39 research outputs found
SAPS 3—From evaluation of the patient to evaluation of the intensive care unit. Part 1: Objectives, methods and cohort description
No full textOBJECTIVE: Risk adjustment systems now in use were developed more than a decade ago and lack prognostic performance. Objective of the SAPS 3 study was to collect data about risk factors and outcomes in a heterogeneous cohort of intensive care unit (ICU) patients, in order to develop a new, improved model for risk adjustment. DESIGN: Prospective multicentre, multinational cohort study. PATIENTS AND SETTING: A total of 19,577 patients consecutively admitted to 307 ICUs from 14 October to 15 December 2002. MEASUREMENTS AND RESULTS: Data were collected at ICU admission, on days 1, 2 and 3, and the last day of the ICU stay. Data included sociodemographics, chronic conditions, diagnostic information, physiological derangement at ICU admission, number and severity of organ dysfunctions, length of ICU and hospital stay, and vital status at ICU and hospital discharge. Data reliability was tested with use of kappa statistics and intraclass-correlation coefficients, which were >0.85 for the majority of variables. Completeness of the data was also satisfactory, with 1 [0-3] SAPS II parameter missing per patient. Prognostic performance of the SAPS II was poor, with significant differences between observed and expected mortality rates for the overall cohort and four (of seven) defined regions, and poor calibration for most tested subgroups. CONCLUSIONS: The SAPS 3 study was able to provide a high-quality multinational database, reflecting heterogeneity of current ICU case-mix and typology. The poor performance of SAPS II in this cohort underscores the need for development of a new risk adjustment system for critically ill patient
SAPS 3--From evaluation of the patient to evaluation of the intensive care unit. Part 2 : Development of a prognostic model for hospital mortality at ICU admission
No full textOBJECTIVE: To develop a model to assess severity of illness and predict vital status at hospital discharge based on ICU admission data. DESIGN: Prospective multicentre, multinational cohort study. PATIENTS AND SETTING: A total of 16,784 patients consecutively admitted to 303 intensive care units from 14 October to 15 December 2002. MEASUREMENTS AND RESULTS: ICU admission data (recorded within +/-1 h) were used, describing: prior chronic conditions and diseases; circumstances related to and physiologic derangement at ICU admission. Selection of variables for inclusion into the model used different complementary strategies. For cross-validation, the model-building procedure was run five times, using randomly selected four fifths of the sample as a development- and the remaining fifth as validation-set. Logistic regression methods were then used to reduce complexity of the model. Final estimates of regression coefficients were determined by use of multilevel logistic regression. Variables selection and weighting were further checked by bootstraping (at patient level and at ICU level). Twenty variables were selected for the final model, which exhibited good discrimination (aROC curve 0.848), without major differences across patient typologies. Calibration was also satisfactory (Hosmer-Lemeshow goodness-of-fit test H=10.56, p=0.39, C=14.29, p=0.16). Customized equations for major areas of the world were computed and demonstrate a good overall goodness-of-fit. CONCLUSIONS: The SAPS 3 admission score is able to predict vital status at hospital discharge with use of data recorded at ICU admission. Furthermore, SAPS 3 conceptually dissociates evaluation of the individual patient from evaluation of the ICU and thus allows them to be assessed at their respective reference levels
Stop 2 Kainui silt loam and Naike clay, Gordonton Rd
No full textAt this stop are several remarkable features both stratigraphic and pedological, and a “two-storied” soil, the Kainui silt loam alongside (in just a few places) the Naike clay. Both soils are Ultisols. The sequence of tephra beds and buried soil horizons spanning about 1 million years was exposed in 2007 by road works
The Eldicus prospective, observational study of triage decision making in European intensive care units: Part I-European Intensive Care Admission Triage Scores
No full textObjective: Life and death triage decisions are made daily by intensive care unit physicians. Scoring systems have been developed for prognosticating intensive care unit mortality but none for intensive care unit triage. The objective of this study was to develop an intensive care unit triage decision rule based on 28-day mortality rates of admitted and refused patients.
Design: Prospective, observational study of triage decisions from September 2003 until March 2005.
Setting: Eleven intensive care units in seven European countries.
