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1. Risk Factors for Mortality in Pediatric Postsurgical versus Medical Severe Sepsis

Author

Rajan K. Thakkar, Scott L. Weiss, Julie C. Fitzgerald, Luke Keele, Neal J. Thomas, Vinay M. Nadkarni, Jennifer A. Muszynski, Mark W. Hall, P. Fontela, M. Tucci, M. Dumistrascu, P. Skippen, G. Krahn, E. Bezares, G. Puig, A. Puig-Ramos, R. Garcia, M. Villar, M. Bigham, T. Polanski, S. Latifi, D. Giebner, H. Anthony, J. Hume, A. Galster, L. Linnerud, R. Sanders, G. Hefley, K. Madden, A. Thompson, S. Shein, S. Gertz, Y. Han, T. Williams, A. Hughes-Schalk, H. Chandler, A. Orioles, E. Zielinski, A. Doucette, C. Zebuhr, T. Wilson, C. Dimitriades, J. Ascani, S. Layburn, S. Valley, B. Markowitz, J. Terry, R. Morzov, A. Mcinnes, J. McArthur, K. Woods, K. Murkowski, M. Spaeder, M. Sharron, D. Wheeler, E. Beckman, E. Frank, K. Howard, C. Carroll, S. Nett, D. Jarvis, V. Patel, R. Higgerson, L. Christie, K. Typpo, J. Deschenes, A. Kirby, T. Uhl, K. Rehder, I. Cheifetz, S. Wrenn, K. Kypuros, K. Ackerman, F. Maffei, G. Bloomquist, N. Rizkalla, D. Kimura, S. Shah, C. Tigges, F. Su, C. Barlow, K. Michelson, K. Wolfe, D. Goodman, L. Campbell, L. Sorce, K. Bysani, T. Monjure, M. Evans, B. Totapally, M. Chegondi, C. Rodriguez, J. Frazier, L. Steele, S. Viteri, A. Costarino, N. Thomas, D. Spear, E. Hirshberg, J. Lilley, C. Rowan, C. Rider, J. Kane, J. Zimmerman, C. Greeley, J. Lin, R. Jacobs, M. Parker, K. Culver, L. Loftis, N. Jaimon, M. Goldsworthy, J. Fitzgerald, S. Weiss, V. Nadkarni, J. Bush, M. Diliberto, C. Allen, M. Gessouroun, A. Sapru, T. Lang, M. Alkhouli, S. Kamath, D. Friel, J. Daufeldt, D. Hsing, C. Carlo, S. Pon, J. Scimeme, A. Shaheen, A. Hassinger, H. Qiao, J. Giuliano, J. Tala, D. Vinciguerra, A. Fernandez, R. Carrero, P. Hoyos, J. Jaramillo, A. Posada, L. Izquiierdo, B.E. Piñeres Olave, J. Donado, R. Dalmazzo, S. Rendich, L. Palma, M. Lapadula, C. Acuna, P. Cruces, S. Clement De Clety, M. Dujardin, C. Berghe, S. Renard, J. Zurek, H. Steinherr, K. Mougkou, E. Critselis, M. Di Nardo, S. Picardo, F. Tortora, E. Rossetti, T. Fragasso, P. Cogo, R. Netto, A. Dagys, V. Gurskis, R. Kevalas, C. Neeleman, J. Lemson, C. Luijten, K. Wojciech, I. Pagowska-Klimek, M. Szczepanska, J. Karpe, P. Nunes, H. Almeida, J. Rios, M. Vieira, J. P. Garcia Iniguez, P. Revilla, J. Urbano, J. Lopez-Herce, A. Bustinza, A. Palacios, S. Hofheinz, A. Rodriguez-Nunez, S. Sanagustin, E. Gonzalez, M. Riaza, R. Piaya, P. Soler, E. Esteban, J. Laraudogoitia, C. Monge, V. Herrera, J. Granados, C. Gonzalez, T. Koroglu, E. Ozcelik, P. Baines, A. Plunkett, P. Davis, S. George, S. Tibby, J. Harris, R. Agbeko, R. Lampitt, J. Brierley, M. Peters, A. Jones, T. Dominguez, T. Thiruchelvam, A. Deep, L. Ridley, W. Bowen, R. Levin, I. Macleod, M. Gray, N. Hemat, J. Alexander, S. Ali, J. Pappachan, J. McCorkell, P. Fortune, M. MacDonald, P. Hudnott, Q. Suyun, S. Singhi, K. Nallasamy, R. Lodha, N. Shime, Y. Tabata, O. Saito, T. Ikeyama, T. Kawasaki, L. Lum, A. Abidin, S. Kee, S. Tang, R. Jalil, Y. Guan, L. Yao, K. Lin, J. Ong, A. Salloo, L. Doedens, L. Mathivha, G. Reubenson, S. Moaisi, A. Pentz, R. Green, A. Schibler, S. Erickson, J. McEneiry, D. Long, T. Dorofaeff, M. Coulthard, J. Millar, C. Delzoppo, G. Williams, M. Morritt, N. Watts, J. Beca, C. Sherring, and T. Bushell

