WorldWideScience

Sample records for global sepsis initiative

  1. World Federation of Pediatric Intensive Care and Critical Care Societies: Global Sepsis Initiative.

    Science.gov (United States)

    Kissoon, Niranjan; Carcillo, Joseph A; Espinosa, Victor; Argent, Andrew; Devictor, Denis; Madden, Maureen; Singhi, Sunit; van der Voort, Edwin; Latour, Jos

    2011-09-01

    According to World Health Organization estimates, sepsis accounts for 60%-80% of lost lives per year in childhood. Measures appropriate for resource-scarce and resource-abundant settings alike can reduce sepsis deaths. In this regard, the World Federation of Pediatric Intensive Care and Critical Care Societies Board of Directors announces the Global Pediatric Sepsis Initiative, a quality improvement program designed to improve quality of care for children with sepsis. To announce the global sepsis initiative; to justify some of the bundles that are included; and to show some preliminary data and encourage participation. The Global Pediatric Sepsis Initiative is developed as a Web-based education, demonstration, and pyramid bundles/checklist tool (http://www.pediatricsepsis.org or http://www.wfpiccs.org). Four health resource categories are included. Category A involves a nonindustrialized setting with mortality rate 30 of 1,000 children. Category B involves a nonindustrialized setting with mortality rate children. Category C involves a developing industrialized nation. In category D, developed industrialized nation are determined and separate accompanying administrative and clinical parameters bundles or checklist quality improvement recommendations are provided, requiring greater resources and tasks as resource allocation increased from groups A to D, respectively. In the vanguard phase, data for 361 children (category A, n = 34; category B, n = 12; category C, n = 84; category D, n = 231) were successfully entered, and quality-assurance reports were sent to the 23 participating international centers. Analysis of bundles for categories C and D showed that reduction in mortality was associated with compliance with the resuscitation (odds ratio, 0.369; 95% confidence interval, 0.188-0.724; p Initiative is online. Success in reducing pediatric mortality and morbidity, evaluated yearly as a measure of global child health care quality improvement, requires ongoing

  2. Preventing intensive care admissions for sepsis in tropical Africa (PICASTA): an extension of the international pediatric global sepsis initiative: an African perspective.

    Science.gov (United States)

    Pollach, Gregor; Namboya, Felix

    2013-07-01

    The Global Sepsis Initiative recommends prevention of sepsis through immunizations, vitamins, breast feeding, and other important interventions. In our study, we consider a second set of proposals for preventing intensive care admissions for sepsis in tropical Africa, which have been specifically designed to further prevent ICU admissions for sepsis in the group A nation hospital setting. To reduce admissions with severe sepsis in an ICU of a group A nation through the identification of challenges leading to preventable, foreseeable, or nosocomial sepsis specific to our setting. Malawi is one of the poorest countries in the world. Lacking the ability to comply with standard sepsis treatment, we conducted over 4 years several studies, audits, and surveys to identify challenges leading to preventable pediatric sepsis in our setting. We developed a method to identify malnourished children through a "gatekeeper" in the theaters without any equipment, tried to implement the World Health Organization's Safe Surgery Campaign checklist, evaluated our educational courses for the districts to improve the quality of referrals, looked into the extreme fasting times discovered in our hospital, trained different cadres in the districts to deal with peripartal and posttraumatic sepsis, and identified the needs in human resources to deal with pediatric sepsis in our setting. Six foci were identified as promising to work on in future. Focus 1: Preventing elective operations and procedures in malnourished children in the hospital and in the district: 134 of 145 nurses (92.4%) and even 25 of 31 African laymen (80.6%) were able to identify malnourished children with their own fingers. Focus 2: Preventing sepsis-related problems in emergencies through the implementation of the Safe Surgery Campaign checklist: only 100 of 689 forms (14.5%) were filled in due to challenges in ownership, communication responsibility, and time constraints. Focus 3: Preventing sepsis through the reduction

  3. Sepsis

    DEFF Research Database (Denmark)

    Perner, Anders; Gordon, Anthony C; De Backer, Daniel

    2016-01-01

    Sepsis is a major growing global burden and a major challenge to intensive care clinicians, researchers, guideline committee members and policy makers, because of its high and increasing incidence and great pathophysiological, molecular, genetic and clinical complexity. In spite of recent progress......, short-term mortality remains high and there is growing evidence of long-term morbidity and increased long-term mortality in survivors of sepsis both in developed and developing countries. Further improvement in the care of patients with sepsis will impact upon global health. In this narrative review...... and subsequent outcomes are to be improved in patients with sepsis....

  4. Insulin accelerates global and mitochondrial protein synthesis rates in neonatal muscle during sepsis

    Science.gov (United States)

    In neonatal pigs, sepsis decreases protein synthesis in skeletal muscle by decreasing translation initiation. However, insulin stimulates muscle protein synthesis despite persistent repression of translation initiation signaling. To determine whether the insulin-induced increase in global rates of m...

  5. Sepsis

    DEFF Research Database (Denmark)

    Perner, Anders; Rhodes, Andrew; Venkatesh, Bala

    2017-01-01

    Because of its high incidence and clinical complexity, sepsis is a major challenge to clinicians and researchers and a global burden to healthcare systems and society. Despite recent progress, short- and long-term morbidity, mortality and costs remain high in both developed and developing countri...

  6. Sepsis

    Science.gov (United States)

    ... mild sepsis, but the mortality rate for septic shock is nearly 50 percent. Also, an episode of severe sepsis may ... of Nondiscrimination Advertising Mayo Clinic is a not-for-profit organization ...

  7. Global Methane Initiative

    Science.gov (United States)

    The Global Methane Initiative promotes cost-effective, near-term methane recovery through partnerships between developed and developing countries, with participation from the private sector, development banks, and nongovernmental organizations.

  8. Paramedic-Initiated CMS Sepsis Core Measure Bundle Prior to Hospital Arrival: A Stepwise Approach.

    Science.gov (United States)

    Walchok, Jason G; Pirrallo, Ronald G; Furmanek, Douglas; Lutz, Martin; Shope, Colt; Giles, Brandi; Gue, Greta; Dix, Aaron

    2017-01-01

    To improve patient outcomes, the Center for Medicare and Medicaid Services (CMS) implemented core measures that outline the initial treatment of the septic patient. These measures include initial blood culture collection prior to antibiotics, adequate intravenous fluid resuscitation, and early administration of broad spectrum antibiotics. We sought to determine if Paramedics can initiate the CMS sepsis core measure bundle in the prehospital field reliably. This is a retrospective, case series from a 3rd service EMS system model in Greenville, South Carolina between November 17, 2014 and February 20, 2016. An adult Prehospital Sepsis Assessment Tool was created using the 2012 Surviving Sepsis guidelines: 2 of 3 signs of systemic inflammatory response (heart rate, respiratory rate, oral temperature) and a known or suspected source of infection. A "Sepsis Alert" was called by paramedics and upon IV access a set of blood cultures and blood for lactate analysis was collected prior to field antibiotic administration. The Sepsis Alert was compared to serum lactate levels and ICD 9 or 10 admitting diagnosis of Sepsis, Severe Sepsis, or Septic Shock. Blood culture contamination, serum lactate, and antibiotic match were determined by in-hospital laboratory analysis. A total of 120 trained paramedics called 1,185 "Sepsis Alerts" on 56,643 patients (50.3% Male, mean age 70). Patients with missing discharge diagnosis were eliminated (n = 31). The admitting diagnosis of sepsis overall was 73.5% (848/1154): Sepsis 50% (578/1154), Severe Sepsis 14.6% (169/1154), Septic Shock 8.9% (101/1154). A total of 946 blood cultures were collected in the prehospital setting, with a 95.04% (899/946) no contamination rate. Contamination was found in 4.96% (47/946). A total of 179 (18.9%) of the uncontaminated blood cultures were found to have positive growth with 720 (76.1%) having no growth. EMS administered antibiotics matched blood culture positive growth in 72% of patients. The lactate

  9. Implementation of an Emergency Department Sepsis Bundle and System Redesign: A Process Improvement Initiative.

    Science.gov (United States)

    McColl, Tamara; Gatien, Mathieu; Calder, Lisa; Yadav, Krishan; Tam, Ryan; Ong, Melody; Taljaard, Monica; Stiell, Ian

    2017-03-01

    In 2008-2009, the Canadian Institute for Health Information reported over 30,000 cases of sepsis hospitalizations in Canada, an increase of almost 4,000 from 2005. Mortality rates from severe sepsis and septic shock continue to remain greater than 30% in Canada and are significantly higher than other critical conditions treated in the emergency department (ED). Our group formed a multidisciplinary sepsis committee, conducted an ED process of care analysis, and developed a quality improvement protocol. The objective of this study was to evaluate the effects of this sepsis management bundle on patient mortality. This before and after study was conducted in two large Canadian tertiary care EDs and included adult patients with suspected severe infection that met at least two systemic inflammatory response syndrome (SIRS) criteria. We studied the implementation of a sepsis bundle including triage flagging, RN medical directive, education campaign, and a modified sepsis protocol. The primary outcomes were 30-day all-cause mortality and sepsis protocol use. We included a total of 167 and 185 patients in the pre- and post-intervention analysis, respectively. Compared to the pre-intervention group, mortality was significantly lower in the post-intervention group (30.7% versus 17.3%; absolute difference, 13.4%; 95% CI 9.8-17.0; p=0.006). There was also a higher rate of sepsis protocol use in the post-intervention group (20.3% versus 80.5%, absolute difference 60.2%; 95% CI 55.1-65.3; pimproved early identification and protocolized medical care, was associated with improved time to achieve key therapeutic interventions and a reduction in 30-day mortality. Similar low-cost initiatives could be implemented in other EDs to potentially improve outcomes for this high-risk group of patients.

  10. Global trends in the awareness of sepsis: insights from search engine data between 2012 and 2017.

    Science.gov (United States)

    Jabaley, Craig S; Blum, James M; Groff, Robert F; O'Reilly-Shah, Vikas N

    2018-01-17

    Sepsis is an established global health priority with high mortality that can be curtailed through early recognition and intervention; as such, efforts to raise awareness are potentially impactful and increasingly common. We sought to characterize trends in the awareness of sepsis by examining temporal, geographic, and other changes in search engine utilization for sepsis information-seeking online. Using time series analyses and mixed descriptive methods, we retrospectively analyzed publicly available global usage data reported by Google Trends (Google, Palo Alto, CA, USA) concerning web searches for the topic of sepsis between 24 June 2012 and 24 June 2017. Google Trends reports aggregated and de-identified usage data for its search products, including interest over time, interest by region, and details concerning the popularity of related queries where applicable. Outlying epochs of search activity were identified using autoregressive integrated moving average modeling with transfer functions. We then identified awareness campaigns and news media coverage that correlated with epochs of significantly heightened search activity. A second-order autoregressive model with transfer functions was specified following preliminary outlier analysis. Nineteen significant outlying epochs above the modeled baseline were identified in the final analysis that correlated with 14 awareness and news media events. Our model demonstrated that the baseline level of search activity increased in a nonlinear fashion. A recurrent cyclic increase in search volume beginning in 2012 was observed that correlates with World Sepsis Day. Numerous other awareness and media events were correlated with outlying epochs. The average worldwide search volume for sepsis was less than that of influenza, myocardial infarction, and stroke. Analyzing aggregate search engine utilization data has promise as a mechanism to measure the impact of awareness efforts. Heightened information-seeking about sepsis

  11. The global maternal sepsis study and awareness campaign (GLOSS): study protocol.

    Science.gov (United States)

    Bonet, Mercedes; Souza, Joao Paulo; Abalos, Edgardo; Fawole, Bukola; Knight, Marian; Kouanda, Seni; Lumbiganon, Pisake; Nabhan, Ashraf; Nadisauskiene, Ruta; Brizuela, Vanessa; Metin Gülmezoglu, A

    2018-01-30

    Maternal sepsis is the underlying cause of 11% of all maternal deaths and a significant contributor to many deaths attributed to other underlying conditions. The effective prevention, early identification and adequate management of maternal and neonatal infections and sepsis can contribute to reducing the burden of infection as an underlying and contributing cause of morbidity and mortality. The objectives of the Global Maternal Sepsis Study (GLOSS) include: the development and validation of identification criteria for possible severe maternal infection and maternal sepsis; assessment of the frequency of use of a core set of practices recommended for prevention, early identification and management of maternal sepsis; further understanding of mother-to-child transmission of bacterial infection; assessment of the level of awareness about maternal and neonatal sepsis among health care providers; and establishment of a network of health care facilities to implement quality improvement strategies for better identification and management of maternal and early neonatal sepsis. This is a facility-based, prospective, one-week inception cohort study. This study will be implemented in health care facilities located in pre-specified geographical areas of participating countries across the WHO regions of Africa, Americas, Eastern Mediterranean, Europe, South East Asia, and Western Pacific. During a seven-day period, all women admitted to or already hospitalised in participating facilities with suspected or confirmed infection during any stage of pregnancy through the 42nd day after abortion or childbirth will be included in the study. Included women will be followed during their stay in the facilities until hospital discharge, death or transfer to another health facility. The maximum intra-hospital follow-up period will be 42 days. GLOSS will provide a set of actionable criteria for identification of women with possible severe maternal infection and maternal sepsis. This study

  12. Global nuclear cleanout initiative 2004

    International Nuclear Information System (INIS)

    Edlow, J.; Gruber, G.

    2004-01-01

    Full text: During more than 50 years of Atoms for Peace programmes nuclear materials were spread out worldwide. Stranded nuclear materials from nuclear research are left over without any safe back-end solution. 'Dirty Bombs' or so-called 'Radioactive Dispersal Devices (RDD)' are no longer science fiction since the world experienced the 9/11 attack. Governmental, NGO's and private industry organizations having discussed Global Nuclear Cleanout since then and start to take actions. The US Department of Energy (DOE) has announced to establish a dedicated organization in cooperation with IAEA and start the 'Global Threat Reduction Initiative (GTRI)'. The US government will allocate to that program USD 450 M over the next 10 years. Besides the historical development the paper will focus on the progress of the different initiatives and perspectives to threat reduction. (author)

  13. Global threat reduction initiative (GTRI)

    International Nuclear Information System (INIS)

    Chamberlain, Travis

    2009-01-01

    The Global Threat Reduction Initiative (GTRI) is a vital part of the global efforts to combat nuclear terrorism. GTRI's unique mission to reduce and protect vulnerable nuclear and radiological material located at civilian sites both in the United States and abroad directly addresses recommendations of the bipartisan 9/11 Commission. GTRI efforts are focused on the first line of defense, namely securing or removing vulnerable nuclear and radiological material at the source. The international community has promulgated guidance on the best practice on the technical and administrative aspects of radiological source security, and the GTRI seeks to provide technical assistance to national bodies and individual facilities to adopt this best practice. This presentation will discuss security concepts that are implemented by the GTRI in cooperation with the Australian Nuclear Science and Technology Organization's Regional Security of Radioactive Sources Project. (author)

  14. Impact of an electronic sepsis initiative on antibiotic use and health care facility-onset Clostridium difficile infection rates.

    Science.gov (United States)

    Hiensch, Robert; Poeran, Jashvant; Saunders-Hao, Patricia; Adams, Victoria; Powell, Charles A; Glasser, Allison; Mazumdar, Madhu; Patel, Gopi

    2017-10-01

    Although integrated, electronic sepsis screening and treatment protocols are thought to improve patient outcomes, less is known about their unintended consequences. We aimed to determine if the introduction of a sepsis initiative coincided with increases in broad-spectrum antibiotic use and health care facility-onset (HCFO) Clostridium difficile infection (CDI) rates. We used interrupted time series data from a large, tertiary, urban academic medical center including all adult inpatients on 4 medicine wards (June 2011-July 2014). The main exposure was implementation of the sepsis screening program; the main outcomes were the use of broad-spectrum antibiotics (including 3 that were part of an order set designed for the sepsis initiative) and HCFO CDI rates. Segmented regression analyses compared outcomes in 3 time segments: before (11 months), during (14 months), and after (12 months) implementation of a sepsis initiative. Antibiotic use and HFCO CDI rates increased during the period of implementation and the period after implementation compared with baseline; these increases were highest in the period after implementation (level change, 50.4 days of therapy per 1,000 patient days for overall antibiotic use and 10.8 HCFO CDIs per 10,000 patient days; P antibiotic use were not those included in the sepsis order set. The implementation of an electronic sepsis screening and treatment protocol coincided with increased broad-spectrum antibiotic use and HCFO CDIs. Because these protocols are increasingly used, further study of their unintended consequences is warranted. Copyright © 2017 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

  15. Streptococcus pneumoniae sepsis as the initial presentation of systemic lupus erythematosus

    Directory of Open Access Journals (Sweden)

    Erdem I

    2016-09-01

    Full Text Available Ilknur Erdem,1 Senay Elbasan Omar,1 Ridvan Kara Ali,1 Hayati Gunes,2 Aynur Eren Topkaya2 1Department of Infectious Diseases, 2Department of Medical Microbiology, Faculty of Medicine, Namik Kemal University, Tekirdag, Turkey Objective: Infections are among the most important causes of morbidity and mortality in patients with systemic lupus erythematosus (SLE but are rare initial presentation of the disease. Therefore, in this study, we describe a case of Streptococcus pneumoniae sepsis in a young woman with previously undiagnosed SLE. Case report: A 23-year-old female patient was admitted to our outpatient clinic complaining of high fever (40°C, chills, fatigue, generalized myalgia, and cough with brown sputum for 5 days. Blood cultures grew gram-positive coccus defined as S. pneumoniae using standard procedures. Antinuclear antibody was positive at a titer of 1/1,000, and anti-double-stranded DNA was positive at 984 IU/mL. She was diagnosed with SLE. Her respiratory symptoms and pleural effusion were considered to be due to pulmonary manifestation of SLE. Conclusion: The underlying immunosuppression caused by SLE could have predisposed the patient to invasive pneumococcal disease. It may also occur as a primary presenting feature, although a rare condition. Keywords: Streptococcus pneumoniae, sepsis, systemic lupus erythematosus

  16. Feasibility and efficacy of sepsis management guidelines in a pediatric intensive care unit in Saudi Arabia: a quality improvement initiative.

    Science.gov (United States)

    Hasan, Gamal M; Al-Eyadhy, Ayman A; Temsah, Mohamed-Hani A; Al-Haboob, Ali A; Alkhateeb, Mohammad A; Al-Sohime, Fahad

    2018-04-25

    Evaluation of feasibility and effectiveness of Surviving Sepsis Campaign (SSC) Guidelines implementation at a Pediatric Intensive Care Unit (PICU) in Saudi Arabia to reduce severe sepsis associated mortality. Retrospective data analysis for a prospective quality improvement (QI) initiative. PICU at King Saud University Medical City, Saudi Arabia. Children ≤14 years of age admitted to the PICU from July 2010 to March 2011 with suspected or proven sepsis. Comparisons were made to a previously admitted group of patients with sepsis from October 2009 to June 2010. Adaptation and implementation of the Surviving Sepsis Campaign-Clinical Practice Guidelines (SSC-CPGs) through AGREE instrument and ADAPTE process. We reported pre- and post-implementation outcome of interest for this QI initiative, annual sepsis-related mortality rate. Furthermore, we reported follow-up of annual mortality rate until December 2016. Sixty-five patients was included in the study (42 in post-guidelines implementation group and 23 in pre-guidelines implementation group). Mortality was insignificantly lower in the post-implementation group (26.2% vs. 47.8%; P = 0.079). However, when adjusted for severity, identified by number of failing organs in the multivariate regression analysis, the mortality difference was favorable for the post-implementation group (P = 0.006). The lower sepsis-related mortality rate was also sustained, with an average mortality rate of 15.11% for the subsequent years (2012-16). Adaptation and implementation of SSC Guidelines in our setting support its feasibility and potential benefits. However, a larger study is recommended to explore detailed compliance rates.

  17. Global Longitudinal Strain Using Speckle-Tracking Echocardiography as a Mortality Predictor in Sepsis: A Systematic Review.

    Science.gov (United States)

    Vallabhajosyula, Saraschandra; Rayes, Hamza A; Sakhuja, Ankit; Murad, Mohammad Hassan; Geske, Jeffrey B; Jentzer, Jacob C

    2018-01-01

    The data on speckle-tracking echocardiography (STE) in patients with sepsis are limited. This systematic review from 1975 to 2016 included studies in adults and children evaluating cardiovascular dysfunction in sepsis, severe sepsis, and septic shock utilizing STE for systolic global longitudinal strain (GLS). The primary outcome was short- or long-term mortality. Given the significant methodological and statistical differences between published studies, combining the data using meta-analysis methods was not appropriate. A total of 120 studies were identified, with 5 studies (561 patients) included in the final analysis. All studies were prospective observational studies using the 2001 criteria for defining sepsis. Three studies demonstrated worse systolic GLS to be associated with higher mortality, whereas 2 did not show a statistically significant association. Various cutoffs between -10% and -17% were used to define abnormal GLS across studies. This systematic review revealed that STE may predict mortality in patients with sepsis; however, the strength of evidence is low due to heterogeneity in study populations, GLS technologies, cutoffs, and timing of STE. Further dedicated studies are needed to understand the optimal application of STE in patients with sepsis.

  18. An Endotoxin Tolerance Signature Predicts Sepsis and Organ Dysfunction at Initial Clinical Presentation

    Directory of Open Access Journals (Sweden)

    Olga M. Pena

    2014-11-01

    Interpretation: Our data support an updated model of sepsis pathogenesis in which endotoxin tolerance-mediated immune dysfunction (cellular reprogramming is present throughout the clinical course of disease and related to disease severity. Thus endotoxin tolerance might offer new insights guiding the development of new therapies and diagnostics for early sepsis.

  19. Global Peace Operations Initiative (GPOI)

    National Research Council Canada - National Science Library

    Kim-Mitchell, Elena

    2005-01-01

    .... In terms of manpower, the initiative aims at deploying 75,000 peace support operations (PSO) troops worldwide over the next 5 years, primarily to Africa, but also to Latin America, Europe, and Asia...

  20. Initiation to global Finslerian geometry

    CERN Document Server

    Akbar-Zadeh, Hassan

    2006-01-01

    After a brief description of the evolution of thinking on Finslerian geometry starting from Riemann, Finsler, Berwald and Elie Cartan, the book gives a clear and precise treatment of this geometry. The first three chapters develop the basic notions and methods, introduced by the author, to reach the global problems in Finslerian Geometry. The next five chapters are independent of each other, and deal with among others the geometry of generalized Einstein manifolds, the classification of Finslerian manifolds of constant sectional curvatures. They also give a treatment of isometric, affine, p

  1. Initial management of pneumonia and sepsis: factors associated with improved outcome.

    Science.gov (United States)

    Menéndez, R; Torres, A; Reyes, S; Zalacain, R; Capelastegui, A; Aspa, J; Borderías, L; Martín-Villasclaras, J J; Bello, S; Alfageme, I; de Castro, F R; Rello, J; Molinos, L; Ruiz-Manzano, J

    2012-01-01

    Processes of care and adherence to guidelines have been associated with improved survival in community-acquired pneumonia (CAP). In sepsis, bundles of processes of care have also increased survival. We aimed to audit compliance with guideline-recommended processes of care and its impact on outcome in hospitalised CAP patients with sepsis. We prospectively studied 4,137 patients hospitalised with CAP in 13 hospitals. The processes of care evaluated were adherence to antibiotic prescription guidelines, first dose within 6 h and oxygen assessment. Outcome measures were mortality and length of stay (LOS). Oxygen assessment was measured in 3,745 (90.5%) patients; 3,024 (73.1%) patients received antibiotics according to guidelines and 3,053 (73.8%) received antibiotics within 6 h. In CAP patients with sepsis, the strongest independent factor for survival was antibiotic adherence (OR 0.4). In severe sepsis, only compliance to antibiotic adherence plus first dose within 6 h was associated with lower mortality (OR 0.60), adjusted for fine prognostic scale and hospital. Antibiotic adherence was related to shorter hospital stay. In sepsis, antibiotic adherence is the strongest protective factor of care associated with survival and LOS. In severe sepsis, combined antibiotic adherence and first dose within 6 h may reduce mortality.

  2. IKEA: Global sourcing and sustainable leather initiatives

    OpenAIRE

    Jiang, Yan; Jia, Fu; Gong, Yu

    2018-01-01

    Aims: the aim of this teaching case is to illustrate the Sustainable Global Sourcing (SGS) practices of IKEA influenced by its Global Sourcing (GS) strategy and structure aspects through a case study of the sustainable leather initiative.Scope: this study is developed though 20 face-to-face interviews with IKEA managers in both Sweden and China, covering all the major SGS-related departments i.e. purchasing,sustainability, IWAY, and competence center (sustainable project team).Contribution: w...

  3. Global initiatives to prevent nuclear terrorism

    International Nuclear Information System (INIS)

    2010-01-01

    The fight against nuclear and radiological terrorism - someone to blow up a nuclear weapon or spread radioactive material as a 'dirty bomb' that act of terrorism - is one of the most serious threats to international security. The Global Initiative to prevent nuclear terrorism is a Norwegian-sponsored initiative that is aimed directly at combating terrorism by non-state actors. NRPA follow up Norwegian measures, including in Kazakhstan, and verifies that they are implemented and functioning as intended. (AG)

  4. A metadata initiative for global information discovery

    Science.gov (United States)

    Christian, E.

    2001-01-01

    The Global Information Locator Service (GILS) encompasses a global vision framed by the fundamental values of open societies. Societal values such as a free flow of information impose certain requirements on the society's information infrastructure. These requirements in turn shape the various laws, policies, standards, and technologies that determine the infrastructure design. A particular focus of GILS is the requirement to provide the means for people to discover sources of data and information. Information discovery in the GILS vision is designed to be decentralized yet coherent, and globally comprehensive yet useful for detailed data. This article introduces basic concepts and design issues, with emphasis on the techniques by which GILS supports interoperability. It explains the practical implications of GILS for the common roles of organizations involved in handling information, from content provider through system engineer and intermediary to searcher. The article provides examples of GILS initiatives in various types of communities: bibliographic, geographic, environmental, and government. ?? 2001 Elsevier Science Inc.

  5. Sepsis and mechnaical ventilation restrain translation initiation in skeletal muscle by inducing AMPK-associated TSC[2] restriction of mTOR signaling in pigs

    Science.gov (United States)

    In skeletal muscle, AMP-activated protein kinase (AMPK) acts as a cellular energy sensor of AMP: ATP and modulates translation by repressing mammalian target of rapamycin (mTOR) activation. Endotoxin (LPS)-induced sepsis reduces muscle protein synthesis by blunting translation initiation. We hypothe...

  6. Subsidiary-level determinants of global initiatives in multinational corporations

    NARCIS (Netherlands)

    Williams, C.

    2009-01-01

    This article examines subsidiary-level factors that promote global initiatives in MNCs. Global initiatives are a key capability of MNCs that domestic firms do not possess, yet there has been little research on how MNCs promote initiatives on a global basis. I draw principally on the knowledge-based

  7. Making a Difference: a Global Geoscience Initiative

    Science.gov (United States)

    Nickless, E.

    2013-05-01

    Since 2009, an informal group, comprising four former board members of the International Year of Planet Earth, has been promoting the concept of a so-called Global Geoscientific Initiative. The GGI should: i.Be inclusive, involve a geoscience community, which is broad both in terms of discipline and nationality, and involve the social sciences; ii.Have a clear socio-economic context and global societal relevance; iii.Focus on a globally significant science theme and preferably involve global processes; iv.Attract the support of geoscientific communities, funding agencies, governments and other institutions in many countries, under the umbrella of UNESCO, ICSU and its geoscientific unions. A series of five town hall meetings have been held at which usually three invited, well-respected figures from the geoscientific community gave presentations. Those presentations were followed by discussion about the importance or otherwise of particular areas of science, and the need to engage better with legislators, policy makers, the media and the lay public. No one challenged the desirability of a large-scale programme that would attract researchers from many geoscientific disciplines and potentially involve the geo-unions. The discussions can be summarised under three broad themes: i.Mineral and hydrocarbon resources and their waste products; ii.Living with natural hazards; iii.Strategic Earth science in Africa through the Africa Alive corridors. During the course of development of the GGI, ICSU has issued a number of papers, most recently a strategic plan, covering the period 2012-2017, working parties have been undertaking foresight analysis and there have also been discussions concerning regional environmental change: human action and adaptation with the question "what does it take to meet the Belmont challenge?". The Belmont Forum brings together a number of funding agencies and could provide the resource to enable some initiative to go forward. More recently a programme

  8. Global Awareness in the Classroom: Global Classroom Initiative

    Science.gov (United States)

    Education Canada, 2004

    2004-01-01

    As countries around the world move toward global integration, knowledge of how Canada interrelates globally is becoming an increasingly useful asset. It is important that young Canadians learn what it means to become responsible global citizens. Awareness about global issues and appreciation of Canada's efforts in international development offer a…

  9. Novel biomarkers for sepsis

    DEFF Research Database (Denmark)

    Larsen, Frederik Fruergaard; Petersen, J Asger

    2017-01-01

    BACKGROUND: Sepsis is a prevalent condition among hospitalized patients that carries a high risk of morbidity and mortality. Rapid recognition of sepsis as the cause of deterioration is desirable, so effective treatment can be initiated rapidly. Traditionally, diagnosis was based on presence of two...... or more positive SIRS criteria due to infection. However, recently published sepsis-3 criteria put more emphasis on organ dysfunction caused by infection in the definition of sepsis. Regardless of this, no gold standard for diagnosis exist, and clinicians still rely on a number of traditional and novel...... biomarkers to discriminate between patients with and without infection, as the cause of deterioration. METHOD: Narrative review of current literature. RESULTS: A number of the most promising biomarkers for diagnoses and prognostication of sepsis are presented. CONCLUSION: Procalcitonin, presepsin, CD64, su...

  10. Quality Improvement Initiatives in Sepsis in an Emerging Country: Does the Institution's Main Source of Income Influence the Results? An Analysis of 21,103 Patients.

    Science.gov (United States)

    Machado, Flavia R; Ferreira, Elaine M; Sousa, Juliana Lubarino; Silva, Carla; Schippers, Pierre; Pereira, Adriano; Cardoso, Ilusca M; Salomão, Reinaldo; Japiassu, Andre; Akamine, Nelson; Mazza, Bruno F; Assunção, Murillo S C; Fernandes, Haggeas S; Bossa, Aline; Monteiro, Mariana B; Caixeita, Noemi; Azevedo, Luciano C P; Silva, Eliezer

    2017-10-01

    We aimed to assess the results of a quality improvement initiative in sepsis in an emerging setting and to analyze it according to the institutions' main source of income (public or private). Retrospective analysis of the Latin American Sepsis Institute database from 2005 to 2014. Brazilian public and private institutions. Patients with sepsis admitted in the participant institutions. The quality improvement initiative was based on a multifaceted intervention. The institutions were instructed to collect data on 6-hour bundle compliance and outcomes in patients with sepsis in all hospital settings. Outcomes and compliance was measured for eight periods of 6 months each, starting at the time of the enrollment in the intervention. The primary outcomes were hospital mortality and compliance with 6-hour bundle. We included 21,103 patients; 9,032 from public institutions and 12,071 from private institutions. Comparing the first period with the eigth period, compliance with the 6-hour bundle increased from 13.5% to 58.2% in the private institutions (p < 0.0001) and from 7.4% to 15.7% in the public institutions (p < 0.0001). Mortality rates significantly decreased throughout the program in private institutions, from 47.6% to 27.2% in the eighth period (adjusted odds ratio, 0.45; 95% CI, 0.32-0.64). However, in the public hospitals, mortality diminished significantly only in the first two periods. This quality improvement initiative in sepsis in an emerging country was associated with a reduction in mortality and with improved compliance with quality indicators. However, this reduction was sustained only in private institutions.

  11. NASA NDATC Global Climate Change Education Initiative

    Science.gov (United States)

    Bennett, B.; Wood, E.; Meyer, D.; Maynard, N.; Pandya, R. E.

    2009-12-01

    This project aligns with NASA’s Strategic Goal 3A - “Study Earth from space to advance scientific understanding and meet societal needs and focuses on funding from the GCCE Funding Category 2: Strengthen the Teaching and Learning About Global Climate Change Within Formal Education Systems. According to the Intergovernmental Panel on Climate Change Report (2007) those communities with the least amount of resources will be most vulnerable, and least likely to adapt to the impacts brought on by a changing climate. Further, the level of vulnerability of these communities is directly correlated with their ability to implement short, medium and long range mitigation measures. The North Dakota Association of Tribal Colleges (NDATC) has established a climate change education initiative among its six member Tribal Colleges and Universities (TCUs). The goal of this project is to enhance the TCUs capacity to educate their constituents on the science of climate change and mitigation strategies specifically as they apply to Indian Country. NDATC is comprised of six American Indian tribally chartered colleges (TCUs) which include: Cankdeska Cikana Community College, serving the Spirit Lake Dakota Nation; Fort Berthold Community College, serving the Mandan, Hidatsa, and Arikara Nation; Sitting Bull College, serving the Hunkpapa Lakota and Dakota Nation; Turtle Mountain Community College, serving the Turtle Mountain Band of Chippewa; Sisseton Wahpeton College serving the Sisseton and Wahpeton Dakota Nation, and United Tribes Technical College, serving over 70 Tribal groups from across the United States. The purpose of this project is to (1) increase awareness of climate change and its potential impacts in Indian Country through education for students, faculty and presidents of the TCUs as well as Tribal leadership; (2) increase the capacity of TCUs to respond to this global threat on behalf of tribal people; (3) develop climate change mitigation strategies relevant to Indian

  12. Global initiatives to mitigate greenhouse gas emissions

    International Nuclear Information System (INIS)

    Helme, N.; Gille, J.A.

    1994-01-01

    Joint implementation (JI) is a provision, included in the Framework Convention on Climate Change, that allows for two or more nations to jointly plan and implement a greenhouse gas or offsetting project. Joint implementation is important environmentally for two principal reasons: (1) it provides an opportunity to select projects on a global basis that maximize both greenhouse gas reduction benefits and other environmental benefits such as air pollution reduction while minimizing cost, and (2) it creates incentives for developing countries as well as multinational companies to begin to evaluate potential investments through a climate-friendly lens. While the debate on how to establish the criteria and institutional capacity necessary to encourage joint implementation projects continues in the international community, the US government is creating new incentives for US companies to develop joint implementation pilot projects now. While delegates to the United Nations' International Negotiating Committee (INC) debate whether to permit all Parties to the convention to participate in JI, opportunities in Eastern and Central Europe and the former Soviet states abound. The US has taken a leadership role in joint implementation, establishing two complementary domestic programs that allow US companies to measure, track and score their net greenhouse gas reduction achievements now. With a financial investment by three US utilities, the Center for Clean Air Policy is developing a fuel-switching and energy efficiency project in the city of Decin in the Czech Republic which offers a concrete example of what a real-world JI project could look like. The Decin project provides an ideal test case for assessing the adequacy and potential impact of the draft criteria for the US Initiative on Joint Implementation, as well as for the draft criteria prepared by the INC Secretariat

  13. For a Global HTR Marketing Initiative

    International Nuclear Information System (INIS)

    Bredimas, Alexandre; Venneri, Francesco; Richards, Matthew

    2014-01-01

    HTRs are at a crossroads in their history. The technology is proven and the current technical developments relatively mastered but the marketing track record is disappointing. This paper comes to the conclusion that an international, collaborative marketing and communication plan must be implemented in order to address the marketing bottleneck of HTRs. The paper reflects about the HTR product specificities, its unique selling points and its positioning against other nuclear designs and gas cogeneration. It summarises the global market status and demonstrates that the global market for HTRs is there, for electricity generation, industrial cogeneration and polygeneration. The paper finally argues that HTR vendors have a shared interest to unite in order to succeed in activating the market demand for HTR, and suggests an action plan for an international collaboration among HTR vendors to market and communicate globally on HTRs and reach together a critical mass of business leads worldwide, a mutually beneficial outcome. (author)

  14. Global Explorers Journaling and Reflection Initiative

    Directory of Open Access Journals (Sweden)

    John Bennion

    2016-12-01

    Full Text Available Research suggests that journaling will increase reflection and improve program outcomes (Bain, et al, 1999; Duerden, et al, 2012 This study involved a partnership with a non-profit, Global Explorers (GEx, which provides international immersion experiences for youth. Their programs are designed to teach youth participants principles of leadership, environmental awareness, service, and science. This study, which tested whether teaching journaling techniques to youth program facilitators would have a positive impact on participant outcomes, addressed the following hypotheses: 1 Greater training in reflective thinking among participants would be associated with higher outcome scores, and 2 Participants in the intervention group (facilitators trained in journaling pedagogy would show greater increases in reflective thinking than comparison group members. Results based on participant self-assessment were significant in testing the first hypothesis; reflective thinking is positively associated with outcome measures, but the intervention group did not show increases in reflective thinking.

  15. Think Globally, Act Locally -- Global Maritime Partnership Initiative and the Necessity for Cooperation and Coalition

    National Research Council Canada - National Science Library

    Reller, Jason S

    2008-01-01

    ... to "police the global commons and suppress common threats." The Global Maritime Partnership Initiative, or GMPI, is intended to play a major role in this effort as one embodiment of the cooperation envisioned...

  16. What?s New in Paediatric Sepsis

    OpenAIRE

    Farrell, Deborah; Nadel, Simon

    2016-01-01

    Severe sepsis and septic shock remains a leading cause of mortality and morbidity in children. There is ongoing uncertainty regarding the optimal treatment pathways however the initial management of sepsis is crucial. This article is designed to be an informal and personal review of recent developments in paediatric sepsis over the past 3?years.

  17. Global polio eradication initiative: lessons learned and legacy.

    Science.gov (United States)

    Cochi, Stephen L; Freeman, Andrew; Guirguis, Sherine; Jafari, Hamid; Aylward, Bruce

    2014-11-01

    The world is on the verge of achieving global polio eradication. During >25 years of operations, the Global Polio Eradication Initiative (GPEI) has mobilized and trained millions of volunteers, social mobilizers, and health workers; accessed households untouched by other health initiatives; mapped and brought health interventions to chronically neglected and underserved communities; and established a standardized, real-time global surveillance and response capacity. It is important to document the lessons learned from polio eradication, especially because it is one of the largest ever global health initiatives. The health community has an obligation to ensure that these lessons and the knowledge generated are shared and contribute to real, sustained changes in our approach to global health. We have summarized what we believe are 10 leading lessons learned from the polio eradication initiative. We have the opportunity and obligation to build a better future by applying the lessons learned from GPEI and its infrastructure and unique functions to other global health priorities and initiatives. In so doing, we can extend the global public good gained by ending for all time one of the world's most devastating diseases by also ensuring that these investments provide public health dividends and benefits for years to come. Published by Oxford University Press on behalf of the Infectious Diseases Society of America 2014. This work is written by (a) US Government employee(s) and is in the public domain in the US.

  18. Responding to Globalization and Urban Conflict: Human Rights City Initiatives

    OpenAIRE

    Jackie Smith

    2018-01-01

    Expanding globalization and urbanization have intensified the threats to human rights for many vulnerable groups and have restricted resources available to the primary guarantors of these rights—local authorities. Human rights cities initiatives are bottom-up efforts to advance human rights implementation in local contexts. They are emerging around the world in response to the global pressures on cities that intensify urban inequality and conflict. In this article I discuss how global changes...

  19. WHO Initiative to Estimate the Global Burden of Foodborne Diseases

    DEFF Research Database (Denmark)

    Havelaar, Arie H.; Cawthorne, Amy; Angulo, Fred

    2013-01-01

    BackgroundThe public health impact of foodborne diseases globally is unknown. The WHO Initiative to Estimate the Global Burden of Foodborne Diseases was launched out of the need to fill this data gap. It is anticipated that this effort will enable policy makers and other stakeholders to set...... appropriate, evidence-informed priorities in the area of food safety. MethodsThe Initiative aims to provide estimates on the global burden of foodborne diseases by age, sex, and region; strengthen country capacity for conducting burden of foodborne disease assessments in parallel with food safety policy...

  20. On global error estimation and control for initial value problems

    NARCIS (Netherlands)

    J. Lang (Jens); J.G. Verwer (Jan)

    2007-01-01

    textabstractThis paper addresses global error estimation and control for initial value problems for ordinary differential equations. The focus lies on a comparison between a novel approach based onthe adjoint method combined with a small sample statistical initialization and the classical approach

  1. On global error estimation and control for initial value problems

    NARCIS (Netherlands)

    Lang, J.; Verwer, J.G.

    2007-01-01

    Abstract. This paper addresses global error estimation and control for initial value problems for ordinary differential equations. The focus lies on a comparison between a novel approach based on the adjoint method combined with a small sample statistical initialization and the classical approach

  2. Sepsis (For Parents)

    Science.gov (United States)

    ... Staying Safe Videos for Educators Search English Español Sepsis KidsHealth / For Parents / Sepsis What's in this article? ... When to Call the Doctor Print What Is Sepsis? Sepsis is when the immune system responds to ...

  3. Role of microRNAs in sepsis.

    Science.gov (United States)

    Kingsley, S Manoj Kumar; Bhat, B Vishnu

    2017-07-01

    MicroRNAs have been found to be of high significance in the regulation of various genes and processes in the body. Sepsis is a serious clinical problem which arises due to the excessive host inflammatory response to infection. The non-specific clinical features and delayed diagnosis of sepsis has been a matter of concern for long time. MicroRNAs could enable better diagnosis of sepsis and help in the identification of the various stages of sepsis. Improved diagnosis may enable quicker and more effective treatment measures. The initial acute and transient phase of sepsis involves excessive secretion of pro-inflammatory cytokines which causes severe damage. MicroRNAs negatively regulate the toll-like receptor signaling pathway and regulate the production of inflammatory cytokines during sepsis. Likewise, microRNAs have shown to regulate the vascular barrier and endothelial function in sepsis. They are also involved in the regulation of the apoptosis, immunosuppression, and organ dysfunction in later stages of sepsis. Their importance at various levels of the pathophysiology of sepsis has been discussed along with the challenges and future perspectives. MicroRNAs could be key players in the diagnosis and staging of sepsis. Their regulation at various stages of sepsis suggests that they may have an important role in altering the outcome associated with sepsis.

  4. The Global Reporting Initiative: What Value is Added?

    OpenAIRE

    W. Richard Sherman

    2011-01-01

    This paper explores the extent to which the Global Reporting Initiative G3 Reporting Framework adds value to the external reporting of a companys financial, environmental and social performance. This inquiry takes the form of analyzing the content of the published sustainability reports of well-known companies to compare and contrast the information communicated in these reports.

  5. Global peatland initiation driven by regionally asynchronous warming.

    Science.gov (United States)

    Morris, Paul J; Swindles, Graeme T; Valdes, Paul J; Ivanovic, Ruza F; Gregoire, Lauren J; Smith, Mark W; Tarasov, Lev; Haywood, Alan M; Bacon, Karen L

    2018-05-08

    Widespread establishment of peatlands since the Last Glacial Maximum represents the activation of a globally important carbon sink, but the drivers of peat initiation are unclear. The role of climate in peat initiation is particularly poorly understood. We used a general circulation model to simulate local changes in climate during the initiation of 1,097 peatlands around the world. We find that peat initiation in deglaciated landscapes in both hemispheres was driven primarily by warming growing seasons, likely through enhanced plant productivity, rather than by any increase in effective precipitation. In Western Siberia, which remained ice-free throughout the last glacial period, the initiation of the world's largest peatland complex was globally unique in that it was triggered by an increase in effective precipitation that inhibited soil respiration and allowed wetland plant communities to establish. Peat initiation in the tropics was only weakly related to climate change, and appears to have been driven primarily by nonclimatic mechanisms such as waterlogging due to tectonic subsidence. Our findings shed light on the genesis and Holocene climate space of one of the world's most carbon-dense ecosystem types, with implications for understanding trajectories of ecological change under changing future climates.

  6. Leadership Development Initiative: Growing Global Leaders… Advancing Palliative Care.

    Science.gov (United States)

    Ferris, Frank D; Moore, Shannon Y; Callaway, Mary V; Foley, Kathleen M

    2018-02-01

    The International Palliative Care Leadership Development Initiative (LDI) was a model demonstration project that aimed to expand the global network of palliative care leaders in low- and moderate-resource countries who are well positioned to apply their new leadership skills. Thirty-nine palliative medicine physicians from 25 countries successfully completed the two-year curriculum that included three thematic residential courses, mentorship, and site visits by senior global palliative care leaders and personal projects to apply their new leadership skills. The focus on self-reflection, leadership behaviors and practices, strategic planning, high-level communication, and teaching skills led to significant personal and professional transformation among the participants, mentors, and the LDI team. The resulting residential course curriculum and the personal leadership stories and biosketches of the leaders are now available open access at IPCRC.net. Already, within their first-year postgraduation, the leaders are using their new leadership skills to grow palliative care capacity through significant changes in policy, improved opioid/other medication availability, new and enhanced educational curricula and continuing education activities, and development/expansion of palliative care programs in their organizations and regions. We are not aware of another palliative care initiative that achieves the global reach and ripple effect that LDI has produced. Copyright © 2017 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

  7. Sepsis-Induced Cardiomyopathy: Mechanisms and Treatments

    Directory of Open Access Journals (Sweden)

    Yan-Cun Liu

    2017-08-01

    Full Text Available Sepsis is a lethal syndrome with a high incidence and a weighty economy burden. The pathophysiology of sepsis includes inflammation, immune dysfunction, and dysfunction of coagulation, while sepsis-induced cardiomyopathy (SIC, defined as a global but reversible dysfunction of both sides of the heart induced by sepsis, plays a significant role in all of the aspects above in the pathogenesis of sepsis. The complex pathogenesis of SIC involves a combination of dysregulation of inflammatory mediators, mitochondrial dysfunction, oxidative stress, disorder of calcium regulation, autonomic nervous system dysregulation, and endothelial dysfunction. The treatments for SIC include the signal pathway intervention, Chinese traditional medicine, and other specific therapy. Here, we reviewed the latest literatures on the mechanisms and treatments of SIC and hope to provide further insights to researchers and create a new road for the therapy of sepsis.

  8. Global health initiative investments and health systems strengthening: a content analysis of global fund investments

    OpenAIRE

    Warren, Ashley E; Wyss, Kaspar; Shakarishvili, George; Atun, Rifat; de Savigny, Don

    2013-01-01

    Background: Millions of dollars are invested annually under the umbrella of national health systems strengthening. Global health initiatives provide funding for low- and middle-income countries through disease-oriented programmes while maintaining that the interventions simultaneously strengthen systems. However, it is as yet unclear which, and to what extent, system-level interventions are being funded by these initiatives, nor is it clear how much funding they allocate to disease-specific a...

  9. The Global Polio Eradication Initiative (GPEI) in Pakistan.

    Science.gov (United States)

    Nadeem, Nighat Jahan

    2016-11-01

    The Global Polio Eradication Initiative (GPEI) has significantly reduced the worldwide incidence of poliomyelitis. However, polio remains endemic in Pakistan which poses a threat to the success of the GPEI. Issues faced by Pakistan relate to politics, terrorism, war, natural disasters, funding constraints, misconceptions and inadequate infrastructure. These contribute in hampering the aims of the GPEI and allow the deadly poliovirus to maintain its reservoir in Pakistan. Until polio is completely eradicated, all countries remain at risk of its re-emergence and this is of grave concern as potentially it could reverse the polio-free certified status of a whole World Health Organisation (WHO) region. With the increase in global travel and international migration, even the smallest potential risk should not be taken lightly. Recommendations are made to help to improve the state of polio in Pakistan to make full use of the GPEI investment and move towards a polio-free world.

  10. Sulfur dioxide initiates global climate change in four ways

    International Nuclear Information System (INIS)

    Ward, Peter L.

    2009-01-01

    Global climate change, prior to the 20th century, appears to have been initiated primarily by major changes in volcanic activity. Sulfur dioxide (SO 2 ) is the most voluminous chemically active gas emitted by volcanoes and is readily oxidized to sulfuric acid normally within weeks. But trace amounts of SO 2 exert significant influence on climate. All major historic volcanic eruptions have formed sulfuric acid aerosols in the lower stratosphere that cooled the earth's surface ∼ 0.5 o C for typically three years. While such events are currently happening once every 80 years, there are times in geologic history when they occurred every few to a dozen years. These were times when the earth was cooled incrementally into major ice ages. There have also been two dozen times during the past 46,000 years when major volcanic eruptions occurred every year or two or even several times per year for decades. Each of these times was contemporaneous with very rapid global warming. Large volumes of SO 2 erupted frequently appear to overdrive the oxidizing capacity of the atmosphere resulting in very rapid warming. Such warming and associated acid rain becomes extreme when millions of cubic kilometers of basalt are erupted in much less than one million years. These are the times of the greatest mass extinctions. When major volcanic eruptions do not occur for decades to hundreds of years, the atmosphere can oxidize all pollutants, leading to a very thin atmosphere, global cooling and decadal drought. Prior to the 20th century, increases in atmospheric carbon dioxide (CO 2 ) followed increases in temperature initiated by changes in SO 2 . By 1962, man burning fossil fuels was adding SO 2 to the atmosphere at a rate equivalent to one 'large' volcanic eruption each 1.7 years. Global temperatures increased slowly from 1890 to 1950 as anthropogenic sulfur increased slowly. Global temperatures increased more rapidly after 1950 as the rate of anthropogenic sulfur emissions increased. By

  11. Global initiatives to tackle organ trafficking and transplant tourism.

    Science.gov (United States)

    Bagheri, Alireza; Delmonico, Francis L

    2013-11-01

    The increasing gap between organ supply and demand has opened the door for illegal organ sale, trafficking of human organs, tissues and cells, as well as transplant tourism. Currently, underprivileged and vulnerable populations in resource-poor countries are a major source of organs for rich patient-tourists who can afford to purchase organs at home or abroad. This paper presents a summary of international initiatives, such as World Health Organization's Principle Guidelines, The Declaration of Istanbul, Asian Task Force Recommendations, as well as UNESCO's and the United Nation's initiatives against trafficking of human organs, tissues, cells, and transplant tourism. Beyond the summary, it calls for more practical measures to be taken to implement the existing guidelines and recommendations, in order to prevent exploitation of the poor as organ providers. The paper suggests that an international legally binding agreement in criminalizing organ trafficking would be a step forward to bring a change in the global picture of organ trafficking and transplant tourism.

  12. Coordinating the Global Information Grid Initiative with the NG9-1-1 Initiative

    Energy Technology Data Exchange (ETDEWEB)

    Michael Schmitt

    2008-05-01

    As the Department of Defense develops the Global Information Grid, the Department of Transportation develops the Next Generation 9-1-1 system. Close examinations of these initiatives show that the two are similar in architectures, applications, and communications interoperability. These similarities are extracted from the lowest user level to the highest commander rank that will be involved in each network. Once the similarities are brought into perspective, efforts should be made to collaborate between the two departments.

  13. How have Global Health Initiatives impacted on health equity?

    Science.gov (United States)

    Hanefeld, Johanna

    2008-01-01

    This review examines the impact of Global Health Initiatives (GHIs) on health equity, focusing on low- and middle-income countries. It is a summary of a literature review commissioned by the WHO Commission on the Social Determinants of Health. GHIs have emerged during the past decade as a mechanism in development assistance for health. The review focuses on three GHIs, the US President's Emergency Plan For AIDS Relief (PEPFAR), the World Bank's Multi-country AIDS Programme (MAP) and the Global Fund to Fight AIDS, TB and Malaria. All three have leveraged significant amounts of funding for their focal diseases - together these three GHIs provide an estimated two-thirds of external resources going to HIV/AIDS. This paper examines their impact on gender equity. An analysis of these Initiatives finds that they have a significant impact on health equity, including gender equity, through their processes of programme formulation and implementation, and through the activities they fund and implement, including through their impact on health systems and human resources. However, GHIs have so far paid insufficient attention to health inequities. While increasingly acknowledging equity, including gender equity, as a concern, Initiatives have so far failed to adequately translate this into programmes that address drivers of health inequity, including gender inequities. The review highlights the comparative advantage of individual GHIs, which point to an increased need for, and continued difficulties in, harmonisation of activities at country level. On the basis of this comparative analysis, key recommendations are made. They include a call for equity-sensitive targets, the collection of gender-disaggregated data, the use of policy-making processes for empowerment, programmes that explicitly address causes of health inequity and impact assessments of interventions' effect on social inequities.

  14. Neonatal sepsis

    Directory of Open Access Journals (Sweden)

    Angelica Dessì

    2014-06-01

    Full Text Available In this paper on neonatal sepsis, after a short presentation of etiopathogenesis and physiopathology, we will briefly present the clinical picture, the diagnosis and the therapy. Concerning diagnosis, we will focus our attention on procalcitonin (PCT, serum amyloid A (SAA, presepsin (sCD14 and metabolomics. Three practical tables complete the review. Proceedings of the International Course on Perinatal Pathology (part of the 10th International Workshop on Neonatology · October 22nd-25th, 2014 · Cagliari (Italy · October 25th, 2014 · The role of the clinical pathological dialogue in problem solving Guest Editors: Gavino Faa, Vassilios Fanos, Peter Van Eyken

  15. DELTAS: A new Global Delta Sustainability Initiative (Invited)

    Science.gov (United States)

    Foufoula-Georgiou, E.

    2013-12-01

    Deltas are economic and environmental hotspots, food baskets for many nations, home to a large part of the world population, and hosts of exceptional biodiversity and rich ecosystems. Deltas, being at the land-water interface, are international, regional, and local transport hubs, thus providing the basis for intense economic activities. Yet, deltas are deteriorating at an alarming rate as 'victims' of human actions (e.g. water and sediment reduction due to upstream basin development), climatic impacts (e.g. sea level rise and flooding from rivers and intense tropical storms), and local exploration (e.g. sand or aggregates, groundwater and hydrocarbon extraction). Although many efforts exist on individual deltas around the world, a comprehensive global delta sustainability initiative that promotes awareness, science integration, data and knowledge sharing, and development of decision support tools for an effective dialogue between scientists, managers and policy makers is lacking. Recently, the international scientific community proposed to establish the International Year of Deltas (IYD) to serve as the beginning of such a Global Delta Sustainability Initiative. The IYD was proposed as a year to: (1) increase awareness and attention to the value and vulnerability of deltas worldwide; (2) promote and enhance international and regional cooperation at the scientific, policy, and stakeholder level; and (3) serve as a launching pad for a 10-year committed effort to understand deltas as complex socio-ecological systems and ensure preparedness in protecting and restoring them in a rapidly changing environment. In this talk, the vision for such an international coordinated effort on delta sustainability will be presented as developed by a large number of international experts and recently funded through the Belmont Forum International Opportunities Fund. Participating countries include: U.S., France, Germany, U.K., India, Japan, Netherlands, Norway, Brazil, Bangladesh

  16. Seeking Sepsis in the Emergency Department- Identifying Barriers to Delivery of the Sepsis 6.

    Science.gov (United States)

    Bentley, James; Henderson, Susan; Thakore, Shobhan; Donald, Michael; Wang, Weijie

    2016-01-01

    The Sepsis 6 is an internationally accepted management bundle that, when initiated within one hour of identifying sepsis, can reduce morbidity and mortality. This management bundle was advocated by the Scottish Patient Safety Programme as part of its Acute Adult campaign launched in 2008 and adopted by NHS Tayside in 2012. Despite this, the Emergency Department (ED) of Ninewells Hospital, a tertiary referral centre and major teaching hospital in Scotland, was displaying poor success in the Sepsis 6. We therefore set out to improve compliance by evaluating the application of all aspects of the NHS Tayside Sepsis 6 bundle within one hour of ED triage time, to identify what human factors may influence achieving the one hour The Sepsis 6 bundle. This allowed us to tailor a number of specific interventions including educational sessions, regular audit and personal feedback and check list Sepsis 6 sticker. These interventions promoted a steady increase in compliance from an initial rate of 51.0% to 74.3%. The project highlighted that undifferentiated patients create a challenge in initiating the Sepsis 6. Pyrexia is a key human factor-trigger for recognising sepsis with initial nursing assessment being vital in recognition and identifying the best area (resus) of the department to manage severely septic patients. EDs need to recognise these challenges and develop educational and feedback plans for staff and utilise available resources to maximise the Sepsis 6 compliance.

  17. Surviving the first hours in sepsis: getting the basics right (an intensivist's perspective).

    Science.gov (United States)

    Daniels, Ron

    2011-04-01

    Severe sepsis is a major cause of morbidity and mortality, claiming between 36 000 and 64 000 lives annually in the UK, with a mortality rate of 35%. International guidelines for the management of severe sepsis were published in 2004 by the Surviving Sepsis Campaign and condensed into two Care Bundles. In 2010, the Campaign published results from its improvement programme showing that, although an absolute mortality reduction of 5.4% was seen over a 2 year period in line with increasing compliance with the Bundles, reliability was not achieved and Bundle compliance reached only 31%. This article explores current challenges in sepsis care and opportunities for further improvements. Basic care tasks [microbiological sampling and antibiotic delivery within 1 h, fluid resuscitation, and risk stratification using serum lactate (or alternative)] are likely to benefit patients most, yet are unreliably performed. Barriers include lack of awareness and robust process, the lack of supporting controlled trials, and complex diagnostic criteria leading to recognition delays. Reliable, timely delivery of more complex life-saving tasks (such as early goal-directed therapy) demands greater awareness, faster recognition and initiation of basic care, and more effective collaboration between clinicians and nurses on the front line, in critical care and in specialist support services, such as microbiology and infectious diseases. Organizations such as Survive Sepsis, the Surviving Sepsis Campaign and the Global Sepsis Alliance are working to raise awareness and promote further improvement initiatives. Future developments will focus on sepsis biomarkers and microarray techniques to rapidly screen for pathogens, risk stratification using genetic profiling, and the development of novel therapeutic agents targeting immunomodulation.

  18. The global coherence initiative: creating a coherent planetary standing wave.

    Science.gov (United States)

    McCraty, Rollin; Deyhle, Annette; Childre, Doc

    2012-03-01

    The much anticipated year of 2012 is now here. Amidst the predictions and cosmic alignments that many are aware of, one thing is for sure: it will be an interesting and exciting year as the speed of change continues to increase, bringing both chaos and great opportunity. One benchmark of these times is a shift in many people from a paradigm of competition to one of greater cooperation. All across the planet, increasing numbers of people are practicing heart-based living, and more groups are forming activities that support positive change and creative solutions for manifesting a better world. The Global Coherence Initiative (GCI) is a science-based, co-creative project to unite people in heart-focused care and intention. GCI is working in concert with other initiatives to realize the increased power of collective intention and consciousness. The convergence of several independent lines of evidence provides strong support for the existence of a global information field that connects all living systems and consciousness. Every cell in our bodies is bathed in an external and internal environment of fluctuating invisible magnetic forces that can affect virtually every cell and circuit in biological systems. Therefore, it should not be surprising that numerous physiological rhythms in humans and global collective behaviors are not only synchronized with solar and geomagnetic activity, but disruptions in these fields can create adverse effects on human health and behavior. The most likely mechanism for explaining how solar and geomagnetic influences affect human health and behavior are a coupling between the human nervous system and resonating geomagnetic frequencies, called Schumann resonances, which occur in the earth-ionosphere resonant cavity and Alfvén waves. It is well established that these resonant frequencies directly overlap with those of the human brain and cardiovascular system. If all living systems are indeed interconnected and communicate with each other

  19. Global teaching and training initiatives for emerging cohort studies

    Directory of Open Access Journals (Sweden)

    Jessica K. Paulus

    2012-09-01

    Full Text Available A striking disparity exists across the globe, with essentially no large-scale longitudinal studies ongoing in regions that will be significantly affected by the oncoming non-communicable disease epidemic. The successful implementation of cohort studies in most low-resource research environments presents unique challenges that may be aided by coordinated training programs. Leaders of emerging cohort studies attending the First World Cohort Integration Workshop were surveyed about training priorities, unmet needs and potential cross-cohort solutions to these barriers through an electronic pre-workshop questionnaire and focus groups. Cohort studies representing India, Mexico, Nigeria, South Africa, Sweden, Tanzania and Uganda described similar training needs, including on-the-job training, data analysis software instruction, and database and bio-bank management. A lack of funding and protected time for training activities were commonly identified constraints. Proposed solutions include a collaborative cross-cohort teaching platform with web-based content and interactive teaching methods for a range of research personnel. An international network for research mentorship and idea exchange, and modifying the graduate thesis structure were also identified as key initiatives. Cross-cohort integrated educational initiatives will efficiently meet shared needs, catalyze the development of emerging cohorts, speed closure of the global disparity in cohort research, and may fortify scientific capacity development in low-resource settings.

  20. Injuria renal aguda en la sepsis grave Acute kidney injury in severe sepsis

    Directory of Open Access Journals (Sweden)

    Hernán Trimarchi

    2009-06-01

    consists on a one-year prospective, observational, longitudinal trial undergone in 80 severe septic patients to determine the risk of development of acute kidney injury and its relationship with mortality; the association of the clinical course and blood parameter variations with mortality; the severe sepsis mortality rate; an eventual correlation between death and septic focus, and to assess mortality predictibility based on initial creatinine levels and final variations. Two groups were defined: Dead (n=25 and Not-dead (n=55. According to creatinine on admission, 39 subjects presented with normal creatinine levels (10 deaths and 41 presented elevated creatinine measurements (15 deaths; regarding final creatinine levels, 48 presented normal levels and 7 patients died, while 32 developed acute kidney injury, with 18 deaths. Of the total of 25 deaths, 72% presented renal injury. Seven alive patients and 2 deceased patients required hemodialysis. The most frequent primary septic focus was the airway (26.4%. The development of kidney injury is a high predictor of mortality in sepsis, independent of initial serum creatinine levels. Older patients, hypertension, a higher APACHE score, a more severe degree of anemia, hypoalbuminemia, hyperphosphatemia and hyperkalemia were associated with a higher mortality rate. The global mortality was: 31.3%. The failure to identify the primary septic focus was associated with higher mortality. The respiratory focus was related with a higher risk to require hemodialysis.

  1. JOICFP included in GII mission to Ghana. Global Issues Initiative.

    Science.gov (United States)

    1996-03-01

    Among countries in West Africa, Ghana is the main focus of the Global Issues Initiative (GII) on Population and AIDS and one of twelve priority countries selected for official development assistance (ODA) under the program. A ten-member project formulation mission sent to Ghana by the Ministry of Foreign Affairs (MOFA) of Japan was in the country during January 10-18. This mission was the first of its kind to be sent to Africa. It was led by the director of the Third Project Formulation Study Division, Project Formulation Study Department, Japan International Cooperation Agency (JICA), and included representatives of MOFA, JICA, and the Ministry of Health and Welfare, and an observer from UNAIDS. The mission's chief objective was to explore possibilities for Japanese cooperation in the areas of population, child health, and HIV/AIDS in line with the Mid-Term Health Strategy (MTHS) formulated in 1995 by the government of Ghana. The mission also explored the possibility of collaboration with major donors, international organizations, international agencies, and NGOs. The mission met with representatives of NGOs from population, women, AIDS, and health-related areas on January 13, who were then briefed upon Japan's Grant Assistance for Grassroots Project for local NGOs. Views were exchanged upon NGO activities.

  2. Environmental surveillance for polioviruses in the Global Polio Eradication Initiative.

    Science.gov (United States)

    Asghar, Humayun; Diop, Ousmane M; Weldegebriel, Goitom; Malik, Farzana; Shetty, Sushmitha; El Bassioni, Laila; Akande, Adefunke O; Al Maamoun, Eman; Zaidi, Sohail; Adeniji, Adekunle J; Burns, Cara C; Deshpande, Jagadish; Oberste, M Steve; Lowther, Sara A

    2014-11-01

    This article summarizes the status of environmental surveillance (ES) used by the Global Polio Eradication Initiative, provides the rationale for ES, gives examples of ES methods and findings, and summarizes how these data are used to achieve poliovirus eradication. ES complements clinical acute flaccid paralysis (AFP) surveillance for possible polio cases. ES detects poliovirus circulation in environmental sewage and is used to monitor transmission in communities. If detected, the genetic sequences of polioviruses isolated from ES are compared with those of isolates from clinical cases to evaluate the relationships among viruses. To evaluate poliovirus transmission, ES programs must be developed in a manner that is sensitive, with sufficiently frequent sampling, appropriate isolation methods, and specifically targeted sampling sites in locations at highest risk for poliovirus transmission. After poliovirus ceased to be detected in human cases, ES documented the absence of endemic WPV transmission and detected imported WPV. ES provides valuable information, particularly in high-density populations where AFP surveillance is of poor quality, persistent virus circulation is suspected, or frequent virus reintroduction is perceived. Given the benefits of ES, GPEI plans to continue and expand ES as part of its strategic plan and as a supplement to AFP surveillance. Published by Oxford University Press on behalf of the Infectious Diseases Society of America 2014. This work is written by (a) US Government employee(s) and is in the public domain in the US.

  3. Global process industry initiatives to reduce major accident hazards

    Energy Technology Data Exchange (ETDEWEB)

    Pitblado, Robin [DNV Energy Houston, TX (United States). SHE Risk Management; Pontes, Jose [DNV Energy Rio de Janeiro, RJ (Brazil). Americas Region; Oliveira, Luiz [DNV Energy Rio de Janeiro, RJ (Brazil)

    2008-07-01

    Since 2000, disasters at Texas City, Toulouse, Antwerp, Buncefield, P-36 and several near total loss events offshore in Norway have highlighted that major accident process safety is still a serious issue. Hopes that Process Safety Management or Safety Case regulations would solve these issues have not proven true. The Baker Panel recommended to BP several actions mainly around leadership, incentives, metrics, safety culture and more effective implementation of PSM systems. In Europe, an approach built around mechanical integrity and safety barriers, especially relating to technical safety systems, is being widely adopted. DNV has carried out a global survey of process industry initiatives, by interview and by literature review, for both upstream and downstream activities, to identify what the industry itself is planning to implement to enhance process safety in the next 5 - 10 years. This shows that an approach combining Baker Panel and EU barrier approaches and some nuclear industry real-time risk management approaches might be the best means to achieve a factor of 3-4 improvement in process safety. (author)

  4. Towards a global initiative for fibrosis treatment (GIFT

    Directory of Open Access Journals (Sweden)

    Maria Molina-Molina

    2017-12-01

    Full Text Available Idiopathic pulmonary fibrosis (IPF is a progressive lung disease characterised by increased scarring of lung tissue. Despite the recent introduction of novel drugs that slow disease progression, IPF remains a deadly disease, and the benefits of these new drugs differ markedly between patients. Human diseases arise due to alterations in an almost limitless network of interconnected genes, proteins, metabolites, cells and tissues, in direct relationship with a continuously changing macro- or microenvironment. Systems biology is a novel research strategy that seeks to understand the structure and behaviour of the so-called “emergent properties” of complex systems, such as those involved in disease pathogenesis, which are most often overlooked when just one element of disease pathogenesis is observed in isolation. This article summarises the debate that took place during a European Respiratory Society research seminar in Barcelona, Spain on December 15–16, 2016, which focused on how systems biology could generate new data by integrating the different IPF pathogenic levels of complexity. The main conclusion of the seminar was to create a global initiative to improve IPF outcomes by integrating cutting-edge international research that leverages systems biology to develop a precision medicine approach to tackle this devastating disease.

  5. Global health initiative investments and health systems strengthening: a content analysis of global fund investments.

    Science.gov (United States)

    Warren, Ashley E; Wyss, Kaspar; Shakarishvili, George; Atun, Rifat; de Savigny, Don

    2013-07-26

    Millions of dollars are invested annually under the umbrella of national health systems strengthening. Global health initiatives provide funding for low- and middle-income countries through disease-oriented programmes while maintaining that the interventions simultaneously strengthen systems. However, it is as yet unclear which, and to what extent, system-level interventions are being funded by these initiatives, nor is it clear how much funding they allocate to disease-specific activities - through conventional 'vertical-programming' approach. Such funding can be channelled to one or more of the health system building blocks while targeting disease(s) or explicitly to system-wide activities. We operationalized the World Health Organization health system framework of the six building blocks to conduct a detailed assessment of Global Fund health system investments. Our application of this framework framework provides a comprehensive quantification of system-level interventions. We applied this systematically to a random subset of 52 of the 139 grants funded in Round 8 of the Global Fund to Fight AIDS, Tuberculosis and Malaria (totalling approximately US$1 billion). According to the analysis, 37% (US$ 362 million) of the Global Fund Round 8 funding was allocated to health systems strengthening. Of that, 38% (US$ 139 million) was for generic system-level interventions, rather than disease-specific system support. Around 82% of health systems strengthening funding (US$ 296 million) was allocated to service delivery, human resources, and medicines & technology, and within each of these to two to three interventions. Governance, financing, and information building blocks received relatively low funding. This study shows that a substantial portion of Global Fund's Round 8 funds was devoted to health systems strengthening. Dramatic skewing among the health system building blocks suggests opportunities for more balanced investments with regard to governance, financing, and

  6. Economic analysis of the global polio eradication initiative.

    Science.gov (United States)

    Duintjer Tebbens, Radboud J; Pallansch, Mark A; Cochi, Stephen L; Wassilak, Steven G F; Linkins, Jennifer; Sutter, Roland W; Aylward, R Bruce; Thompson, Kimberly M

    2010-12-16

    The global polio eradication initiative (GPEI), which started in 1988, represents the single largest, internationally coordinated public health project to date. Completion remains within reach, with type 2 wild polioviruses apparently eradicated since 1999 and fewer than 2000 annual paralytic poliomyelitis cases of wild types 1 and 3 reported since then. This economic analysis of the GPEI reflects the status of the program as of February 2010, including full consideration of post-eradication policies. For the GPEI intervention, we consider the actual pre-eradication experience to date followed by two distinct potential future post-eradication vaccination policies. We estimate GPEI costs based on actual and projected expenditures and poliomyelitis incidence using reported numbers corrected for underreporting and model projections. For the comparator, which assumes only routine vaccination for polio historically and into the future (i.e., no GPEI), we estimate poliomyelitis incidence using a dynamic infection transmission model and costs based on numbers of vaccinated children. Cost-effectiveness ratios for the GPEI vs. only routine vaccination qualify as highly cost-effective based on standard criteria. We estimate incremental net benefits of the GPEI between 1988 and 2035 of approximately 40-50 billion dollars (2008 US dollars; 1988 net present values). Despite the high costs of achieving eradication in low-income countries, low-income countries account for approximately 85% of the total net benefits generated by the GPEI in the base case analysis. The total economic costs saved per prevented paralytic poliomyelitis case drive the incremental net benefits, which become positive even if we estimate the loss in productivity as a result of disability as below the recommended value of one year in average per-capita gross national income per disability-adjusted life year saved. Sensitivity analysis suggests that the finding of positive net benefits of the GPEI remains

  7. The Global Interaction Research Initiative at the IT University of Copenhagen, Denmark

    DEFF Research Database (Denmark)

    Bardram, Jakob Eyvind; Bjørn, Pernille; Glenstrup, Arne John

    2011-01-01

    This showcase paper describes the Global Interaction Research Initiative – GIRI – recently inaugurated at the IT University of Copenhagen. It presents the motivation for this initiative, namely that the use of information technology is the core enabling factor for global collaboration and business...... initiative, and we invite other researchers to join....

  8. Pediatric Sepsis Guidelines: Summary for resource-limited countries

    Science.gov (United States)

    Khilnani, Praveen; Singhi, Sunit; Lodha, Rakesh; Santhanam, Indumathi; Sachdev, Anil; Chugh, Krishan; Jaishree, M.; Ranjit, Suchitra; Ramachandran, Bala; Ali, Uma; Udani, Soonu; Uttam, Rajiv; Deopujari, Satish

    2010-01-01

    Justification: Pediatric sepsis is a commonly encountered global issue. Existing guidelines for sepsis seem to be applicable to the developed countries, and only few articles are published regarding application of these guidelines in the developing countries, especially in resource-limited countries such as India and Africa. Process: An expert representative panel drawn from all over India, under aegis of Intensive Care Chapter of Indian Academy of Pediatrics (IAP) met to discuss and draw guidelines for clinical practice and feasibility of delivery of care in the early hours in pediatric patient with sepsis, keeping in view unique patient population and limited availability of equipment and resources. Discussion included issues such as sepsis definitions, rapid cardiopulmonary assessment, feasibility of early aggressive fluid therapy, inotropic support, corticosteriod therapy, early endotracheal intubation and use of positive end expiratory pressure/mechanical ventilation, initial empirical antibiotic therapy, glycemic control, and role of immunoglobulin, blood, and blood products. Objective: To achieve a reasonable evidence-based consensus on the basis of published literature and expert opinion to formulating clinical practice guidelines applicable to resource-limited countries such as India. Recommendations: Pediatric sepsis guidelines are presented in text and flow chart format keeping resource limitations in mind for countries such as India and Africa. Levels of evidence are indicated wherever applicable. It is anticipated that once the guidelines are used and outcomes data evaluated, further modifications will be necessary. It is planned to periodically review and revise these guidelines every 3–5 years as new body of evidence accumulates. PMID:20606908

  9. How to re-establish Openness as default? Towards a global joint initiative

    NARCIS (Netherlands)

    Stracke, Christian M.

