12 research outputs found
Experiences and perspectives of Technology-enhanced learning and teaching in higher education - Serbian case
No full text© 2018 The Author(s). This paper presents different approaches, experiences and perspectives of using technologies in higher education institutionS. Particular case studies of application of social media (especially wikis), game-based learning and various technology-enhanced learning tools in different courses at several Serbian institutions are presented. In-house developed intelligent tutoring System Protus and possibilities to enhance it by software agents and eye-tracking are also shown in detail. Our experiences of using different technology-enhanced learning tools and mechanisms showed that educational processes must be modernized and enhanced by technological progresS
Table_1_Sepsis affects kidney graft function and one-year mortality of the recipients in contrast with systemic inflammatory response.DOCX
No full textBackgroundInfections remain a major cause of morbidity and mortality after kidney transplantation. The aim of our study was to determine the effect of sepsis on kidney graft function and recipient mortality.MethodsA prospective, observational, single-center study was performed. Selected clinical and biochemical parameters were recorded and compared between an experimental group (with sepsis, n = 34) and a control group (with systemic inflammatory response syndrome, n = 31) comprising kidney allograft recipients.ResultsSepsis worsened both patient (HR = 14.77, p = 0.007) and graft survival (HR = 15.07, p = 0.007). Overall one-year mortality was associated with age (HR = 1.08, p = 0.048), APACHE II score (HR = 1.13, p = 0.035), and combination immunosuppression therapy (HR = 0.1, p = 0.006), while graft survival was associated with APACHE II (HR = 1.25, p = 0.004) and immunosuppression. In sepsis patients, mortality correlated with the maximal dose of noradrenalin (HR = 100.96, p = 0.008), fungal infection (HR = 5.64, p = 0.024), SAPS II score (HR = 1.06, p = 0.033), and mechanical ventilation (HR = 5.97, p = 0.033), while graft survival was influenced by renal replacement therapy (HR = 21.16, p = 0.005), APACHE II (HR = 1.19, p = 0.035), and duration of mechanical ventilation (HR = 1.01, p = 0.015).ConclusionIn contrast with systemic inflammatory response syndrome, septic kidney allograft injury is associated with early graft loss and may represent a significant risk of mortality.</p
Welcoming the book "In sunshine and shadow: reflections on lithuanian immigrant life"
No full textXX a. niekaip nepalieka mūsų ramybėje. Jis užvaldė istorinę atmintį savomis ir svetimomis patirtimis, kurios vis randa būdų prabilti į žmonių protus ir širdis. Praėjusi epocha nevirsta vakarykščiu pasauliu labiausiai dėl knygos galios. Pasakyti dalykai virsta parašytais, ir tai kuria ne tiesioginio, bet vis dėlto artimo bendravimo su žmonėmis iš tolimų laikų ir dar tolimesnių kraštų galimybę. Susitikimą su vadinamųjų dipukų (angį. displaced persons) kartos Australijos lietuviais per knygą įgalino šiame žemyne 1944 m. gimusi Evė Puodžiūnaitė-Viks (Wicks), 2018 m. išleidusi, jos pačios žodžiais tariant, atminties paveldo (angl. memory heritage) knygą „Saulėje ir šešėlyje: pamąstymai apie lietuvių imigrantų gyvenimą“ ("In Sunshine and Shadow: Reflections on Lithuanian Immigrant Life"). Knyga išleista 2018 m., bet Lietuvos skaitytojus ji pasieks šių metų Knygų mugėje. Knygą sudaro devyni skyriai: „Įžanga. Piligrimės kelionė“, „Mano mamos žemė“, „Prieglobstis po Pietų Kryžiumi“, „Saldi pradžia“, „Dievaičių gerbimas“, „Pergalės ir vargai“, „Trūkstami veidai“, „Nuo pavergtos tautos iki nepriklausomybės“, „Motulei Žemei ir Aušrinei“. Reikšminiai žodžiai: Antropologinis tyrimas; Atminties kultūra; Atsiminimai; Australija (Australia); Australijos lietuviai; Evė Puodžiūnaitė-Viks; Imigrantai; Išeivija; Lietuviai imigrantai; Lietuvių emigracija; Tapatybė; Anthropological research; Australian Lithuanians; Emigration; Eve Puodžiūnaitė Wicks; Identity; Immigrants; Lithuanian Australians; Lithuanian emigration; Lithuanian migrants; Memories; Memory cultureThe article overviews that memory heritage book of Eve Puodžiūnaitė-Wicks, "In Sunshine and Shadow: Reflections on Lithuanian Immigrant Life" (2017). This book - aesthetic, empathic and perfect for slow reading - gives a voice