Subjects
Male, medicine.medical_specialty, Population, Vascular damage Radboud Institute for Health Sciences [Radboudumc 16], Prevalence, Logistic regression, Malignancy, Intensive Care Units, Pediatric, Severity of Illness Index, law.invention, Medical sepsis, Sepsis, 03 medical and health sciences, 0302 clinical medicine, Postoperative Complications, law, Risk Factors, Intensive care, Surgical sepsis, medicine, Humans, Pediatric sepsis, Hospital Mortality, Prospective Studies, Mortality, education, Child, education.field_of_study, business.industry, Infant, Length of Stay, medicine.disease, Intensive care unit, Cross-Sectional Studies, 030220 oncology & carcinogenesis, Child, Preschool, Surgical Procedures, Operative, Emergency medicine, 030211 gastroenterology & hepatology, Surgery, Female, Multiple organ dysfunction syndrome, business
Abstract

Item does not contain fulltext BACKGROUND: Sepsis is a leading cause of morbidity and mortality after surgery. Most studies regarding sepsis do not differentiate between patients who have had recent surgery and those without. Few data exist regarding the risk factors for poor outcomes in pediatric postsurgical sepsis. Our hypothesis is pediatric postsurgical, and medical patients with severe sepsis have unique risk factors for mortality. METHODS: Data were extracted from a secondary analysis of an international point prevalence study of pediatric severe sepsis. Sites included 128 pediatric intensive care units from 26 countries. Pediatric patients with severe sepsis were categorized into those who had recent surgery (postsurgical sepsis) versus those that did not (medical sepsis) before sepsis onset. Multivariable logistic regression models were used to determine risk factors for mortality. RESULTS: A total of 556 patients were included: 138 with postsurgical and 418 with medical sepsis. In postsurgical sepsis, older age, admission from the hospital ward, multiple organ dysfunction syndrome at sepsis recognition, and cardiovascular and respiratory comorbidities were independent risk factors for death. In medical sepsis, resource-limited region, hospital-acquired infection, multiple organ dysfunction syndrome at sepsis recognition, higher Pediatric Index of Mortality-3 score, and malignancy were independent risk factors for death. CONCLUSIONS: Pediatric patients with postsurgical sepsis had different risk factors for mortality compared with medical sepsis. This included a higher mortality risk in postsurgical patients presenting to the intensive care unit from the hospital ward. These data suggest an opportunity to develop and test early warning systems specific to pediatric sepsis in the postsurgical population.