    2017-01-01

    Stracke, C. M. (2016, 14 April). How to re-establish Openness as default? Towards a global joint initiative. Results from the Action Lab at the Open Education Global Conference 2016, Krakow, Poland. More about the Action Lab:

  10. Global health initiatives in Africa - governance, priorities, harmonisation and alignment.

    Science.gov (United States)

    Mwisongo, Aziza; Nabyonga-Orem, Juliet

    2016-07-18

    The advent of global health initiatives (GHIs) has changed the landscape and architecture of health financing in low and middle income countries, particularly in Africa. Over the last decade, the African Region has realised improvements in health outcomes as a result of interventions implemented by both governments and development partners. However, alignment and harmonisation of partnerships and GHIs are still difficult in the African countries with inadequate capacity for their effective coordination. Both published and grey literature was reviewed to understand the governance, priorities, harmonisation and alignment of GHIs in the African Region; to synthesise the knowledge and highlight the persistent challenges; and to identify gaps for future research. GHI governance structures are often separate from those of the countries in which they operate. Their divergent funding channels and modalities may have contributed to the failure of governments to track their resources. There is also evidence that basically, earmarking and donor conditions drive funding allocations regardless of countries' priorities. Although studies cite the lack of harmonisation of GHI priorities with national strategies, evidence shows improvements in that area over time. GHIs have used several strategies and mechanisms to involve the private sector. These have widened the pool of health service policy-makers and providers to include groups such as civil society organisations (CSOs), with both positive and negative implications. GHI strategies such as co-financing by countries as a condition for support have been positive in achieving sustainability of interventions. GHI approaches have not changed substantially over the years but there has been evolution in terms of donor funding and conditions. GHIs still largely operate in a vertical manner, bypassing country systems; they compete for the limited human resources; they influence country policies; and they are not always harmonised with

  11. Toll-like receptors in neonatal sepsis.

    LENUS (Irish Health Repository)

    O'Hare, Fiona M

    2013-06-01

    Toll-like receptors are vital transmembrane receptors that initiate the innate immune response to many micro-organisms. The discovery of these receptors has improved our understanding of host-pathogen interactions, and these receptors play an important role in the pathogenesis of multiple neonatal conditions such as sepsis and brain injury. Toll-like receptors, especially TLRs 2 and 4, are associated with necrotizing enterocolitis, periventricular leukomalacia and sepsis.

  12. Glucocorticosteroids for sepsis

    DEFF Research Database (Denmark)

    Volbeda, M; Wetterslev, J; Gluud, C

    2015-01-01

    INTRODUCTION: Glucocorticosteroids (steroids) are widely used for sepsis patients. However, the potential benefits and harms of both high and low dose steroids remain unclear. A systematic review of randomised clinical trials with meta-analysis and trial sequential analysis (TSA) might shed light...... for sepsis patients (systemic inflammatory response syndrome, sepsis, severe sepsis or septic shock) aged >18 years. Cochrane Central Register of Controlled Trials (CENTRAL), PubMed/Medline, Embase, Web of Science and Cinahl were searched until 18 February 2015. No language restrictions were applied. Primary......-adjusted CI 0.7-1.48). The effects did not vary according to the degree of sepsis. TSA showed that many more randomised patients are needed before definitive conclusions may be drawn. CONCLUSION: Evidence to support or negate the use of steroids in any dose in sepsis patients is lacking. The results...

  13. New initiative to further global sustainable development goals in ...

    International Development Research Centre (IDRC) Digital Library (Canada)

    2016-03-17

    Mar 17, 2016 ... Representatives from some 60 think tanks met in November 2015 in Geneva to discuss how to further global objectives in health. ... Read the first submission, Accelerating achievement of the sustainable development goals, co-authored by the Graduate Institute, IDRC, the Harvard School of Public Health, ...

  14. Global initiative for meticillin-resistant Staphylococcus aureus pneumonia (GLIMP)

    DEFF Research Database (Denmark)

    Aliberti, Stefano; Reyes, Luis F; Faverio, Paola

    2016-01-01

    BACKGROUND: Antibiotic resistance is a major global health problem and pathogens such as meticillin-resistant Staphylococcus aureus (MRSA) have become of particular concern in the management of lower respiratory tract infections. However, few data are available on the worldwide prevalence and ris...

  15. Skill of a global seasonal streamflow forecasting system, relative roles of initial conditions and meteorological forcing

    NARCIS (Netherlands)

    Candogan Yossef, N.; Winsemius, H.C.; Weerts, A.; Van Beek, R.; Bierkens, M.F.P.

    2013-01-01

    We investigate the relative contributions of initial conditions (ICs) and meteorological forcing (MF) to the skill of the global seasonal streamflow forecasting system FEWS-World, using the global hydrological model PCRaster Global Water Balance. Potential improvement in forecasting skill through

  16. Initial Assessment of Cyclone Global Navigation Satellite System (CYGNSS) Observations

    Science.gov (United States)

    McKague, D. S.; Ruf, C. S.

    2017-12-01

    The NASA Cyclone Global Navigation Satellite System (CYNSS) mission provides high temporal resolution observations of cyclones from a constellation of eight low-Earth orbiting satellites. Using the relatively new technique of Global Navigation Satellite System reflectometry (GNSS-R), all-weather observations are possible, penetrating even deep convection within hurricane eye walls. The compact nature of the GNSS-R receivers permits the use of small satellites, which in turn enables the launch of a constellation of satellites from a single launch vehicle. Launched in December of 2016, the eight CYGNSS satellites provide 25 km resolution observations of mean square slope (surface roughness) and surface winds with a 2.8 hour median revisit time from 38 S to 38 N degrees latitude. In addition to the calibration and validation of CYGNSS sea state observations, the CYGNSS science team is assessing the ability of the mission to provide estimates of cyclone size, intensity, and integrated kinetic energy. With its all-weather ability and high temporal resolution, the CYGNSS mission will add significantly to our ability to monitor cyclone genesis and intensification and will significantly reduce uncertainties in our ability to estimate cyclone intensity, a key variable in predicting its destructive potential. Members of the CYGNSS Science Team are also assessing the assimilation of CYGNSS data into hurricane forecast models to determine the impact of the data on forecast skill, using the data to study extra-tropical cyclones, and looking at connections between tropical cyclones and global scale weather, including the global hydrologic cycle. This presentation will focus on the assessment of early on-orbit observations of cyclones with respect to these various applications.

  17. Language teachers and teaching global perspectives, local initiatives

    CERN Document Server

    Ben Said, Selim

    2013-01-01

    This volume gathers contributions from a range of global experts in teacher education to address the topic of language teacher education. It shows how teacher education involves the agency of teachers, which forms part of their identity, and which they take on when integrating into the teaching community of practice. In addition, the volume explores the teachers' situated practice--the dynamic negotiation of classroom situations, socialization into the professional teaching culture, and "on the ground experimentation" with pedagogical skills/techniques.

  18. One watt initiative: A global effort to reduce leaking electricity

    International Nuclear Information System (INIS)

    Meier, Alan K.; LeBot, Benoit

    1999-01-01

    Many domestic appliances and commercial equipment consume some electric power when they are switched off or not performing their primary purpose. The typical loss per appliance is low (from 1 to 25 W) but, when multiplied by the billions of appliances in houses and in commercial buildings, standby losses represent a significant fraction of total electricity use. Several initiatives to reduce standby losses have appeared in different parts of the world. One proposal, the 1-watt plan, seeks to harmonize these initiatives by establishing a single target for all appliances. This paper explains the background to the 1-watt plan, identifies some unresolved aspects, and gives some estimates of energy savings

  19. Anaesthetic management of patients with severe sepsis.

    Science.gov (United States)

    Eissa, D; Carton, E G; Buggy, D J

    2010-12-01

    Severe sepsis, a syndrome characterized by systemic inflammation and acute organ dysfunction in response to infection, is a major healthcare problem affecting all age groups throughout the world. Anaesthetists play a central role in the multidisciplinary management of patients with severe sepsis from their initial deterioration at ward level, transfer to the diagnostic imaging suite, and intraoperative management for emergency surgery. The timely administration of appropriate i.v. antimicrobial therapy is a crucial step in the care of patients with severe sepsis who may require surgery to control the source of sepsis. Preoperative resuscitation, aimed at optimizing major organ perfusion, is based on judicious use of fluids, vasopressors, and inotropes. Intraoperative anaesthesia management requires careful induction and maintenance of anaesthesia, optimizing intravascular volume status, avoidance of lung injury during mechanical ventilation, and ongoing monitoring of arterial blood gases, lactate concentration, haematological and renal indices, and electrolyte levels. Postoperative care overlaps with ongoing management of the severe sepsis syndrome patient in the intensive care unit. These patients are by definition, high risk, already requiring multiple supports, and require experienced and skilful decision-making to optimize their chances of a favourable outcome. Similar to acute myocardial infarction, stroke, or acute trauma, the initial hours (golden hours) of clinical management of severe sepsis represent an important opportunity to reduce morbidity and mortality. Rapid clinical assessment, resuscitation and surgical management by a focused multidisciplinary team, and early effective antimicrobial therapy are the key components to improved patient outcome.

  20. Where theory and practice of global health intersect: the developmental history of a Canadian global health initiative.

    Science.gov (United States)

    Daibes, Ibrahim; Sridharan, Sanjeev

    2014-01-01

    This paper examines the scope of practice of global health, drawing on the practical experience of a global health initiative of the Government of Canada--the Teasdale-Corti Global Health Research Partnership Program. A number of challenges in the practical application of theoretical definitions and understandings of global health are addressed. These challenges are grouped under five areas that form essential characteristics of global health: equity and egalitarian North-South partnerships, interdisciplinary scope, focus on upstream determinants of health, global conceptualization, and global health as an area of both research and practice. Information in this paper is based on the results of an external evaluation of the program, which involved analysis of project proposals and technical reports, surveys with grantees and interviews with grantees and program designers, as well as case studies of three projects and a review of relevant literature. The philosophy and recent definitions of global health represent a significant and important departure from the international health paradigm. However, the practical applicability of this maturing area of research and practice still faces significant systemic and structural impediments that, if not acknowledged and addressed, will continue to undermine the development of global health as an effective means to addressing health inequities globally and to better understanding, and acting upon, upstream determinants of health toward health for all. While it strives to redress global inequities, global health continues to be a construct that is promoted, studied, and dictated mostly by Northern institutions and scholars. Until practical mechanisms are put in place for truly egalitarian partnerships between North and South for both the study and practice of global health, the emerging philosophy of global health cannot be effectively put into practice.

  1. Clinical management of sepsis.

    Science.gov (United States)

    Lam, S M; Lau, A Cw; Lam, R Pk; Yan, W W

    2017-06-01

    Sepsis is a common cause of hospital admission worldwide and contributes significantly to morbidity and mortality. The definition of sepsis has evolved from the 1991 American College of Chest Physicians/Society of Critical Care Medicine definition based on the criteria of systemic inflammatory response syndrome, to the 2016 Sepsis-3 definition that incorporates the Sequential Organ Failure Assessment score. The landmark trial on protocolised early goal-directed therapy was published in 2001, but three subsequent multicentre randomised controlled trials (ProCESS, ARISE, and ProMISe) in 2014-2015 did not confirm a survival benefit with protocolised care. Over the years, there has been considerable improvement in sepsis outcome and management that hinges on early detection; timely source control; prompt, appropriate, and correctly dosed antibiotics; aggressive fluid resuscitation; and shock reversal. These are all directed by repeated bedside assessment. This article summarises recent developments and landmark trials that should guide current sepsis management.

  2. Global Geoscience Initiatives From Windows to the Universe

    Science.gov (United States)

    Russell, R. M.; Johnson, R.; Gardiner, L.; Lagrave, M.; Genyuk, J.; Bergman, J.; Foster, S. Q.

    2006-12-01

    The Windows to the Universe (www.windows.ucar.edu) Earth and space science educational program and web site has an extensive international presence. The web site reaches a vast user audience, having served more than 124 million page views across approximately 14 million user sessions in the past year. About 44% of these user sessions originated from domains outside of the United States. The site, which contains roughly 7,000 pages originally offered in English, is being translated into Spanish. This effort, begun in 2003, is now approximately 80% complete. Availability in a second major language has dramatically increased use of the site both in the U.S.A. and abroad; about 29% (4.1 million) of the annual user sessions visit Spanish-language portions of the site. In September 2005 we began distributing a monthly electronic newsletter for teachers that highlights features on the web site as well as other geoscience programs and events of relevance to educators. We currently have more than 4,400 subscribers, 33.6% of whom are outside of the United States. We are actively seeking news and information about other programs of relevance to this audience to distribute via our newsletter. We have also begun to solicit information (tips, anecdotes, lesson plans, etc.) from geoscience teachers around the world to share via this newsletter. Finally, Windows to the Universe participated in the Education and Outreach efforts of the MILAGRO scientific field campaign in Mexico in March of 2006. MILAGRO was a collaborative, multi-agency, international campaign to conduct a coordinated study of the extent and effects of pollutants emitted by a "mega-city" (in this case Mexico City) in order to understand the impacts of vast urban environments on global climate modeling. We enlisted several scientists involved with MILAGRO to write "Postcards from the Field" about their ongoing research during the project; these electronic "postcards" were distributed, in English and Spanish, via

  3. The Global Context of Vaccine Refusal: Insights from a Systematic Comparative Ethnography of the Global Polio Eradication Initiative.

    Science.gov (United States)

    Closser, Svea; Rosenthal, Anat; Maes, Kenneth; Justice, Judith; Cox, Kelly; Omidian, Patricia A; Mohammed, Ismaila Zango; Dukku, Aminu Mohammed; Koon, Adam D; Nyirazinyoye, Laetitia

    2016-09-01

    Many of medical anthropology's most pressing research questions require an understanding how infections, money, and ideas move around the globe. The Global Polio Eradication Initiative (GPEI) is a $9 billion project that has delivered 20 billion doses of oral polio vaccine in campaigns across the world. With its array of global activities, it cannot be comprehensively explored by the traditional anthropological method of research at one field site. This article describes an ethnographic study of the GPEI, a collaborative effort between researchers at eight sites in seven countries. We developed a methodology grounded in nuanced understandings of local context but structured to allow analysis of global trends. Here, we examine polio vaccine acceptance and refusal to understand how global phenomena-in this case, policy decisions by donors and global health organizations to support vaccination campaigns rather than building health systems-shape local behavior. © 2016 by the American Anthropological Association.

  4. Biomarkers of sepsis

    Science.gov (United States)

    2013-01-01

    Sepsis is an unusual systemic reaction to what is sometimes an otherwise ordinary infection, and it probably represents a pattern of response by the immune system to injury. A hyper-inflammatory response is followed by an immunosuppressive phase during which multiple organ dysfunction is present and the patient is susceptible to nosocomial infection. Biomarkers to diagnose sepsis may allow early intervention which, although primarily supportive, can reduce the risk of death. Although lactate is currently the most commonly used biomarker to identify sepsis, other biomarkers may help to enhance lactate’s effectiveness; these include markers of the hyper-inflammatory phase of sepsis, such as pro-inflammatory cytokines and chemokines; proteins such as C-reactive protein and procalcitonin which are synthesized in response to infection and inflammation; and markers of neutrophil and monocyte activation. Recently, markers of the immunosuppressive phase of sepsis, such as anti-inflammatory cytokines, and alterations of the cell surface markers of monocytes and lymphocytes have been examined. Combinations of pro- and anti-inflammatory biomarkers in a multi-marker panel may help identify patients who are developing severe sepsis before organ dysfunction has advanced too far. Combined with innovative approaches to treatment that target the immunosuppressive phase, these biomarkers may help to reduce the mortality rate associated with severe sepsis which, despite advances in supportive measures, remains high. PMID:23480440

  5. Sepsis and septic shock

    Science.gov (United States)

    Hotchkiss, Richard S.; Moldawer, Lyle L.; Opal, Steven M.; Reinhart, Konrad; Turnbull, Isaiah R.; Vincent, Jean-Louis

    2017-01-01

    For more than two decades, sepsis was defined as a microbial infection that produces fever (or hypothermia), tachycardia, tachypnoea and blood leukocyte changes. Sepsis is now increasingly being considered a dysregulated systemic inflammatory and immune response to microbial invasion that produces organ injury for which mortality rates are declining to 15–25%. Septic shock remains defined as sepsis with hyperlactataemia and concurrent hypotension requiring vasopressor therapy, with in-hospital mortality rates approaching 30–50%. With earlier recognition and more compliance to best practices, sepsis has become less of an immediate life-threatening disorder and more of a long-term chronic critical illness, often associated with prolonged inflammation, immune suppression, organ injury and lean tissue wasting. Furthermore, patients who survive sepsis have continuing risk of mortality after discharge, as well as long-term cognitive and functional deficits. Earlier recognition and improved implementation of best practices have reduced in-hospital mortality, but results from the use of immunomodulatory agents to date have been disappointing. Similarly, no biomarker can definitely diagnose sepsis or predict its clinical outcome. Because of its complexity, improvements in sepsis outcomes are likely to continue to be slow and incremental. PMID:28117397

  6. New biomarkers for sepsis

    Directory of Open Access Journals (Sweden)

    Li-xin XIE

    2013-01-01

    Full Text Available There is a higher sepsis rate in the intensive care unit (ICU patients, which is one of the most important causes for patient death, but the sepsis lacks specific clinical manifestations. Exploring sensitive and specific molecular markers for infection that accurately reflect infection severity and prognosis is very clinically important. In this article, based on our previous study, we introduce some new biomarkers with high sensitivity and specificity for the diagnosis and predicting the prognosis and severity of sepsis. Increase of serum soluble(s triggering receptor expressed on myeloid cells-1 (sTREM-1 suggests a poor prognosis of septic patients, and changes of locus rs2234237 of sTREM-1 may be the one of important mechanisms. Additionally, urine sTREM-1 can provide an early warning of possible secondary acute kidney injury (AKI in sepsis patients. Serum sCD163 level was found to be a more important factor than procalcitonin (PCT and C-reactive protein (CRP in prognosis of sepsis, especially severe sepsis. Moreover, urine sCD163 also shows excellent performance in the diagnosis of sepsis and sepsis-associated AKI. Circulating microRNAs, such as miR-150, miR-297, miR-574-5p, miR -146a , miR-223, miR -15a and miR-16, also play important roles in the evaluation of status of septic patients. In the foreseeable future, newly-emerging technologies, including proteomics, metabonomics and trans-omics, may exert profound effects on the discovery of valuable biomarkers for sepsis.

  7. View from Silicon Valley: Maximizing the Scientific Impact of Global Brain Initiatives through Entrepreneurship.

    Science.gov (United States)

    Joshi, Pushkar S; Ghosh, Kunal K

    2016-11-02

    In this era of technology-driven global neuroscience initiatives, the role of the neurotechnology industry remains woefully ambiguous. Here, we explain why industry is essential to the success of these global initiatives, and how it can maximize the scientific impact of these efforts by (1) scaling and ultimately democratizing access to breakthrough neurotechnologies, and (2) commercializing technologies as part of integrated, end-to-end solutions that accelerate neuroscientific discovery. Copyright © 2016 Elsevier Inc. All rights reserved.

  8. Japan's English-Medium Instruction Initiatives and the Globalization of Higher Education

    Science.gov (United States)

    Rose, Heath; McKinley, Jim

    2018-01-01

    This article analyzes a recent initiative of Japan's Ministry of Education, which aims to internationalize higher education in Japan. The large-investment project "Top Global University Project" (TGUP) has emerged to create globally oriented universities, to increase the role of foreign languages in higher education, and to foster global…

  9. Alternative Food in the Global South: Reflections on a Direct Marketing Initiative in Kenya

    Science.gov (United States)

    Freidberg, Susanne; Goldstein, Lissa

    2011-01-01

    Amidst booming scholarship on alternative food networks (AFNs) in the global North, research on AFN in the global South remains scarce. Partly this is because explicitly alternative initiatives are themselves scarce, except for those focused on export markets. Yet in countries such as Kenya, urban consumers and rural smallholders have good reason…

  10. Designing a Pediatric Severe Sepsis Screening Tool

    Directory of Open Access Journals (Sweden)

    Robert eSepanski

    2014-06-01

    Full Text Available We sought to create a screening tool with improved predictive value for pediatric severe sepsis and septic shock that can be incorporated into the electronic medical record and actively screen all patients arriving at a pediatric Emergency Department (ED. Gold standard severe sepsis cases were identified using a combination of coded discharge diagnosis and physician chart review from 7,402 children who visited a pediatric ED over two months. The tool’s identification of severe sepsis was initially based on International Consensus Conference on Pediatric Sepsis (ICCPS parameters that were refined by an iterative, virtual process that allowed us to propose successive changes in sepsis detection parameters in order to optimize the tool’s predictive value based on receiver operating curve (ROC characteristics. Age-specific normal and abnormal values for heart rate (HR and respiratory rate (RR were empirically derived from 143,603 children seen in a second pediatric ED over three years. Univariate analyses were performed for each measure in the tool to assess its association with severe sepsis and to characterize it as an early or late indicator of severe sepsis. A split-sample was used to validate the final, optimized tool. The final tool incorporated age-specific thresholds for abnormal HR and RR and employed a linear temperature correction for each category. The final tool’s positive predictive value was 48.7%, a significant, nearly three-fold improvement over the original ICCPS tool. False positive Systemic Inflammatory Response Syndrome (SIRS identifications were nearly six-fold lower.

  11. Global alignment, coordination and collaboration in perinatal research: the Global Obstetrics Network (GONet) Initiative

    NARCIS (Netherlands)

    Mol, Ben Willem; Ruifrok, Anneloes Elisabeth

    2013-01-01

    Large clinical studies provide information and insight that are used to develop clinical guidelines. In view of the large sample sizes needed, many researchers have initiated multicenter studies. In some situations, the activities of these groups have led to networks, through which multiple trials

  12. Generation of political priority for global health initiatives: a framework and case study of maternal mortality.

    Science.gov (United States)

    Shiffman, Jeremy; Smith, Stephanie

    2007-10-13

    Why do some global health initiatives receive priority from international and national political leaders whereas others receive little attention? To analyse this question we propose a framework consisting of four categories: the strength of the actors involved in the initiative, the power of the ideas they use to portray the issue, the nature of the political contexts in which they operate, and characteristics of the issue itself. We apply this framework to the case of a global initiative to reduce maternal mortality, which was launched in 1987. We undertook archival research and interviewed people connected with the initiative, using a process-tracing method that is commonly employed in qualitative research. We report that despite two decades of effort the initiative remains in an early phase of development, hampered by difficulties in all these categories. However, the initiative's 20th year, 2007, presents opportunities to build political momentum. To generate political priority, advocates will need to address several challenges, including the creation of effective institutions to guide the initiative and the development of a public positioning of the issue to convince political leaders to act. We use the framework and case study to suggest areas for future research on the determinants of political priority for global health initiatives, which is a subject that has attracted much speculation but little scholarship.

  13. Diagnosis and management of sepsis

    Science.gov (United States)

    Arifin

    2018-03-01

    Sepsis is the life-threatening condition with organ dysfunction caused by dysregulated host response to the infection. Septic shock is part of sepsis where circulatory abnormalities and cellular metabolism occur. Sepsis and septic shock are still a problem in the world, where one in four people with sepsis will die. As well as any trauma case, acute myocardial infarction, or stroke, early identification and appropriate treatment of sepsis immediately after sepsis will improve the prognosis of the patient. Comprehensive management of septic patients is required, ranging from infection controls that include antibiotic administration and infection source control as well as hemodynamic stabilization that included fluid resuscitation and vasoactive drug delivery.

  14. Perioperative treatment of patients with sepsis

    DEFF Research Database (Denmark)

    Ibsen, Michael; Perner, Anders

    2013-01-01

    Key elements in the initial resuscitation and stabilization of the patient with sepsis are fluid therapy, vasopressor or inotropic support, administration of adequate antibiotics and source control. This review will primarily discuss fluid, vasopressor and antibiotic therapy because these have been...

  15. Improving Outcomes in Patients With Sepsis.

    Science.gov (United States)

    Armen, Scott B; Freer, Carol V; Showalter, John W; Crook, Tonya; Whitener, Cynthia J; West, Cheri; Terndrup, Thomas E; Grifasi, Marissa; DeFlitch, Christopher J; Hollenbeak, Christopher S

    2016-01-01

    Sepsis mortality may be improved by early recognition and appropriate treatment based on evidence-based guidelines. An intervention was developed that focused on earlier identification of sepsis, early antimicrobial administration, and an educational program that was disseminated throughout all hospital units and services. There were 1331 patients with sepsis during the intervention period and 1401 patients with sepsis during the control period. After controlling for expected mortality, patients in the intervention period had 30% lower odds of dying (odds ratio = 0.70, 95% confidence interval [CI] = 0.57 to 0.84). They also had 1.07 fewer days on average in the intensive care unit (95% CI = -1.98 to -0.16), 2.15 fewer hospital days (95% CI = -3.45 to -0.86), and incurred on average $1949 less in hospital costs, although the effect on costs was not statistically significant. Continued incremental improvement and sustainment is anticipated through organizational oversight, continued education, and initiation of an automated electronic sepsis alert function. © The Author(s) 2014.

  16. Exploring the Case for a Global Alliance for Medical Diagnostics Initiative

    Directory of Open Access Journals (Sweden)

    Melissa L. Mugambi

    2017-01-01

    Full Text Available In recent years, the private and public sectors have increased investments in medical diagnostics for low- and middle-income countries (LMICs. Despite these investments, numerous barriers prevent the adoption of existing diagnostics and discourage the development and introduction of new diagnostics in LMICs. In the late 1990s, the global vaccine community had similar challenges, as vaccine coverage rates stagnated and the introduction of new vaccines was viewed as a distraction to delivering existing vaccines. To address these challenges, the international community came together and formed the Global Alliance for Vaccines Initiative (GAVI. Sixteen years after the formation of GAVI, we see evidence of a healthier global vaccine landscape. We discuss how GAVI’s four guiding principles (product, health systems strengthening, financing and market shaping might apply to the advancement of medical diagnostics in LMICs. We present arguments for the international community and existing organizations to establish a Global Alliance for Medical Diagnostics Initiative (GAMDI.

  17. Assessment of global cloud datasets from satellites: Project and database initiated by the GEWEX radiation panel

    OpenAIRE

    Stubenrauch , C.J.; Rossow , W.B.; Kinne , S.; Ackerman , S.; Cesana , G.; Chepfer , H.; Di Girolamo , L.; Getzewich , B.; Guignard , A.; Heidinger , A.; Maddux , B.C.; Menzel , W.P.; Minnis , P.; Pearl , C.; Platnick , S.

    2013-01-01

    International audience; The Global Energy and Water Cycle Experiment (GEWEX) Radiation Panel initiated the GEWEX Cloud Assessment in 2005 to compare available, global, long-term cloud data products with the International Satellite Cloud Climatology Project (ISCCP). The GEWEX Cloud Assessment database included cloud properties retrieved from different satellite sensor measurements, taken at various local times and over various time periods. The relevant passive satellite sensors measured radia...

  18. The global initiative against the nuclear terrorism; La iniciativa global contra el terrorismo nuclear

    Energy Technology Data Exchange (ETDEWEB)

    Lossada Torres-Quevedo, A.

    2008-07-01

    The magnitude of the terrorist attacks of September 11 and subsequent attacks in Madrid, London, Bali and Iraq have been cause for condemnation and have forced the international community to make a concerted effort to prevent this kind of attack. Moreover, the risk that Al Qaeda could get hold of weapons of mass destruction has led to the inclusion of non-proliferation as a key element of the strategies to combat terrorism and to the launch of several initiative to prevent the possibility of these types of weapons or their precursors from falling into the hands of terrorist groups and to adequately manage the consequences. (Author)

  19. The Global Polio Eradication Initiative: Progress, Lessons Learned, And Polio Legacy Transition Planning.

    Science.gov (United States)

    Cochi, Stephen L; Hegg, Lea; Kaur, Anjali; Pandak, Carol; Jafari, Hamid

    2016-02-01

    The world is closer than ever to achieving global polio eradication, with record-low polio cases in 2015 and the impending prospect of a polio-free Africa. Tens of millions of volunteers, social mobilizers, and health workers have participated in the Global Polio Eradication Initiative. The program contributes to efforts to deliver other health benefits, including health systems strengthening. As the initiative nears completion after more than twenty-five years, it becomes critical to document and transition the knowledge, lessons learned, assets, and infrastructure accumulated by the initiative to address other health goals and priorities. The primary goals of this process, known as polio legacy transition planning, are both to protect a polio-free world and to ensure that investments in polio eradication will contribute to other health goals after polio is completely eradicated. The initiative is engaged in an extensive transition process of consultations and planning at the global, regional, and country levels. A successful completion of this process will result in a well-planned and -managed conclusion of the initiative that will secure the global public good gained by ending one of the world's most devastating diseases and ensure that these investments provide public health benefits for years to come. Project HOPE—The People-to-People Health Foundation, Inc.

  20. Mechanisms of Intestinal Barrier Dysfunction in Sepsis.

    Science.gov (United States)

    Yoseph, Benyam P; Klingensmith, Nathan J; Liang, Zhe; Breed, Elise R; Burd, Eileen M; Mittal, Rohit; Dominguez, Jessica A; Petrie, Benjamin; Ford, Mandy L; Coopersmith, Craig M

    2016-07-01

    Intestinal barrier dysfunction is thought to contribute to the development of multiple organ dysfunction syndrome in sepsis. Although there are similarities in clinical course following sepsis, there are significant differences in the host response depending on the initiating organism and time course of the disease, and pathways of gut injury vary widely in different preclinical models of sepsis. The purpose of this study was to determine whether the timecourse and mechanisms of intestinal barrier dysfunction are similar in disparate mouse models of sepsis with similar mortalities. FVB/N mice were randomized to receive cecal ligation and puncture (CLP) or sham laparotomy, and permeability was measured to fluoresceinisothiocyanate conjugated-dextran (FD-4) six to 48 h later. Intestinal permeability was elevated following CLP at all timepoints measured, peaking at 6 to 12 h. Tight junction proteins claudin 1, 2, 3, 4, 5, 7, 8, 13, and 15, Junctional Adhesion Molecule-A (JAM-A), occludin, and ZO-1 were than assayed by Western blot, real-time polymerase chain reaction, and immunohistochemistry 12 h after CLP to determine potential mechanisms underlying increases in intestinal permeability. Claudin 2 and JAM-A were increased by sepsis, whereas claudin-5 and occludin were decreased by sepsis. All other tight junction proteins were unchanged. A further timecourse experiment demonstrated that alterations in claudin-2 and occludin were detectable as early as 1 h after the onset of sepsis. Similar experiments were then performed in a different group of mice subjected to Pseudomonas aeruginosa pneumonia. Mice with pneumonia had an increase in intestinal permeability similar in timecourse and magnitude to that seen in CLP. Similar changes in tight junction proteins were seen in both models of sepsis although mice subjected to pneumonia also had a marked decrease in ZO-1 not seen in CLP. These results indicate that two disparate, clinically relevant models of sepsis

  1. Sepsis-induced immunosuppression: from cellular dysfunctions to immunotherapy

    Science.gov (United States)

    Hotchkiss, Richard S.; Monneret, Guillaume; Payen, Didier

    2014-01-01

    Sepsis — severe life-threatening infection with organ dysfunction — initiates a complex interplay of host pro- and anti-inflammatory processes. In a real sense, sepsis can be considered a race to the death between the pathogens and the host immune system. It is the proper balance between the often competing pro- and anti-inflammatory pathways that determines the fate of the individual. Although the field of sepsis research has witnessed the failure of many highly-touted clinical trials, a better understanding of the pathophysiological basis of the disorder and the mechanisms responsible for the associated pro- and anti-inflammatory responses is leading to a novel approach to treat this highly lethal condition. Biomarker-guided immunotherapy administered to patients at the proper immune phase of sepsis represents a potential major advance in the treatment of sepsis and more broadly in the field of infectious disease. PMID:24232462

  2. Lactic acidosis, hyperlactatemia and sepsis

    Directory of Open Access Journals (Sweden)

    Andrea Montagnani

    2016-12-01

    Full Text Available Among hospitalized patients, lactic acidosis represents the most common cause of metabolic acidosis. Lactate is not just a metabolic product of anaerobic glycolysis but is triggered by a variety of metabolites even before the onset of anaerobic metabolism as part of an adaptive response to a hypermetabolic state. On the basis of such considerations, lactic acidosis is divided into two classes: inadequate tissue oxygenation (type A and absence of tissue hypoxia (type B. Lactic acidosis is characterized by non-specific symptoms but it should be suspected in all critical patients who show hypovolemic, hypoxic, in septic or cardiogenic shock or if in the presence of an unexplained high anion gap metabolic acidosis. Lactic acidosis in sepsis and septic shock has traditionally been explained as a result of tissue hypoxia when whole-body oxygen delivery fails to meet whole body oxygen requirements. In sepsis lactate levels correlate with increased mortality with a poor prognostic threshold of 4 mmol/L. In hemodynamically stable patients with sepsis, hyperlactatemia might be the result of impaired lactate clearance rather than overproduction. In critically ill patients the speed at which hyperlactatemia resolves with appropriate therapy may be considered a useful prognostic indicator. The measure of blood lactate should be performed within 3 h of presentation in acute care setting. The presence of lactic acidosis requires early identification of the primary cause of shock for the best appropriate treatment. Since most cases of lactic acidosis depend on whole-body oxygen delivery failure, the maximization of systemic oxygen delivery remains the primary therapeutic option. When initial resuscitation does not substantially or completely correct lactic acidosis, it is also essential to consider other causes. The treatment of acidosis with buffering agents (specifically bicarbonate is generally advocated only in the setting of severe acidosis. Ongoing

  3. Under the (legal) radar screen: global health initiatives and international human rights obligations

    Science.gov (United States)

    2012-01-01

    Background Given that many low income countries are heavily reliant on external assistance to fund their health sectors the acceptance of obligations of international assistance and cooperation with regard to the right to health (global health obligations) is insufficiently understood and studied by international health and human rights scholars. Over the past decade Global Health Initiatives, like the Global Fund to fight AIDS, Tuberculosis and Malaria (Global Fund) have adopted novel approaches to engaging with stakeholders in high and low income countries. This article explores how this experience impacted on acceptance of the international obligation to (help) fulfil the right to health beyond borders. Methods The authors conducted an extensive review of international human rights law literature, transnational legal process literature, global public health literature and grey literature pertaining to Global Health Initiatives. To complement this desk work and deepen their understanding of how and why different legal norms evolve the authors conducted 19 in-depth key informant interviews with actors engaged with three stakeholders; the European Union, the United States and Belgium. The authors then analysed the interviews through a transnational legal process lens. Results Through according value to the process of examining how and why different legal norms evolve transnational legal process offers us a tool for engaging with the dynamism of developments in global health suggesting that operationalising global health obligations could advance the right to health for all. Conclusions In many low-income countries the health sector is heavily dependent on external assistance to fulfil the right to health of people thus it is vital that policies and tools for delivering reliable, long-term assistance are developed so that the right to health for all becomes more than a dream. Our research suggests that the Global Fund experience offers lessons to build on. PMID

  4. Under the (legal radar screen: global health initiatives and international human rights obligations

    Directory of Open Access Journals (Sweden)

    Hammonds Rachel

    2012-11-01

    Full Text Available Abstract Background Given that many low income countries are heavily reliant on external assistance to fund their health sectors the acceptance of obligations of international assistance and cooperation with regard to the right to health (global health obligations is insufficiently understood and studied by international health and human rights scholars. Over the past decade Global Health Initiatives, like the Global Fund to fight AIDS, Tuberculosis and Malaria (Global Fund have adopted novel approaches to engaging with stakeholders in high and low income countries. This article explores how this experience impacted on acceptance of the international obligation to (help fulfil the right to health beyond borders. Methods The authors conducted an extensive review of international human rights law literature, transnational legal process literature, global public health literature and grey literature pertaining to Global Health Initiatives. To complement this desk work and deepen their understanding of how and why different legal norms evolve the authors conducted 19 in-depth key informant interviews with actors engaged with three stakeholders; the European Union, the United States and Belgium. The authors then analysed the interviews through a transnational legal process lens. Results Through according value to the process of examining how and why different legal norms evolve transnational legal process offers us a tool for engaging with the dynamism of developments in global health suggesting that operationalising global health obligations could advance the right to health for all. Conclusions In many low-income countries the health sector is heavily dependent on external assistance to fulfil the right to health of people thus it is vital that policies and tools for delivering reliable, long-term assistance are developed so that the right to health for all becomes more than a dream. Our research suggests that the Global Fund experience offers

  5. Under the (legal) radar screen: global health initiatives and international human rights obligations.

    Science.gov (United States)

    Hammonds, Rachel; Ooms, Gorik; Vandenhole, Wouter

    2012-11-15

    Given that many low income countries are heavily reliant on external assistance to fund their health sectors the acceptance of obligations of international assistance and cooperation with regard to the right to health (global health obligations) is insufficiently understood and studied by international health and human rights scholars. Over the past decade Global Health Initiatives, like the Global Fund to fight AIDS, Tuberculosis and Malaria (Global Fund) have adopted novel approaches to engaging with stakeholders in high and low income countries. This article explores how this experience impacted on acceptance of the international obligation to (help) fulfil the right to health beyond borders. The authors conducted an extensive review of international human rights law literature, transnational legal process literature, global public health literature and grey literature pertaining to Global Health Initiatives. To complement this desk work and deepen their understanding of how and why different legal norms evolve the authors conducted 19 in-depth key informant interviews with actors engaged with three stakeholders; the European Union, the United States and Belgium. The authors then analysed the interviews through a transnational legal process lens. Through according value to the process of examining how and why different legal norms evolve transnational legal process offers us a tool for engaging with the dynamism of developments in global health suggesting that operationalising global health obligations could advance the right to health for all. In many low-income countries the health sector is heavily dependent on external assistance to fulfil the right to health of people thus it is vital that policies and tools for delivering reliable, long-term assistance are developed so that the right to health for all becomes more than a dream. Our research suggests that the Global Fund experience offers lessons to build on.

  6. World Community: Middlesex CC Infuses Global Initiatives into Core Curriculum and beyond

    Science.gov (United States)

    Cowan, Carole A.

    2006-01-01

    Twenty years ago, Middlesex Community College (MCC) in Massachusetts decided to add a global focus to its programs. Since then, the college has garnered worldwide recognition for the range of international initiatives it has integrated into its curriculum across academic disciplines. Today, Middlesex offers unique opportunities for international…

  7. Los Alamos National Laboratory Training Capabilities (Possible Applications in the Global Initiatives for Proliferation Prevention Program)

    Energy Technology Data Exchange (ETDEWEB)

    Martin, Olga [Los Alamos National Laboratory

    2012-06-04

    The briefing provides an overview of the training capabilities at Los Alamos National Laboratory that can be applied to nonproliferation/responsible science education at nuclear institutes in the Former Soviet Union, as part of the programmatic effort under the Global Initiatives for Proliferation Prevention program (GIPP).

  8. Ademe et Vous. International Newsletter No. 43, December 2017. A global initiative for efficient solutions

    International Nuclear Information System (INIS)

    Martin, Valerie; Seguin-Jacques, Catherine; Aulas, Camille

    2017-12-01

    Content: - Focus: A global initiative for efficient solutions. On 14 November, during COP23, ADEME officially joined the World Alliance for Efficient Solutions, an initiative launched by the Solar Impulse Foundation. - Expertise: Energy: an industrial sector in transition. At a time when reducing energy consumption and improving energy efficiency seem to be essential to the development of a sustainable and competitive industry, electrical load management has emerged as a promising solution. - Worldwide: Ivory Coast: promoting sustainable construction. From 18 to 20 September, ADEME took part in two events held in Abidjan dedicated to sustainable construction in the Ivory Coast, a subject in which the Agency had a long-standing experience to share at the heart of the Global Alliance for Building and Construction (Global ABC)

  9. Global Well-Posedness of the Boltzmann Equation with Large Amplitude Initial Data

    Science.gov (United States)

    Duan, Renjun; Huang, Feimin; Wang, Yong; Yang, Tong

    2017-07-01

    The global well-posedness of the Boltzmann equation with initial data of large amplitude has remained a long-standing open problem. In this paper, by developing a new {L^∞_xL^1v\\cap L^∞_{x,v}} approach, we prove the global existence and uniqueness of mild solutions to the Boltzmann equation in the whole space or torus for a class of initial data with bounded velocity-weighted {L^∞} norm under some smallness condition on the {L^1_xL^∞_v} norm as well as defect mass, energy and entropy so that the initial data allow large amplitude oscillations. Both the hard and soft potentials with angular cut-off are considered, and the large time behavior of solutions in the {L^∞_{x,v}} norm with explicit rates of convergence are also studied.

  10. Sepsis and Septic Shock Strategies.

    Science.gov (United States)

    Armstrong, Bracken A; Betzold, Richard D; May, Addison K

    2017-12-01

    Three therapeutic principles most substantially improve organ dysfunction and survival in sepsis: early, appropriate antimicrobial therapy; restoration of adequate cellular perfusion; timely source control. The new definitions of sepsis and septic shock reflect the inadequate sensitivity, specify, and lack of prognostication of systemic inflammatory response syndrome criteria. Sequential (sepsis-related) organ failure assessment more effectively prognosticates in sepsis and critical illness. Inadequate cellular perfusion accelerates injury and reestablishing perfusion limits injury. Multiple organ systems are affected by sepsis and septic shock and an evidence-based multipronged approach to systems-based therapy in critical illness results in improve outcomes. Copyright © 2017 Elsevier Inc. All rights reserved.

  11. MICRONUTRIENT THERAPY FOR SEPSIS

    Directory of Open Access Journals (Sweden)

    Agung Prasetiyo

    2015-05-01

    Full Text Available Micronutrients are nutrients which are needed by the body to perform the function of body. The amounts is less than 100% μg per day and consist of vitamins and minerals. It cannot be synthesized in the body. Research in the US mentioned that the rate prevalence of sepsis is tended to be increased 8.7 % annually. In sepsis, nutrition is one of the important component which could drive the success treatment. Micronutrient, especially a vitamin which is soluble in fats, it would be toxic if the number exceed the capability of body to receive it. Although there are guidance and mutual agreement about sepsis using, it still need to concern on micronutrient which potentially giving bad effect. In sepsis case, micronutrients also determine the success of treatment due to redistribution of vitamin and trace element from circulation to the tissue which involved in the proteins formation and immune system. The conclusions of the latest 7 experiments and 4 random controlled studies of multi-centre support the micronutrients supplementation because it can decrease mortality rate. However, it still need to be aware to the toxicity of fat soluble micronutrient if the doses are excessive.

  12. Approach to neonatal sepsis

    Directory of Open Access Journals (Sweden)

    Shankar Narayan

    2015-01-01

    The treatment includes supportive care along with administration of appropriate antibiotics. Adjuvant treatment includes IVIG, GCSF, exchange transfusion and pentoxifylline administration. This paper aims to present an algorithmic approach to neonatal sepsis to expedite the diagnosis along with providing appropriate and adequate treatment.

  13. Nitrogenoxid og sepsis

    DEFF Research Database (Denmark)

    El-Haj, Lama; Bestle, Morten Heiberg

    2018-01-01

    The main purpose of this study is to review the function of nitric oxide during sepsis and septic shock. Futhermore, the study reviews the various physiological functions of nitric oxide in the human body, and how these functions can and have been used clinically. Nitric oxide plays an important ...

  14. Sepsis Associated Encephalopathy

    Directory of Open Access Journals (Sweden)

    Neera Chaudhry

    2014-01-01

    Full Text Available Sepsis associated encephalopathy (SAE is a common but poorly understood neurological complication of sepsis. It is characterized by diffuse brain dysfunction secondary to infection elsewhere in the body without overt CNS infection. The pathophysiology of SAE is complex and multifactorial including a number of intertwined mechanisms such as vascular damage, endothelial activation, breakdown of the blood brain barrier, altered brain signaling, brain inflammation, and apoptosis. Clinical presentation of SAE may range from mild symptoms such as malaise and concentration deficits to deep coma. The evaluation of cognitive dysfunction is made difficult by the absence of any specific investigations or biomarkers and the common use of sedation in critically ill patients. SAE thus remains diagnosis of exclusion which can only be made after ruling out other causes of altered mentation in a febrile, critically ill patient by appropriate investigations. In spite of high mortality rate, management of SAE is limited to treatment of the underlying infection and symptomatic treatment for delirium and seizures. It is important to be aware of this condition because SAE may present in early stages of sepsis, even before the diagnostic criteria for sepsis can be met. This review discusses the diagnostic approach to patients with SAE along with its epidemiology, pathophysiology, clinical presentation, and differential diagnosis.

  15. Analysis of the mass media coverage of the Gates Foundation grand challenges in global health initiative.

    Science.gov (United States)

    Verma, G

    2009-03-01

    The Grand Challenges were launched in 2003 by the Gates Foundation and other collaborators to address the health needs of developing countries. This paper outlines the current problem with health research and development in the context of inequality as conveyed by the 90/10 divide. The paper then looks at the focus and nature of press reporting of global health issues by analysing how press articles have portrayed the Grand Challenges in Global Health initiative. Analysis of the mass media illustrates that the focus of reporting on the Grand Challenges tends to be on utilitarian themes, leaving issues related to justice and equity comparatively under-reported.

  16. The recognition and management of sepsis and septic shock: a guide for non-intensivists.

    Science.gov (United States)

    Keeley, Alexander; Hine, Paul; Nsutebu, Emmanuel

    2017-10-01

    Sepsis is common, often fatal and requires rapid interventions to improve outcomes. While the optimal management of sepsis in the intensive care setting is the focus of extensive research interest, the mainstay of the recognition and initial management of sepsis will occur outside the intensive care setting. Therefore, it is key that institutions and clinicians remain well informed of the current updates in sepsis management and continue to use them to deliver appropriate and timely interventions to enhance patient survival. This review discusses the latest updates in sepsis care including the new consensus definition of sepsis, the outcome of the proCESS, ProMISe and ARISE trials of early goal directed therapy (EGDT), and the most recent guidelines from the Surviving Sepsis Campaign. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  17. Towards a consensus definition of maternal sepsis: results of a systematic review and expert consultation.

    Science.gov (United States)

    Bonet, Mercedes; Nogueira Pileggi, Vicky; Rijken, Marcus J; Coomarasamy, Arri; Lissauer, David; Souza, João Paulo; Gülmezoglu, Ahmet Metin

    2017-05-30

    There is a need for a clear and actionable definition of maternal sepsis, in order to better assess the burden of this condition, trigger timely and effective treatment and allow comparisons across facilities and countries. The objective of this study was to review maternal sepsis definitions and identification criteria and to report on the results of an expert consultation to develop a new international definition of maternal sepsis. All original and review articles and WHO documents, as well as clinical guidelines providing definitions and/or identification criteria of maternal sepsis were included. A multidisciplinary international panel of experts was surveyed through an online consultation in March-April 2016 on their opinion on the existing sepsis definitions, including new definition of sepsis proposed for the adult population (2016 Third International Consensus Definitions for Sepsis and Septic Shock) and importance of different criteria for identification of maternal sepsis. The definition was agreed using an iterative process in an expert face-to-face consensus development meeting convened by WHO and Jhpiego. Standardizing the definition of maternal sepsis and aligning it with the current understanding of sepsis in the adult population was considered a mandatory step to improve the assessment of the burden of maternal sepsis by the expert panel. The literature review and expert consultation resulted in a new WHO consensus definition "Maternal sepsis is a life-threatening condition defined as organ dysfunction resulting from infection during pregnancy, child-birth, post-abortion, or post-partum period". Plans are in progress to validate the new WHO definition of maternal sepsis in a large international population. The operationalization of the new maternal sepsis definition requires generation of a set of practical criteria to identify women with sepsis. These criteria should enable clinicians to focus on the timely initiation of actionable elements of

  18. Where does subduction initiate and die? Insights from global convection models with continental drift

    Science.gov (United States)

    Ulvrova, Martina; Williams, Simon; Coltice, Nicolas; Tackley, Paul

    2017-04-01

    Plate tectonics is a prominent feature on Earth. Together with the underlying convecting mantle, plates form a self-organized system. In order to understand the dynamics of the coupled system, subduction of the lithospheric plates plays the key role since it links the exterior with the interior of the planet. In this work we study subduction initiation and death with respect to the position of the continental rafts. Using thermo-mechanical numerical calculations we investigate global convection models featuring self-consistent plate tectonics and continental drifting employing a pseudo-plastic rheology and testing the effect of a free surface. We consider uncompressible mantle convection in Boussinesq approximation that is basaly and internaly heated. Our calculations indicate that the presence of the continents alterns stress distribution within a certain distance from the margins. Intra-oceanic subudction initiation is favorable during super-continent cycles while the initiation at passive continental margin prevails when continents are dispersed. The location of subduction initiation is additionally controlled by the lithospheric strength. Very weak lithosphere results in domination of intra-oceanic subduction initiation. The subduction zones die more easily in the vicinity of the continent due to the strong rheological contrast between the oceanic and continental lithosphere. In order to compare our findings with subduction positions through time recorded on Earth, we analyse subduction birth in global plate reconstruction back to 410 My.

  19. Global initiatives to prevent nuclear terrorism; Globalt initiativ for aa hindre nukleaer terrorisme

    Energy Technology Data Exchange (ETDEWEB)

    2010-07-01

    The fight against nuclear and radiological terrorism - someone to blow up a nuclear weapon or spread radioactive material as a 'dirty bomb' that act of terrorism - is one of the most serious threats to international security. The Global Initiative to prevent nuclear terrorism is a Norwegian-sponsored initiative that is aimed directly at combating terrorism by non-state actors. NRPA follow up Norwegian measures, including in Kazakhstan, and verifies that they are implemented and functioning as intended. (AG)

  20. Sepsis progression and outcome: a dynamical model

    Directory of Open Access Journals (Sweden)

    Gessler Damian DG

    2006-02-01

    Full Text Available Abstract Background Sepsis (bloodstream infection is the leading cause of death in non-surgical intensive care units. It is diagnosed in 750,000 US patients per annum, and has high mortality. Current understanding of sepsis is predominately observational and correlational, with only a partial and incomplete understanding of the physiological dynamics underlying the syndrome. There exists a need for dynamical models of sepsis progression, based upon basic physiologic principles, which could eventually guide hourly treatment decisions. Results We present an initial mathematical model of sepsis, based on metabolic rate theory that links basic vascular and immunological dynamics. The model includes the rate of vascular circulation, a surrogate for the metabolic rate that is mechanistically associated with disease progression. We use the mass-specific rate of blood circulation (SRBC, a correlate of the body mass index, to build a differential equation model of circulation, infection, organ damage, and recovery. This introduces a vascular component into an infectious disease model that describes the interaction between a pathogen and the adaptive immune system. Conclusion The model predicts that deviations from normal SRBC correlate with disease progression and adverse outcome. We compare the predictions with population mortality data from cardiovascular disease and cancer and show that deviations from normal SRBC correlate with higher mortality rates.

  1. Global mobility orientation and the success of self-initiated expatriates in greater China

    DEFF Research Database (Denmark)

    Lauring, Jakob; Selmer, Jan

    2014-01-01

    We investigated 640 self-initiated expatriate academics residing in Greater China. We examined whether their inherent demographic characteristics (age/gender) and acquired demographic characteristics (marital status/seniority) differentiated their work outcomes regarding job adjustment, time...... to proficiency, performance and satisfaction. We also explored the associations between global mobility orientation and these four work outcomes and examined to what extent the demographic characteristics differentiated the relationships. Results support most hypothesized differences. We found that a global...... mobility orientation was associated with all the work outcomes, except satisfaction. For inherent demographic characteristics, we found support for our hypotheses that for individuals with less successful demographics (younger, male), there was a stronger relationship between global mobility orientation...

  2. Application of Global Reporting Initiative (GRI) in the sustainability reporting of financial services

    OpenAIRE

    MONTE, TOMAS

    2009-01-01

    Sustainability reporting refers to the process in which an organization gives an account of issues related to corporate sustainability over a particular reporting period. The report is meant for both internal and external use. Sustainability reporting gives information about the organization’s interactions with its social and ecological environment. The Global Reporting Initiative (GRI) has pioneered the development of the world’s most widely used sustainability reporting framework. GRI Repor...

  3. REPORTING SOCIETAL : LIMITES ET ENJEUX DE LA PROPOSITION DE NORMALISATION INTERNATIONALE " GLOBAL REPORTING INITIATIVE "

    OpenAIRE

    Michel Capron; Françoise Quairel

    2003-01-01

    International audience; En s'inspirant de la normalisation comptable anglo-saxonne, la Global Reporting Initiative (GRI) propose un référentiel de publication volontaire d'informations sociétales. La transposition présente des limites qui rendent en fait ses principes inapplicables. Néanmoins il tend à s'imposer et les grandes entreprises peuvent y trouver le moyen d'éviter une régulation contraignante.

  4. Assessments in the Global Peace Operations Initiative: A Systems Engineering Approach

    Science.gov (United States)

    2014-06-01

    police unit GCC GPOI Coordination Committee GIG GPOI Implementation Guide GPOI Global Peace Operations Initiative GRC GPOI Regional Committee G8...degree necessary to build a coherent assessments framework. The GPOI Implementation Guide ( GIG ) begins by alluding to what the program intended to...elements and associated interactions fully observed and understood. Using the U.S. economy as an example, Driscoll (2011) illustrates the common

  5. Emergence of a global science–business initiative for ocean stewardship

    Science.gov (United States)

    Jouffray, Jean-Baptiste; Folke, Carl; Rockström, Johan

    2017-01-01

    The ocean represents a fundamental source of micronutrients and protein for a growing world population. Seafood is a highly traded and sought after commodity on international markets, and is critically dependent on healthy marine ecosystems. A global trend of wild stocks being overfished and in decline, as well as multiple sustainability challenges associated with a rapid growth of aquaculture, represent key concerns in relation to the United Nations Sustainable Development Goals. Existing efforts aimed to improve the sustainability of seafood production have generated important progress, primarily at the local and national levels, but have yet to effectively address the global challenges associated with the ocean. This study highlights the importance of transnational corporations in enabling transformative change, and thereby contributes to advancing the limited understanding of large-scale private actors within the sustainability science literature. We describe how we engaged with large seafood producers to coproduce a global science–business initiative for ocean stewardship. We suggest that this initiative is improving the prospects for transformative change by providing novel links between science and business, between wild-capture fisheries and aquaculture, and across geographical space. We argue that scientists can play an important role in facilitating change by connecting knowledge to action among global actors, while recognizing risks associated with such engagement. The methods developed through this case study contribute to identifying key competences in sustainability science and hold promises for other sectors as well. PMID:28784792

  6. Emergence of a global science-business initiative for ocean stewardship.

    Science.gov (United States)

    Österblom, Henrik; Jouffray, Jean-Baptiste; Folke, Carl; Rockström, Johan

    2017-08-22

    The ocean represents a fundamental source of micronutrients and protein for a growing world population. Seafood is a highly traded and sought after commodity on international markets, and is critically dependent on healthy marine ecosystems. A global trend of wild stocks being overfished and in decline, as well as multiple sustainability challenges associated with a rapid growth of aquaculture, represent key concerns in relation to the United Nations Sustainable Development Goals. Existing efforts aimed to improve the sustainability of seafood production have generated important progress, primarily at the local and national levels, but have yet to effectively address the global challenges associated with the ocean. This study highlights the importance of transnational corporations in enabling transformative change, and thereby contributes to advancing the limited understanding of large-scale private actors within the sustainability science literature. We describe how we engaged with large seafood producers to coproduce a global science-business initiative for ocean stewardship. We suggest that this initiative is improving the prospects for transformative change by providing novel links between science and business, between wild-capture fisheries and aquaculture, and across geographical space. We argue that scientists can play an important role in facilitating change by connecting knowledge to action among global actors, while recognizing risks associated with such engagement. The methods developed through this case study contribute to identifying key competences in sustainability science and hold promises for other sectors as well.

  7. A Student-Led Global Health Education Initiative: Reflections on the Kenyan Village Medical Education Program

    Science.gov (United States)

    John, Christopher; Asquith, Heidi; Wren, Tom; Mercuri, Stephanie; Brownlow, Sian

    2016-01-01

    The Kenyan Village Medical Education Program is a student-led global health initiative that seeks to improve health outcomes in rural Kenya through culturally appropriate health education. The month-long program, which is organised by the Melbourne University Health Initiative (Australia), is conducted each January in southern rural Kenya. Significance for public health The Kenyan Village Medical Education (KVME) Program is a student-led global health initiative that involves exploring well-established strategies for the prevention of disease through workshops that are conducted in southern rural Kenya. These workshops are tailored to the unique needs and circumstances of rural Kenyan communities, and are delivered to community leaders, as well as to adults and children within the wider community. Aside from the KVME Program’s emphasis on reducing the burden of preventable disease through health education, the positive impact of the KVME Program on the Program’s student volunteers also deserves consideration. Throughout the month-long KVME Program, student volunteers are presented with opportunities to develop their understanding of cultural competency, the social and economic determinants of health, as well as the unique challenges associated with working in resource-poor communities. Importantly, the KVME Program also represents an avenue through which global health leadership can be fostered amongst student volunteers. PMID:27190974

  8. Surviving Sepsis Campaign

    DEFF Research Database (Denmark)

    Rhodes, Andrew; Evans, Laura E; Alhazzani, Waleed

    2017-01-01

    OBJECTIVE: To provide an update to "Surviving Sepsis Campaign Guidelines for Management of Sepsis and Septic Shock: 2012." DESIGN: A consensus committee of 55 international experts representing 25 international organizations was convened. Nominal groups were assembled at key international meetings...... (for those committee members attending the conference). A formal conflict-of-interest (COI) policy was developed at the onset of the process and enforced throughout. A stand-alone meeting was held for all panel members in December 2015. Teleconferences and electronic-based discussion among subgroups......, and evidence profiles were generated. Each subgroup generated a list of questions, searched for best available evidence, and then followed the principles of the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system to assess the quality of evidence from high to very low...

  9. Surviving Sepsis Campaign

    DEFF Research Database (Denmark)

    Rhodes, Andrew; Evans, Laura E; Alhazzani, Waleed

    2017-01-01

    OBJECTIVE: To provide an update to "Surviving Sepsis Campaign Guidelines for Management of Sepsis and Septic Shock: 2012". DESIGN: A consensus committee of 55 international experts representing 25 international organizations was convened. Nominal groups were assembled at key international meetings...... (for those committee members attending the conference). A formal conflict-of-interest (COI) policy was developed at the onset of the process and enforced throughout. A stand-alone meeting was held for all panel members in December 2015. Teleconferences and electronic-based discussion among subgroups......, and evidence profiles were generated. Each subgroup generated a list of questions, searched for best available evidence, and then followed the principles of the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system to assess the quality of evidence from high to very low...

  10. Experimental models of sepsis and septic shock: an overview

    Directory of Open Access Journals (Sweden)

    Garrido Alejandra G.

    2004-01-01

    Full Text Available Sepsis remains a major cause of morbidity and mortality in surgical patients and trauma victims, mainly due to sepsis-induced multiple organ dysfunction. In contrast to preclinical studies, most clinical trials of promising new treatment strategies for sepsis have fails to demonstrate efficacy. Although many reasons could account for this discrepancy, the misinterpretation of preclinical data obtained from experimental studies, and especially the use of animal models that do not adequately mimic human sepsis may have been contributing factors. In this review, the benefits and limitations of various animal models of sepsis are discussed to clarify the extend to which findings are relevant to human sepsis, particularly with respect to the subsequent design and execution of clinical trials. Such models include intravascular infusion of endotoxin or live bacteria, bacterial peritonitis, cecal ligation and perforation, soft tissue infection, pneumonia or meningitis models, using different animal species including rats, mice, rabbits, dogs, pigs, sheep and nonhuman primates. Despite several limitations, animal models remain essential in the development of all new therapies for sepsis and septic shock, because they provide fundamental information about the pharmacokinetics, toxicity, and mechanism of drug action that cannot be duplicated by other methods. New therapeutic agents should be studies in infection models, even after the initiation of the septic process. Furthermore, debility conditions need to be reproduced to avoid the exclusive use of healthy animals, which often do not represent the human septic patient.

  11. Neonatal sepsis: Highlighting the principles of diagnosis and management

    Directory of Open Access Journals (Sweden)

    Melantha Coetzee

    2017-07-01

    Full Text Available Neonatal sepsis is a clinical syndrome consisting of nonspecific symptoms and signs of infection, accompanied by a bacteraemia in the first 28 days of life. The risk of neonatal sepsis and death increases with decreasing birth weight and gestational age. South African data have reported the overall incidence of neonatal sepsis to be 8.5 - 10%, with late-onset sepsis accounting for most of these infections. The diagnosis of neonatal sepsis is not always straightforward, and the initiation and continuation of antimicrobials in these situations relies on good clinical judgment. The need for empirical antimicrobials is driven by the existence of risk factors for early-onset sepsis and clinical symptoms and signs of late-onset sepsis. Antimicrobial stewardship programmes should be in place to guide clinicians to either stop, change, or continue antimicrobials. Institution-specific knowledge of the most common pathogens and the antimicrobial susceptibility pattern is important to prevent the emergence of further antimicrobial resistance.

  12. Oversight role of the Independent Monitoring Board of the Global Polio Eradication Initiative.

    Science.gov (United States)

    Rutter, Paul D; Donaldson, Liam J

    2014-11-01

    The Global Polio Eradication Initiative (GPEI) established its Independent Monitoring Board (IMB) in 2010 to monitor and guide its progress toward stopping polio transmission globally. The concept of an IMB is innovative, with no clear analogue in the history of the GPEI or in any other global health program. The IMB meets with senior program officials every 3-6 months. Its reports provide analysis and recommendations about individual polio-affected countries. The IMB also examines issues affecting the global program as a whole. Its areas of focus have included escalating the level of priority afforded to polio eradication (particularly by recommending a World Health Assembly resolution to declare polio eradication a programmatic emergency, which was enacted in May 2012), placing greater emphasis on people factors in the delivery of the program, encouraging innovation, strengthening focus on the small number of so-called sanctuaries where polio persists, and continuous quality improvement to reach every missed child with vaccination. The IMB's true independence from the agencies and countries delivering the program has enabled it to raise difficult issues that others cannot. Other global health programs might benefit from establishing similar independent monitoring mechanisms. © The Author 2014. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.

  13. Information data systems for a global change technology initiative architecture trade study

    Science.gov (United States)

    Murray, Nicholas D.

    1991-01-01

    The Global Change Technology Initiative (GCTI) was established to develop technology which will enable use of satellite systems of Earth observations on a global scale, enable use of the observations to predictively model Earth's changes, and provide scientists, government, business, and industry with quick access to the resulting information. At LaRC, a GCTI Architecture Trade Study was undertaken to develop and evaluate the architectural implications to meet the requirements of the global change studies and the eventual implementation of a global change system. The output of the trade study are recommended technologies for the GCTI. That portion of the study concerned with the information data system is documented. The information data system for an earth global change modeling system can be very extensive and beyond affordability in terms of today's costs. Therefore, an incremental approach to gaining a system is most likely. An options approach to levels of capability versus needed technologies was developed. The primary drivers of the requirements for the information data system evaluation were the needed science products, the science measurements, the spacecraft orbits, the instruments configurations, and the spacecraft configurations and their attendant architectures. The science products requirements were not studied here; however, some consideration of the product needs were included in the evaluation results. The information data system technology items were identified from the viewpoint of the desirable overall information system characteristics.

  14. The IGAC activity for the development of global emissions inventories: Description and initial results

    International Nuclear Information System (INIS)

    Benkovitz, C.M.; Graedel, T.E.

    1992-02-01

    Modeling assessments of the atmospheric chemistry, air quality and climatic conditions of the past, present and future require as input inventories of emissions of the appropriate chemical species constructed on appropriate spatial and temporal scales. The task of the Global Emissions Inventories Activity (GEIA) of the International Global Atmospheric Chemistry Project (IGAC) is the production of global inventories suitable for a range of research applications. Current GEIA programs are generally based on addressing emissions by species; these include CO 2 , NH 3 /N 2 O, SO 2 /NO x , CFC, volatile organic compounds and radioisotopes. In addition a separate program to inventory emissions from biomass burning is also being structured, plus an additional program to address data management issues for all the developing inventories. Program priorities are based on current knowledge and tasks needed to produce the desired inventories. This paper will discuss the different types of global inventories to be developed by the GEIA programs, their key characteristics, and areas to be addressed in the compilation of such inventories. Results of the first GEIA task, a survey of existing inventories and auxiliary data, will be presented. The survey included status assessments for the available inventory information for nineteen different atmospheric species or groups of species on global and regional scales and over time. Of this entire body of information, the only inventory regarded as satisfactory was that for the global emissions of CFCs. An implication of the results of these assessments is that properly gridded emissions inventories are badly needed to support atmospheric modeling calculations on a variety of spatial and temporal scales. Initial studies in the development of global inventories of sulfur dioxide, currently the most advanced GEIA program, will be presented and discussed

  15. A method of recovering the initial vectors of globally coupled map lattices based on symbolic dynamics

    International Nuclear Information System (INIS)

    Sun Li-Sha; Kang Xiao-Yun; Zhang Qiong; Lin Lan-Xin

    2011-01-01

    Based on symbolic dynamics, a novel computationally efficient algorithm is proposed to estimate the unknown initial vectors of globally coupled map lattices (CMLs). It is proved that not all inverse chaotic mapping functions are satisfied for contraction mapping. It is found that the values in phase space do not always converge on their initial values with respect to sufficient backward iteration of the symbolic vectors in terms of global convergence or divergence (CD). Both CD property and the coupling strength are directly related to the mapping function of the existing CML. Furthermore, the CD properties of Logistic, Bernoulli, and Tent chaotic mapping functions are investigated and compared. Various simulation results and the performances of the initial vector estimation with different signal-to-noise ratios (SNRs) are also provided to confirm the proposed algorithm. Finally, based on the spatiotemporal chaotic characteristics of the CML, the conditions of estimating the initial vectors using symbolic dynamics are discussed. The presented method provides both theoretical and experimental results for better understanding and characterizing the behaviours of spatiotemporal chaotic systems. (general)

  16. A method of recovering the initial vectors of globally coupled map lattices based on symbolic dynamics

    Science.gov (United States)

    Sun, Li-Sha; Kang, Xiao-Yun; Zhang, Qiong; Lin, Lan-Xin

    2011-12-01

    Based on symbolic dynamics, a novel computationally efficient algorithm is proposed to estimate the unknown initial vectors of globally coupled map lattices (CMLs). It is proved that not all inverse chaotic mapping functions are satisfied for contraction mapping. It is found that the values in phase space do not always converge on their initial values with respect to sufficient backward iteration of the symbolic vectors in terms of global convergence or divergence (CD). Both CD property and the coupling strength are directly related to the mapping function of the existing CML. Furthermore, the CD properties of Logistic, Bernoulli, and Tent chaotic mapping functions are investigated and compared. Various simulation results and the performances of the initial vector estimation with different signal-to-noise ratios (SNRs) are also provided to confirm the proposed algorithm. Finally, based on the spatiotemporal chaotic characteristics of the CML, the conditions of estimating the initial vectors using symbolic dynamics are discussed. The presented method provides both theoretical and experimental results for better understanding and characterizing the behaviours of spatiotemporal chaotic systems.

  17. Transitioning Lessons Learned and Assets of the Global Polio Eradication Initiative to Global and Regional Measles and Rubella Elimination.

    Science.gov (United States)

    Kretsinger, Katrina; Strebel, Peter; Kezaala, Robert; Goodson, James L

    2017-07-01

    The Global Polio Eradication Initiative has built an extensive infrastructure with capabilities and resources that should be transitioned to measles and rubella elimination efforts. Measles continues to be a major cause of child mortality globally, and rubella continues to be the leading infectious cause of birth defects. Measles and rubella eradication is feasible and cost saving. The obvious similarities in strategies between polio elimination and measles and rubella elimination include the use of an extensive surveillance and laboratory network, outbreak preparedness and response, extensive communications and social mobilization networks, and the need for periodic supplementary immunization activities. Polio staff and resources are already connected with those of measles and rubella, and transitioning existing capabilities to measles and rubella elimination efforts allows for optimized use of resources and the best opportunity to incorporate important lessons learned from polio eradication, and polio resources are concentrated in the countries with the highest burden of measles and rubella. Measles and rubella elimination strategies rely heavily on achieving and maintaining high vaccination coverage through the routine immunization activity infrastructure, thus creating synergies with immunization systems approaches, in what is termed a "diagonal approach." © The Author 2017. Published by Oxford University Press for the Infectious Diseases Society of America.

  18. Public policy and risk financing strategies for global catastrophe risk management - the role of global risk initiatives

    Science.gov (United States)

    McSharry, Patrick; Mitchell, Andrew; Anderson, Rebecca

    2010-05-01

    Decision-makers in both public and private organisations depend on accurate data and scientific understanding to adequately address climate change and the impact of extreme events. The financial impacts of catastrophes on populations and infrastructure can be offset through effective risk transfer mechanisms, structured to reflect the specific perils and levels of exposure to be covered. Optimal strategies depend on the likely socio-econonomic impact, the institutional framework, the overall objectives of the covers placed and the level of both the frequency and severity of loss potential expected. The diversity of approaches across different countries has been documented by the Spanish "Consorcio de Compensación de Seguros". We discuss why international public/private partnerships are necessary for addressing the risk of natural catastrophes. International initiatives such as the Global Earthquake Model (GEM) and the World Forum of Catastrophe Programmes (WFCP) can provide effective guidelines for constructing natural catastrophe schemes. The World Bank has been instrumental in the creation of many of the existing schemes such as the Turkish Catastrophe Insurance Pool, the Caribbean Catastrophe Risk Insurance Facility and the Mongolian Index-Based Livestock Insurance Program. We review existing schemes and report on best practice in relation to providing protection against natural catastrophe perils. The suitability of catastrophe modelling approaches to support schemes across the world are discussed and we identify opportunities to improve risk assessment for such schemes through transparent frameworks for quantifying, pricing, sharing and financing catastrophe risk on a local and global basis.

  19. A guide to the translation of the Global Initiative for Asthma (GINA) strategy into improved care

    DEFF Research Database (Denmark)

    Boulet, Louis-Philippe; FitzGerald, J Mark; Levy, Mark L

    2012-01-01

    In 1995, the Global Initiative for Asthma (GINA) published an evidence-based workshop report as a guide to clinicians managing asthma patients, and has updated it annually to ensure that recommendations remain current. Although the report has been widely disseminated and influenced clinical...... practice and research, its major objective, of forming the basis for local and national initiatives to improve services for asthma patients, remains to be achieved. Over recent years, the science of guideline implementation has progressed, and encouraging examples of successful asthma programmes have been...... published. This report is intended to draw on this experience and assist with the translation of asthma guideline recommendations into quality programmes for patients with asthma using current knowledge translation principles. It also provides examples of successful initiatives in various socioeconomic...

  20. Unrevealing culture-negative severe sepsis

    OpenAIRE

    de Prost, Nicolas; Razazi, Keyvan; Brun-Buisson, Christian

    2013-01-01

    Sepsis involves a wide array of sources and microorganisms, only a fraction of which are microbiologically documented. Culture-negative sepsis poses special diagnostic challenges to both clinicians and microbiologists and further questions the validity of sepsis definitions.

  1. Developing and implementing a data acquisition strategy for global agricultural monitoring: an inter-agency initiative

    Science.gov (United States)

    Justice, C. O.; Whitcraft, A. K.; Becker-Reshef, I.; Killough, B.