to one group of Lithuanian immigrants in Australia. These are the people who were forced to leave Lithuania at the start of WWII. The author was born into a family of so-called "displaced people", but she found out most about the experiences of her parent’s generation through anthropological research into the experience of Lithuanian immigrants in the new land. Her studies led to this book being written, the main of which is to demonstrate that each nation and community, no matter where it lives, deserved respect. The work is unique in that it is prepared in Lithuanian and English. Thus, the message is sent to both Englishspeakers and Lithuanian readers
Philosophy, theurgy, and the gods
No full textStraipsnyje aptariama Jamblicho ir Algio Uždavinio teurgijos sampratos, pažymint, kad A. Uždavinio atlikti tyrinėjimai labai svarbūs atskleidžiant teurgijos reikšmę Jamblicho filosofijoje, parodant jos santykį su egiptiečių, chaldėjų ir neoplatonizmo mąstymo tradicijomis. Teigiama, kad A. Uždavinys savo knygoje „Filosofija ir teurgija vėlyvojoje antikoje“ reflektuoja teurgijos reikšmę ir svarbą Jamblicho filosofijoje, pastebėdamas, kad žodį „teurgija“ Jamblichas, kaip ir jo bendraminčiai platonikai, vartojo kalbėdamas apie ryšį tarp dievų ir mirtingųjų. Pažymima, kad A. Uždavinio žodžiais, teurgija reiškia dieviškus veiksmus, kurie atliekami skirtinguose išreikštos tikrovės lygmenyse, būtent dėl to ne tik neoplatonikų chaldėjų hieratinė mistagonija gali būti laikoma teurgija, bet ir visos sakramentinės procedūros, kurios sulaukia tiesioginės aukštesnių būtybių paramos. Autoriaus teigimu, teurgija - tai būdas susieti senovę ir Platoną. Nagrinėdamas Jamblicho teurgijos sampratą, autorius pažymi, kad jei teurgai nori patirti dieviškumą savais kūnais aukštesniame lygyje, jie, pasitelkdami asketiškas ir panašias praktikas, turi apvalyti ne tik kūną ir žemesnes sielas, bet ir savo protus. Konstatuojama, kad pagal Jamblichą žinios, kurias mes įgyjame žemėje, garantuoja mums vietą danguje, o tai reiškia, kad mūsų racionalios sielos yra susitelkusios universalioms galioms, o proto dėka galime keliauti tarp dviejų karalysčių: eterinės bei tos, kurią vadiname Vieniu. Daroma išvada, kad teurgija suteikia taiką, pasitenkinimą, galią, saugumą, ir dieviškąjį statusą. Reikšminiai žodžiai: Egiptiečių mąstymas; Egipto mąstymo tradicija; Filosofija; Jamblichas; Teurgija; Vėlyvoji antika; Egyptian thinking; Egyptian thinking tradition; Iamblichus; Late Antiquity; Philosophy; Teurgy; TheurgyThe article discusses Iamblichus' and Algis Uždavinys' concepts of theurgy, pointing out that studies performed by Uždavinys are very important in revealing the importance of theurgy in Iamblichus' philosophy and showing its relationship with the traditions of Egyptian, Chaldean, and Neoplatonist way of thinking. It is argued that in his book "Philosophy and Theurgy in Late Antiquity" Uždavinys reflects the significance and importance of theurgy in Iamblichus' philosophy, noting that Iamblichus, just like his like-minded Platonists, used the word "theurgy" in relation to the connection between the gods and the mortals. It is noted that, in the words of Uždavinys, theurgy refers to divine acts performed at different levels of expressed reality, which is why not only the hieratic mystagogy of Neoplatonic Chaldeans can be considered theurgy, but also all the sacramental procedures that receive direct support from higher beings. According to the author, theurgy is a way of linking the past times and Plato. While studying Iamblichus' concept of theurgy, the author states that if theurgists want to experience divinity with their own bodies at a higher level, they must purify not only the body and the lower souls but also their own minds, using ascetic and similar practices. It is stated that according to Iamblichus, the knowledge that we receive on earth guarantees us a place in heaven, which means that our rational souls are concentrated on universal powers, and through reason we can travel between two kingdoms: the ethereal one and the one we call One. It is concluded that theurgy provides peace, satisfaction, power, security, and divine status
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Accuracy and Feasibility of Real-time Continuous Glucose Monitoring in Critically Ill Patients After Abdominal Surgery and Solid Organ Transplantation.