Published
2019

2. Violencia, espacio y vida cotidiana en la guerra mexicana contra las drogas: un análisis de Tijuana

Author

Héctor E. Bezares Buenrostro

Subjects
violencia, media_common.quotation_subject, México, Vulnerability, General Social Sciences, Context (language use), Space (commercial competition), Criminology, Politics, Spanish Civil War, State (polity), Political science, guerra contra las drogas, espacialidad, Urban space, Sociología, Tijuana, Demographic expansion, media_common
Abstract

The following paper explores the spatiality of Mexico’s war on drugs by developing an analytical frame to examine urban space in Tijuana, a Mexican northern border city. Tijuana has been signified and construed as an unsafe and violent place within the context of the Mexican antinarcotics strategy. Its construction as a dangerous space coincides with its urban and demographic expansion, as well as its connection with the global circuits of drug distribution and the implementation of the war on drugs within the city. By representing it as an unsafe space, it has been authorized the exertion of unlimited violence upon its users and inhabitants by both state and private agents producing forms of extreme citizen vulnerability. As a consequence, both the political life of the city and its citizens´ rights have been reduced to their bare minimum. Building on the analysis of Tijuana´s symbolic, demographic and urban configuration, the consequences these processes have had upon the production of the city´s residents’ political identities are explored. By delving into the microphysics of the geographical imaginations on criminality and drugs in Tijuana, this paper contributes to the analysis on the ways in which the exertion of violence within the war on drugs is linked to the variegated forms urban space is interpreted by both citizens and authorities.

Published
2019

3. Black holes, gravitational waves and fundamental physics: A roadmap

Author

Barack, L. Cardoso, V. Nissanke, S. Sotiriou, T.P. Askar, A. Belczynski, C. Bertone, G. Bon, E. Blas, D. Brito, R. Bulik, T. Burrage, C. Byrnes, C.T. Caprini, C. Chernyakova, M. Chruściel, P. Colpi, M. Ferrari, V. Gaggero, D. Gair, J. García-Bellido, J. Hassan, S.F. Heisenberg, L. Hendry, M. Heng, I.S. Herdeiro, C. Hinderer, T. Horesh, A. Kavanagh, B.J. Kocsis, B. Kramer, M. Le Tiec, A. Mingarelli, C. Nardini, G. Nelemans, G. Palenzuela, C. Pani, P. Perego, A. Porter, E.K. Rossi, E.M. Schmidt, P. Sesana, A. Sperhake, U. Stamerra, A. Stein, L.C. Tamanini, N. Tauris, T.M. Urena-López, L.A. Vincent, F. Volonteri, M. Wardell, B. Wex, N. Yagi, K. Abdelsalhin, T. Aloy, M.Á. Amaro-Seoane, P. Annulli, L. Arca-Sedda, M. Bah, I. Barausse, E. Barakovic, E. Benkel, R. Bennett, C.L. Bernard, L. Bernuzzi, S. Berry, C.P.L. Berti, E. Bezares, M. Blanco-Pillado, J.J. Blázquez-Salcedo, J.L. Bonetti, M. Bošković, M. Bosnjak, Z. Bricman, K. Brügmann, B. Capelo, P.R. Carloni, S. Cerdá-Durán, P. Charmousis, C. Chaty, S. Clerici, A. Coates, A. Colleoni, M. Collodel, L.G. Compère, G. Cook, W. Cordero-Carrión, I. Correia, M. De La Cruz-Dombriz, Á. Czinner, V.G. Destounis, K. Dialektopoulos, K. Doneva, D. Dotti, M. Drew, A. Eckner, C. Edholm, J. Emparan, R. Erdem, R. Ferreira, M. Ferreira, P.G. Finch, A. Font, J.A. Franchini, N. Fransen, K. Gal'tsov, D. Ganguly, A. Gerosa, D. Glampedakis, K. Gomboc, A. Goobar, A. Gualtieri, L. Guendelman, E. Haardt, F. Harmark, T. Hejda, F. Hertog, T. Hopper, S. Husa, S. Ihanec, N. Ikeda, T. Jaodand, A. Jetzer, P. Jimenez-Forteza, X. Kamionkowski, M. Kaplan, D.E. Kazantzidis, S. Kimura, M. Kobayashi, S. Kokkotas, K. Krolik, J. Kunz, J. Lämmerzahl, C. Lasky, P. Lemos, J.P.S. Levi Said, J. Liberati, S. Lopes, J. Luna, R. Ma, Y.-Z. Maggio, E. Mangiagli, A. Montero, M.M. Maselli, A. Mayer, L. Mazumdar, A. Messenger, C. Ménard, B. Minamitsuji, M. Moore, C.J. Mota, D. Nampalliwar, S. Nerozzi, A. Nichols, D. Nissimov, E. Obergaulinger, M. Obers, N.A. Oliveri, R. Pappas, G. Pasic, V. Peiris, H. Petrushevska, T. Pollney, D. Pratten, G. Rakic, N. Racz, I. Radia, M. Ramazanoǧlu, F.M. Ramos-Buades, A. Raposo, G. Rogatko, M. Rosca-Mead, R. Rosinska, D. Rosswog, S. Ruiz-Morales, E. Sakellariadou, M. Sanchis-Gual, N. Sharan Salafia, O. Samajdar, A. Sintes, A. Smole, M. Sopuerta, C. Souza-Lima, R. Stalevski, M. Stergioulas, N. Stevens, C. Tamfal, T. Torres-Forné, A. Tsygankov, S. İ Ünlütürk, Ki. Valiante, R. Van De Meent, M. Velhinho, J. Verbin, Y. Vercnocke, B. Vernieri, D. Vicente, R. Vitagliano, V. Weltman, A. Whiting, B. Williamson, A. Witek, H. Wojnar, A. Yakut, K. Yan, H. Yazadjiev, S. Zaharijas, G. Zilhão, M.

