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Copyright © 2016 by the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies.Objectives: To describe the epidemiology, morbidity, and mortality of new or progressive multiple organ dysfunction syndrome in children with severe sepsis. Design: Secondary analysis of a prospective, cross-sectional, point prevalence study. Setting: International, multicenter PICUs. Patients: Pediatric patients with severe sepsis identified on five separate days over a 1-year period. Interventions: None. Measurements and Main Results: Of 567 patients from 128 PICUs in 26 countries enrolled, 384 (68%) developed multiple organ dysfunction syndrome within 7 days of severe sepsis recognition. Three hundred twenty-seven had multiple organ dysfunction syndrome on the day of sepsis recognition. Ninety-one of these patients developed progressive multiple organ dysfunction syndrome, whereas an additional 57 patients subsequently developed new multiple organ dysfunction syndrome, yielding a total proportion with severe sepsis-associated new or progressive multiple organ dysfunction syndrome of 26%. Hospital mortality in patients with progressive multiple organ dysfunction syndrome was 51% compared with patients with new multiple organ dysfunction syndrome (28%) and those with single-organ dysfunction without multiple organ dysfunction syndrome (10%) (p < 0.001). Survivors of new or progressive multiple organ dysfunction syndrome also had a higher frequency of moderate to severe disability defined as a Pediatric Overall Performance Category score of greater than or equal to 3 and an increase of greater than or equal to 1 from baseline: 22% versus 29% versus 11% for progressive, new, and no multiple organ dysfunction syndrome, respectively (p < 0.001). Conclusions: Development of new or progressive multiple organ dysfunction syndrome is common (26%) in severe sepsis and is associated with a higher risk of morbidity and mortality than severe sepsis without new or progressive multiple organ dysfunction syndrome. Our data support the use of new or progressive multiple organ dysfunction syndrome as an important outcome in trials of pediatric severe sepsis although efforts are needed to validate whether reducing new or progressive multiple organ dysfunction syndrome leads to improvements in more definitive morbidity and mortality endpoints.

Simultaneous laser locking of IR and UV lasers to a visible stabilized reference laser is demonstrated via a Fabry-Perot cavity. LabVIEW is used to analyze the input and an internal PID algorithm converts the Fabry-Perot signal to an analog locking feedback signal. The locking program stabilized both lasers to a long term stability of better than 9 MHz, with a custom-built IR laser undergoing significant improvement in frequency stabilization. The results of this study demonstrate the viability of a simple computer-controlled, non temperature-stabilized Fabry-Perot locking scheme for our application, laser cooling of Ca+ ions, and its use in other applications with similar modest frequency stabilization requirements., Comment: 12 pages, 7 figures

We present measurements of the total elastic and resonant charge-exchange ion-atom collision rate coefficient $k_\mathrm{ia}$ of cold sodium (\ce{Na}) with optically-dark low energy \ce{Na+} ions in a hybrid ion-neutral trap. To determine $k_\mathrm{ia}$, we measured the trap loading and loss from both a \ce{Na} magneto-optical trap (MOT) and a linear radio frequency quadrupole Paul trap. We found the total rate coefficient to be $7.4 \pm 1.9 \times 10^{-8}$ cm$^3$/s for the type I \ce{Na} MOT immersed within an $\approx 140$ K ion cloud and $1.10 \pm 0.25 \times 10^{-7}$ cm$^3$/s for the type II \ce{Na} MOT within an $\approx 1070$ K ion cloud. Our measurements show excellent agreement with previously reported theoretical fully quantal \textit{ab initio} calculations. In the process of determining the total rate coefficient, we demonstrate that a MOT can be used to probe an optically dark ion cloud's spatial distribution within a hybrid trap., Comment: 14 pages, 15 figures

Objective To determine the safety and efficacy of 3 clinically relevant vaccines in patients with systemic lupus erythematosus (SLE). Methods We studied 73 consecutive SLE patients immunized with pneumococcal, tetanus toxoid (TT), and Haemophilus influenzae type B (HIB) vaccines. Patients were evaluated preimmunization and 12 weeks postimmunization for disease activity and immunization side effects. Results Eighty-four percent of the SLE patients developed a 4-fold titer increase in response to at least 1 vaccine, with 51% developing a 2-fold titer increase with all 3 vaccines. The majority of SLE patients developed protective levels of antibody to TT (90%) and HIB (88%). Although protective antibody levels could not be determined for pneumococcus, almost half of the patients (47%) developed a 4-fold antibody response. There was a trend toward a lower antibody response in patients with active disease treated with immunosuppressive therapy. Overall lupus disease activity was unaffected by immunization. Conclusion Immunization is safe in SLE patients, with the overwhelming majority developing protective antibody levels. Therefore, SLE patients should receive immunizations according to the recommendations of the Centers for Disease Control and Prevention and the Immunization Practices Advisory Committee.