    2013-12-01

    In 2011, in response to global food crises, the G20 Agricultural Ministers launched a satellite-based global agricultural monitoring initiative to develop the Group on Earth Observations Global Agriculture Monitoring (GEOGLAM) system. The GEO is aimed at enhancing the availability and use of both satellite and in situ data for societal benefit. This initiative builds on the observation requirements developed by the GEO Agricultural Community of Practice, the understanding that no one satellite system can currently provide all the data needed for agricultural monitoring and the resulting recommendation for improved acquisition and availability of data by the World's space agencies. Implicit in this recommendation is the fact that certain regions of the Earth are imagery rich while others are imagery poor, leaving knowledge gaps about agricultural processes and food supply for certain areas of the World. In order to respond to these knowledge gaps and to strengthen national, regional, and global agricultural monitoring networks, GEOGLAM is working with the Committee on Earth Observations (CEOS), the space arm of GEO, to develop a coordinated global acquisition strategy. A key component of GEOGLAM is an effort to articulate the temporal and spatial Earth Observation (EO) requirements for monitoring; second, the identification of current and planned missions which are capable of fulfilling these EO requirements; and third, the development of a multi-agency, multi-mission image acquisition strategy for agricultural monitoring. CEOS engineers and GEOGLAM scientists have been collaborating on the EO requirements since 2012, and are now beginning the first implementation phase of the acquisition strategy. The goal is to put in place an operational system of systems using a virtual constellation of satellite-based sensors acquiring data to meet the needs for monitoring and early warning of shortfalls in agricultural production, a goal that was articulated in the 1970's

  2. Meningococcal disease in the Asia-Pacific region: Findings and recommendations from the Global Meningococcal Initiative.

    Science.gov (United States)

    Borrow, Ray; Lee, Jin-Soo; Vázquez, Julio A; Enwere, Godwin; Taha, Muhamed-Kheir; Kamiya, Hajime; Kim, Hwang Min; Jo, Dae Sun

    2016-11-21

    The Global Meningococcal Initiative (GMI) is a global expert group that includes scientists, clinicians, and public health officials with a wide range of specialties. The purpose of the Initiative is to promote the global prevention of meningococcal disease (MD) through education, research, and cooperation. The first Asia-Pacific regional meeting was held in November 2014. The GMI reviewed the epidemiology of MD, surveillance, and prevention strategies, and outbreak control practices from participating countries in the Asia-Pacific region.Although, in general, MD is underreported in this region, serogroup A disease is most prominent in low-income countries such as India and the Philippines, while Taiwan, Japan, and Korea reported disease from serogroups C, W, and Y. China has a mixed epidemiology of serogroups A, B, C, and W. Perspectives from countries outside of the region were also provided to provide insight into lessons learnt. Based on the available data and meeting discussions, a number of challenges and data gaps were identified and, as a consequence, several recommendations were formulated: strengthen surveillance; improve diagnosis, typing and case reporting; standardize case definitions; develop guidelines for outbreak management; and promote awareness of MD among healthcare professionals, public health officials, and the general public. Copyright © 2016. Published by Elsevier Ltd.

  3. The critical role of acute flaccid paralysis surveillance in the Global Polio Eradication Initiative.

    Science.gov (United States)

    Tangermann, Rudolf H; Lamoureux, Christine; Tallis, Graham; Goel, Ajay

    2017-05-01

    Acute flaccid paralysis (AFP) surveillance is a key strategy used by the Global Polio Eradication Initiative (GPEI) to measure progress towards reaching the global eradication goal. Supported by a global polio laboratory network, AFP surveillance is conducted in 179 of 194 WHO member states. Active surveillance visits to priority health facilities are used to assure all children polio laboratories. The quality of AFP surveillance is regularly monitored with standardized surveillance quality indicators. In highest risk countries and areas, the sensitivity of AFP surveillance is enhanced by environmental surveillance (testing of sewage samples). Genetic sequencing of detected poliovirus isolates yields programmatically important information on polio transmission pathways. AFP surveillance is one of the most valuable assets of the GPEI, with the potential to serve as a platform to build integrated disease surveillance systems. Continued support to maintain AFP surveillance systems will be essential, to reliably monitor the completion of global polio eradication, and to assure that a key resource for building surveillance capacity is transitioned post-eradication to support other health priorities. © The Author 2017. Published by Oxford University Press on behalf of Royal Society of Tropical Medicine and Hygiene. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  4. Applying a global justice lens to health systems research ethics: an initial exploration.

    Science.gov (United States)

    Pratt, Bridget; Hyder, Adnan A

    2015-03-01

    Recent scholarship has considered what, if anything, rich people owe to poor people to achieve justice in global health and the implications of this for international research. Yet this work has primarily focused on international clinical research. Health systems research is increasingly being performed in low and middle income countries and is essential to reducing global health disparities. This paper provides an initial description of the ethical issues related to priority setting, capacity-building, and the provision of post-study benefits that arise during the conduct of such research. It presents a selection of issues discussed in the health systems research literature and argues that they constitute ethical concerns based on their being inconsistent with a particular theory of global justice (the health capability paradigm). Issues identified include the fact that priority setting for health systems research at the global level is often not driven by national priorities and that capacity-building efforts frequently utilize one-size-fits-all approaches.

  5. Early management of sepsis with emphasis on early goal directed therapy: AME evidence series 002

    OpenAIRE

    Zhang, Zhongheng; Hong, Yucai; Smischney, Nathan J.; Kuo, Han-Pin; Tsirigotis, Panagiotis; Rello, Jordi; Kuan, Win Sen; Jung, Christian; Robba, Chiara; Taccone, Fabio Silvio; Leone, Marc; Spapen, Herbert; Grimaldi, David; Van Poucke, Sven; Simpson, Steven Q.

    2017-01-01

    Severe sepsis and septic shock are major causes of morbidity and mortality in patients entering the emergency department (ED) or intensive care unit (ICU). Despite substantial efforts to improve patient outcome, treatment of sepsis remains challenging to clinicians. In this context, early goal directed therapy (EGDT) represents an important concept emphasizing both early recognition of sepsis and prompt initiation of a structured treatment algorithm. As part of the AME evidence series on seps...

  6. Global solubility of the three-dimensional Navier-Stokes equations with uniformly large initial vorticity

    International Nuclear Information System (INIS)

    Makhalov, A S; Nikolaenko, V P

    2003-01-01

    This paper is a survey of results concerning the three-dimensional Navier-Stokes and Euler equations with initial data characterized by uniformly large vorticity. The existence of regular solutions of the three-dimensional Navier-Stokes equations on an unbounded time interval is proved for large initial data both in R 3 and in bounded cylindrical domains. Moreover, the existence of smooth solutions on large finite time intervals is established for the three-dimensional Euler equations. These results are obtained without additional assumptions on the behaviour of solutions for t>0. Any smooth solution is not close to any two-dimensional manifold. Our approach is based on the computation of singular limits of rapidly oscillating operators, non-linear averaging, and a consideration of the mutual absorption of non-linear oscillations of the vorticity field. The use of resonance conditions, methods from the theory of small divisors, and non-linear averaging of almost periodic functions leads to the limit resonant Navier-Stokes equations. Global solubility of these equations is proved without any conditions on the three-dimensional initial data. The global regularity of weak solutions of three-dimensional Navier-Stokes equations with uniformly large vorticity at t=0 is proved by using the regularity of weak solutions and the strong convergence

  7. Endotoxin dosage in sepsis

    Directory of Open Access Journals (Sweden)

    Vincenzo Rondinelli

    2012-03-01

    Full Text Available Introduction. Endotoxin, a component of the cell wall of Gram-negative bacteria is a major contributor to the pathogenesis of septic shock and multiple organ failure (MOF. Its entry into the bloodstream stimulates monocytes/macrophages which once activated produce and release cytokines, nitric oxide and other mediators that induce systemic inflammation, endothelial damage, organ dysfunction, hypotension (shock and MOF.The aim of this study is to evaluate the usefulness of a quantitative test for the dosage of endotoxin to determine the risk of severe Gram-negative sepsis. Materials and methods. In the period January 2009 - June 2011 we performed 897 tests for 765 patients, mostly coming from the emergency room and intensive care, of which 328 (43% women (mean age 53 and 437 (57% male (mean age 49. Fifty-nine patients, no statistically significant difference in sex, were monitored by an average of two determinations of EA.All patients had procalcitonin values significantly altered.The kit used was EAA (Endotoxin Activity Assay Estor Company, Milan, which has three ranges of endotoxin activity (EA: low risk of sepsis if <0.40 units, medium if between 0.40 and 0.59; high if 0.60. Results. 78 out of 765 patients (10% had a low risk, 447 (58% a medium risk and 240 (32% a high risk.The dosage of EA, combined with that of procalcitonin, has allowed a more targeted antibiotic therapy. Six patients in serious clinical conditions were treated by direct hemoperfusion with Toraymyxin, a device comprising a housing containing a fiber polypropylene and polystyrene with surface-bound polymyxin B, an antibiotic that removes bacterial endotoxins from the blood. Conclusions.The test is useful in risk stratification as well as Gram negative sepsis, to set and monitor targeted therapies, also based on the neutralization of endotoxin.

  8. Global Initiative of the Special Olympics Movement for People with Intellectual Disabilities

    Directory of Open Access Journals (Sweden)

    Myśliwiec Andrzej

    2015-03-01

    Full Text Available The mission of the Special Olympics is to provide year-round sports training and competition in a variety (33 of Olympic-type sports for children and adults with intellectual disabilities, giving them continuing opportunities to develop physical fitness, demonstrate courage, experience joy, and participate in sharing of gifts and friendship with their families, other athletes, and their communities. The Special Olympics movement often goes beyond the sports competition formula. During the last few years, the movement has developed many new global initiatives, which expand its former sports activities. They include:

  9. New Zealand among global social media initiative leaders for primary care advocacy.

    Science.gov (United States)

    Hoedebecke, Kyle; Scott-Jones, Joseph; Pinho-Costa, Luís

    2016-06-01

    The international '#1WordforFamilyMedicine' initiative explores the identity of General Practitioners (GPs) and Family Physicians (FPs) by allowing the international Family Medicine community to collaborate on advocating for the discipline via social media. The New Zealand version attracted 83 responses on social media. Thematic analysis was performed on the responses and a 'word cloud' image was created based on an image identifying the country around the world - that of the silver fern. The '#1WorldforFamilyMedicine' project was promoted by WONCA (World Organisation of Family Doctors) globally to help celebrate World Family Doctor Day on 19 May 2015. To date, over 80 images have been created in 60 different countries on six continents. The images represent GPs' love for their profession and the community they serve. We hope that this initiative will help inspire current and future Family Medicine and Primary Care providers.

  10. Adherence of private health system hospitals to dissemination of outcomes according to the Global Reporting Initiative (GRI) model.

    Science.gov (United States)

    Machado, Celso; César, Robson Danúbio da Silva; Souza, Maria Tereza Saraiva de

    2017-01-01

    To verify if there is an analogy between the indicators of the Global Reporting Initiative adopted by hospitals in the private healthcare system. Documentary research supported by reports that are electronically available on the website of the companies surveyed. The organizations surveyed had a significant adherence of their economic, social and environmental indicators of the model proposed by the Global Reporting Initiative, showing an analogous field of common indicators between them. There is similarity between the indicators adopted by companies, but one of the hospitals analyzed had a greater number of converging indicators to Global Reporting Initiative.

  11. Detoxification in Abdominal Sepsis

    Directory of Open Access Journals (Sweden)

    A. F. Potapov

    2005-01-01

    Full Text Available Objective. To comparatively analyze the efficiency of methods for extracorporeal detoxification (ED of the body in abdominal sepsis (AS and to choose the optimum detoxifying methods in relation to the level of endotoxicosis.Material and methods. 56 patients (41 males and 15 females; mean age 39.4±12.2 years with surgical abdominal infection of various genesis, complicated by the development of sepsis whose treatment included ED methods, were examined. The level of intoxication and the efficiency of detoxification were evaluated by general clinical and biochemical blood parameters, the leukocytic intoxication index, the levels of low and medium molecular-weight substances in the body’s media. Hemosorption, plasmapheresis, hemodialysis, hemodiafiltration, and hemofiltration were used for detoxification.Results. Surgical abdominal infection is accompanied by endotoxemia that has no clear nosological specificity, but it depends on the pattern of a clinical course of the disease and is most pronounced in the septic syndrome. In AS, 80.4% of the patients are observed to have an irreversible decompensation phase and a terminal degree of endotoxicosis, which require detoxification. The use of different ED methods according to the level of intoxication may reduce the level of endotoxicosis and yield a persistent beneficial effect in 85.2% of cases of its application. Conclusion. Filtration and dialysis techniques (hemodialysis, hemofiltration, and hemodiafiltration are the methods of choice in AS. Hemosorption and plasmapheresis may be recommended for use at the early stages of endotoxicosis development and in preserved renal excretory function.

  12. The global threat reduction initiative and conversion of isotope production to LEU targets

    International Nuclear Information System (INIS)

    Kuperman, A. J.

    2005-01-01

    The U.S. Global Threat Reduction Initiative (GTRI) has given a decisive impetus to the RERTR program's longstanding goal of converting worldwide production of medical radioisotopes from reliance on bomb-grade, highly enriched uranium (HEU) to low-enriched uranium (LEU) unsuitable for weapons. Although the four major; isotope producers continue to resist calls for conversion, they face mounting pressure from a variety of fronts including: (1) GTRI; (2) a related, multilateral U.S. initiative to forge agreement on conversion among the states that are home to the major producers; (3) an IAEA effort to provide technical assistance that will facilitate large-scale production of medical isotopes using LEU by producers who seek to do so; (4) planned production in the United States of substantial quantities of medical isotopes using LEU; and (5) pending U.S. legislation that would prohibit the export of HEU for production of isotopes as soon as alternative, LEU-produced isotopes are available. Accordingly, it now appears inevitable that worldwide isotope production will be converted from reliance on HEU to LEU. The only remaining question is which producers will be the first to reliably deliver sizeable quantities of LEU-produced isotopes and thereby capture global market share from the others. (author)

  13. Developing the "120 by 20" goal for the Global FP2020 Initiative.

    Science.gov (United States)

    Brown, Win; Druce, Nel; Bunting, Julia; Radloff, Scott; Koroma, Desmond; Gupta, Srishti; Siems, Brian; Kerrigan, Monica; Kress, Dan; Darmstadt, Gary L

    2014-03-01

    This report describes the purpose for developing a quantitative goal for the London Summit on Family Planning held in July 2012, the methodology behind its formulation, and the lessons learned in the process. The London Summit has evolved into the global initiative known as FP2020, and the goal has become "120 by 20," or reaching 120 million additional users of modern contraceptive methods by 2020 in the world's poorest countries. The success of FP2020 will first be evaluated on the basis of quantitative verification to determine that the "120 by 20" goal was reached. More important, however, is the extent to which the goal today serves as a global rallying cry to mobilize resources and leadership around current family planning programs, with a focus on voluntary family planning and quality of care, and with an emphasis on meeting girls' and women's unmet needs and their right to practice contraception. We hope this article provides greater transparency and understanding of the FP2020 goal, and that the global goal spurs annual monitoring of progress toward national goals in the world's poorest countries. © 2014 The Population Council, Inc.

  14. Evaluating surveillance indicators supporting the Global Polio Eradication Initiative, 2011-2012.

    Science.gov (United States)

    2013-04-12

    The Global Polio Eradication Initiative (GPEI) was established in 1988 by the World Health Assembly to interrupt transmission of wild poliovirus (WPV); completion of this initiative was declared a programmatic emergency of public health in January 2012. Polio cases are detected through surveillance for acute flaccid paralysis (AFP) with linked stool specimens tested for polioviruses (PVs) at accredited laboratories within the Global Polio Laboratory Network (GPLN). AFP surveillance findings are supplemented by testing sewage samples (environmental surveillance) collected at selected sites. Virologic data guide where targeted immunization activities should be conducted or improved. Key performance indicators are used to 1) monitor AFP surveillance quality at national and subnational levels to identify gaps where PV transmission could occur undetected; 2) provide evidence of where PV circulation has been interrupted; and 3) allow timely detection of an outbreak. Standardized surveillance indicators allow progress to be monitored over time and compared among countries. This report presents AFP surveillance performance indicators at national and subnational levels for countries affected by polio during 2011-2012, and trends in environmental surveillance, updating previous reports. In the 19 countries with transmission of PV (WPV and/or circulating vaccine-derived poliovirus [cVDPV]) during 2011-2012, national performance indicator targets were met in 12 (63%) countries in 2011 and 13 (68%) countries in 2012. Seven countries (37%) in 2011 had ≥80% of the population living in areas meeting performance indicators, increasing to nine countries (47%) in 2012. Performance indicators for timely reporting of PV isolation and characterization were met in four of six World Health Organization (WHO) regions in 2011 and five regions in 2012. To achieve global polio eradication, efforts are needed to improve and maintain AFP surveillance and laboratory performance.

  15. Constructing a Global Learning Partnership in Physiotherapy: An Ireland–Uganda Initiative

    Directory of Open Access Journals (Sweden)

    Cliona O’Sullivan

    2017-06-01

    Full Text Available Background and aimThere is a strong correlation between disability and poverty and it is acknowledged that until disability issues are addressed, the goal of poverty reduction in low-income countries is unlikely to be achieved. Despite the high prevalence of disability in developing countries, there remains a significant shortage of rehabilitation professionals as highlighted by the WHO report, Human resources for Health (2006. The purpose of this project was to develop a collaborative and sustainable partnership to strengthen educational and research capacity in global health, disability, and rehabilitation between two physiotherapy schools; University College Dublin, Ireland, and Mbarara University of Science and Technology, Uganda. This article aims to describe the approach used and initial project outcomes.MethodsThis project involved a bilateral visit to both institutions by two members of staff of respective physiotherapy programs. These visits entailed stakeholder meetings, clinical site visits, and workshops to identify the priorities for the partnership and shape the collaboration going forward. Appreciative inquiry methodology was used during the workshops and the four-dimensional framework for curriculum development was used to guide analysis and underpin findings.FindingsThe key priorities identified were (i development of joint global health learning initiative, (ii to explore the possibility of postgraduate learning and research opportunities for Ugandan colleagues, and (iii to develop joint clinical placements. The rationale and context and a plan of action is described.Discussion and conclusionThe project is ambitious and in order to be sustainable, the importance of long-term interinstitutional commitment and further funding cannot be ignored. This work provides a framework for other universities and institutions wishing to undertake similar activities. Such partnerships provide rich learning opportunities for students and

  16. Constructing a Global Learning Partnership in Physiotherapy: An Ireland-Uganda Initiative.

    Science.gov (United States)

    O'Sullivan, Cliona; Kazibwe, Herman; Whitehouse, Zillah; Blake, Catherine

    2017-01-01

    There is a strong correlation between disability and poverty and it is acknowledged that until disability issues are addressed, the goal of poverty reduction in low-income countries is unlikely to be achieved. Despite the high prevalence of disability in developing countries, there remains a significant shortage of rehabilitation professionals as highlighted by the WHO report, Human resources for Health (2006). The purpose of this project was to develop a collaborative and sustainable partnership to strengthen educational and research capacity in global health, disability, and rehabilitation between two physiotherapy schools; University College Dublin, Ireland, and Mbarara University of Science and Technology, Uganda. This article aims to describe the approach used and initial project outcomes. This project involved a bilateral visit to both institutions by two members of staff of respective physiotherapy programs. These visits entailed stakeholder meetings, clinical site visits, and workshops to identify the priorities for the partnership and shape the collaboration going forward. Appreciative inquiry methodology was used during the workshops and the four-dimensional framework for curriculum development was used to guide analysis and underpin findings. The key priorities identified were (i) development of joint global health learning initiative, (ii) to explore the possibility of postgraduate learning and research opportunities for Ugandan colleagues, and (iii) to develop joint clinical placements. The rationale and context and a plan of action is described. The project is ambitious and in order to be sustainable, the importance of long-term interinstitutional commitment and further funding cannot be ignored. This work provides a framework for other universities and institutions wishing to undertake similar activities. Such partnerships provide rich learning opportunities for students and health professionals and facilitate a deeper understanding of global health

  17. Early Prediction of Sepsis Incidence in Critically Ill Patients Using Specific Genetic Polymorphisms.

    Science.gov (United States)

    David, Vlad Laurentiu; Ercisli, Muhammed Furkan; Rogobete, Alexandru Florin; Boia, Eugen S; Horhat, Razvan; Nitu, Razvan; Diaconu, Mircea M; Pirtea, Laurentiu; Ciuca, Ioana; Horhat, Delia; Horhat, Florin George; Licker, Monica; Popovici, Sonia Elena; Tanasescu, Sonia; Tataru, Calin

    2017-06-01

    Several diagnostic methods for the evaluation and monitoring were used to find out the pro-inflammatory status, as well as incidence of sepsis in critically ill patients. One such recent method is based on investigating the genetic polymorphisms and determining the molecular and genetic links between them, as well as other sepsis-associated pathophysiologies. Identification of genetic polymorphisms in critical patients with sepsis can become a revolutionary method for evaluating and monitoring these patients. Similarly, the complications, as well as the high costs associated with the management of patients with sepsis, can be significantly reduced by early initiation of intensive care.

  18. Educational Contributions Of The Nurse In The Prevention Of Sepsis In The Unit Of Intensive Therapy: Integrative Review

    Directory of Open Access Journals (Sweden)

    Alana Morais Venancio

    2017-02-01

    Full Text Available Sepsis is defined as a syndrome of inflammatory response, motivated by an aggressive agent, associated with systemic infection, the early approach of the infectious agent, both in the direction of diagnosis and in the control of infectious focus, are fundamental for the good evolution of the patient. This pathology has been considered a global health problem, affecting a large number of people and causing high rates of morbidity and mortality. OBJECTIVE: The study aimed to investigate how nurses contribute in an educational way in the prevention of complications caused by sepsis in an intensive care unit. METHOD: The research was carried out through an electronic search of scientific papers published in the databases LILACS, SCIELO and PUBMED, portal of the virtual library in health. Other materials were located in scientific journals available on university websites and articles related to the subject. The initial evaluation of the material occurred through the reading of the abstracts, in order to select those that met the objectives of the study, with this, 37 articles were selected. In carrying out the research it was possible to verify that the recognition of sepsis by nursing professionals is mainly identified through the changes in the signs and symptoms that are observed through the provision of care to these critical patients. RESULTS: It has been shown that even with all the advances in the production of knowledge about the pathophysiology and the treatment of sepsis, it is still possible to find several difficulties for the proper handling in the diagnosis and in the ideal treatment for each particular case. CONCLUSION: The professional nurse should always be updating and seeking new knowledge for a fast, safe and effective action, in conjunction with the entire health team to promote quality and resolutive care for the patient, especially those affected by sepsis.

  19. Adherence of private health system hospitals to dissemination of outcomes according to the Global Reporting Initiative (GRI) model

    OpenAIRE

    Machado Junior, Celso; César, Robson Danúbio da Silva; Souza, Maria Tereza Saraiva de

    2017-01-01

    ABSTRACT Objective To verify if there is an analogy between the indicators of the Global Reporting Initiative adopted by hospitals in the private healthcare system. Methods Documentary research supported by reports that are electronically available on the website of the companies surveyed. Results The organizations surveyed had a significant adherence of their economic, social and environmental indicators of the model proposed by the Global Reporting Initiative, showing an analogous fie...

  20. Adherence of private health system hospitals to dissemination of outcomes according to the Global Reporting Initiative (GRI) model

    OpenAIRE

    Machado, Celso; César, Robson Danúbio da Silva; de Souza, Maria Tereza Saraiva

    2017-01-01

    ABSTRACT Objective To verify if there is an analogy between the indicators of the Global Reporting Initiative adopted by hospitals in the private healthcare system. Methods Documentary research supported by reports that are electronically available on the website of the companies surveyed. Results The organizations surveyed had a significant adherence of their economic, social and environmental indicators of the model proposed by the Global Reporting Initiative, showing an analogous field of ...

  1. Global initiative of the special olympics movement for people with intellectual disabilities.

    Science.gov (United States)

    Myśliwiec, Andrzej; Damentko, Mariusz

    2015-03-29

    The mission of the Special Olympics is to provide year-round sports training and competition in a variety (33) of Olympic-type sports for children and adults with intellectual disabilities, giving them continuing opportunities to develop physical fitness, demonstrate courage, experience joy, and participate in sharing of gifts and friendship with their families, other athletes, and their communities. The Special Olympics movement often goes beyond the sports competition formula. During the last few years, the movement has developed many new global initiatives, which expand its former sports activities. They include: Coaching excellence and the coaching modelPartnerships with international (regional) sports federationsSports Resources Teams (SRT)Extended quota for high level athletesAthletes Leadership Program (ALPS)Young Athletes ProgramYouth volunteer initiativesUnified Sports ProgramMotor Activity Training ProgramHealthy Athletes Program These initiatives fulfill and expand the existing program, which was launched in 1968 and is the largest sports organization for people with disabilities worldwide, with very important new social, marketing, and developmental aspects of life, going far beyond activities met in other sports organizations.

  2. Global Initiative of the Special Olympics Movement for People with Intellectual Disabilities

    Science.gov (United States)

    Myśliwiec, Andrzej; Damentko, Mariusz

    2015-01-01

    The mission of the Special Olympics is to provide year-round sports training and competition in a variety (33) of Olympic-type sports for children and adults with intellectual disabilities, giving them continuing opportunities to develop physical fitness, demonstrate courage, experience joy, and participate in sharing of gifts and friendship with their families, other athletes, and their communities. The Special Olympics movement often goes beyond the sports competition formula. During the last few years, the movement has developed many new global initiatives, which expand its former sports activities. They include: Coaching excellence and the coaching modelPartnerships with international (regional) sports federationsSports Resources Teams (SRT)Extended quota for high level athletesAthletes Leadership Program (ALPS)Young Athletes ProgramYouth volunteer initiativesUnified Sports ProgramMotor Activity Training ProgramHealthy Athletes Program These initiatives fulfill and expand the existing program, which was launched in 1968 and is the largest sports organization for people with disabilities worldwide, with very important new social, marketing, and developmental aspects of life, going far beyond activities met in other sports organizations. PMID:25964828

  3. Premise for Standardized Sepsis Models.

    Science.gov (United States)

    Remick, Daniel G; Ayala, Alfred; Chaudry, Irshad; Coopersmith, Craig M; Deutschman, Clifford; Hellman, Judith; Moldawer, Lyle; Osuchowski, Marcin

    2018-06-05

    Sepsis morbidity and mortality exacts a toll on patients and contributes significantly to healthcare costs. Preclinical models of sepsis have been used to study disease pathogenesis and test new therapies, but divergent outcomes have been observed with the same treatment even when using the same sepsis model. Other disorders such as diabetes, cancer, malaria, obesity and cardiovascular diseases have used standardized, preclinical models that allow laboratories to compare results. Standardized models accelerate the pace of research and such models have been used to test new therapies or changes in treatment guidelines. The National Institutes of Health (NIH) mandated that investigators increase data reproducibility and the rigor of scientific experiments and has also issued research funding announcements about the development and refinement of standardized models. Our premise is that refinement and standardization of preclinical sepsis models may accelerate the development and testing of potential therapeutics for human sepsis, as has been the case with preclinical models for other disorders. As a first step towards creating standardized models, we suggest 1) standardizing the technical standards of the widely used cecal ligation and puncture model and 2) creating a list of appropriate organ injury and immune dysfunction parameters. Standardized sepsis models could enhance reproducibility and allow comparison of results between laboratories and may accelerate our understanding of the pathogenesis of sepsis.

  4. Sepsis por shigella flexneri

    Directory of Open Access Journals (Sweden)

    César Cabrera C

    2005-04-01

    Full Text Available Se presenta un caso raro de sepsis por Shigella flexneri en una paciente de 45 años de edad quien estando hospitalizada para el estudio de un tumor cerebral, requirió el uso de manitol y dosis altas de corticoides; luego de ello presenta deposiciones líquidas con moco y sangre, desarrolla síndrome de respuesta inflamatoria sistémica, luego se aísla Shigella flexneri en el hemocultivo; recibió tratamiento antibiótico con ciprofloxacina. Se describen las características del caso y se comenta de acuerdo con la revisión de literatura.

  5. Moraxella catarrhalis sepsis

    Directory of Open Access Journals (Sweden)

    Paola Gualdi

    2008-06-01

    Full Text Available Moraxella catarrhalis is a Gram-negative aerobic diplococcus, commensal of the oro-pharingeal cavity, actually playing an emerging role in the upper respiratory tract infections together with Streptococcus pneumoniae and Haemophilus influenzae. This study reports the case of a twoyearold child who was admitted into hospital with fever, headache and vomit. The chest radiograph showed signs of basal lung involvementmaking the clinical suspicion of bacterial infectionlikely. From blood culture a Moraxella catarrhalis strain was isolated. In young children M. catarrhalis is known to cause otitis media and sinusitis, but only rarely bacteremia. In this case the child showed a clinical picture of lung infection and consequent sepsis due to M. catarrhalis.

  6. Corporate responsibility reporting according to Global Reporting Initiative: an international comparison

    Directory of Open Access Journals (Sweden)

    Ionela-Corina CHERSAN

    2016-04-01

    Full Text Available The Global Reporting Initiative (GRI is an organization that has managed to impose its reporting practices on corporate responsibility among large transnational companies. The model proposed by GRI is based on the supposed convergence between the economic, social and environmental dimensions of sustainable development. This convergence can be presumed at macroeconomic level, but at the level of enterprises, the three dimensions are often divergent. By analyzing the structure of reports included in the GRI database, our article aims to identify the factors that impact on company’s behavior in the corporate responsibility reporting process. In addition, our research invites to answer the following question: is it not possible that these reports attempt to exaggerate company environmental and social performance, rather than to cause a change in their conduct?

  7. International institutions, global health initiatives and the challenge of sustainability: lessons from the Brazilian AIDS programme.

    Science.gov (United States)

    Le Loup, G; Fleury, S; Camargo, K; Larouzé, B

    2010-01-01

    The sustainability of successful public health programmes remains a challenge in low and middle income settings. These programmes are often subjected to mobilization-demobilization cycle. Indeed, political and organizational factors are of major importance to ensure this sustainability. The cooperation between the World Bank and the Brazilian AIDS programme highlights the role of international institutions and global health initiatives (GHI), not only to scale up programmes but also to guarantee their stability and sustainability, at a time when advocacy is diminishing and vertical programmes are integrated within health systems. This role is critical at the local level, particularly when economic crisis may hamper the future of public health programmes. Political and organizational evolution should be monitored and warnings should trigger interventions of GHI before the decline of these programmes.

  8. Absolute counts of peripheral blood leukocyte subpopulations in intraabdominal sepsis and pneumonia-derived sepsis: a pilot study Absolute counts of peripheral blood leukocyte subpopulations in intraabdominal sepsis and pneumonia-derived sepsis: a pilot study

    Directory of Open Access Journals (Sweden)

    Grazyna Anna Hoser

    2012-10-01

    Full Text Available The leading pathophysiological changes during sepsis include systemic abnormalities in the immune
    response. Due to the general character of these disturbances, sepsis is usually studied as a homogenous clinical
    condition. We aimed to compare the immune response in intraabdominal sepsis (IAS and pneumonia-derived
    sepsis (PDS. The following cell populations were examined: white blood cell count (WBC, monocytes, lymphocytes:
    CD3+, CD4+ and CD8+ T cells, B cells, and NK cells. In both studied groups (i.e. IAS and PDS, the
    WBC was elevated. However, it was significantly higher in the IAS group than in the PDS group. The difference
    was due to a lower granulocyte count, as well as a lower monocyte count in PDS. We found no significant
    correlation between the total lymphocyte number and CD3+CD8+ T cells in either form of sepsis. Similarly, we
    observed no correlation between the total lymphocyte number and the NK cells subset in IAS. However, the
    numbers of CD3+CD8+ and NK cells correlated similarly in both types of sepsis. Both studied types of sepsis
    induced profound lymphocytopenia, with marked loss of CD8+ T cells and the NK cells. However, the similar
    relation between them, which was independent of the infection type, suggests that the NK and CD3+CD8+ cells
    have shared mechanisms of regulation. The primary site of infection has an impact on the global immune reaction.
    These alternations include especially myeloid cells: granulocytes and monocytes which disappear from peripheral
    blood during PDS, but increase in IAS.
    The leading pathophysiological changes during sepsis include systemic abnormalities in the immune
    response. Due to the general character of these disturbances, sepsis is usually studied as a homogenous clinical
    condition. We aimed to compare the immune response in intraabdominal sepsis (IAS and pneumonia-derived
    sepsis (PDS. The following cell

  9. Building the Nightingale Initiative for Global Health--NIGH: can we engage and empower the public voices of nurses worldwide?

    Science.gov (United States)

    Beck, Deva-Marie; Dossey, Barbara M; Rushton, Cynda H

    2013-10-01

    The Nightingale Initiative for Global Health (NIGH) is a major grassroots-to-global movement of "daring, caring and sharing" of nursing and others around the world inspired by the outstanding legacy of Florence Nightingale. The Nightingale Initiative envisions and emulates what Nightingale might have accomplished if she lived in the digital age and with international agencies such as the United Nations and World Health Organization. It challenges nurses everywhere to think and act both locally and globally, to raise their voices about the contribution of nursing, and to become authentic advocates, particularly in addressing the United Nations Millennium Development Goals.

  10. An assessment of interactions between global health initiatives and country health systems.

    Science.gov (United States)

    Samb, Badara; Evans, Tim; Dybul, Mark; Atun, Rifat; Moatti, Jean-Paul; Nishtar, Sania; Wright, Anna; Celletti, Francesca; Hsu, Justine; Kim, Jim Yong; Brugha, Ruairi; Russell, Asia; Etienne, Carissa

    2009-06-20

    Since 2000, the emergence of several large disease-specific global health initiatives (GHIs) has changed the way in which international donors provide assistance for public health. Some critics have claimed that these initiatives burden health systems that are already fragile in countries with few resources, whereas others have asserted that weak health systems prevent progress in meeting disease-specific targets. So far, most of the evidence for this debate has been provided by speculation and anecdotes. We use a review and analysis of existing data, and 15 new studies that were submitted to WHO for the purpose of writing this Report to describe the complex nature of the interplay between country health systems and GHIs. We suggest that this Report provides the most detailed compilation of published and emerging evidence so far, and provides a basis for identification of the ways in which GHIs and health systems can interact to mutually reinforce their effects. On the basis of the findings, we make some general recommendations and identify a series of action points for international partners, governments, and other stakeholders that will help ensure that investments in GHIs and country health systems can fulfil their potential to produce comprehensive and lasting results in disease-specific work, and advance the general public health agenda. The target date for achievement of the health-related Millennium Development Goals is drawing close, and the economic downturn threatens to undermine the improvements in health outcomes that have been achieved in the past few years. If adjustments to the interactions between GHIs and country health systems will improve efficiency, equity, value for money, and outcomes in global public health, then these opportunities should not be missed.

  11. Assessment of Global Cloud Datasets from Satellites: Project and Database Initiated by the GEWEX Radiation Panel

    Science.gov (United States)

    Stubenrauch, C. J.; Rossow, W. B.; Kinne, S.; Ackerman, S.; Cesana, G.; Chepfer, H.; Getzewich, B.; Di Girolamo, L.; Guignard, A.; Heidinger, A.; hide

    2012-01-01

    Clouds cover about 70% of the Earth's surface and play a dominant role in the energy and water cycle of our planet. Only satellite observations provide a continuous survey of the state of the atmosphere over the whole globe and across the wide range of spatial and temporal scales that comprise weather and climate variability. Satellite cloud data records now exceed more than 25 years in length. However, climatologies compiled from different satellite datasets can exhibit systematic biases. Questions therefore arise as to the accuracy and limitations of the various sensors. The Global Energy and Water cycle Experiment (GEWEX) Cloud Assessment, initiated in 2005 by the GEWEX Radiation Panel, provided the first coordinated intercomparison of publically available, standard global cloud products (gridded, monthly statistics) retrieved from measurements of multi-spectral imagers (some with multiangle view and polarization capabilities), IR sounders and lidar. Cloud properties under study include cloud amount, cloud height (in terms of pressure, temperature or altitude), cloud radiative properties (optical depth or emissivity), cloud thermodynamic phase and bulk microphysical properties (effective particle size and water path). Differences in average cloud properties, especially in the amount of high-level clouds, are mostly explained by the inherent instrument measurement capability for detecting and/or identifying optically thin cirrus, especially when overlying low-level clouds. The study of long-term variations with these datasets requires consideration of many factors. A monthly, gridded database, in common format, facilitates further assessments, climate studies and the evaluation of climate models.

  12. The impact of global health initiatives on the health system in Angola.

    Science.gov (United States)

    Craveiro, Isabel; Dussault, Gilles

    2016-01-01

    We assessed the impact of global health initiatives (GHIs) on the health care system of Angola, as a contribution to documenting how GHIs, such as the Global Fund, GAVI and PEPFAR, influence the planning and delivery of health services in low-income countries and how national systems respond. We collected the views of national and sub-national key informants through 42 semi-structured interviews between April 2009 and May 2011 (12 at the national level and 30 at the sub-national level). We used a snowball technique to identify respondents from government, donors and non-governmental organisations. GHIs stimulated the formulation of a health policy and of plans and strategies, but the country has yet to decide on its priorities for health. At the regional level, managers lack knowledge of how GHIs' function, but they assess the effects of external funds as positive as they increased training opportunities, and augment the number of workers engaged in HIV or other specific disease programmes. However, GHIs did not address the challenge of attraction and retention of qualified personnel in provinces. Since Angola is not entirely dependent on external funding, national strategic programmes and the interventions of GHIs co-habit well, in contrast to countries such as Mozambique, which heavily depend on external aid.

  13. Pregnancy-associated severe sepsis.

    Science.gov (United States)

    Oud, Lavi

    2016-04-01

    This article examines the contemporary knowledge and uncertainties about the burden of pregnancy-associated severe sepsis (PASS), and its manifestations, management, and outcomes. There are relatively sparse data on PASS, related in part to infrequent reports and varying use of terminology and case definitions. PASS remains rare, although its incidence appears to be rapidly rising in some high-resource countries, affecting especially women with limited resources, minorities, and those with chronic illness. High level of clinician vigilance and rapid initiation of appropriate antimicrobial therapy, coupled with effective systemic support for organ dysfunction and correction of occult and overt hypoperfusion are the keys to limit adverse outcomes. However, timely diagnosis and provision of effective care remain a challenge, with reported prevalent delay in recognition and delivery of time-sensitive care interventions among maternal decedents. The mortality rate of PASS has been rising and its case fatality, although relatively low, has remained unchanged, in contrast to the outcome gains in the general population. The long-term sequelae of PASS remain unknown. The relatively limited contemporary data on PASS suggest a rising public health hazard in the obstetric population in high-resource countries, with ongoing challenges in assuring consistent provision of time-sensitive care.

  14. Radiologic findings of neonatal sepsis

    International Nuclear Information System (INIS)

    Kim, Sam Soo; Han, Dae Hee; Choi, Guk Myeong; Jung, Hye Won; Yoon, Hye Kyung; Han, Bokyung Kim; Lee, Nam Yong

    1997-01-01

    To review the simple radiographic and sonographic findings in infants with neonatal sepsis. We retrospectively analyzed simple chest and abdominal radiographs, and brain sonograms in 36 newborn infants (preterm : term=23 :13). With neonatal sepsis diagnosed by blood culture and clinical manifestations. Pulmonary parenchymal infiltrate excluding respiratory distress syndrome and pulmonary edema or atelectasis was found in 22 infants (61%). Paralytic ileus, hepatosplenomegaly, and necrotizing enterocolitis were present in 18(50%), 9(25%), and 1(3%) infants, respectively, while skeletal changes suggesting osteomyelitis were found in three. Brain sonography was performed in 29 infants and in four, abnormalities were seen ; these comprised three germinal matrix hemorrhages and one intraparenchymal hemorrhage. In six patients(17%) radiologic examinations revealed no abnormality. In patients with neonatal sepsis, pulmonary infiltrates and paralytic ileus were common abnormalities. Although these were nonspecific, radiologic findings may be used to supplement clinical and laboratory findings in diagnosing neonatal sepsis and planning its treatment

  15. Radiologic findings of neonatal sepsis

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Sam Soo; Han, Dae Hee; Choi, Guk Myeong; Jung, Hye Won [Seoul National Univ. College of Medicine, Seoul (Korea, Republic of); Yoon, Hye Kyung; Han, Bokyung Kim; Lee, Nam Yong [Sansung Medical Center, Seoul (Korea, Republic of)

    1997-06-01

    To review the simple radiographic and sonographic findings in infants with neonatal sepsis. We retrospectively analyzed simple chest and abdominal radiographs, and brain sonograms in 36 newborn infants (preterm : term=23 :13). With neonatal sepsis diagnosed by blood culture and clinical manifestations. Pulmonary parenchymal infiltrate excluding respiratory distress syndrome and pulmonary edema or atelectasis was found in 22 infants (61%). Paralytic ileus, hepatosplenomegaly, and necrotizing enterocolitis were present in 18(50%), 9(25%), and 1(3%) infants, respectively, while skeletal changes suggesting osteomyelitis were found in three. Brain sonography was performed in 29 infants and in four, abnormalities were seen ; these comprised three germinal matrix hemorrhages and one intraparenchymal hemorrhage. In six patients(17%) radiologic examinations revealed no abnormality. In patients with neonatal sepsis, pulmonary infiltrates and paralytic ileus were common abnormalities. Although these were nonspecific, radiologic findings may be used to supplement clinical and laboratory findings in diagnosing neonatal sepsis and planning its treatment.

  16. In Search of a Cure for Sepsis: Taming the Monster in Critical Care Medicine.

    Science.gov (United States)

    Okeke, Emeka B; Uzonna, Jude E

    2016-01-01

    In spite of over half a century of research, sepsis still constitutes a major problem in health care delivery. Although advances in research have significantly increased our knowledge of the pathogenesis of sepsis and resulted in better prognosis and improved survival outcome, sepsis still remains a major challenge in modern medicine with an increase in occurrence predicted and a huge socioeconomic burden. It is generally accepted that sepsis is due to an initial hyperinflammatory response. However, numerous efforts aimed at targeting the proinflammatory cytokine network have been largely unsuccessful and the search for novel potential therapeutic targets continues. Recent studies provide compelling evidence that dysregulated anti-inflammatory responses may also contribute to sepsis mortality. Our previous studies on the role of regulatory T cells and phosphoinositide 3-kinases in sepsis highlight immunological approaches that could be explored for sepsis therapy. In this article, we review the current and emerging concepts in sepsis, highlight novel potential therapeutic targets and immunological approaches for sepsis treatment and propose a biphasic treatment approach for management of the condition. © 2016 S. Karger AG, Basel.

  17. Septris: a novel, mobile, online, simulation game that improves sepsis recognition and management.

    Science.gov (United States)

    Evans, Kambria H; Daines, William; Tsui, Jamie; Strehlow, Matthew; Maggio, Paul; Shieh, Lisa

    2015-02-01

    Annually affecting over 18 million people worldwide, sepsis is common, deadly, and costly. Despite significant effort by the Surviving Sepsis Campaign and other initiatives, sepsis remains underrecognized and undertreated. Research indicates that educating providers may improve sepsis diagnosis and treatment; thus, the Stanford School of Medicine has developed a mobile-accessible, case-based, online game entitled Septris (http://med.stanford.edu/septris/). Septris, launched online worldwide in December 2011, takes an innovative approach to teaching early sepsis identification and evidence-based management. The free gaming platform leverages the massive expansion over the past decade of smartphones and the popularity of noneducational gaming.The authors sought to assess the game's dissemination and its impact on learners' sepsis-related knowledge, skills, and attitudes. In 2012, the authors trained Stanford pregraduate (clerkship) and postgraduate (resident) medical learners (n = 156) in sepsis diagnosis and evidence-based practices via 20 minutes of self-directed game play with Septris. The authors administered pre- and posttests. By October 2014, Septris garnered over 61,000 visits worldwide. After playing Septris, both pre- and postgraduate groups improved their knowledge on written testing in recognizing and managing sepsis (P game scores with sepsis knowledge.

  18. The effects of levosimendan on brain metabolism during initial recovery from global transient ischaemia/hypoxia

    Directory of Open Access Journals (Sweden)

    Roehl Anna B

    2012-08-01

    Full Text Available Abstract Backround Neuroprotective strategies after cardiopulmonary resuscitation are currently the focus of experimental and clinical research. Levosimendan has been proposed as a promising drug candidate because of its cardioprotective properties, improved haemodynamic effects in vivo and reduced traumatic brain injury in vitro. The effects of levosimendan on brain metabolism during and after ischaemia/hypoxia are unknown. Methods Transient cerebral ischaemia/hypoxia was induced in 30 male Wistar rats by bilateral common carotid artery clamping for 15 min and concomitant ventilation with 6% O2 during general anaesthesia with urethane. After 10 min of global ischaemia/hypoxia, the rats were treated with an i.v. bolus of 24 μg kg-1 levosimendan followed by a continuous infusion of 0.2 μg kg-1 min-1. The changes in the energy-related metabolites lactate, the lactate/pyruvate ratio, glucose and glutamate were monitored by microdialysis. In addition, the effects on global haemodynamics, cerebral perfusion and autoregulation, oedema and expression of proinflammatory genes in the neocortex were assessed. Results Levosimendan reduced blood pressure during initial reperfusion (72 ± 14 vs. 109 ± 2 mmHg, p = 0.03 and delayed flow maximum by 5 minutes (p = 0.002. Whereas no effects on time course of lactate, glucose, pyruvate and glutamate concentrations in the dialysate could be observed, the lactate/pyruvate ratio during initial reperfusion (144 ± 31 vs. 77 ± 8, p = 0.017 and the glutamate release during 90 minutes of reperfusion (75 ± 19 vs. 24 ± 28 μmol·L-1 were higher in the levosimendan group. The increased expression of IL-6, IL-1ß TNFα and ICAM-1, extend of cerebral edema and cerebral autoregulation was not influenced by levosimendan. Conclusion Although levosimendan has neuroprotective actions in vitro and on the spinal cord in vivo and has been shown to cross the blood–brain barrier, the present

  19. Northern Eurasia Future Initiative: Facing the Challenges of Global Change in the 21st century

    Science.gov (United States)

    Groisman, Pavel; Gutman, Garik; Gulev, Sergey; Maksyutov, Shamil; Qi, Jiaguo

    2016-04-01

    During the past 12 years, the Northern Eurasia Earth Science Partnership Initiative (NEESPI) - an interdisciplinary program of internationally-supported Earth systems and science research - has addressed large-scale and long-term manifestations of climate and environmental changes over Northern Eurasia and their impact on the Global Earth system. With more than 1500 peer-reviewed journal publications and 40 books to its credit, NEESPI's activities resulted in significant scientific outreach. This created a new research realm through self-organization of NEESPI scientists in a broad research network, accumulation of knowledge while developing new tools (observations, models, and collaborative networks) and producing new, exciting results that can be applied to directly support decision-making for societal needs. This realm was summed up at the Synthesis NEESPI Workshop in Prague, Czech Republic (April 9-12, 2015) where it was decided to shift gradually the foci of regional studies in Northern Eurasia towards applications with the following major Science Question: " What dynamic and interactive change(s) will affect societal well-being, activities, and health, and what might be the mitigation and adaptation strategies that could support sustainable development and decision-making activities in Northern Eurasia?". To answer this question requires a stronger socio-economic component in the ongoing and future regional studies focused on sustainable societal development under changing climatic and environmental conditions, especially, under conditions when societal decision-making impacts and feeds back on the environment. This made the NEESPI studies closer to the ICSU research initiative "Future Earth". Accordingly, the NEESPI Research Team decided to reorganize in the nearest future NEESPI into "Northern Eurasia Future Initiative" (NEFI) and began development of its Programmatic White Paper (in preparation at the time of this abstract submission). The NEFI research

  20. China's International Education Initiatives and View of Its Role in Global Governance

    Science.gov (United States)

    Li, Sharon X.

    2012-01-01

    China is becoming an increasingly important actor in global governance. This paper contends that China participates by promoting its own global governance concepts on the one hand and by complying with the established global norms on the other. The paper introduces several key global governance concepts of the Chinese government and argues that…

  1. The Ozone Budget in the Upper Troposphere from Global Modeling Initiative (GMI)Simulations

    Science.gov (United States)

    Rodriquez, J.; Duncan, Bryan N.; Logan, Jennifer A.

    2006-01-01

    Ozone concentrations in the upper troposphere are influenced by in-situ production, long-range tropospheric transport, and influx of stratospheric ozone, as well as by photochemical removal. Since ozone is an important greenhouse gas in this region, it is particularly important to understand how it will respond to changes in anthropogenic emissions and changes in stratospheric ozone fluxes.. This response will be determined by the relative balance of the different production, loss and transport processes. Ozone concentrations calculated by models will differ depending on the adopted meteorological fields, their chemical scheme, anthropogenic emissions, and treatment of the stratospheric influx. We performed simulations using the chemical-transport model from the Global Modeling Initiative (GMI) with meteorological fields from (It)h e NASA Goddard Institute for Space Studies (GISS) general circulation model (GCM), (2) the atmospheric GCM from NASA's Global Modeling and Assimilation Office(GMAO), and (3) assimilated winds from GMAO . These simulations adopt the same chemical mechanism and emissions, and adopt the Synthetic Ozone (SYNOZ) approach for treating the influx of stratospheric ozone -. In addition, we also performed simulations for a coupled troposphere-stratosphere model with a subset of the same winds. Simulations were done for both 4degx5deg and 2degx2.5deg resolution. Model results are being tested through comparison with a suite of atmospheric observations. In this presentation, we diagnose the ozone budget in the upper troposphere utilizing the suite of GMI simulations, to address the sensitivity of this budget to: a) the different meteorological fields used; b) the adoption of the SYNOZ boundary condition versus inclusion of a full stratosphere; c) model horizontal resolution. Model results are compared to observations to determine biases in particular simulations; by examining these comparisons in conjunction with the derived budgets, we may pinpoint

  2. Global Carbon-and-Conservation Models, Global Eco-States? Ecuador’s Yasuní-ITT Initiative and Governance Implications

    Directory of Open Access Journals (Sweden)

    Conny Davidsen

    2013-05-01

    Full Text Available The “global carbon age” marks a structural change far beyond the economic realms of implementing carbon trade, affecting the fabric of global environmental governance and its actors. Carbon trade and conservation in the Global South have taken on various forms, and climate change mitigation efforts in light of continued rainforest deforestation are scrambling to establish effective approaches. Ecuador’s Yasuní-ITT Initiative proposes a new global carbon-and-conservation model in the Ecuadorian Amazon that leaves oil reserves of the Yasuní Ishpingo Tambococha Tiputini (ITT oil fields underground, in exchange for international compensation payments that would be based on voluntary contributions of governments and nongovernmental actors in an international conservation partnership and trust fund under the auspices of the United Nations Development Programme. This model suggests far-reaching consequences, as it introduces new global scales for the sharing and management of environmental costs within a framework of neoliberal cost internalization. The analysis in this paper uses the concept of the “ecological state” (Duit, 2008 as a theoretical point of departure to examine the trans-scalar implications of such a carbon-and-conservation model on global governance structures toward a “global ecological state” (or global eco-state.

  3. Living with risk. A global review of disaster reduction initiatives. Preliminary version

    International Nuclear Information System (INIS)

    2002-01-01

    In recent years the world has witnessed an interminable succession of disasters - floods, storms, earthquakes, landslides, volcanic eruptions and wildfires that have claimed many thousands of lives, caused material losses in the tens of billions of dollars, and inflicted a terrible toll on developing countries in particular, where disasters divert attention and resources needed desperately to escape poverty. Communities will always face natural hazards, but today's disasters are often generated by, or at least exacerbated by, human activities. At the most dramatic level, human activities are changing the natural balance of the earth, interfering as never before with the atmosphere, the oceans, the polar ice caps, the forest cover and the natural pillars that make our world a livable home. But we are also putting ourselves in harm's way in less visible ways. At no time in human history have so many people lived in cities clustered around seismically active areas. Destitution and demographic pressure have led more people than ever before to live in flood plains or in areas prone to landslides. Poor land-use planning; environmental mismanagement; and a lack of regulatory mechanisms both increase the risk and exacerbate the effects of disasters. Living with risk: a global review of disaster reduction is the first comprehensive effort by the United Nations system to take stock of disaster reduction initiatives throughout the world. Coordinated by the secretariat of the International Strategy for Disaster Reduction (ISDR), the report discusses current disaster trends, assesses policies aimed at mitigating the impact of disasters, and offers examples of successful initiatives. It also recommends that risk reduction be integrated into sustainable development at all levels - global, national and local. Most of all, Living with risk shows that we are far from helpless in the face of natural hazards. Early warning and risk reduction measures have been important factors in

  4. [Nutritional support in sepsis].

    Science.gov (United States)

    Ortiz Leyba, C; López Martínez, J; Blesa Malpica, A L

    2005-06-01

    Although it is considered that metabolic and nutritional support must be part of the management of septic patients, it has not been conclusively shown that nutritional support will improve survival or complications from sepsis. Specific data on this issue are scarce since there are few studies that have investigated specialized nutritional support in septic patients. Thus, most of the recommendations are based on outcomes obtained in severely ill patients with different pathologies. It is assumed that nutritional support should be carried out through the enteral route whenever possible, as in other critically ill patients. The energetic waste in these patients is highly variable, although in general terms the hypermetabolic situation may be classified as moderate. An adjustment factor of 1.25-1.30 is recommended for the Harris-Benedict's equation to calculate the caloric intake. Septic patients should receive a hyperproteic intake. The amount of glucose administered should not exceed 70% of non-protein calories, and lipids intake should not exceed 40%. With regards to micronutrients, it is recommended to increase the supply of those with antioxidant properties (vitamin E, carotenes, vitamin C, selenium). There are data to consider that the use of diets enriched with pharmaco-nutrients (both with parenteral and enteral routes) may be beneficial in septic patients, although there is some controversy when interpreting the outcomes.

  5. Using Green's Functions to initialize and adjust a global, eddying ocean biogeochemistry general circulation model

    Science.gov (United States)

    Brix, H.; Menemenlis, D.; Hill, C.; Dutkiewicz, S.; Jahn, O.; Wang, D.; Bowman, K.; Zhang, H.

    2015-11-01

    The NASA Carbon Monitoring System (CMS) Flux Project aims to attribute changes in the atmospheric accumulation of carbon dioxide to spatially resolved fluxes by utilizing the full suite of NASA data, models, and assimilation capabilities. For the oceanic part of this project, we introduce ECCO2-Darwin, a new ocean biogeochemistry general circulation model based on combining the following pre-existing components: (i) a full-depth, eddying, global-ocean configuration of the Massachusetts Institute of Technology general circulation model (MITgcm), (ii) an adjoint-method-based estimate of ocean circulation from the Estimating the Circulation and Climate of the Ocean, Phase II (ECCO2) project, (iii) the MIT ecosystem model "Darwin", and (iv) a marine carbon chemistry model. Air-sea gas exchange coefficients and initial conditions of dissolved inorganic carbon, alkalinity, and oxygen are adjusted using a Green's Functions approach in order to optimize modeled air-sea CO2 fluxes. Data constraints include observations of carbon dioxide partial pressure (pCO2) for 2009-2010, global air-sea CO2 flux estimates, and the seasonal cycle of the Takahashi et al. (2009) Atlas. The model sensitivity experiments (or Green's Functions) include simulations that start from different initial conditions as well as experiments that perturb air-sea gas exchange parameters and the ratio of particulate inorganic to organic carbon. The Green's Functions approach yields a linear combination of these sensitivity experiments that minimizes model-data differences. The resulting initial conditions and gas exchange coefficients are then used to integrate the ECCO2-Darwin model forward. Despite the small number (six) of control parameters, the adjusted simulation is significantly closer to the data constraints (37% cost function reduction, i.e., reduction in the model-data difference, relative to the baseline simulation) and to independent observations (e.g., alkalinity). The adjusted air-sea gas

  6. The global polio eradication initiative Stop Transmission of Polio (STOP) program - 1999-2013.

    Science.gov (United States)

    2013-06-21

    In 1988, the Global Polio Eradication Initiative (GPEI) was established through a partnership between the World Health Organization (WHO), Rotary International, CDC, and the United Nations Children's Fund (UNICEF). By 2012, the annual incidence of polio had decreased by >99%, compared with 1988, and the number of countries in which wild poliovirus (WPV) circulation has never been interrupted was reduced to three: Afghanistan, Nigeria, and Pakistan. However, because of the persistence of endemic WPV transmission and recurring outbreaks in polio-free countries after the original polio eradication target date of 2000, the World Health Assembly in 2012 declared the completion of polio eradication a programmatic emergency. A key component of GPEI is the Stop Transmission of Polio (STOP) program, which was developed and initiated by CDC with WHO in 1999 to mobilize additional human resources and technical assistance for countries affected by WPV transmission. During 1999-2013, 1,563 volunteers were identified, trained, and deployed for 2,221 assignments in 69 countries. The number of volunteers increased from 90-120 per year during 1999-2011 to 287 in 2012 and 378 in 2013, and the number of volunteer person-months in the field per year increased from 273 in 1999 to 1,456 in 2012. The STOP program has aided GPEI by strengthening the capacity of country-level immunization programs and by allowing a large cohort of volunteers to gain valuable field experience that prepares them well for subsequent work as staff members of WHO, UNICEF, and other public health agencies.

  7. Salt Reduction Initiatives around the World - A Systematic Review of Progress towards the Global Target.

    Science.gov (United States)

    Trieu, Kathy; Neal, Bruce; Hawkes, Corinna; Dunford, Elizabeth; Campbell, Norm; Rodriguez-Fernandez, Rodrigo; Legetic, Branka; McLaren, Lindsay; Barberio, Amanda; Webster, Jacqui

    2015-01-01

    To quantify progress with the initiation of salt reduction strategies around the world in the context of the global target to reduce population salt intake by 30% by 2025. A systematic review of the published and grey literature was supplemented by questionnaires sent to country program leaders. Core characteristics of strategies were extracted and categorised according to a pre-defined framework. A total of 75 countries now have a national salt reduction strategy, more than double the number reported in a similar review done in 2010. The majority of programs are multifaceted and include industry engagement to reformulate products (n = 61), establishment of sodium content targets for foods (39), consumer education (71), front-of-pack labelling schemes (31), taxation on high-salt foods (3) and interventions in public institutions (54). Legislative action related to salt reduction such as mandatory targets, front of pack labelling, food procurement policies and taxation have been implemented in 33 countries. 12 countries have reported reductions in population salt intake, 19 reduced salt content in foods and 6 improvements in consumer knowledge, attitudes or behaviours relating to salt. The large and increasing number of countries with salt reduction strategies in place is encouraging although activity remains limited in low- and middle-income regions. The absence of a consistent approach to implementation highlights uncertainty about the elements most important to success. Rigorous evaluation of ongoing programs and initiation of salt reduction programs, particularly in low- and middle- income countries, will be vital to achieving the targeted 30% reduction in salt intake.

  8. Salt Reduction Initiatives around the World - A Systematic Review of Progress towards the Global Target.

    Directory of Open Access Journals (Sweden)

    Kathy Trieu

    Full Text Available To quantify progress with the initiation of salt reduction strategies around the world in the context of the global target to reduce population salt intake by 30% by 2025.A systematic review of the published and grey literature was supplemented by questionnaires sent to country program leaders. Core characteristics of strategies were extracted and categorised according to a pre-defined framework.A total of 75 countries now have a national salt reduction strategy, more than double the number reported in a similar review done in 2010. The majority of programs are multifaceted and include industry engagement to reformulate products (n = 61, establishment of sodium content targets for foods (39, consumer education (71, front-of-pack labelling schemes (31, taxation on high-salt foods (3 and interventions in public institutions (54. Legislative action related to salt reduction such as mandatory targets, front of pack labelling, food procurement policies and taxation have been implemented in 33 countries. 12 countries have reported reductions in population salt intake, 19 reduced salt content in foods and 6 improvements in consumer knowledge, attitudes or behaviours relating to salt.The large and increasing number of countries with salt reduction strategies in place is encouraging although activity remains limited in low- and middle-income regions. The absence of a consistent approach to implementation highlights uncertainty about the elements most important to success. Rigorous evaluation of ongoing programs and initiation of salt reduction programs, particularly in low- and middle- income countries, will be vital to achieving the targeted 30% reduction in salt intake.

  9. The GED4GEM project: development of a Global Exposure Database for the Global Earthquake Model initiative

    Science.gov (United States)

    Gamba, P.; Cavalca, D.; Jaiswal, K.S.; Huyck, C.; Crowley, H.

    2012-01-01

    In order to quantify earthquake risk of any selected region or a country of the world within the Global Earthquake Model (GEM) framework (www.globalquakemodel.org/), a systematic compilation of building inventory and population exposure is indispensable. Through the consortium of leading institutions and by engaging the domain-experts from multiple countries, the GED4GEM project has been working towards the development of a first comprehensive publicly available Global Exposure Database (GED). This geospatial exposure database will eventually facilitate global earthquake risk and loss estimation through GEM’s OpenQuake platform. This paper provides an overview of the GED concepts, aims, datasets, and inference methodology, as well as the current implementation scheme, status and way forward.

  10. A global, multi-disciplinary, multi-sectorial initiative to combat leptospirosis: Global Leptospirosis Environmental Action Network (GLEAN).

    Science.gov (United States)

    Durski, Kara N; Jancloes, Michel; Chowdhary, Tej; Bertherat, Eric

    2014-06-05

    Leptospirosis has emerged as a major public health problem in both animals and humans. The true burden of this epidemic and endemic disease is likely to be grossly under-estimated due to the non-specific clinical presentations of the disease and the difficulty of laboratory confirmation. The complexity that surrounds the transmission dynamics, particularly in epidemic situations, requires a coordinated, multi-disciplinary effort. Therefore, the Global Leptospirosis Environmental Action Network (GLEAN) was developed to improve global and local strategies of how to predict, prevent, detect, and intervene in leptospirosis outbreaks in order to prevent and control leptospirosis in high-risk populations.

  11. Pregnancy-Associated Severe Sepsis: Contemporary State and Future Challenges.

    Science.gov (United States)

    Oud, Lavi

    2014-12-01

    Pregnancy is associated with an increased risk of infection related to its associated mechanical and physiological changes. Sepsis remains among the top causes of maternal death worldwide and is associated with substantial maternal morbidity. However, there are sparse data on pregnancy-associated severe sepsis (PASS), related in part to infrequent reports, varying case definitions and methodological approach, small cohort size, and often limited focus on severe sepsis in selected phases of pregnancy outcomes. Available reports vary, but indicate that PASS is a rare but likely increasing complication, and it is more likely to develop with increased maternal age, among minority women, the poor, those lacking health insurance, those with chronic illness or pregnancy-associated complications, and following invasive procedures. Obstetric sites of infection are the most prevalent, but non-obstetric infections often underlie pregnancy-associated severe sepsis, though the source of infection is often not readily apparent during initial care. Women with PASS can have a rapidly fatal course and require heightened clinician vigilance for early diagnosis and timely effective intervention. Nevertheless, available reports raise concerns about prevalent substandard care of these patients, contributing to adverse outcomes. The case fatality of PASS appears lower than that in the general population with severe sepsis, while the long-term outcomes of survivors remain unknown.

  12. On the effectiveness of private transnational governance regimes - evaluating corporate sustainability reporting according to the Global Reporting Initiative

    OpenAIRE

    Barkemeyer, Ralf; Preuss, Lutz; Lee, Lindsay

    2015-01-01

    The increasing involvement of multinational enterprises (MNEs) in global governance has been both applauded for its potential to make governance more effective and criticized for lacking democratic legitimization. Hence we investigate the effectiveness of one transnational governance regime, corporate sustainability reporting according to the Global Reporting Initiative (GRI). We found that the GRI has been successful in terms of output effectiveness by promoting the dissemination of sustaina...

  13. Global Threat Reduction Initiative Fuel Thermo-Physical Characterization Project: Sample Management Plan

    Energy Technology Data Exchange (ETDEWEB)

    Casella, Amanda J. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Pereira, Mario M. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Steen, Franciska H. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States)

    2013-01-01

    This sample management plan provides guidelines for sectioning, preparation, acceptance criteria, analytical path, and end-of-life disposal for the fuel element segments utilized in the Global Threat Reduction Initiative (GTRI), Fuel Thermo-Physical Characterization Project. The Fuel Thermo-Physical Characterization Project is tasked with analysis of irradiated Low Enriched Uranium (LEU) Molybdenum (U-Mo) fuel element samples to support the GTRI conversion program. Sample analysis may include optical microscopy (OM), scanning electron microscopy (SEM) fuel-surface interface analysis, gas pycnometry (density) measurements, laser flash analysis (LFA), differential scanning calorimetry (DSC), thermogravimetry and differential thermal analysis with mass spectroscopy (TG /DTA-MS), Inductively Coupled Plasma Spectrophotometry (ICP), alpha spectroscopy, and Thermal Ionization Mass Spectroscopy (TIMS). The project will utilize existing Radiochemical Processing Laboratory (RPL) operating, technical, and administrative procedures for sample receipt, processing, and analyses. Test instructions (TIs), which are documents used to provide specific details regarding the implementation of an existing RPL approved technical or operational procedure, will also be used to communicate to staff project specific parameters requested by the Principal Investigator (PI). TIs will be developed, reviewed, and issued in accordance with the latest revision of the RPL-PLN-700, RPL Operations Plan. Additionally, the PI must approve all project test instructions and red-line changes to test instructions.

  14. Global Threat Reduction Initiative International Partners' Conference. Summary of the proceedings and findings of the conference

    International Nuclear Information System (INIS)

    2004-01-01

    The Global Threat Reduction Initiative (GTRI) International Partners' Conference took place in Vienna, Austria, from September 18-19, 2004. More than 590 representatives from 100 International Atomic Energy Agency (IAEA) Member States attended the GTRI International Partners' Conference on September 18-19, 2004, in Vienna, Austria. Representatives from ten non-governmental and international organizations were also present during the conference. The Governments of the United States and the Russian Federation co-sponsored the International Partners Conference, with support from the International Atomic Energy Agency. The purpose of the International Partners' Conference was to build and broaden international support for efforts by national authorities to identify, secure, recover, and/or facilitate the disposition of high-risk nuclear and radioactive materials that pose a potential threat to the international community. One of the significant outcomes of the International Partners Conference was reaching agreement on the Findings of the Conference (enclosed in this document) by participating Member States that outlined a broadly shared opinion of participating Member States on efforts to reduce the potential threat posed by vulnerable, unsecured nuclear and other radioactive material. It is hoped that this document can be used as a framework to consolidate, expand, and accelerate domestic, regional, and IAEA programs that address unsecured vulnerable nuclear and radioactive materials, as deemed necessary by Member States. As a first step, participating members states urged the international community to note additional opportunities to further build support for activities related to GTRI

  15. Activities of NASA's Global Modeling Initiative (GMI) in the Assessment of Subsonic Aircraft Impact

    Science.gov (United States)

    Rodriquez, J. M.; Logan, J. A.; Rotman, D. A.; Bergmann, D. J.; Baughcum, S. L.; Friedl, R. R.; Anderson, D. E.

    2004-01-01

    The Intergovernmental Panel on Climate Change estimated a peak increase in ozone ranging from 7-12 ppbv (zonal and annual average, and relative to a baseline with no aircraft), due to the subsonic aircraft in the year 2015, corresponding to aircraft emissions of 1.3 TgN/year. This range of values presumably reflects differences in model input (e.g., chemical mechanism, ground emission fluxes, and meteorological fields), and algorithms. The model implemented by the Global Modeling Initiative allows testing the impact of individual model components on the assessment calculations. We present results of the impact of doubling the 1995 aircraft emissions of NOx, corresponding to an extra 0.56 TgN/year, utilizing meteorological data from NASA's Data Assimilation Office (DAO), the Goddard Institute for Space Studies (GISS), and the Middle Atmosphere Community Climate Model, version 3 (MACCM3). Comparison of results to observations can be used to assess the model performance. Peak ozone perturbations ranging from 1.7 to 2.2 ppbv of ozone are calculated using the different fields. These correspond to increases in total tropospheric ozone ranging from 3.3 to 4.1 Tg/Os. These perturbations are consistent with the IPCC results, due to the difference in aircraft emissions. However, the range of values calculated is much smaller than in IPCC.

  16. The Global Opioid Policy Initiative: a wealth of information, but what is next?

    Science.gov (United States)

    Scholten, Willem

    2014-03-01

    Recently, the outcomes were published of the Global Opioid Policy Initiative, evaluating the availability, cost of opioid medicines and the regulatory barriers that are possibly impeding access for the management of cancer pain in developing countries. Other studies have shown that the vast majority of the world population has no access to opioid analgesics. This study shows by country which opioid medicines are available, what they cost to the patient, and investigates the presence of barriers for access to these medicines. Data from the project will be an important resource for those who advocate for improved access to opioid analgesics. Yet, like so often, many more aspects of inadequate opioid analgesic consumption require exploration and reporting, including legislative barriers. The last publication on the project is a "What's next?" that is over focusing on palliative care, forgetting that outside palliative care is also a huge need for opioid analgesics in moderate and severe pain. While promoting access to palliative care and pain management, their recognition as a human right by UN bodies would be of great help. Moreover, WHO's Access to Controlled Medicines Programme, could be an important programme to support the countries in making these improvements.

  17. Meningococcal disease in the Middle East and Africa: Findings and updates from the Global Meningococcal Initiative.

    Science.gov (United States)

    Borrow, Ray; Caugant, Dominique A; Ceyhan, Mehmet; Christensen, Hannah; Dinleyici, Ener Cagri; Findlow, Jamie; Glennie, Linda; Von Gottberg, Anne; Kechrid, Amel; Vázquez Moreno, Julio; Razki, Aziza; Smith, Vincent; Taha, Muhamed-Kheir; Tali-Maamar, Hassiba; Zerouali, Khalid

    2017-07-01

    The Global Meningococcal Initiative (GMI) has recently considered current issues in Middle Eastern and African countries, and produced two recommendations: (i) that vaccination of attendees should be considered for some types of mass-gathering events, as some countries mandate for the Hajj, and (ii) vaccination of people with human immunodeficiency virus should be used routinely, because of increased meningococcal disease (MD) risk. Differences exist between Middle Eastern and African countries regarding case and syndrome definitions, surveillance, and epidemiologic data gaps. Sentinel surveillance provides an overview of trends and prevalence of different capsular groups supporting vaccine selection and planning, whereas cost-effectiveness decisions require comprehensive disease burden data, ideally counting every case. Surveillance data showed importance of serogroup B MD in North Africa and serogroup W expansion in Turkey and South Africa. Success of MenAfriVac ® in the African "meningitis belt" was reviewed; the GMI believes similar benefits may follow development of a low-cost meningococcal pentavalent vaccine, currently in phase 1 clinical trial, by 2022. The importance of carriage and herd protection for controlling invasive MD and the importance of advocacy and awareness campaigns were also highlighted. Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.

  18. The coagulopathy in sepsis: significance and implications for treatment

    Directory of Open Access Journals (Sweden)

    Berardino Pollio

    2011-09-01

    Full Text Available Sepsis related coagulopathy ranges from mild laboratory alterations up to severe disseminated intravascular coagulation (DIC. There is evidence that DIC is involved in the pathogenesis of microvascular dysfunction contributing to organ failure. Additionally, the systemic activation of coagulation, by consuming platelets and coagulation factors, may cause bleeding. Thrombin generation via the tissue factor/factor VIIa route, contemporary depression of antithrombin and protein C anticoagulant system, as well as impaired fibrin degradation, due to high circulating levels of PAI-1, contribute to enhanced intravascular fibrin deposition. This deranged coagulopathy is an independent predictor of clinical outcome in patients with severe sepsis. Innovative supportive strategies aiming at the inhibition of coagulation activation comprise inhibition of tissue factor-mediated activation or restoration of physiological anticoagulant pathways, as the administration of recombinant human activated protein C or concentrate. In spite of some promising initial studies, additional trials are needed to define their clinical effectiveness in adults and children with severe sepsis.