Subjects
General Relativity and Quantum Cosmology
Abstract

The grand challenges of contemporary fundamental physics-dark matter, dark energy, vacuum energy, inflation and early universe cosmology, singularities and the hierarchy problem-all involve gravity as a key component. And of all gravitational phenomena, black holes stand out in their elegant simplicity, while harbouring some of the most remarkable predictions of General Relativity: event horizons, singularities and ergoregions. The hitherto invisible landscape of the gravitational Universe is being unveiled before our eyes: the historical direct detection of gravitational waves by the LIGO-Virgo collaboration marks the dawn of a new era of scientific exploration. Gravitational-wave astronomy will allow us to test models of black hole formation, growth and evolution, as well as models of gravitational-wave generation and propagation. It will provide evidence for event horizons and ergoregions, test the theory of General Relativity itself, and may reveal the existence of new fundamental fields. The synthesis of these results has the potential to radically reshape our understanding of the cosmos and of the laws of Nature. The purpose of this work is to present a concise, yet comprehensive overview of the state of the art in the relevant fields of research, summarize important open problems, and lay out a roadmap for future progress. This write-up is an initiative taken within the framework of the European Action on 'Black holes, Gravitational waves and Fundamental Physics'. © 2019 IOP Publishing Ltd.

Published
2019

4. The Association of Nutrition Status Expressed as Body Mass Index z Score With Outcomes in Children With Severe Sepsis: A Secondary Analysis From the Sepsis Prevalence, Outcomes, and Therapies (SPROUT) Study

Author

D. Giebner, Eileen Beckman, A. Galster, T. Williams, G. Bloomquist, Erin Frank, K. Woods, C. Tigges, Lisa Steele, V. Patel, Michael C. Spaeder, Alexandra L. Hanlon, Kate G. Ackerman, J. Ascani, Sharon Y. Irving, Tammy Uhl, Steven L. Shein, Bridget Daly, T. Wilson, S. Wrenn, M. Dumis-trascu, M. Villar, Vijay Srinivasan, D. Jarvis, Janet R. Hume, Julie C. Fitzgerald, Denise M. Goodman, T. Monjure, J. Deschenes, G. Krahn, Judy Verger, Frank A. Maffei, Kelli Howard, Ann Thompson, Marisa Tucci, Dai Kimura, Heather K. Chandler, H. Anthony, Shirley Viteri, Sholeen Nett, A. Orioles, C. Rodriguez, K. Typpo, Michael T. Bigham, Ira M. Cheifetz, Neal J. Thomas, Patricia S. Fontela, Laura Campbell, Melissa Evans, Kate Madden, K. Murkowski, Felice Su, E. Bezares, Samir S. Shah, Katri V. Typpo, N. Rizkalla, S. Valley, A. Puig-Ramos, Ronald C. Sanders, G. Puig, LeeAnn M. Christie, S. Latifi, Christopher L. Carroll, B. Markowitz, Renee A. Higgerson, Glenda Hefley, R. Morzov, K. Kypuros, S. Gertz, Kris Bysani, Aileen Kirby, A. Doucette, L. Linnerud, Balagangadhar R. Totapally, Jennifer McArthur, Peter Skippen, Lauren R. Sorce, T. Polanski, Yong Yun Han, Andrew D. McInnes, Madhuradhar Chegondi, Ann-Marie Brown, Derek S. Wheeler, Kyle J Rehder, Carleen Zebuhr, Constantine Dimitriades, Scott L. Weiss, Matthew Sharron, K. Wolfe, Ricardo L. Garcia, Kelly Michelson, Vinay M. Nadkarni, S. Layburn, J. Frazier, J. Terry, C. Barlow, Andrew T. Costarino, E. Zielinski, and A. Hughes-Schalk

