[Show abstract][Hide abstract] ABSTRACT: We present a measurement of the cosmic ray (e[superscript +] + e[superscript -]) flux in the range 0.5 GeV to 1 TeV based on the analysis of 10.6 million (e[superscript +] + e[superscript -]) events collected by AMS. The statistics and the resolution of AMS provide a precision measurement of the flux. The flux is smooth and reveals new and distinct information. Above 30.2 GeV, the flux can be described by a single power law with a spectral index γ = -3.170 ± 0.008(stat + syst) ± 0.008(energy scale).
Full-text · Article · Nov 2014 · Physical Review Letters
[Show abstract][Hide abstract] ABSTRACT: Background: Abdominal infections are frequent causes of sepsis and septic shock in the intensive care unit (ICU) and are associated with adverse outcomes. We analyzed the characteristics, treatments and outcome of ICU patients with abdominal infections using data extracted from a one-day point prevalence study, the Extended Prevalence of Infection in the ICU (EPIC) II. Methods: EPIC II included 13,796 adult patients from 1,265 ICUs in 75 countries. Infection was defined using the International Sepsis Forum criteria. Microbiological analyses were performed locally. Participating ICUs provided patient follow-up until hospital discharge or for 60 days. Results: Of the 7,087 infected patients, 1,392 (19.6%) had an abdominal infection on the study day (60% male, mean age 62 +/- 16 years, SAPS II score 39 +/- 16, SOFA score 7.6 +/- 4.6). Microbiological cultures were positive in 931 (67%) patients, most commonly Gram-negative bacteria (48.0%). Antibiotics were administered to 1366 (98.1%) patients. Patients who had been in the ICU for <= 2 days prior to the study day had more Escherichia coli, methicillin-sensitive Staphylococcus aureus and anaerobic isolates, and fewer enterococci than patients who had been in the ICU longer. ICU and hospital mortality rates were 29.4% and 36.3%, respectively. ICU mortality was higher in patients with abdominal infections than in those with other infections (29.4% vs. 24.4%, p < 0.001). In multivariable analysis, hematological malignancy, mechanical ventilation, cirrhosis, need for renal replacement therapy and SAPS II score were independently associated with increased mortality. Conclusions: The characteristics, microbiology and antibiotic treatment of abdominal infections in critically ill patients are diverse. Mortality in patients with isolated abdominal infections was higher than in those who had other infections.
[Show abstract][Hide abstract] ABSTRACT: A facility that can deliver beams of electron and muon neutrinos from the
decay of a stored muon beam has the potential to unambiguously resolve the
issue of the evidence for light sterile neutrinos that arises in short-baseline
neutrino oscillation experiments and from estimates of the effective number of
neutrino flavors from fits to cosmological data. In this paper, we show that
the nuSTORM facility, with stored muons of 3.8 GeV/c $\pm$ 10%, will be able to
carry out a conclusive muon neutrino appearance search for sterile neutrinos
and test the LSND and MiniBooNE experimental signals with 10$\sigma$
sensitivity, even assuming conservative estimates for the systematic
uncertainties. This experiment would add greatly to our knowledge of the
contribution of light sterile neutrinos to the number of effective neutrino
flavors from the abundance of primordial helium production and from constraints
on neutrino energy density from the cosmic microwave background. The appearance
search is complemented by a simultaneous muon neutrino disappearance analysis
that will facilitate tests of various sterile neutrino models.
[Show abstract][Hide abstract] ABSTRACT: Background
Infections are a leading cause of death in patients with advanced cirrhosis, but there are relatively few data on the epidemiology of infection in intensive care unit (ICU) patients with cirrhosis. AimsWe used data from the Extended Prevalence of Infection in Intensive Care (EPIC) II one-day point-prevalence study to better define the characteristics of infection in these patients. Methods
We compared characteristics, including occurrence and types of infections in non-cirrhotic and cirrhotic patients who had not undergone liver transplantation. ResultsThe EPIC II database includes 13,796 adult patients from 1,265 ICUs: 410 of the patients had cirrhosis. The prevalence of infection was higher in cirrhotic than in non-cirrhotic patients (59 vs. 51%, p<0.01). The lungs were the most common site of infection in all patients, but abdominal infections were more common in cirrhotic than in non-cirrhotic patients (30 vs. 19%, p<0.01). Infected cirrhotic patients more often had Gram-positive (56 vs. 47%, p<0.05) isolates than did infected non-cirrhotic patients. Methicillin-resistant Staphylococcus aureus (MRSA) was more frequent in cirrhotic patients. The hospital mortality rate of cirrhotic patients was 42%, compared to 24% in the non-cirrhotic population (p<0.001). Severe sepsis and septic shock were associated with higher in-hospital mortality rates in cirrhotic than in non-cirrhotic patients (41% and 71% vs. 30% and 49%, respectively, p<0.05). Conclusions
Infection is more common in cirrhotic than in non-cirrhotic ICU patients and more commonly due to Gram-positive organisms, including MRSA. Infection in patients with cirrhosis was associated with higher mortality rates than in non-cirrhotic patients.This article is protected by copyright. All rights reserved.