Patients: All patients >18 yrs with a request for intensive care unit admission.
Interventions: Admission or rejection to an intensive care unit.
Measurements and Main Results: Clinical, laboratory, and physiological variables and data from severity scores were collected. Separate scores for accepted and rejected patients with 28-day mortality end point were built. Values for variables were grouped into categories determined by the locally weighted least squares graphical method applied to the logit of the mortality and by univariate logistic regressions for reducing candidates for the score. Multivariate logistic regression was used to construct the final score. Cutoff values for 99.5% specificity were determined. Of 6796 patients, 5602 were admitted and 1194 rejected. The initial refusal score included age, diagnosis, systolic blood pressure, pulse, respirations, creatinine, bilirubin, PaO2, bicarbonate, albumin, use of vasopressors, Glasgow Coma Scale score, Karnofsky Scale, operative status and chronic disorder, and the initial refusal receiver operating characteristics were area under the curve 0.77 (95% confidence interval 0.76–0.79). The final triage score included age, diagnosis, creatinine, white blood cells, platelets, albumin, use of vasopressors, Glasgow Coma Scale score, Karnofsky Scale, operative status and chronic disorder, and the final score receiver operating characteristics were area under the curve 0.83 (95% confidence interval 0.80–0.86). Patients with initial refusal scores >173.5 or final triage scores = 0 should be rejected.
Conclusions: The initial refusal score and final triage score provide objective data for rejecting patients that will die even if admitted to the intensive care unit and survive if refused intensive care unit admission
The Eldicus prospective, observational study of triage decision making in European intensive care units : part II: Intensive care benefit for the elderly
No full textRationale: Life and death triage decisions are made daily by intensive care unit physicians. Admission to an intensive care unit is denied when intensive care unit resources are constrained, especially for the elderly.
Objective: To determine the effect of intensive care unit triage decisions on mortality and intensive care unit benefit, specifically for elderly patients.
Design: Prospective, observational study of triage decisions from September 2003 until March 2005.
Setting: Eleven intensive care units in seven European countries.
Patients: All patients >18 yrs with an explicit request for intensive care unit admission.
Interventions: Admission or rejection to intensive care unit.
Measurements and Main Results: Demographic, clinical, hospital, physiologic variables, and 28-day mortality were obtained on consecutive patients. There were 8,472 triages in 6,796 patients, 5,602 (82%) were accepted to the intensive care unit, 1,194 (18%) rejected; 3,795 (49%) were >65 yrs. Refusal rate increased with increasing patient age (18-44: 11%; 45-64: 15%; 65-74: 18%; 75-84: 23%; >84: 36%). Mortality was higher for older patients (18-44: 11%; 45-64: 21%; 65-74: 29%; 75-84: 37%; >84: 48%). Differences between mortalities of accepted vs. rejected patients, however, were greatest for older patients (18-44: 10.2% vs. 12.5%; 45-64: 21.2% vs. 22.3%; 65-74: 27.9% vs. 34.6%; 75-84: 35.5% vs. 40.4%; >84: 41.5% vs. 58.5%). Logistic regression showed a greater mortality reduction for accepted vs. rejected patients corrected for disease severity for elderly patients (age >65 [odds ratio 0.65, 95% confidence interval 0.550.78, p <.0001]) than younger patients (age <65 [odds ratio 0.74, 95% confidence interval 0.57-0.97, p = .01]).