  19. The Global Evidence Mapping Initiative: Scoping research in broad topic areas

    Directory of Open Access Journals (Sweden)

    Tavender Emma

    2011-06-01

    Full Text Available Abstract Background Evidence mapping describes the quantity, design and characteristics of research in broad topic areas, in contrast to systematic reviews, which usually address narrowly-focused research questions. The breadth of evidence mapping helps to identify evidence gaps, and may guide future research efforts. The Global Evidence Mapping (GEM Initiative was established in 2007 to create evidence maps providing an overview of existing research in Traumatic Brain Injury (TBI and Spinal Cord Injury (SCI. Methods The GEM evidence mapping method involved three core tasks: 1. Setting the boundaries and context of the map: Definitions for the fields of TBI and SCI were clarified, the prehospital, acute inhospital and rehabilitation phases of care were delineated and relevant stakeholders (patients, carers, clinicians, researchers and policymakers who could contribute to the mapping were identified. Researchable clinical questions were developed through consultation with key stakeholders and a broad literature search. 2. Searching for and selection of relevant studies: Evidence search and selection involved development of specific search strategies, development of inclusion and exclusion criteria, searching of relevant databases and independent screening and selection by two researchers. 3. Reporting on yield and study characteristics: Data extraction was performed at two levels - 'interventions and study design' and 'detailed study characteristics'. The evidence map and commentary reflected the depth of data extraction. Results One hundred and twenty-nine researchable clinical questions in TBI and SCI were identified. These questions were then prioritised into high (n = 60 and low (n = 69 importance by the stakeholders involved in question development. Since 2007, 58 263 abstracts have been screened, 3 731 full text articles have been reviewed and 1 644 relevant neurotrauma publications have been mapped, covering fifty-three high priority

  20. The Global Evidence Mapping Initiative: scoping research in broad topic areas.

    Science.gov (United States)

    Bragge, Peter; Clavisi, Ornella; Turner, Tari; Tavender, Emma; Collie, Alex; Gruen, Russell L

    2011-06-17

    Evidence mapping describes the quantity, design and characteristics of research in broad topic areas, in contrast to systematic reviews, which usually address narrowly-focused research questions. The breadth of evidence mapping helps to identify evidence gaps, and may guide future research efforts. The Global Evidence Mapping (GEM) Initiative was established in 2007 to create evidence maps providing an overview of existing research in Traumatic Brain Injury (TBI) and Spinal Cord Injury (SCI). The GEM evidence mapping method involved three core tasks:1. Setting the boundaries and context of the map: Definitions for the fields of TBI and SCI were clarified, the prehospital, acute inhospital and rehabilitation phases of care were delineated and relevant stakeholders (patients, carers, clinicians, researchers and policymakers) who could contribute to the mapping were identified. Researchable clinical questions were developed through consultation with key stakeholders and a broad literature search. 2. Searching for and selection of relevant studies: Evidence search and selection involved development of specific search strategies, development of inclusion and exclusion criteria, searching of relevant databases and independent screening and selection by two researchers. 3. Reporting on yield and study characteristics: Data extraction was performed at two levels - 'interventions and study design' and 'detailed study characteristics'. The evidence map and commentary reflected the depth of data extraction. One hundred and twenty-nine researchable clinical questions in TBI and SCI were identified. These questions were then prioritised into high (n = 60) and low (n = 69) importance by the stakeholders involved in question development. Since 2007, 58 263 abstracts have been screened, 3 731 full text articles have been reviewed and 1 644 relevant neurotrauma publications have been mapped, covering fifty-three high priority questions. GEM Initiative evidence maps have a broad

  1. International Surface Temperature Initiative (ISTI) Global Land Surface Temperature Databank - Stage 2 Monthly

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — The global land surface temperature databank contains monthly timescale mean, max, and min temperature for approximately 40,000 stations globally. It was developed...

  2. International Surface Temperature Initiative (ISTI) Global Land Surface Temperature Databank - Stage 3 Monthly

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — The Global Land Surface Temperature Databank contains monthly timescale mean, maximum, and minimum temperature for approximately 40,000 stations globally. It was...

  3. International Surface Temperature Initiative (ISTI) Global Land Surface Temperature Databank - Stage 2 Daily

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — The global land surface temperature databank contains monthly timescale mean, max, and min temperature for approximately 40,000 stations globally. It was developed...

  4. International Surface Temperature Initiative (ISTI) Global Land Surface Temperature Databank - Stage 1 Monthly

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — The global land surface temperature databank contains monthly timescale mean, max, and min temperature for approximately 40,000 stations globally. It was developed...

  5. International Surface Temperature Initiative (ISTI) Global Land Surface Temperature Databank - Stage 1 Daily

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — The global land surface temperature databank contains monthly timescale mean, max, and min temperature for approximately 40,000 stations globally. It was developed...

  6. Sepsis in Internal Medicine wards: current knowledge, uncertainties and new approaches for management optimization.

    Science.gov (United States)

    Zaccone, Vincenzo; Tosoni, Alberto; Passaro, Giovanna; Vallone, Carla Vincenza; Impagnatiello, Michele; Li Puma, Domenica Donatella; De Cosmo, Salvatore; Landolfi, Raffaele; Mirijello, Antonio

    2017-11-01

    Sepsis represents a global health problem in terms of morbidity, mortality, social and economic costs. Although usually managed in Intensive Care Units, sepsis showed an increased prevalence among Internal Medicine wards in the last decade. This is substantially due to the ageing of population and to multi-morbidity. These characteristics represent both a risk factor for sepsis and a relative contra-indication for the admission to Intensive Care Units. Although there is a lack of literature on the management of sepsis in Internal Medicine, the outcome of these patients seems to be gradually improving. This is due to Internists' increased adherence to guidelines and "bundles". The routine use of SOFA score helps physicians in the definition of septic patients, even if the optimal score has still to come. Point-of-care ultrasonography, lactates, procalcitonin and beta-d-glucan are of help for treatment optimization. The purpose of this narrative review is to focus on the management of sepsis in Internal Medicine departments, particularly on crucial concepts regarding diagnosis, risk assessment and treatment. Key Messages Sepsis is a life-threatening organ dysfunction caused by a dysregulated host response to infection. The prevalence of sepsis is constantly increasing, affecting more hospital patients than any other disease. At least half of patients affected by sepsis are admitted to Internal Medicine wards. Adherence to guidelines, routine use of clinical and lab scores and point-of-care ultrasonography are of help for early recognition of septic patients and treatment optimization.

  7. Risk of fever and sepsis evaluations after routine immunizations in the neonatal intensive care unit.

    Science.gov (United States)

    Navar-Boggan, A M; Halsey, N A; Golden, W C; Escobar, G J; Massolo, M; Klein, N P

    2010-09-01

    Premature infants can experience cardiorespiratory events such as apnea after immunization in the neonatal intensive care unit (NICU). These changes in clinical status may precipitate sepsis evaluations. This study evaluated whether sepsis evaluations are increased after immunizations in the NICU. We conducted a retrospective cohort study of infants older than 53 days who were vaccinated in the NICU at the KPMCP (Kaiser Permanente Medical Care Program). Chart reviews were carried out before and after all immunizations were administered and for all sepsis evaluations after age 53 days. The clinical characteristics of infants on the day before receiving a sepsis evaluation were compared between children undergoing post-immunization sepsis evaluations and children undergoing sepsis evaluation at other times. The incidence rate of sepsis evaluations in the post-immunization period was compared with the rate in a control time period not following immunization using Poisson regression. A total of 490 infants met the inclusion criteria. The rate of fever was increased in the 24 h period after vaccination (2.3%, Pimmunization than during the control period, although this was not statistically significant (P=0.09). Infants undergoing a sepsis evaluation after immunization were more likely to have an apneic, bradycardic or moderate-to-severe cardiorespiratory event in the day before the evaluation than were infants undergoing sepsis evaluations at other times (Pimmunization in the NICU, routine vaccination was not associated with increased risk of receiving sepsis evaluations. Providers may be deferring immunizations until infants are clinically stable, or may have a higher threshold for initiating sepsis evaluations after immunization than at other times.

  8. The Global Tracheostomy Collaborative: one institution's experience with a new quality improvement initiative.

    Science.gov (United States)

    Lavin, Jennifer; Shah, Rahul; Greenlick, Hannah; Gaudreau, Philip; Bedwell, Joshua

    2016-01-01

    Given the low frequency of adverse events after tracheostomy, individual institutions struggle to collect outcome data to generate effective quality improvement protocols. The Global Tracheostomy Collaborative (GTC) is a multi-institutional, multi-disciplinary organization that utilizes a prospective database to collect data on patients undergoing tracheostomy. We describe our institution's preliminary experience with this collaborative. It was hypothesized that entry into the database would be non-burdensome and could be easily and accurately initiated by skilled specialists at the time of tracheostomy placement and completed at time of patient discharge. Demographic, diagnostic, and outcome data on children undergoing tracheostomy at our institution from January 2013 to June 2015 were entered into the GTC database, a database collected and managed by REDCap (Research Electronic Data Capture). All data entry was performed by pediatric otolaryngology fellows and all post-operative updates were completed by a skilled tracheostomy nurse. Tracked outcomes included accidental decannulation, failed decannulation, tracheostomy tube obstruction, bleeding/tracheoinnominate fistula, and tracheocutaneous fistula. Data from 79 patients undergoing tracheostomy at our institution were recorded. Database entry was straightforward and entry of patient demographic information, medical comorbidities, surgical indications, and date of tracheostomy placement was completed in less than 5min per patient. The most common indication for surgery was facilitation of ventilation in 65 patients (82.3%). Average time from admission to tracheostomy was 62.6 days (range 0-246). Stomal breakdown was seen in 1 patient. A total of 72 patients were tracked to hospital discharge with 53 patients surviving (88.3%). No mortalities were tracheostomy-related. The Global Tracheostomy Collaborative is a multi-institutional, multi-disciplinary collaborative that collects data on patients undergoing

  9. Impact of global health governance on country health systems: the case of HIV initiatives in Nigeria.

    Science.gov (United States)

    Chima, Charles Chikodili; Homedes, Nuria

    2015-06-01

    Three global health initiatives (GHIs) - the US President's Emergency Plan for AIDS Relief, the Global Fund to Fight AIDS, Tuberculosis and Malaria, and the World Bank Multi-Country HIV/AIDS Program - finance most HIV services in Nigeria. Critics assert that GHIs burden fragile health systems in resource-poor countries and that health system limitations in these countries constrain the achievement of the objectives of GHIs. This study analyzed interactions between HIV GHIs and the Nigerian Health System and explored how the impact of the GHIs could be optimized. A country case study was conducted using qualitative methods, including: semi-structured interviews, direct observation, and archival review. Semi-structured interviews were held with key informants selected to reach a broad range of stakeholders including policymakers, program managers, service providers, representatives of donor agencies and their implementing partners; the WHO country office in Nigeria; independent consultants; and civil society organizations involved in HIV work. The fieldwork was conducted between June and August 2013. HIV GHIs have had a mixed impact on the health system. They have enhanced availability of and access to HIV services, improved quality of services, and strengthened health information systems and the role of non-state actors in health care. On the negative end, HIV donor funding has increased dependency on foreign aid, widened disparities in access to HIV services, done little to address the sustainability of the services, crowded out non-HIV health services, and led to the development of a parallel supply management system. They have also not invested significantly in the production of new health workers and have not addressed maldistribution problems, but have rather contributed to internal brain drain by luring health workers from the public sector to non-governmental organizations and have increased workload for existing health workers. There is poor policy direction

  10. Local adaptations to a global health initiative: penalties for home births in Zambia.

    Science.gov (United States)

    Greeson, Dana; Sacks, Emma; Masvawure, Tsitsi B; Austin-Evelyn, Katherine; Kruk, Margaret E; Macwan'gi, Mubiana; Grépin, Karen A

    2016-11-01

    Global health initiatives (GHIs) are implemented across a variety of geographies and cultures. Those targeting maternal health often prioritise increasing facility delivery rates. Pressure on local implementers to meet GHI goals may lead to unintended programme features that could negatively impact women. This study investigates penalties for home births imposed by traditional leaders on women during the implementation of Saving Mothers, Giving Life (SMGL) in Zambia. Forty focus group discussions (FGDs) were conducted across four rural districts to assess community experiences of SMGL at the conclusion of its first year. Participants included women who recently delivered at home (3 FGDs/district), women who recently delivered in a health facility (3 FGDs/district), community health workers (2 FGDs/district) and local leaders (2 FGDs/district). Findings indicate that community leaders in some districts-independently of formal programme directive-used fines to penalise women who delivered at home rather than in a facility. Participants in nearly all focus groups reported hearing about the imposition of penalties following programme implementation. Some women reported experiencing penalties firsthand, including cash and livestock fines, or fees for child health cards that are typically free. Many women who delivered at home reported their intention to deliver in a facility in the future to avoid penalties. While communities largely supported the use of penalties to promote facility delivery, the penalties effectively introduced a new tax on poor rural women and may have deterred their utilization of postnatal and child health care services. The imposition of penalties is thus a punitive adaptation that can impose new financial burdens on vulnerable women and contribute to widening health, economic and gender inequities in communities. Health initiatives that aim to increase demand for health services should monitor local efforts to achieve programme targets in order

  11. The global polio eradication initiative: lessons learned and prospects for success.

    Science.gov (United States)

    Aylward, Bruce; Tangermann, Rudolf

    2011-12-30

    Following the rapid progress towards interrupting indigenous wild poliovirus transmission in the Americas in the early 1980s, the Global Polio Eradication Initiative (GPEI) was launched with a resolution of the World Health Assembly (WHA) in 1988. The GPEI built on many lessons learned from smallpox eradication, including the large-scale deployment of technical assistance, implementing agendas of innovation and research and the use of professionally planned and guided advocacy. By the year 2000, the incidence of polio globally had decreased by 99% compared with the estimated >350,000 cases reported from 125 endemic countries in 1988. By 2002, three WHO Regions (the Americas, Western Pacific and European Regions) had been certified polio-free. By 2005, transmission of indigenous wild poliovirus (WPV) had been interrupted in all but 4 'endemic' countries: India, Nigeria, Pakistan and Afghanistan, where eradication efforts effectively stalled. WPV exported from northern Nigeria and northern India subsequently caused >50 outbreaks and paralysed >1500 children in previously polio-free countries across Asia and Africa. In each of the four remaining polio-endemic countries different challenges, or a combination of factors, prevented to build up sufficient levels of population immunity to stop transmission. Consequently, specific strategies were increasingly tailored to each setting. A new 2010-2012 GPEI Strategic Plan was developed which brought together several approaches to overcome the remaining hurdles to eradication, including the large-scale use of bivalent oral poliovaccine (bOPV) in supplementary immunization activities (SIAs). By the end of 2010, the impact of the new GPEI Strategic Plan 2010-2012 was apparent. Compared to 2009, the number of new polio cases in 2010 fell by 95% in both northern Nigeria and northern India, the world's largest remaining reservoirs of indigenous WPVs. By mid-2011, India had not reported a polio case for more than 5 months, and in

  12. Evaluation of the Global Lung Initiative 2012 Reference Values for Spirometry in African Children.

    Science.gov (United States)

    Arigliani, Michele; Canciani, Mario C; Mottini, Giovanni; Altomare, Michele; Magnolato, Andrea; Loa Clemente, Sofia Vanda; Tshilolo, Leon; Cogo, Paola; Quanjer, Philip H

    2017-01-15

    Despite the high burden of respiratory disease, no spirometry reference values for African children are available. Investigate whether the Global Lung Initiative (GLI-2012) reference values for spirometry are appropriate for children in sub-Saharan Africa and assess the impact of malnutrition on lung function. Anthropometry and spirometry were obtained in children aged 6 to 12 years from urban and semiurban schools in three African countries. Spirometry z-scores were derived using the GLI-2012 prediction equations for African Americans. Thinness (body mass index z-score Spirometry outcomes were compared with those of African American children from the third National Health and Nutrition Survey. Spirometry data were analyzed from 1,082 schoolchildren (51% boys) aged 6.0 to 12.8 years in Angola (n = 306), Democratic Republic of the Congo (n = 377), and Madagascar (n = 399). GLI-2012 provided a good fit with mean (SD) z-scores of -0.11 (0.83) for FEV 1 , -0.08 (0.86) for FVC, and -0.07 (0.83) for FEV 1 /FVC. Because of low scatter, the fifth centile corresponded to -1.3 z-scores in boys and -1.5 z-scores in girls. Malnourished African children had a normal FEV 1 /FVC ratio but significant reductions of ∼0.5 z-scores (∼5%) in FEV 1 and FVC compared with African American peers from the third National Health and Nutrition Survey. Children in Angola had the lowest, and those in Madagascar had the highest, zFEV 1 and zFVC. The results of this study support the use of GLI-2012 reference values for schoolchildren in sub-Saharan Africa. Malnutrition affects body growth, leading to a proportionately smaller FEV 1 and FVC without respiratory impairment, as shown by the normal FEV 1 /FVC ratio.

  13. The global threat reduction initiative's radiological security cooperation with Russia - 59361

    International Nuclear Information System (INIS)

    Blanchard, Tiffany A.; Abramson, William J.; Russell, James W. Jr.; Roberts, Catherine K.

    2012-01-01

    The United States (U.S.) Department of Energy (DOE) / National Nuclear Security Administration's (NNSA) Global Threat Reduction Initiative (GTRI) supports both U.S. and international threat reduction goals by securing vulnerable nuclear and radiological material located at civilian sites throughout the world. GTRI's approach to reducing the threat posed by vulnerable, high-activity radioactive sources includes removing and disposing of orphan or disused radioactive sources; implementing physical security upgrades at civilian sites containing radioactive sources; and establishing a cooperative sustainability program at sites to ensure that upgrades are maintained. For many years GTRI has collaborated successfully with the Russian Federation and international partners to improve radiological security in Russia. This paper provides a synopsis of GTRI's accomplishments and cooperation with Russia in the following areas: 1.) recovering and disposing of orphan and disused radioactive sources, 2.) recovering and disposing of radioisotope thermoelectric generators (RTGs), and 3.) providing physical security upgrades at civilian sites that contain vulnerable radiological material. The success of GTRI's program to secure radiological material in the Russian Federation over the past decade is due largely to the hard work, technical expertise, and tenacity of the U.S. laboratory teams and the Russian partner organizations with whom GTRI has worked. GTRI plans to continue building on this history of cooperation in order to recover and secure additional, vulnerable radioactive sources in locations throughout Russia. GTRI also is committed to sustainability efforts so that facilities in Russia receiving physical protection equipment and training are prepared to eventually assume responsibility for those security upgrades. In the years to come, GTRI will combine financial support with capacity building to enhance Russia's domestic programs to address these challenges. Through

  14. Transforming forest landscape conflicts: the promises and perils of global forest management initiatives such as REDD+

    Directory of Open Access Journals (Sweden)

    Seth Kane

    2018-04-01

    Full Text Available Implementation of Reducing Emissions from Deforestation and Forest Degradation (REDD+ is designed to relieve pressure on tropical forests, however, many are concerned that it is a threat to the rights of forest communities. These potential risks need serious attention as earlier studies have shown that the Asia-Pacific region is a forest conflict hotspot, with many economic, environmental and social implications at global (e.g. climate change to local levels (e.g. poverty. Drawing on an analysis of nine case studies from four countries (Cambodia, Myanmar, Nepal and Vietnam this paper examines why and how REDD+ can be a driver for forest conflict and how it also has the potential to simultaneously transform these conflicts. The analytical framework, “sources of impairment”, applied in the study was developed to increase understanding and facilitate the resolution of forest landscape conflicts in a sustainable manner (i.e. transformation. The main findings are that REDD+ can be a source of conflict in the study sites, but also had transformative potential when good practices were followed. For example, in some sites, the REDD+ projects were sources of impairment for forest communities by restricting access to forest resources. However, the research also identified REDD+ projects that enabled the participation of traditionally marginalized groups and built local forest management capacities, leading to strengthened tenure for some forest communities. Similarly, in some countries REDD+ has served as a mechanism to pilot Free, Prior and Informed Consent (FPIC, which will likely have significant impacts in mitigating conflicts by addressing the sources at local to national levels. Based on these findings, there are many reasons to be optimistic that REDD+ can address the underlying causes of forest landscape conflicts, especially when linked with other governance initiatives such as Forest Law Enforcement, Governance and Trade – Voluntary

  15. Global Soil Moisture from the Aquarius/SAC-D Satellite: Description and Initial Assessment

    Science.gov (United States)

    Bindlish, Rajat; Jackson, Thomas; Cosh, Michael; Zhao, Tianjie; O'Neil, Peggy

    2015-01-01

    Aquarius satellite observations over land offer a new resource for measuring soil moisture from space. Although Aquarius was designed for ocean salinity mapping, our objective in this investigation is to exploit the large amount of land observations that Aquarius acquires and extend the mission scope to include the retrieval of surface soil moisture. The soil moisture retrieval algorithm development focused on using only the radiometer data because of the extensive heritage of passive microwave retrieval of soil moisture. The single channel algorithm (SCA) was implemented using the Aquarius observations to estimate surface soil moisture. Aquarius radiometer observations from three beams (after bias/gain modification) along with the National Centers for Environmental Prediction model forecast surface temperatures were then used to retrieve soil moisture. Ancillary data inputs required for using the SCA are vegetation water content, land surface temperature, and several soil and vegetation parameters based on land cover classes. The resulting global spatial patterns of soil moisture were consistent with the precipitation climatology and with soil moisture from other satellite missions (Advanced Microwave Scanning Radiometer for the Earth Observing System and Soil Moisture Ocean Salinity). Initial assessments were performed using in situ observations from the U.S. Department of Agriculture Little Washita and Little River watershed soil moisture networks. Results showed good performance by the algorithm for these land surface conditions for the period of August 2011-June 2013 (rmse = 0.031 m(exp 3)/m(exp 3), Bias = -0.007 m(exp 3)/m(exp 3), and R = 0.855). This radiometer-only soil moisture product will serve as a baseline for continuing research on both active and combined passive-active soil moisture algorithms. The products are routinely available through the National Aeronautics and Space Administration data archive at the National Snow and Ice Data Center.

  16. The use of economic indicators from the Global Reporting Initiative by Spanish listed companies

    Directory of Open Access Journals (Sweden)

    María José García

    2014-12-01

    Full Text Available Purpose: Corporate Social Responsibility (CSR in companies is widely accepted within today’s business community. However, the intangibility of this concept and the dispersion of related standards and regulations has created a context characterized by lack of homogeneity in the publishing of CSR results. The present study aims to determine the extent to which Global Reporting Initiative (GRI indicators are used by Spanish listed companies. Design/methodology/approach: An empirical analysis has been performed to asses and evaluate the 2011 CSR reports published by the companies listed on the IBEX-35, the Spanish stock exchange index which includes the most important listed companies. The analysis is centered exclusively on the economic indicators established by the GRI. The methodology used to interpret the results is based on the procedures of multivariate analysis, namely principal components analysis, correlation matrix, and hierarchical clustering. Findings: The results of the study show that although the GRI tool is used extensively within the IBEX-35, the level of performance regarding the parameters established by the GRI varies depending on the studied company and indicator. Research limitations: This study focuses on the biggest Spanish listed companies; thus, the conclusions may differ in other geographic locations, as well as for smaller businesses. Practical implications: This line of research helps to know more about the social reporting policies of big Spanish listed companies. Social implications: The evidence provided by this study helps to know more about the Corporate Social Responsibility policies and sustainability reports and declarations of social and environmental values governing their organizations. Originality/value: This study is the first using principal component analysis in Spanish listed companies focusing in the economic indicators of the GRI.

  17. Initial global 2-D shielding analysis for the Advanced Neutron Source core and reflector

    Energy Technology Data Exchange (ETDEWEB)

    Bucholz, J.A.

    1995-08-01

    This document describes the initial global 2-D shielding analyses for the Advanced Neutron Source (ANS) reactor, the D{sub 2}O reflector, the reflector vessel, and the first 200 mm of light water beyond the reflector vessel. Flux files generated here will later serve as source terms in subsequent shielding analyses. In addition to reporting fluxes and other data at key points of interest, a major objective of this report was to document how these analyses were performed, the phenomena that were included, and checks that were made to verify that these phenomena were properly modeled. In these shielding analyses, the fixed neutron source distribution in the core was based on the `lifetime-averaged` spatial power distribution. Secondary gamma production cross sections in the fuel were modified so as to account intrinsically for delayed fission gammas in the fuel as well as prompt fission gammas. In and near the fuel, this increased the low-energy gamma fluxes by 50 to 250%, but out near the reflector vessel, these same fluxes changed by only a few percent. Sensitivity studies with respect to mesh size were performed, and a new 2-D mesh distribution developed after some problems were discovered with respect to the use of numerous elongated mesh cells in the reflector. All of the shielding analyses were performed sing the ANSL-V 39n/44g coupled library with 25 thermal neutron groups in order to obtain a rigorous representation of the thermal neutron spectrum throughout the reflector. Because of upscatter in the heavy water, convergence was very slow. Ultimately, the fission cross section in the various materials had to be artificially modified in order to solve this fixed source problem as an eigenvalue problem and invoke the Vondy error-mode extrapolation technique which greatly accelerated convergence in the large 2-D RZ DORT analyses. While this was quite effective, 150 outer iterations (over energy) were still required.

  18. Initial global 2-D shielding analysis for the Advanced Neutron Source core and reflector

    International Nuclear Information System (INIS)

    Bucholz, J.A.

    1995-08-01

    This document describes the initial global 2-D shielding analyses for the Advanced Neutron Source (ANS) reactor, the D 2 O reflector, the reflector vessel, and the first 200 mm of light water beyond the reflector vessel. Flux files generated here will later serve as source terms in subsequent shielding analyses. In addition to reporting fluxes and other data at key points of interest, a major objective of this report was to document how these analyses were performed, the phenomena that were included, and checks that were made to verify that these phenomena were properly modeled. In these shielding analyses, the fixed neutron source distribution in the core was based on the 'lifetime-averaged' spatial power distribution. Secondary gamma production cross sections in the fuel were modified so as to account intrinsically for delayed fission gammas in the fuel as well as prompt fission gammas. In and near the fuel, this increased the low-energy gamma fluxes by 50 to 250%, but out near the reflector vessel, these same fluxes changed by only a few percent. Sensitivity studies with respect to mesh size were performed, and a new 2-D mesh distribution developed after some problems were discovered with respect to the use of numerous elongated mesh cells in the reflector. All of the shielding analyses were performed sing the ANSL-V 39n/44g coupled library with 25 thermal neutron groups in order to obtain a rigorous representation of the thermal neutron spectrum throughout the reflector. Because of upscatter in the heavy water, convergence was very slow. Ultimately, the fission cross section in the various materials had to be artificially modified in order to solve this fixed source problem as an eigenvalue problem and invoke the Vondy error-mode extrapolation technique which greatly accelerated convergence in the large 2-D RZ DORT analyses. While this was quite effective, 150 outer iterations (over energy) were still required

  19. The epidemiology of sepsis in Brazilian intensive care units (the Sepsis PREvalence Assessment Database, SPREAD): an observational study.

    Science.gov (United States)

    Machado, Flavia R; Cavalcanti, Alexandre Biasi; Bozza, Fernando Augusto; Ferreira, Elaine M; Angotti Carrara, Fernanda Sousa; Sousa, Juliana Lubarino; Caixeta, Noemi; Salomao, Reinaldo; Angus, Derek C; Pontes Azevedo, Luciano Cesar

    2017-11-01

    The sepsis burden on acute care services in middle-income countries is a cause for concern. We estimated incidence, prevalence, and mortality of sepsis in adult Brazilian intensive care units (ICUs) and association of ICU organisational factors with outcome. We did a 1-day point prevalence study with follow-up of patients in ICU with sepsis in a nationally representative pseudo-random sample. We produced a sampling frame initially stratified by geographical region. Each stratum was then stratified by hospitals' main source of income (serving general public vs privately insured individuals) and ICU size (ten or fewer beds vs more than ten beds), finally generating 40 strata. In each stratum we selected a random sample of ICUs so as to enrol the total required beds in 1690 Brazilian adult ICUs. We followed up patients until hospital discharge censored at 60 days, estimated incidence from prevalence and length of stay, and generated national estimates. We assessed mortality prognostic factors using random-effects logistic regression models. On Feb 27, 2014, 227 (72%) of 317 ICUs that were randomly selected provided data on 2632 patients, of whom 794 had sepsis (30·2 septic patients per 100 ICU beds, 95% CI 28·4-31·9). The ICU sepsis incidence was 36·3 per 1000 patient-days (95% CI 29·8-44·0) and mortality was observed in 439 (55·7%) of 788 patients (95% CI 52·2-59·2). Low availability of resources (odds ratio [OR] 1·67, 95% CI 1·02-2·75, p=0·045) and adequacy of treatment (OR 0·56, 0·37-0·84, p=0·006) were independently associated with mortality. The projected incidence rate is 290 per 100 000 population (95% CI 237·9-351·2) of adult cases of ICU-treated sepsis per year, which yields about 420 000 cases annually, of whom 230 000 die in hospital. The incidence, prevalence, and mortality of ICU-treated sepsis is high in Brazil. Outcome varies considerably, and is associated with access to adequate resources and treatment. Our results show the

  20. Global solutions to the initial-boundary value problem for the quasilinear viscoelastic equation with a derivative nonlinearity

    Directory of Open Access Journals (Sweden)

    Mitsuhiro Nakao

    2014-01-01

    Full Text Available We prove the existence and uniqueness of a global decaying solution to the initial boundary value problem for the quasilinear wave equation with Kelvin-Voigt dissipation and a derivative nonlinearity. To derive the required estimates of the solutions we employ a 'loan' method and use a difference inequality on the energy.

  1. The use of international service learning initiatives for global health education: case studies from Rwanda and Mexico.

    Science.gov (United States)

    Plumb, Ellen; Roe, Kathleen; Plumb, James; Sepe, Priscilla; Soin, Komal; Ramirez, Aragon; Baganizi, Edmond; Simmons, Rob; Khubchandani, Jagdish

    2013-05-01

    Global health education and health promotion have the potential to engage students, scholars, and practitioners in ways that go beyond the classroom teaching routine. This engagement in global communities, can range from reflection on continuing deep-seated questions about human rights and civic responsibility to the use of health education and promotion-related theoretical, intellectual, and practical skills. In the arena of global health education and promotion, these skills also range from leadership and advocacy to decision making, critical and creative thinking, teamwork, and problem solving. In recent times, there has been a growing interest in cross-cultural collaborations and educational initiatives to improve stakeholder's understanding of global health principles and practices, to enrich the experiences of health professionals, and to improve the lives of those who are disenfranchised and live across borders. In this article of Health Promotion Practice, we highlight two unique cases of cross-national collaborations and provide a glimpse of the various shapes and forms taken by cross-cultural educational initiatives for global health education and promotion. We summarize the history, philosophy, and current working practices relevant to these collaborations, keeping in view the global health domains, competencies, and activities. In addition, we also compare the key components and activities of these two case studies from Rwanda and Mexico, wherein communities in these two countries collaborated with academic institutions and health professionals in the United States.

  2. From smallpox eradication to contemporary global health initiatives: enhancing human capacity towards a global public health goal.

    Science.gov (United States)

    Tarantola, Daniel; Foster, Stanley O

    2011-12-30

    The eradication of smallpox owes its success first and foremost to the thousands of lay health workers and community members who, throughout the campaign and across continents, took on the roles of advocates, educators, vaccinators, care providers and contributors to epidemic surveillance and containment. Bangladesh provides a good example where smallpox eradication and the capacity enhancement needed to achieve this goal resulted in a two-way mutually beneficial process. Smallpox-dedicated staff provided community members with information guidance, support and tools. In turn, communities not only created the enabling environment for smallpox program staff to perform their work but acquired the capacity to perform essential eradication tasks. Contemporary global health programmes can learn much from these core lessons including: the pivotal importance of supporting community aspirations, capacity and resilience; the critical need to enhance commitment, capacity and accountability across the workforce; and the high value of attentive human resources management and support. We owe to subsequent global disease control, elimination and eradication ventures recognition of the need for social and behavioural science to inform public health strategies; the essential roles that civil society organizations and public-private partnerships can play in public health discourse and action; the overall necessity of investing in broad-based health system strengthening; and the utility of applying human rights principles, norms and standards to public health policy and practice. Crown Copyright © 2011. Published by Elsevier Ltd. All rights reserved.

  3. Companies' opinions and acceptance of global food safety initiative benchmarks after implementation.

    Science.gov (United States)

    Crandall, Phil; Van Loo, Ellen J; O'Bryan, Corliss A; Mauromoustakos, Andy; Yiannas, Frank; Dyenson, Natalie; Berdnik, Irina

    2012-09-01

    International attention has been focused on minimizing costs that may unnecessarily raise food prices. One important aspect to consider is the redundant and overlapping costs of food safety audits. The Global Food Safety Initiative (GFSI) has devised benchmarked schemes based on existing international food safety standards for use as a unifying standard accepted by many retailers. The present study was conducted to evaluate the impact of the decision made by Walmart Stores (Bentonville, AR) to require their suppliers to become GFSI compliant. An online survey of 174 retail suppliers was conducted to assess food suppliers' opinions of this requirement and the benefits suppliers realized when they transitioned from their previous food safety systems. The most common reason for becoming GFSI compliant was to meet customers' requirements; thus, supplier implementation of the GFSI standards was not entirely voluntary. Other reasons given for compliance were enhancing food safety and remaining competitive. About 54 % of food processing plants using GFSI benchmarked schemes followed the guidelines of Safe Quality Food 2000 and 37 % followed those of the British Retail Consortium. At the supplier level, 58 % followed Safe Quality Food 2000 and 31 % followed the British Retail Consortium. Respondents reported that the certification process took about 10 months. The most common reason for selecting a certain GFSI benchmarked scheme was because it was widely accepted by customers (retailers). Four other common reasons were (i) the standard has a good reputation in the industry, (ii) the standard was recommended by others, (iii) the standard is most often used in the industry, and (iv) the standard was required by one of their customers. Most suppliers agreed that increased safety of their products was required to comply with GFSI benchmarked schemes. They also agreed that the GFSI required a more carefully documented food safety management system, which often required

  4. Initializing carbon cycle predictions from the Community Land Model by assimilating global biomass observations

    Science.gov (United States)

    Fox, A. M.; Hoar, T. J.; Smith, W. K.; Moore, D. J.

    2017-12-01

    The locations and longevity of terrestrial carbon sinks remain uncertain, however it is clear that in order to predict long-term climate changes the role of the biosphere in surface energy and carbon balance must be understood and incorporated into earth system models (ESMs). Aboveground biomass, the amount of carbon stored in vegetation, is a key component of the terrestrial carbon cycle, representing the balance of uptake through gross primary productivity (GPP), losses from respiration, senescence and mortality over hundreds of years. The best predictions of current and future land-atmosphere fluxes are likely from the integration of process-based knowledge contained in models and information from observations of changes in carbon stocks using data assimilation (DA). By exploiting long times series, it is possible to accurately detect variability and change in carbon cycle dynamics through monitoring ecosystem states, for example biomass derived from vegetation optical depth (VOD), and use this information to initialize models before making predictions. To make maximum use of information about the current state of global ecosystems when using models we have developed a system that combines the Community Land Model (CLM) with the Data Assimilation Research Testbed (DART), a community tool for ensemble DA. This DA system is highly innovative in its complexity, completeness and capabilities. Here we described a series of activities, using both Observation System Simulation Experiments (OSSEs) and real observations, that have allowed us to quantify the potential impact of assimilating VOD data into CLM-DART on future land-atmosphere fluxes. VOD data are particularly suitable to use in this activity due to their long temporal coverage and appropriate scale when combined with CLM, but their absolute values rely on many assumptions. Therefore, we have had to assess the implications of the VOD retrieval algorithms, with an emphasis on detecting uncertainty due to

  5. Global assessments of the state of the marine environment: Contemporary initiatives

    International Nuclear Information System (INIS)

    Bewers, J.M.; Boelens, R.G.V.

    1999-01-01

    A large number of assessments of regional marine areas have been conducted in recent years for a variety of purposes. Periodic reviews of the state of the marine environment have been undertaken by the United Nations Joint Group of Experts on the Scientific Aspects of Marine Environmental Protection (GESAMP). The most recent of these global assessments was published in 1990. The international adoption of a Global Programme of Action for the Protection of the Marine Environment from Land-Based Activities in 1995 has led to additional demand for regional assessments and a global review. The regional assessments are either completed or in train largely through mechanisms associated with the UNEP Regional Seas Programme. The global assessment has been assigned to GESAMP and incorporated into its plans for the preparation of a new global review to be completed in the year 2002. The Intergovernmental Oceanographic Commission, (IOC) the Scientific Committee for Oceanic Research (SCOR) and the Scientific Committee on Problems of the Environment (SCOPE) are collaborating in a review of ocean science. The Global Environment Facility (GEF) recently approved funding for a 'Global International Waters Assessment' (GIWA) partly as a means of determining priorities within its International Waters Portfolio. This paper outlines the nature of, and contemporary activities within, these various assessments. (author)

  6. 77 FR 58412 - Meeting of the Global Justice Information Sharing Initiative Federal Advisory Committee

    Science.gov (United States)

    2012-09-20

    ... support of the Administration's justice priorities. The GAC will guide and monitor the development of the Global information sharing concept. It will advise the Assistant Attorney General, OJP; the Attorney...

  7. 76 FR 13226 - Meeting of the Department of Justice Global Justice Information Sharing Initiative Federal...

    Science.gov (United States)

    2011-03-10

    ... coordination of national policy, practices, and technical solutions in support of the Administration's justice priorities. The GAC will guide and monitor the development of the Global information sharing concept. It will...

  8. Automated Detection of Sepsis Using Electronic Medical Record Data: A Systematic Review.

    Science.gov (United States)

    Despins, Laurel A

    Severe sepsis and septic shock are global issues with high mortality rates. Early recognition and intervention are essential to optimize patient outcomes. Automated detection using electronic medical record (EMR) data can assist this process. This review describes automated sepsis detection using EMR data. PubMed retrieved publications between January 1, 2005 and January 31, 2015. Thirteen studies met study criteria: described an automated detection approach with the potential to detect sepsis or sepsis-related deterioration in real or near-real time; focused on emergency department and hospitalized neonatal, pediatric, or adult patients; and provided performance measures or results indicating the impact of automated sepsis detection. Detection algorithms incorporated systemic inflammatory response and organ dysfunction criteria. Systems in nine studies generated study or care team alerts. Care team alerts did not consistently lead to earlier interventions. Earlier interventions did not consistently translate to improved patient outcomes. Performance measures were inconsistent. Automated sepsis detection is potentially a means to enable early sepsis-related therapy but current performance variability highlights the need for further research.

  9. Reducing the global threat of radiological terrorism in Central Asia and Caucus regions. The global threat reduction initiative approach to radioactive source security

    International Nuclear Information System (INIS)

    Smith, E.

    2010-01-01

    The security of radioactive sources is of worldwide concern, due to their wide use in civilian commerce and the potentially devastating effects of their misuse. In cooperation with host countries and international partners, the Global Threat Reduction Initiative has utilized a proven process for providing technical and financial assistance to protect radioactive sources in diverse uses and unique circumstances at hundreds of sites worldwide. The mission of the Department of Energy, National Nuclear Security Administration's program includes reducing the risk posed by vulnerable radiological materials that could be used in a Radioactive Dispersal Device). The program's objectives are to identify, consolidate, secure, and/or dispose of high-activity radiological materials to prevent their theft and malicious use. The Global Threat Reduction Initiative Program's scope is global, with projects in over 100 countries at more than 755 radiological sites, including industrial, medical and commercial facilities. In addition to working bilaterally, the Program works closely with the International Atomic Energy Agency (IAEA) and other partner countries. (author)

  10. Nursing considerations to complement the Surviving Sepsis Campaign guidelines.

    Science.gov (United States)

    Aitken, Leanne M; Williams, Ged; Harvey, Maurene; Blot, Stijn; Kleinpell, Ruth; Labeau, Sonia; Marshall, Andrea; Ray-Barruel, Gillian; Moloney-Harmon, Patricia A; Robson, Wayne; Johnson, Alexander P; Lan, Pang Nguk; Ahrens, Tom

    2011-07-01

    To provide a series of recommendations based on the best available evidence to guide clinicians providing nursing care to patients with severe sepsis. Modified Delphi method involving international experts and key individuals in subgroup work and electronic-based discussion among the entire group to achieve consensus. We used the Surviving Sepsis Campaign guidelines as a framework to inform the structure and content of these guidelines. We used the Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) system to rate the quality of evidence from high (A) to very low (D) and to determine the strength of recommendations, with grade 1 indicating clear benefit in the septic population and grade 2 indicating less confidence in the benefits in the septic population. In areas without complete agreement between all authors, a process of electronic discussion of all evidence was undertaken until consensus was reached. This process was conducted independently of any funding. Sixty-three recommendations relating to the nursing care of severe sepsis patients are made. Prevention recommendations relate to education, accountability, surveillance of nosocomial infections, hand hygiene, and prevention of respiratory, central line-related, surgical site, and urinary tract infections, whereas infection management recommendations related to both control of the infection source and transmission-based precautions. Recommendations related to initial resuscitation include improved recognition of the deteriorating patient, diagnosis of severe sepsis, seeking further assistance, and initiating early resuscitation measures. Important elements of hemodynamic support relate to improving both tissue oxygenation and macrocirculation. Recommendations related to supportive nursing care incorporate aspects of nutrition, mouth and eye care, and pressure ulcer prevention and management. Pediatric recommendations relate to the use of antibiotics, steroids, vasopressors and

  11. A situational analysis of pharmacovigilance plans in the Global Fund Malaria and U.S. President's Malaria Initiative proposals.

    Science.gov (United States)

    Stergachis, Andy; Bartlein, Rebecca J K; Dodoo, Alexander; Nwokike, Jude; Kachur, S Patrick

    2010-05-30

    Pharmacovigilance programmes can monitor and help ensure the safe use of medicines that are critical to the success of global public health programmes. The widespread deployment of artemisinin-based combination therapy (ACT) by national malaria control programmes as part of the overall Global Malaria Action Plan for malaria control to elimination and eradication makes ACT an excellent candidate for pharmacovigilance activities. In 2008, The Roll Back Malaria partnership issued guidelines for inclusion of pharmacovigilance in Global Fund and other related proposals. In light of this recommendation and the rapid scale-up of ACT worldwide, an analysis of Global Fund Round 8 proposals and the President's Malaria Initiative (PMI) 2009 Malaria Operational Plans was conducted to assess if and how pharmacovigilance has been incorporated into countries' national malaria plans and donor budget requests. The Global Fund-Malaria Round 8 proposals for the 26 countries and the PMI Malaria Operational Plans (MOPs) for fiscal year 2009 for the 15 countries that were approved and received funding from either the Global Fund-Malaria Round 8 or PMI were accessed through the programme websites. The analysis consisted of conducting word counts and key word in context analyses of each proposal and plan. Twelve out of 26 (46%) of the Global Fund proposals mentioned that established pharmacovigilance systems were present in their countries. Four of the fifteen PMI MOPs (27%) mentioned that established pharmacovigilance systems were present in their countries. Only seven of the 26 (27%) Global Fund proposals included a request for funding for new or current pharmacovigilance activities. Seven of 15 (47%) MOPs included a request for funding for pharmacovigilance activities. There were relatively few requests for funding for pharmacovigilance activities, demonstrating a lack of emphasis placed on pharmacovigilance systems in recipient countries. The findings stress the need for more active

  12. WHE-PAGER Project: A new initiative in estimating global building inventory and its seismic vulnerability

    Science.gov (United States)

    Porter, K.A.; Jaiswal, K.S.; Wald, D.J.; Greene, M.; Comartin, Craig

    2008-01-01

    The U.S. Geological Survey’s Prompt Assessment of Global Earthquake’s Response (PAGER) Project and the Earthquake Engineering Research Institute’s World Housing Encyclopedia (WHE) are creating a global database of building stocks and their earthquake vulnerability. The WHE already represents a growing, community-developed public database of global housing and its detailed structural characteristics. It currently contains more than 135 reports on particular housing types in 40 countries. The WHE-PAGER effort extends the WHE in several ways: (1) by addressing non-residential construction; (2) by quantifying the prevalence of each building type in both rural and urban areas; (3) by addressing day and night occupancy patterns, (4) by adding quantitative vulnerability estimates from judgment or statistical observation; and (5) by analytically deriving alternative vulnerability estimates using in part laboratory testing.

  13. Asthma in pregnancy: association between the Asthma Control Test and the Global Initiative for Asthma classification and comparisons with spirometry.

    Science.gov (United States)

    de Araujo, Georgia Véras; Leite, Débora F B; Rizzo, José A; Sarinho, Emanuel S C

    2016-08-01

    The aim of this study was to identify a possible association between the assessment of clinical asthma control using the Asthma Control Test (ACT) and the Global Initiative for Asthma (GINA) classification and to perform comparisons with values of spirometry. Through this cross-sectional study, 103 pregnant women with asthma were assessed in the period from October 2010 to October 2013 in the asthma pregnancy clinic at the Clinical Hospital of the Federal University of Pernambuco. Questionnaires concerning the level of asthma control were administered using the Global Initiative for Asthma classification, the Asthma Control Test validated for asthmatic expectant mothers and spirometry; all three methods of assessing asthma control were performed during the same visit between the twenty-first and twenty-seventh weeks of pregnancy. There was a significant association between clinical asthma control assessment using the Asthma Control Test and the Global Initiative for Asthma classification (pspirometry. This study shows that both the Global Initiative for Asthma classification and the Asthma Control Test can be used for asthmatic expectant mothers to assess the clinical control of asthma, especially at the end of the second trimester, which is assumed to be the period of worsening asthma exacerbations during pregnancy. We highlight the importance of the Asthma Control Test as a subjective instrument with easy application, easy interpretation and good reproducibility that does not require spirometry to assess the level of asthma control and can be used in the primary care of asthmatic expectant mothers. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  14. Global Polio Eradication Initiative (GPEI): Future Perspectives and Need for a New Generation of Inactivated Poliovirus Vaccine

    OpenAIRE

    VASHISHTHA, Vipin; NAVEEN, Thacker

    2010-01-01

    More than two decade-old Global Polio Eradication Initiative (GPEI) has finally tasted success and wild poliovirus is now on the verge of eradication. The pre-eradication era was full of challenges and a great learning experience for all those involved with this tedious process. Many new phenomena emerged and new information about poliovirus learned during this campaign. Many new developments such as vaccine-derived polioviruses (VDPVs) were not anticipated and resulted in serious thinking re...

  15. Voluntary initiatives in global value chains : Towards labour-led social upgrading?

    NARCIS (Netherlands)

    K.A. Siegmann (Karin Astrid); J. Merk (Jeroen); P. Knorringa (Peter)

    2014-01-01

    textabstractThe organization of production in global value chains (GVCs) has been accompanied by a rise of informal and insecure work. Yet, the role of labour agency has received scant attention in the GVC and related literatures. Selwyn (2013) therefore demands to shift attention towards engagement

  16. Voluntary initiatives in global value chains: towards labour-led social upgrading?

    NARCIS (Netherlands)

    K.A. Siegmann (Karin Astrid); P. Knorringa (Peter); J.J.S. Merk

    2014-01-01

    markdownabstract__Abstract__ The organization of production in global value chains (GVCs) has been accompanied by a rise of informal and insecure work. Yet, the role of labour agency has received scant attention in the GVC and related literatures. Selwyn (2013) therefore demands to shift

  17. International cooperative initiatives in global climate governance: Raising the ambition level or delegitimizing the UNFCCC?

    NARCIS (Netherlands)

    Widerberg, O.E.; Pattberg, P.H.

    2015-01-01

    To close the gap between existing country pledges and the necessary ambition level to limit anthropogenic climate change to not more than 2°C average global temperature increase above pre-industrial levels, decision makers from both the public and private domain have started to explore a number of

  18. Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock, 2012.

    Science.gov (United States)

    Dellinger, R P; Levy, Mitchell M; Rhodes, Andrew; Annane, Djillali; Gerlach, Herwig; Opal, Steven M; Sevransky, Jonathan E; Sprung, Charles L; Douglas, Ivor S; Jaeschke, Roman; Osborn, Tiffany M; Nunnally, Mark E; Townsend, Sean R; Reinhart, Konrad; Kleinpell, Ruth M; Angus, Derek C; Deutschman, Clifford S; Machado, Flavia R; Rubenfeld, Gordon D; Webb, Steven; Beale, Richard J; Vincent, Jean-Louis; Moreno, Rui

    2013-02-01

    ); infection source control with attention to the balance of risks and benefits of the chosen method within 12 h of diagnosis (1C); initial fluid resuscitation with crystalloid (1B) and consideration of the addition of albumin in patients who continue to require substantial amounts of crystalloid to maintain adequate mean arterial pressure (2C) and the avoidance of hetastarch formulations (1B); initial fluid challenge in patients with sepsis-induced tissue hypoperfusion and suspicion of hypovolemia to achieve a minimum of 30 mL/kg of crystalloids (more rapid administration and greater amounts of fluid may be needed in some patients (1C); fluid challenge technique continued as long as hemodynamic improvement is based on either dynamic or static variables (UG); norepinephrine as the first-choice vasopressor to maintain mean arterial pressure ≥65 mmHg (1B); epinephrine when an additional agent is needed to maintain adequate blood pressure (2B); vasopressin (0.03 U/min) can be added to norepinephrine to either raise mean arterial pressure to target or to decrease norepinephrine dose but should not be used as the initial vasopressor (UG); dopamine is not recommended except in highly selected circumstances (2C); dobutamine infusion administered or added to vasopressor in the presence of (a) myocardial dysfunction as suggested by elevated cardiac filling pressures and low cardiac output, or (b) ongoing signs of hypoperfusion despite achieving adequate intravascular volume and adequate mean arterial pressure (1C); avoiding use of intravenous hydrocortisone in adult septic shock patients if adequate fluid resuscitation and vasopressor therapy are able to restore hemodynamic stability (2C); hemoglobin target of 7-9 g/dL in the absence of tissue hypoperfusion, ischemic coronary artery disease, or acute hemorrhage (1B); low tidal volume (1A) and limitation of inspiratory plateau pressure (1B) for acute respiratory distress syndrome (ARDS); application of at least a minimal amount of

  19. Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock: 2012.

    Science.gov (United States)

    Dellinger, R Phillip; Levy, Mitchell M; Rhodes, Andrew; Annane, Djillali; Gerlach, Herwig; Opal, Steven M; Sevransky, Jonathan E; Sprung, Charles L; Douglas, Ivor S; Jaeschke, Roman; Osborn, Tiffany M; Nunnally, Mark E; Townsend, Sean R; Reinhart, Konrad; Kleinpell, Ruth M; Angus, Derek C; Deutschman, Clifford S; Machado, Flavia R; Rubenfeld, Gordon D; Webb, Steven A; Beale, Richard J; Vincent, Jean-Louis; Moreno, Rui

    2013-02-01

    -escalation, when appropriate (1B); infection source control with attention to the balance of risks and benefits of the chosen method within 12 hrs of diagnosis (1C); initial fluid resuscitation with crystalloid (1B) and consideration of the addition of albumin in patients who continue to require substantial amounts of crystalloid to maintain adequate mean arterial pressure (2C) and the avoidance of hetastarch formulations (1C); initial fluid challenge in patients with sepsis-induced tissue hypoperfusion and suspicion of hypovolemia to achieve a minimum of 30 mL/kg of crystalloids (more rapid administration and greater amounts of fluid may be needed in some patients) (1C); fluid challenge technique continued as long as hemodynamic improvement, as based on either dynamic or static variables (UG); norepinephrine as the first-choice vasopressor to maintain mean arterial pressure ≥ 65 mm Hg (1B); epinephrine when an additional agent is needed to maintain adequate blood pressure (2B); vasopressin (0.03 U/min) can be added to norepinephrine to either raise mean arterial pressure to target or to decrease norepinephrine dose but should not be used as the initial vasopressor (UG); dopamine is not recommended except in highly selected circumstances (2C); dobutamine infusion administered or added to vasopressor in the presence of a) myocardial dysfunction as suggested by elevated cardiac filling pressures and low cardiac output, or b) ongoing signs of hypoperfusion despite achieving adequate intravascular volume and adequate mean arterial pressure (1C); avoiding use of intravenous hydrocortisone in adult septic shock patients if adequate fluid resuscitation and vasopressor therapy are able to restore hemodynamic stability (2C); hemoglobin target of 7-9 g/dL in the absence of tissue hypoperfusion, ischemic coronary artery disease, or acute hemorrhage (1B); low tidal volume (1A) and limitation of inspiratory plateau pressure (1B) for acute respiratory distress syndrome (ARDS); application of

  20. Sepsis: from bench to bedside

    Directory of Open Access Journals (Sweden)

    Eliézer Silva

    2008-01-01

    Full Text Available Sepsis is a syndrome related to severe infections. It is defined as the systemic host response to microorganisms in previously sterile tissues and is characterized by end-organ dysfunction away from the primary site of infection. The normal host response to infection is complex and aims to identify and control pathogen invasion, as well as to start immediate tissue repair. Both the cellular and humoral immune systems are activated, giving rise to both anti-inflammatory and proinflammatory responses. The chain of events that leads to sepsis is derived from the exacerbation of these mechanisms, promoting massive liberation of mediators and the progression of multiple organ dysfunction. Despite increasing knowledge about the pathophysiological pathways and processes involved in sepsis, morbidity and mortality remain unacceptably high. A large number of immunomodulatory agents have been studied in experimental and clinical settings in an attempt to find an efficacious anti-inflammatory drug that reduces mortality. Even though preclinical results had been promising, the vast majority of these trials actually showed little success in reducing the overwhelmingly high mortality rate of septic shock patients as compared with that of other critically ill intensive care unit patients. Clinical management usually begins with prompt recognition, determination of the probable infection site, early administration of antibiotics, and resuscitation protocols based on "early-goal" directed therapy. In this review, we address the research efforts that have been targeting risk factor identification, including genetics, pathophysiological mechanisms and strategies to recognize and treat these patients as early as possible.

  1. The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3)

    NARCIS (Netherlands)

    Singer, Mervyn; Deutschman, Clifford S.; Seymour, Christopher Warren; Shankar-Hari, Manu; Annane, Djillali; Bauer, Michael; Bellomo, Rinaldo; Bernard, Gordon R.; Chiche, Jean-Daniel; Coopersmith, Craig M.; Hotchkiss, Richard S.; Levy, Mitchell M.; Marshall, John C.; Martin, Greg S.; Opal, Steven M.; Rubenfeld, Gordon D.; van der Poll, Tom; Vincent, Jean-Louis; Angus, Derek C.

    2016-01-01

    IMPORTANCE Definitions of sepsis and septic shock were last revised in 2001. Considerable advances have since been made into the pathobiology (changes in organ function, morphology, cell biology, biochemistry, immunology, and circulation), management, and epidemiology of sepsis, suggesting the need

  2. Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016

    NARCIS (Netherlands)

    Rhodes, Andrew; Evans, Laura E.; Alhazzani, Waleed; Levy, Mitchell M.; Antonelli, Massimo; Ferrer, Ricard; Kumar, Anand; Sevransky, Jonathan E.; Sprung, Charles L.; Nunnally, Mark E.; Rochwerg, Bram; Rubenfeld, Gordon D.; Angus, Derek C.; Annane, Djillali; Beale, Richard J.; Bellinghan, Geoffrey J.; Bernard, Gordon R.; Chiche, Jean-Daniel; Coopersmith, Craig; de Backer, Daniel P.; French, Craig J.; Fujishima, Seitaro; Gerlach, Herwig; Hidalgo, Jorge Luis; Hollenberg, Steven M.; Jones, Alan E.; Karnad, Dilip R.; Kleinpell, Ruth M.; Koh, Younsuck; Lisboa, Thiago Costa; Machado, Flavia R.; Marini, John J.; Marshall, John C.; Mazuski, John E.; McIntyre, Lauralyn A.; McLean, Anthony S.; Mehta, Sangeeta; Moreno, Rui P.; Myburgh, John; Navalesi, Paolo; Nishida, Osamu; Osborn, Tiffany M.; Perner, Anders; Plunkett, Colleen M.; Ranieri, Marco; Schorr, Christa A.; Seckel, Maureen A.; Seymour, Christopher W.; Shieh, Lisa; Shukri, Khalid A.; Simpson, Steven Q.; Singer, Mervyn; Thompson, B. Taylor; Townsend, Sean R.; van der Poll, Thomas; Vincent, Jean-Louis; Wiersinga, W. Joost; Zimmerman, Janice L.; Dellinger, R. Phillip

    2017-01-01

    Objective: To provide an update to "Surviving Sepsis Campaign Guidelines for Management of Sepsis and Septic Shock: 2012!' Design: A consensus committee of 55 international experts representing 25 international organizations was convened. Nominal groups were assembled at key international meetings

  3. Experimental sepsis impairs humoral memory in mice.

    Directory of Open Access Journals (Sweden)

    Christian Pötschke

    Full Text Available Patients with sepsis are often immune suppressed, and experimental mouse models of sepsis also display this feature. However, acute sepsis in mice is also characterized by a generalized B cell activation and plasma cell differentiation, resulting in a marked increase in serum antibody concentration. Its effects on humoral memory are not clearly defined. We measured the effects of experimental sepsis on long-term immunological memory for a defined antigen: we induced colon ascendens stent peritonitis (CASP 8 weeks after 2 rounds of immunization with ovalbumin. Four weeks later, the antigen-specific bone marrow plasma cell count had doubled in immunized non-septic animals, but remained unchanged in immunized septic animals. Sepsis also caused a decrease in antigen-specific serum antibody concentration. We conclude that sepsis weakens humoral memory by impeding the antigen-specific plasma cell pool's development, which is not complete 8 weeks after secondary immunization.

  4. Emerging Global Initiatives in Neurogenetics: The Enhancing Neuroimaging Genetics through Meta-analysis (ENIGMA) Consortium.

    Science.gov (United States)

    Bearden, Carrie E; Thompson, Paul M

    2017-04-19

    The Enhancing Neuroimaging Genetics through Meta-analysis (ENIGMA) Consortium is a global team science effort, now including over 800 scientists spread across 340 institutions in 35 countries, with the shared goal of understanding disease and genetic influences on the brain. This "crowdsourcing" approach to team neuroscience has unprecedented power for advancing our understanding of both typical and atypical human brain development. Copyright © 2017 Elsevier Inc. All rights reserved.

  5. Sepsis is a preventable public health problem.

    Science.gov (United States)

    Kempker, Jordan A; Wang, Henry E; Martin, Greg S

    2018-05-06

    There is a paradigm shift happening for sepsis. Sepsis is no longer solely conceptualized as problem of individual patients treated in emergency departments and intensive care units but also as one that is addressed as public health issue with population- and systems-based solutions. We offer a conceptual framework for sepsis as a public health problem by adapting the traditional model of primary, secondary, and tertiary prevention.

  6. Advances in sepsis-associated liver dysfunction

    OpenAIRE

    Wang, Dawei; Yin, Yimei; Yao, Yongming

    2014-01-01

    Recent studies have revealed liver dysfunction as an early event in sepsis. Sepsis-associated liver dysfunction is mainly resulted from systemic or microcirculatory disturbances, spillovers of bacteria and endotoxin (lipopolysaccharide, LPS), and subsequent activation of inflammatory cytokines as well as mediators. Three main cell types of the liver which contribute to the hepatic response in sepsis are Kupffer cells (KCs), hepatocytes and liver sinusoidal endothelial cells (LSECs). In additi...

  7. Globalization

    Directory of Open Access Journals (Sweden)

    Tulio Rosembuj

    2006-12-01

    Full Text Available There is no singular globalization, nor is the result of an individual agent. We could start by saying that global action has different angles and subjects who perform it are different, as well as its objectives. The global is an invisible invasion of materials and immediate effects.

  8. Globalization

    OpenAIRE

    Tulio Rosembuj

    2006-01-01

    There is no singular globalization, nor is the result of an individual agent. We could start by saying that global action has different angles and subjects who perform it are different, as well as its objectives. The global is an invisible invasion of materials and immediate effects.

  9. Comparison of QSOFA score and SIRS criteria as screening mechanisms for emergency department sepsis.

    Science.gov (United States)

    Haydar, Samir; Spanier, Matthew; Weems, Patricia; Wood, Samantha; Strout, Tania

    2017-11-01

    The Quick Sequential [Sepsis-related] Organ Failure Assessment (qSOFA) score has been shown to accurately predict mortality in septic patients and is part of recently proposed diagnostic criteria for sepsis. We sought to ascertain the sensitive of the score in diagnosing sepsis, as well as the diagnostic timeliness of the score when compared to traditional systemic inflammatory response syndrome (SIRS) criteria in a population of emergency department (ED) patients treated in the ED, admitted, and subsequently discharged with a diagnosis of sepsis. Electronic health records of 200 patients who were treated for suspected sepsis in our ED and ultimately discharged from our hospital with a diagnosis of sepsis were randomly selected for review from a population of adult ED patients (N=1880). Data extracted included the presence of SIRS criteria and the qSOFA score as well as time required to meet said criteria. In this cohort, 94.5% met SIRS criteria while in the ED whereas only 58.3% met qSOFA. The mean time from arrival to SIRS documentation was 47.1min (95% CI: 36.5-57.8) compared to 84.0min (95% CI: 62.2-105.8) for qSOFA. The median ED "door" to positive SIRS criteria was 12min and 29min for qSOFA. Although qSOFA may be valuable in predicting sepsis-related mortality, it performed poorly as a screening tool for identifying sepsis in the ED. As the time to meet qSOFA criteria was significantly longer than for SIRS, relying on qSOFA alone may delay initiation of evidence-based interventions known to improve sepsis-related outcomes. Copyright © 2017 Elsevier Inc. All rights reserved.

  10. Advances in sepsis-associated liver dysfunction

    Directory of Open Access Journals (Sweden)

    Dawei Wang

    2014-07-01

    Full Text Available Recent studies have revealed liver dysfunction as an early event in sepsis. Sepsis-associated liver dysfunction is mainly resulted from systemic or microcirculatory disturbances, spillovers of bacteria and endotoxin (lipopolysaccharide, LPS, and subsequent activation of inflammatory cytokines as well as mediators. Three main cell types of the liver which contribute to the hepatic response in sepsis are Kupffer cells (KCs, hepatocytes and liver sinusoidal endothelial cells (LSECs. In addition, activated neutrophils, which are also recruited to the liver and produce potentially destructive enzymes and oxygen-free radicals, may further enhance acute liver injury. The clinical manifestations of sepsis-associated liver dysfunction can roughly be divided into two categories: Hypoxic hepatitis and jaundice. The latter is much more frequent in the context of sepsis. Hepatic failure is traditionally considered as a late manifestation of sepsis-induced multiple organ dysfunction syndrome. To date, no specific therapeutics for sepsis-associated liver dysfunction are available. Treatment measure is mainly focused on eradication of the underlying infection and management for severe sepsis. A better understanding of the pathophysiology of liver response in sepsis may lead to further increase in survival rates.

  11. Current insights in sepsis: from pathogenesis to new treatment targets

    NARCIS (Netherlands)

    Wiersinga, W. Joost

    2011-01-01

    Sepsis continues to be a leading cause of ICU death. This review summarizes current knowledge on sepsis pathogenesis and new therapeutical strategies. Although systemic inflammatory response syndrome predominates in early sepsis, the compensatory anti-inflammatory response syndrome causes

  12. Subdivision, Sampling, and Initialization Strategies for Simplical Branch and Bound in Global Optimization

    DEFF Research Database (Denmark)

    Clausen, Jens; Zilinskas, A,

    2002-01-01

    We consider the problem of optimizing a Lipshitzian function. The branch and bound technique is a well-known solution method, and the key components for this are the subdivision scheme, the bound calculation scheme, and the initialization. For Lipschitzian optimization, the bound calculations are...

  13. A Framework to Support Global Corporate M-Learning: Learner Initiative and Technology Acceptance across Cultures

    Science.gov (United States)

    Farrell, Wendy

    2015-01-01

    Corporations are growing more and more international and accordingly need to train and develop an increasingly diverse and dispersed employee based. M-learning seems like it may be the solution if it can cross cultures. Learner initiative has been shown to be a disadvantage of distant learning environments, which would include m-learning.…

  14. Effects of Initial Symmetry on the Global Symmetry of One-Dimensional Legal Cellular Automata

    Directory of Open Access Journals (Sweden)

    Ikuko Tanaka

    2015-09-01

    Full Text Available To examine the development of pattern formation from the viewpoint of symmetry, we applied a two-dimensional discrete Walsh analysis to a one-dimensional cellular automata model under two types of regular initial conditions. The amount of symmetropy of cellular automata (CA models under regular and random initial conditions corresponds to three Wolfram’s classes of CAs, identified as Classes II, III, and IV. Regular initial conditions occur in two groups. One group that makes a broken, regular pattern formation has four types of symmetry, whereas the other group that makes a higher hierarchy pattern formation has only two types. Additionally, both final pattern formations show an increased amount of symmetropy as time passes. Moreover, the final pattern formations are affected by iterations of base rules of CA models of chaos dynamical systems. The growth design formations limit possibilities: the ratio of developing final pattern formations under a regular initial condition decreases in the order of Classes III, II, and IV. This might be related to the difference in degree in reference to surrounding conditions. These findings suggest that calculations of symmetries of the structures of one-dimensional cellular automata models are useful for revealing rules of pattern generation for animal bodies.

  15. Technical Report Series on Global Modeling and Data Assimilation, Volume 43. MERRA-2; Initial Evaluation of the Climate

    Science.gov (United States)

    Koster, Randal D. (Editor); Bosilovich, Michael G.; Akella, Santha; Lawrence, Coy; Cullather, Richard; Draper, Clara; Gelaro, Ronald; Kovach, Robin; Liu, Qing; Molod, Andrea; hide

    2015-01-01

    The years since the introduction of MERRA have seen numerous advances in the GEOS-5 Data Assimilation System as well as a substantial decrease in the number of observations that can be assimilated into the MERRA system. To allow continued data processing into the future, and to take advantage of several important innovations that could improve system performance, a decision was made to produce MERRA-2, an updated retrospective analysis of the full modern satellite era. One of the many advances in MERRA-2 is a constraint on the global dry mass balance; this allows the global changes in water by the analysis increment to be near zero, thereby minimizing abrupt global interannual variations due to changes in the observing system. In addition, MERRA-2 includes the assimilation of interactive aerosols into the system, a feature of the Earth system absent from previous reanalyses. Also, in an effort to improve land surface hydrology, observations-corrected precipitation forcing is used instead of model-generated precipitation. Overall, MERRA-2 takes advantage of numerous updates to the global modeling and data assimilation system. In this document, we summarize an initial evaluation of the climate in MERRA-2, from the surface to the stratosphere and from the tropics to the poles. Strengths and weaknesses of the MERRA-2 climate are accordingly emphasized.

  16. [The department budget, in the context of the hospital global budget. Initial results in general medicine].

    Science.gov (United States)

    Besançon, F

    1984-02-23

    In a general hospital (Hôtel-Dieu, in the center of Paris), run with a global budget, budgets determined for each unit were introduced as an experiment in 1980. Physicians were in charge of certain expenses, mainly: linen, drugs, transportation of patients to and from other hospitals within Paris, and blood fractions. The whole does not exceed 4% of the turnover (FF 20 millions in 1980) of a 67 bed internal medicine unit. Other accounts deal with the stays, admissions, prescriptions of technical acts, laboratory analyses, and X-rays. In 1980, expenses were 11% more than budgeted, but the increase in stays and particularly in admissions was significantly greater. The resulting savings were 8.8% and 18.7% for stays and admissions respectively. Psychic reactions were variable. The subsequent budgets followed the fluctuations of recorded expenses, which were fairly important in both directions. The unit budget may be an advance or a regression, in a restrictive and past-perpetuating context. The coherence between the unit budget and the global hospital budget is questionable. Physicians were willing to take part in accounting and saving. They have good reason for not enlarging their financial responsibilities. Conversely, they may give more attention to diseases of public opinion.

  17. PVO / NGO initiatives. The Global Dialogues Trust -- "Scenarios from the Sahel".

    Science.gov (United States)

    1997-01-01

    Scenarios from the Sahel is an HIV/AIDS prevention project for adolescents and young adults in Senegal, Mali, Burkina Faso, and Niger, organized by the Global Dialogues Trust and launched in January 1997. The project invites people aged 24 years and younger to engage in a competition in which they write scenarios for a 1-5 minute video on HIV/AIDS. Those 30 scenarios judged to be the most valuable to the HIV/AIDS prevention effort in the Sahel will be developed into video spots by the region's film-makers and screened at cinemas and broadcast on television stations in West Africa. The spots will also be collected upon a compilation video available for use by local nongovernmental organizations in their HIV/AIDS prevention activities in the region. The compilation video will be dubbed from French into local languages and English to facilitate its broad dissemination in the 4 participating countries and their neighbors. The video together with an education pack will also be distributed to local organizations and schools. The project, to be conducted in close partnership with local people and their organizations, will end with its evaluation in June 1998. Global Dialogues Trust is a charitable trust based in the UK dedicated to advance the education of the public throughout the world in all matters concerning the prevention of HIV/AIDS. The organization's main priority is to develop local capacity to fight HIV/AIDS through preventive education.

  18. Filtering authentic sepsis arising in the ICU using administrative codes coupled to a SIRS screening protocol.

    Science.gov (United States)

    Sudduth, Christopher L; Overton, Elizabeth C; Lyu, Peter F; Rimawi, Ramzy H; Buchman, Timothy G

    2017-06-01

    Using administrative codes and minimal physiologic and laboratory data, we sought a high-specificity identification strategy for patients whose sepsis initially appeared during their ICU stay. We studied all patients discharged from an academic hospital between September 1, 2013 and October 31, 2014. Administrative codes and minimal physiologic and laboratory criteria were used to identify patients at high risk of developing the onset of sepsis in the ICU. Two clinicians then independently reviewed the patient record to verify that the screened-in patients appeared to become septic during their ICU admission. Clinical chart review verified sepsis in 437/466 ICU stays (93.8%). Of these 437 encounters, only 151 (34.6%) were admitted to the ICU with neither SIRS nor evidence of infection and therefore appeared to become septic during their ICU stay. Selected administrative codes coupled to SIRS criteria and applied to patients admitted to ICU can yield up to 94% authentic sepsis patients. However, only 1/3 of patients thus identified appeared to become septic during their ICU stay. Studies that depend on high-intensity monitoring for description of the time course of sepsis require clinician review and verification that sepsis initially appeared during the monitoring period. Copyright © 2017 Elsevier Inc. All rights reserved.

  19. Global solutions to random 3D vorticity equations for small initial data

    Science.gov (United States)

    Barbu, Viorel; Röckner, Michael

    2017-11-01

    One proves the existence and uniqueness in (Lp (R3)) 3, 3/2 4p - 6)3 with respect to the time variable. Furthermore, we obtain the pathwise continuous dependence of solutions with respect to the initial data. In particular, one gets a locally unique solution of 3D stochastic Navier-Stokes equation in vorticity form up to some explosion stopping time τ adapted to the Brownian motion.

  20. Collaborative training program in coastal management in the Philippines: a local initiative with a global perspective

    OpenAIRE

    Balgos, M.C.

    1995-01-01

    A collaborative project in developing a broad-based coastal management training program in the Philippines is being undertaken by a group of government and nongovernment agencies. It addresses the lack of expertise in planning an implementation for coastal management in the country. The process will be documented to serve as a guide in starting and maintaining the process of collaborative training in coastal management in the region. Other training initiatives are outlined including regional ...

  1. Procalcitonin as an adjunctive biomarker in sepsis

    Directory of Open Access Journals (Sweden)

    Mahua Sinha

    2011-01-01

    Full Text Available Sepsis can sometimes be difficult to substantiate, and its distinction from non-infectious conditions in critically ill patients is often a challenge. Serum procalcitonin (PCT assay is one of the biomarkers of sepsis. The present study was aimed to assess the usefulness of PCT assay in critically ill patients with suspected sepsis. The study included 40 patients from the intensive care unit with suspected sepsis. Sepsis was confirmed clinically and/or by positive blood culture. Serum PCT was assayed semi-quantitatively by rapid immunochromatographic technique (within 2 hours of sample receipt. Among 40 critically ill patients, 21 had clinically confirmed sepsis. There were 12 patients with serum PCT ≥10 ng/ml (8, blood culture positive; 1, rickettsia; 2, post-antibiotic blood culture sterile; and 1, non-sepsis; 7 patients with PCT 2-10 ng/ml (4, blood culture positive; 1, falciparum malaria; 2, post-antibiotic blood culture sterile; 3 patients with PCT of 0.5 to 2 ng/ml (sepsis in 1 patient; and 18 patients with PCT < 0.5 ng/ml (sepsis in 2 patients. Patients with PCT ≥ 2 ng/ml had statistically significant correlation with the presence of sepsis (P<0.0001. The PCT assay revealed moderate sensitivity (86% and high specificity (95% at a cut-off ≥ 2 ng/ml. The PCT assay was found to be a useful biomarker of sepsis in this study. The assay could be performed and reported rapidly and provided valuable information before availability of culture results. This might assist in avoiding unwarranted antibiotic usage.