Full-text · Article · Mar 2014 · Liver international: official journal of the International Association for the Study of the Liver
[Show abstract][Hide abstract] ABSTRACT: The nuSTORM facility has been designed to deliver beams of electron neutrinos
and muon neutrinos (and their anti-particles) from the decay of a stored muon
beam with a central momentum of 3.8 GeV/c and a momentum acceptance of 10%. The
facility is unique in that it will: 1. Allow searches for sterile neutrinos of
exquisite sensitivity to be carried out; 2. Serve future long- and
short-baseline neutrino-oscillation programs by providing definitive
measurements of electron neutrino and muon neutrino scattering cross sections
off nuclei with percent-level precision; and 3. Constitutes the crucial first
step in the development of muon accelerators as a powerful new technique for
particle physics. The document describes the facility in detail and
demonstrates its physics capabilities. This document was submitted to the
Fermilab Physics Advisory Committee in consideration for Stage I approval.
[Show abstract][Hide abstract] ABSTRACT: ABSTRACT BACKGROUND: In a recent multicenter randomized trial comparing unfractionated heparin (UFH) with low-molecular-weight heparin (dalteparin) for thromboprophylaxis in 3746 critically-ill patients, 17 (0.5%) patients developed heparin-induced thrombocytopenia (HIT) based on serotonin-release assay-positive (SRA+) status. A trend to lower frequency of HIT with dalteparin vs UFH was observed in the intention-to-treat analysis (5 vs 12 patients; P=0.14), which was statistically significant (3 vs 12 patients; P=0.046) in a prespecified per-protocol analysis which excluded patients with deep-vein thrombosis (DVT) at study entry. We sought to characterize HIT outcomes and to determine how dalteparin thromboprophylaxis might reduce HIT frequency in ICU patients. METHODS: In 17 patients with HIT, we analyzed platelet counts and thrombotic events in relation to study drug and other open-label heparin, to determine whether study drug plausibly explained seroconversion to SRA+ status and/or breakthrough of thrombocytopenia/thrombosis. We also compared antibody frequencies (dalteparin vs UFH) in 409 patients serologically investigated for HIT. RESULTS: HIT-associated thrombosis occurred in 10/17 (58.8%) patients (8:1:1 venous:arterial:both). Dalteparin was associated with fewer study drug-attributable HIT-related events (P=0.020), including less seroconversion (P=0.058) and less breakthrough of thrombocytopenia/thrombosis (P=0.032). Anti-PF4/heparin IgG antibodies by ELISA were less frequent among patients receiving dalteparin vs UFH (13.5% vs 27.3%; P<0.001). One patient with HIT-associated DVT died post-UFH bolus, whereas platelet counts recovered in two others with HIT-associated VTE despite continuation of therapeutic-dose UFH. CONCLUSIONS: The lower risk of HIT in ICU patients receiving dalteparin appears related to both decreased antibody formation and decreased clinical breakthrough of HIT among patients forming antibodies.
[Show abstract][Hide abstract] ABSTRACT: The nuSTORM facility has been designed to deliver beams of electron and muon
neutrinos from the decay of a stored muon beam with a central momentum of 3.8
GeV/c and a momentum spread of 10%. The facility is unique in that it will:
serve the future long- and short-baseline neutrino-oscillation programmes by
providing definitive measurements of electron-neutrino- and
muon-neutrino-nucleus cross sections with percent-level precision; allow
searches for sterile neutrinos of exquisite sensitivity to be carried out; and
constitute the essential first step in the incremental development of muon
accelerators as a powerful new technique for particle physics.
Of the world's proton-accelerator laboratories, only CERN and FNAL have the
infrastructure required to mount nuSTORM. Since no siting decision has yet been
taken, the purpose of this Expression of Interest (EoI) is to request the
resources required to: investigate in detail how nuSTORM could be implemented
at CERN; and develop options for decisive European contributions to the nuSTORM
facility and experimental programme wherever the facility is sited.