Conclusions: Despite the fact that elderly patients have more intensive care unit rejections than younger patients and have a higher mortality when admitted, the mortality benefit appears greater for the elderly. Physicians should consider changing their intensive care unit triage practices for the elderly
Implications of ICU triage decisions on patient mortality: a cost-effectiveness analysis
No full textINTRODUCTION: Intensive care is generally regarded as expensive, and as a result beds are limited. This has raised serious questions about rationing when there are insufficient beds for all those referred. However, the evidence for the cost effectiveness of intensive care is weak and the work that does exist usually assumes that those who are not admitted do not survive, which is not always the case. Randomised studies of the effectiveness of intensive care are difficult to justify on ethical grounds; therefore, this observational study examined the cost effectiveness of ICU admission by comparing patients who were accepted into ICU after ICU triage to those who were not accepted, while attempting to adjust such comparison for confounding factors. METHODS: This multi-centre observational cohort study involved 11 hospitals in 7 EU countries and was designed to assess the cost effectiveness of admission to intensive care after ICU triage. A total of 7,659 consecutive patients referred to the intensive care unit (ICU) were divided into those accepted for admission and those not accepted. The two groups were compared in terms of cost and mortality using multilevel regression models to account for differences across centres, and after adjusting for age, Karnofsky score and indication for ICU admission. The analyses were also stratified by categories of Simplified Acute Physiology Score (SAPS) II predicted mortality (40%). Cost effectiveness was evaluated as cost per life saved and cost per life-year saved. RESULTS: Admission to ICU produced a relative reduction in mortality risk, expressed as odds ratio, of 0.70 (0.52 to 0.94) at 28 days. When stratified by predicted mortality, the odds ratio was 1.49 (0.79 to 2.81), 0.7 (0.51 to 0.97) and 0.55 (0.37 to 0.83) for 40% predicted mortality, respectively. Average cost per life saved for all patients was 7,065 (€5,607). These figures decreased substantially for patients with predicted mortality higher than 40%, 4,088 (€3,244), respectively. Results were very similar when considering three-month mortality. Sensitivity analyses performed to assess the robustness of the results provided findings similar to the main analyses. CONCLUSIONS: Not only does ICU appear to produce an improvement in survival, but the cost per life saved falls for patients with greater severity of illness. This suggests that intensive care is similarly cost effective to other therapies that are generally regarded as essential
Exercise in cancer care for people with lung cancer: A narrative synthesis
No full textObjectives: Lung cancer is the second most common cancer diagnosed worldwide, resulting in significant physical and psychological consequences. In this narrative review, we explore the role of exercise as an adjunct therapy to counteract health issues experienced by people before, during and after treatment for lung cancer, and offer recommendations for exercise prescription and future research. Design: Narrative cornerstone review. Methods: A narrative review was conducted to explore the role of exercise in cancer care for people diagnosed with lung cancer. Results: Improvements in fitness, strength and quality of life have been demonstrated in people with lung cancer following participation in exercise programmes before, during and post treatment. Whilst combined aerobic (50–100 % heart rate maximum) and resistance (50–85 % of 1 repetition maximum) training, 2–5 times per week across the cancer continuum is typically prescribed, few people with lung cancer currently access exercise services. ‘Optimal’ exercise prescription is unclear, although is likely individual-specific. The immediate priority is to identify a tolerable starting exercise dosage, with the side effects of lung cancer and its treatment on the respiratory system, particularly shortness of breath (dyspnoea), likely driving the initial maximum threshold for session mode, duration and intensity. To date, exercise safety for people with lung cancer has been poorly evaluated and reported — few trials report it, but those that do report small numbers of serious adverse events. Conclusions: Recommendations for health professionals prescribing exercise therapy to people with lung cancer are provided, with consideration of the strengths and limitations of the current evidence base
Where geology meets pedology: Late Quaternary tephras, loess, and paleosols in the Mamaku Plateau and Lake Rerewhakaaitu areas
No full textOn this trip we focus on tephrostratigraphy and soil stratigraphy together with aspects of palaeoenvironmental reconstruction over long and short time-spans. We will examine the relationship between the deposition of tephras and tephric loess and the formation of soils in these deposits as they accumulate, either incrementally (millimetre by millimetre) or as thicker layers, in a process known as upbuilding pedogenesis. Development of age models for the eruption of marker tephras, and of the new climate event stratigraphy for New Zealand within the NZ-INTIMATE project (Integration of ice-core, marine, and terrestrial records for New Zealand since 30,000 years ago), will also be touched upon
Constitutive and NF-κB—like proteins in the regulation of the serum amyloid a gene by interleukin 1
No full textDeon Bahr Architectural Image Collection
No full textCreators and Architects in this collection:
Abadie, Paul, 1812-1884; Adam, Robert, 1728-1792; Aga, Davut, d. 1599 ;Cavus, Dalgic Ahmed ;Aga, Mustafa; Alberti, Leon Battista, 1404-1472; Alexandros of Antioch-on-the-Menander; Ambasz, Emilio; Ammannati, Bartolomeo, 1511-1592; Andrews, Todd, sculptor; Anthemios, ho Trallianos, 6th cent. ;Isidorus, of Miletus, 6th cent.; Armajani, Siah, 1939-; Arnal, Leon Eugene; Arnolfo, di Cambio, 13th cent.; Arnolfo, di Cambio, active 13th century; Arp, Jean, 1887-1966; Aycock, Alice; Bacon, Henry, 1866-1924; Bahr, Deon F.; Baizerman, Saul, 1889-1957; Balyan, Garabet ;Baylan, Nigogayos; Barnes, Edward Larrabee, 1915-; Barnett, George Dennis, 1863-ca. 1925; Barry, Charles, Sir, 1795-1860; Baum, Dwight James, 1886-1939; Beasley, Bruce, 1939-; Beattie, W. Hamilton; Beindorf, Charles F.; Belluschi, Pietro, 1899-1994; Benedetto, da Maiano, 1442-1497; Benton, Fletcher, 1931-; Bernini, Gian Lorenzo, 1598-1680; Birkerts, Gunnar; Blackall, Clarence H., 1857-1942; Bladen, Ronald, 1918-1988; Boal, Theodore Davis, 1867-1938; Bodley, G. F. (George Frederick); Bodley, Thomas, Sir, 1545-1613; Borcherot, Fred; Borromini, Francesco, 1599-1667; Bourgeois, Louis, 1856-1930; Bowen, Gary Roger; Boyington, William W., 1818-1898; Bramante, Donato, 1444?