  2. I costi della sepsi in Italia

    Directory of Open Access Journals (Sweden)

    C. Lucioni

    2001-09-01

    Full Text Available The aim of this study is to evaluate additional hospitalisation costs and intangible costs (mortality in patients with sepsis (intended as severe sepsis or sepsis shock in Italy. The evaluation is based on clinical data from the Italian Sepsis Study, a prospective, multicentre study conducted in 99 Intensive Care Units (ICUslocated across Italy. Each ICU enrolled the first two (or three patients admitted each month, during the year April 1993 to March 1994. In particular, data collected included the Average Length Of Stay (ALOS in ICU and later in the regular ward, and the mortality within four weeks and in hospital. Out of the 2,946 patients enrolled, 2,641 never developed sepsis and were considered as the control group (comparability was confirmed based on gender, age, and comorbidity. The additional (respective to the control group ALOSs of the patients with sepsis were valued in monetary terms using per diem full costs, inflated to 2000: 1,033.43 Euro for l day in ICU (published data and 299.54 Euro for l day in the regular ward (estimated data based on published materials. Statistical significance was tested with Student t test. The hospitalisation cost of a patient with sepsis (21,571.88 Euro is significantly higher (+86% than that patient without sepsis (11,590.84 Euro, due to a longer (+ 163% stay in the expensive ICU, not balanced by shorter stay in the regular ward. Also intangible costs are significantly higher: the risk for an ICU patient with sepsis to die in hospital is 3 times higher than that of an ICU patient without sepsis. In particular, those patients developing sepsis after admission are more costly and with a higher mortality risk.

  3. Methionine Metabolites in Patients With Sepsis.

    Science.gov (United States)

    Wexler, Orren; Gough, Michael S; Morgan, Mary Anne M; Mack, Cynthia M; Apostolakos, Michael J; Doolin, Kathleen P; Mooney, Robert A; Arning, Erland; Bottiglieri, Teodoro; Pietropaoli, Anthony P

    2018-01-01

    Sepsis is characterized by microvascular dysfunction and thrombophilia. Several methionine metabolites may be relevant to this sepsis pathophysiology. S-adenosylmethionine (SAM) serves as the methyl donor for trans-methylation reactions. S-adenosylhomocysteine (SAH) is the by-product of these reactions and serves as the precursor to homocysteine. Relationships between plasma total homocysteine concentrations (tHcy) and vascular disease and thrombosis are firmly established. We hypothesized that SAM, SAH, and tHcy levels are elevated in patients with sepsis and associated with mortality. This was a combined case-control and prospective cohort study consisting of 109 patients with sepsis and 50 control participants without acute illness. The study was conducted in the medical and surgical intensive care units of the University of Rochester Medical Center. Methionine, SAM, SAH, and tHcy concentrations were compared in patients with sepsis versus control participants and in sepsis survivors versus nonsurvivors. Patients with sepsis had significantly higher plasma SAM and SAH concentrations than control participants (SAM: 164 [107-227] vs73 [59-87 nM], P sepsis patients compared to healthy control participants (4 [2-6]) vs 7 [5-9] μM; P = .04). In multivariable analysis, quartiles of SAM, SAH, and tHcy were independently associated with sepsis ( P = .006, P = .05, and P Sepsis nonsurvivors had significantly higher plasma SAM and SAH concentrations than survivors (SAM: 223 [125-260] vs 136 [96-187] nM; P = .01; SAH: 139 [81-197] vs 86 [55-130] nM, P = .006). Plasma tHcy levels were similar in survivors vs nonsurvivors. The associations between SAM or SAH and hospital mortality were no longer significant after adjusting for renal dysfunction. Methionine metabolite concentrations are abnormal in sepsis and linked with clinical outcomes. Further study is required to determine whether these abnormalities have pathophysiologic significance.

  4. The next generation of sepsis clinical trial designs: what is next after the demise of recombinant human activated protein C?*.

    Science.gov (United States)

    Opal, Steven M; Dellinger, R Phillip; Vincent, Jean-Louis; Masur, Henry; Angus, Derek C

    2014-07-01

    The developmental pipeline for novel therapeutics to treat sepsis has diminished to a trickle compared to previous years of sepsis research. While enormous strides have been made in understanding the basic molecular mechanisms that underlie the pathophysiology of sepsis, a long list of novel agents have now been tested in clinical trials without a single immunomodulating therapy showing consistent benefit. The only antisepsis agent to successfully complete a phase III clinical trial was human recumbent activated protein C. This drug was taken off the market after a follow-up placebo-controlled trial (human recombinant activated Protein C Worldwide Evaluation of Severe Sepsis and septic Shock [PROWESS SHOCK]) failed to replicate the favorable results of the initial registration trial performed ten years earlier. We must critically reevaluate our basic approach to the preclinical and clinical evaluation of new sepsis therapies. We selected the major clinical studies that investigated interventional trials with novel therapies to treat sepsis over the last 30 years. Phase II and phase III trials investigating new treatments for sepsis and editorials and critiques of these studies. Selected manuscripts and clinical study reports were analyzed from sepsis trials. Specific shortcomings and potential pit falls in preclinical evaluation and clinical study design and analysis were reviewed and synthesized. After review and discussion, a series of 12 recommendations were generated with suggestions to guide future studies with new treatments for sepsis. We need to improve our ability to define appropriate molecular targets for preclinical development and develop better methods to determine the clinical value of novel sepsis agents. Clinical trials must have realistic sample sizes and meaningful endpoints. Biomarker-driven studies should be considered to categorize specific "at risk" populations most likely to benefit from a new treatment. Innovations in clinical trial design

  5. Early Expansion of Circulating Granulocytic Myeloid-derived Suppressor Cells Predicts Development of Nosocomial Infections in Patients with Sepsis.

    Science.gov (United States)

    Uhel, Fabrice; Azzaoui, Imane; Grégoire, Murielle; Pangault, Céline; Dulong, Joelle; Tadié, Jean-Marc; Gacouin, Arnaud; Camus, Christophe; Cynober, Luc; Fest, Thierry; Le Tulzo, Yves; Roussel, Mikael; Tarte, Karin

    2017-08-01

    Sepsis induces a sustained immune dysfunction responsible for poor outcome and nosocomial infections. Myeloid-derived suppressor cells (MDSCs) described in cancer and inflammatory processes may be involved in sepsis-induced immune suppression, but their clinical impact remains poorly defined. To clarify phenotype, suppressive activity, origin, and clinical impact of MDSCs in patients with sepsis. Peripheral blood transcriptomic analysis was performed on 29 patients with sepsis and 15 healthy donors. A second cohort of 94 consecutive patients with sepsis, 11 severity-matched intensive care patients, and 67 healthy donors was prospectively enrolled for flow cytometry and functional experiments. Genes involved in MDSC suppressive functions, including S100A12, S100A9, MMP8, and ARG1, were up-regulated in the peripheral blood of patients with sepsis. CD14 pos HLA-DR low/neg monocytic (M)-MDSCs were expanded in intensive care unit patients with and without sepsis and CD14 neg CD15 pos low-density granulocytes/granulocytic (G)-MDSCs were more specifically expanded in patients with sepsis (P sepsis. G-MDSCs, made of immature and mature granulocytes expressing high levels of degranulation markers, were specifically responsible for arginase 1 activity. High initial levels of G-MDSCs, arginase 1, and S100A12 but not M-MDSCs were associated with subsequent occurrence of nosocomial infections. M-MDSCs and G-MDSCs strongly contribute to T-cell dysfunction in patients with sepsis. More specifically, G-MDSCs producing arginase 1 are associated with a higher incidence of nosocomial infections and seem to be major actors of sepsis-induced immune suppression.

  6. Globalization

    OpenAIRE

    Andru?cã Maria Carmen

    2013-01-01

    The field of globalization has highlighted an interdependence implied by a more harmonious understanding determined by the daily interaction between nations through the inducement of peace and the management of streamlining and the effectiveness of the global economy. For the functioning of the globalization, the developing countries that can be helped by the developed ones must be involved. The international community can contribute to the institution of the development environment of the gl...

  7. Le reporting extra-financier selon la Global reporting initiative à l’épreuve du greenwashing

    OpenAIRE

    Huguet, Ivan

    2016-01-01

    La présente contribution vise à offrir une meilleure compréhension du reporting extra-financier et des enjeux, qu’ils soient théoriques ou pratiques, sous-jacents à ce dernier. Par ailleurs, en explorant cette pratique aux contours flous qu’est le greenwashing, le présent texte vise également à déterminer la crédibilité qu’il est possible d’accorder aux rapports extra-financiers établis selon la Global reporting initiative.

  8. The future of the oceans past: towards a global marine historical research initiative.

    Science.gov (United States)

    Schwerdtner Máñez, Kathleen; Holm, Poul; Blight, Louise; Coll, Marta; MacDiarmid, Alison; Ojaveer, Henn; Poulsen, Bo; Tull, Malcolm

    2014-01-01

    Historical research is playing an increasingly important role in marine sciences. Historical data are also used in policy making and marine resource management, and have helped to address the issue of shifting baselines for numerous species and ecosystems. Although many important research questions still remain unanswered, tremendous developments in conceptual and methodological approaches are expected to contribute to a comprehensive understanding of the global history of human interactions with life in the seas. Based on our experiences and knowledge from the "History of Marine Animal Populations" project, this paper identifies the emerging research topics for future historical marine research. It elaborates on concepts and tools which are expected to play a major role in answering these questions, and identifies geographical regions which deserve future attention from marine environmental historians and historical ecologists.

  9. Sinusitis and intracranial sepsis: the CT imaging and clinical presentation

    International Nuclear Information System (INIS)

    Saxton, V.J.; Boldt, D.W.; Shield, L.K.

    1995-01-01

    The CT imaging and clinical presentation in 14 children with coexistent intracranial sepsis and sinusitis were reviewed. A routine CT head scan (10-mm thick semi-axial slices through the cranium done before and after intravenous contrast medium administration) was found to be an inadequate initial investigation as the intracranial collection was missed in four patients and the abnormal sinuses not shown in six. In half the children the dagnosis of sinusitis was unsuspected at the time of admission. The dominant clinical features were fever, intense headache and facial swelling in early adolescent males. In this clinical setting we recommend: (1) The routine scan is extended through the frontal and ethmoidal sinuses and photographed at a window level and width showing both bone detail and air/soft tissue interfaces; (2) direct coronal projections are performed through the anterior cranial fossa if no collection is seen on the routine study; (3) an early repeat scan within 48 h if the initial study shows no intracranial pathology but the fronto-ethomoidal sinuses are abnormal and there is a high clinical supicion of intracranial sepsis; and (4) in the presence of intracranial sepsis the vault is viewed at bone window settings to exclude cranial osteomyelitis. (orig.)

  10. Severe sepsis and septic shock [author's reply

    NARCIS (Netherlands)

    Angus, Derek C.; van der Poll, Tom

    2013-01-01

    To the Editor: We would like to address two potentially confusing issues concerning venous oxygen saturation (Svo(2)) as presented in Table 1 of the review by Angus and van der Poll (Aug. 29 issue).(1) First, Table 1 suggests that Svo(2) is raised in sepsis, severe sepsis, and septic shock.

  11. Neuro-oxidative-nitrosative stress in sepsis

    DEFF Research Database (Denmark)

    Berg, Ronan M G; Møller, Kirsten; Bailey, Damian M

    2011-01-01

    Neuro-oxidative-nitrosative stress may prove the molecular basis underlying brain dysfunction in sepsis. In the current review, we describe how sepsis-induced reactive oxygen and nitrogen species (ROS/RNS) trigger lipid peroxidation chain reactions throughout the cerebrovasculature and surrounding...

  12. Think Sepsis. Time Matters. PSA (:60)

    Centers for Disease Control (CDC) Podcasts

    2016-08-23

    This 60 second public service announcement is based on the August 2016 CDC Vital Signs report. Sepsis is a medical emergency and can happen quickly. Learn the signs of sepsis and how to prevent it.  Created: 8/23/2016 by National Center for Injury Prevention and Control (NCIPC).   Date Released: 8/23/2016.

  13. Age, exercise, and the outcome of sepsis.

    Science.gov (United States)

    Banerjee, Debasree; Opal, Steven M

    2017-11-23

    We report on the increasingly important need to diagnose and care for the elderly with sepsis as a distinct patient population. We share an overview of age-related changes in sepsis physiology and the potential role of exercise.See related research by Tyml et al., https://ccforum.biomedcentral.com/articles/10.1186/s13054-017-1783-1.

  14. Radiodiagnosis of lung syndrome in surgical sepsis

    International Nuclear Information System (INIS)

    Dvojnykh, V.P.; Palagin, E.K.

    1991-01-01

    The results of treatment of 23 patients with acute surgical sepsis were analysed. It was shown that the X-ray examination must be obligatory in surveillance of patients with purulent foci. Two roentgenological variants are possible in surgical sepsis: central and perepheric. X-ray examinations of chest organs should be conducted every 2-3 day

  15. Renal replacement therapy in sepsis-induced acute renal failure

    Directory of Open Access Journals (Sweden)

    Rajapakse Senaka

    2009-01-01

    Full Text Available Acute renal failure (ARF is a common complication of sepsis and carries a high mortality. Renal replacement therapy (RRT during the acute stage is the mainstay of therapy. Va-rious modalities of RRT are available. Continuous RRT using convective methods are preferred in sepsis-induced ARF, especially in hemodynamically unstable patients, although clear evidence of benefit over intermittent hemodialysis is still not available. Peritoneal dialysis is clearly inferior, and is not recommended. Early initiation of RRT is probably advantageous, although the optimal timing of dialysis is yet unknown. Higher doses of RRT are more likely to be beneficial. Use of bio-compatible membranes and bicarbonate buffer in the dialysate are preferred. Anticoagulation during dialysis must be carefully adjusted and monitored.

  16. Forced sexual initiation, sexual intimate partner violence and HIV risk in women: A global review of the literature

    Science.gov (United States)

    Stockman, Jamila K.; Lucea, Marguerite B.; Campbell, Jacquelyn C.

    2012-01-01

    Coerced or forced sexual initiation and sexual intimate partner violence (sexual IPV) contribute significantly to a woman’s risk for HIV infection. This review systematically examines global research (n=21 studies) published since 2000 on the role of coerced/forced sexual initiation and sexual IPV on HIV risk in women. In predominantly low- and middle-income countries, coerced/forced sexual initiation was associated with HIV/STIs, multiple and high-risk sex partners, and no condom use. Most studies using behaviorally specific terms for sexual IPV found strong associations between sexual IPV and HIV risk behaviors. In contrast, studies using less specific definitions often failed to find these significant associations. To develop more comprehensive HIV prevention programs, future efforts should integrate behaviorally specific terms into assessing prevalence of sexual IPV and its association with HIV risk, consider cultural differences, and identify causal pathways between coerced or forced sexual initiation, HIV risk behaviors and HIV/STI infection. PMID:23143750

  17. A Sepsis-related Diagnosis Impacts Interventions and Predicts Outcomes for Emergency Patients with Severe Sepsis.

    Science.gov (United States)

    Kim, Mitchell; Watase, Taketo; Jablonowski, Karl D; Gatewood, Medley O; Henning, Daniel J

    2017-10-01

    Many patients meeting criteria for severe sepsis are not given a sepsis-related diagnosis by emergency physicians (EP). This study 1) compares emergency department (ED) interventions and in-hospital outcomes among patients with severe sepsis, based on the presence or absence of sepsis-related diagnosis, and 2) assesses how adverse outcomes relate to three-hour sepsis bundle completion among patients fulfilling severe sepsis criteria but not given a sepsis-related diagnosis. We performed a retrospective cohort study using patients meeting criteria for severe sepsis at two urban, academic tertiary care centers from March 2015 through May 2015. We included all ED patients with the following: 1) the 1992 Consensus definition of severe sepsis, including two or more systemic inflammatory response syndrome criteria and evidence of organ dysfunction; or 2) physician diagnosis of severe sepsis or septic shock. We excluded patients transferred to or from another hospital and those <18 years old. Patients with an EP-assigned sepsis diagnosis created the "Physician Diagnosis" group; the remaining patients composed the "Consensus Criteria" group. The primary outcome was in-hospital mortality. Secondary outcomes included completed elements of the current three-hour sepsis bundle; non-elective intubation; vasopressor administration; intensive care unit (ICU) admission from the ED; and transfer to the ICU in < 24 hours. We compared proportions of each outcome between groups using the chi-square test, and we also performed a stratified analysis using chi square to assess the association between failure to complete the three-hour bundle and adverse outcomes in each group. Of 418 patients identified with severe sepsis we excluded 54, leaving 364 patients for analysis: 121 "Physician Diagnosis" and 243 "Consensus Criteria." The "Physician Diagnosis" group had a higher in-hospital mortality (12.4% vs 3.3%, P < 0.01) and compliance with the three-hour sepsis bundle (52.1% vs 20.2%, P

  18. An effort to improve track and intensity prediction of tropical cyclones through vortex initialization in NCUM-global model

    Science.gov (United States)

    Singh, Vivek; Routray, A.; Mallick, Swapan; George, John P.; Rajagopal, E. N.

    2016-05-01

    Tropical cyclones (TCs) have strong impact on socio-economic conditions of the countries like India, Bangladesh and Myanmar owing to its awful devastating power. This brings in the need of precise forecasting system to predict the tracks and intensities of TCs accurately well in advance. However, it has been a great challenge for major operational meteorological centers over the years. Genesis of TCs over data sparse warm Tropical Ocean adds more difficulty to this. Weak and misplaced vortices at initial time are one of the prime sources of track and intensity errors in the Numerical Weather Prediction (NWP) models. Many previous studies have reported the forecast skill of track and intensity of TC improved due to the assimilation of satellite data along with vortex initialization (VI). Keeping this in mind, an attempt has been made to investigate the impact of vortex initialization for simulation of TC using UK-Met office global model, operational at NCMRWF (NCUM). This assessment is carried out by taking the case of a extremely severe cyclonic storm "Chapala" that occurred over Arabian Sea (AS) from 28th October to 3rd November 2015. Two numerical experiments viz. Vort-GTS (Assimilation of GTS observations with VI) and Vort-RAD (Same as Vort-GTS with assimilation of satellite data) are carried out. This vortex initialization study in NCUM model is first of its type over North Indian Ocean (NIO). The model simulation of TC is carried out with five different initial conditions through 24 hour cycles for both the experiments. The results indicate that the vortex initialization with assimilation of satellite data has a positive impact on the track and intensity forecast, landfall time and position error of the TCs.

  19. The Global Threat Reduction Initiative's Return of Highly Enriched Uranium from Chile

    Energy Technology Data Exchange (ETDEWEB)

    Messick, C.E.; Dickerson, S.L.; Greenberg, R.F. Jr. [U.S. Department of Energy, National Nuclear Security Administration, Washington D.C. (United States); Andes, T.C. [Y-12 National Security Complex, Oak Ridge, TN (United States)

    2011-07-01

    In March 2010, the U.S. National Nuclear Security Administration's Office of Global Threat Reduction (GTRI), in collaboration with the Chilean Nuclear Energy Commission (CCHEN), completed a shipment of 18.2 kilograms of non-U.S.-origin highly enriched uranium (HEU) to the United States. The HEU was in the form of 71 aluminium-clad material test reactor (MTR) fuel elements and was the first GTRI Gap Program shipment that included non-U.S. origin irradiated nuclear fuel. Although shipments of research reactor fuels are not unique, this shipment served as a cornerstone to the first Presidential Nuclear Security Summit held in Washington, D.C., in April 2010. Carrying out the shipment became critical when a severe earthquake struck Chile just one day before the shipment was to occur. As the fuel had already been packaged in casks and the ocean vessels were nearing the port, U.S. and Chilean officials decided that it was most imperative that the shipment continue as planned. After careful analysis of the situation, inspection of the transportation packages, roadways, and port services, the shipment team was able to make the shipment occur in a safe and secure manner. This paper describes the loading activities at both the RECH-1 and RECH-2 reactors as well as the transportation of the loaded casks to the port of departure. (author)

  20. www.elearnSCI.org: a global educational initiative of ISCoS.

    Science.gov (United States)

    Chhabra, H S; Harvey, L A; Muldoon, S; Chaudhary, S; Arora, M; Brown, D J; Biering-Sorensen, F; Wyndaele, J J; Charlifue, S; Horsewell, J; Ducharme, S; Green, D; Simpson, D; Glinsky, J; Weerts, E; Upadhyay, N; Aito, S; Wing, P; Katoh, S; Kovindha, A; Krassioukov, A; Weeks, C; Srikumar, V; Reeves, R; Siriwardane, C; Hasnan, N; Kalke, Y B; Lanig, I

    2013-03-01

    To develop a web-based educational resource for health professionals responsible for the management of spinal cord injury (SCI). The resource:www.elearnSCI.org is comprised of seven learning modules, each subdivided into various submodules. Six of the seven modules address the educational needs of all disciplines involved in comprehensive SCI management. The seventh module addresses prevention of SCI. Each submodule includes an overview, activities, self-assessment questions and references. Three hundred and thirty-two experts from The International Spinal Cord Society (ISCoS) and various affiliated societies from 36 countries were involved in developing the resource through 28 subcommittees. The content of each submodule was reviewed and approved by the Education and Scientific Committees of ISCoS and finally by an Editorial Committee of 23 experts. The content of the learning modules is relevant to students and to new as well as experienced SCI healthcare professionals. The content is applicable globally, has received consumer input and is available at no cost. The material is presented on a website underpinned by a sophisticated content-management system, which allows easy maintenance and ready update of all the content. The resource conforms to key principles of e-learning, including appropriateness of curriculum, engagement of learners, innovative approaches, effective learning, ease of use, inclusion, assessment, coherence, consistency, transparency, cost effectiveness and feedback. www.elearnSCI.org provides a cost effective way of training healthcare professionals that goes beyond the textbook and traditional face-to-face teaching.

  1. Hemostasis and endothelial damage during sepsis.

    Science.gov (United States)

    Johansen, Maria Egede

    2015-08-01

    The sepsis syndrome represents a disease continuum, including severe sepsis and septic shock associated with high mortality. One of the main problems in severe sepsis and septic shock, resulting in organ failure and death, are disturbances in the hemostasis due to sepsis-related coagulopathy. Sepsis-related coagulopathy affects not only traditional coagulation factors, but also the platelets and endothelium. Functional testing of the hemostatic system has found application in critical illness. Thrombelastography (TEG) provides an overview of the hemostatic system allowing for an evaluation of interactions between coagulation factors and platelets. Additionally, the role of the endothelium during sepsis can be explored through testing of biomarkers of endothelial damage. The three studies comprising this PhD thesis all investigate important aspects of the disturbed hemostasis during sepsis, including endothelial damage. Together, the specific findings from the three studies improve the existing understanding of sepsis-related coagulopathy, and the possible influences of some of the treatments offered these patients. The first study investigates the occurrence of antimicrobial-induced thrombocytopenia among critically ill patients. In sepsis, thrombocytopenia is a predictor of poor outcome, and reports, of mainly casuistic nature, have previously hypothesized that specific antimicrobial agents could induce in sepsis-related thrombocytopenia. This hypothesis was tested using a randomized designed set-up, encompassing 1147 critically ill patients, and no significant difference in risk of thrombocytopenia was observed among patients receiving large amounts of antimicrobials vs. patients receiving standard-of-care. As a consequence, the risk of antimicrobial-induced thrombocytopenia in the general population of critically ill patients seemingly does not represent a substantial problem and thrombocytopenia during critical illness is most likely due to other factors such

  2. Tradução e adaptação cultural do global appraisal of individual needs - initial

    Directory of Open Access Journals (Sweden)

    Heloísa Garcia Claro

    2012-10-01

    Full Text Available Este estudo objetivou traduzir e adaptar culturalmente o instrumento Global Appraisal of Individual Needs - Initial e calcular seu Índice de Validade de Conteúdo. Trata-se de estudo metodológico, de adaptação cultural do instrumento. O instrumento foi traduzido para o português em duas versões que deram origem à síntese das traduções, submetida à avaliação de quatro juízes experts na área de álcool e outras drogas. Após modificações, foi retraduzido e ressubmetido aos juízes e autores do instrumento original, resultando na versão final do instrumento, Avaliação Global das Necessidades Individuais - Inicial O Índice de Validade de Conteúdo do instrumento foi de 0,91, considerado válido pela literatura. O instrumento Avaliação Global das Necessidades Individuais - Inicial é um instrumento adaptado culturalmente para o português falado no Brasil; entretanto, não foi submetido a testes com a população-alvo, o que sugere que sejam realizados estudos que testem sua confiabilidade e validade.

  3. Status, progress and plans for the U.S. Department of Energy, National Nuclear Security Administration, Global Threat Reduction Initiative

    International Nuclear Information System (INIS)

    Bieniawski, Andrew

    2005-01-01

    This presentation discusses the efforts under the US Department of Energy/National Nuclear Security Administration's Global Threat Reduction Initiative, also known as GTRI. On May 26, 2004, then Secretary of Energy Abraham established GTRI. GTRI is a cooperative program to provide international support for countries' national programs to identify, secure, recover or facilitate the disposition of vulnerable nuclear and radiological materials around the world that pose a potential threat to the international community. The formation of GTRI consolidated a number of nonproliferation programs you may be familiar with that work together to minimize and, to the extent possible, eliminate the use of highly enriched uranium (HEU) in civil nuclear applications worldwide. In particular, the Office of Global Threat Reduction, which was set up to implement GTRI, has oversight of the Reduced Enrichment for Research and Test Reactors program, the Foreign Research Reactor Spent Nuclear Fuel Acceptance program, and the Russian Research Reactor Fuel Return program. This consolidation allows these three programs to work in concert to bring about the elimination of research reactor materials as a source of proliferation concern. This speech is highlighting the work that these programs have undertaken in cooperation with the global research reactor community and the importance placed on fuel development under the RERTR program It contains an update on the work done to support the US - Russian Presidential Bratislava Summit Statement

  4. Introductory remarks at the Global Threat Reduction Initiative Partners Conference (GTRI). 18 September 2004, Vienna, Austria

    International Nuclear Information System (INIS)

    ElBaradei, M.

    2004-01-01

    The security of nuclear and other radioactive material has taken on dramatically heightened significance in recent years, due to a number of factors: first, the increasing awareness that nuclear weapons related 'know-how' is no longer confined to a relatively few countries; second, the uncovering of an illicit procurement network capable of supplying nuclear designs and equipment; and third, the rise of extremist groups that have demonstrated an interest in obtaining and using nuclear and radiological weapons. Against this background, the need to protect nuclear material and facilities, and to control nuclear material and radioactive sources, has become an ever more global priority. The IAEA has been active in the field of nuclear security for many years, but the urgency and scope of our efforts underwent a 'sea-change' in the months following September 2001. International cooperation has become the hallmark of these security efforts. While nuclear security is and should remain a national responsibility, many countries still lack the programmes and the resources to respond properly to the threat of nuclear and radiological terrorism. International efforts are focused both on assisting these countries in strengthening their programmes, and on building global networks for combating cross-border threats. The Agency's work has three main points of focus: prevention, detection and response. Our first objective is to assist States in preventing any illicit or non-peaceful use of nuclear or other radioactive materials - including acts of terrorism. This requires effective physical protection of nuclear materials in use, storage and transport, as well as protection of related nuclear facilities. It demands strong State programmes for accounting and control of nuclear material. It recognizes the benefits of the conversion of research reactors to use low enriched uranium a process that requires substantial funding and, in some cases, the development of technological

  5. Global trends on reef fishes' ecology of fear: Flight initiation distance for conservation.

    Science.gov (United States)

    Nunes, José Anchieta C C; Costa, Yuri; Blumstein, Daniel T; Leduc, Antoine O H C; Dorea, Antônio C; Benevides, Larissa J; Sampaio, Cláudio L S; Barros, Francisco

    2018-05-01

    Escape behaviors have a great potential as an indicator of the efficacy of management. For instance, the degree of fear perceived by fishes targeted by fisheries is frequently higher in unprotected marine areas than in areas where some protection is provided. We systematically reviewed the literature on how fear, which we define as variation in escape behavior, was quantified in reef fishes. In the past 25 years, a total of 33 studies were identified, many of which were published within the last five years and nearly 40% of those (n = 13) focused on Indo-Pacific reefs, showing that there are still many geographical gaps. While eleven escape metrics were identified to evaluate fish escape, flight initiation distance (FID) was the most commonly employed (n = 23). FID was used to study different questions of applied and theoretical ecology, which involved 14 reef fish families. We also used a formal meta-analysis to investigate the effects of fishing by comparing FID inside and outside marine protected areas. Fishes outside MPAs had increased FID compared to those inside MPAs. The Labridae family had a significantly higher effect sizes than Acanthuridae and Epinephelidae, suggesting that fishes in this family may be indicators of effective MPAs using FID. We conclude that protocols aimed to quantify fear in fishes, which provide accurate assessments of fishing effects on fish escape behavior, will help gauge the compliance of marine protected areas. Copyright © 2018 Elsevier Ltd. All rights reserved.

  6. Modeling Global Water Use for the 21st Century: Water Futures and Solutions (WFaS) Initiative and Its Approaches

    Science.gov (United States)

    Wada, Y.; Florke, M.; Hanasaki, N.; Eisner, S.; Fischer, G.; Tramberend, S.; Satoh, Y.; van Vliet, M. T. H.; Yillia, P.; Ringler, C.; hide

    2016-01-01

    To sustain growing food demand and increasing standard of living, global water use increased by nearly 6 times during the last 100 years, and continues to grow. As water demands get closer and closer to the water availability in many regions, each drop of water becomes increasingly valuable and water must be managed more efficiently and intensively. However, soaring water use worsens water scarcity conditions already prevalent in semi-arid and arid regions, increasing uncertainty for sustainable food production and economic development. Planning for future development and investments requires that we prepare water projections for the future. However, estimations are complicated because the future of the world's waters will be influenced by a combination of environmental, social, economic, and political factors, and there is only limited knowledge and data available about freshwater resources and how they are being used. The Water Futures and Solutions (WFaS) initiative coordinates its work with other ongoing scenario efforts for the sake of establishing a consistent set of new global water scenarios based on the shared socio-economic pathways (SSPs) and the representative concentration pathways (RCPs). The WFaS "fast track" assessment uses three global water models, namely H08, PCR-GLOBWB, and WaterGAP. This study assesses the state of the art for estimating and projecting water use regionally and globally in a consistent manner. It provides an overview of different approaches, the uncertainty, strengths and weaknesses of the various estimation methods, types of management and policy decisions for which the current estimation methods are useful. We also discuss additional information most needed to be able to improve water use estimates and be able to assess a greater range of management options across the water-energy-climate nexus.

  7. AN INITIATIVE FOR CONSTRUCTION OF NEW-GENERATION LUNAR GLOBAL CONTROL NETWORK USING MULTI-MISSION DATA

    Directory of Open Access Journals (Sweden)

    K. Di

    2017-07-01

    Full Text Available A lunar global control network provides geodetic datum and control points for mapping of the lunar surface. The widely used Unified Lunar Control Network 2005 (ULCN2005 was built based on a combined photogrammetric solution of Clementine images acquired in 1994 and earlier photographic data. In this research, we propose an initiative for construction of a new-generation lunar global control network using multi-mission data newly acquired in the 21st century, which have much better resolution and precision than the old data acquired in the last century. The new control network will be based on a combined photogrammetric solution of an extended global image and laser altimetry network. The five lunar laser ranging retro-reflectors, which can be identified in LROC NAC images and have cm level 3D position accuracy, will be used as absolute control points in the least squares photogrammetric adjustment. Recently, a new radio total phase ranging method has been developed and used for high-precision positioning of Chang’e-3 lander; this shall offer a new absolute control point. Systematic methods and key techniques will be developed or enhanced, including rigorous and generic geometric modeling of orbital images, multi-scale feature extraction and matching among heterogeneous multi-mission remote sensing data, optimal selection of images at areas of multiple image coverages, and large-scale adjustment computation, etc. Based on the high-resolution new datasets and developed new techniques, the new generation of global control network is expected to have much higher accuracy and point density than the ULCN2005.

  8. Urban Environmental Education for Global Transformation Initiatives - Integrating Information and Communication Systems for Urban Sustainability in 2050.

    Science.gov (United States)

    Chaudhari, K.

    2017-12-01

    The Urban population of developing countries is predicted to rise from one third in 1990 to over 50% by 2025. In 1950 the world's total urban population was 734 million, of whom 448 million were living in developed countries and remaining 286 were in developing region. The total population on earth is predicted to increase by more than one billion people within the next 15 years, reaching 8.5 billion in 2030, and to increase further to 9.7 billion in 2050 and 11.2 billion by 2100. Looking at the ever increasing urbanization.In 2016, an estimated 54.5 per cent of the world's populations inhabited in urban region. By 2030, urban areas are projected to shelter 60 per cent of people worldwide and one in every three people will live in cities with at least half a million inhabitants.On the basis of these figures and other global trends, it would appear that Africa and Asia will have the highest share of world's urban growth in next 25 years, resulting consideration rise of large number of metropolitan cities and towns. Therefore issues related to urban climate change will be important for socio economic development for urban transformation through environmental sustainability.The information and communication systems plays an important role in achieving the social sustainability through environmental sustainability for urban transformation. This presentation aims to start the Global initiatives on the problem identifications in environment education for global transformation, education for socio-economic and environmental sustainability due to urbanization in 2050 to investigate problems related to social-economic risks and management issues resulting from urbanization to aid mitigation planning in globalized world and to educate scientists and local populations to form a basis for sustainable solutions in environment learning.The presentation aims to assess the potential of information and communication technology for environment education,both within different

  9. Identifying patients with severe sepsis using administrative claims: patient-level validation of the angus implementation of the international consensus conference definition of severe sepsis.

    Science.gov (United States)

    Iwashyna, Theodore J; Odden, Andrew; Rohde, Jeffrey; Bonham, Catherine; Kuhn, Latoya; Malani, Preeti; Chen, Lena; Flanders, Scott

    2014-06-01

    Severe sepsis is a common and costly problem. Although consistently defined clinically by consensus conference since 1991, there have been several different implementations of the severe sepsis definition using ICD-9-CM codes for research. We conducted a single center, patient-level validation of 1 common implementation of the severe sepsis definition, the so-called "Angus" implementation. Administrative claims for all hospitalizations for patients initially admitted to general medical services from an academic medical center in 2009-2010 were reviewed. On the basis of ICD-9-CM codes, hospitalizations were sampled for review by 3 internal medicine-trained hospitalists. Chart reviews were conducted with a structured instrument, and the gold standard was the hospitalists' summary clinical judgment on whether the patient had severe sepsis. Three thousand one hundred forty-six (13.5%) hospitalizations met ICD-9-CM criteria for severe sepsis by the Angus implementation (Angus-positive) and 20,142 (86.5%) were Angus-negative. Chart reviews were performed for 92 randomly selected Angus-positive and 19 randomly-selected Angus-negative hospitalizations. Reviewers had a κ of 0.70. The Angus implementation's positive predictive value was 70.7% [95% confidence interval (CI): 51.2%, 90.5%]. The negative predictive value was 91.5% (95% CI: 79.0%, 100%). The sensitivity was 50.4% (95% CI: 14.8%, 85.7%). Specificity was 96.3% (95% CI: 92.4%, 100%). Two alternative ICD-9-CM implementations had high positive predictive values but sensitivities of Angus implementation of the international consensus conference definition of severe sepsis offers a reasonable but imperfect approach to identifying patients with severe sepsis when compared with a gold standard of structured review of the medical chart by trained hospitalists.

  10. An international sepsis survey: a study of doctors' knowledge and perception about sepsis

    Science.gov (United States)

    Poeze, Martijn; Ramsay, Graham; Gerlach, Herwig; Rubulotta, Francesca; Levy, Mitchel

    2004-01-01

    Background To be able to diagnose and treat sepsis better it is important not only to improve the knowledge about definitions and pathophysiology, but also to gain more insight into specialists' perception of, and attitude towards, the current diagnosis and treatment of sepsis. Methods The study was conducted as a prospective, international survey by structured telephone interview. The subjects were intensive care physicians and other specialist physicians caring for intensive care unit (ICU) patients. Results The 1058 physicians who were interviewed (including 529 intensivists) agreed that sepsis is a leading cause of death on the ICU and that the incidence of sepsis is increasing, but that the symptoms of sepsis can easily be misattributed to other conditions. Physicians were concerned that this could lead to under-reporting of sepsis. Two-thirds (67%) were concerned that a common definition is lacking and 83% said it is likely that sepsis is frequently missed. Not more than 17% agreed on any one definition. Conclusion There is a general awareness about the inadequacy of the current definitions of sepsis. Physicians caring for patients with sepsis recognise the difficulty of defining and diagnosing sepsis and are aware that they miss the diagnosis frequently. PMID:15566585

  11. Sepsis

    Science.gov (United States)

    ... that may be done include: Blood differential Blood gases Kidney function tests Platelet count and fibrin degradation ... 2018, A.D.A.M., Inc. Duplication for commercial use must be authorized in writing by ADAM ...

  12. ProVac Global Initiative: a vision shaped by ten years of supporting evidence-based policy decisions.

    Science.gov (United States)

    Jauregui, Barbara; Janusz, Cara Bess; Clark, Andrew D; Sinha, Anushua; Garcia, Ana Gabriela Felix; Resch, Stephen; Toscano, Cristiana M; Sanderson, Colin; Andrus, Jon Kim

    2015-05-07

    evaluated, the availability of data, and the time frame of the decision. Decision support for new vaccine introduction in low- and middle-income countries is critical to maximizing the efficiency and impact of vaccination programs. Global technical cooperation will be required. In the future, PAHO and WHO have an opportunity to expand the reach of the ProVac philosophy, models, and methods to additional regions and countries requiring real-time support. The ProVac Global Initiative is proposed as an effective mechanism to do so. Copyright © 2015. Published by Elsevier Ltd.

  13. Optimizing Quality of Care and Patient Safety in Malaysia: The Current Global Initiatives, Gaps and Suggested Solutions.

    Science.gov (United States)

    Jarrar, Mu'taman; Abdul Rahman, Hamzah; Don, Mohammad Sobri

    2015-10-20

    Demand for health care service has significantly increased, while the quality of healthcare and patient safety has become national and international priorities. This paper aims to identify the gaps and the current initiatives for optimizing the quality of care and patient safety in Malaysia. Review of the current literature. Highly cited articles were used as the basis to retrieve and review the current initiatives for optimizing the quality of care and patient safety. The country health plan of Ministry of Health (MOH) Malaysia and the MOH Malaysia Annual Reports were reviewed. The MOH has set four strategies for optimizing quality and sustaining quality of life. The 10th Malaysia Health Plan promotes the theme "1 Care for 1 Malaysia" in order to sustain the quality of care. Despite of these efforts, the total number of complaints received by the medico-legal section of the MOH Malaysia is increasing. The current global initiatives indicted that quality performance generally belong to three main categories: patient; staffing; and working environment related factors. There is no single intervention for optimizing quality of care to maintain patient safety. Multidimensional efforts and interventions are recommended in order to optimize the quality of care and patient safety in Malaysia.

  14. Optimizing Quality of Care and Patient Safety in Malaysia: The Current Global Initiatives, Gaps and Suggested Solutions

    Science.gov (United States)

    Jarrar, Mu’taman; Rahman, Hamzah Abdul; Don, Mohammad Sobri

    2016-01-01

    Background and Objective: Demand for health care service has significantly increased, while the quality of healthcare and patient safety has become national and international priorities. This paper aims to identify the gaps and the current initiatives for optimizing the quality of care and patient safety in Malaysia. Design: Review of the current literature. Highly cited articles were used as the basis to retrieve and review the current initiatives for optimizing the quality of care and patient safety. The country health plan of Ministry of Health (MOH) Malaysia and the MOH Malaysia Annual Reports were reviewed. Results: The MOH has set four strategies for optimizing quality and sustaining quality of life. The 10th Malaysia Health Plan promotes the theme “1 Care for 1 Malaysia” in order to sustain the quality of care. Despite of these efforts, the total number of complaints received by the medico-legal section of the MOH Malaysia is increasing. The current global initiatives indicted that quality performance generally belong to three main categories: patient; staffing; and working environment related factors. Conclusions: There is no single intervention for optimizing quality of care to maintain patient safety. Multidimensional efforts and interventions are recommended in order to optimize the quality of care and patient safety in Malaysia. PMID:26755459

  15. Global baby-friendly hospital initiative monitoring data: update and discussion.

    Science.gov (United States)

    Labbok, Miriam H

    2012-08-01

    The World Health Organization (WHO)/UNICEF Baby-Friendly Hospital Initiative (BFHI) was developed to support the implementation of the Ten Steps for Successful Breastfeeding. The purpose of this study is to assess trends in the numbers facilities ever-designated "baby-friendly," to consider uptake of the new WHO/UNICEF BFHI materials, and to consider implications for future breastfeeding support. The national contacts from the 2006-2007 UNICEF BFHI update were recontacted, as were WHO and UNICEF officers worldwide, to ascertain the number of hospitals ever-designated "baby-friendly," presence of a government breastfeeding oversight committee, use of the new BFHI materials and, if yes, use of the new maternity or human immunodeficiency virus (HIV) materials. Seventy countries reporting in 2010-2011 and the updates from an additional 61 reporting in 2006-2007 (n=131, or 66% of the 198 countries) confirm that there are at least 21,328 ever-designated facilities. This is 27.5% of maternities worldwide: 8.5% of those in industrialized countries and 31% in less developed settings. In 2010, government committees were reported by 18 countries, and 34 reported using the new BFHI materials: 14 reported using the maternity care and 11 reported using the HIV materials. Rates of increase in the number of ever-certified "baby-friendly" hospitals vary by region and show some chronological correlation with trends in breastfeeding rates. Although it is not possible to attribute this increase to the BFHI alone, there is ongoing interest in Ten Steps implementation and in BFHI. The continued growth may reflect the dedication of ministries of health and national BFHI groups, as well as increasing recognition that the Ten Steps are effective quality improvement practices that increase breastfeeding and synergize with community interventions and other program efforts. With renewed interest in maternal/neonatal health, revitalization of support for Ten Steps and their effective

  16. Procalcitonin is not sufficiently reliable to be the sole marker of neonatal sepsis of nosocomial origin

    Directory of Open Access Journals (Sweden)

    Moro Serrano Manuel

    2006-05-01

    Full Text Available Abstract Background It has recently been suggested that serum procalcitonin (PCT is of value in the diagnosis of neonatal sepsis, with varying results. The aim of this prospective multicenter study was to assess the usefulness of PCT as a marker of neonatal sepsis of nosocomial origin. Methods One hundred infants aged between 4 and 28 days of life admitted to the Neonatology Services of 13 acute-care teaching hospitals in Spain over 1-year with clinical suspicion of neonatal sepsis of nosocomial origin were included in the study. Serum PCT concentrations were determined by a specific immunoluminometric assay. The reliability of PCT for the diagnosis of nosocomial neonatal sepsis at the time of suspicion of infection and at 12–24 h and 36–48 h after the onset of symptoms was calculated by receiver-operating characteristics (ROC curves. The Youden's index (sensitivity + specificity - 1 was used for determination of optimal cutoff values of the diagnostic tests in the different postnatal periods. Sensitivity, specificity, and the likelihood ratio of a positive and negative result with the 95% confidence interval (CI were calculated. Results The diagnosis of nosocomial sepsis was confirmed in 61 neonates. Serum PCT concentrations were significantly higher at initial suspicion and at 12–24 h and 36–48 h after the onset of symptoms in neonates with confirmed sepsis than in neonates with clinically suspected but not confirmed sepsis. Optimal PCT thresholds according to ROC curves were 0.59 ng/mL at the time of suspicion of sepsis (sensitivity 81.4%, specificity 80.6%; 1.34 ng/mL within 12–24 h of birth (sensitivity 73.7%, specificity 80.6%, and 0.69 ng/mL within 36–48 h of birth (sensitivity 86.5%, specificity 72.7%. Conclusion Serum PCT concentrations showed a moderate diagnostic reliability for the detection of nosocomial neonatal sepsis from the time of suspicion of infection. PCT is not sufficiently reliable to be the sole marker of

  17. Disruption of Brain-Heart Coupling in Sepsis

    NARCIS (Netherlands)

    Admiraal, Marjolein M.; Gilmore, Emily J.; Van Putten, Michel J.A.M.; Zaveri, Hitten P.; Hirsch, Lawrence J.; Gaspard, Nicolas

    2017-01-01

    Purpose: To investigate heart rate and EEG variability and their coupling in patients with sepsis and determine their relationship to sepsis severity and severity of sepsis-Associated brain dysfunction. Methods: Fifty-Two patients with sepsis were prospectively identified, categorized as comatose (N

  18. Is hypertriglyceridemia a prognostic factor in sepsis?

    Directory of Open Access Journals (Sweden)

    Cetinkaya A

    2014-02-01

    Full Text Available Ali Cetinkaya,1 Abdulsamet Erden,1 Deniz Avci,1 Hatice Karagoz,1 Samet Karahan,1 Mustafa Basak,1 Kadir Bulut,1 Vedat Gencer,1 Hasan Mutlu2 1Internal Medicine Department, Kayseri Training and Research Hospital, Kayseri, Turkey; 2Medical Oncology Department, Acibadem Kayseri Hospital, Kayseri, Turkey Introduction: Sepsis and septic shock are important causes of mortality in intensive care unit patients, hence early diagnosis and therapy are important in management of their treatment. The available information on sepsis patients is not enough to recommend or to discard the routine evaluation of triglyceride (TG levels at the onset of sepsis. The aim of this study was to investigate the association of hypertriglyceridemia and clinical outcome (or mortality in patients with severe sepsis. Materials and methods: Between January 1 and December 31, 2011, a total of 84 patients with sepsis from the intensive internal care unit at the Kayseri Training and Research Hospital, Kayseri, Turkey, were investigated retrospectively. Sepsis was defined according to the American College of Chest Physicians/Society of Critical Care Medicine/European Society of Intensive Care Medicine consensus conference definitions. For each patient, survival was recorded at the end of the last day of hospitalization as dead or alive. The TG values were taken retrospectively from the records, which were performed routinely for each patient with sepsis at the time of diagnosis. TG >150 mg/dL was considered as hypertriglyceridemia. Results: The percentages of male and female patients were 44% and 56%, respectively. The mean age of patients was 71.49±11.071 years. The percentage of patients with TG values more than 150 mg/dL was 81% (25/31 in the non-survivor group and 19% (6/31 in the survivor group. There was a significant difference regarding TG values between groups (P=0.039. Discussion: It was observed in this study that patients in the intensive care unit with sepsis had high

  19. The intestinal microenvironment in sepsis.

    Science.gov (United States)

    Fay, Katherine T; Ford, Mandy L; Coopersmith, Craig M

    2017-10-01

    The gastrointestinal tract has long been hypothesized to function as "the motor" of multiple organ dysfunction syndrome. The gastrointestinal microenvironment is comprised of a single cell layer epithelia, a local immune system, and the microbiome. These three components of the intestine together play a crucial role in maintaining homeostasis during times of health. However, the gastrointestinal microenvironment is perturbed during sepsis, resulting in pathologic changes that drive both local and distant injury. In this review, we seek to characterize the relationship between the epithelium, gastrointestinal lymphocytes, and commensal bacteria during basal and pathologic conditions and how the intestinal microenvironment may be targeted for therapeutic gain in septic patients. Published by Elsevier B.V.

  20. Globalization

    DEFF Research Database (Denmark)

    Plum, Maja

    Globalization is often referred to as external to education - a state of affair facing the modern curriculum with numerous challenges. In this paper it is examined as internal to curriculum; analysed as a problematization in a Foucaultian sense. That is, as a complex of attentions, worries, ways...... of reasoning, producing curricular variables. The analysis is made through an example of early childhood curriculum in Danish Pre-school, and the way the curricular variable of the pre-school child comes into being through globalization as a problematization, carried forth by the comparative practices of PISA...

  1. Globalization

    OpenAIRE

    F. Gerard Adams

    2008-01-01

    The rapid globalization of the world economy is causing fundamental changes in patterns of trade and finance. Some economists have argued that globalization has arrived and that the world is “flat†. While the geographic scope of markets has increased, the author argues that new patterns of trade and finance are a result of the discrepancies between “old†countries and “new†. As the differences are gradually wiped out, particularly if knowledge and technology spread worldwide, the t...

  2. The effects of global health initiatives on country health systems: a review of the evidence from HIV/AIDS control.

    Science.gov (United States)

    Biesma, Regien G; Brugha, Ruairí; Harmer, Andrew; Walsh, Aisling; Spicer, Neil; Walt, Gill

    2009-07-01

    This paper reviews country-level evidence about the impact of global health initiatives (GHIs), which have had profound effects on recipient country health systems in middle and low income countries. We have selected three initiatives that account for an estimated two-thirds of external funding earmarked for HIV/AIDS control in resource-poor countries: the Global Fund to Fight AIDS, TB and Malaria, the World Bank Multi-country AIDS Program (MAP) and the US President's Emergency Plan for AIDS Relief (PEPFAR). This paper draws on 31 original country-specific and cross-country articles and reports, based on country-level fieldwork conducted between 2002 and 2007. Positive effects have included a rapid scale-up in HIV/AIDS service delivery, greater stakeholder participation, and channelling of funds to non-governmental stakeholders, mainly NGOs and faith-based bodies. Negative effects include distortion of recipient countries' national policies, notably through distracting governments from coordinated efforts to strengthen health systems and re-verticalization of planning, management and monitoring and evaluation systems. Sub-national and district studies are needed to assess the degree to which GHIs are learning to align with and build the capacities of countries to respond to HIV/AIDS; whether marginalized populations access and benefit from GHI-funded programmes; and about the cost-effectiveness and long-term sustainability of the HIV and AIDS programmes funded by the GHIs. Three multi-country sets of evaluations, which will be reporting in 2009, will answer some of these questions.

  3. Global Earth Observation System of Systems (GEOSS): Initial Actions to Enhance Data Sharing to Meet Societal Needs

    Science.gov (United States)

    Adang, T.

    2006-05-01

    Over 60 nations and 50 participating organizations are working to make the Global Earth Observation System of Systems (GEOSS) a reality. The U.S. contribution to GEOSS is the Integrated Earth Observation System (IEOS), with a vision of enabling a healthy public, economy and planet through an integrated, comprehensive, and sustained Earth observation system. The international Group on Earth Observations (GEO) and the U.S. Group on Earth Observations have developed strategic plans for both GEOSS and IEOS, respectively, and are now working the first phases of implementation. Many of these initial actions are data architecture related and are being addressed by architecture and data working groups from both organizations - the GEO Architecture and Data Committee and the USGEO Architecture and Data Management Working Group. NOAA has actively participated in both architecture groups and has taken internal action to better support GEOSS and IEOS implementation by establishing the Global Earth Observation Integrated Data Environment (GEO IDE). GEO IDE provides a "system of systems" framework for effective and efficient integration of NOAA's many quasi-independent systems, which individually address diverse mandates in such areas resource management, weather forecasting, safe navigation, disaster response, and coastal mapping among others. GEO IDE will have a services oriented architecture, allowing NOAA Line Offices to retain a high level of independence in many of their data management decisions, and encouraging innovation in pursuit of their missions. Through GEO IDE, NOAA partners (both internal and external) will participate in a well-ordered, standards-based data and information infrastructure that will allow users to easily locate, acquire, integrate and utilize NOAA data and information. This paper describes the initial progress being made by GEO and USGEO architecture and data working groups, a status report on GEO IDE development within NOAA, and an assessment of

  4. Strengthening the partnership between routine immunization and the global polio eradication initiative to achieve eradication and assure sustainability.

    Science.gov (United States)

    Abdelwahab, Jalaa; Dietz, Vance; Eggers, Rudolf; Maher, Christopher; Olaniran, Marianne; Sandhu, Hardeep; Vandelaer, Jos

    2014-11-01

    Since the launch of the Global Polio Eradication Initiative (GPEI) in 1988, the number of polio endemic countries has declined from 125 to 3 in 2013. Despite this remarkable achievement, ongoing circulation of wild poliovirus in polio-endemic countries and the increase in the number of circulating vaccine-derived poliovirus cases, especially those caused by type 2, is a cause for concern. The Polio Eradication and Endgame Strategic Plan 2013-2018 (PEESP) was developed and includes 4 objectives: detection and interruption of poliovirus transmission, containment and certification, legacy planning, and a renewed emphasis on strengthening routine immunization (RI) programs. This is critical for the phased withdrawal of oral poliovirus vaccine, beginning with the type 2 component, and the introduction of a single dose of inactivated polio vaccine into RI programs. This objective has inspired renewed consideration of how the GPEI and RI programs can mutually benefit one another, how the infrastructure from the GPEI can be used to strengthen RI, and how a strengthened RI can facilitate polio eradication. The PEESP is the first GPEI strategic plan that places strong and clear emphasis on the necessity of improving RI to achieve and sustain global polio eradication. Published by Oxford University Press on behalf of the Infectious Diseases Society of America 2014. This work is written by (a) US Government employee(s) and is in the public domain in the US.

  5. Evaluating the Credibility of Transport Processes in Simulations of Ozone Recovery using the Global Modeling Initiative Three-dimensional Model

    Science.gov (United States)

    Strahan, Susan E.; Douglass, Anne R.

    2004-01-01

    The Global Modeling Initiative (GMI) has integrated two 36-year simulations of an ozone recovery scenario with an offline chemistry and tra nsport model using two different meteorological inputs. Physically ba sed diagnostics, derived from satellite and aircraft data sets, are d escribed and then used to evaluate the realism of temperature and transport processes in the simulations. Processes evaluated include barri er formation in the subtropics and polar regions, and extratropical w ave-driven transport. Some diagnostics are especially relevant to sim ulation of lower stratospheric ozone, but most are applicable to any stratospheric simulation. The global temperature evaluation, which is relevant to gas phase chemical reactions, showed that both sets of me teorological fields have near climatological values at all latitudes and seasons at 30 hPa and below. Both simulations showed weakness in upper stratospheric wave driving. The simulation using input from a g eneral circulation model (GMI(GCM)) showed a very good residual circulation in the tropics and Northern Hemisphere. The simulation with inp ut from a data assimilation system (GMI(DAS)) performed better in the midlatitudes than it did at high latitudes. Neither simulation forms a realistic barrier at the vortex edge, leading to uncertainty in the fate of ozone-depleted vortex air. Overall, tracer transport in the offline GML(GCM) has greater fidelity throughout the stratosphere tha n it does in the GMI(DAS)

  6. Is Green Regulation Effective or a Failure: Comparative Analysis between Bangladesh Bank (BB Green Guidelines and Global Reporting Initiative Guidelines

    Directory of Open Access Journals (Sweden)

    Md. Abdul Kaium Masud

    2018-04-01

    Full Text Available Green reporting and green regulation have been commonly used in the sustainability movement. This study evaluates Bangladesh Bank’s (BB’s green regulation by considering the global reporting initiative (GRI of environmental regulation along with self-determined content to justify BB’s institutional effort in the banking sector. The analytical study has considered secondary data of all listed banks on the Dhaka Stock Exchange between 2013 to 2016. A multi-theoretical framework has been adopted in which the research is comprised of institutional, stakeholder, and legitimacy theories. Considering the analytical research, we have drawn-up a green reporting score and undertaken SWOT analysis. The results of the study have identified the narrow coverage of BB’s regulation and strategic limitations. Moreover, the findings of the study show that banking companies disclosed more green information in line with BB’s regulation. Furthermore, our analysis has found the lack of transparency of green reporting in terms of absent global reporting as well as external verification. Additionally, we have documented that BB’s regulation falls into a legitimacy threat owing to political, corporate, and social responsibility. Therefore, we concluded that for BB to overcome all possible weaknesses and threats, it should consider all possible opportunities for a holistic international reporting framework while taking into account a transparent financial sector.

  7. Official ERS technical standards: Global Lung Function Initiative reference values for the carbon monoxide transfer factor for Caucasians.

    Science.gov (United States)

    Stanojevic, Sanja; Graham, Brian L; Cooper, Brendan G; Thompson, Bruce R; Carter, Kim W; Francis, Richard W; Hall, Graham L

    2017-09-01

    There are numerous reference equations available for the single-breath transfer factor of the lung for carbon monoxide ( T  LCO ); however, it is not always clear which reference set should be used in clinical practice. The aim of the study was to develop the Global Lung Function Initiative (GLI) all-age reference values for T  LCO Data from 19 centres in 14 countries were collected to define T  LCO reference values. Similar to the GLI spirometry project, reference values were derived using the LMS (lambda, mu, sigma) method and the GAMLSS (generalised additive models for location, scale and shape) programme in R.12 660 T  LCO measurements from asymptomatic, lifetime nonsmokers were submitted; 85% of the submitted data were from Caucasians. All data were uncorrected for haemoglobin concentration. Following adjustments for elevation above sea level, gas concentration and assumptions used for calculating the anatomic dead space volume, there was a high degree of overlap between the datasets. Reference values for Caucasians aged 5-85 years were derived for T  LCO , transfer coefficient of the lung for carbon monoxide and alveolar volume.This is the largest collection of normative T  LCO data, and the first global reference values available for T  LCO . Copyright ©ERS 2017.

  8. A STUDY OF LABORATORY PROFILE OF NEONATAL SEPSIS AT NICU (SNCU, WARANGAL

    Directory of Open Access Journals (Sweden)

    Sudhakar

    2016-05-01

    Full Text Available BACKGROUND Of the 130 million babies born worldwide each year, 26 million are born in India alone. Four million babies die with in first 30 days of birth and another four million are stillborn. Newborn mortality represents 40% of all deaths of children less than five years of age. Of the four million deaths each year, nearly 98% occur in developing countries. Globally major causes of neonatal deaths are due to preterm births (28%, sepsis or pneumonia (26% and birth asphyxia (23%. Neonatal sepsis is one of the commonest causes of neonatal deaths in the developing world accounting to 30-50% of all neonatal deaths per year. The present study is intended to help the practising paediatrician to accurately diagnose the sepsis early using the specific laboratory tests and avert the progression of the disease. METHODS It is an observational cross-sectional study in NICU, Mahatma Gandhi Memorial Hospital. The study was conducted in the period November 2013 to October 2014. After admission, detailed history and thorough clinical examination was done. Required data was entered in a pre-set proforma and statistical analysis was done. Blood culture was sent. Bacterial culture and sensitivity was checked. RESULTS In proven sepsis, 50.25% were Gram-positive, 43.65% were Gram-negative and 6.09% were fungal sepsis Candida. Klebsiella (32.48% was the most common organism followed by Coagulase positive Staphylococcus (25.38% and CONS (20.81%. In this study, Gram-negative sepsis was more common in preterm and Gram-positive sepsis was more common in term neonates. Early onset sepsis was the common presentation of proven sepsis, Klebsiella was common organism causing EOS. Whereas CONS was commonest causing late onset sepsis. Among Gram-negative organisms, 58.1% and 27.9% were resistant to cefotaxime and ampicillin+sulbactam respectively. Among Gram-positive isolates, 35% and 22% were resistant to cefotaxime and ampicillin+sulbactam respectively. Klebsiella, most

  9. Northern Eurasia Future Initiative (NEFI): facing the challenges and pathways of global change in the twenty-first century

    Science.gov (United States)

    Groisman, Pavel; Shugart, Herman; Kicklighter, David; Henebry, Geoffrey; Tchebakova, Nadezhda; Maksyutov, Shamil; Monier, Erwan; Gutman, Garik; Gulev, Sergey; Qi, Jiaguo; Prishchepov, Alexander; Kukavskaya, Elena; Porfiriev, Boris; Shiklomanov, Alexander; Loboda, Tatiana; Shiklomanov, Nikolay; Nghiem, Son; Bergen, Kathleen; Albrechtová, Jana; Chen, Jiquan; Shahgedanova, Maria; Shvidenko, Anatoly; Speranskaya, Nina; Soja, Amber; de Beurs, Kirsten; Bulygina, Olga; McCarty, Jessica; Zhuang, Qianlai; Zolina, Olga

    2017-12-01

    During the past several decades, the Earth system has changed significantly, especially across Northern Eurasia. Changes in the socio-economic conditions of the larger countries in the region have also resulted in a variety of regional environmental changes that can have global consequences. The Northern Eurasia Future Initiative (NEFI) has been designed as an essential continuation of the Northern Eurasia Earth Science Partnership Initiative (NEESPI), which was launched in 2004. NEESPI sought to elucidate all aspects of ongoing environmental change, to inform societies and, thus, to better prepare societies for future developments. A key principle of NEFI is that these developments must now be secured through science-based strategies co-designed with regional decision-makers to lead their societies to prosperity in the face of environmental and institutional challenges. NEESPI scientific research, data, and models have created a solid knowledge base to support the NEFI program. This paper presents the NEFI research vision consensus based on that knowledge. It provides the reader with samples of recent accomplishments in regional studies and formulates new NEFI science questions. To address these questions, nine research foci are identified and their selections are briefly justified. These foci include warming of the Arctic; changing frequency, pattern, and intensity of extreme and inclement environmental conditions; retreat of the cryosphere; changes in terrestrial water cycles; changes in the biosphere; pressures on land use; changes in infrastructure; societal actions in response to environmental change; and quantification of Northern Eurasia's role in the global Earth system. Powerful feedbacks between the Earth and human systems in Northern Eurasia (e.g., mega-fires, droughts, depletion of the cryosphere essential for water supply, retreat of sea ice) result from past and current human activities (e.g., large-scale water withdrawals, land use, and governance

  10. Y spaces and global smooth solution of fractional Navier-Stokes equations with initial value in the critical oscillation spaces

    Science.gov (United States)

    Yang, Qixiang; Yang, Haibo

    2018-04-01

    For fractional Navier-Stokes equations and critical initial spaces X, one used to establish the well-posedness in the solution space which is contained in C (R+ , X). In this paper, for heat flow, we apply parameter Meyer wavelets to introduce Y spaces Y m , β where Y m , β is not contained in C (R+, B˙∞ 1 - 2 β , ∞). Consequently, for 1/2 global well-posedness of fractional Navier-Stokes equations with small initial data in all the critical oscillation spaces. The critical oscillation spaces may be any Besov-Morrey spaces (B˙p,q γ1 ,γ2 (Rn)) n or any Triebel-Lizorkin-Morrey spaces (F˙p,q γ1 ,γ2 (Rn)) n where 1 ≤ p , q ≤ ∞ , 0 ≤γ2 ≤ n/p, γ1 -γ2 = 1 - 2 β. These critical spaces include many known spaces. For example, Besov spaces, Sobolev spaces, Bloch spaces, Q-spaces, Morrey spaces and Triebel-Lizorkin spaces etc.

  11. The microcirculation is the motor of sepsis

    NARCIS (Netherlands)

    Ince, Can

    2005-01-01

    Regional tissue distress caused by microcirculatory dysfunction and mitochondrial depression underlies the condition in sepsis and shock where, despite correction of systemic oxygen delivery variables, regional hypoxia and oxygen extraction deficit persist. We have termed this condition

  12. Apolipoprotein M - a new biomarker in sepsis

    DEFF Research Database (Denmark)

    Christoffersen, Christina; Nielsen, Lars Bo

    2012-01-01

    Care Kumaraswamy and colleagues have investigated whether plasma apolipoprotein M (apoM) is affected during different grades of sepsis, septic shock and systemic inflammatory response syndrome. Interestingly, plasma apoM was significantly decreased in all groups of patients with a relationship...... to severity of disease. This identifies apoM as a potential new biomarker in sepsis. It also underscores the possibility that altered high-density lipoprotein in sepsis patients can affect the course of disease. Thus, since apoM is the carrier of Sphingosine-1-P (S1P), a molecule with great influence...... on vascular barrier function, the study presented raises the interest and relevance for further studies of apoM and S1P in relation to sepsis and inflammation....

  13. Thromboelastography in patients with severe sepsis

    DEFF Research Database (Denmark)

    Haase, Nicolai; Ostrowski, Sisse Rye; Wetterslev, Jørn

    2015-01-01

    PURPOSE: To investigate the association between consecutively measured thromboelastographic (TEG) tracings and outcome in patients with severe sepsis. METHODS: Multicentre prospective observational study in a subgroup of the Scandinavian Starch for Severe Sepsis/Septic Shock (6S) Trial (NCT00962156......) comparing hydroxyethyl starch (HES) 130/0.42 vs. Ringer's acetate for fluid resuscitation in severe sepsis. TEG (standard and functional fibrinogen) was measured consecutively for 5 days, and clinical data including bleeding and death was retrieved from the trial database. Statistical analyses included Cox...... bleeding [HR 2.43 (1.16-5.07)] and possibly explained the excess bleeding with HES in the 6S trial. CONCLUSIONS: In our cohort of patients with severe sepsis, progressive hypocoagulability defined by TEG variables was associated with increased risk of death and increased risk of bleeding....

  14. Interactions between Global Health Initiatives and country health systems: the case of a neglected tropical diseases control program in Mali.

    Science.gov (United States)

    Cavalli, Anna; Bamba, Sory I; Traore, Mamadou N; Boelaert, Marleen; Coulibaly, Youssouf; Polman, Katja; Pirard, Marjan; Van Dormael, Monique

    2010-08-17

    Recently, a number of Global Health Initiatives (GHI) have been created to address single disease issues in low-income countries, such as poliomyelitis, trachoma, neonatal tetanus, etc.. Empirical evidence on the effects of such GHIs on local health systems remains scarce. This paper explores positive and negative effects of the Integrated Neglected Tropical Disease (NTD) Control Initiative, consisting in mass preventive chemotherapy for five targeted NTDs, on Mali's health system where it was first implemented in 2007. Campaign processes and interactions with the health system were assessed through participant observation in two rural districts (8 health centres each). Information was complemented by interviews with key informants, website search and literature review. Preliminary results were validated during feedback sessions with Malian authorities from national, regional and district levels. We present positive and negative effects of the NTD campaign on the health system using the WHO framework of analysis based on six interrelated elements: health service delivery, health workforce, health information system, drug procurement system, financing and governance. At point of delivery, campaign-related workload severely interfered with routine care delivery which was cut down or totally interrupted during the campaign, as nurses were absent from their health centre for campaign-related activities. Only 2 of the 16 health centres, characterized by a qualified, stable and motivated workforce, were able to keep routine services running and to use the campaign as an opportunity for quality improvement. Increased workload was compensated by allowances, which significantly improved staff income, but also contributed to divert attention away from core routine activities. While the campaign increased the availability of NTD drugs at country level, parallel systems for drug supply and evaluation requested extra efforts burdening local health systems. The campaign budget

  15. Interactions between Global Health Initiatives and country health systems: the case of a neglected tropical diseases control program in Mali.

    Directory of Open Access Journals (Sweden)

    Anna Cavalli

    Full Text Available BACKGROUND: Recently, a number of Global Health Initiatives (GHI have been created to address single disease issues in low-income countries, such as poliomyelitis, trachoma, neonatal tetanus, etc.. Empirical evidence on the effects of such GHIs on local health systems remains scarce. This paper explores positive and negative effects of the Integrated Neglected Tropical Disease (NTD Control Initiative, consisting in mass preventive chemotherapy for five targeted NTDs, on Mali's health system where it was first implemented in 2007. METHODS AND FINDINGS: Campaign processes and interactions with the health system were assessed through participant observation in two rural districts (8 health centres each. Information was complemented by interviews with key informants, website search and literature review. Preliminary results were validated during feedback sessions with Malian authorities from national, regional and district levels. We present positive and negative effects of the NTD campaign on the health system using the WHO framework of analysis based on six interrelated elements: health service delivery, health workforce, health information system, drug procurement system, financing and governance. At point of delivery, campaign-related workload severely interfered with routine care delivery which was cut down or totally interrupted during the campaign, as nurses were absent from their health centre for campaign-related activities. Only 2 of the 16 health centres, characterized by a qualified, stable and motivated workforce, were able to keep routine services running and to use the campaign as an opportunity for quality improvement. Increased workload was compensated by allowances, which significantly improved staff income, but also contributed to divert attention away from core routine activities. While the campaign increased the availability of NTD drugs at country level, parallel systems for drug supply and evaluation requested extra efforts

  16. Global Reporting Initiative

    NARCIS (Netherlands)

    Planken, B.C.; Idowu, S.; Capaldi, N.; Zu, L.; Das Gupta, A.

    2013-01-01

    The role of Corporate Social Responsibility in the business world has developed from a fig leaf marketing front into an important aspect of corporate behavior over the past several years. Sustainable strategies are valued, desired and deployed more and more by relevant players in many industries all

  17. Procalcitonin ? Assisted Antibiotic Strategy in Sepsis

    OpenAIRE

    Tr?sy, Domonkos; Moln?r, Zsolt

    2017-01-01

    Sepsis is one of the biggest challenges in critical care nowadays. Defining sepsis is a difficult task on its own and its diagnosis and treatment requires well trained, devoted personnel with interdisciplinary collaboration in order to provide the patients the best chance for survival. Immediate resuscitation, early adequate antimicrobial therapy, source control and highly sophisticated organ support on the intensive care units are all inevitable necessities for successful recovery. To help f...

  18. Regulators of Intestinal Epithelial Migration in Sepsis.

    Science.gov (United States)

    Meng, Mei; Klingensmith, Nathan J; Liang, Zhe; Lyons, John D; Fay, Katherine T; Chen, Ching-Wen; Ford, Mandy L; Coopersmith, Craig M

    2018-02-08

    The gut is a continuously renewing organ, with cell proliferation, migration and death occurring rapidly under basal conditions. Since the impact of critical illness on cell movement from crypt base to villus tip is poorly understood, the purpose of this study was to determine how sepsis alters enterocyte migration. Wild type, transgenic and knockout mice were injected with 5-bromo-2'deoxyuridine (BrdU) to label cells in S phase before and after the onset of cecal ligation and puncture and were sacrificed at pre-determined endpoints to determine distance proliferating cells migrated up the crypt-villus unit. Enterocyte migration rate was decreased from 24-96 hours following sepsis. BrdU was not detectable on villi 6 days after sham laparotomy, meaning all cells had migrated the length of the gut and been exfoliated into its lumen. However, BrdU positive cells were detectable on villi 10 days after sepsis. Multiple components of gut integrity altered enterocyte migration. Sepsis decreased crypt proliferation, which further slowed enterocyte transit as mice injected with BrdU after the onset of sepsis (decreased proliferation) had slower migration than mice injected with BrdU prior to the onset of sepsis (normal proliferation). Decreasing intestinal apoptosis via gut-specific overexpression of Bcl-2 prevented sepsis-induced slowing of enterocyte migration. In contrast, worsened intestinal hyperpermeability by genetic deletion of JAM-A increased enterocyte migration. Sepsis therefore significantly slows enterocyte migration, and intestinal proliferation, apoptosis and permeability all affect migration time, which can potentially be targeted both genetically and pharmacologically.

  19. The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3).

    Science.gov (United States)

    Singer, Mervyn; Deutschman, Clifford S; Seymour, Christopher Warren; Shankar-Hari, Manu; Annane, Djillali; Bauer, Michael; Bellomo, Rinaldo; Bernard, Gordon R; Chiche, Jean-Daniel; Coopersmith, Craig M; Hotchkiss, Richard S; Levy, Mitchell M; Marshall, John C; Martin, Greg S; Opal, Steven M; Rubenfeld, Gordon D; van der Poll, Tom; Vincent, Jean-Louis; Angus, Derek C

    2016-02-23

    Definitions of sepsis and septic shock were last revised in 2001. Considerable advances have since been made into the pathobiology (changes in organ function, morphology, cell biology, biochemistry, immunology, and circulation), management, and epidemiology of sepsis, suggesting the need for reexamination. To evaluate and, as needed, update definitions for sepsis and septic shock. A task force (n = 19) with expertise in sepsis pathobiology, clinical trials, and epidemiology was convened by the Society of Critical Care Medicine and the European Society of Intensive Care Medicine. Definitions and clinical criteria were generated through meetings, Delphi processes, analysis of electronic health record databases, and voting, followed by circulation to international professional societies, requesting peer review and endorsement (by 31 societies listed in the Acknowledgment). Limitations of previous definitions included an excessive focus on inflammation, the misleading model that sepsis follows a continuum through severe sepsis to shock, and inadequate specificity and sensitivity of the systemic inflammatory response syndrome (SIRS) criteria. Multiple definitions and terminologies are currently in use for sepsis, septic shock, and organ dysfunction, leading to discrepancies in reported incidence and observed mortality. The task force concluded the term severe sepsis was redundant. Sepsis should be defined as life-threatening organ dysfunction caused by a dysregulated host response to infection. For clinical operationalization, organ dysfunction can be represented by an increase in the Sequential [Sepsis-related] Organ Failure Assessment (SOFA) score of 2 points or more, which is associated with an in-hospital mortality greater than 10%. Septic shock should be defined as a subset of sepsis in which particularly profound circulatory, cellular, and metabolic abnormalities are associated with a greater risk of mortality than with sepsis alone. Patients with septic shock

  20. Activation of M1 macrophages in sepsis-induced acute kidney injury in response to heparin-binding protein.

    Directory of Open Access Journals (Sweden)

    Li Xing

    Full Text Available In the early stage of sepsis, M1 macrophages result in the production of inflammatory mediators and AKI. Heparin-binding protein (HBP have been shown to play important roles in sepsis-induced AKI. In this study, we investigate the association of HBP with M1 macrophages in sepsis-induced AKI.Male C57BL6 mice were subjected to cecal ligation and puncture (CLP or sham surgery. Biochemical and histological renal damage was assessed. Macrophage infiltration was assessed by immunohistochemistry. RT-PCR was used to investigate the expression of heparin-binding protein (HBP, the inducible nitric oxide synthase (iNOS and arginase 1 (Arg-1 mRNAs. Western blots were performed to assay the tissue levels of HBP, tumor necrosis factor alpha (TNF-α and interleukin-6 (IL-6.High levels of HBP were obviously detected 24 h after sepsis-induced AKI. Heparin inhibited HBP expression during sepsis-induced AKI. The suppression of HBP expression by heparin injection after the establishment of sepsis-induced AKI resulted in a reduction in renal injury severity accompanied with a significant repression of M1 macrophage activation and expression of TNF-α and IL-6.HBP plays an important role in the initial inflammatory reaction associated with sepsis-induced AKI, presumably by activating M1 macrophages and suppressing TNF-α and IL-6 secretion.