No full textOBJECTIVE: Glycemia management in critical care is posing a challenge in frequent measuring and adequate insulin dose adjustment. In recent years, continuous glucose measurement has gained accuracy and reliability in outpatient and inpatient settings. The aim of this study was to assess the feasibility and accuracy of real-time continuous glucose monitoring (CGM) in ICU patients after major abdominal surgery. RESEARCH DESIGN AND METHODS: We included patients undergoing pancreatic surgery and solid organ transplantation (liver, pancreas, islets of Langerhans, kidney) requiring an ICU stay after surgery. We used a Dexcom G6 sensor, placed in the infraclavicular region, for real-time CGM. Arterial blood glucose measured by the amperometric principle (ABL 800; Radiometer, Copenhagen, Denmark) served as a reference value and for calibration. Blood glucose was also routinely monitored by a StatStrip bedside glucose meter. Sensor accuracy was assessed by mean absolute relative difference (MARD), bias, modified Bland-Altman plot, and surveillance error grid for paired samples of glucose values from CGM and acid-base analyzer (ABL). RESULTS: We analyzed data from 61 patients and obtained 1,546 paired glucose values from CGM and ABL. Active sensor use was 95.1%. MARD was 9.4%, relative bias was 1.4%, and 92.8% of values fell in zone A, 6.1% fell in zone B, and 1.2% fell in zone C of the surveillance error grid. Median time in range was 78%, with minimum (<1%) time spent in hypoglycemia. StatStrip glucose meter MARD compared with ABL was 5.8%. CONCLUSIONS: Our study shows clinically applicable accuracy and reliability of Dexcom G6 CGM in postoperative ICU patients and a feasible alternative sensor placement site
Accuracy and Feasibility of Real-time Continuous Glucose Monitoring in Critically Ill Patients after Abdominal Surgery and Solid Organ Transplantation
No full textObjectives: Glycemia management in critical care is posing a challenge in frequent measuring and adequate insulin dose adjustment. In recent years continuous glucose measurement is gaining accuracy and reliability in outpatient and inpatient setting. The aim of this study was to assess the feasibility and accuracy of real-time continuous glucose monitoring in ICU patients after major abdominal surgery. Research design and methods: We included patients undergoing pancreatic surgery and solid organ transplantation (liver, pancreas, islets of Langerhans, kidney) requiring ICU stay after surgery. We used a Dexcom G6 sensor, placed in the infraclavicular region, for rtCGM. Arterial blood glucose measured by the amperometric principle (ABL 800, Radiometer, Copenhagen, Denmark) served as reference values and for calibration. Blood glucose was also routinely monitored by StatStrip bedside glucose meter. Sensor accuracy was assessed by mean absolute relative difference (MARD), bias, modified Bland-Altman plot and Surveillance Error Grid for paired samples of glucose values from CGM and ABL. Results: We analyzed data from 61 patients and obtained 1546 paired glucose values from CGM and ABL. Active sensor use was 95.1%. MARD was 9.4%, relative bias 1,4%, 92.8% values fell in zone A, 6.1% in zone B and 1.2% in zone C of Surveillance Error Grid. Median time in range was 78%, with minimum (Conclusions: Our study shows clinically applicable accuracy and reliability of Dexcom G6 CGM in postoperative ICU patients and a feasible alternative sensor placement site.</p
Epidemiology of intra-abdominal infection and sepsis in critically ill patients: “AbSeS”, a multinational observational cohort study and ESICM Trials Group Project
