428 research outputs found
Appendix_3_GLeblanc – Supplemental material for Incidence and impact of withdrawal of life-sustaining therapies in clinical trials of severe traumatic brain injury: A systematic review
No full textSupplemental material, Appendix_3_GLeblanc for Incidence and impact of withdrawal of
life-sustaining therapies in clinical trials of severe traumatic brain injury: A
systematic review by Guillaume Leblanc, Amélie Boutin, Michèle Shemilt, François Lauzier,
Lynne Moore, Véronique Potvin, Ryan Zarychanski, Patrick Archambault, François Lamontagne,
Caroline Léger and Alexis F Turgeon in Clinical Trials</p
Appendix_4_GLeblanc – Supplemental material for Incidence and impact of withdrawal of life-sustaining therapies in clinical trials of severe traumatic brain injury: A systematic review
No full textSupplemental material, Appendix_4_GLeblanc for Incidence and impact of withdrawal of
life-sustaining therapies in clinical trials of severe traumatic brain injury: A
systematic review by Guillaume Leblanc, Amélie Boutin, Michèle Shemilt, François Lauzier,
Lynne Moore, Véronique Potvin, Ryan Zarychanski, Patrick Archambault, François Lamontagne,
Caroline Léger and Alexis F Turgeon in Clinical Trials</p
Appendix_2_GLeblanc – Supplemental material for Incidence and impact of withdrawal of life-sustaining therapies in clinical trials of severe traumatic brain injury: A systematic review
No full textSupplemental material, Appendix_2_GLeblanc for Incidence and impact of withdrawal of
life-sustaining therapies in clinical trials of severe traumatic brain injury: A
systematic review by Guillaume Leblanc, Amélie Boutin, Michèle Shemilt, François Lauzier,
Lynne Moore, Véronique Potvin, Ryan Zarychanski, Patrick Archambault, François Lamontagne,
Caroline Léger and Alexis F Turgeon in Clinical Trials</p
10.1177_0269216314566060_supplementary_files – Supplemental material for Admission of the very elderly to the intensive care unit: Family members’ perspectives on clinical decision-making from a multicenter cohort study
No full textSupplemental material, 10.1177_0269216314566060_supplementary_files for Admission of the very elderly to the intensive care unit: Family members’ perspectives on clinical decision-making from a multicenter cohort study by Daren K Heyland, Peter Dodek, Sangeeta Mehta, Deborah Cook, Allan Garland, Henry T Stelfox, Sean M Bagshaw, Demetrios J Kutsogiannis, Karen Burns, John Muscedere, Alexis F Turgeon, Rob Fowler, Xuran Jiang and Andrew G Day in Palliative Medicine</p
Design Features of Explicit Values Clarification Methods: A Systematic Review
No full textAnalysis and support of clinical decision makin
Effects of design features of explicit values clarification methods: A systematic review
No full textAnalysis and support of clinical decision makin
Hemoglobin Area and Time Index Above 90 g/L are Associated with Improved 6-Month Functional Outcomes in Patients with Severe Traumatic Brain Injury
No full textPurpose: There is conflicting data on the relationship between anemia and outcomes in patients with traumatic brain injuries (TBI). The objective of this study was to determine if the proportion of time and area under the hemoglobin-time curve of ≥90 g/L are independently associated with 6-month functional outcomes. Methods: Retrospective cohort study of 116 patients with a severe TBI who underwent invasive neuromonitoring between June 2006 and December 2013. Hemoglobin area (HAI) and time (HTI) indices were calculated by dividing the total area, or time, under the hemoglobin-time curve at 90 g/L or above by the total duration of monitoring. Multivariable log-binomial regression was used to model the association between HAI or HTI and 6 month favorable neurologic outcome (Glasgow Outcome Score 4 or 5). Results: Patients had a mean age of 38 years (SD 16) with a median admission Glasgow Coma Scale of 6 (IQR 4–7). There were 1523 hemoglobin measurements and 523 monitoring days. Patients had a hemoglobin ≥90 g/L for a median of 70 % (IQR 37–100) of the time. Each 10 g/L increase in HAI (RR 1.23, 95 %CI 1.04–1.44, P = 0.011), and 10 % increase in HTI (1.10, 95 %CI 1.04–1.16, P < 0.001) were associated with improved neurologic outcome. Thirty-one patients (27 %) received a transfusion with the median pre-transfusion hemoglobin being 81 g/L (IQR 76–87). Conclusions: In patients with severe TBI, increased area under the curve and percentage of time that the hemoglobin concentration was ≥90 g/L, were associated with improved neurologic outcomes
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Oriental enlightenment: the problematic military experiences and cultural claims of Count Maurice Auguste comte de Benyowsky in Formosa during 1771