  1. Infectious Diseases Society of America (IDSA) POSITION STATEMENT: Why IDSA Did Not Endorse the Surviving Sepsis Campaign Guidelines.

    Science.gov (United States)

    2018-05-02

    IDSA did not endorse the 2016 Surviving Sepsis Campaign Guidelines despite being represented in the working group that drafted the guidelines document. Leadership from the IDSA, the Surviving Sepsis Campaign Guidelines, and the Society of Critical Care Medicine had numerous amicable discussions primarily regarding the bolded, rated guidelines recommendations. Our societies had different perspectives, however, regarding the interpretation of the major studies that informed the guidelines' recommendations, thus leading us to different conclusions and different perspectives on the recommendations. IDSA consequently elected not to endorse the guidelines. IDSA nonetheless hopes to be able to continue collaborating with the Surviving Sepsis Campaign and the Society of Critical Care Medicine to resolve our differences and to develop further strategies together to prevent sepsis and septic shock as well as reduce death and disability from these conditions both nationally and globally.

  2. A case study in intra-abdominal sepsis.

    Science.gov (United States)

    Paul, Jasmeet S; Ridolfi, Timothy J

    2012-12-01

    Intra-abdominal infections are a common problem for the general surgeon and major sources of morbidity and mortality in the intensive care unit. Some of these patients present with peritonitis that can rapidly progress to septic shock. The basic principles of care include prompt resuscitation, antibiotics, and source control. This article will use a detailed case study to outline the management of a patient with severe intra-abdominal infection from diverticulitis from initial resuscitation to reconstruction. Components of the Surviving Sepsis Campaign as they pertain to surgical patients are discussed and updated, and the concept of damage control general surgery is applied. Copyright © 2012. Published by Elsevier Inc.

  3. A prospective treatment for sepsis

    Directory of Open Access Journals (Sweden)

    Shahidi Bonjar MR

    2015-05-01

    Full Text Available Mohammad Rashid Shahidi Bonjar,1 Leyla Shahidi Bonjar2 1School of Dentistry, 2College of Pharmacy, Kerman University of Medical Sciences, Kerman, Iran Abstract: The present paper proposes a prospective auxiliary treatment for sepsis. There exists no record in the published media on the subject. As an auxiliary therapy, efficacious extracorporeal removal of sepsis-causing bacterial antigens and their toxins (BATs from the blood of septic patients is discussed. The principal component to this approach is a bacterial polyvalent antibody-column (BPVAC, which selectively traps wide spectrum of BATs from blood in an extracorporeal circuit, and detoxified blood returns back to the patient’s body. BPVAC treatment would be a device of targeted medicine. Detoxification is performed under supervision of trained personnel using simple blood-circulating machines in which blood circulates from the patient to BPVAC and back to the patient aseptically. BPVACs’ reactive sites consist of carbon nanotubes on which a vast spectra of polyvalent BATs-antibodies are bond to. The devise acts as a biological filter that selectively immobilizes harmful BATs from intoxicated blood; however, no dialysis is involved. For effective neutralization, BPVAC provides large contact surface area with blood. BPVAC approach would have advantages of: 1 urgent neutralization of notorious BATs from blood of septic patients; 2 applicability in parallel with conventional treatments; 3 potential to minimize side effects of the malady; 4 applicability for a vast range of BATs; 5 potential to eliminate contact of BATs with internal tissues and organs; 6 tolerability by patients sensitive to antiserum injections; 7 capability for universal application; 8 affectivity when antibiotic-resistant bacteria are involved and the physician has no or limited access to appropriate antibiotics; and 10 being a single-use, disposable, and stand-alone device. Before using it for clinical trials in

  4. National and subnational HIV/AIDS coordination: are global health initiatives closing the gap between intent and practice?

    Directory of Open Access Journals (Sweden)

    Rukhadze Natia

    2010-03-01

    Full Text Available Abstract Background A coordinated response to HIV/AIDS remains one of the 'grand challenges' facing policymakers today. Global health initiatives (GHIs have the potential both to facilitate and exacerbate coordination at the national and subnational level. Evidence of the effects of GHIs on coordination is beginning to emerge but has hitherto been limited to single-country studies and broad-brush reviews. To date, no study has provided a focused synthesis of the effects of GHIs on national and subnational health systems across multiple countries. To address this deficit, we review primary data from seven country studies on the effects of three GHIs on coordination of HIV/AIDS programmes: the Global Fund to Fight AIDS, Tuberculosis and Malaria, the President's Emergency Plan for AIDS Relief (PEPFAR, and the World Bank's HIV/AIDS programmes including the Multi-country AIDS Programme (MAP. Methods In-depth interviews were conducted at national and subnational levels (179 and 218 respectively in seven countries in Europe, Asia, Africa and South America, between 2006 and 2008. Studies explored the development and functioning of national and subnational HIV coordination structures, and the extent to which coordination efforts around HIV/AIDS are aligned with and strengthen country health systems. Results Positive effects of GHIs included the creation of opportunities for multisectoral participation, greater political commitment and increased transparency among most partners. However, the quality of participation was often limited, and some GHIs bypassed coordination mechanisms, especially at the subnational level, weakening their effectiveness. Conclusions The paper identifies residual national and subnational obstacles to effective coordination and optimal use of funds by focal GHIs, which these GHIs, other donors and country partners need to collectively address.

  5. Impact of the Global Food Safety Initiative on Food Safety Worldwide: Statistical Analysis of a Survey of International Food Processors.

    Science.gov (United States)

    Crandall, Philip G; Mauromoustakos, Andy; O'Bryan, Corliss A; Thompson, Kevin C; Yiannas, Frank; Bridges, Kerry; Francois, Catherine

    2017-10-01

    In 2000, the Consumer Goods Forum established the Global Food Safety Initiative (GFSI) to increase the safety of the world's food supply and to harmonize food safety regulations worldwide. In 2013, a university research team in conjunction with Diversey Consulting (Sealed Air), the Consumer Goods Forum, and officers of GFSI solicited input from more than 15,000 GFSI-certified food producers worldwide to determine whether GFSI certification had lived up to these expectations. A total of 828 usable questionnaires were analyzed, representing about 2,300 food manufacturing facilities and food suppliers in 21 countries, mainly across Western Europe, Australia, New Zealand, and North America. Nearly 90% of these certified suppliers perceived GFSI as being beneficial for addressing their food safety concerns, and respondents were eight times more likely to repeat the certification process knowing what it entailed. Nearly three-quarters (74%) of these food manufacturers would choose to go through the certification process again even if certification were not required by one of their current retail customers. Important drivers for becoming GFSI certified included continuing to do business with an existing customer, starting to do business with new customer, reducing the number of third-party food safety audits, and continuing improvement of their food safety program. Although 50% or fewer respondents stated that they saw actual increases in sales, customers, suppliers, or employees, significantly more companies agreed than disagreed that there was an increase in these key performance indicators in the year following GFSI certification. A majority of respondents (81%) agreed that there was a substantial investment in staff time since certification, and 50% agreed there was a significant capital investment. This survey is the largest and most representative of global food manufacturers conducted to date.

  6. Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016

    NARCIS (Netherlands)

    Rhodes, Andrew; Evans, Laura E.; Alhazzani, Waleed; Levy, Mitchell M.; Antonelli, Massimo; Ferrer, Ricard; Kumar, Anand; Sevransky, Jonathan E.; Sprung, Charles L.; Nunnally, Mark E.; Rochwerg, Bram; Rubenfeld, Gordon D.; Angus, Derek C.; Annane, Djillali; Beale, Richard J.; Bellinghan, Geoffrey J.; Bernard, Gordon R.; Chiche, Jean-Daniel; Coopersmith, Craig; de Backer, Daniel P.; French, Craig J.; Fujishima, Seitaro; Gerlach, Herwig; Hidalgo, Jorge Luis; Hollenberg, Steven M.; Jones, Alan E.; Karnad, Dilip R.; Kleinpell, Ruth M.; Koh, Younsuk; Lisboa, Thiago Costa; Machado, Flavia R.; Marini, John J.; Marshall, John C.; Mazuski, John E.; McIntyre, Lauralyn A.; McLean, Anthony S.; Mehta, Sangeeta; Moreno, Rui P.; Myburgh, John; Navalesi, Paolo; Nishida, Osamu; Osborn, Tiffany M.; Perner, Anders; Plunkett, Colleen M.; Ranieri, Marco; Schorr, Christa A.; Seckel, Maureen A.; Seymour, Christopher W.; Shieh, Lisa; Shukri, Khalid A.; Simpson, Steven Q.; Singer, Mervyn; Thompson, B. Taylor; Townsend, Sean R.; van der Poll, Thomas; Vincent, Jean-Louis; Wiersinga, W. Joost; Zimmerman, Janice L.; Dellinger, R. Phillip

    2017-01-01

    To provide an update to "Surviving Sepsis Campaign Guidelines for Management of Sepsis and Septic Shock: 2012". A consensus committee of 55 international experts representing 25 international organizations was convened. Nominal groups were assembled at key international meetings (for those committee

  7. Methods for reducing sepsis mortality in emergency departments and inpatient units.

    Science.gov (United States)

    Doerfler, Martin E; D'Angelo, John; Jacobsen, Diane; Jarrett, Mark P; Kabcenell, Andrea I; Masick, Kevin D; Parmentier, Darlene; Nelson, Karen L; Stier, Lori

    2015-05-01

    As part of a zero-tolerance approach to preventable deaths, North Shore-LIJ Health System (North Shore-LIJ) leadership prioritized a major patient safety initiative to reduce sepsis mortality in 2009 across 10 acute care hospitals (an 11th joined later). At baseline (2008), approximately 3,500 patients were discharged with a diagnosis of sepsis, which ranked as the top All Patient Refined Diagnosis-Related Group by number of deaths (N = 883). Initially, the focus was sepsis recognition and treatment in the emergency departments (EDs). North Shore-LIJ, the 14th largest health care system in the United States, cares for individuals at every stage of life at 19 acute care and specialty hospitals and more than 400 outpatient physician practice sites throughout New York City and the greater New York metropolitan area. The health system launched a strategic partnership with the Institute for Healthcare Improvement (IHI) in August 2011 to accelerate the pace of sepsis improvement. Throughout the course of the initiative, North Shore-LIJ collaborated with many local, state, national, and international organizations to test innovative ideas, share evidence-based best practices, and, more recently, to raise public awareness. North Shore-LIJ reduced overall sepsis mortality by approximately 50% in a six-year period (2008-2013; sustained through 2014) and increased compliance with sepsis resuscitation bundle elements in the EDs and inpatient units in the 11 acute care hospitals. Improvements were achieved by engaging leadership; fostering interprofessional collaboration, collaborating with other leading health care organizations; and developing meaningful, real-time metrics for all levels of staff.

  8. 5-azacytidine promotes microspore embryogenesis initiation by decreasing global DNA methylation, but prevents subsequent embryo development in rapeseed and barley

    Directory of Open Access Journals (Sweden)

    María-Teresa eSolís

    2015-06-01

    Full Text Available Microspores are reprogrammed by stress in vitro towards embryogenesis. This process is an important tool in breeding to obtain double-haploid plants. DNA methylation is a major epigenetic modification that changes in differentiation and proliferation. We have shown changes in global DNA methylation during microspore reprogramming. 5-Azacytidine (AzaC cannot be methylated and leads to DNA hypomethylation. AzaC is a useful demethylating agent to study DNA dynamics, with a potential application in microspore embryogenesis. This work analyzes the effects of short and long AzaC treatments on microspore embryogenesis initiation and progression in two species, the dicot Brassica napus and the monocot Hordeum vulgare. This involved the quantitative analyses of proembryo and embryo production, the quantification of DNA methylation, 5mdC immunofluorescence and confocal microscopy, and the analysis of chromatin organization (condensation/ decondensation by light and electron microscopy. Four days of AzaC treatments (2.5 µM increased embryo induction, response associated with a decrease of DNA methylation, modified 5mdC and heterochromatin patterns compared to untreated embryos. By contrast, longer AzaC treatments diminished embryo production. Similar effects were found in both species, indicating that DNA demethylation promotes microspore reprogramming, totipotency acquisition and embryogenesis initiation, while embryo differentiation requires de novo DNA methylation and is prevented by AzaC. This suggests a role for DNA methylation in the repression of microspore reprogramming and possibly totipotency acquisition.Results provide new insights into the role of epigenetic modifications in microspore embryogenesis and suggest a potential benefit of inhibitors, such as AzaC, to improve the process efficiency in biotechnology and breeding programs.

  9. Global threat reduction initiative efforts to address transportation challenges associated with the recovery of disused radioactive sealed sources - 10460

    International Nuclear Information System (INIS)

    Whitworth, Julie; Abeyta, Cristy L.; Griffin, Justin M.; Matzke, James L.; Pearson, Michael W.; Cuthbertson, Abigail; Rawl, Richard; Singley, Paul

    2010-01-01

    Proper disposition of disused radioactive sources is essential for their safe and secure management and necessary to preclude their use in malicious activities. Without affordable, timely transportation options, disused sealed sources remain in storage at hundreds of sites throughout the country and around the world. While secure storage is a temporary measure, the longer sources remain disused or unwanted the chances increase that they will become unsecured or abandoned. The Global Threat Reduction Initiative's Off-Site Source Recovery Project (GTRIlOSRP), recovers thousands of disused and unwanted sealed sources annually as part of GTRl's larger mission to reduce and protect high risk nuclear and radiological materials located at civilian sites worldwide. Faced with decreasing availability of certified transportation containers to support movement of disused and unwanted neutron- and beta/gamma-emitting radioactive sealed sources, GTRIlOSRP has initiated actions to ensure the continued success of the project in timely recovery and management of sealed radioactive sources. Efforts described in this paper to enhance transportation capabilities include: (sm b ullet) Addition of authorized content to existing and planned Type B containers to support the movement of non-special form and other Type B-quantity sealed sources; (sm b ullet) Procurement of vendor services for the design, development, testing and certification of a new Type B container to support transportation of irradiators, teletherapy heads or sources removed from these devices using remote handling capabilities such as the IAEA portable hot cell facility; (sm b ullet) Expansion of shielded Type A container inventory for transportation of gamma-emitting sources in activity ranges requiring use of shielding for conformity with transportation requirements; (sm b ullet) Approval of the S300 Type A fissile container for transport of Pu-239 sealed sources internationally; (sm b ullet) Technology transfer of

  10. MicroRNA-155 attenuates late sepsis-induced cardiac dysfunction through JNK and β-arrestin 2.

    Science.gov (United States)

    Zhou, Yu; Song, Yan; Shaikh, Zahir; Li, Hui; Zhang, Haiju; Caudle, Yi; Zheng, Shouhua; Yan, Hui; Hu, Dan; Stuart, Charles; Yin, Deling

    2017-07-18

    Cardiac dysfunction is correlated with detrimental prognosis of sepsis and contributes to a high risk of mortality. After an initial hyperinflammatory reaction, most patients enter a protracted state of immunosuppression (late sepsis) that alters both innate and adaptive immunity. The changes of cardiac function in late sepsis are not yet known. MicroRNA-155 (miR-155) is previously found to play important roles in both regulations of immune activation and cardiac function. In this study, C57BL/6 mice were operated to develop into early and late sepsis phases, and miR-155 mimic was injected through the tail vein 48 h after cecal ligation and puncture (CLP). The effect of miR-155 on CLP-induced cardiac dysfunction was explored in late sepsis. We found that increased expression of miR-155 in the myocardium protected against cardiac dysfunction in late sepsis evidenced by attenuating sepsis-reduced cardiac output and enhancing left ventricular systolic function. We also observed that miR-155 markedly reduced the infiltration of macrophages and neutrophils into the myocardium and attenuated the inflammatory response via suppression of JNK signaling pathway. Moreover, overexpression of β-arrestin 2 (Arrb2) exacerbated the mice mortality and immunosuppression in late sepsis. Furthermore, transfection of miR-155 mimic reduced Arrb2 expression, and then restored immunocompetence and improved survival in late septic mice. We conclude that increased miR-155 expression through systemic administration of miR-155 mimic attenuates cardiac dysfunction and improves late sepsis survival by targeting JNK associated inflammatory signaling and Arrb2 mediated immunosuppression.

  11. Much Ado About the New Definitions of Sepsis

    Directory of Open Access Journals (Sweden)

    Copotoiu Sanda-Maria

    2016-04-01

    Full Text Available Following the publication of the new definition of sepsis (Sepsis-3, a plethora of articles have been published in medical journals. Recognizing the epidemiological importance of the previous definitions, first issued in 1992 (Sepsis-1, and subsequently revised in 2001 (Sepsis-2, the most recent opinion emphasizes the failure “to provide adequate groups of patients with homogenous aetiologies, presentations and outcomes”, and blamed one of the causes “for the failure of several randomized controlled trials (RCTs, that tested the efficacy of adjuvant sepsis therapies”. This review summarizes the recent advances in sepsis definition.

  12. Increased plasma zonulin in patients with sepsis.

    Science.gov (United States)

    Klaus, Daniel A; Motal, Michael C; Burger-Klepp, Ursula; Marschalek, Corinna; Schmidt, Elisabeth M; Lebherz-Eichinger, Diana; Krenn, Claus G; Roth, Georg A

    2013-01-01

    Zonulin is a eukaryotic protein structurally similar to Vibrio cholerae's zonula occludens toxin. It plays an important role in the opening of small intestine tight junctions. The loss of gut wall integrity during sepsis might be pivotal and has been described in various experimental as well as human studies. Increased levels of zonulin could be demonstrated in diseases associated with increased intestinal inflammation, such as celiac disease and type 1 diabetes. We therefore investigated the role of plasma levels of zonulin in patients with sepsis as a non-invasive marker of gut wall integrity. Plasma level of zonulin was measured in 25 patients with sepsis, severe sepsis or septic shock according to ACCP/SCCM criteria at the first day of diagnosed sepsis. 18 non-septic post-surgical ICU-patients and 20 healthy volunteers served as control. Plasma levels were determined by using commercially available ELISA kit. Data are given as median and interquartile range (IQR). Significantly higher plasma concentration of zonulin were found in the sepsis group: 6.61 ng/mL (IQR 3.51-9.46), as compared to the to the post-surgical control group: 3.40 ng/mL (IQR 2.14-5.70) (P = 0.025), as well as to the healthy group: 3.55 ng/mL (IQR 3.14-4.14) (P = 0.008). We were able demonstrate elevated levels of plasma zonulin, a potential marker of intestinal permeability in septic patients. Increased zonulin may serve as an additional mechanism for the observed increased intestinal permeability during sepsis and SIRS.

  13. The global pertussis initiative: Meeting report from the Regional Latin America Meeting, Costa Rica, 5-6 December, 2008.

    Science.gov (United States)

    Ulloa-Gutierrez, Rolando; Hozbor, Daniela; Avila-Aguero, Maria L; Caro, Jaime; Wirsing von König, Carl-Heinz; Tan, Tina; Plotkin, Stanley

    2010-11-01

    Pertussis remains endemic across the world, with an estimated 279,000 deaths in 2002, the majority in infants under 1 year of age. Worldwide epidemiologic data indicates increasing infection rates in older children and adults, which act as a source of infection to young infants. The Global Pertussis Initiative (GPI) is an expert scientific forum, which has published consensus recommendations for the monitoring, prevention, and treatment of the disease. This paper reports the proceedings of a regional meeting, held in Costa Rica in December 2008. The meeting gathered information on regional epidemiological, diagnostic capabilities and the ability to introduce GPI recommended vaccine strategies in Latin America. The capacity of Latin American countries to conduct vaccination programs is high and there is considerable government support. Whole-cell pertussis vaccines are used across Latin America, which appear to be quite effective. A 4-dose schedule is typically used (2, 4, 6, and 18 months), and a booster given at 4 to 6 years of age, with coverage often above 90%, but with regions of low coverage due to political and geographical difficulties. Adequate surveillance is lacking in many countries, giving insufficient data to guide vaccination policy. Improvements are being made, with countries such as Costa Rica, Panama, and Argentina introducing polymerase chain reaction (PCR) diagnosis. Those countries that do not currently use a preschool booster should launch one. Implementing vaccination programs in adolescents and/or adults to reduce exposure to infants would be beneficial and possible in most countries, given their current infrastructure.

  14. An Investigation of Global Reporting Initiative Performance Indicators in Corporate Sustainability Reports: Greek, Italian and Spanish Evidence

    Directory of Open Access Journals (Sweden)

    Lara Tarquinio

    2018-03-01

    Full Text Available This study has two main purposes. First, it explores the performance indicators disclosed in the Global Reporting Initiative (GRI-based Sustainability Reports (SRs produced by the companies of three different countries: Italy, Spain and Greece. Second, it verifies how some corporate variables, country of origin variables and “attributes” of the SRs can explain the disclosure of GRI indicators. To verify the quantity and type of the indicators disclosed, we performed a content analysis of the SRs. We use a regression trees technique to describe how the companies’ variables explain a different use of the indicators. The findings show that Spanish companies, on average, disclose the greatest number of indicators. The social indicators related to Labour are those more frequently reported in the SRs of the three countries. The least reported are social indicators related to Human Rights. The results show the central role that assurance, ROA and sector may have in classifying the disclosure level of indicators. The study contributes both theoretical and empirical literature on sustainability indicators. It also sheds further light on the determinants of the disclosure of indicators.

  15. Global gene expression analysis of canine osteosarcoma stem cells reveals a novel role for COX-2 in tumour initiation.

    Science.gov (United States)

    Pang, Lisa Y; Gatenby, Emma L; Kamida, Ayako; Whitelaw, Bruce A; Hupp, Ted R; Argyle, David J

    2014-01-01

    Osteosarcoma is the most common primary bone tumour of both children and dogs. It is an aggressive tumour in both species with a rapid clinical course leading ultimately to metastasis. In dogs and children distant metastasis occurs in >80% of individuals treated by surgery alone. Both canine and human osteosarcoma has been shown to contain a sub-population of cancer stem cells (CSCs), which may drive tumour growth, recurrence and metastasis, suggesting that naturally occurring canine osteosarcoma could act as a preclinical model for the human disease. Here we report the successful isolation of CSCs from primary canine osteosarcoma, as well as established cell lines. We show that these cells can form tumourspheres, and demonstrate relative resistance to chemotherapy. We demonstrate similar results for the human osteosarcma cell lines, U2OS and SAOS2. Utilizing the Affymetrix canine microarray, we are able to definitively show that there are significant differences in global gene expression profiles of isolated osteosarcoma stem cells and the daughter adherent cells. We identified 13,221 significant differences (p = 0.05), and significantly, COX-2 was expressed 141-fold more in CSC spheres than daughter adherent cells. To study the role of COX-2 expression in CSCs we utilized the COX-2 inhibitors meloxicam and mavacoxib. We found that COX-2 inhibition had no effect on CSC growth, or resistance to chemotherapy. However inhibition of COX-2 in daughter cells prevented sphere formation, indicating a potential significant role for COX-2 in tumour initiation.

  16. Global gene expression analysis of canine osteosarcoma stem cells reveals a novel role for COX-2 in tumour initiation.

    Directory of Open Access Journals (Sweden)

    Lisa Y Pang

    Full Text Available Osteosarcoma is the most common primary bone tumour of both children and dogs. It is an aggressive tumour in both species with a rapid clinical course leading ultimately to metastasis. In dogs and children distant metastasis occurs in >80% of individuals treated by surgery alone. Both canine and human osteosarcoma has been shown to contain a sub-population of cancer stem cells (CSCs, which may drive tumour growth, recurrence and metastasis, suggesting that naturally occurring canine osteosarcoma could act as a preclinical model for the human disease. Here we report the successful isolation of CSCs from primary canine osteosarcoma, as well as established cell lines. We show that these cells can form tumourspheres, and demonstrate relative resistance to chemotherapy. We demonstrate similar results for the human osteosarcma cell lines, U2OS and SAOS2. Utilizing the Affymetrix canine microarray, we are able to definitively show that there are significant differences in global gene expression profiles of isolated osteosarcoma stem cells and the daughter adherent cells. We identified 13,221 significant differences (p = 0.05, and significantly, COX-2 was expressed 141-fold more in CSC spheres than daughter adherent cells. To study the role of COX-2 expression in CSCs we utilized the COX-2 inhibitors meloxicam and mavacoxib. We found that COX-2 inhibition had no effect on CSC growth, or resistance to chemotherapy. However inhibition of COX-2 in daughter cells prevented sphere formation, indicating a potential significant role for COX-2 in tumour initiation.

  17. The effect of ghrelin upon the early immune response in lean and obese mice during sepsis.

    Directory of Open Access Journals (Sweden)

    Daniel Siegl

    Full Text Available It is well established that obesity-related hormones can have modulatory effects associated with the immune response. Ghrelin, a hormone mainly derived from endocrine cells of the gastric mucosa, regulates appetite, energy expenditure and body weight counteracting leptin, a hormone mainly derived from adipocytes. Additionally, receptors of both have been detected on immune cells and demonstrated an immune regulatory function during sepsis.In the present study, the effect of peripheral ghrelin administration on early immune response and survival was investigated with lean mice and mice with diet-induced obesity using cecal ligation and puncture to induce sepsis.In the obese group, we found that ghrelin treatment improved survival, ameliorated hypothermia, and increased hyperleptinemia as compared to the lean controls. We also observed that ghrelin treatment divergently regulated serum IL-1ß and TNF-α concentrations in both lean and obese septic mice. Ghrelin treatment initially decreased but later resulted in increased bacteriaemia in lean mice while having no impact upon obese mice. Similarly, ghrelin treatment increased early neutrophil oxidative burst while causing a decrease 48 hours after sepsis inducement.In conclusion, as the immune response to sepsis temporally changes, ghrelin treatment differentially mediates this response. Specifically, we observed that ghrelin conferred protective effects during the early phase of sepsis, but during the later phase deteriorated immune response and outcome. These adverse effects were more pronounced upon lean mice as compared to obese mice.

  18. Nível de disclosure nos relatórios de sustentabilidade em conformidade com o Global Reporting Initiative (GRI = Level of disclosure in sustainability reports in compliance with Global Reporting Initiative (GRI

    Directory of Open Access Journals (Sweden)

    Daniela Di Domenico

    2017-12-01

    Full Text Available O objetivo do artigo é analisar o nível de disclosure nos relatórios de sustentabilidade em conformidade com o Global Reporting Initiative (GRI nas empresas listadas na BM&FBovespa. Nesse sentido, realizou-se pesquisa descritiva com procedimentos de coleta documental e abordagem quantitativa. A amostra analisada ficou composta por 93 empresas listadas na BM&FBovespa, que divulgaram o relatório de sustentabilidade no ano de 2014 em conformidade com o modelo GRI. Os resultados mostram que à medida em que há maior complexidade nas informações, que compreendem os grupos de indicadores apresentados nos relatórios de sustentabilidade, reduz o nível de evidenciação pelas empresas. Com relação ao nível de evidenciação, percebe-se que o maior grupo de empresas se concentra com baixa evidenciação. Representa cerca de 30% das empresas analisadas, atendendo até 50 itens dos 150 que o relatório propõe. Quanto ao setor econômico, utilidade pública apresentou maior nível de evidenciação nos relatórios de sustentabilidade em conformidade com o modelo GRI. Conclui-se que, embora tenha havido aumento na divulgação dos relatórios de sustentabilidade, as empresas ainda carecem de adaptação para atender aos indicadores do GRI, melhorando a qualidade dos relatórios divulgados e elevando a transparência aos diversos públicos de interesse. The objective of the study is to analyze the level of disclosure in the sustainability reports in compliance with the Global Reporting Initiative (GRI in the companies listed on the BM&FBovespa. In this sense, a descriptive research was carried out with procedures of documentary collection and quantitative approach. The sample analyzed was composed of 93 companies listed on the BM&FBovespa, which published the sustainability report in 2014 in compliance with the GRI model. The results show that to the extent that there is more complexity in the information that comprises the groups of indicators

  19. Development of global health education at Johns Hopkins University School of Medicine: a student-driven initiative

    Directory of Open Access Journals (Sweden)

    Dane Moran

    2015-07-01

    Full Text Available Global health is increasingly present in the formal educational curricula of medical schools across North America. In 2008, students at Johns Hopkins University School of Medicine (JHUSOM perceived a lack of structured global health education in the existing curriculum and began working with the administration to enhance global health learning opportunities, particularly in resource-poor settings. Key events in the development of global health education have included the introduction of a global health intersession mandatory for all first-year students; required pre-departure ethics training for students before all international electives; and the development of a clinical global health elective (Global Health Leadership Program, GHLP. The main challenges to improving global health education for medical students have included securing funding, obtaining institutional support, and developing an interprofessional program that benefits from the resources of the Schools of Medicine, Public Health, and Nursing. Strategies used included objectively demonstrating the need for and barriers to more structured global health experiences; obtaining guidance and modifying existing resources from other institutions and relevant educational websites; and harnessing institution-specific strengths including the large Johns Hopkins global research footprint and existing interprofessional collaborations across the three schools. The Johns Hopkins experience demonstrates that with a supportive administration, students can play an important and effective role in improving global health educational opportunities. The strategies we used may be informative for other students and educators looking to implement global health programs at their own institutions.

  20. Post–Acute Care Use and Hospital Readmission after Sepsis

    Science.gov (United States)

    Jones, Tiffanie K.; Fuchs, Barry D.; Small, Dylan S.; Halpern, Scott D.; Hanish, Asaf; Umscheid, Craig A.; Baillie, Charles A.; Kerlin, Meeta Prasad; Gaieski, David F.

    2015-01-01

    Rationale: The epidemiology of post–acute care use and hospital readmission after sepsis remains largely unknown. Objectives: To examine the rate of post–acute care use and hospital readmission after sepsis and to examine risk factors and outcomes for hospital readmissions after sepsis. Methods: In an observational cohort study conducted in an academic health care system (2010–2012), we compared post–acute care use at discharge and hospital readmission after 3,620 sepsis hospitalizations with 108,958 nonsepsis hospitalizations. We used three validated, claims-based approaches to identify sepsis and severe sepsis. Measurements and Main Results: Post–acute care use at discharge was more likely after sepsis, driven by skilled care facility placement (35.4% after sepsis vs. 15.8%; P Readmission rates at 7, 30, and 90 days were higher postsepsis (P readmission risk was present regardless of sepsis severity (27.3% after sepsis and 26.0–26.2% after severe sepsis). After controlling for presepsis characteristics, the readmission risk was found to be 1.51 times greater (95% CI, 1.38–1.66) than nonsepsis hospitalizations. Readmissions after sepsis were more likely to result in death or transition to hospice care (6.1% vs. 13.3% after sepsis; P readmissions after sepsis hospitalizations included age, malignancy diagnosis, hospitalizations in the year prior to the index hospitalization, nonelective index admission type, one or more procedures during the index hospitalization, and low hemoglobin and high red cell distribution width at discharge. Conclusions: Post–acute care use and hospital readmissions were common after sepsis. The increased readmission risk after sepsis was observed regardless of sepsis severity and was associated with adverse readmission outcomes. PMID:25751120

  1. Plasminogen activators in inflammation and sepsis.

    Science.gov (United States)

    Pechlaner, Ch

    2002-01-01

    Mortality of severe sepsis remains at 40% to 50%. Intensive efforts over the past two decades have only marginally improved outcome. Improving outcome in sepsis depends on understanding its pathophysiology, which involves triggers, responses of the organism, and dysfunction. Stress, injury, or infection trigger host responses, including local and systemic orchestrated mechanisms. Dysfunction and outcome depend on both trigger and response. Blood coagulation, inflammation, immunity, and fibrinolysis are critical components of the organism's responses. Understanding their role in sepsis pathophysiology is the key to effective treatment. Relevant studies were identified by a systematic literature search, complemented by manual search of individual citations. Using PubMed, 'sepsis' yields more than 62,000 references, 'plasminogen activators' more than 21,000. The selection of citations was guided by preference for reviews that expand important threads of argumentation. Single original studies were included when relevant to critical points. This analytical review describes the essential elements of pathophysiology and the current status of sepsis treatment. Based on this context, an emerging therapeutic option will be discussed: plasminogen activators.

  2. Determination the bacterial etiologies for sepsis in premature newborns admitted in neonatal intensive care unit

    Directory of Open Access Journals (Sweden)

    Nastaran Khosravi

    2017-02-01

    Full Text Available Background: Bacterial sepsis is a main cause of mortality and morbidity especially in preterm newborns. The aim of this study was to search the bacterial etiologies of neonatal sepsis in NICU admitted preterm neonates. Methods: A descriptive cross-sectional study had done in NICU of Ali Asghar Hospital, Tehran, Iran from March 2007 to March 2009. Seventy septicemic preterm newborns (<37 weeks were studied. At admission day, for blood culture, 1-2 ml of venous blood was drawn after swabbing the venipuncture site with alcohol. After centrifugation of blood samples, deposits were cultured on sheep blood agar and incubated in a candle jar at 37 °C for 48 h and followed by subcultured. Isolates were identified using standard techniques (Nima pouyesh, Iran. Type of isolated bacterial organisms determined. Its correlation with gestational age, birth weight, premature rupture of membranes (PROM and other variables determined we used the nonparametric two independent sample test, Mann-Whitney U test. Chi-square values (CI 95%, P< 0.05 were calculated for all categorical variables. P-value less than 0.05 considered statistically significant. Results: Of 70 studied septicemic preterm cases, 17 (10.6% cases had positive blood culture. Overall gram-negative organisms were more frequent than gram-positive organisms, Klebsiella (K. pneumoniae, Escherichia (E. coli and Staphylococcus (S. aureus organisms were the 3 common causes of bacterial sepsis in studied cases. Early onset sepsis produced by K. pneumonia (40%, E. coli (20% and S. aureus (20%. K. pneumonia, E. coli, S. aureus had equal incidence in late onset sepsis (26.8%. K. pneumonia was more frequent in early onset sepsis (P= 0.05, and in low birth weight (< 1500 g neonates (P= 0.005, and PROM (P= 0.05. Conclusion: Three causes for sepsis in premature newborns were determined: K. pneumonia, E. coli and S. aureus, it is so important for initial antibiotic treatment in admission day. Low birth weight

  3. Sepsis: at-risk patients, clinical manifestations and management

    African Journals Online (AJOL)

    management of sepsis has resulted in a remarkable increase of new knowledge on the ... As sepsis progresses to septic shock, the risk of dying increases substantially. Where .... altered mental state, thrombocytopenia, raised serum lactate ...

  4. Prevalence and factors associated with neonatal sepsis among ...

    African Journals Online (AJOL)

    TOSHIBA

    Relationship between outcome variable and exposure variable was done using Chi ... A recent study in Ethiopia indicates that neonatal sepsis in the major newborn ... Neonatal sepsis was defined as infection that had occurred during the.

  5. Attenuation of sepsis-induced rat liver injury by epigallocatechin ...

    African Journals Online (AJOL)

    rat model of sepsis established by cercal ligation and puncture (CLP). Methods: Male Wistar ... capacity, resulting in excessive oxidants in cells. [6]. ... Care (NIH publication no. 85-23 ..... estimates of severe sepsis in United States emergency.

  6. Soluble L-selectin levels predict survival in sepsis

    DEFF Research Database (Denmark)

    Seidelin, Jakob B; Nielsen, Ole H; Strøm, Jens

    2002-01-01

    To evaluate serum soluble L-selectin as a prognostic factor for survival in patients with sepsis.......To evaluate serum soluble L-selectin as a prognostic factor for survival in patients with sepsis....

  7. The new sepsis definition: limitations and contribution to research and diagnosis of sepsis.

    Science.gov (United States)

    Verdonk, Franck; Blet, Alice; Mebazaa, Alexandre

    2017-04-01

    Based on recent clinical, epidemiological, and pathophysiological data, a third international consensus conference was carried out to define new criteria of sepsis in February 2016. This review presents the different items of this new definition, their limitations and their contribution to research and diagnosis of sepsis, in comparison with the previous definitions. Incidence, management, and pathophysiological knowledge of sepsis have improved over the past 20 years. However, sepsis still evolves to a mortal outcome, in one case out of five, with no new recent or specific therapy showing its efficacy on the patient's prognosis. These findings have led to the development of new definition. The new definition of sepsis incorporates relevant clinical and biological criteria such as SOFA score or serum lactate levels. It no longer takes into account the items of the systemic inflammatory response syndrome, which present a lack of specificity. It also simplifies the different stages of severity by deleting the term of 'severe sepsis' and by defining septic shock as a subset of sepsis. This definition, endorsed by only two international societies of intensive care, has some limitations and so merits prospective validation at different levels.

  8. Immunotherapy in the management of sepsis.

    Science.gov (United States)

    Sikora, Janusz Piotr

    2002-01-01

    This work presents the role of Gram-negative bacteria endotoxins, pro- and anti-inflammatory cytokines and reactive oxygen species (ROS) in the complex and not fully explained pathogenesis of sepsis. The so-called "respiratory burst" of neutrophils and the antioxidant mechanisms of the host are also discussed. The work focuses on possible approaches to the management of sepsis connected with immunotherapy. Neutralization of endotoxin lipopolysaccharide (LPS), anti-tumor necrosis factor alpha (TNF-alpha) therapy with monoclonal antibodies or pentoxifylline (PTXF), as well as soluble recombinant cytokine agonists and antagonists used in clinical trials are taken into consideration. In addition, cytokine manipulation therapy, anti-adhesion techniques, glucocorticoides and antioxidant barrier interference are also described. So far there has been no immunotherapy of sepsis in children of proven clinical efficacy, which prompts an aggressive examination of the immune system aimed at affecting its function.

  9. Environmental Surveillance of Polioviruses in Rio de Janeiro, Brazil, in Support to the Activities of Global Polio Eradication Initiative.

    Science.gov (United States)

    de Oliveira Pereira, Joseane Simone; da Silva, Lidiane Rodrigues; de Meireles Nunes, Amanda; de Souza Oliveira, Silas; da Costa, Eliane Veiga; da Silva, Edson Elias

    2016-03-01

    Wild polioviruses still remain endemic in three countries (Afghanistan, Pakistan, and Nigeria) and re-emergency of wild polio has been reported in previously polio-free countries. Environmental surveillance has been used as a supplementary tool in monitoring the circulation of wild poliovirus (PVs) and/or vaccine-derived PVs even in the absence of acute flaccid paralysis cases. This study aimed to monitor the presence of polioviruses in wastewater samples collected at one wastewater treatment plant located in the municipality of Rio de Janeiro, Brazil. From December 2011 to June 2012 and from September to December 2012, 31 samples were collected and processed. RD and L20B cell cultures were able to isolate PVs and non-polio enteroviruses in 27/31 samples. Polioviruses were isolated in eight samples (type 1 Sabin = 1, type 2 Sabin = 5, and type 3 Sabin = 2). Vaccine-derived polioviruses were not detected nor evidence of recombination with other PVs or non-polio enterovirus serotypes were observed among the isolates. The Sabin-related serotypes 2 and 3 presented nucleotide substitutions in positions associated with the neurovirulent phenotype at the 5'-UTR. Changes in important Amino acid residues at VP1 were also observed in the serotypes 2 and 3. Environmental surveillance has been used successfully in monitoring the circulation of PVs and non-polio enteroviruses and it is of crucial importance in the final stages of the WHO global polio eradication initiative. Our results show the continuous circulation of Sabin-like PVs and non-polio enteroviruses in the analyzed area during the study period.

  10. Validation of Global Lung Function Initiative and All Ages Reference Equations for Forced Spirometry in Healthy Spanish Preschoolers.

    Science.gov (United States)

    Martín de Vicente, Carlos; de Mir Messa, Inés; Rovira Amigo, Sandra; Torrent Vernetta, Alba; Gartner, Silvia; Iglesias Serrano, Ignacio; Carrascosa Lezcano, Antonio; Moreno Galdó, Antonio

    2018-01-01

    Recent publication of multi-ethnic spirometry reference equations for subjects aged from 3-95 years aim to avoid age-related discontinuities and provide a worldwide standard for interpreting spirometric test results. To assess the agreement of the Global Lung Function Initiative (GLI-2012) and All ages (FEV 0.5 ) reference equations with the Spanish preschool lung function data. To verify the appropriateness of these reference values for clinical use in Spanish preschool children. Spirometric measurements were obtained from children aged 3 to 6 years attending 10 randomly selected schools in Barcelona (Spain). Stanojevic's quality control criteria were applied. Z-scores were calculated for the spirometry outcomes based on the GLI equations. If the z-score (mean) of each parameter was close to 0, with a maximum variance of ± 0.5 from the mean and a standard deviation of 1, the GLI-2012 equations would be applicable in our population. Of 543 children recruited, 405 (74.6%) were 'healthy', and of these, 380 were Caucasians. Of these 380, 81.6% (169 females, 141 males) performed technically acceptable and reproducible maneuvers to assess FEVt, and 69.5% achieved a clear end-expiratory plateau. Z-scores for FVC, FEV 1 , FEV 1 /FVC, FEV 0.75 , FEV 0.75 /FVC, FEV 0.5 , FEF 75 and FEF 25-75 all fell within ± 0.5, except for FEV 1 /FVC (0.53 z-scores). GLI equations are appropriate for Spanish preschool children. These data provide further evidence to support widespread application of the GLI reference equations. Copyright © 2017 SEPAR. Publicado por Elsevier España, S.L.U. All rights reserved.

  11. Behavioral deficits in sepsis-surviving rats induced by cecal ligation and perforation

    Directory of Open Access Journals (Sweden)

    T. Barichello

    2007-06-01

    Full Text Available Sepsis and its complications are the leading causes of mortality in intensive care units, accounting for 10-50% of deaths. Intensive care unit survivors present long-term cognitive impairment, including alterations in memory, attention, concentration, and/or global loss of cognitive function. In the present study, we investigated behavioral alterations in sepsis-surviving rats. One hundred and ten male Wistar rats (3-4 months, 250-300 g were submitted to cecal ligation and puncture (CLP, and 44 were submitted to sham operation. Forty-four rats (40% survived after CLP, and all sham-operated animals survived and were used as control. Twenty animals of each group were used in the object recognition task (10 in short-term memory and 10 in long-term memory, 12 in the plus-maze test and 12 in the forced swimming test. Ten days after surgery, the animals were submitted individually to an object recognition task, plus-maze and forced swimming tests. A significant impairment of short- and long-term recognition memory was observed in the sepsis group (recognition index 0.75 vs 0.55 and 0.74 vs 0.51 for short- and long-term memory, respectively (P < 0.05. In the elevated plus-maze test no difference was observed between groups in any of the parameters assessed. In addition, sepsis survivors presented an increase in immobility time in the forced swimming test (180 vs 233 s, P < 0.05, suggesting the presence of depressive-like symptoms in these animals after recovery from sepsis. The present results demonstrated that rats surviving exposure to CLP, a classical sepsis model, presented recognition memory impairment and depressive-like symptoms but not anxiety-like behavior.

  12. Interval Changes in Myocardial Performance Index Predict Outcome in Severe Sepsis.

    Science.gov (United States)

    Nizamuddin, Junaid; Mahmood, Feroze; Tung, Avery; Mueller, Ariel; Brown, Samuel M; Shaefi, Shahzad; O'Connor, Michael; Talmor, Daniel; Shahul, Sajid

    2017-06-01

    Septic cardiomyopathy is a well-described consequence of septic shock and is associated with increased sepsis-related mortality. The myocardial performance index (MPI), a parameter derived from echocardiographic tissue Doppler measurements, allows for a more sensitive assessment of global cardiac function than do traditional metrics for cardiac function. The authors hypothesized that changes in left ventricular MPI in patients with severe sepsis would be associated with a higher 90-day mortality. Prospective, observational study. Intensive care units of a tertiary medical center. The study comprised 47 patients admitted with new diagnoses of severe sepsis or septic shock. All patients underwent transthoracic echocardiograms with assessment of MPI at enrollment and 24 hours later. Hemodynamic data and information on sepsis-related mortality were collected. In the primary analysis, the association between change in MPI from enrollment to 24 hours and sepsis-related 90-day mortality was assessed. Of the 47 patients enrolled, 30 demonstrated an improvement in MPI from 0 to 24 hours ("improved" group), and MPI worsened in the remaining 17 patients ("worsened" group). Despite no significant differences in ejection fraction or severity of illness, the median MPI at enrollment in the "improved" group was higher than baseline values in the "worsened" group (p = 0.005). A worsening MPI over the 24-hour study interval was associated with increased mortality at 90 days (p = 0.04), which remained significant (hazard ratio 3.72; 95% confidence interval 1.12-12.41; p = 0.03) after adjusting for severity of illness (Acute Physiology and Chronic Health Evaluation II score), intravenous fluids, and vasopressor use. In patients admitted to the intensive care unit with a diagnosis of severe sepsis or septic shock, a worsening MPI during the first 24 hours after intensive care unit admission was associated with higher 90-day mortality. Copyright © 2017 Elsevier Inc. All rights

  13. The impact of evidence-based sepsis guidelines on emergency department clinical practice: a pre-post medical record audit.

    Science.gov (United States)

    Romero, Bernadine; Fry, Margaret; Roche, Michael

    2017-11-01

    To explore the number of patients presenting with sepsis before and after guideline implementation; the impact of sepsis guidelines on triage assessment, emergency department management and time to antibiotics. Sepsis remains one of the leading causes of mortality and morbidity within hospitals. Globally, strategies have been implemented to reduce morbidity and mortality rates, which rely on the early recognition and management of sepsis. To improve patient outcomes, the New South Wales government in Australia introduced sepsis guidelines into emergency departments. However, the impact of the guidelines on clinical practice remains unclear. A 12-month pre-post retrospective randomised medical record audit of adult patients with a sepsis diagnosis. Data were extracted from the emergency department database and paper medical record. Data included patient demographic (age, gender), clinical information (time of arrival, triage code, seen by time, disposition, time to antibiotic, pathology, time to intravenous fluids) and patient assessment data (heart rate, respiratory rate, blood pressure, temperature, oxygen saturations, medication). This study demonstrated a statistically significant 230-minute reduction in time to antibiotics post implementation of the guidelines. The post group (n = 165) received more urgent triage categories (n = 81; 49·1%), a 758-minute reduction in mean time to second litre of intravenous fluids and an improvement in collection of lactate (n = 112, 67·9%), also statistically significant. The findings highlight the impact the guidelines can have on clinician decision-making and behaviour that support best practice and positive patient outcomes. The sepsis guidelines improved the early assessment, recognition and management of patients presenting with sepsis in one tertiary referral emergency department. The use of evidenced-based guidelines can impact clinical decision-making and behaviour, resulting in the translation and support of

  14. Comparing Global Initiative for Asthma (GINA) criteria with the Childhood Asthma Control Test (C-ACT) and Asthma Control Test (ACT)

    NARCIS (Netherlands)

    Koolen, B.B.; Pijnenburg, M.W.; Brackel, H.J.; Landstra, A.M.; Berg, N.J. van den; Merkus, P.J.F.M.; Hop, W.C.J.; Vaessen-Verberne, A.A.

    2011-01-01

    Several tools are useful in detecting uncontrolled asthma in children. The aim of this study was to compare Global Initiative for Asthma (GINA) guidelines with the Childhood Asthma Control Test (C-ACT) and the Asthma Control Test (ACT) in detecting uncontrolled asthma in children. 145 children with

  15. Problem solving for breast health care delivery in low and middle resource countries (LMCs): consensus statement from the Breast Health Global Initiative.

    NARCIS (Netherlands)

    Harford, J.B.; Otero, I.V.; Anderson, B.O.; Cazap, E.; Gradishar, W.J.; Gralow, J.R.; Kane, G.M.; Niens, L.M.; Porter, P.L.; Reeler, A.V.; Rieger, P.T.; Shockney, L.D.; Shulman, L.N.; Soldak, T.; Thomas, D.B.; Thompson, B.; Winchester, D.P.; Zelle, S.G.; Badwe, R.A.

    2011-01-01

    International collaborations like the Breast Health Global Initiative (BHGI) can help low and middle income countries (LMCs) to establish or improve breast cancer control programs by providing evidence-based, resource-stratified guidelines for the management and control of breast cancer. The Problem

  16. Sepsis: Current Definition, Pathophysiology, Diagnosis, and Management.

    Science.gov (United States)

    Taeb, Abdalsamih M; Hooper, Michael H; Marik, Paul E

    2017-06-01

    Sepsis is a clinical syndrome that results from the dysregulated inflammatory response to infection that leads to organ dysfunction. The resulting losses to society in terms of financial burden, morbidity, and mortality are enormous. We provide a review of sepsis, its underlying pathophysiology, and guidance for diagnosis and management of this common disease. Current established treatments include appropriate antimicrobial agents to target the underlying infection, optimization of intravascular volume to improve stroke volume, vasopressors to counteract vasoplegic shock, and high-quality supportive care. Appropriate implementation of established treatments combined with novel therapeutic approaches promises to continue to decrease the impact of this disease.

  17. Indium 111 leucocyte scintigraphy in abdominal sepsis

    International Nuclear Information System (INIS)

    Baba, A.A.; McKillop, J.H.; Gray, H.W.; Cuthbert, G.F.; Neilson, W.; Anderson, J.R.

    1990-01-01

    We have studied the clinical utility of indium 111 autologous leucocyte scintigraphy retrospectively in 45 patients presenting with suspected intra-abdominal sepsis. The sensitivity was 95% (21/22) and the specificity was 91% (21/23). Some 34 of the studies (17 positive and 17 negative) were considered helpful in furthering patient management (76%) and 8, unhelpful (18%). In 3, the study results were misleading and led to inappropriate treatment. Indium 111 scintigraphy, whether positive or negative, provides information in patients with suspected intra-abdominal sepsis upon which therapeutic decisions can be based. (orig.)

  18. Assessment of Clinical Criteria for Sepsis

    Science.gov (United States)

    Seymour, Christopher W.; Liu, Vincent X.; Iwashyna, Theodore J.; Brunkhorst, Frank M.; Rea, Thomas D.; Scherag, André; Rubenfeld, Gordon; Kahn, Jeremy M.; Shankar-Hari, Manu; Singer, Mervyn; Deutschman, Clifford S.; Escobar, Gabriel J.; Angus, Derek C.

    2016-01-01

    IMPORTANCE The Third International Consensus Definitions Task Force defined sepsis as “life-threatening organ dysfunction due to a dysregulated host response to infection.” The performance of clinical criteria for this sepsis definition is unknown. OBJECTIVE To evaluate the validity of clinical criteria to identify patients with suspected infection who are at risk of sepsis. DESIGN, SETTINGS, AND POPULATION Among 1.3 million electronic health record encounters from January 1, 2010, to December 31, 2012, at 12 hospitals in southwestern Pennsylvania, we identified those with suspected infection in whom to compare criteria. Confirmatory analyses were performed in 4 data sets of 706 399 out-of-hospital and hospital encounters at 165 US and non-US hospitals ranging from January 1, 2008, until December 31, 2013. EXPOSURES Sequential [Sepsis-related] Organ Failure Assessment (SOFA) score, systemic inflammatory response syndrome (SIRS) criteria, Logistic Organ Dysfunction System (LODS) score, and a new model derived using multivariable logistic regression in a split sample, the quick Sequential [Sepsis-related] Organ Failure Assessment (qSOFA) score (range, 0–3 points, with 1 point each for systolic hypotension [≤100 mm Hg], tachypnea [≥22/min], or altered mentation). MAIN OUTCOMES AND MEASURES For construct validity, pairwise agreement was assessed. For predictive validity, the discrimination for outcomes (primary: in-hospital mortality; secondary: in-hospital mortality or intensive care unit [ICU] length of stay ≥3 days) more common in sepsis than uncomplicated infection was determined. Results were expressed as the fold change in outcome over deciles of baseline risk of death and area under the receiver operating characteristic curve (AUROC). RESULTS In the primary cohort, 148 907 encounters had suspected infection (n = 74 453 derivation; n = 74 454 validation), of whom 6347 (4%) died. Among ICU encounters in the validation cohort (n = 7932 with suspected

  19. Neonatal Sepsis: past, present and future; a review article | Tripathi ...

    African Journals Online (AJOL)

    Sepsis is the most common cause of neonatal mortality. As per National Neonatal Perinatal Database (NNPD) 2002-2003, the incidence of neonatal sepsis in India was 30 per 1000 live birth. It is 3% among intramural babies and 39.7% among extramural admissions. The early manifestations of neonatal sepsis are vague ...

  20. Severe hyperglycaemia due to neonatal sepsis - A case report ...

    African Journals Online (AJOL)

    Neonatal sepsis is a clinical syndrome characterized by signs and symptoms of infection with or without accompanying bacteremia in the first month of life. The clinical signs of neonatal sepsis are neither specific nor uniform. Neonatal sepsis may present with fever, hypotonia, respiratory distress, apnea and hyperglycaemia.

  1. Thrombocytopenia in neonatal sepsis: Incidence, severity and risk factors

    NARCIS (Netherlands)

    Ree, Isabelle M. C.; Fustolo-Gunnink, Suzanne F.; Bekker, Vincent; Fijnvandraat, Karin J.; Steggerda, Sylke J.; Lopriore, Enrico

    2017-01-01

    Thrombocytopenia is a frequent problem in neonatal sepsis and is among the most predictive, independent risk factors for sepsis-associated mortality. This study aims to clarify the occurrence, severity and duration of thrombocytopenia in neonatal sepsis. A cohort study was carried out among all

  2. Can Resistin be a New Indicator of Neonatal Sepsis?

    Directory of Open Access Journals (Sweden)

    Didem Aliefendioglu

    2014-02-01

    Conclusion: Resistin levels were higher in premature newborns with sepsis and correlated with IL-6 levels, which is an indicator of neonatal sepsis. This suggests that resistin may also be used in the diagnosis of neonatal sepsis. However, it has limited value when compared with the other inflammatory markers including C-reactive protein, procalcitonin, and IL-6.

  3. Sepsis in HIV-infected patients; epidemiology and host response

    NARCIS (Netherlands)

    Huson, M.A.M.

    2016-01-01

    In this thesis, we examined the impact of HIV infection on the epidemiology (Part I) of sepsis, and host response (Part II) to sepsis. We studied sepsis patients in Gabon, a setting with a high prevalence of HIV, and in Dutch intensive care units (ICUs). In Part I, we found that HIV positive

  4. Sepsis in intensive care patients: challenges in diagnosis and prognostication

    NARCIS (Netherlands)

    Klein Klouwenberg, P.M.C.

    2015-01-01

    Sepsis is a syndrome that arises when the body’s response to a severe infection injures its own tissues. It is a major and increasing cause of in-hospital morbidity and mortality. Despite recent advances in the management of sepsis, the morbidity and mortality caused by sepsis remain unacceptably

  5. Implementatie van de Surviving Sepsis Campaign bundels : Monitoring van ervaringen

    NARCIS (Netherlands)

    Lilian Vloet; J. Schouten; N. Stevens; A. Rensen; A. Willems; F. Zeegers

    2011-01-01

    Sepsis komt vaak voor in ziekenhuizen. Ernstige sepsis is verantwoordelijk voor 10 - 20% van alle Intensive Care (IC) opnames en is de belangrijkste doodsoorzaak op niet-cardiale IC?s. De gemiddelde mortaliteit van volwassenen met ernstige sepsis op de IC is 33% en van volwassenen met septische

  6. Leukocyte counts in urine reflect the risk of concomitant sepsis in bacteriuric infants: A retrospective cohort study

    Directory of Open Access Journals (Sweden)

    Harper Marvin B

    2007-06-01

    Full Text Available Abstract Background When urine infections are missed in febrile young infants with normal urinalysis, clinicians may worry about the risk – hitherto unverified – of concomitant invasion of blood and cerebrospinal fluid by uropathogens. In this study, we determine the extent of this risk. Methods In a retrospective cohort study of febrile 0–89 day old infants evaluated for sepsis in an urban academic pediatric emergency department (1993–1999, we estimated rates of bacteriuric sepsis (urinary tract infections complicated by sepsis after stratifying infants by urine leukocyte counts higher, or lower than 10 cells/hpf. We compared the global accuracy of leukocytes in urine, leukocytes in peripheral blood, body temperature, and age for predicting bacteruric sepsis. The global accuracy of each test was estimated by calculating the area under its receiver operating characteristic curve (AUC. Chi-square and Fisher exact tests compared count data. Medians for data not normally distributed were compared by the Kruskal-Wallis test. Results Two thousand two hundred forty-nine young infants had a normal screening dipstick. None of these developed bacteremia or meningitis despite positive urine culture in 41 (1.8%. Of 1516 additional urine specimens sent for formal urinalysis, 1279 had 0–9 leukocytes/hpf. Urine pathogens were isolated less commonly (6% vs. 76% and at lower concentrations in infants with few, compared to many urine leukocytes. Urine leukocytes (AUC: 0.94 were the most accurate predictors of bacteruric sepsis. Infants with urinary leukocytes Conclusion In young infants evaluated for fever, leukocytes in urine reflect the likelihood of bacteriuric sepsis. Infants with urinary tract infections missed because of few leukocytes in urine are at relatively low risk of invasive bacterial sepsis by pathogens isolated from urine.

  7. The “Right to Remain Here” as an Evolving Component of Global Refugee Protection: Current Initiatives and Critical Questions

    Directory of Open Access Journals (Sweden)

    Daniel Kanstroom

    2017-08-01

    Full Text Available This article considers the relationship between two human rights discourses (and two specific legal regimes: refugee and asylum protection and the evolving body of international law that regulates expulsions and deportations. Legal protections for refugees and asylum seekers are, of course, venerable, well-known, and in many respects still cherished, if challenged and perhaps a bit frail. Anti-deportation discourse is much newer, multifaceted, and evolving. It is in many respects a young work in progress. It has arisen in response to a rising tide of deportations, and the worrisome development of massive, harsh deportation machinery in the United States, Germany, the United Kingdom, France, Mexico, Australia, and South Africa, among others. This article’s main goal is to consider how these two discourses do and might relate to each other. More specifically, it suggests that the development of procedural and substantive rights against removal — as well as rights during and after removal — aids our understanding of the current state and possible future of the refugee protection regime. The article’s basic thesis is this: The global refugee regime, though challenged both theoretically and in practice, must be maintained and strengthened. Its historical focus on developing criteria for admission into safe states, on protections against expulsion (i.e., non-refoulement, and on regimes of temporary protection all remain critically important. However, a focus on other protections for all noncitizens facing deportation is equally important. Deportation has become a major international system that transcends the power of any single nation-state. Its methods have migrated from one regime to another; its size and scope are substantial and expanding; its costs are enormous; and its effects frequently constitute major human rights violations against millions who do not qualify as refugees. In recent years there has been increasing reliance by states

  8. Frontline Science: HMGB1 induces neutrophil dysfunction in experimental sepsis and in patients who survive septic shock.

    Science.gov (United States)

    Grégoire, Murielle; Tadié, Jean-Marc; Uhel, Fabrice; Gacouin, Arnaud; Piau, Caroline; Bone, Nathaniel; Le Tulzo, Yves; Abraham, Edward; Tarte, Karin; Zmijewski, Jaroslaw W

    2017-06-01

    Sepsis is accompanied by the initial activation of proinflammatory pathways and long-lasting immunosuppression that appears to contribute to late-occurring mortality. Although high-mobility group box 1 (HMGB1) is involved in many aspects of inflammation, its role in sepsis-induced immune suppression remains unclear. In this study, we examined HMGB1's contribution to neutrophil NADPH oxidase activity dysfunction and associated neutrophil-dependent bacterial clearance in mice subjected to sepsis and in patients who survive septic shock. Using a murine model of polymicrobial septic peritonitis, we demonstrated that treatment with anti-HMGB1 Ab significantly diminished sepsis-induced dysfunction of neutrophil NADPH oxidase activity. In a subsequent set of experiments, we found that blocking HMGB1 preserved the ability of neutrophils from patients recovering from septic shock to activate NADPH oxidase. Taken together, our data suggest that HMGB1 accumulation in the late phase of sepsis plays a specific role in the development of postsepsis immunosuppression and specifically affects neutrophil-dependent antibacterial defense mechanisms. Thus, blocking HMGB1 may be a promising therapeutic intervention to diminish the adverse effects of sepsis-induced immunosuppression. © Society for Leukocyte Biology.

  9. Managing sepsis: Electronic recognition, rapid response teams, and standardized care save lives.

    Science.gov (United States)

    Guirgis, Faheem W; Jones, Lisa; Esma, Rhemar; Weiss, Alice; McCurdy, Kaitlin; Ferreira, Jason; Cannon, Christina; McLauchlin, Laura; Smotherman, Carmen; Kraemer, Dale F; Gerdik, Cynthia; Webb, Kendall; Ra, Jin; Moore, Frederick A; Gray-Eurom, Kelly

    2017-08-01

    Sepsis can lead to poor outcomes when treatment is delayed or inadequate. The purpose of this study was to evaluate outcomes after initiation of a hospital-wide sepsis alert program. Retrospective review of patients ≥18years treated for sepsis. There were 3917 sepsis admissions: 1929 admissions before, and 1988 in the after phase. Mean age (57.3 vs. 57.1, p=0.94) and Charlson Comorbidity Scores (2.52 vs. 2.47, p=0.35) were similar between groups. Multivariable analyses identified significant reductions in the after phase for odds of death (OR 0.62, 95% CI 0.39-0.99, p=0.046), mean intensive care unit LOS (2.12days before, 95%CI 1.97, 2.34; 1.95days after, 95%CI 1.75, 2.06; p<0.001), mean overall hospital LOS (11.7days before, 95% CI 10.9, 12.7days; 9.9days after, 95% CI 9.3, 10.6days, p<0.001), odds of mechanical ventilation use (OR 0.62, 95% CI 0.39, 0.99, p=0.007), and total charges with a savings of $7159 per sepsis admission (p=0.036). There was no reduction in vasopressor use (OR 0.89, 95% CI 0.75, 0.1.06, p=0.18). A hospital-wide program utilizing electronic recognition and RRT intervention resulted in improved outcomes in patients with sepsis. Copyright © 2017 Elsevier Inc. All rights reserved.

  10. Sensitivity of aerosol indirect forcing and autoconversion to cloud droplet parameterization: an assessment with the NASA Global Modeling Initiative.

    Science.gov (United States)

    Sotiropoulou, R. P.; Meshkhidze, N.; Nenes, A.

    2006-12-01

    The aerosol indirect forcing is one of the largest sources of uncertainty in assessments of anthropogenic climate change [IPCC, 2001]. Much of this uncertainty arises from the approach used for linking cloud droplet number concentration (CDNC) to precursor aerosol. Global Climate Models (GCM) use a wide range of cloud droplet activation mechanisms ranging from empirical [Boucher and Lohmann, 1995] to detailed physically- based formulations [e.g., Abdul-Razzak and Ghan, 2000; Fountoukis and Nenes, 2005]. The objective of this study is to assess the uncertainties in indirect forcing and autoconversion of cloud water to rain caused by the application of different cloud droplet parameterization mechanisms; this is an important step towards constraining the aerosol indirect effects (AIE). Here we estimate the uncertainty in indirect forcing and autoconversion rate using the NASA Global Model Initiative (GMI). The GMI allows easy interchange of meteorological fields, chemical mechanisms and the aerosol microphysical packages. Therefore, it is an ideal tool for assessing the effect of different parameters on aerosol indirect forcing. The aerosol module includes primary emissions, chemical production of sulfate in clear air and in-cloud aqueous phase, gravitational sedimentation, dry deposition, wet scavenging in and below clouds, and hygroscopic growth. Model inputs include SO2 (fossil fuel and natural), black carbon (BC), organic carbon (OC), mineral dust and sea salt. The meteorological data used in this work were taken from the NASA Data Assimilation Office (DAO) and two different GCMs: the NASA GEOS4 finite volume GCM (FVGCM) and the Goddard Institute for Space Studies version II' (GISS II') GCM. Simulations were carried out for "present day" and "preindustrial" emissions using different meteorological fields (i.e. DAO, FVGCM, GISS II'); cloud droplet number concentration is computed from the correlations of Boucher and Lohmann [1995], Abdul-Razzak and Ghan [2000

  11. Characterisation and antimicrobial resistance of sepsis pathogens in neonates born in tertiary care centres in Delhi, India: a cohort study.

    Science.gov (United States)

    2016-10-01

    Sepsis is one of the most common causes of neonatal deaths globally. Most sepsis-related deaths occur in low-income and middle-income countries, where the epidemiology of neonatal sepsis remains poorly understood. Most of these countries lack proper surveillance networks, hampering accurate assessment of the burden of sepsis, implementation of preventive measures, and investment in research. We report results of neonates born in hospital from a multicentre collaboration on neonatal sepsis. In this cohort study, dedicated research teams prospectively followed up neonates born in one of three tertiary care centres in Delhi, India (Vardhaman Mahavir Medical College, Maulana Azad Medical College, and All India Institute of Medical Sciences [coordinating centre]) and subsequently admitted to the intensive care unit. Neonates were followed up daily until discharge or death. On clinical suspicion, neonates underwent sepsis work-up including blood cultures. The isolated organisms were identified and tested for antimicrobial susceptibility. We defined Gram-negative isolates resistant to any three of five antibiotic classes (extended-spectrum cephalosporins, carbapenems, aminoglycosides, fluoroquinolones, and piperacillin-tazobactam) as multidrug resistant. 13 530 neonates of 88 636 livebirths were enrolled between July 18, 2011, and Feb 28, 2014. The incidence of total sepsis was 14·3% (95% CI 13·8-14·9) and of culture-positive sepsis was 6·2% (5·8-6·6). Nearly two-thirds of total episodes occurred at or before 72 h of life (defined as early onset; 1351 [83%] of 1980). Two-thirds (645 [64%]) of 1005 isolates were Gram-negative including, Acinetobacter spp (22%), Klebsiella spp (17%), and Escherichia coli (14%). The pathogen mix in early-onset sepsis did not differ from that of late-onset sepsis (ie, after 72 h). High rates of multidrug resistance were observed in Acinetobacter spp (181/222, 82%), Klebsiella spp (91/169, 54%), and Escherichia coli (52/137, 38

  12. Current challenges in the management of sepsis in ICUs in resource-poor settings and suggestions for the future.

    Science.gov (United States)

    Schultz, Marcus J; Dunser, Martin W; Dondorp, Arjen M; Adhikari, Neill K J; Iyer, Shivakumar; Kwizera, Arthur; Lubell, Yoel; Papali, Alfred; Pisani, Luigi; Riviello, Beth D; Angus, Derek C; Azevedo, Luciano C; Baker, Tim; Diaz, Janet V; Festic, Emir; Haniffa, Rashan; Jawa, Randeep; Jacob, Shevin T; Kissoon, Niranjan; Lodha, Rakesh; Martin-Loeches, Ignacio; Lundeg, Ganbold; Misango, David; Mer, Mervyn; Mohanty, Sanjib; Murthy, Srinivas; Musa, Ndidiamaka; Nakibuuka, Jane; Serpa Neto, Ary; Nguyen Thi Hoang, Mai; Nguyen Thien, Binh; Pattnaik, Rajyabardhan; Phua, Jason; Preller, Jacobus; Povoa, Pedro; Ranjit, Suchitra; Talmor, Daniel; Thevanayagam, Jonarthan; Thwaites, C Louise

    2017-05-01

    Sepsis is a major reason for intensive care unit (ICU) admission, also in resource-poor settings. ICUs in low- and middle-income countries (LMICs) face many challenges that could affect patient outcome. To describe differences between resource-poor and resource-rich settings regarding the epidemiology, pathophysiology, economics and research aspects of sepsis. We restricted this manuscript to the ICU setting even knowing that many sepsis patients in LMICs are treated outside an ICU. Although many bacterial pathogens causing sepsis in LMICs are similar to those in high-income countries, resistance patterns to antimicrobial drugs can be very different; in addition, causes of sepsis in LMICs often include tropical diseases in which direct damaging effects of pathogens and their products can sometimes be more important than the response of the host. There are substantial and persisting differences in ICU capacities around the world; not surprisingly the lowest capacities are found in LMICs, but with important heterogeneity within individual LMICs. Although many aspects of sepsis management developed in rich countries are applicable in LMICs, implementation requires strong consideration of cost implications and the important differences in resources. Addressing both disease-specific and setting-specific factors is important to improve performance of ICUs in LMICs. Although critical care for severe sepsis is likely cost-effective in LMIC setting, more detailed evaluation at both at a macro- and micro-economy level is necessary. Sepsis management in resource-limited settings is a largely unexplored frontier with important opportunities for research, training, and other initiatives for improvement.

  13. A polar stratospheric cloud parameterization for the global modeling initiative three-dimensional model and its response to stratospheric aircraft

    International Nuclear Information System (INIS)

    Considine, D. B.; Douglass, A. R.; Connell, P. S.; Kinnison, D. E.; Rotman, D. A.

    2000-01-01

    We describe a new parameterization of polar stratospheric clouds (PSCs) which was written for and incorporated into the three-dimensional (3-D) chemistry and transport model (CTM) developed for NASA's Atmospheric Effects of Aviation Project (AEAP) by the Global Modeling Initiative (GMI). The parameterization was designed to respond to changes in NO y and H 2 O produced by high-speed civilian transport (HSCT) emissions. The parameterization predicts surface area densities (SADs) of both Type 1 and Type 2 PSCs for use in heterogeneous chemistry calculations. Type 1 PSCs are assumed to have a supercooled ternary sulfate (STS) composition, and Type 2 PSCs are treated as water ice with a coexisting nitric acid trihydrate (NAT) phase. Sedimentation is treated by assuming that the PSC particles obey lognormal size distributions, resulting in a realistic mass flux of condensed phase H 2 O and HNO 3 . We examine a simulation of the Southern Hemisphere high-latitude lower stratosphere winter and spring seasons driven by temperature and wind fields from a modified version of the National Center for Atmospheric Research (NCAR) Middle Atmosphere Community Climate Model Version 2 (MACCM2). Predicted PSC SADs and median radii for both Type 1 and Type 2 PSCs are consistent with observations. Gas phase HNO 3 and H 2 O concentrations in the high-latitude lower stratosphere qualitatively agree with Cryogenic Limb Array Etalon Spectrometer (CLAES) HNO 3 and Microwave Limb Sounder (MLS) H 2 O observations. The residual denitrification and dehydration of the model polar vortex after polar winter compares well with atmospheric trace molecule spectroscopy (ATMOS) observations taken during November 1994. When the NO x and H 2 O emissions of a standard 500-aircraft HSCT fleet with a NO x emission index of 5 are added, NO x and H 2 O concentrations in the Southern Hemisphere polar vortex before winter increase by up to 3%. This results in earlier onset of PSC formation, denitrification, and

  14. Polarization of microglia and its role in bacterial sepsis.

    Science.gov (United States)

    Michels, Monique; Sonai, Beatriz; Dal-Pizzol, Felipe

    2017-02-15

    Microglial polarization in response to brain inflammatory conditions is a crescent field in neuroscience. However, the effect of systemic inflammation, and specifically sepsis, is a relatively unexplored field that has great interest and relevance. Sepsis has been associated with both early and late harmful events of the central nervous system, suggesting that there is a close link between sepsis and neuroinflammation. During sepsis evolution it is supposed that microglial could exert both neurotoxic and repairing effects depending on the specific microglial phenotype assumed. In this context, here it was reviewed the role of microglial polarization during sepsis-associated brain dysfunction. Copyright © 2017 Elsevier B.V. All rights reserved.

  15. Glucocorticoid resistance as a major drive in sepsis pathology.

    Science.gov (United States)

    Dendoncker, Karen; Libert, Claude

    2017-06-01

    Sepsis is an acute systemic inflammatory disease. Glucocorticoids (GCs), which function by binding to the GC receptor GR have very powerful anti-inflammatory activities, yet they are hardly useful in sepsis. We can thus consider sepsis as a GC resistant disease. We here review the literature which has investigated this GC resistance, and summarize the mechanisms of GC resistance that have been observed in other diseases and in experimental models. We also discuss the importance of GC resistance in sepsis, in terms of the contribution of this phenomenon to the pathogenesis of sepsis. Copyright © 2017 Elsevier Ltd. All rights reserved.