-1514; Brancusi, Constantin, 1876-1957; Breuer, Marcel, 1902-1981; Breuer, Marcel, 1902-1981 ;Zehrfuss, Bernard ;Nervi, Pier Luigi; Brown, Arthur, 1874-1957; Brown, Lancelot, 1716-1783 ;Pope, Alexander, 1688-1744; Brunelleschi, Filippo, 1377-1446; Buchanan, Sidney; Buonarroti, Michelangelo (1475-1564); Buontalenti, Bernardo, 1536-1608; Burnham, Daniel H. (Daniel Hudson), 1886-1961 ;Burnham, Hubert, 1882-1968; Burnham, Daniel Hudson, 1846-1912; Burton, Scott, 1939-1989; Butterfield, Deborah, 1949-; Calder, Alexander, 1898-1976; Cameron, Ralph, 1892-1970; Caprarola, Cola da, 1494?-1518; Carlisle, Roger; Cesar Pelli; Chagall, Marc, 1887-1985; Chermayeff, Peter; Cochrane, John C.; Contino, Antonio di Bernardino, 1506-1600; Cossutta, Araldo; Craig, Fritz; Crane, C. Howard (Charles Howard), 1885-1952; Creator.Persons#1; Cret, Paul Philippe, 1876-1945; Da Ponte, Antonio, ca. 1512-1597; De Yevele, Henry, d. 1400; Delk, Edward Beuhler, 1885-1956; Dine, Jim, 1935-; Diotisalvi, fl. 1152; Domenic, da Cortona, ca. 1470-ca. 1549; Donald Grieb Associates; Dougherty, Patrick, 1945-; Dubuffet, Jean, 1901-1985; Eads, James Buchanan, 1820-1887; Edbrooke, Frank, 1840-1921; Edbrooke, Willoughby J.; Edbrooke, Willoughby J., 1843-1896 ;Burnham, Franklin P.; Eiffel, Gustave, 1832-1923; Erickson, Arthur, 1924-; Fedi, Pio, 1816-1892; Fentress, C. W.; Fetterman, James; Fischer, Johann Michael, 1691-1766; Flanagan, Barry, 1941-2009; Fuller, R. Buckminster (Richard Buckminster), 1895-; Furness, Frank, 1839-1912; Gabo, Naum, 1890-1977; Gabriel, Ange-Jacques, 1698-1782; Gaddi, Taddeo, ca. 1300-ca. 1366; Gaona, Ignacio; Garnier, Charles, 1825-1898; Gehry, Frank O., 1929-; Giambologna, 1529-1608; Gibbs, James, 1682-1754; Gideon, Cecil C. (C.C.); Gilbert, Cass, 1859-1934; Ginnever, Charles; Girault, Charles Louis, 1851-1932; Goff, Bruce, 1904-; Goldberg, Bertrand, 1913-; Goodhue, Bertram Grosvenor, 1869-1924; Gordon, James Riely, 1863-1937; Graves, Michael, 1934-; Grossman, Irving, 1926-; Guimard, Hector, 1867-1942; Haag, Richard; Habzous, Bob; Hadrian, Emperor of Rome, 76-138; Haecker, George; Halprin, Lawrence; Harrison, Peter, 1716-1775; Hawksmoor, Nicholas, 1661-1736; Hays, Warren H.; Hedrick, Wyatt C.; Hellmuth, George Francis, 1907- ;Obata, Gyo, 1923- ;Kassabaum, George Edward, 1920-1982; Heurn, P.; Hicks, Thomas C.; Highstein, Jene, 1942-2013; Hoare, Henry, 1705-1785 ;Flitcroft, Henry, 1697-1769; Hoban, James, ca. 1762-1831; Hoffman, F. Burrall (Francis Burrall), 1882-1980; Holl, Steven; Holland, Henry, 1745-1806; Holt, Thomas, 1578-1624; Hughes, T. Harold (Thomas Harold) ;Waugh, David S.R.; Iktinos; Imagineers (Group); Ireland, David, 1930-2009; Isozaki, Arata; Jackson, Thomas Graham, Sir, 1835-1924; Jacobshagen, Keith, 1941-; Jahn, Helmut, 1940-; Jefferson, Thomas, 1743-1826; Jenney, W. L. B. (William Le Baron), 1832-1907; Johnson, Philip, 1906-2005; Johnson, Philip, 1906-2005 ;Burgee, John, 1933-; Jones, Horace, Sir, 1819-1887; Kahn, Louis I., 1901- 1974; Kahn, Louis I., 1901-1974; Kallmann, Gerhard Michael, 1915-; Keith, William, Sir, 1680-1749; Kelly, Ellsworth, 1923-; Kelsey, Albert, 1870-1950; Kenny, Sean, d. 1973; Kimball, Thomas R., 1862-1934; Kimball, Thomas Rogers, 1862-1934; Klauder, Charles Z. (Charles Zeller), 1872-1938; Kling, Vincent G. (Vincent George), 1916-; Kohn, A. Eugene, 1930- ;Pedersen, William, 1938-; Koons, Jeff, 1955-; Kromhout, Willem, 1864-1940; Kusser, Josef; Latenser, John; Latrobe, Benjamin Henry, 1764-1820; Le Corbusier, 1887-1965; Le Vau, Louis, 1612-1670; Le Vau, Louis, 1612-1670 ;Le Roy, Philibert ;Le Notre, Andre, 1613-1700 ;Mansart, Jules Hardouin, 1645 or 6-1708; Leonardo, da Vinci, 1452-1519; Lescot, Pierre, ca. 1510-1578; Lewis, William S.; LeWitt, Sol, 1928-2007; Liberman, Alexander, 1912-1999; Lichtenstein, Roy, 1923-1997; Lin, Maya Ying; Link, Theodore C. (Theodore Carl), 1850-1923; Lipchitz, Jacques, 1891-1973; Lombardo, Pietro, ca. 1435-1515; Longhena, Baldassare, 1598-1682; Lugar, Robert; Mackintosh, Charles Rennie, 1868-1928; Magonigle, Harold Van Buren, 1867-1935; Maitani, Lorenzo, 1270?