No full textMaurice Benyowsky's colourful version of his global adventures during the heady, expansive days of the late-Enlightenment remains still as an historical account, and is perhaps destined for reification at a time of romantic, postmodernist cultural affirmation. Yet this paper argues that within it there lies a virile and possibly dangerous Orientalism, one at least partially based upon a lurid, opportunistic and self-seeking fabrication of his visit to Taiwan (Formosa) in the year 1771. This paper examines the veracity, provenance and historiography of the Benyowsky account of late-eighteenth century Formosa, both as an exercise in one facet of Taiwanese history and as some exploration of the origin and maintenance of European views of the "other" and of the "orient" as they were transforming during the late-Enlightenment period. Furthermore a principal task is to provide an historiographical analysis that illustrates both the initial reasons for the acceptance of Benyowsky's lurid account as well as the wider contexts of its long life as a seemingly reliable and authentic tale. Questions remain as to the cultural contexts of any general acceptance of otherwise doubtful stories, experiments, claims and "adventures". Here there is little doubt that the original Memoirs were given greater credence by Benyowsky's talent in self-fashioning his character and status as those of a reliable gentleman
Designing an experiment to study absorption vs. dose for feedback enabled radiation therapy
No full textThesis: S.B., Massachusetts Institute of Technology, Department of Nuclear Science and Engineering, 2017.This electronic version was submitted by the student author. The certified thesis is available in the Institute Archives and Special Collections.Cataloged from student-submitted PDF version of thesis.Includes bibliographical references (pages 43-44).In the field of radiation oncology, while there are simulations and devices that allow users to be relatively confident that radiation to the tumor and sparing of healthy tissue is being maximized, the inability to reliably measure and control the dose during radiation treatment is a major source of uncertainty. This uncertainty is due to issues such as organ movement, a lack of precise and constant knowledge of beam current at the target site, and the inability to correctly register dose during hardware or software failures; all of which result in radiation treatments being measured after the procedure or in a fault susceptible manner during the procedure. The integrating feedback f-center dosimeter (IF2D) is a dosimeter that would address these challenges and enable feedback during radiotherapy procedures, which would give doctors and patients confidence that the correct dose was delivered to the target sites without exceeding allowable doses to healthy tissue. An in-situ irradiator will be designed and later used to quantify the relationship between dose and f-center absorption. This design will help guide the future experiment and further the development of the IF2D.by Hadrick Alexis Green.S.B
Mortality associated with withdrawal of life-sustaining therapy for patients with severe traumatic brain injury: a Canadian multicentre cohort study
No full textBACKGROUND: Severe traumatic brain injury often leads to death from withdrawal of life-sustaining therapy, although prognosis is difficult to determine.METHODS: To evaluate variation in mortality following the withdrawal of life-sustaining therapy and hospital mortality in patients with critical illness and severe traumatic brain injury, we conducted a two-year multicentre retrospective cohort study in six Canadian level-one trauma centres. The effect of centre on hospital mortality and withdrawal of life-sustaining therapy was evaluated using multivariable logistic regression adjusted for baseline patient-level covariates (sex, age, pupillary reactivity and score on the Glasgow coma scale).RESULTS: We randomly selected 720 patients with traumatic brain injury for our study. The overall hospital mortality among these patients was 228/720 (31.7%, 95% confidence interval [CI] 28.4%-35.2%) and ranged from 10.8% to 44.2% across centres (χ(2) test for overall difference, p < 0.001). Most deaths (70.2% [160/228], 95% CI 63.9%-75.7%) were associated with withdrawal of life-sustaining therapy, ranging from 45.0% (18/40) to 86.8% (46/53) (χ(2) test for overall difference, p < 0.001) across centres. Adjusted odd ratios (ORs) for the effect of centre on hospital mortality ranged from 0.61 to 1.55 (p < 0.001). The incidence of withdrawal of life-sustaining therapy varied by centre, with ORs ranging from 0.42 to 2.40 (p = 0.001). About one half of deaths that occurred following the withdrawal of life-sustaining therapies happened within the first three days of care.INTERPRETATION: We observed significant variation in mortality across centres. This may be explained in part by regional variations in physician, family or community approaches to the withdrawal of life-sustaining therapy. Considering the high proportion of early deaths associated with the withdrawal of life-sustaining therapy and the limited accuracy of current prognostic indicators, caution should be used regarding early withdrawal of life-sustaining therapy following severe traumatic brain injury.</p
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