No full textPurpose: To describe the epidemiology of intra-abdominal infection in an international cohort of ICU patients according to a new system that classifies cases according to setting of infection acquisition (community-acquired, early onset hospital-acquired, and late-onset hospital-acquired), anatomical disruption (absent or present with localized or diffuse peritonitis), and severity of disease expression (infection, sepsis, and septic shock). Methods: We performed a multicenter (n = 309), observational, epidemiological study including adult ICU patients diagnosed with intra-abdominal infection. Risk factors for mortality were assessed by logistic regression analysis. Results: The cohort included 2621 patients. Setting of infection acquisition was community-acquired in 31.6%, early onset hospital-acquired in 25%, and late-onset hospital-acquired in 43.4% of patients. Overall prevalence of antimicrobial resistance was 26.3% and difficult-to-treat resistant Gram-negative bacteria 4.3%, with great variation according to geographic region. No difference in prevalence of antimicrobial resistance was observed according to setting of infection acquisition. Overall mortality was 29.1%. Independent risk factors for mortality included late-onset hospital-acquired infection, diffuse peritonitis, sepsis, septic shock, older age, malnutrition, liver failure, congestive heart failure, antimicrobial resistance (either methicillin-resistant Staphylococcus aureus, vancomycin-resistant enterococci, extended-spectrum beta-lactamase-producing Gram-negative bacteria, or carbapenem-resistant Gram-negative bacteria) and source control failure evidenced by either the need for surgical revision or persistent inflammation. Conclusion: This multinational, heterogeneous cohort of ICU patients with intra-abdominal infection revealed that setting of infection acquisition, anatomical disruption, and severity of disease expression are disease-specific phenotypic characteristics associated with outcome, irrespective of the type of infection. Antimicrobial resistance is equally common in community-acquired as in hospital-acquired infection. © 2019, The Author(s)
Antimicrobial lessons from a large observational cohort on intra-abdominal infections in intensive care units
No full textSevere intra-abdominal infection commonly requires intensive care. Mortality is high and is mainly determined by disease-specific characteristics, i.e. setting of infection onset, anatomical barrier disruption, and severity of disease expression. Recent observations revealed that antimicrobial resistance appears equally common in community-acquired and late-onset hospital-acquired infection. This challenges basic principles in anti-infective therapy guidelines, including the paradigm that pathogens involved in community-acquired infection are covered by standard empiric antimicrobial regimens, and second, the concept of nosocomial acquisition as the main driver for resistance involvement. In this study, we report on resistance profiles of Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, Enterococcus faecalis and Enterococcus faecium in distinct European geographic regions based on an observational cohort study on intra-abdominal infections in intensive care unit (ICU) patients. Resistance against aminopenicillins, fluoroquinolones, and third-generation cephalosporins in E. coli, K. pneumoniae and P. aeruginosa is problematic, as is carbapenem-resistance in the latter pathogen. For E. coli and K. pneumoniae, resistance is mainly an issue in Central Europe, Eastern and South-East Europe, and Southern Europe, while resistance in P. aeruginosa is additionally problematic in Western Europe. Vancomycin-resistance in E. faecalis is of lesser concern but requires vigilance in E. faecium in Central and Eastern and South-East Europe. In the subcohort of patients with secondary peritonitis presenting with either sepsis or septic shock, the appropriateness of empiric antimicrobial therapy was not associated with mortality. In contrast, failure of source control was strongly associated with mortality. The relevance of these new insights for future recommendations regarding empiric antimicrobial therapy in intra-abdominal infections is discussed
Poor timing and failure of source control are risk factors for mortality in critically ill patients with secondary peritonitis
No full textPurpose: To describe data on epidemiology, microbiology, clinical characteristics and outcome of adult patients admitted in the intensive care unit (ICU) with secondary peritonitis, with special emphasis on antimicrobial therapy and source control.
