventions have been reported within the literature in the form of case reports and observational studies, but there are no long-term clinical trials with results on the efficacy of different therapeutic approaches to date. This review demonstrates the high prevalence of different TMDs in different subtypes of EDS, but also shows that little is known about the success of treatment thus far. Further clinical research is necessary to provide adequate guidance on targeted treatment.
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- Ribeiro, Luis, et al.
(författare)
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Self-organization in automation - The IDEAS pre-demonstrator
- 2011
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Ingår i: IECON Proceedings (Industrial Electronics Conference). - : IEEE. - 9781612849720 ; , s. 2752-2757, s. 2752-2757
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Konferensbidrag (refereegranskat)abstract
- While the application of IT in automation gains traction, mostly motivated by the introduction of Service Orientated Approaches and Multiagent modelling, it is sometimes unclear to practitioners what is the full potential and boundaries of such concepts and technologies. The FP7 IDEAS project is focused in the design and development of Multiagent systems in a Mechatronic context which, to a great extent, implies that Mechatronic Agents must consider and respect mechanical/physical constraints while delivering the widely acknowledged (yet elusively demonstrated) characteristics that may render Agent-based control unique in respect to tolerance to disturbances, plug-ability and scalability. In this context, the present paper details the preliminary proof of concept prototype that validates the IDEAS Mechatronic Agent Architecture. The focus of this early demonstrator is to enlighten on how self-organization, inspired by the Evolvable Assembly System (EAS) Paradigm, can be exploited towards promoting the above mentioned characteristics. The main lessons learned, open points and future developing directions are distilled as the prototype is presented.
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| 8. |
- Siewert, Matthias B., et al.
(författare)
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Comparing carbon storage of Siberian tundra and taiga permafrost ecosystems at very high spatial resolution
- 2015
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Ingår i: Journal of Geophysical Research - Biogeosciences. - 2169-8953 .- 2169-8961. ; 120:10, s. 1973-1994
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Tidskriftsartikel (refereegranskat)abstract
- Permafrost-affected ecosystems are important components in the global carbon (C) cycle that, despite being vulnerable to disturbances under climate change, remain poorly understood. This study investigates ecosystem carbon storage in two contrasting continuous permafrost areas of NE and East Siberia. Detailed partitioning of soil organic carbon (SOC) and phytomass carbon (PC) is analyzed for one tundra (Kytalyk) and one taiga (Spasskaya Pad/Neleger) study area. In total, 57 individual field sites (24 and 33 in the respective areas) have been sampled for PC and SOC, including the upper permafrost. Landscape partitioning of ecosystem C storage was derived from thematic upscaling of field observations using a land cover classification from very high resolution (2x2m) satellite imagery. Nonmetric multidimensional scaling was used to explore patterns in C distribution. In both environments the ecosystem C is mostly stored in the soil (86%). At the landscape scale C stocks are primarily controlled by the presence of thermokarst depressions (alases). In the tundra landscape, site-scale variability of C is controlled by periglacial geomorphological features, while in the taiga, local differences in catenary position, soil texture, and forest successions are more important. Very high resolution remote sensing is highly beneficial to the quantification of C storage. Detailed knowledge of ecosystem C storage and ground ice distribution is needed to predict permafrost landscape vulnerability to projected climatic changes. We argue that vegetation dynamics are unlikely to offset mineralization of thawed permafrost C and that landscape-scale reworking of SOC represents the largest potential changes to C cycling.
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- Stinner, B, et al.
(författare)
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Granulocyte-colony stimulating factor in the prevention of postoperative infectious complications and sub-optimal recovery from operation in patients with colorectal cancer and increased preoperative risk (ASA 3 and 4) - Protocol of a controlled clinical trial developed by consensus of an international study group Part three : individual patient, complication algorithm and quality management
- 2001
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Ingår i: Inflammation Research. - 1023-3830 .- 1420-908X. ; 50:5, s. 233-248
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Forskningsöversikt (refereegranskat)abstract
- General design: Presentation of a new type of a study protocol for evaluation of the effectiveness of an immune modifier (rhG-CSF, filgrastim): prevention of postoperative infectious complications and of sub-optimal recovery from operation in patients with colorectal cancer and increased preoperative risk (ASA 3 and 4). A randomised placebo controlled, double-blinded, single-centre study is performed at an University Hospital (n = 40 patients for each group). This part presents the course of the individual patient and a complication algorithm for the management of anastomotic leakage and quality management. Objective: In part three of the protocol, the three major sections include: - The course of the individual patient using a comprehensive graphic display, including the perioperative period, hospital stay and post discharge outcome. - A center based clinical practice guideline for the management of the most important postoperative complication anastomotic leakage - including evidence based support for each step of the algorithm. - Data management, ethics and organisational structure. Conclusions: Future studies with immune modifiers will also fail if not better structured (reduction of variance) to achieve uniform patient management in a complex clinical scenario. This new type of a single-centre trial aims to reduce the gap between animal experiments and clinical trials or - if it fails - at least demonstrates new ways for explaining the failures.
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