  16. Neutrophil migration under normal and sepsis conditions.

    Science.gov (United States)

    Lerman, Yelena V; Kim, Minsoo

    2015-01-01

    Neutrophil migration is critical for pathogen clearance and host survival during severe sepsis. Interaction of neutrophil adhesion receptors with ligands on endothelial cells results in firm adhesion of the circulating neutrophils, followed by neutrophil activation and directed migration to sites of infection through the basement membrane and interstitial extracellular matrix. Proteolytic enzymes and reactive oxygen species are produced and released by neutrophils in response to a variety of inflammatory stimuli. Although these mediators are important for host defense, they also promote tissue damage. Excessive neutrophil migration during the early stages of sepsis may lead to an exaggerated inflammatory response with associated tissue damage and subsequent organ dysfunction. On the other hand, dysregulation of migration and insufficient migratory response that occurs during the latter stages of severe sepsis contributes to neutrophils' inability to contain and control infection and impaired wound healing. This review discusses the major steps and associated molecules involved in the balance of neutrophil trafficking, the precise regulation of which during sepsis spells life or death for the host.

  17. Procalcitonin - Assisted Antibiotic Strategy in Sepsis.

    Science.gov (United States)

    Trásy, Domonkos; Molnár, Zsolt

    2017-05-01

    Sepsis is one of the biggest challenges in critical care nowadays. Defining sepsis is a difficult task on its own and its diagnosis and treatment requires well trained, devoted personnel with interdisciplinary collaboration in order to provide the patients the best chance for survival. Immediate resuscitation, early adequate antimicrobial therapy, source control and highly sophisticated organ support on the intensive care units are all inevitable necessities for successful recovery. To help fast and accurate diagnosis biomarkers have been measured for decades. Procalcitonin (PCT) is one of the most studied, but the results are conflicting. Sepsis means a very loose cohort of a large heterogeneous patient population, hence defining certain cut off values for PCT to differentiate between different severities of the disease is almost impossible. Clinicians first have to understand the pathophysiological background of sepsis to be able to interpret correctly the PCT results. Nevertheless, PCT has been shown to have the best sensitivity and specificity to indicate infection, antibiotic appropriateness and stopping therapy. In this article we will focus on some important aspects of pathophysiology and advice on how to implement that in the everyday clinical practice. We believe that this multimodal evaluation of the clinical picture together with PCT results can be a useful tool to make the most out of the PCT results, and do the best for patients on the ICU.

  18. Diagnostic value of procalcitonin in neonatal sepsis

    African Journals Online (AJOL)

    2015-04-27

    Apr 27, 2015 ... Abstract: Introduction: Neonatal sepsis is a major cause of mortal- ity in developing countries. Accu- rate and quick diagnosis are diffi- cult because clinical presentation are non-specific, bacterial cultures are time-consuming and other laboratory tests lack sensitivity and specificity. Serum procalci-.

  19. [Pharmaconutrition with parenteral selenium in sepsis].

    Science.gov (United States)

    Langlois, P L; de Oliveira Figliolino, L F; Hardy, G; Manzanares, W

    2014-04-01

    Critical illness is characterized by oxidative stress which leads to multiple organ failure, and sepsis-related organ dysfunction remains the most common cause of death in the intensive care unit. Over the last 2 decades, different antioxidant therapies have been developed to improve outcomes in septic patients. According to recent evidence, selenium therapy should be considered the cornerstone of the antioxidant strategies. Selenium given as selenious acid or sodium selenite should be considered as a drug or pharmaconutrient with prooxidant and cytotoxic effects when a loading dose in intravenous bolus form is administered, particularly in the early stage of severe sepsis/septic shock. To date, several phase ii trials have demonstrated that selenium therapy may be able to decrease mortality, improve organ dysfunction and reduce infections in critically ill septic patients. The effect of selenium therapy in sepsis syndrome must be confirmed by large, well designed phase iii clinical trials. The purpose of this review is to discuss current evidence on selenium pharmaconutrition in sepsis syndrome. Copyright © 2013 Elsevier España, S.L. and SEMICYUC. All rights reserved.

  20. Immunotolerance during bacterial pneumonia and sepsis

    NARCIS (Netherlands)

    Hoogerwerf, J.J.

    2010-01-01

    Bacterial pneumonia and sepsis are a major cause of morbidity and mortality worldwide. Massive use of antibiotics promotes pathogen resistance, and, as a consequence, the incidence of drug-resistant bacteria is increasing. Therefore, it is of the utmost importance to expand our comprehension of host

  1. Percutaneous biliary drainage in acute suppurative cholangitis with biliary sepsis

    International Nuclear Information System (INIS)

    Kim, Hyung Lyul; Cho, June Sik; Kwon, Soon Tae; Lee, Sang Jin; Rhee, Byung Chull

    1993-01-01

    Acute suppurative cholangitis is a severe inflammatory process of the bile duct occurred as result of partial or complete obstruction of the bile duct, and may manifest clinically severe form of disease, rapidly deteriorating to life-threatening condition. We analyzed emergency percutaneous transhepatic biliary drainage in 20 patients of acute suppurative cholangitis with biliary sepsis to evaluate the therapeutic effect and complication of the procedure. The underlying cause were 12 benign disease(stones) and eight malignant tumors and among eight malignant tumors, bile duct stones(n=4) and clonorchiasis(n=1) were combined. Percutaneous transhepatic biliary drainage was performed successfully in 17 of 20 patients resulting in improvement of general condition and failed in three patients. The procedure were preterminated due to the patient's condition in two and biliary-proto fistula was developed in one. After biliary decompression by percutaneous transhepatic biliary drainage, effective and successful elective surgery was performed in nine cases, which were seven biliary stones and two biliary cancer with stones. Our experience suggest that emergency percutaneous transhepatic biliary drainage is an initial and effective treatment of choice for acute suppurative cholangitis with sepsis and a safe alternative for nonsurgical treatment

  2. Managing Neonatal and Early Childhood Syndromic Sepsis in Sub-District Hospitals in Resource Poor Settings: Improvement in Quality of Care through Introduction of a Package of Interventions in Rural Bangladesh.

    Directory of Open Access Journals (Sweden)

    Ahmed Ehsanur Rahman

    Full Text Available Sepsis is dysregulated systemic inflammatory response which can lead to tissue damage, organ failure, and death. With an estimated 30 million cases per year, it is a global public health concern. Severe infections leading to sepsis account for more than half of all under five deaths and around one quarter of all neonatal deaths annually. Most of these deaths occur in low and middle income countries and could be averted by rapid assessment and appropriate treatment. Evidence suggests that service provision and quality of care pertaining to sepsis management in resource poor settings can be improved significantly with minimum resource allocation and investments. Cognizant of the stark realities, a project titled 'Interrupting Pathways to Sepsis Initiative' (IPSI introduced a package of interventions for improving quality of care pertaining to sepsis management at 2 sub-district level public hospitals in rural Bangladesh. We present here the quality improvement process and achievements regarding some fundamental steps of sepsis management which include rapid identification and admission, followed by assessment for hypoxemia, hypoglycaemia and hypothermia, immediate resuscitation when required and early administration of parenteral broad spectrum antibiotics.Key components of the intervention package include identification of structural and functional gaps through a baseline environmental scan, capacity development on protocolized management through training and supportive supervision by onsite 'Program Coaches', facilitating triage and rapid transfer of patients through 'Welcoming Persons' and enabling rapid treatment through 'Task Shifting' from on-call physicians to on-duty paramedics in the emergency department and on-call physicians to on-duty nurses in the inpatient department.From August, 2013 to March, 2015, 1,262 under-5 children were identified as syndromic sepsis in the emergency departments; of which 82% were admitted. More neonates (30

  3. The effect of bacterial sepsis severity on triglyceride value

    Science.gov (United States)

    Fahila, R.; Kembaren, T.; Rahimi, A.

    2018-03-01

    Sepsis can increase the amount of triglyceride as well as change the functional and structural components of lipoproteins. The triglyceride level is directly proportional to the severity of sepsis and associated with a systemic inflammatory response. The study aims to determine the correlation between the severity of bacterial sepsis with triglyceride value. An observational study with case control design from January2017 to March 2017 in 30 sepsis and 30 non-sepsis patients at H. Adam Malik General Hospital Medan. We examined Procalcitonin (PCT) and triglyceride level on the 1st, 3rd and 5th day and then analyzed using MannWhitney to assess their correlation.The triglyceride value in the sepsis group was 120 ± 5.1 mg/dl on day 1, non-sepsis 117.53 ± 36.37mg/dl. However, on the fifth day, the sepsis group of triglyceride values was 124.2±50.29mg/dl and the non-sepsis group triglyceride values 134.03±68.12mg/dl. There was no specific connection between the severity of sepsis and triglyceride value in a patient with sepsis.

  4. Autophagy Primes Neutrophils for Neutrophil Extracellular Trap Formation during Sepsis.

    Science.gov (United States)

    Park, So Young; Shrestha, Sanjeeb; Youn, Young-Jin; Kim, Jun-Kyu; Kim, Shin-Yeong; Kim, Hyun Jung; Park, So-Hee; Ahn, Won-Gyun; Kim, Shin; Lee, Myung Goo; Jung, Ki-Suck; Park, Yong Bum; Mo, Eun-Kyung; Ko, Yousang; Lee, Suh-Young; Koh, Younsuck; Park, Myung Jae; Song, Dong-Keun; Hong, Chang-Won

    2017-09-01

    Neutrophils are key effectors in the host's immune response to sepsis. Excessive stimulation or dysregulated neutrophil functions are believed to be responsible for sepsis pathogenesis. However, the mechanisms regulating functional plasticity of neutrophils during sepsis have not been fully determined. We investigated the role of autophagy in neutrophil functions during sepsis in patients with community-acquired pneumonia. Neutrophils were isolated from patients with sepsis and stimulated with phorbol 12-myristate 13-acetate (PMA). The levels of reactive oxygen species generation, neutrophil extracellular trap (NET) formation, and granule release, and the autophagic status were evaluated. The effect of neutrophil autophagy augmentation was further evaluated in a mouse model of sepsis. Neutrophils isolated from patients who survived sepsis showed an increase in autophagy induction, and were primed for NET formation in response to subsequent PMA stimulation. In contrast, neutrophils isolated from patients who did not survive sepsis showed dysregulated autophagy and a decreased response to PMA stimulation. The induction of autophagy primed healthy neutrophils for NET formation and vice versa. In a mouse model of sepsis, the augmentation of autophagy improved survival via a NET-dependent mechanism. These results indicate that neutrophil autophagy primes neutrophils for increased NET formation, which is important for proper neutrophil effector functions during sepsis. Our study provides important insights into the role of autophagy in neutrophils during sepsis.

  5. National Studies as a Component of the World Health Organization Initiative to Estimate the Global and Regional Burden of Foodborne Disease.

    Directory of Open Access Journals (Sweden)

    Robin J Lake

    Full Text Available The World Health Organization (WHO initiative to estimate the global burden of foodborne diseases established the Foodborne Diseases Burden Epidemiology Reference Group (FERG in 2007. In addition to global and regional estimates, the initiative sought to promote actions at a national level. This involved capacity building through national foodborne disease burden studies, and encouragement of the use of burden information in setting evidence-informed policies. To address these objectives a FERG Country Studies Task Force was established and has developed a suite of tools and resources to facilitate national burden of foodborne disease studies. This paper describes the process and lessons learned during the conduct of pilot country studies under the WHO FERG initiative.Pilot country studies were initiated in Albania, Japan and Thailand in 2011 and in Uganda in 2012. A brief description of each study is provided. The major scientific issue is a lack of data, particularly in relation to disease etiology, and attribution of disease burden to foodborne transmission. Situation analysis, knowledge translation, and risk communication to achieve evidence-informed policies require specialist expertise and resources.The FERG global and regional burden estimates will greatly enhance the ability of individual countries to fill data gaps and generate national estimates to support efforts to reduce the burden of foodborne disease.

  6. The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3)

    Science.gov (United States)

    Singer, Mervyn; Deutschman, Clifford S.; Seymour, Christopher Warren; Shankar-Hari, Manu; Annane, Djillali; Bauer, Michael; Bellomo, Rinaldo; Bernard, Gordon R.; Chiche, Jean-Daniel; Coopersmith, Craig M.; Hotchkiss, Richard S.; Levy, Mitchell M.; Marshall, John C.; Martin, Greg S.; Opal, Steven M.; Rubenfeld, Gordon D.; van der Poll, Tom; Vincent, Jean-Louis; Angus, Derek C.

    2016-01-01

    IMPORTANCE Definitions of sepsis and septic shock were last revised in 2001. Considerable advances have since been made into the pathobiology (changes in organ function, morphology, cell biology, biochemistry, immunology, and circulation), management, and epidemiology of sepsis, suggesting the need for reexamination. OBJECTIVE To evaluate and, as needed, update definitions for sepsis and septic shock. PROCESS A task force (n = 19) with expertise in sepsis pathobiology, clinical trials, and epidemiology was convened by the Society of Critical Care Medicine and the European Society of Intensive Care Medicine. Definitions and clinical criteria were generated through meetings, Delphi processes, analysis of electronic health record databases, and voting, followed by circulation to international professional societies, requesting peer review and endorsement (by 31 societies listed in the Acknowledgment). KEY FINDINGS FROMEVIDENCE SYNTHESIS Limitations of previous definitions included an excessive focus on inflammation, the misleading model that sepsis follows a continuum through severe sepsis to shock, and inadequate specificity and sensitivity of the systemic inflammatory response syndrome (SIRS) criteria. Multiple definitions and terminologies are currently in use for sepsis, septic shock, and organ dysfunction, leading to discrepancies in reported incidence and observed mortality. The task force concluded the term severe sepsis was redundant. RECOMMENDATIONS Sepsis should be defined as life-threatening organ dysfunction caused by a dysregulated host response to infection. For clinical operationalization, organ dysfunction can be represented by an increase in the Sequential [Sepsis-related] Organ Failure Assessment (SOFA) score of 2 points or more, which is associated with an in-hospital mortality greater than 10%. Septic shock should be defined as a subset of sepsis in which particularly profound circulatory, cellular, and metabolic abnormalities are associated with a

  7. Effects of fluids on microvascular perfusion in patients with severe sepsis.

    Science.gov (United States)

    Ospina-Tascon, Gustavo; Neves, Ana Paula; Occhipinti, Giovanna; Donadello, Katia; Büchele, Gustavo; Simion, Davide; Chierego, Maria-Luisa; Silva, Tatiana Oliveira; Fonseca, Adriana; Vincent, Jean-Louis; De Backer, Daniel

    2010-06-01

    To evaluate the effects of fluid administration on microcirculatory alterations in sepsis. With a Sidestream Dark Field device, we evaluated the effects of fluids on the sublingual microcirculation in 60 patients with severe sepsis. These patients were investigated either within 24 h (early, n = 37) or more than 48 h (late, n = 23) after a diagnosis of severe sepsis. Hemodynamic and microcirculatory measurements were obtained before and 30 min after administration of 1,000 ml Ringer's lactate (n = 29) or 400 ml 4% albumin (n = 31) solutions. Fluid administration increased perfused small vessel density from 3.5 (2.9-4.3) to 4.4 (3.7-4.9) n/mm (p density from 5.3 (4.4-5.9) to 5.6 (4.8-6.3) n/mm (p fluids were not related to changes in cardiac index (R(2) = 0.05, p = ns) or mean arterial pressure (R(2) = 0.04, p = ns). In this non-randomized trial, fluid administration improved microvascular perfusion in the early but not late phase of sepsis. This effect is independent of global hemodynamic effects and of the type of solution.

  8. The Lifespan Self-Esteem Scale: Initial Validation of a New Measure of Global Self-Esteem.

    Science.gov (United States)

    Harris, Michelle A; Donnellan, M Brent; Trzesniewski, Kali H

    2018-01-01

    This article introduces the Lifespan Self-Esteem Scale (LSE), a short measure of global self-esteem suitable for populations drawn from across the lifespan. Many existing measures of global self-esteem cannot be used across multiple developmental periods due to changes in item content, response formats, and other scale characteristics. This creates a need for a new lifespan scale so that changes in global self-esteem over time can be studied without confounding maturational changes with alterations in the measure. The LSE is a 4-item measure with a 5-point response format using items inspired by established self-esteem scales. The scale is essentially unidimensional and internally consistent, and it converges with existing self-esteem measures across ages 5 to 93 (N = 2,714). Thus, the LSE appears to be a useful measure of global self-esteem suitable for use across the lifespan as well as contexts where a short measure is desirable, such as populations with short attention spans or large projects assessing multiple constructs. Moreover, the LSE is one of the first global self-esteem scales to be validated for children younger than age 8, which provides the opportunity to broaden the field to include research on early formation and development of global self-esteem, an area that has previously been limited.

  9. Revisiting global mean sea level budget closure : Preliminary results from an integrative study within ESA's Climate Change Initiative -Sea level Budget Closure-Climate Change Initiative

    Science.gov (United States)

    Palanisamy, H.; Cazenave, A. A.

    2017-12-01

    The global mean sea level budget is revisited over two time periods: the entire altimetry era, 1993-2015 and the Argo/GRACE era, 2003-2015 using the version '0' of sea level components estimated by the SLBC-CCI teams. The SLBC-CCI is an European Space Agency's project on sea level budget closure using CCI products. Over the entire altimetry era, the sea level budget was performed as the sum of steric and mass components that include contributions from total land water storage, glaciers, ice sheets (Greenland and Antarctica) and total water vapor content. Over the Argo/GRACE era, it was performed as the sum of steric and GRACE based ocean mass. Preliminary budget analysis performed over the altimetry era (1993-2015) results in a trend value of 2.83 mm/yr. On comparison with the observed altimetry-based global mean sea level trend over the same period (3.03 ± 0.5 mm/yr), we obtain a residual of 0.2 mm/yr. In spite of a residual of 0.2 mm/yr, the sea level budget result obtained over the altimetry era is very promising as this has been performed using the version '0' of the sea level components. Furthermore, uncertainties are not yet included in this study as uncertainty estimation for each sea level component is currently underway. Over the Argo/GRACE era (2003-2015), the trend estimated from the sum of steric and GRACE ocean mass amounts to 2.63 mm/yr while that observed by satellite altimetry is 3.37 mm/yr, thereby leaving a residual of 0.7 mm/yr. Here an ensemble GRACE ocean mass data (mean of various available GRACE ocean mass data) was used for the estimation. Using individual GRACE data results in a residual range of 0.5 mm/yr -1.1 mm/yr. Investigations are under way to determine the cause of the vast difference between the observed sea level and the sea level obtained from steric and GRACE ocean mass. One main suspect is the impact of GRACE data gaps on sea level budget analysis due to lack of GRACE data over several months since 2011. The current action plan

  10. Communication dated 23 June 2009 received from the Permanent Mission of the United States of America with regard to Global Initiative to Combat Nuclear Terrorism Plenary Meeting

    International Nuclear Information System (INIS)

    2009-01-01

    The Secretariat has received a communication dated 23 June 2009 from the Permanent Mission of the United States of America transmitting the 16 June 2009 message from President Barack Obama to the Global Initiative to Combat Nuclear Terrorism (GICNT) Plenary Meeting held in the Hague on 16-17 June 2009. As requested in that communication, the abovementioned message is herewith circulated for the information of all Member States

  11. Governing and Managing Customer-initiated Engineering Change – An in-depth case study of a global industrial supplier

    DEFF Research Database (Denmark)

    Sommer, Anita Friis; Storbjerg, Simon Haahr; Dukovska-Popovska, Iskra

    2013-01-01

    or externally by for instance customers. Managing initiated engineering changes is a vital source for improving product performance and radically reducing change costs. Customer-initiated engineering change is an area growing in importance decreasing product life cycles and increasing demand for customisation....... Through an in-depth case study, this paper investigates which process and what governance setup is appropriate to manage customer initiated engineering changes, referred to as request management. The paper includes a proposal for a request management framework and a task-based iterative process model...

  12. Long-term survival and healthcare utilization outcomes attributable to sepsis and pneumonia

    Directory of Open Access Journals (Sweden)

    Dick Andrew

    2012-11-01

    Full Text Available Abstract Background Hospital associated infections are major problems, which are increasing in incidence and very costly. However, most research has focused only on measuring consequences associated with the initial hospitalization. We explored the long-term consequences of infections in elderly Medicare patients admitted to an intensive care unit (ICU and discharged alive, focusing on: sepsis, pneumonia, central-line-associated bloodstream infections (CLABSI, and ventilator-associated pneumonia (VAP; the relationships between the infections and long-term survival and resource utilization; and how resource utilization was related to impending death during the follow up period. Methods Clinical data and one year pre- and five years post-index hospitalization Medicare records were examined. Hazard ratios (HR and healthcare utilization incidence ratios (IR were estimated from state of the art econometric models. Patient demographics (i.e., age, gender, race and health status and Medicaid status (i.e., dual eligibility were controlled for in these models. Results In 17,537 patients, there were 1,062 sepsis, 1,802 pneumonia, 42 CLABSI and 52 VAP cases. These subjects accounted for 62,554 person-years post discharge. The sepsis and CLABSI cohorts were similar as were the pneumonia and VAP cohorts. Infection was associated with increased mortality (sepsis HR = 1.39, P  Conclusions The infections had significant and lasting adverse consequences among the elderly. Yet, many of these infections may be preventable. Investments in infection prevention interventions are needed in both community and hospitals settings.

  13. Leukocyte counts in urine reflect the risk of concomitant sepsis in bacteriuric infants: a retrospective cohort study.

    Science.gov (United States)

    Bonsu, Bema K; Harper, Marvin B

    2007-06-13

    When urine infections are missed in febrile young infants with normal urinalysis, clinicians may worry about the risk--hitherto unverified--of concomitant invasion of blood and cerebrospinal fluid by uropathogens. In this study, we determine the extent of this risk. In a retrospective cohort study of febrile 0-89 day old infants evaluated for sepsis in an urban academic pediatric emergency department (1993-1999), we estimated rates of bacteriuric sepsis (urinary tract infections complicated by sepsis) after stratifying infants by urine leukocyte counts higher, or lower than 10 cells/hpf. We compared the global accuracy of leukocytes in urine, leukocytes in peripheral blood, body temperature, and age for predicting bacteruric sepsis. The global accuracy of each test was estimated by calculating the area under its receiver operating characteristic curve (AUC). Chi-square and Fisher exact tests compared count data. Medians for data not normally distributed were compared by the Kruskal-Wallis test. Two thousand two hundred forty-nine young infants had a normal screening dipstick. None of these developed bacteremia or meningitis despite positive urine culture in 41 (1.8%). Of 1516 additional urine specimens sent for formal urinalysis, 1279 had 0-9 leukocytes/hpf. Urine pathogens were isolated less commonly (6% vs. 76%) and at lower concentrations in infants with few, compared to many urine leukocytes. Urine leukocytes (AUC: 0.94) were the most accurate predictors of bacteruric sepsis. Infants with urinary leukocytes urinary tract infections complicated by bacteremia (N = 11) or bacterial meningitis (N = 1)--relative risk, 0 (CI:0-0.06) [RR, 0 (CI: 0-0.02), when including infants with negative dipstick]. Bands in peripheral blood had modest value for detecting bacteriuric sepsis (AUC: 0.78). Cases of sepsis without concomitant bacteriuria were comparatively rare (0.8%) and equally common in febrile young infants with low and high concentrations of urine leukocytes. In

  14. Optimizing Quality of Care and Patient Safety in Malaysia: The Current Global Initiatives, Gaps and Suggested Solutions

    OpenAIRE

    Jarrar, Mu?taman; Rahman, Hamzah Abdul; Don, Mohammad Sobri

    2015-01-01

    Background and Objective: Demand for health care service has significantly increased, while the quality of healthcare and patient safety has become national and international priorities. This paper aims to identify the gaps and the current initiatives for optimizing the quality of care and patient safety in Malaysia. Design: Review of the current literature. Highly cited articles were used as the basis to retrieve and review the current initiatives for optimizing the quality of care and patie...

  15. [Recognizing prevention and treatment of burn sepsis with the concept of holistic integrative medicine].

    Science.gov (United States)

    Huan, J N

    2017-04-20

    Sepsis remains a major cause of death in severe burns. The effect of sepsis management is influenced by its complicated pathophysiologic changes. In order to improve the outcome of burn sepsis, the predisposing factor of sepsis after burn analyzed by advanced technology, the early prevention, antibiotics therapy, and combined treatment in severe burns with sepsis are discussed using the concept of holistic integrative medicine.

  16. Biomarkers for sepsis: past, present and future

    Directory of Open Access Journals (Sweden)

    Giuseppe Chesi

    2016-12-01

    Full Text Available Sepsis is a complication of severe infection associated with high mortality and open diagnostic issues. Treatment strategies are currently limited and essentially based on prompt recognition, aggressive supportive care and early antibiotic treatment. In the last years, extensive antibiotic use has led to selection, propagation and maintenance of drug-resistant microorganisms. In this context, several biomarkers have been proposed for early identification, etiological definition, risk stratification and improving antibiotic stewardship in septic patient care. Among these molecules, only a few have been translated into clinical practice. In this review, we provided an updated overview of established and developing biomarkers for sepsis, focusing our attention on their pathophysiological profile, advantages, limitations, and appropriate evidence-based use in the management of septic patients.

  17. Sepsis and multiorgan failure following TVT procedure.

    Science.gov (United States)

    Stec, Piotr; Connell, Rowan

    2014-04-01

    Tension-free vaginal tape (TVT), is a commonly performed, low risk procedure for treatment of stress urinary incontinence (SUI). Severe complications are rare, but can be potentially life threatening. We present a case of 66 year old patient who sustained bladder perforation at the time of TVT procedure and subsequently developed sepsis rapidly leading to multi-organ failure and triggering sequence of serious complications. During her inpatient stay she required ITU admission, emergency laparotomy, TVT mesh removal, bowel resection due to ischemic colitis and anticoagulation for pulmonary embolism. Despite of clinical picture of sepsis her microbiology tests were almost consistently negative. This case emphasise importance of awareness and quick recognition of TVT related complications. Patient ultimately survived and recovered thanks to timely and coordinated management by the multidisciplinary team of doctors.

  18. Serum Neutrophil Gelatinase-Associated Lipocalin in Infants and Children with Sepsis-Related Conditions with or without Acute Renal Dysfunction

    Directory of Open Access Journals (Sweden)

    Mohammed Farouk M. Afify

    2016-01-01

    Full Text Available Purpose To validate serum neutrophil gelatinase-associated lipocalin (NGAL as an early biomarker for acute kidney injury (AKI in sepsis-related conditions and its predictive and prognostic values. Patients and Methods This study included 65 patients, who were clinically evaluated for sepsis, severe sepsis, or septic shock, and 20 apparently healthy served as controls. Patients were divided into two groups: Group I (AKI-sepsis: 65 newly admitted patients diagnosed as sepsis, who were further divided into three subgroups according to the severity: systemic inflammatory response syndrome, severe sepsis, and septic shock, and Group II (control group: 20 apparently healthy subjects matched for age and sex, serum creatinine and serum NGAL concentrations were estimated initially within 24 hours of admission and after 72 hours of admission in all patients and control groups. Results Serum NGAL increased significantly with increasing severity of renal impairment. Receiver-operating characteristic analysis suggested that serum NGAL cutoff value of 40 ng/mL within the first 24 hours of admission is highly specific and sensitive for predicting AKI, with sensitivity of 90.9% and specificity of 75.8%. Conclusion We concluded that early measurement of serum NGAL level in sepsis can serve as a clinically useful marker for early prediction of AKI and for grading of its severity.

  19. A Prospective Study to Compare the Diagnostic Value of Serum Procalcitonin and Crp in Early Onset Sepsis

    Directory of Open Access Journals (Sweden)

    Suresh Kumar Verma

    2017-10-01

    Full Text Available Introduction: Neonatal sepsis is the most common cause of death in newborns in developing countries. Prompt diagnosis is the critical determinant in its outcome. As manifestations are often vague, clinically it is difficult to differentiate sepsis from non-infective conditions. Timely diagnosis is important as delay in initiation of antimicrobials can prove fatal. On the other hand empirical use of antibiotics not only increases the risk of antibiotic resistance but also delays the diagnosis of true condition. Procalcitonin (PCT has been well evaluated in late onset sepsis but data pertaining to Early Onset Sepsis (EOS are still lacking. We compared the diagnostic value of PCT and CRP (C-Reactive Protein in EOS. Aim: To compare the diagnostic value of serum PCT and CRP in early onset sepsis. Materials and Methods: It was a prospective observational study conducted in Neonatal Intensive Care Unit of the Department of Paediatrics, Dr.S.N. Medical College, Jodhpur, India. All neonates delivered in hospitals attached to this medical college or referred here within 7 days of life and having ≥2 perinatal risk factors for sepsis or displaying clinical sepsis were included in the study. All enrolled neonates were subjected to sepsis screen, PCT levels and blood culture at birth or admission which ever was the earliest. PCT levels ≥ 0.5 ng/ml and CRP levels above 8mg/l were considered positive for EOS. Results: Sensitivity and negative predictive value of PCT were higher than CRP (90.12% vs. 50.62% and 93.33% vs. 79.06% respectively. Also it had a higher positive predictive value of 40.56% than CRP where it was 37.61%. CRP was more specific (68.95% vs. 51.4% with overall higher diagnostic accuracy (0.64 vs. 0.61 in comparison to PCT. Conclusion: PCT is more sensitive and has a higher negative predictive value than CRP in early onset sepsis. Higher positive predictive value and specificity of CRP suggest that, PCT should not be used alone rather

  20. Updated global soil map for the Weather Research and Forecasting model and soil moisture initialization for the Noah land surface model

    Science.gov (United States)

    DY, C. Y.; Fung, J. C. H.

    2016-08-01

    A meteorological model requires accurate initial conditions and boundary conditions to obtain realistic numerical weather predictions. The land surface controls the surface heat and moisture exchanges, which can be determined by the physical properties of the soil and soil state variables, subsequently exerting an effect on the boundary layer meteorology. The initial and boundary conditions of soil moisture are currently obtained via National Centers for Environmental Prediction FNL (Final) Operational Global Analysis data, which are collected operationally in 1° by 1° resolutions every 6 h. Another input to the model is the soil map generated by the Food and Agriculture Organization of the United Nations - United Nations Educational, Scientific and Cultural Organization (FAO-UNESCO) soil database, which combines several soil surveys from around the world. Both soil moisture from the FNL analysis data and the default soil map lack accuracy and feature coarse resolutions, particularly for certain areas of China. In this study, we update the global soil map with data from Beijing Normal University in 1 km by 1 km grids and propose an alternative method of soil moisture initialization. Simulations of the Weather Research and Forecasting model show that spinning-up the soil moisture improves near-surface temperature and relative humidity prediction using different types of soil moisture initialization. Explanations of that improvement and improvement of the planetary boundary layer height in performing process analysis are provided.

  1. Sepsis - tunnistaminen ja hoito ensi- ja akuuttihoidossa

    OpenAIRE

    Ansio, Susa; Saarenketo, Tiia

    2016-01-01

    Sepsiksellä tarkoitetaan tilannetta, jolloin ihmisen verenkierrossa on bakteereita ja tämä aiheuttaa vakavia oireita. Lähes kaikki sepsiksen oireet johtuvat elimistön puolustusreaktiosta bakteeria vastaan. Sepsiksen hoito on monivaiheista ja kallista, ja siihen kuolleisuus on suurta. Ensihoidossa olisi tärkeää tunnistaa mahdollinen sepsis ja aloittaa tarvittava hoito mahdollisimman varhaisessa vaiheessa. Opinnäytetyön tarkoituksena on kuvata sepsiksen tunnistamista ensihoidossa, myöhäisem...

  2. In vitro diagnosis of sepsis: a review

    Directory of Open Access Journals (Sweden)

    Guido M

    2016-03-01

    Full Text Available Marcello Guido,1 Maria Rosaria Tumolo,2 Antonella De Donno,1 Tiziano Verri,3 Francesca Serio,1 Francesco Bagordo,1 Antonella Zizza2 1Laboratory of Hygiene, Department of Biological and Environmental Sciences and Technologies, Faculty of Sciences, University of Salento, Lecce, Italy; 2National Research Council, Institute of Clinical Physiology, 3Laboratory of Physiology, Department of Biological and Environmental Sciences and Technologies, Faculty of Sciences, University of Salento, Lecce, ItalyAbstract: Sepsis, severe sepsis and septic shock, systemic inflammatory response, and other related manifestations represent a relevant medical problem with high morbidity and mortality, despite the improvements in diagnosis, treatment, and preventive measures over the last few decades. The limited knowledge of the pathophysiology in association with the lack of in vitro diagnostic methods for the certain and quick determination of the causative microbiological agents and their antibiotic resistance means the condition is still critical and of high impact in health care. The current gold standard method to detect the sepsis-causing pathogens, which is based on blood culture, is still insufficiently sensitive and slow. The new culture-independent molecular biology-based techniques can lead to the identification of a broad range of microorganisms and resistance markers within a few hours and with high sensitivity and specificity; nevertheless, limitations of, for example, the polymerase chain reaction-based methods still hamper their application in the clinical routine. This review summarizes the in vitro diagnostic methods and their approach in the clinical diagnosis of the bloodstream infections, and explores their advantages and disadvantages at the current state of the art. A quick analysis of the future prospective in multiplex technologies for microbiological diagnosis of sepsis is also provided. Keywords: PCR, PCR/ESI-MS, microarray, MALDI-TOF, next

  3. Development of Immunopathobiogenesis on SIRS-Sepsis

    Directory of Open Access Journals (Sweden)

    A Guntur Hermawan

    2009-04-01

    Full Text Available Over the past decade, sepsis has been diagnosed according to consensus guidelines established in 1991 as an infection in addition to the symptoms of systemic inflammatory response syndrome (SIRS. In addition to the previous criteria, the 2001 conference added several new diagnostic criteria for sepsis. Of particular interest was the inclusion of the biomarkers procalcitonin (PCT and C-reactive protein (CRP, despite the overall conclusion that it was premature to use biomarkers for sepsis diagnosis. The primary recommendation of the panel was the implementation of the Predisposition, insult Infection, Response, and Organ dysfunction (PIRO.The immune system has traditionally been devided into innate and adaptive components, each of which has a different role and function in defending the host against infectious agents. Stimulation of different TLRs induces distinct patterns of gene expression, which not only leads to the activation of innate immunity but also increasing evidence supports an additional critical role for TLRs in orchestrating the development of adaptive immune responses. The superantigens are able to induce toxic shock syndrome and can sometimes cause multiple organ failure via adaptive immune system. The superantigenic activity of the bacterial exotoxins can be attributed to their ability to cross-link major histocompatibility complex class II molecules on antigen-presenting cells outside the peptide groove with T-cell receptors to form a trimolecular complex. This trimolecular interaction leads to uncontrolled release of a number of proinflammatory cytokines. Proinflammatory cytokines especially IFN-γ and TNF-α, the key cytokines causing toxic shock syndrome. KEYWORDS: sepsis, innate immunity, adaptive.

  4. [Sepsis with Staphylococcus aureus in immunocompromised patients].

    Science.gov (United States)

    Petrache, Simona Magdalena; Miftode, Egidia; Vâţă, A; Petrovici, Cristina Mirela; Dorneanu, Olivia; Luca, V

    2009-01-01

    The aim of our study was to analyze clinical and biological characteristics of immunocompromised patients with staphylococcal sepsis and to compare with the same data in non-immunocompromised patients. The diagnosis of sepsis was made based on Bone criteria. MiniAPI system ID 32 STAPH was used for identification and antibiotic susceptibility was assessed by ATB STAPH method and by E-test for oxacillin and vancomycin. Among the 147 patients with Staphylococcus aureus sepsis--66.67% had concomitant immunosuppressive conditions (diabetes mellitus, liver diseases, renal failure, corticotherapy, etc). We have found a significant correlation between the immunosuppressed status and MRSA (methicillin-resistant Staphylococcus aureus) involvement (p = 0.0018) and also, between this group of patients and treatment failure (p = 0.0012). Because of the high rate of MRSA involvement in systemic infections in the Eastern region of Romania first intention treatment of patients with staphylococcal infections and conditions of immunosuppression must include antibiotics effective against methicillin-resistant strains.

  5. Sepsis due to clostridium septicum: case report

    International Nuclear Information System (INIS)

    Foga, M.M.; McGinn, G.J.; Kroeker, M.A.; Guzman, R.

    2000-01-01

    Clostridium septicum is an unusual anaerobic, gram-positive, gas-producing bacillus, which has been identified as a cause of fulminant rapidly fatal infection in humans. Infection with C. septicum usually occurs in patients with cancer, patients receiving immunosuppressive chemotherapy, or patients with a nonmalignant hematological disorder such as hemolytic uremic syndrome. C. septicum infection most commonly involves the abdomen, and a recent review article has identified 164 cases in the medical literature describing the abdominal findings in this disease. Intracranial manifestation of C. septicum infection are less common and include meningitis, cerebritis, abscess formation and pneumocephalus. There have been only 12 documented cases in the English literature describing central nervous system lesions associated with C. septicum. We present a case report of a 56-year-old man in whom septicemia due to C. septicum developed as a complication of Crohn's disease. To our knowledge, there has never been a previous report of C. septicum sepsis related to underlying Crohn's disease. Our case is also remarkable in that an intracerebral gas collection developed at the site of a mycotic infarct related to C. septicum bacteremia, Intracranial, intraparenchymal gas formation related to anaerobic infection is extremely rare; to our knowledge, this radiological finding related to C. septicum sepsis has been described in only 1 previous case report in the medical literature. We also describe the intra-abdominal manifestations of C. septicum sepsis that occurred in this patient as well as the associated radiographic and pathologic findings. (author)

  6. The AgMIP GRIDded Crop Modeling Initiative (AgGRID) and the Global Gridded Crop Model Intercomparison (GGCMI)

    Science.gov (United States)

    Elliott, Joshua; Muller, Christoff

    2015-01-01

    Climate change is a significant risk for agricultural production. Even under optimistic scenarios for climate mitigation action, present-day agricultural areas are likely to face significant increases in temperatures in the coming decades, in addition to changes in precipitation, cloud cover, and the frequency and duration of extreme heat, drought, and flood events (IPCC, 2013). These factors will affect the agricultural system at the global scale by impacting cultivation regimes, prices, trade, and food security (Nelson et al., 2014a). Global-scale evaluation of crop productivity is a major challenge for climate impact and adaptation assessment. Rigorous global assessments that are able to inform planning and policy will benefit from consistent use of models, input data, and assumptions across regions and time that use mutually agreed protocols designed by the modeling community. To ensure this consistency, large-scale assessments are typically performed on uniform spatial grids, with spatial resolution of typically 10 to 50 km, over specified time-periods. Many distinct crop models and model types have been applied on the global scale to assess productivity and climate impacts, often with very different results (Rosenzweig et al., 2014). These models are based to a large extent on field-scale crop process or ecosystems models and they typically require resolved data on weather, environmental, and farm management conditions that are lacking in many regions (Bondeau et al., 2007; Drewniak et al., 2013; Elliott et al., 2014b; Gueneau et al., 2012; Jones et al., 2003; Liu et al., 2007; M¨uller and Robertson, 2014; Van den Hoof et al., 2011;Waha et al., 2012; Xiong et al., 2014). Due to data limitations, the requirements of consistency, and the computational and practical limitations of running models on a large scale, a variety of simplifying assumptions must generally be made regarding prevailing management strategies on the grid scale in both the baseline and

  7. MicroRNA's are novel biomarkers in sepsis

    DEFF Research Database (Denmark)

    Søndergaard, Edith Smed; Alamili, Mahdi; Coskun, Mehmet

    2015-01-01

    Purpose: Sepsis is one of the leading causes of death after admission to the intensive care unit (ICU). The discovery of small non-coding microRNAs (miRs) and their correlation to sepsis has gained increasing interest. Our aim was to systematically review the literature examining the association ...... searching the computational target prediction databases. Conclusion: Various miRs are associated with sepsis, but no corresponding predictor genes were found....

  8. THE STUDY OF SERUM PROCALCITONIN LEVEL IN CORRELATION WITH SEPSIS

    Directory of Open Access Journals (Sweden)

    Girish M

    2016-09-01

    Full Text Available BACKGROUND Sepsis refers to the systemic response to serious infection. It can be response to the infection caused by any class of microorganism. The presence of bacteraemia is an indicator of disseminated infection and generally indicates a poorer prognosis when associated with localised disease. This study was undertaken to study the diagnostic and prognostic value of Procalcitonin (PCT in patients with sepsis. AIM To study the diagnostic and prognostic value of Procalcitonin (PCT in patients with sepsis. MATERIALS AND METHODS Fifty patients of age more than 18 years with sepsis admitted in KMC Hospitals, Mangalore, from August 2008 to June 2010 were subjects in the study after due permission from institution and informed consent from the patients. Diagnosis of sepsis was made according to criteria by ACCP/SCCM definition for sepsis. Definitive aetiological diagnosis requires isolation of microorganism from the blood and local site of infection, Gram stain and culture of the material from the primary site of infection for the microbial aetiology was taken. Other appropriate laboratory investigations depending upon requirement were done as mentioned in the investigations. RESULTS Out of total 50 patients, 23 patients were in group of sepsis, 14 were in group of severe sepsis while 13 had septic shock. Maximum number of the study patients were in the age group of 51-60 years. 52% of the study patients were male and 48% were female. Most common symptom in patients with sepsis was fever. Most common sign in the patient with sepsis is tachycardia followed by high temperature and then tachypnoea. Most common source of sepsis was respiratory infection followed by UTI. CONCLUSION Our data suggest the possibility that the addition of Procalcitonin into the standard workup of critically ill patients with suspected sepsis could increase diagnostic certainty and improve patient management.

  9. SIGNALING MECHANISMS IN SEPSIS-INDUCED IMMUNE DYSFUNCTION

    OpenAIRE

    Hasan, Zirak

    2013-01-01

    Sepsis and subsequent organ failure remain the major cause of mortality in intensive care units in spite of significant research efforts. The lung is the most vulnerable organ affected by early hyper-inflammatory immune response in septic patients. On the other hand, the septic insult induces immune dysfunction in later phases of sepsis which in turn increases susceptibility to infections. The aim of this thesis was to investigate early and late inflammatory mechanisms in abdominal sepsis ind...

  10. Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016.

    Science.gov (United States)

    Rhodes, Andrew; Evans, Laura E; Alhazzani, Waleed; Levy, Mitchell M; Antonelli, Massimo; Ferrer, Ricard; Kumar, Anand; Sevransky, Jonathan E; Sprung, Charles L; Nunnally, Mark E; Rochwerg, Bram; Rubenfeld, Gordon D; Angus, Derek C; Annane, Djillali; Beale, Richard J; Bellinghan, Geoffrey J; Bernard, Gordon R; Chiche, Jean-Daniel; Coopersmith, Craig; De Backer, Daniel P; French, Craig J; Fujishima, Seitaro; Gerlach, Herwig; Hidalgo, Jorge Luis; Hollenberg, Steven M; Jones, Alan E; Karnad, Dilip R; Kleinpell, Ruth M; Koh, Younsuck; Lisboa, Thiago Costa; Machado, Flavia R; Marini, John J; Marshall, John C; Mazuski, John E; McIntyre, Lauralyn A; McLean, Anthony S; Mehta, Sangeeta; Moreno, Rui P; Myburgh, John; Navalesi, Paolo; Nishida, Osamu; Osborn, Tiffany M; Perner, Anders; Plunkett, Colleen M; Ranieri, Marco; Schorr, Christa A; Seckel, Maureen A; Seymour, Christopher W; Shieh, Lisa; Shukri, Khalid A; Simpson, Steven Q; Singer, Mervyn; Thompson, B Taylor; Townsend, Sean R; Van der Poll, Thomas; Vincent, Jean-Louis; Wiersinga, W Joost; Zimmerman, Janice L; Dellinger, R Phillip

    2017-03-01

    To provide an update to "Surviving Sepsis Campaign Guidelines for Management of Sepsis and Septic Shock: 2012." A consensus committee of 55 international experts representing 25 international organizations was convened. Nominal groups were assembled at key international meetings (for those committee members attending the conference). A formal conflict-of-interest (COI) policy was developed at the onset of the process and enforced throughout. A stand-alone meeting was held for all panel members in December 2015. Teleconferences and electronic-based discussion among subgroups and among the entire committee served as an integral part of the development. The panel consisted of five sections: hemodynamics, infection, adjunctive therapies, metabolic, and ventilation. Population, intervention, comparison, and outcomes (PICO) questions were reviewed and updated as needed, and evidence profiles were generated. Each subgroup generated a list of questions, searched for best available evidence, and then followed the principles of the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system to assess the quality of evidence from high to very low, and to formulate recommendations as strong or weak, or best practice statement when applicable. The Surviving Sepsis Guideline panel provided 93 statements on early management and resuscitation of patients with sepsis or septic shock. Overall, 32 were strong recommendations, 39 were weak recommendations, and 18 were best-practice statements. No recommendation was provided for four questions. Substantial agreement exists among a large cohort of international experts regarding many strong recommendations for the best care of patients with sepsis. Although a significant number of aspects of care have relatively weak support, evidence-based recommendations regarding the acute management of sepsis and septic shock are the foundation of improved outcomes for these critically ill patients with high mortality.

  11. The New York Sepsis Severity Score: Development of a Risk-Adjusted Severity Model for Sepsis.

    Science.gov (United States)

    Phillips, Gary S; Osborn, Tiffany M; Terry, Kathleen M; Gesten, Foster; Levy, Mitchell M; Lemeshow, Stanley

    2018-05-01

    In accordance with Rory's Regulations, hospitals across New York State developed and implemented protocols for sepsis recognition and treatment to reduce variations in evidence informed care and preventable mortality. The New York Department of Health sought to develop a risk assessment model for accurate and standardized hospital mortality comparisons of adult septic patients across institutions using case-mix adjustment. Retrospective evaluation of prospectively collected data. Data from 43,204 severe sepsis and septic shock patients from 179 hospitals across New York State were evaluated. Prospective data were submitted to a database from January 1, 2015, to December 31, 2015. None. Maximum likelihood logistic regression was used to estimate model coefficients used in the New York State risk model. The mortality probability was estimated using a logistic regression model. Variables to be included in the model were determined as part of the model-building process. Interactions between variables were included if they made clinical sense and if their p values were less than 0.05. Model development used a random sample of 90% of available patients and was validated using the remaining 10%. Hosmer-Lemeshow goodness of fit p values were considerably greater than 0.05, suggesting good calibration. Areas under the receiver operator curve in the developmental and validation subsets were 0.770 (95% CI, 0.765-0.775) and 0.773 (95% CI, 0.758-0.787), respectively, indicating good discrimination. Development and validation datasets had similar distributions of estimated mortality probabilities. Mortality increased with rising age, comorbidities, and lactate. The New York Sepsis Severity Score accurately estimated the probability of hospital mortality in severe sepsis and septic shock patients. It performed well with respect to calibration and discrimination. This sepsis-specific model provides an accurate, comprehensive method for standardized mortality comparison of adult

  12. Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016.

    Science.gov (United States)

    Rhodes, Andrew; Evans, Laura E; Alhazzani, Waleed; Levy, Mitchell M; Antonelli, Massimo; Ferrer, Ricard; Kumar, Anand; Sevransky, Jonathan E; Sprung, Charles L; Nunnally, Mark E; Rochwerg, Bram; Rubenfeld, Gordon D; Angus, Derek C; Annane, Djillali; Beale, Richard J; Bellinghan, Geoffrey J; Bernard, Gordon R; Chiche, Jean-Daniel; Coopersmith, Craig; De Backer, Daniel P; French, Craig J; Fujishima, Seitaro; Gerlach, Herwig; Hidalgo, Jorge Luis; Hollenberg, Steven M; Jones, Alan E; Karnad, Dilip R; Kleinpell, Ruth M; Koh, Younsuk; Lisboa, Thiago Costa; Machado, Flavia R; Marini, John J; Marshall, John C; Mazuski, John E; McIntyre, Lauralyn A; McLean, Anthony S; Mehta, Sangeeta; Moreno, Rui P; Myburgh, John; Navalesi, Paolo; Nishida, Osamu; Osborn, Tiffany M; Perner, Anders; Plunkett, Colleen M; Ranieri, Marco; Schorr, Christa A; Seckel, Maureen A; Seymour, Christopher W; Shieh, Lisa; Shukri, Khalid A; Simpson, Steven Q; Singer, Mervyn; Thompson, B Taylor; Townsend, Sean R; Van der Poll, Thomas; Vincent, Jean-Louis; Wiersinga, W Joost; Zimmerman, Janice L; Dellinger, R Phillip

    2017-03-01

    To provide an update to "Surviving Sepsis Campaign Guidelines for Management of Sepsis and Septic Shock: 2012". A consensus committee of 55 international experts representing 25 international organizations was convened. Nominal groups were assembled at key international meetings (for those committee members attending the conference). A formal conflict-of-interest (COI) policy was developed at the onset of the process and enforced throughout. A stand-alone meeting was held for all panel members in December 2015. Teleconferences and electronic-based discussion among subgroups and among the entire committee served as an integral part of the development. The panel consisted of five sections: hemodynamics, infection, adjunctive therapies, metabolic, and ventilation. Population, intervention, comparison, and outcomes (PICO) questions were reviewed and updated as needed, and evidence profiles were generated. Each subgroup generated a list of questions, searched for best available evidence, and then followed the principles of the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system to assess the quality of evidence from high to very low, and to formulate recommendations as strong or weak, or best practice statement when applicable. The Surviving Sepsis Guideline panel provided 93 statements on early management and resuscitation of patients with sepsis or septic shock. Overall, 32 were strong recommendations, 39 were weak recommendations, and 18 were best-practice statements. No recommendation was provided for four questions. Substantial agreement exists among a large cohort of international experts regarding many strong recommendations for the best care of patients with sepsis. Although a significant number of aspects of care have relatively weak support, evidence-based recommendations regarding the acute management of sepsis and septic shock are the foundation of improved outcomes for these critically ill patients with high mortality.

  13. Impact of Prehospital Care on Outcomes in Sepsis: A Systematic Review

    Directory of Open Access Journals (Sweden)

    Michael A Smyth

    2016-06-01

    Full Text Available Introduction: Sepsis is a common and potentially life-threatening response to an infection. International treatment guidelines for sepsis advocate that treatment be initiated at the earliest possible opportunity. It is not yet clear if very early intervention by ambulance clinicians prior to arrival at hospital leads to improved clinical outcomes among sepsis patients. Methoda: We systematically searched the electronic databases MEDLINE, EMBASE, CINAHL, the Cochrane Library and PubMed up to June 2015. In addition, subject experts were contacted. We adopted the GRADE (grading recommendations assessment, development and evaluation methodology to conduct the review and follow PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses recommendations to report findings. Results: Nine studies met the eligibility criteria – one study was a randomized controlled trial while the remaining studies were observational in nature. There was considerable variation in the methodological approaches adopted and outcome measures reported across the studies. Because of these differences, the studies did not answer a unique research question and meta-analysis was not appropriate. A narrative approach to data synthesis was adopted. Conclusion: There is little robust evidence addressing the impact of prehospital interventions on outcomes in sepsis. That which is available is of low quality and indicates that prehospital interventions have limited impact on outcomes in sepsis beyond improving process outcomes and expediting the patient’s passage through the emergency care pathway. Evidence indicating that prehospital antibiotic therapy and fluid resuscitation improve patient outcomes is currently lacking. [West J Emerg Med. 2017;17(4427-437.

  14. Multiplex identification of sepsis-causing Gram-negative pathogens from the plasma of infected blood.

    Science.gov (United States)

    Chung, Boram; Park, Chulmin; Cho, Sung-Yeon; Shin, Juyoun; Shin, Sun; Yim, Seon-Hee; Lee, Dong-Gun; Chung, Yeun-Jung

    2018-02-01

    Early and accurate detection of bacterial pathogens in the blood is the most crucial step for sepsis management. Gram-negative bacteria are the most common organisms causing severe sepsis and responsible for high morbidity and mortality. We aimed to develop a method for rapid multiplex identification of clinically important Gram-negative pathogens and also validated whether our system can identify Gram-negative pathogens with the cell-free plasm DNA from infected blood. We designed five MLPA probe sets targeting the genes specific to major Gram-negative pathogens (uidA and lacY for E. coli, ompA for A. baumannii, phoE for K. pneumoniae, and ecfX for P. aeruginosa) and one set targeting the CTX-M group 1 to identify the ESBL producing Gram-negative pathogens. All six target-specific peaks were clearly separated without any non-specific peaks in a multiplex reaction condition. The minimum detection limit was 100 fg of pathogen DNA. When we tested 28 Gram-negative clinical isolates, all of them were successfully identified without any non-specific peaks. To evaluate the clinical applicability, we tested seven blood samples from febrile patients. Three blood culture positive cases showed E. coli specific peaks, while no peak was detected in the other four culture negative samples. This technology can be useful for detection of major sepsis-causing, drug-resistant Gram-negative pathogens and also the major ESBL producing Gram-negatives from the blood of sepsis patients in a clinical setting. This system can help early initiation of effective antimicrobial treatment against Gram-negative pathogens for sepsis patients, which is very crucial for better treatment outcomes. © 2017 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

  15. Shisha (waterpipe) smoking initiation among youth in Malaysia and global perspective: a scoping review (2006-2015).

    Science.gov (United States)

    Singh, S K; Enzhong, L; Reidpath, D D; Allotey, P

    2017-03-01

    To explore the initiating factors of waterpipe tobacco smoking (WTS) among youth. The analytic framework for this scoping review was performed using the methodology outlined by Arksey and O'Malley, which includes identification of the research question, study selection, charting the data, collating, summarizing and reporting the results that were primarily guided by the research question; 'what is known about the initiation of shisha smoking among youth?' Electronic databases such as Cochrane, MEDLINE and PsycINFO were used to search for relevant articles. Articles included were all in English and published within the year of 2006 to 2015. Inclusion criteria; i) age range of 10 to 29 years; ii) examined the reasons why youth started or tried WTS; iii) in full text. Therefore, 26 articles were included in this scoping review. This review has identified and classified the initiating factors of WTS among youth in four subtopics: individual factors, interpersonal influences, cigarettes and alcohol use, and media influences. Individual factors and interpersonal influences played an important role in initiation factors of WTS among youth. This study concludes that public health professionals within the Southeast Asia region need to promote innovative preventive measures through peer-to-peer led interventions that are also easily assessable on social media platforms. The public health messages need to address the misconceptions of risk associated to WTS use. Copyright © 2016 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

  16. [Value of sepsis single-disease manage system in predicting mortality in patients with sepsis].

    Science.gov (United States)

    Chen, J; Wang, L H; Ouyang, B; Chen, M Y; Wu, J F; Liu, Y J; Liu, Z M; Guan, X D

    2018-04-03

    Objective: To observe the effect of sepsis single-disease manage system on the improvement of sepsis treatment and the value in predicting mortality in patients with sepsis. Methods: A retrospective study was conducted. Patients with sepsis admitted to the Department of Surgical Intensive Care Unit of Sun Yat-Sen University First Affiliated Hospital from September 22, 2013 to May 5, 2015 were enrolled in this study. Sepsis single-disease manage system (Rui Xin clinical data manage system, China data, China) was used to monitor 25 clinical quality parameters, consisting of timeliness, normalization and outcome parameters. Based on whether these quality parameters could be completed or not, the clinical practice was evaluated by the system. The unachieved quality parameter was defined as suspicious parameters, and these suspicious parameters were used to predict mortality of patients with receiver operating characteristic curve (ROC). Results: A total of 1 220 patients with sepsis were enrolled, included 805 males and 415 females. The mean age was (59±17) years, and acute physiology and chronic health evaluation (APACHE Ⅱ) scores was 19±8. The area under ROC curve of total suspicious numbers for predicting 28-day mortality was 0.70; when the suspicious parameters number was more than 6, the sensitivity was 68.0% and the specificity was 61.0% for predicting 28-day mortality. In addition, the area under ROC curve of outcome suspicious number for predicting 28-day mortality was 0.89; when the suspicious outcome parameters numbers was more than 1, the sensitivity was 88.0% and the specificity was 78.0% for predicting 28-day mortality. Moreover, the area under ROC curve of total suspicious number for predicting 90-day mortality was 0.73; when the total suspicious parameters number was more than 7, the sensitivity was 60.0% and the specificity was 74.0% for predicting 90-day mortality. Finally, the area under ROC curve of outcome suspicious numbers for predicting 90

  17. Sepsis neonatal cervicomaxilofacial (1996 a 2005 Neonatal cervicomaxillofacial sepsis (1996-2005

    Directory of Open Access Journals (Sweden)

    Zoila del S. López Díaz

    2007-12-01

    Full Text Available Se realiza un estudio retrospectivo y longitudinal de la sepsis cervicomaxilofacial en los neonatos ingresados en nuestra unidad de cuidados intensivos en un período de 10 años. Encontramos una incidencia promedio de 1,20 por cada 100 ingresos, y el predominio del grupo de edades entre 7 y 27 días de vida (sepsis tardía, del sexo femenino y del color blanco de la piel. La celulitis facial fue ocasionada por trauma obstétrico y fue el diagnóstico más frecuente. No encontramos relación entre la presencia de sepsis y la edad gestacional, el conteo de Apgar o el peso al nacer, pues en el mayor número de niños estos resultados estuvieron dentro de límites normales. El tratamiento más utilizado fue la antibioticoterapia con asociación de 2 o más antibióticos, y entre estas la más socorrida fue la asociación de penicilina y gentamicina. Cuando la sepsis tuvo una repercusión sistémica muy grave, se utilizó además inmunoglobulinoterapia. La evolución fue satisfactoria en el 100 % de los casos, la mayoría de los cuales necesitó internación hospitalaria hasta los 7 días. No hubo fallecidos.A retrospective and longitudinal study of cervicomaxillofacial sepsis in the neonates admitted in our intensive care unit in a period of 10 years was conducted. An average incidence of 1.20 per 100 admissions, as well as the predominance of white female infants aged 7-27 days old (late sepsis were observed. Facial cellulitis was caused by obstetric trauma and it was the most frequent diagnosis. No relation between the presence of sepsis and gestational age, Apgar score, or birth weight, was found, since in most of the children these results were within the normal limits. The most used treatment was the antibiotic therapy with the association of 2 or more antibiotics. The combination of penicillin and gentamicin was the most common treatment. In those cases, among whom the sepsis had a very severe systemic repercussion, immunoglobulin therapy was

  18. Impact of Operative Delay on Sepsis and Mortality in Patients with Acute Diverticulitis

    Directory of Open Access Journals (Sweden)

    Robin F. Irons

    2017-03-01

    Full Text Available Background Ideal operative timing for non-emergent, acute diverticulitis (AD remains unclear. Medical management is initially attempted to convert a high risk urgent surgery to a less morbid elective surgery, or to avoid surgery altogether. A large proportion of patients will fail medical treatment and require colectomy. Objectives To evaluate the effect of operative delay on sepsis and mortality in patients with AD. Methods Patients from the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP database who underwent colectomy with a primary diagnosis of diverticulitis between 2005 and 2014 were included. Multiple patient variables were analyzed to see their combined effect on death and sepsis. Patients undergoing surgical intervention on hospital day 0, emergent cases and those with preoperative sepsis were excluded. The impact of operative delay on mortality and sepsis was evaluated using day from admission as the predictor of the primary outcomes. Secondary outcomes included urinary tract infection (UTI, pneumonia (PNA, need for blood transfusion, septic shock, return to the operating room, length of stay (LOS, readmission, wound dehiscence, and surgical site infections (SSI. Frequency of patient variables was recorded and a multiple variable logistic regression analysis was performed to control for possible confounders. Odds ratios (OR with 95% confidence intervals (CI were calculated for primary and secondary outcomes. Results 32,399 patients underwent colectomy for AD on hospital day 1 - 20. Adjusted for other factors, days to operation was found to be a significant predictor for death (OR = 1.038, 95% CI 1.020 - 1.057; P < 0.0001 and sepsis (OR = 1.051, 95% CI, 1.035 - 1.067; P < 0.0001. Each day in which surgical intervention was delayed was associated with a 3.8% increased risk of mortality and 5.1% increased risk of sepsis. Delay of surgery was also associated with an increased risk of blood transfusion

  19. Endothelial Activation: The Ang/Tie Axis in Sepsis

    Directory of Open Access Journals (Sweden)

    Aleksandra Leligdowicz

    2018-04-01

    Full Text Available Sepsis, a dysregulated host response to infection that causes life-threatening organ dysfunction, is a highly heterogeneous syndrome with no specific treatment. Although sepsis can be caused by a wide variety of pathogenic organisms, endothelial dysfunction leading to vascular leak is a common mechanism of injury that contributes to the morbidity and mortality associated with the syndrome. Perturbations to the angiopoietin (Ang/Tie2 axis cause endothelial cell activation and contribute to the pathogenesis of sepsis. In this review, we summarize how the Ang/Tie2 pathway is implicated in sepsis and describe its prognostic as well as therapeutic utility in life-threatening infections.

  20. Sepsis Within 30 Days of Geriatric Hip Fracture Surgery.

    Science.gov (United States)

    Bohl, Daniel D; Iantorno, Stephanie E; Saltzman, Bryan M; Tetreault, Matthew W; Darrith, Brian; Della Valle, Craig J

    2017-10-01

    Sepsis after hip fracture typically develops from one of the 3 potential infectious sources: urinary tract infection (UTI), pneumonia, and surgical site infection (SSI). The purpose of this investigation is to determine (1) the proportion of cases of sepsis that arises from each of these potential infectious sources; (2) baseline risk factors for developing each of the potential infectious sources; and (3) baseline risk factors for developing sepsis. The National Surgical Quality Improvement Program database was searched for geriatric patients (aged >65 years) who underwent surgery for hip fracture during 2005-2013. Patients subsequently diagnosed with sepsis were categorized according to concomitant diagnosis with UTI, SSI, and/or pneumonia. Multivariate regression was used to test for associations while adjusting for baseline characteristics. Among the 466 patients who developed sepsis (2.4% of all patients), 157 (33.7%) also had a UTI, 135 (29.0%) also had pneumonia, and 36 (7.7%) also had SSI. The rate of sepsis was elevated in patients who developed UTI (13.0% vs 1.7%; P sepsis (21.0% vs 3.8%; P Sepsis occurs in about 1 in 40 patients after geriatric hip fracture surgery. Of these septic cases, 1 in 3 is associated with UTI, 1 in 3 with pneumonia, and 1 in 15 with SSI. The cause of sepsis is often unknown on clinical diagnosis, and this distribution of potential infectious sources allows clinicians for direct identification and treatment. Copyright © 2017 Elsevier Inc. All rights reserved.

  1. Viewpoint on the current status of researches on sepsis

    Directory of Open Access Journals (Sweden)

    Zheng-guo WANG

    2012-11-01

    Full Text Available Sepsis is a common complication after severe trauma and burn, and also one of the main causes of death. Recently, although some new progresses were seen in antibiotic therapy, the mortality of sepsis is still on the rise, and the death rate as a result of sepsis is higher than a total of that of prostate cancer, breast cancer and AIDS. Therefore, sepsis has obviously become one of the serious ailments threatening human health. The present paper introduced the international definition of sepsis, severe sepsis and septic shock, the current researches on diagnosis and therapy, and proposed that we should not only pay attention to pathogenesis and treatment, but also to sepsis prevention in sepsis researches, and we should try to find out the breakthrough in the interaction and dynamic balance between human being and pathogenic factors. Researches on the strategies to revert strong toxicity of infectious agents to non-toxic or weak pathogenic factors, and to conduct further research concerning biological characteristics of microorganisms and mechanism of drug resistance in order to render them to lose the drug resistance ability, or to increase its sensitivity to the drugs. The above suggested approaches might form the future strategies for preventing and controlling sepsis.

  2. To create a consensus on malnutrition diagnostic criteria: A report from the Global Leadership Initiative on Malnutrition (GLIM) meeting at the ESPEN Congress 2016.

    Science.gov (United States)

    Cederholm, Tommy; Jensen, Gordon L

    2017-02-01

    During the ESPEN Congress in Copenhagen, Denmark (September 2016) representatives of the 4 largest global PEN-societies from Europe (ESPEN), USA (ASPEN), Asia (PENSA) and Latin America (FELANPE), and from national PEN-societies around the world met to continue the conversation on how to diagnose malnutrition that started during the Clinical Nutrition Week, Austin, USA (February 2016). Current thinking on diagnostic approaches was shared; ESPEN suggested a grading approach that could encompass various types of signs, symptoms and etiologies to support diagnosis. ASPEN emphasized where the parties agree; i.e. that the three major published approaches (ESPEN, ASPEN/AND and Subjective Global Assessment (SGA)) all propose weight loss as a key indicator for malnutrition. FELANPE suggested that the anticipated consensus approach needs to prioritize a diagnostic methodology that is available for everybody since resources differ globally. PENSA highlighted that BMI varies by ethnicity/race, and that sarcopenia/muscle mass evaluation is important for the diagnosis of malnutrition. A Core Working Committee of the Global Leadership Initiative on Malnutrition (GLIM) has been established (comprised of two representatives each from the 4 largest PEN-societies) that will lead consensus development in collaboration with a larger Working Group with broad global representation, using e-mail, telephone conferences, and face-to-face meetings during the up-coming ASPEN and ESPEN Congresses. Transparency and external input will be sought. Objectives include: 1. Consensus development around evidence-based criteria for broad application. 2. Promotion of global dissemination of the consensus criteria. 3. Seeking adoption by the World Health Organization (WHO) and the International Classification of Diseases (ICD). Copyright © 2017 American Society for Parenteral and Enteral Nutrition, Elsevier Ltd, European Society for Clinical Nutrition and Metabolism. Published by Elsevier Ltd.. All

  3. Pediatric sepsis in the developing world: challenges in defining sepsis and issues in post-discharge mortality.

    Science.gov (United States)

    Wiens, Matthew O; Kumbakumba, Elias; Kissoon, Niranjan; Ansermino, J Mark; Ndamira, Andrew; Larson, Charles P

    2012-01-01

    Sepsis represents the progressive underlying inflammatory pathway secondary to any infectious illness, and ultimately is responsible for most infectious disease-related deaths. Addressing issues related to sepsis has been recognized as an important step towards reducing morbidity and mortality in developing countries, where the majority of the 7.5 million annual deaths in children under 5 years of age are considered to be secondary to sepsis. However, despite its prevalence, sepsis is largely neglected. Application of sepsis definitions created for use in resource-rich countries are neither practical nor feasible in most developing country settings, and alternative definitions designed for use in these settings need to be established. It has also been recognized that the inflammatory state created by sepsis increases the risk of post-discharge morbidity and mortality in developed countries, but exploration of this issue in developing countries is lacking. Research is urgently required to characterize better this potentially important issue.

  4. Sepsis-induced myocardial dysfunction and myocardial protection from ischemia/reperfusion injury.

    Science.gov (United States)

    McDonough, Kathleen H; Virag, Jitka Ismail

    2006-01-01

    Sepsis, bacteremia and inflammation cause myocardial depression. The mechanism of the dysfunction is not clearly established partly because dysfunction can be elicited by many different mechanisms which can all manifest in disruption of myocardial mechanical function. In addition the models of sepsis and bacteremia and inflammation may vary drastically in the sequence of the coordinated immune response to the inflammatory or septic stimulus. Patterns of cytokine expression can vary as can other responses of the immune system. Patterns of neurohumoral activation in response to the stress of sepsis or bacteremia or inflammation can also vary in both magnitude of response and temporal sequence of response. Stress induced activation of the sympathetic nervous system and humoral responses to stress have a wide range of intensity that can be elicited. The fairly uniform response of the myocardium indicating cardiac dysfunction is surprisingly constant. Systolic performance, as measured by stroke volume or cardiac output and pressure work as estimated by ventricular pressure, are impaired when myocardial contraction is compromised. At times, diastolic function, assessed by ventricular relaxation and filling, is impaired. In addition to the dysfunction that occurs, there is a longer term response of the myocardium to sepsis, and this response is similar to that which is elicited in the heart by multiple brief ischemia/reperfusion episodes and by numerous pharmacological agents as well as heat stress and modified forms of lipopolysaccharide. The myocardium develops protection after an initial stress such that during a second stress, the myocardium does not exhibit as much damage as does a non-protected heart. Many agents can induce this protection which has been termed preconditioning. Both early preconditioning (protection that is measurable min to hours after the initial stimulus) and late preconditioning (protection that is measurable hours to days after the initial

  5. A hazy nuclear renaissance [Global initiatives call for developing advanced reactors and promoting nuclear education. The future is far from clear

    International Nuclear Information System (INIS)

    Murogov, V.M.

    2007-01-01

    As energy issues rise on the global agenda, what role is foreseen for nuclear power over the coming decades? Is enough being done to bring new reactors - and the knowledge to run them safely - on line when they are needed, especially in developing countries where energy demand is growing fastest? There are no easy answers, though some directions are emerging. Important developments are influencing the changing nuclear workforce, nuclear power technology, and the education of the next generation of leaders. A prime challenge is to preserve the knowledge and experience already acquired in nuclear fields so as to have a solid foundation from which to achieve safe and secure solutions. Fortunately, some global initiatives can help to pave the road to nuclear power's future and its contributions to sustainable development. They include steps taken by the IAEA, such as the International Project on Innovative Nuclear Reactors and Fuel Cycles (INPRO) and the World Nuclear University (WNU). Both initiatives are helping to raise awareness about education and knowledge management and the need for advanced nuclear technologies. Regrettably in Russia, as in the USA, Western Europe and developing nuclear countries, more attention and support is needed for nuclear education and training - and in preserving decades of nuclear experience that has fed such international initiatives. According to this author, opportunities are being lost in his view, leading to a hazy nuclear future

  6. Diagnosis of post-traumatic sepsis according to "Sepsis guidelines": a cross-sectional survey of sepsis in a trauma intensive care unit

    Directory of Open Access Journals (Sweden)

    Hao TANG

    2016-04-01

    Full Text Available Objective  To investigate the prevalence and risk factors of post-traumatic sepsis, and to evaluate the rationality of the 1992, 2001 and 2012 international sepsis definitions in diagnosing post-traumatic sepsis in a trauma intensive care unit (ICU in China. Methods  A one-day cross-sectional survey of trauma patients who met the inclusion criteria was conducted from 8:00 a.m., June 16, 2014 to 8:00 a.m., June 17, 2014 in the trauma ICU of Daping Hospital. The survey data included demographic information, clinical characteristics, pertinent scores (APACHE Ⅱ, SOFA, GCS, ISS and injury mechanism. According to the definition of sepsis as depicted in the 1992, 2001, and 2012 "International Guideline of Sepsis", the patients were divided into A, B and C groups. The infection site, infection pathogens, and key medical treatment were recorded, the infection identified, and the 28day mortality recorded. A positive pathogen culture of respiratory and urinary tracts, blood, cerebrospinal fluid, and wound secretion was adopted as the diagnostic "gold standard" for septic infection. The diagnostic sensitivity and specificity of the three versions of the guidelines were statistically analyzed and the diagnostic feasibility of each definition was assessed. Results  A total of 30 trauma patients were enrolled, twenty-three patients met the 1992 sepsis criteria, 22 met the 2001 criteria, and 20 met the 2012 criteria. The prevalence rates were 76.7%, 73.3%, and 66.7%, respectively, and there was no significant statistical difference. Four patients died within 28 days, which was in line with the diagnostic criteria of the three versions of the sepsis criteria. The 28-day mortality in the three sepsis guidelines groups was 17.4%, 18.2%, and 25.0%, respectively, indicating no statistical difference. By adopting culture-positive pathogens as the "gold standard" of septic infection, the diagnostic sensitivity and specificity of the group A was 77.8% and 25

  7. Impetigo asacause of sepsis ininfants

    Directory of Open Access Journals (Sweden)

    Alicja Moes-Wójtowicz

    2015-06-01

    Full Text Available Impetigo is a fairly common disease of the childhood. This infection exists in two distinct forms: bullous and non-bullous impetigo. In non-bullous impetigo, a tiny vesicle or pustule shows initially and after 4–6 days develops into a honey-coloured crusted plaque. Bullous impetigo is always caused by Staphylococcus aureus, a bacterium that produces exfoliative toxins (ETA and ETB. Infection is limited to the superficial layers of the skin, and skin changes typically occur on the face and limbs. The disease is most prevalent in children aged 2 to 5, but it can occur at any age. The treatment involves topical or systemic antibiotics depending on the severity of symptoms and the patient’s condition. The differential diagnosis of impetigo includes: staphylococcal scalded-skin syndrome, Herpes simplex infection, eosinophilic pustular folliculitis, epidermolysis bullosa, pemphigus and pemphigoid. The differentiation between impetigo and staphylococcal scalded-skin syndrome can be challenging. Both diseases are caused by the same strain of Staphylococcus aureus that produces exfoliative toxins. However, in impetigo toxins are produced only within skin lesions whereas in staphylococcal scalded-skin syndrome, toxins are produced in organs colonised by Staphylococcus aureus and then released systemically. In the course of staphylococcal scalded-skin syndrome severe tenderness of the skin and a positive Nikolsky’s sign are observed. The paper presents two cases of impetigo in infants. In both cases, the correct diagnosis was not established immediately, which delayed appropriate treatment. In one of the cases, due to the imprecise initial diagnosis and the lack of the holistic approach to the patient, a correct diagnosis was established so late, that a systemic infection developed.