The EoI defines a two-year programme culminating in the delivery of a
Technical Design Report.
[Show abstract][Hide abstract] ABSTRACT: The peer review in intensive care medicine is an evaluation process, which promotes a professional understanding of quality and the exchange of experience in intensive care. It will help integrating evidence based knowledge sooner into the treatment process and thus improving quality of intensive care and intensive nursing care. The process is a learning experience for all involved and is highly satisfying to the participants. The exchange of experience is an essential part of quality control. In the future the further development of quality control indicators will be done by the DIVI. The medical boards will provide organisational support.
No preview · Article · Mar 2012 · Anasthesiologie und Intensivmedizin
[Show abstract][Hide abstract] ABSTRACT: Background: In 2003 the cost analysis of German intensive care units for the year 1999 was published by the working group "Anaesthesia and Economics" of the German Society of Anaesthesiology and Intensive Care Medicine (DGAI) and the Association of German Anaesthetists (BDA). One of the aims of the original study was, in view of the upcoming introduction of the DRG system, to analyse the cost data of German intensive care units headed by anaesthetists. The objective of the follow-up study presented here was to analyse the 2009 cost data of German intensive care units to obtain a current picture of the cost situation 10 years after the first study and 6 years after the introduction of the DRG-System. Methods: In June 2010 all members of the German Society of Anaesthesiology and Intensive Care Medicine recorded as "Head of Department" were invited to participate in a postal survey. The questionnaire was based in part on the original 1999 cost analysis by Prien et al. It comprised sections dealing with the hospital, its resources and departments, the intensive care unit with its personnel and equipment, and the cost data for the year 2009. For data analysis the ICUs were clustered according to hospital size (<250 beds, 250-499 beds, >499 beds, university hospitals). Data were analysed using MS Excel 2003 and IBM SPSS Statistics 19. Results: 110 anaesthetist-headed ICUs participated in the study. The number of beds per ICU increased with increasing size of the hospital. The percentage of intensive care patients on ventilatory support varied between 20% (small hospitals) and 50% (university hospitals). The ratio of nursing and physician staff per bed was appreciably higher in university hospitals than in the other hospital types (nursing: 0.35±0.07 beds per nurse vs. 0.52±0.13; 0.53±0.14; 0.49±0.11; physician: 1.4±0.3 beds/ physician vs. 1.9±0.6; 2.1±0.7; 2.2±0.7). The costs for drugs and materials were higher for university hospitals (drugs: 155±72 euros vs. 55±29; 73±30; 81±28 euros; materials: 129±85 euros vs. 64±45; 77±60; 86±45 euros). In comparison to the 1999 study the higher costs for physicians contrast with a stagnation of inflation-adjusted nursing costs; the costs of drugs in university hospitals and the material costs in all hospital groups have increased considerably. The accurate assignment of costs to intensive care units and to individual cases apparently continues to be a problem for the hospital administration, even 6 years on from the introduction of the DRG system. A case-severity adjustment of costs proved impossible, due to inadequate recording of case severity data. Conclusions: Intensive care cost transparency remains less than optimal, so that benchmarking would seem possible only on the basis of a staff count. Adjustment for case severity, however, continues to be indispensable.
No preview · Article · Feb 2012 · Anasthesiologie und Intensivmedizin
[Show abstract][Hide abstract] ABSTRACT: The E672/E706 Spectrometer, located in the MW beam at Fermilab, was used to collect data on events containing a pair of muons in the final state with large effective mass. The momentum of incident pions and protons was 530 GeV/c. Nuclear targets included Be, C, Al, Cu and Pb. We report on a preliminary measurement of the A-dependence of the per nucleus cross section for forward J/psi production. The apparatus also detected charged particles and gamma's produced in association with the muon pair. The expected physics results on the hadroproduction of chi states and beauty particles are discussed.
[Show abstract][Hide abstract] ABSTRACT: To provide a global, up-to-date picture of the prevalence, treatment, and outcomes of Candida bloodstream infections in intensive care unit patients and compare Candida with bacterial bloodstream infection.
A retrospective analysis of the Extended Prevalence of Infection in the ICU Study (EPIC II). Demographic, physiological, infection-related and therapeutic data were collected. Patients were grouped as having Candida, Gram-positive, Gram-negative, and combined Candida/bacterial bloodstream infection. Outcome data were assessed at intensive care unit and hospital discharge.
EPIC II included 1265 intensive care units in 76 countries.
Patients in participating intensive care units on study day.