Methods: Post hoc analysis of a multicenter observational study (Abdominal Sepsis Study, AbSeS) including 2621 adult ICU patients with intra-abdominal infection in 306 ICUs from 42 countries. Time-till-source control intervention was calculated as from time of diagnosis and classified into 'emergency' (< 2 h), 'urgent' (2-6 h), and 'delayed' (> 6 h). Relationships were assessed by logistic regression analysis and reported as odds ratios (OR) and 95% confidence interval (CI).
Results: The cohort included 1077 cases of microbiologically confirmed secondary peritonitis. Mortality was 29.7%. The rate of appropriate empiric therapy showed no difference between survivors and non-survivors (66.4% vs. 61.3%, p = 0.1). A stepwise increase in mortality was observed with increasing Sequential Organ Failure Assessment (SOFA) scores (19.6% for a value ≤ 4-55.4% for a value > 12, p < 0.001). The highest odds of death were associated with septic shock (OR 3.08 [1.42-7.00]), late-onset hospital-acquired peritonitis (OR 1.71 [1.16-2.52]) and failed source control evidenced by persistent inflammation at day 7 (OR 5.71 [3.99-8.18]). Compared with 'emergency' source control intervention (< 2 h of diagnosis), 'urgent' source control was the only modifiable covariate associated with lower odds of mortality (OR 0.50 [0.34-0.73]).
Conclusion: 'Urgent' and successful source control was associated with improved odds of survival. Appropriateness of empirical antimicrobial treatment did not significantly affect survival suggesting that source control is more determinative for outcome
Poor timing and failure of source control are risk factors for mortality in critically ill patients with secondary peritonitis
No full textPurpose To describe data on epidemiology, microbiology, clinical characteristics and outcome of adult patients admitted in the intensive care unit (ICU) with secondary peritonitis, with special emphasis on antimicrobial therapy and source control. Methods Post hoc analysis of a multicenter observational study (Abdominal Sepsis Study, AbSeS) including 2621 adult ICU patients with intra-abdominal infection in 306 ICUs from 42 countries. Time-till-source control intervention was calculated as from time of diagnosis and classified into 'emergency' (< 2 h), 'urgent' (2-6 h), and 'delayed' (> 6 h). Relationships were assessed by logistic regression analysis and reported as odds ratios (OR) and 95% confidence interval (CI). Results The cohort included 1077 cases of microbiologically confirmed secondary peritonitis. Mortality was 29.7%. The rate of appropriate empiric therapy showed no difference between survivors and non-survivors (66.4% vs. 61.3%, p = 0.1). A stepwise increase in mortality was observed with increasing Sequential Organ Failure Assessment (SOFA) scores (19.6% for a value <= 4-55.4% for a value > 12, p < 0.001). The highest odds of death were associated with septic shock (OR 3.08 [1.42-7.00]), late-onset hospital-acquired peritonitis (OR 1.71 [1.16-2.52]) and failed source control evidenced by persistent inflammation at day 7 (OR 5.71 [3.99-8.18]). Compared with 'emergency' source control intervention (< 2 h of diagnosis), 'urgent' source control was the only modifiable covariate associated with lower odds of mortality (OR 0.50 [0.34-0.73]). Conclusion 'Urgent' and successful source control was associated with improved odds of survival. Appropriateness of empirical antimicrobial treatment did not significantly affect survival suggesting that source control is more determinative for outcome