Subjects
Male, medicine.medical_specialty, Asia, Adolescent, Vascular damage Radboud Institute for Health Sciences [Radboudumc 16], Nutritional Status, Comorbidity, macromolecular substances, Critical Care and Intensive Care Medicine, Intensive Care Units, Pediatric, Risk Assessment, Severity of Illness Index, Article, Body Mass Index, Sepsis, 03 medical and health sciences, 0302 clinical medicine, Overnutrition, Internal medicine, Severity of illness, medicine, Prevalence, Humans, 030212 general & internal medicine, Child, business.industry, Septic shock, Malnutrition, 030208 emergency & critical care medicine, Odds ratio, South America, medicine.disease, Europe, Child, Preschool, North America, Female, business, Body mass index
Abstract

Contains fulltext : 200437.pdf (Publisher’s version ) (Closed access) OBJECTIVES: The impact of nutrition status on outcomes in pediatric severe sepsis is unclear. We studied the association of nutrition status (expressed as body mass index z score) with outcomes in pediatric severe sepsis. DESIGN: Secondary analysis of the Sepsis Prevalence, Outcomes, and Therapies study. Patient characteristics, ICU interventions, and outcomes were compared across nutrition status categories (expressed as age- and sex-adjusted body mass index z scores using World Health Organization standards). Multivariable regression models were developed to determine adjusted differences in all-cause ICU mortality and ICU length of stay by nutrition status. SETTING: One-hundred twenty-eight PICUs across 26 countries. PATIENTS: Children less than 18 years with severe sepsis enrolled in the Sepsis Prevalence, Outcomes, and Therapies study (n = 567). INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Nutrition status data were available for 417 patients. Severe undernutrition was seen in Europe (25%), Asia (20%), South Africa (17%), and South America (10%), with severe overnutrition seen in Australia/New Zealand (17%) and North America (14%). Severe undernutrition was independently associated with all-cause ICU mortality (adjusted odds ratio, 3.0; 95% CI, 1.2-7.7; p = 0.02), whereas severe overnutrition in survivors was independently associated with longer ICU length of stay (1.6 d; p = 0.01). CONCLUSIONS: There is considerable variation in nutrition status for children with severe sepsis treated across this selected network of PICUs from different geographic regions. Severe undernutrition was independently associated with higher all-cause ICU mortality in children with severe sepsis. Severe overnutrition was independently associated with greater ICU length of stay in childhood survivors of severe sepsis.

Published
2018

5. [Malrotation of the cecum]

Author

O H, Mammoni, A F, Pineda, and A E, Bezares

Subjects
Adult, Intestines, Male, Humans, Middle Aged, Cecum
Published
1965

6. [Cecal diverticulitis]

Author

O O, Mammoni, A E, Bezares, J, De Barrio, and A F, Pineda

Subjects
Adult, Male, Cecal Diseases, Humans, Female, Middle Aged, Diverticulitis, Aged
Published
1965

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