-1330; Mansart, Francois, 1598-1666; Mansart, Jules Hardouin, 1645 or 6-1708; Marshall, Joseph, architect; Masqueray, E. L. (Emmanuel Louis), 1861-1917; Maybeck, Bernard R.; McArthur, John, 1823-1890; McBean, Thomas, fl. 1764; McCaw, William Frederick ;Martin, Richard H., 1858-1950; McDonald, John, 1861-1956; Meier, Richard, 1934-; Mengoni, Giuseppe, 1829-1877; Mesrobian, M. (Mihran), 1889-1975; Michelangelo Buonarroti, 1475-1564; Michelozzo, 1396-1472; Mies van der Rohe, Ludwig, 1886-1969; Mills, Robert, 1781-1855; Mix, Edward Townsend; Mnesicles, 5th cent. B.C.; Montreuil, Pierre de; Moore, Arthur Cotton, 1935-; Moore, Charles Willard, 1925-; Moore, Charles Willard, 1925- ;Ruble, John; Morgan, Julia, 1872-1957; Muchow, W. C.; Musick, G. Meridith; Myers, Elijah E., 1832-1909; Nash, John, 1752-1835 ;Blore, Edward. 1787-1879; Nouvel, Jean, 1945-; Obata, Gyo, 1923-; Obregon Santacilia, Carlos, 1896-; Ott, Carlos, 1946-; Palean, Karabet, 1800-1866 ;Palean, Nikoghos, 1826-1858; Palladio, Andrea, 1508-1580; Pei, I. M. , 1917-; Pei, I. M., 1917-; Pelli, Cesar; Percier, Charles, 1764-1838 ;Fontaine, Pierre Francois Leonard, 1762-1853; Phillips, John H., architect; Piano, Renzo; Piano, Renzo ;Rogers, Richard George; Pisano, Giovanni, 1240?-1320?; Polyclitus, the Younger, 4th cent. B.C; Pope, John Russell, 1874-1937; Porphyrios, Demetri; Portman, John Calvin; Predock, Antoine; Rembrandt Harmenszoon van Rijn, 1606-1669; Renner, Klaus ;Heinz Rocke; Renwick, James, 1818-1895; Richardson, H. H. (Henry Hobson) 1838-1886; Riddle, Herbert Hugh, 1875-1939; Riedel, Eduard, 1813-1885; Roche, Kevin, 1922- ;Dinkeloo, John G. (John Gerard), 1918-1981; Rossi, Aldo, 1931-; Rubens, Peter Paul, Sir, 1577-1640; Rudolph, Paul, 1918-; Saarinen, Eero, 1910-1961; Safdie, Moshe, 1938-; Sangallo, Antonio da, 1484-1546; Sansovino, Iacopo, 1486-1570; Schindler, R. M. (Rudolph M.), 1887-1953; Simpson, John William, 1858-1933; Singleton, Henry; Skislewicz, Anton; Soleri, Paolo, 1919-; Specchi, Alessandro, 1668-1729; Spence, Basil, Sir, 1907-1976; Spiry, Daniel; Stanley, Freelan Oscar, 1849-1940; Stark, Otto; Sterner, Frederick J., 1862-1931; Sullivan, Louis H., 1856-1924; Sullivan, Louis H., 1856-1924 ;Adler, Dankmar, 1844-1900; Theodorus, of Phokaia; Tigerman, Stanley, 1930-; Tribolo, 1500-1550; Tuthill, William Burnet, 1855-1929; Van Alen, William, 1883-1954; Vasconi, Claude, 1940-; Venturi, Robert; Venturi, Robert ;Scott Brown, Denise, 1931-; Vieux, Marian; Vignola, 1507-1573; Vignon, P. (Pierre), 1763-1828; Wagoner, Harold E. (Harold Eugene), 1905-1986; Walker, Richard A. (Richard Amerman), 1871-1951 ;Morris, Charles, 1869-1930; Washington, George, 1732-1799; Webb, Aston, Sir, 1849-1930; Weese, Harry, 1915-; White, E. B. (Edward Brickell), 1806-1882; Wiegmann, Richard; Willcox, William H.; Williams, Warren A.; Wolfram, William R.; Wood, John, 1705?-1754; Wood, John, 1728-1781; Wooley, Edmund; Wren, Christopher, Sir, 1632-1723; Wright, Frank Lloyd, 1867-1959; Yamasaki, Minoru, 1912-; Yamasaki, Minoru, 1912-1986; Zimmermann, Dominikus, 1685-176