Of the 14,414 patients in EPIC II, 99 patients had Candida bloodstream infections for a prevalence of 6.9 per 1000 patients. Sixty-one patients had candidemia alone and 38 patients had combined bloodstream infections. Candida albicans (n = 70) was the predominant species. Primary therapy included monotherapy with fluconazole (n = 39), caspofungin (n = 16), and a polyene-based product (n = 12). Combination therapy was infrequently used (n = 10). Compared with patients with Gram-positive (n = 420) and Gram-negative (n = 264) bloodstream infections, patients with candidemia were more likely to have solid tumors (p < .05) and appeared to have been in an intensive care unit longer (14 days [range, 5-25 days], 8 days [range, 3-20 days], and 10 days [range, 2-23 days], respectively), but this difference was not statistically significant. Severity of illness and organ dysfunction scores were similar between groups. Patients with Candida bloodstream infections, compared with patients with Gram-positive and Gram-negative bloodstream infections, had the greatest crude intensive care unit mortality rates (42.6%, 25.3%, and 29.1%, respectively) and longer intensive care unit lengths of stay (median [interquartile range]) (33 days [18-44], 20 days [9-43], and 21 days [8-46], respectively); however, these differences were not statistically significant.
Candidemia remains a significant problem in intensive care units patients. In the EPIC II population, Candida albicans was the most common organism and fluconazole remained the predominant antifungal agent used. Candida bloodstream infections are associated with high intensive care unit and hospital mortality rates and resource use.
Full-text · Article · Dec 2010 · Critical care medicine
[Show abstract][Hide abstract] ABSTRACT: The Benchmarking Project "National Register for Quality Control in Intensive Care Medicine" has so far been attended by 59 Intensive care units from the majority of those specialties practicing intensive care, with 127,872 patients and a total of 589.635 treatment days. The underlying idea was the revision of the "1999 core data set". The high daily documentation requirement, new stratification instruments (e.g. SAPS3) and new developments in quality assurance (e.g. quality indicators) necessitated an updating of the core data. In addition to the newly introduced recording of SAPS3 (once on patient admission) and quality indicators (once a year or once per patient) the daily documentation requirement was reduced by abandoning the recording of a whole range of parameters, and limiting recording to those patients only who remained in the ICU for at least 24 hours. For paediatric patients, specific modifications were im - plemented. The "2010 ICM core data set" was officially agreed by both DIVI and DGAI and, to enable external quality comparison, its application by all ICUs recommended.
No preview · Article · Nov 2010 · Anasthesiologie und Intensivmedizin
[Show abstract][Hide abstract] ABSTRACT: Critical care medicine usually involves the implementation of measures resulting in significant consequences for the pa tient - including possible mistakes arising directly or indirectly from daily routine processes. In addition, an ever-widening range of pharmaceutical and technological options may also often have an impact. The increasing complex ity of pharmaceuticals and technical aids must be monitored and taken into account. The need for 24-hour care requires the daily presence of a variety of IC specialists and the interchange of data. Immediate coordinated expert action is equally as important as profession al competence in dealing with current limitations of medical science. Intensivists are increasingly being confronted with the demands of profession al quality management requirements within the ICU. This aspect is highlighted by the Vienna declaration on ICU patient safety drawn up at the 2009 European Congress of the ESICM . This includes a commitment to actively pursue quality management within the setting of intensive care medicine. The present article describes a practical and effective approach to this complex subject matter and the external evaluation of critical care by peer review, which has already been successfully implemented in Germany and is set to gain in significance.
No preview · Article · Nov 2010 · Anasthesiologie und Intensivmedizin
[Show abstract][Hide abstract] ABSTRACT: Practice guidelines are systematically developed statements and recommendations that assist the physicians and patients in making decisions about appropriate health care measures for specific clinical circumstances taking into account specific national health care structures. The 1(st) revision of the S-2k guideline of the German Sepsis Society in collaboration with 17 German medical scientific societies and one self-help group provides state-of-the-art information (results of controlled clinical trials and expert knowledge) on the effective and appropriate medical care (prevention, diagnosis, therapy and follow-up care) of critically ill patients with severe sepsis or septic shock. The guideline had been developed according to the "German Instrument for Methodological Guideline Appraisal" of the Association of the Scientific Medical Societies (AWMF). In view of the inevitable advancements in scientific knowledge and technical expertise, revisions, updates and amendments must be periodically initiated. The guideline recommendations may not be applied under all circumstances. It rests with the clinician to decide whether a certain recommendation should be adopted or not, taking into consideration the unique set of clinical facts presented in connection with each individual patient as well as the available resources.
Full-text · Article · Jun 2010 · German medical science : GMS e-journal