  8. Introduction to the yogurt in nutrition initiative and the First Global Summit on the health effects of yogurt.

    Science.gov (United States)

    Donovan, Sharon M; Shamir, Raanan

    2014-05-01

    Yogurt has been part of the human diet for thousands of years, and during that time a number of health benefits have been associated with its consumption. The goal of the First Global Summit on the Health Effects of Yogurt was to review and evaluate the strength of current scientific knowledge with regard to the health benefits of yogurt and to identify areas where further research is needed. The evidence base for the benefits of yogurt in promoting bone health, maintaining health throughout the life cycle, improving diet quality, and reducing the incidence of chronic diseases, such as obesity, metabolic syndrome, and cardiovascular disease, was presented. When assessing a complex food matrix, rather than specific nutrients, scientists and consumers are faced with new challenges as to how a food item's quality or necessity would be judged as part of an individual's whole diet. To tackle this challenge, speakers described methods for assessing the nutrient density of foods and its application to yogurt, use of yogurt for lactose intolerance, and the cost-effectiveness of yogurt and dairy products in reducing health care expenses. Last, speakers described the role of dairy products in global public health and nutrition, the scientific basis for current dairy recommendations, and future scientific and policy needs related to dairy and yogurt recommendations.

  9. The NNSA global threat reduction initiative's efforts to minimize the use of highly enriched uranium for medical isotope production

    International Nuclear Information System (INIS)

    Staples, Parrish

    2010-01-01

    The mission of the National Nuclear Security Administration's (NNSA) Office of Global Threat Reduction (GTRI) is to reduce and protect vulnerable nuclear and radiological materials located at civilian sites worldwide. GTRI is a key organization for supporting domestic and global efforts to minimize and, to the extent possible, eliminate the use of highly enriched uranium (HEU) in civilian nuclear applications. GTRI implements the following activities in order to achieve its threat reduction and HEU minimization objectives: Converting domestic and international civilian research reactors and isotope production facilities from the use of HEU to low enriched uranium (LEU); Demonstrating the viability of medical isotope production technologies that do not use HEU; Removing or disposing excess nuclear and radiological materials from civilian sites worldwide; and Protecting high-priority nuclear and radiological materials worldwide from theft and sabotage. This paper provides a brief overview on the recent developments and priorities for GTRI program activities in 2010, with a particular focus on GTRI's efforts to demonstrate the viability of non-HEU based medical isotope production technologies. (author)

  10. STEAMakers- a global initiative to connect STEM career professionals with the public to inspire the next generation and nurture a creative approach to science, technology, maths & engineering

    Science.gov (United States)

    Shaw, Niamh; Sorkhabi, Elburz; Gasquez, Oriol; Yajima, Saho

    2016-04-01

    STEAMakers is a global initiative founded by Niamh Shaw, Elburz Sorkhabi, Oriol Gasquez & Saho Yajima, four alumni of The International Space University's Space Studies Programme 2015 who each shared a vision to inspire the next generation to embrace science, technology, engineering & maths (STEM) in new ways, by embedding the Arts within STEM, putting the 'A' in STEAM. STEAMakers invited STEM professionals around the world to join their community, providing training and a suite of STEAM events, specially designed to encourage students to perceive science, technology, engineering & maths as a set of tools with which to create, design, troubleshoot, innovate, and imagine. The ultimate goal of STEAMakers is to grow this community and create a global culture of non-linear learning among the next generation, to nurture within them a new multidisciplinary mindset and incubate new forms of innovation and thought leadership required for the future through the power of inspiration and creativity.

  11. The efficacy of procalcitonin as a biomarker in the management of sepsis: slaying dragons or tilting at windmills?

    Science.gov (United States)

    Sridharan, Prasanna; Chamberlain, Ronald S

    2013-12-01

    Sepsis is defined as systemic inflammatory response syndrome (SIRS) in the context of an underlying infectious process, and is associated with high rates of morbidity and mortality, particularly when initial therapy is delayed. Numerous biomarkers, including but not limited to cytokines (interleukins-2 and -6 [IL-2, IL-6] and tumor necrosis factor-α [TNF-α]), leukotrienes, acute-phase proteins (C-reactive protein [CRP]), and adhesion molecules, have been evaluated and rejected as unsuitable for the diagnosis of sepsis, predicting its severity, and guiding its treatment. Most recently, procalcitonin (PCT) has been suggested as a novel biomarker that may be useful in guiding therapeutic decision making in the management of sepsis. This article assesses critically the published literature on the clinical utility of PCT concentrations for guiding the treatment of sepsis in adult patients. A comprehensive search of all published studies of the use of serum concentrations of PCT to guide the treatment of sepsis in adult patients (1996 to 2011) was conducted with PubMed and Google Scholar. The search focused on the value of PCT concentrations to guide the diagnosis, prognosis, monitoring, and escalation and de-escalation of antbiotic therapy in these patients. Keywords searched included "procalcitonin," "sepsis," "sepsis biomarker," "sepsis diagnosis," "sepsis prognosis," "sepsis mortality," "antibiotic escalation," "antibiotic de-escalation," "antibiotic duration," and "antimicrobial stewardship." Forty-six trials evaluating the efficacy of PCT concentrations in diagnosing sepsis have been published, with 39 of these trials yielding positive results and 7 yielding negative results. Wanner et al. published the largest study (n=405) demonstrating that peak PCT concentrations occur early after injury in both patients with sepsis and those with multiple organ dysfunction syndrome (MODS). Among 17 trials assessing the prognostic value of PCT concentrations with regard to

  12. Efficacy and effectiveness of recombinant human activated protein C in severe sepsis of adults

    Directory of Open Access Journals (Sweden)

    Greiner, Wolfgang

    2007-07-01

    risk of death, but not in patients with a low risk of death. Bleeding events and mortality are considerable higher in studies in the usual care setting compared to clinical trials. In a number of subgroup analyses, both retrospectively and prospectively performed, DAA was not significantly associated with improved survival. The role of concurrent therapy with heparin is unclear, as DAA was only effective in reducing mortality in patients without heparin. There was no significant long-term survival benefit associated with DAA beyond the initial 28 days. Also, there is a lack of studies assessing prospectively functional ability, health-related quality of life, and morbidity in the long-term. In the subgroup of patients with a high risk of death, therapy with DAA ranges at the top level of generally accepted costs per LYG or QALY, in the subgroup of patients with low risk of death, cost effectiveness ratios were higher than those accepted for resource allocation. Conclusion: Due to the lack of effectiveness of DAA in patients with severe sepsis and a low risk of death as well as with regard to the high bleeding rates in the usual care setting, indication for DAA therapy. In those subgroups with no significant survival benefit, prospective studies with adequate sample size are needed. With regard to the heterogeneity of severe sepsis, comorbidity and concurrent medication have to be taken into account in further studies. Studies with alternative study designs, for example studies comparing heparin alone or in combination with DAA to placebo, as well as studies conducted by different researchers are needed. Costs induced by bleeding events should also be taken into account in future studies, as bleeding events are the major complica-tion associated the DAA therapy.

  13. Quality criteria for micronutrient powder products: report of a meeting organized by the World Food Programme and Sprinkles Global Health Initiative.

    Science.gov (United States)

    de Pee, Saskia; Kraemer, Klaus; van den Briel, Tina; Boy, Erick; Grasset, Christopher; Moench-Pfanner, Regina; Zlotkin, Stanley; Bloem, Martin W

    2008-09-01

    Distribution of micronutrient powder (MNP), also known as Sprinkles", is becoming a preferred strategy for addressing micronutrient deficiencies. In response, different formulations are being developed, different producers manufacture MNP and several organizations coordinate distribution. However, as yet, the supply of MNP as well as experience with large-scale MNP programs is limited. To facilitate expansion of MNP use such that acceptability and compliance are high and effectiveness maintained, product quality, of both powder and packaging, good advocacy among decision makers, and providing good information to the target population are crucial. A meeting was organized in Toronto by the Sprinkles Global Health Initiative and the World Food Programme to review and reach consensus on quality criteria for composition, manufacturing, packaging, and labeling of MNP propose guidelines for wide-scale production, and discuss MNP program experience. It was recognized that the durability of some of the more sensitive micronutrients in their powdered form in the harsh climatic conditions of many countries has implications for formulation, packaging, storage, and handling of the MNP product. A question-and-answer manual would greatly facilitate program design and implementation. It was agreed to form an interim Technical Advisory Group to prepare for formation of a Technical Advisory Group with agreed-upon tasks and responsibilities. The MNP manufacturing manual of the Sprinkles Global Health Initiative can continue to be used, with reference to the recommendations from the Toronto Meeting outlined in this paper. Meanwhile, the Sprinkles Global Health Initiative will not place any encumbrances on production using its manual; however, the brand name Sprinkles" will stay protected under various trademark laws.

  14. An Initial Assessment of the Impact of CYGNSS Ocean Surface Wind Assimilation on Navy Global and Mesoscale Numerical Weather Prediction

    Science.gov (United States)

    Baker, N. L.; Tsu, J.; Swadley, S. D.

    2017-12-01

    We assess the impact of assimilation of CYclone Global Navigation Satellite System (CYGNSS) ocean surface winds observations into the NAVGEM[i] global and COAMPS®[ii] mesoscale numerical weather prediction (NWP) systems. Both NAVGEM and COAMPS® used the NRL 4DVar assimilation system NAVDAS-AR[iii]. Long term monitoring of the NAVGEM Forecast Sensitivity Observation Impact (FSOI) indicates that the forecast error reduction for ocean surface wind vectors (ASCAT and WindSat) are significantly larger than for SSMIS wind speed observations. These differences are larger than can be explained by simply two pieces of information (for wind vectors) versus one (wind speed). To help understand these results, we conducted a series of Observing System Experiments (OSEs) to compare the assimilation of ASCAT wind vectors with the equivalent (computed) ASCAT wind speed observations. We found that wind vector assimilation was typically 3 times more effective at reducing the NAVGEM forecast error, with a higher percentage of beneficial observations. These results suggested that 4DVar, in the absence of an additional nonlinear outer loop, has limited ability to modify the analysis wind direction. We examined several strategies for assimilating CYGNSS ocean surface wind speed observations. In the first approach, we assimilated CYGNSS as wind speed observations, following the same methodology used for SSMIS winds. The next two approaches converted CYGNSS wind speed to wind vectors, using NAVGEM sea level pressure fields (following Holton, 1979), and using NAVGEM 10-m wind fields with the AER Variational Analysis Method. Finally, we compared these methods to CYGNSS wind speed assimilation using multiple outer loops with NAVGEM Hybrid 4DVar. Results support the earlier studies suggesting that NAVDAS-AR wind speed assimilation is sub-optimal. We present detailed results from multi-month NAVGEM assimilation runs along with case studies using COAMPS®. Comparisons include the fit of

  15. A Multicenter Survey of House Staff Knowledge About Sepsis and the "Surviving Sepsis Campaign Guidelines for Management of Severe Sepsis and Septic Shock".

    Science.gov (United States)

    Watkins, Richard R; Haller, Nairmeen; Wayde, Melinda; Armitage, Keith B

    2017-01-01

    We aimed to assess the knowledge, attitudes, and perceptions of resident physicians regarding sepsis in general and the Surviving Sepsis Campaign Guidelines in particular. After institutional review board approval, we surveyed internal medicine (IM) and emergency medicine (EM) house staff from 3 separate institutions. House staff were notified of the survey via e-mail from their residency director or chief resident. The survey was Internet-based (using http://www.surveymonkey.com ), voluntary, and anonymous. The Surviving Sepsis Campaign Guidelines were used to develop the survey. The survey was open between December 2015 and April 2016. No incentives for participation were given. Reminder e-mails were sent approximately every 3 to 4 weeks to all eligible participants. Comparisons of responses were evaluated using the N-1 2-proportion test. A total of 133 responses were received. These included 84 from IM house staff, 27 from EM house staff, and 22 who selected "other." Eighty (101/126) percent reported managing at least 1 patient with sepsis in the preceding 30 days, 85% (97/114) rated their knowledge of the Surviving Sepsis Guidelines as "very familiar" or at least "somewhat familiar," and 84% (91/108) believed their training in the diagnosis and management of sepsis was "excellent" or at least "good." However, 43% (47/108) reported not receiving any feedback on their treatment of patients with sepsis in the last 30 days, while 24% (26/108) received feedback once. Both IM and EM house staff received comparable rates of feedback (62% vs 48%, respectively; P = .21). For the 3 questions that directly tested knowledge of the guidelines, the scores of the IM and EM house staff were similar. Notably, house staff on the Surviving Sepsis Campaign Guidelines is warranted, along with more consistent feedback regarding their diagnosis and management of sepsis.

  16. Severe sepsis secondary to emphysematous cystitis

    Directory of Open Access Journals (Sweden)

    M.M. Gargouri

    2015-03-01

    Full Text Available Emphysematous cystitis (EC is a rare, rapidly progressive infection characterized by gas formation within the bladder wall. Gas production is mainly due to fermentation of glucose or albumin by the pathogenic organisms. We present the case of a patient with EC who presented with severe sepsis of unknown origin. He was also found to have two vesical calculi and a horseshoe kidney. EC was diagnosed on ultrasonography which showed circumferential, acoustic shadowing around the bladder wall. Computed tomography (CT confirmed the diagnosis. Rapid healing could be achieved with appropriate antibiotics and bladder drainage. Endoscopic disintegration of the stones was performed three weeks later, and follow-up was uneventful.

  17. Biomarkers of Endothelial Cell Activation in Early Sepsis

    DEFF Research Database (Denmark)

    Skibsted, Simon; Jones, Alan E; Puskarich, Michael A

    2013-01-01

    and mortality in sepsis and that (ii) soluble fms-like tyrosine kinase 1 (sFlt-1) holds promise as a novel prognostic marker in sepsis. METHODS: This was a prospective, multicenter, observational study of a convenience sample of emergency department (ED) patients with a suspected infection presenting to one...

  18. Neonatal sepsis: Highlighting the principles of diagnosis and ...

    African Journals Online (AJOL)

    Neonatal sepsis is a clinical syndrome consisting of nonspecific symptoms and signs of infection, accompanied by a bacteraemia in the first 28 days of life. The risk of neonatal sepsis and death increases with decreasing birth weight and gestational age. South African data have reported the overall incidence of neonatal ...

  19. Diagnostic methods in sepsis: the need of speed

    Directory of Open Access Journals (Sweden)

    Fernando Rodrigues Coelho

    2012-08-01

    Full Text Available OBJECTIVE: Sepsis is a common condition encountered in hospital environments. There is no effective treatment for sepsis, and it remains an important cause of death at intensive care units. This study aimed to discuss some methods that are available in clinics, and tests that have been recently developed for the diagnosis of sepsis. METHODS: A systematic review was performed through the analysis of the following descriptors: sepsis, diagnostic methods, biological markers, and cytokines. RESULTS: The deleterious effects of sepsis are caused by an imbalance between the invasiveness of the pathogen and the ability of the host to mount an effective immune response. Consequently, the host's immune surveillance fails to eliminate the pathogen, allowing it to spread. Moreover, there is a pro-inflammatory mediator release, inappropriate activation of the coagulation and complement cascades, leading to dysfunction of multiple organs and systems. The difficulty achieve total recovery of the patient is explainable. There is an increased incidence of sepsis worldwide due to factors such as aging population, larger number of surgeries, and number of microorganisms resistant to existing antibiotics. CONCLUSION: The search for new diagnostic markers associated with increased risk of sepsis development and molecules that can be correlated to certain steps of sepsis is becoming necessary. This would allow for earlier diagnosis, facilitate patient prognosis characterization, and prediction of possible evolution of each case. All other markers are regrettably constrained to research units.

  20. Serum procalcitonin as an early marker of neonatal sepsis | Ballot ...

    African Journals Online (AJOL)

    Background. It has recently been suggested that procalcitonin (PCT) is of value in the diagnosis of neonatal sepsis, with varying results. This study was to evaluate the role of PCT as a single early marker of neonatal sepsis. Setting. Neonatal Unit, Johannesburg Hospital, and Microbiology Laboratory, National Health ...

  1. Trends in profiles of bacteria causing neonatal sepsis in Central ...

    African Journals Online (AJOL)

    Developing countries suffer from a huge burden of neonatal sepsis. Neonatal mortality and long term sequelae or morbidity portends huge costs for the poor Nigerian economy. We identified trends in bacterial agents implicated in neonatal sepsis and their antibiotic susceptibility profiles at the National Hospital Abuja over ...

  2. Seasonal Variation in the Emergency Department Prevalence Of Sepsis

    LENUS (Irish Health Repository)

    McNevin, C

    2018-05-01

    The incidence and mortality of sepsis and severe sepsis in hospitalised patients is seasonal and consistently highest during the winter. The primary aim of this study was to measure the seasonal variation in the prevalence of emergency department (ED) patients with sepsis. This cross-sectional study was performed over two four-week periods in the summer and in the winter, respectively. The clinical records of all patients presenting to the ED during the study periods were retrospectively screened to determine if they met the criteria for “uncomplicated” sepsis and severe sepsis or septic shock. The prevalence of “uncomplicated” sepsis was higher in the winter (43.9 per 1000) compared to the summer (30.7 per 1000). The prevalence of severe sepsis or septic shock was also higher in the winter (17.7 per 1000) compared to the summer (11.7 per 1000). This quantitatively demonstrates the increased ED burden of sepsis in the winter that can be used to inform healthcare planning and resource allocation.

  3. Treatment of neonatal sepsis with intravenous immune globulin

    DEFF Research Database (Denmark)

    Brocklehurst, Peter; Farrell, Barbara; King, Andrew

    2011-01-01

    Neonatal sepsis is a major cause of death and complications despite antibiotic treatment. Effective adjunctive treatments are needed. Newborn infants are relatively deficient in endogenous immunoglobulin. Meta-analyses of trials of intravenous immune globulin for suspected or proven neonatal sepsis...

  4. Disseminated intravascular coagulation in meningococcal sepsis. Case 7

    NARCIS (Netherlands)

    Zeerleder, S.; Zürcher Zenklusen, R.; Hack, C. E.; Wuillemin, W. A.

    2003-01-01

    We report on a man (age: 49 years), who died from severe meningococcal sepsis with disseminated intravascular coagulation (DIC), multiple organ dysfunction syndrome and extended skin necrosis. We discuss in detail the pathophysiology of the activation of coagulation and fibrinolysis during sepsis.

  5. Letter to editor Platelet volume evaluation in patients with sepsis ...

    African Journals Online (AJOL)

    I have read the article published by Guclu et al. with a great interest.1 They examined platelet indices in patients with sepsis. Mean platelet volume (MPV) and platelet distribution width (PDW) were significantly higher in patients with sepsis than in controls. MPV and PDW were significantly higher in patients with severe ...

  6. An unusual case of sepsis and petechial rash.

    Science.gov (United States)

    Gardner, Christina

    2017-05-01

    This article describes a man who presented to the ED in acute distress with signs and symptoms of sepsis, pneumonia, and a new petechial rash on his chest. He was eventually diagnosed with Rocky Mountain spotted fever. Aggressive treatment of sepsis and timely administration of empiric antibiotics were lifesaving in this situation.

  7. Patients with sepsis exhibit increased mitochondrial respiratory capacity in peripheral blood immune cells

    DEFF Research Database (Denmark)

    Sjövall, Fredrik; Morota, Saori; Persson, Johan Mikael

    2013-01-01

    to 7). Mitochondrial DNA (mtDNA), cytochrome c (Cyt c), and citrate synthase (CS) were measured as indicators of cellular mitochondrial content. RESULTS: In intact PBICs with endogenous substrates, a gradual increase in cellular respiration reached 173% of controls after 1 week (P = 0......INTRODUCTION: In sepsis, mitochondria have been associated with both initial dysfunction and subsequent upregulation (biogenesis). However, the evolvement of mitochondrial function in sepsis over time is largely unknown, and we therefore investigated mitochondrial respiration in peripheral blood.......001). In permeabilized cells, respiration using substrates of complex I, II, and IV were significantly increased days 1 to 2, reaching 137%, 130%, and 173% of controls, respectively. In parallel, higher levels of CS activity, mtDNA, and Cyt c content in PBICs (211%, 243%, and 331% of controls for the respective...

  8. Effect of plasmapheresis on the immune system in endotoxin-induced sepsis

    DEFF Research Database (Denmark)

    Toft, P; Schmidt, R; Broechner, A C

    2008-01-01

    BACKGROUND: It has been proposed that plasmapheresis is most effective when applied early in Gram-negative sepsis. We therefore studied the effect of early plasmapheresis on immunity in experimental Escherichia coli endotoxin-induced sepsis. METHODS: 20 pigs received 30 microg/kg of E. coli...... endotoxin. 40 min later, half of the pigs were treated with plasmapheresis which lasted 4 h. The adhesion molecules, the oxidative burst, the number of neutrophils in blood and lungs, and cytokines were measured. RESULTS: Infusion of endotoxin was associated with activation of adhesion molecules increased...... oxidative burst, increased concentration of cytokine, and accumulation of granulocytes in lung tissue. Plasmapheresis reduced the oxidative burst, and there was a tendency towards a reduced accumulation of granulocytes in the lung. CONCLUSION: Though plasmapheresis was initiated early after the endotoxin...

  9. The role of Imperial Oil Limited in the global priorities and local initiatives of Exxon Corporation R and D

    International Nuclear Information System (INIS)

    Seguin-Dulude, L.; Desranleau, C.; Fortier, Y.

    1997-01-01

    Research and development expenditures by Exxon Corporation, one of the major multi-national oil companies, was studied in an effort to demonstrate the manner in which research and development is planned, managed and financed on a global scale, and to discern the role played in the worldwide network of Exxon Corporation laboratories by Exxon's main Canadian affiliate, Imperial Oil Limited of Sarnia. The findings are based upon close examination of all public documents regarding Exxon and its affiliates since 1882 to 1975, and interviews with research personnel. It was described how in the 1920s, the Sarnia research centre of Imperial Oil began to develop its expertise in lubricant research, earning a world research mandate in 1967 with exclusive rights in this area for the entire Exxon Corporation. It is evident that by being able to concentrate in areas that took advantage of their technological competence and expertise while, on the other hand, ensuring that the processes and products generated by the whole network of laboratories were available and adapted to the Canadian context, the commercial impact of Imperial's research and development efforts have been greatly enhanced by its affiliation with the large multinational company. 27 refs

  10. Global faculty development: lessons learned from the Foundation for Advancement of International Medical Education and Research (FAIMER) initiatives.

    Science.gov (United States)

    Burdick, William P

    2014-08-01

    Foundation for Advancement of International Medical Education and Research (FAIMER) faculty development programs have operated since 2001 and are designed to overcome many of the challenges inherent in global health collaborations, including alignment with local needs, avoiding persistent dependency, and development of trust. FAIMER fellowship programs, developed for midcareer faculty members in all health professions from around the world, share goals of strengthening knowledge and skills in education leadership, education methods, and project management and evaluation. Building community is another explicit goal that allows participants to support and learn from each other.The author recommends several practices for successful international collaborations based on 13 years of experience with FAIMER fellowships. These include using authentic education projects to maintain alignment with local needs and apply newly acquired knowledge and skills, teaching leadership across cultures with careful communication and adaptation of concepts to local environments, cultivating a strong field of health professions education to promote diffusion of ideas and advocate for policy change, intentionally promoting field development and leadership to reduce dependency, giving generously of time and resources, learning from others as much as teaching others, and recognizing that effective partnerships revolve around personal relationships to build trust. These strategies have enabled the FAIMER fellowship programs to stay aligned with local needs, reduce dependency, and maintain trust.

  11. Epidemiología de la sepsis en unidades de cuidado intensivo en Colombia

    Directory of Open Access Journals (Sweden)

    Guillermo Ortíz

    2014-03-01

    Full Text Available Introducción. Actualmente no se cuenta con muchos datos disponibles sobre la sepsis en los países en desarrollo y especialmente en América Latina. Objetivo. Este estudio tuvo como objetivo determinar la frecuencia, las características clínicas y epidemiológicas y las consecuencias de la sepsis en una población de pacientes que requirieron ingreso en algunas unidades colombianas de cuidados intensivos. Materiales y métodos. Este fue un análisis secundario de un estudio prospectivo realizado en un período de seis meses contados a partir del 1° de septiembre de 2007 hasta el 28 de febrero del 2008 en diez unidades médico-quirúrgicas de cuidados intensivos de cuatro ciudades de Colombia. Los pacientes se consideraron elegibles si tenían un diagnóstico probable o confirmado de infección según los registros médicos. Se registraron las características demográficas, los diagnósticos de primer ingreso y las enfermedades concomitantes, el estado clínico y la sepsis, sepsis grave o choque séptico. Resultados. Durante el período de estudio, 826 pacientes fueron ingresados en las unidades de cuidados intensivos seleccionadas para el estudio. De estos pacientes, 421 (51 % desarrollaron sepsis en la comunidad, 361 (44 % en la unidad de cuidados intensivos y 44 (5 % durante la hospitalización en la sala general; 253 pacientes (30,6 % presentaron afectación de un órgano del sistema: 20 % tuvo problemas respiratorios, seguido por problemas en los riñones y el sistema nervioso central con 3,4 % y 2,7 %, respectivamente. Conclusiones. En la muestra de pacientes sépticos, la prevalencia de la sepsis, así como de la mortalidad global, en los pacientes tratados en la unidad de cuidados intensivos fue similar a la reportada en otros estudios.

  12. Inadequate exercise as a risk factor for sepsis mortality.

    Science.gov (United States)

    Williams, Paul T

    2013-01-01

    Test whether inadequate exercise is related to sepsis mortality. Mortality surveillance of an epidemiological cohort of 155,484 National Walkers' and Runners' Health Study participants residing in the United States. Deaths were monitored for an average of 11.6-years using the National Death index through December 31, 2008. Cox proportional hazard analyses were used to compare sepsis mortality (ICD-10 A40-41) to inadequate exercise (<1.07 METh/d run or walked) as measured on their baseline questionnaires. Deaths occurring within one year of the baseline survey were excluded. Sepsis was the underlying cause in 54 deaths (sepsis(underlying)) and a contributing cause in 184 deaths (sepsis(contributing)), or 238 total sepsis-related deaths (sepsis(total)). Inadequate exercise was associated with 2.24-fold increased risk for sepsis(underlying) (95%CI: 1.21 to 4.07-fold, P = 0.01), 2.11-fold increased risk for sepsis(contributing) (95%CI: 1.51- to 2.92-fold, P<10(-4)), and 2.13-fold increased risk for sepsis(total) (95%CI: 1.59- to 2.84-fold, P<10(-6)) when adjusted for age, sex, race, and cohort. The risk increase did not differ significantly between runners and walkers, by sex, or by age. Sepsis(total) risk was greater in diabetics (P = 10(-5)), cancer survivors (P = 0.0001), and heart attack survivors (P = 0.003) and increased with waist circumference (P = 0.0004). The sepsis(total) risk associated with inadequate exercise persisted when further adjusted for diabetes, prior cancer, prior heart attack and waist circumference, and when excluding deaths with cancer, or cardiovascular, respiratory, or genitourinary disease as the underlying cause. Inadequate exercise also increased sepsis(total) risk in 2163 baseline diabetics (4.78-fold, 95%CI: 2.1- to 13.8-fold, P = 0.0001) when adjusted, which was significantly greater (P = 0.03) than the adjusted risk increase in non-diabetics (1.80-fold, 95%CI: 1.30- to 2.46-fold, P = 0

  13. Twenty-Eight Years of Poliovirus Replication in an Immunodeficient Individual: Impact on the Global Polio Eradication Initiative.

    Science.gov (United States)

    Dunn, Glynis; Klapsa, Dimitra; Wilton, Thomas; Stone, Lindsay; Minor, Philip D; Martin, Javier

    2015-08-01

    There are currently huge efforts by the World Health Organization and partners to complete global polio eradication. With the significant decline in poliomyelitis cases due to wild poliovirus in recent years, rare cases related to the use of live-attenuated oral polio vaccine assume greater importance. Poliovirus strains in the oral vaccine are known to quickly revert to neurovirulent phenotype following replication in humans after immunisation. These strains can transmit from person to person leading to poliomyelitis outbreaks and can replicate for long periods of time in immunodeficient individuals leading to paralysis or chronic infection, with currently no effective treatment to stop excretion from these patients. Here, we describe an individual who has been excreting type 2 vaccine-derived poliovirus for twenty eight years as estimated by the molecular clock established with VP1 capsid gene nucleotide sequences of serial isolates. This represents by far the longest period of excretion described from such a patient who is the only identified individual known to be excreting highly evolved vaccine-derived poliovirus at present. Using a range of in vivo and in vitro assays we show that the viruses are very virulent, antigenically drifted and excreted at high titre suggesting that such chronic excreters pose an obvious risk to the eradication programme. Our results in virus neutralization assays with human sera and immunisation-challenge experiments using transgenic mice expressing the human poliovirus receptor indicate that while maintaining high immunisation coverage will likely confer protection against paralytic disease caused by these viruses, significant changes in immunisation strategies might be required to effectively stop their occurrence and potential widespread transmission. Eventually, new stable live-attenuated polio vaccines with no risk of reversion might be required to respond to any poliovirus isolation in the post-eradication era.

  14. Plasma procalcitonin concentrations are increased in dogs with sepsis

    Science.gov (United States)

    Goggs, Robert; Milloway, Matthew; Troia, Roberta; Giunti, Massimo

    2018-01-01

    Sepsis, the life-threatening organ dysfunction caused by a dysregulated host response to infection, is difficult to identify and to prognosticate for. In people with sepsis, procalcitonin (PCT) measurement aids diagnosis, enables therapeutic monitoring and improves prognostic accuracy. This study used a commercial canine PCT assay to measure plasma PCT concentrations in dogs with gastric dilatation volvulus (GDV) syndrome and in dogs with sepsis. It was hypothesised that dogs with GDV syndrome and with sepsis have greater plasma PCT concentrations than healthy dogs and that dogs with sepsis have greater PCT concentrations than dogs with GDV syndrome. Before analysing canine plasma samples, the ability of the assay to identify canine PCT, in addition to assay imprecision and the lower limit of detection were established. The assay had low imprecision with coefficients of variation ≤4.5 per cent. The lower limit of detection was 3.4 pg/ml. Plasma PCT concentrations were measured in 20 dogs with sepsis, in 32 dogs with GDV syndrome and in 52 healthy dogs. Median (IQR) PCT concentration in dogs with sepsis 78.7 pg/ml (39.1–164.7) was significantly greater than in healthy dogs 49.8 pg/ml (36.2–63.7) (P=0.019), but there were no significant differences between PCT concentrations in dogs with GDV syndrome and controls (P=0.072) or between dogs with sepsis and GDV syndrome (P=1.000). Dogs with sepsis have significantly increased plasma PCT concentrations compared with healthy dogs, although considerable overlap between these populations was identified. Future investigations should confirm this finding in other populations and evaluate the diagnostic and prognostic value of PCT in dogs with sepsis. PMID:29682292

  15. Does Dexamethasone Helps in Meningococcal Sepsis?

    Science.gov (United States)

    Tolaj, Ilir; Ramadani, Hamdi; Mehmeti, Murat; Gashi, Hatixhe; Kasumi, Arbana; Gashi, Visar; Jashari, Haki

    2017-06-01

    Prompt recognition and aggressive early treatment are the only effective measures against invasive meningococcal disease (IMD). Anti-inflammatory adjunctive treatment remains controversial and difficult to assess in patients with IMD. The purpose of this study was to evaluate the effect of dexamethasone (DXM) as adjunctive treatment in different clinical forms of IMD, and attempt to answer if DXM should be routinely used in the treatment of IMD. In this non-interventional clinical study (NIS), 39 patients with meningococcal septicaemia with or without of meningitis were included, and compared regarding the impact of dexamethasone (DXM), as an adjunctive treatment, on the outcome of IMD. SPSS statistics is used for statistical processing of data. Thirty (76.9%) patients with IMD had sepsis and meningitis, and 9 (23.1%) of them had sepsis alone. Dexamethasone was used in 24 (61.5%) cases, in both clinical groups. The overall mortality rate was 10.3%. Pneumonia was diagnosed in 6 patients (15.4%), arthritis in 3 of them (7.7%), and subdural effusion in one patient (2.6%). The data showed a significant statistical difference on the length of hospitalization, and WBC normalization in groups of patients treated with DXM. The use of DXM as adjunctive therapy in invasive meningococcal disease has a degree of proven benefits and no harmful effects. In fighting this very dangerous and complex infection, even a limited benefit is sufficient to recommend the use of DXM as adjunctive treatment in invasive meningococcal disease.

  16. Sepsis and cytomegalovirus: foes or conspirators?

    Science.gov (United States)

    Mansfield, Sara; Grießl, Marion; Gutknecht, Michael; Cook, Charles H

    2015-06-01

    Cytomegalovirus (CMV) reactivation in non-immune-suppressed critically ill patients is an area of increasing interest. CMV has long been appreciated as a pathogen in immunocompromised hosts. CMV reactivates in approximately one-third of latently infected non-immune-suppressed hosts during critical illness; however, its role as a pathogen in these patients remains unclear. CMV reactivation has been linked to bacterial sepsis and likely results from inflammation, transient immune compromise, and viral epigenetic changes. While CMV may improve immune response to some bacterial infections, other data suggest that CMV induces exaggerated responses to severe infections that may be harmful to latently infected hosts. These results also suggest that previous infection history may explain significant differences seen between human septic responses and murine models of sepsis. While critically ill human hosts clearly have worse outcomes associated with CMV reactivation, determining causality remains an area of investigation, with randomized control trials currently being performed. Here we review the current literature and highlight areas for future investigation.

  17. Management of severe sepsis: advances, challenges, and current status

    Directory of Open Access Journals (Sweden)

    Martin-Loeches I

    2015-04-01

    Full Text Available Ignacio Martin-Loeches,1 Mitchell M Levy,2 Antonio Artigas31Multidisciplinary Intensive Care Research Organization (MICRO, St James’s University Hospital, Trinity Centre for Health Sciences, Dublin, Ireland; 2Brown University, Providence, RI, USA; 3Critical Care Center, CIBER Enfermedades Respiratorias, Sabadell Hospital, Corporació Sanitaria Universitaria Parc Tauli, Autonomous University of Barcelona, Barcelona, SpainAbstract: The complexity of treating severe sepsis and septic shock has been elucidated in myriad studies, particularly in the past 10 years. The development of clinical guidelines, insight into the effect of bundle elements, and results of clinical trials have brought to light further opportunities and questions in the approach to pharmaceutical interventions for the global challenge to save lives and reduce healthcare costs. Therapeutic interventions including fluid resuscitation, hemodynamic monitoring, glycemic control, corticosteroids, and antimicrobial therapy and stewardship inform outcomes. Research on biomarkers, use of mesenchymal stem cells, blood purification, immunoglobulins, and antioxidative treatments apropos the immune response may soon yield viable therapies.Keywords: sepsis, septic shock, guidelines, critical care, biomarkers, surviving sepsis campaign

  18. Glycaemic variability in patients with severe sepsis or septic shock admitted to an Intensive Care Unit.

    Science.gov (United States)

    Silveira, L M; Basile-Filho, A; Nicolini, E A; Dessotte, C A M; Aguiar, G C S; Stabile, A M

    2017-08-01

    Sepsis is associated with morbidity and mortality, which implies high costs to the global health system. Metabolic alterations that increase glycaemia and glycaemic variability occur during sepsis. To verify mean body glucose levels and glycaemic variability in Intensive Care Unit (ICU) patients with severe sepsis or septic shock. Retrospective and exploratory study that involved collection of patients' sociodemographic and clinical data and calculation of severity scores. Glycaemia measurements helped to determine glycaemic variability through standard deviation and mean amplitude of glycaemic excursions. Analysis of 116 medical charts and 6730 glycaemia measurements revealed that the majority of patients were male and aged over 60 years. Surgical treatment was the main reason for ICU admission. High blood pressure and diabetes mellitus were the most usual comorbidities. Patients that died during the ICU stay presented the highest SOFA scores and mean glycaemia; they also experienced more hypoglycaemia events. Patients with diabetes had higher mean glycaemia, evaluated through standard deviation and mean amplitude of glycaemia excursions. Organic impairment at ICU admission may underlie glycaemic variability and lead to a less favourable outcome. High glycaemic variability in patients with diabetes indicates that monitoring of these individuals is crucial to ensure better outcomes. Copyright © 2017 Elsevier Ltd. All rights reserved.

  19. The New .Africa Top Level Domain: An African Initiative in Ensuring Africa's Rightful Place on The Global Network

    Directory of Open Access Journals (Sweden)

    Eddie Hurter

    2014-08-01

    Full Text Available The new gTLD programme of the Internet Corporation for Assigned Names and Numbers (ICANN is the single most important development since the privatisation of the DNS in 1998. The management of the Domain Name System (DNS has developed from a modest undertaking to its current explosive expansion through the new gTLD programme. Africa has boldly entered the arena through the delegation of the .Africa gTLD. This new development heralds an innovative era in the management of the DNS, especially for Africa. The dotAfrica gTLD launch strategy offers several advantages to African governments and traders alike. One of the innovative features of the management of dotAfrica is the fact that a broader set of rights including commercial, cultural, linguistic, religious and personal rights will be protected. Furthermore, African trade mark proprietors and other rights holders are protected, initially at least, by various innovative rights-protection mechanisms. This development is important for African governments and it should form an integral part of right holders' intellectual property management strategy.

  20. Sepsis and Shock Response Team: Impact of a Multidisciplinary Approach to Implementing Surviving Sepsis Campaign Guidelines and Surviving the Process.

    Science.gov (United States)

    Grek, Ami; Booth, Sandra; Festic, Emir; Maniaci, Michael; Shirazi, Ehsan; Thompson, Kristine; Starbuck, Angela; Mcree, Chad; Naessens, James M; Moreno Franco, Pablo

    The Surviving Sepsis Campaign guidelines are designed to decrease mortality through consistent application of a 7-element bundle. This study evaluated the impact of improvement in bundle adherence using a time-series analysis of compliance with the bundle elements before and after interventions intended to improve the process, while also looking at hospital mortality. This article describes interventions used to improve bundle compliance and hospital mortality in patients admitted through the emergency department with sepsis, severe sepsis, or septic shock. Quality improvement methodology was used to develop high-impact interventions that led to dramatically improved adherence to the Surviving Sepsis Campaign guidelines bundle. Improved performance was associated with a significant decrease in the in-hospital mortality of severe sepsis patients presenting to the emergency department.

  1. Relationships Between Caffeine Intake and Risk for Probable Dementia or Global Cognitive Impairment: The Women's Health Initiative Memory Study.

    Science.gov (United States)

    Driscoll, Ira; Shumaker, Sally A; Snively, Beverly M; Margolis, Karen L; Manson, JoAnn E; Vitolins, Mara Z; Rossom, Rebecca C; Espeland, Mark A

    2016-12-01

    Nonhuman studies suggest a protective effect of caffeine on cognition. Although human literature remains less consistent, reviews suggest a possible favorable relationship between caffeine consumption and cognitive impairment or dementia. We investigated the relationship between caffeine intake and incidence of cognitive impairment or probable dementia in women aged 65 and older from the Women's Health Initiative Memory Study. All women with self-reported caffeine consumption at enrollment were included (N = 6,467). In 10 years or less of follow-up with annual assessments of cognitive function, 388 of these women received a diagnosis of probable dementia based on a 4-phase protocol that included central adjudication. We used proportional hazards regression to assess differences in the distributions of times until incidence of probable dementia or composite cognitive impairment among women grouped by baseline level of caffeine intake, adjusting for risk factors (hormone therapy, age, race, education, body mass index, sleep quality, depression, hypertension, prior cardiovascular disease, diabetes, smoking, and alcohol consumption). Women consuming above median levels (mean intake = 261mg) of caffeine intake for this group were less likely to develop incident dementia (hazard ratio = 0.74, 95% confidence interval [0.56, 0.99], p = .04) or any cognitive impairment (hazard ratio = 0.74, confidence interval [0.60, 0.91], p = .005) compared to those consuming below median amounts (mean intake = 64mg) of caffeine for this group. Our findings suggest lower odds of probable dementia or cognitive impairment in older women whose caffeine consumption was above median for this group and are consistent with the existing literature showing an inverse association between caffeine intake and age-related cognitive impairment. © The Author 2016. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e

  2. Neonatal nosocomial sepsis in a level-III NICU: evaluation of the causative agents and antimicrobial susceptibilities.

    Science.gov (United States)

    Yalaz, Mehmet; Cetin, Hasan; Akisu, Mete; Aydemir, Söhret; Tunger, Alper; Kültürsay, Nilgün

    2006-01-01

    Despite advances in supportive care and use of antibiotics, sepsis preserves its importance due to its high mortality and morbidity for neonates. Identifying the causative agents and antibiotic resistance yearly in a neonatal intensive care unit (NICU) helps the physician to choose the most appropriate empirical therapy. In this study we aimed to evaluate positive blood cultures and antibiotic susceptibilities of newborns with proven sepsis during the years 2000-2002 in our NICU. The charts of babies with sepsis were evaluated for clinical characteristics, positive cultures and antimicrobial susceptibilities, retrospectively. Although most of the admitted patients were premature (76.5%), the frequency of proven sepsis was quite low, at 9.1% among 909 newborns. Mortality rate in sepsis was 16%. The most commonly isolated micro-organisms were coagulase-negative staphylococci (CoNS) (31.3%), fungi (19.2%), Staphylococcus aureus (13%) and Klebsiella pneumoniae (10.5%). Methicillin resistance for CoNS was 92.3% and for S. aureus was 72.7%. In the last year, a significant increase in the frequency of Klebsiella pneumoniae (8.3 vs 14.2%), CoNS (27.1 vs 37.1%), Pseudomonas aeruginosa (2.1 vs 8.6%) and fungal infections (18.8 vs 20%) was observed compared to the previous years. An initial empirical antibiotic therapy for late-onset sepsis was designed with teicoplanin + piperacillin-tazobactam/meropenem + antifungal (fluconazole or amphotericin B) as the best combination to cover this spectrum until the culture results arrive. However, this combination is only compatible with our results and may not be applied in all units. Every unit must follow the bacterial spectrum and antibacterial resistance patterns to choose their specific empirical treatment strategy for nosocomial infections.

  3. Reductions in Sepsis Mortality and Costs After Design and Implementation of a Nurse-Based Early Recognition and Response Program

    Science.gov (United States)

    Jones, Stephen L.; Ashton, Carol M.; Kiehne, Lisa; Gigliotti, Elizabeth; Bell-Gordon, Charyl; Disbot, Maureen; Masud, Faisal; Shirkey, Beverly A.; Wray, Nelda P.

    2016-01-01

    Background Sepsis is a leading cause of death, but evidence suggests that early recognition and prompt intervention can save lives. In 2005 Houston Methodist Hospital prioritized sepsis detection and management in its ICU. In late 2007, because of marginal effects on sepsis death rates, the focus shifted to designing a program that would be readily used by nurses and ensure early recognition of patients showing signs suspicious for sepsis, as well as the institution of prompt, evidence-based interventions to diagnose and treat it. Methods The intervention had four components: organizational commitment and data-based leadership; development and integration of an early sepsis screening tool into the electronic health record; creation of screening and response protocols; and education and training of nurses. Twice-daily screening of patients on targeted units was conducted by bedside nurses; nurse practitioners initiated definitive treatment as indicated. Evaluation focused on extent of implementation, trends in inpatient mortality, and, for Medicare beneficiaries, a before-after (2008–2011) comparison of outcomes and costs. A federal grant in 2012 enabled expansion of the program. Results By year 3 (2011) 33% of inpatients were screened (56,190 screens in 9,718 unique patients), up from 10% in year 1 (2009). Inpatient sepsis-associated death rates decreased from 29.7% in the preimplementation period (2006–2008) to 21.1% after implementation (2009–2014). Death rates and hospital costs for Medicare beneficiaries decreased from preimplementation levels without a compensatory increase in discharges to postacute care. Conclusion This program has been associated with lower inpatient death rates and costs. Further testing of the robustness and exportability of the program is under way. PMID:26484679

  4. Getting men in the room: perceptions of effective strategies to initiate men's involvement in gender-based violence prevention in a global sample.

    Science.gov (United States)

    Casey, Erin A; Leek, Cliff; Tolman, Richard M; Allen, Christopher T; Carlson, Juliana M

    2017-09-01

    As engaging men in gender-based violence prevention efforts becomes an increasingly institutionalised component of gender equity work globally, clarity is needed about the strategies that best initiate male-identified individuals' involvement in these efforts. The purpose of this study was to examine the perceived relevance and effectiveness of men's engagement strategies from the perspective of men around the world who have organised or attended gender-based violence prevention events. Participants responded to an online survey (available in English, French and Spanish) and rated the effectiveness of 15 discrete engagement strategies derived from earlier qualitative work. Participants also provided suggestions regarding strategies in open-ended comments. Listed strategies cut across the social ecological spectrum and represented both venues in which to reach men, and the content of violence prevention messaging. Results suggest that all strategies, on average, were perceived as effective across regions of the world, with strategies that tailor messaging to topics of particular concern to men (such as fatherhood and healthy relationships) rated most highly. Open-ended comments also surfaced tensions, particularly related to the role of a gender analysis in initial men's engagement efforts. Findings suggest the promise of cross-regional adaptation and information sharing regarding successful approaches to initiating men's anti-violence involvement.

  5. The political process in global health and nutrition governance: the G8's 2010 Muskoka Initiative on Maternal, Child, and Newborn Health.

    Science.gov (United States)

    Kirton, John; Kulik, Julia; Bracht, Caroline

    2014-12-01

    Why do informal, plurilateral summit institutions such as the Group of Eight (G8) major market democracies succeed in advancing costly public health priorities such as maternal, newborn, and child health (MNCH), even when the formal, multilateral United Nations (UN) system fails to meet such goals, when G8 governments afflicted by recession, deficit, and debt seek to cut expenditures, and when the private sector is largely uninvolved, despite the growing popularity of public-private partnerships to meet global health and related nutrition, food, and agriculture needs? Guided by the concert-equality model of G8 governance, this case study of the G8's 2010 Muskoka Initiative on MNCH traces the process through which that initiative was planned within Canada, internationally prepared through negotiations with Canada's G8 partners, produced at Muskoka by the leaders in June, multiplied in its results by the UN summit in September, and reinforced by the new accountability mechanism put in place. It finds that the Muskoka summit succeeded in mobilizing major money and momentum for MNCH. This was due to the initiative and influence of children-focused nongovernmental organizations (NGOs), working with committed individuals and agencies within the host Canadian government, as well as supportive public opinion and the help of those in the UN responsible for realizing its Millennium Development Goals. Also relevant were the democratic like-mindedness of G8 leaders and their African partners, the deference of G8 members to the host's priority, and the need of the G8 to demonstrate its relevance through a division of labor between it and the new Group of Twenty summit. This study shows that G8 summits can succeed in advancing key global health issues without a global shock on the same subject to galvanize agreement and action. It suggests that, when committed, focused NGOs and government officials will lead and the private sector will follow, but that there will be a lag in the

  6. Global change impact on oxidative potential and toxicity of atmospheric particles from the East Mediterranean basin: the ARCHIMEDES initiative

    Science.gov (United States)

    Alleman, Laurent; Anthérieu, Sébastien; Baeza-Squiban, Armelle; Garçon, Guillaume; Lo Guidice, Jean-Marc; Hamonou, Eric; Öztürk, Fatma; Perdrix, Esperanza; Rudich, Yinon; Sciare, Jean; Sauvage, Stéphane

    2017-04-01

    , several projects under the ARCHIMEDES (Envi-MED funded) initiative including various research groups from Eastern Mediterranean countries have been submitted to French research calls. Their objectives are to develop an integrated testing strategy (ITS) through a combination of high throughput screening (HTS) methods based on acellular and lung cellular systems evaluating the respective OP (DTT, ascorbic acid and GSH depletion, DCFH oxidation) of various PM samples according to their origins in terms of sources and CC forecast. In order to ensure significant variability in ageing of the size segregated PM (fine, coarse) tested, samples from both northern (France) and southern countries (Cyprus, Israel, Turkey) should be collected at different seasons and site typologies, searching for various compositions and mixing states in SOA (biogenic, anthropogenic), metals and PAHs. These projects will combine relevant chemical, microbiological (DNA extract) and toxicological experiments (transcriptome, epigenome and secretome). A joint toxicological analysis related to their harmful effects on relevant oxidative (ATP, TAS, GSH/GSSG, gammaH2AX), inflammatory, genetic, and epigenetic endpoints within novel tissue-engineering tools will help in recapturing the native lung environment ex vivo. In the CC context, such projects will help to (1) better understand the cellular and molecular mechanisms of PM toxicity, (2) detect and predict their respiratory effects, (3) better comprehend the relationship between the physicochemical characteristics and the toxicological effects of PM, (4) provide innovative biomarkers that could be subsequently validated in humans and thereby contribute to the predictive toxicology.

  7. Construction and management of ARDS/sepsis registry with REDCap.

    Science.gov (United States)

    Pang, Xiaoqing; Kozlowski, Natascha; Wu, Sulong; Jiang, Mei; Huang, Yongbo; Mao, Pu; Liu, Xiaoqing; He, Weiqun; Huang, Chaoyi; Li, Yimin; Zhang, Haibo

    2014-09-01

    The study aimed to construct and manage an acute respiratory distress syndrome (ARDS)/sepsis registry that can be used for data warehousing and clinical research. The workflow methodology and software solution of research electronic data capture (REDCap) was used to construct the ARDS/sepsis registry. Clinical data from ARDS and sepsis patients registered to the intensive care unit (ICU) of our hospital formed the registry. These data were converted to the electronic case report form (eCRF) format used in REDCap by trained medical staff. Data validation, quality control, and database management were conducted to ensure data integrity. The clinical data of 67 patients registered to the ICU between June 2013 and December 2013 were analyzed. Of the 67 patients, 45 (67.2%) were classified as sepsis, 14 (20.9%) as ARDS, and eight (11.9%) as sepsis-associated ARDS. The patients' information, comprising demographic characteristics, medical history, clinical interventions, daily assessment, clinical outcome, and follow-up data, was properly managed and safely stored in the ARDS/sepsis registry. Data efficiency was guaranteed by performing data collection and data entry twice weekly and every two weeks, respectively. The ARDS/sepsis database that we constructed and manage with REDCap in the ICU can provide a solid foundation for translational research on the clinical data of interest, and a model for development of other medical registries in the future.

  8. Personalized identification of differentially expressed pathways in pediatric sepsis.

    Science.gov (United States)

    Li, Binjie; Zeng, Qiyi

    2017-10-01

    Sepsis is a leading killer of children worldwide with numerous differentially expressed genes reported to be associated with sepsis. Identifying core pathways in an individual is important for understanding septic mechanisms and for the future application of custom therapeutic decisions. Samples used in the study were from a control group (n=18) and pediatric sepsis group (n=52). Based on Kauffman's attractor theory, differentially expressed pathways associated with pediatric sepsis were detected as attractors. When the distribution results of attractors are consistent with the distribution of total data assessed using support vector machine, the individualized pathway aberrance score (iPAS) was calculated to distinguish differences. Through attractor and Kyoto Encyclopedia of Genes and Genomes functional analysis, 277 enriched pathways were identified as attractors. There were 81 pathways with Ppathways with Ppathway clusters and four sample clusters. Thus, in the majority pediatric sepsis samples, core pathways can be detected as different from accumulated normal samples. In conclusion, a novel procedure that identified the dysregulated attractors in individuals with pediatric sepsis was constructed. Attractors can be markers to identify pathways involved in pediatric sepsis. iPAS may provide a correlation score for each of the signaling pathways present in an individual patient. This process may improve the personalized interpretation of disease mechanisms and may be useful in the forthcoming era of personalized medicine.

  9. Diagnosis trajectories of prior multi-morbidity predict sepsis mortality

    DEFF Research Database (Denmark)

    Beck, Mette Kristina; Jensen, Anders Boeck; Nielsen, Annelaura Bach

    2016-01-01

    Sepsis affects millions of people every year, many of whom will die. In contrast to current survival prediction models for sepsis patients that primarily are based on data from within-admission clinical measurements (e.g. vital parameters and blood values), we aim for using the full disease histo...... of disease history to scoring based on within-admission clinical measurements emphasizing the value of long term data in novel patient scores that combine the two types of data.......Sepsis affects millions of people every year, many of whom will die. In contrast to current survival prediction models for sepsis patients that primarily are based on data from within-admission clinical measurements (e.g. vital parameters and blood values), we aim for using the full disease history...... recurrent trajectories of time-ordered co-morbidities had significantly increased sepsis mortality compared to those who did not follow a trajectory. We identified trajectories which significantly altered sepsis mortality, and found three major starting points in a combined temporal sepsis network: Alcohol...

  10. PROTEOMIC AND EPIGENOMIC MARKERS OF SEPSIS-INDUCED DELIRIUM (SID

    Directory of Open Access Journals (Sweden)

    Adonis eSfera

    2015-10-01

    Full Text Available In elderly population sepsis is one of the leading causes of intensive care unit (ICU admissions in the United States. Sepsis-induced delirium (SID is the most frequent cause of delirium in ICU (1. Together delirium and SID represent under recognized public health problems which place an increasing financial burden on the US health care system, currently estimated at 143 to 152 billion dollars per year (2. The interest in SID was recently reignited as it was demonstrated that, contrary to prior beliefs, cognitive deficits induced by this condition may be irreversible and lead to dementia (3-4. Conversely, it is construed that diagnosing SID early or mitigating its full blown manifestations may preempt geriatric cognitive disorders. Biological markers specific for sepsis and SID would facilitate the development of potential therapies, monitor the disease process and at the same time enable elderly individuals to make better informed decisions regarding surgeries which may pose the risk of complications, including sepsis and delirium.This article proposes a battery of peripheral blood markers to be used for diagnostic and prognostic purposes in sepsis and SID. Though each individual marker may not be specific enough, we believe that together as a battery they may achieve the necessary accuracy to answer two important questions: who may be vulnerable to the development of sepsis, and who may develop SID and irreversible cognitive deficits following sepsis?

  11. Early onset neonatal sepsis in preterm premature rupture of membranes

    International Nuclear Information System (INIS)

    Ashraf, M.N.

    2015-01-01

    To determine the frequency of early onset neonatal sepsis in newborn with various duration of preterm premature rupture of membranes (PPROM). Study Design: Cross sectional study. Place and Duration of Study: Neonatal Intensive Care Unit Combined Military Hospital, Lahore from November 2009 to November 2010. Material and Methods: Neonates of singleton pregnancies complicated by preterm premature rupture of the membranes (PPROM) with delivery between 30 and 36 weeks gestation were included in the study. The overall frequency of neonatal sepsis was calculated on clinical and serological basis. Comparison of the frequency of sepsis among groups with varying duration of rupture of membranes was done. Results: Out of 164 babies, 84 (51.2%) were female and 80 (48.8%) were male. Mean maternal age was 23 years (range: 18-36 years). Mean gestational age was 33 weeks (range: 30-36 weeks). Sepsis was suspected in 41(25%) babies on clinical grounds. C-reactive protein was raised in 36 (22%) neonates. There was statistically insignificant difference between clinical versus serological diagnosis (p=0.515). Frequency of neonatal sepsis was significantly higher in mothers with longer duration of rupture of membrane (p < 0.001). Conclusion: Frequency of neonatal sepsis was observed to be 22%. PPROM is an important risk factor for early onset neonatal sepsis. (author)

  12. Importance of measuring lactate levels in children with sepsis.

    Science.gov (United States)

    Anil, Nisha

    2017-10-10

    Sepsis is a major public health problem as well as one of the leading causes of preventable death in children because of failure to recognise the early signs and symptoms and to resuscitate rapidly. Blood lactate levels are used to assess the severity of sepsis and the effectiveness of resuscitation. Lactate levels are easily obtainable and should be checked in all patients admitted with suspected sepsis within six hours of presentation. The test should be repeated four and eight-hours post-diagnosis of sepsis. For the diagnosis of sepsis, patients' clinical symptoms, along with the combined analysis of partial pressure of oxygen, carbon dioxide and lactate levels, should be used. A multitude of factors can cause elevated lactate levels and so clinicians should use elevated levels cautiously by considering all other aetiologies. This article, which focuses on practice in Australia but makes reference to the UK, discusses the importance of measuring lactate levels in sepsis, the pathophysiology of lactate production, causes of elevated lactate levels, lactate measurement, nursing management of patients with elevated lactate levels, limitations of using lactate as a biomarker for diagnosing sepsis and implications for practice. ©2012 RCN Publishing Company Ltd. All rights reserved. Not to be copied, transmitted or recorded in any way, in whole or part, without prior permission of the publishers.

  13. Serum amyloid A in the diagnosis of feline sepsis.

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    Troìa, Roberta; Gruarin, Marta; Foglia, Armando; Agnoli, Chiara; Dondi, Francesco; Giunti, Massimo

    2017-11-01

    Systemic inflammatory response syndrome (SIRS) and sepsis can be challenging to diagnose in cats. Retrospectively, we investigated the diagnostic and prognostic potential of serum amyloid A (SAA), a major feline acute-phase protein (APP), in a population of critically ill cats with SIRS related to trauma or sepsis. A total of 56 SIRS cats (trauma n = 27; sepsis n = 29) were included and compared with healthy controls ( n = 18). SAA concentration was significantly increased in SIRS cats compared to controls, confirming its potential for the detection of systemic inflammation in this species. Significantly higher values of SAA were detected in cats belonging to the sepsis group; however, according to the results of the receiver operating characteristic curve analysis, the value of using SAA (>81 mg/L) to discriminate septic cats was only moderate (AUC = 0.76). Additionally, cats with sepsis had significantly higher serum bilirubin concentrations and toxic neutrophil changes compared to the trauma group. Overall, 38 of 56 cats were survivors; 18 of 56 were non-survivors, with 83% of the non-survivors (15 of 18) belonging to the sepsis group. Serum bilirubin concentration, but not SAA, was able to predict outcome. Prospective studies are needed to assess the potential of SAA in the diagnosis of feline sepsis and outcome prediction.

  14. Combined treatment with atorvastatin and imipenem improves survival and vascular functions in mouse model of sepsis.

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    Choudhury, Soumen; Kannan, Kandasamy; Pule Addison, M; Darzi, Sazad A; Singh, Vishakha; Singh, Thakur Uttam; Thangamalai, Ramasamy; Dash, Jeevan Ranjan; Parida, Subhashree; Debroy, Biplab; Paul, Avishek; Mishra, Santosh Kumar

    2015-08-01

    We have recently reported that pre-treatment, but not the post-treatment with atorvastatin showed survival benefit and improved hemodynamic functions in cecal ligation and puncture (CLP) model of sepsis in mice. Here we examined whether combined treatment with atorvastatin and imipenem after onset of sepsis can prolong survival and improve vascular functions. At 6 and 18h after sepsis induction, treatment with atorvastatin plus imipenem, atorvastatin or imipenem alone or placebo was initiated. Ex vivo experiments were done on mouse aorta to examine the vascular reactivity to nor-adrenaline and acetylcholine and mRNA expressions of α1D AR, GRK2 and eNOS. Atorvastatin plus imipenem extended the survival time to 56.00±4.62h from 20.00±1.66h observed in CLP mice. The survival time with atorvastatin or imipenem alone was 20.50±1.89h and 27.00±4.09h, respectively. The combined treatment reversed the hyporeactivity to nor-adrenaline through preservation of α1D AR mRNA/protein expression and reversal of α1D AR desensitization mediated by GRK2/Gβγ pathway. The treatment also restored endothelium-dependent relaxation to ACh through restoration of aortic eNOS mRNA expression and NO availability. In conclusion, combined treatment with atorvastatin and imipenem exhibited survival benefit and improved vascular functions in septic mice. Copyright © 2015 Elsevier Inc. All rights reserved.

  15. Splenectomy and the incidence of venous thromboembolism and sepsis in patients with immune thrombocytopenia

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    Boyle, Soames; White, Richard H.; Brunson, Ann

    2013-01-01

    Patients with immune thrombocytopenia (ITP) who relapse after an initial trial of corticosteroid treatment present a therapeutic challenge. Current guidelines recommend consideration of splenectomy, despite the known risks associated with surgery and the postsplenectomy state. To better define these risks, we identified a cohort of 9976 patients with ITP, 1762 of whom underwent splenectomy. The cumulative incidence of abdominal venous thromboembolism (AbVTE) was 1.6% compared with 1% in patients who did not undergo splenectomy; venous thromboembolism (VTE) (deep venous thrombosis and pulmonary embolus) after splenectomy was 4.3% compared with 1.7% in patients who did not undergo splenectomy. There was increased risk of AbVTE early (splenectomy. There was increased risk of VTE both early (HR 5.2 [CI, 3.2-8.5]) and late (HR 2.7 [CI, 1.9-3.8]) after splenectomy. The cumulative incidence of sepsis was 11.1% among the ITP patients who underwent splenectomy and 10.1% among the patients who did not. Splenectomy was associated with a higher adjusted risk of sepsis, both early (HR 3.3 [CI, 2.4-4.6]) and late (HR 1.6 or 3.1, depending on comorbidities). We conclude that ITP patients post splenectomy are at increased risk for AbVTE, VTE, and sepsis. PMID:23637127

  16. Biomarkers, Trauma, and Sepsis in Pediatrics: A Review

    Directory of Open Access Journals (Sweden)

    Marianne Frieri

    2016-01-01

    Full Text Available Context: There is a logical connection with biomarkers, trauma, and sepsis. This review paper provides new information and clinical practice implications. Biomarkers are very important especially in pediatrics. Procalcitonin and other biomarkers are helpful in identifying neonatal sepsis, defense mechanisms of the immune system. Pediatric trauma and sepsis is very important both in infants and in children. Stress management both in trauma is based upon the notion that stress causes an immune imbalance in susceptible individuals. Evidence Acquisition: Data sources included studies indexed in PubMed, a meta- analysis, predictive values, research strategies, and quality assessments. A recent paper by one of the authors stated marked increase in serum procalcitonin during the course of a septic process often indicates an exacerbation of the illness, and a decreasing level is a sign of improvement. A review of epidemiologic studies on pediatric soccer patients was also addressed. Keywords for searching included biomarkers, immunity, trauma, and sepsis. Results: Of 50 reviewed articles, 34 eligible articles were selected including biomarkers, predictive values for procalcitonin, identifying children at risk for intra-abdominal injuries, blunt trauma, and epidemiology, a meta-analysis. Of neonatal associated sepsis, the NF-kappa B pathway by inflammatory stimuli in human neutrophils, predictive value of gelsolin for the outcomes of preterm neonates, a meta-analysis interleukin-8 for neonatal sepsis diagnosis. Conclusions: Biomarkers are very important especially in pediatrics. Procalcitonin and other biomarkers are helpful in identifying neonatal sepsis, defense mechanisms, and physiological functions of the immune system. Pediatric trauma and sepsis is very important both in infants and in children. Various topics were covered such as biomarkers, trauma, sepsis, inflammation, innate immunity, role of neutrophils and IL-8, reactive oxygen species

  17. Analisis Pengungkapan Corporate Social Responsibility Berdasarkan Global Reporting Initiatives (GRI:Studi Kasus Perusahaan Tambang Batubara Bukit Asam (Persero Tbk dan Timah (Persero Tbk.

    Directory of Open Access Journals (Sweden)

    Nuraini Sari

    2014-11-01

    Full Text Available This study aims to provide an overview of the disclosure of Corporate Social Responsibility (CSR in the mining company's corporate sustainability report. It is also to analyze the disclosure of Corporate Social Responsibility (CSR in corporate sustainability report with standard Global Reporting Initiatives (GRI 3.1. Research was conducted in Batubara Bukit Asam (Persero Tbk. and Timah (Persero Tbk. on their corporatesustainability report for the year of 2012. The analysis was conducted on the presentation of economic performance indicator, environmental performance indicator, performance indicators of employment and workplace practices, human rights performance indicator, public performance indicator and performance indicator reported products liability provisions established in the GRI 3.1. The result is the two companies havedisclosed CSR in accordance with GRI3.1. Batubara Bukit Asam (Persero Tbk and Timah (Persero Tbk have disclosed their performance indicators; and the average has exceeded 75%. However, the disclosure of each indicator and its aspects are not comprehensive.

  18. Diagnostic and prognostic value of presepsin in the management of sepsis in the emergency department: a multicenter prospective study.

    Science.gov (United States)

    Ulla, Marco; Pizzolato, Elisa; Lucchiari, Manuela; Loiacono, Maria; Soardo, Flavia; Forno, Daniela; Morello, Fulvio; Lupia, Enrico; Moiraghi, Corrado; Mengozzi, Giulio; Battista, Stefania

    2013-07-30

    experience, presepsin was useful in the early diagnosis of infection in a complex population of patients with SIRS, sepsis, severe sepsis and septic shock who presented to the ED. Presepsin showed a significant prognostic value, and initial values were significantly correlated with in-hospital mortality of patients affected by sepsis, severe sepsis or septic shock.

  19. Circulating Histones Are Major Mediators of Cardiac Injury in Patients With Sepsis.

    Science.gov (United States)

    Alhamdi, Yasir; Abrams, Simon T; Cheng, Zhenxing; Jing, Shengjie; Su, Dunhao; Liu, Zhiyong; Lane, Steven; Welters, Ingeborg; Wang, Guozheng; Toh, Cheng-Hock

    2015-10-01

    To investigate the impact of circulating histones on cardiac injury and dysfunction in a murine model and patients with sepsis. Prospective, observational clinical study with in vivo and ex vivo translational laboratory investigations. General ICU and university research laboratory. Sixty-five septic patients and 27 healthy volunteers. Twelve-week-old male C57BL/6N mice. Serial blood samples from 65 patients with sepsis were analyzed, and left ventricular function was assessed by echocardiography. Patients' sera were incubated with cultured cardiomyocytes in the presence or absence of antihistone antibody, and cellular viability was assessed. Murine sepsis was initiated by intraperitoneal Escherichia coli injection (10(8) colony-forming unit/mouse) in 12-week-old male C57BL/6N mice, and the effect of antihistone antibody (10 mg/kg) was studied. Murine blood samples were collected serially, and left ventricular function was assessed by intraventricular catheters and electrocardiography. Circulating histones and cardiac troponins in human and murine plasma were quantified. In 65 patients with sepsis, circulating histones were significantly elevated compared with healthy controls (n = 27) and linearly correlated with cardiac troponin T levels (rs = 0.650; p histone levels were significantly associated with new-onset left ventricular dysfunction (p = 0.001) and arrhythmias (p = 0.01). Left ventricular dysfunction only predicted adverse outcomes when combined with elevated histones or cardiac troponin levels. Furthermore, patients' sera directly induced histone-specific cardiomyocyte death ex vivo, which was abrogated by antihistone antibodies. In vivo studies on septic mice confirmed the cause-effect relationship between circulating histones and the development of cardiac injury, arrhythmias, and left ventricular dysfunction. Circulating histones are novel and important mediators of septic cardiomyopathy, which can potentially be utilized for prognostic and therapeutic

  20. Systematic review of use of β-blockers in sepsis

    Directory of Open Access Journals (Sweden)

    Cyril Jacob Chacko

    2015-01-01

    Conclusion: There is insufficient evidence to justify the routine use of β-blockers in sepsis. A large adequately powered multi-centered randomized controlled clinical trial is required to address the question on the efficacy of β-blocker usage in sepsis. This trial should also consider a number of important questions including the choice of β-blocker used, optimal dosing, timing of intervention, duration of intervention and discontinuation of the drug. Until such time based on the available evidence, there is no place for the use of β-blockers in sepsis in current clinical practice.

  1. Implications of the new sepsis definition on research and practice.

    Science.gov (United States)

    Peach, Brian C

    2017-04-01

    The Society of Critical-Care Medicine and the European Society of Intensive Care Medicine recently announced a marked change in the sepsis definition. A task force of 19 sepsis clinicians and researchers made the change based on advances in the pathobiological understanding of the septic process. The task force determined that there were numerous justifications for a revision of the sepsis definition, which are outlined in this article. The systemic inflammatory response criteria have been replaced by the Sequential Organ Failure Assessment (SOFA) score in the newly operationalized definition (Singer et al., 2016). In addition to the definition change, the task force recommended using the new quick SOFA (qSOFA) score in non-ICU settings, as a risk stratification tool to identify patients who may be septic or be at risk of developing sepsis. The change in definition will likely have a negative impact on sepsis research in the short-term as hospitals adjust their coding for the new definition, but may result in less misclassification bias and improved research data in the long-term. While the intent of the SCCM/ESICM task force was to better define sepsis for coding and epidemiological research purposes, there is the potential for improved patient outcomes if clinicians are better able to differentiate between sepsis and inflammatory events. The qSOFA tool may also aid clinicians in recognizing sepsis in a quicker manner, leading to more timely treatment, and potentially better outcomes. While the new operationalized Sepsis-3 definition appears on the surface to be an improvement over the previous iterations, it remains to be seen if research data will be more robust using the new criteria. There is the potential for better patient outcomes if clinicians are better able to differentiate sepsis from inflammatory events with the new definition, and if sepsis cases are recognized sooner with qSOFA. Future research on the impact of this definition change on research and

  2. The accomplishments of the global initiative VISION 2020: The Right to Sight and the focus for the next 8 years of the campaign

    Directory of Open Access Journals (Sweden)

    Peter Ackland

    2012-01-01

    Full Text Available In the first 12 years of VISION 2020 sound programmatic approaches have been developed that are capable of delivering equitable eye health services to even the most remote and impoverished communities. A body of evidence around the economic arguments for investment in eye health has been developed that has fuelled successful advocacy work resulting in supportive high level policy statements. More than a 100 national plans to achieve the elimination of avoidable blindness have been developed and some notable contributions made from the corporate and government sectors to resource eye health programs. Good progress has been made to control infectious blinding diseases and at the very least there is anecdotal evidence to suggest that the global increase in the prevalence of blindness and visual impairment has been reversed in recent years, despite the ever increasing and more elderly global population. However if we are to achieve the goal of VISION 2020 we require a considerable scaling up of current efforts-this will depend on our future success in two key areas: i Successful advocacy and engagement at individual country level to secure significantly enhanced national government commitment to financing their own VISION 2020 plans.ii A new approach to VISION 2020 thinking that integrates eye health into health system development and develops new partnerships with wider health development initiatives.

  3. Supportive care during treatment for breast cancer: resource allocations in low- and middle-income countries. A Breast Health Global Initiative 2013 consensus statement.

    Science.gov (United States)

    Cardoso, Fatima; Bese, Nuran; Distelhorst, Sandra R; Bevilacqua, Jose Luiz B; Ginsburg, Ophira; Grunberg, Steven M; Gralla, Richard J; Steyn, Ann; Pagani, Olivia; Partridge, Ann H; Knaul, Felicia Marie; Aapro, Matti S; Andersen, Barbara L; Thompson, Beti; Gralow, Julie R; Anderson, Benjamin O

    2013-10-01

    Breast cancer patients may have unmet supportive care needs during treatment, including symptom management of treatment-related toxicities, and educational, psychosocial, and spiritual needs. Delivery of supportive care is often a low priority in low- and middle-income settings, and is also dependent on resources available. This consensus statement describes twelve key recommendations for supportive care during treatment in low- and middle-income countries, identified by an expert international panel as part of the 5th Breast Health Global Initiative (BHGI) Global Summit for Supportive Care, which was held in October 2012, in Vienna, Austria. Panel recommendations are presented in a 4-tier resource-stratified table to illustrate how health systems can provide supportive care services during treatment to breast cancer patients, starting at a basic level of resource allocation and incrementally adding program resources as they become available. These recommendations include: health professional and patient and family education; management of treatment related toxicities, management of treatment-related symptoms of fatigue, insomnia and non-specific pain, and management of psychosocial and spiritual issues related to breast cancer treatment. Establishing supportive care during breast cancer treatment will help ensure that breast cancer patients receive comprehensive care that can help 1) improve a