Nowadays, it has been accepted that studies on cultural heritage made from just archaeological excavation often cannot provide sufficient and satisfactory information to determine the essential cultural and economic structures of the ancient inhabitants of a region. These researches need to be integrated with data from other disciplines to help thoroughly in delineating the history of the area investigated. In the last 20 years, various scientific disciplines have provided effective tools for an integrated approach to the knowledge, analysis and safeguard of the Cultural Heritage. In particular, geophysical prospecting methods represent an entire range of non-invasive surveying techniques, including data processing and image representation of the different data sets collected from the surface, which can enhance the knowledge of the investigated area.This book was written to appeal to researchers employing the Ground Penetrating Radar method to study the characterization and protection of archaeological and historical sites, contained in the urban territories of both major cities and small historical centres. GPR Remote Sensing in Archaeology introduces Ground Penetrating Radar via understanding the complexity of this geophysical method through a simulator. The book continues with several chapters covering many of the signal and image processes needed to take the raw recorded radargrams, and showing the steps to create 3D data volumes that can be effectively used in the interpretation of subsurface archaeology. Guidelines for generating useful depth slice maps from random GPS tracks or from regularly spaced surveys using interpolation, as well as specialized processing required for hi-density surveying using the latest multichannel GPR systems are presented. Imaging techniques such as overlay analysis for placing important reflections through the depth record into comprehensive 2D maps are given extra attention. The book gives examples of case studies made at a variety of archaeological sites from around the world. Although the book is designed primarily for readers interested in archaeological investigations, geoengineering and geotechnical practitioners may also benefit by incorporating some of the processing techniques outlined. As described in this book, Ground Penetrating Radar (GPR) technique is bringing new powerful tools to help archaeologists and historians in their quest of discovery and exploration. Even though this field is still in progress, the different contributions in this book give us a glimpse of the things to come and the great potential of GPR in archaeology.

Introduction Consensus criteria for pediatric severe sepsis have standardized enrollment for research studies. However, the extent to which critically ill children identified by consensus criteria reflect physician diagnosis of severe sepsis, which underlies external validity for pediatric sepsis research, is not known. We sought to determine the agreement between physician diagnosis and consensus criteria to identify pediatric patients with severe sepsis across a network of international pediatric intensive care units (PICUs). Methods We conducted a point prevalence study involving 128 PICUs in 26 countries across 6 continents. Over the course of 5 study days, 6925 PICU patients Results Of the 706 patients, 301 (42.6 %) met both definitions. The inter-rater agreement (κ ± SE) between physician diagnosis and consensus criteria was 0.57 ± 0.02. Of the 438 patients with a physician’s diagnosis of severe sepsis, only 69 % (301 of 438) would have been eligible to participate in a clinical trial of pediatric severe sepsis that enrolled patients based on consensus criteria. Patients with physician-diagnosed severe sepsis who did not meet consensus criteria were younger and had lower severity of illness and lower PICU mortality than those meeting consensus criteria or both definitions. After controlling for age, severity of illness, number of comorbid conditions, and treatment in developed versus resource-limited regions, patients identified with severe sepsis by physician diagnosis alone or by consensus criteria alone did not have PICU mortality significantly different from that of patients identified by both physician diagnosis and consensus criteria. Conclusions Physician diagnosis of pediatric severe sepsis achieved only moderate agreement with consensus criteria, with physicians diagnosing severe sepsis more broadly. Consequently, the results of a research study based on consensus criteria may have limited generalizability to nearly one-third of PICU patients diagnosed with severe sepsis.

In this paper we describe an architecture which implements call and pass by reference using asynchronous Web Services. This architecture provides a distributed data analysis environment where functions can be dynamically described and used.

The regional impacts of economic development incentives are studied in the context of a computable general equilibrium (CGE) model. The object is to evaluate the effectiveness of several incentives used to attract new businesses in the city of Pueblo, Colorado. The results show that the regional benefits of these incentives are relatively small, and the net benefits to the local population when all impacts are accounted for are likely to be negative. Instead, the benefits are largely transferred to new businesses and employees who migrate to the region in response to the incentives. Contrary to perceptions about the multiplier impacts of economic development, the net impact on the local manufacturing sector is negative as well. The incentives cause a substitution effect, as investment is shifted toward export-oriented manufacturing sectors that are favored for economic development. These results address the seeming paradox that economic development can attract new businesses and jobs, yet be unpopular enough among local residents for them to vote against continuing it.

A computable general equilibrium model of the southeastern Colorado economy is used to compare the economic impacts of a proposed increase in reservoir storage to an alternative: temporary water transfers. While both provide municipalities with reliable water supply during droughts and are shown to benefit both rural and urban communities, temporary transfers are accomplished at a much lower economic and environmental cost. This analysis illustrates how computable general equilibrium models provide a more realistic portrayal of the impact of policy changes than input-output analysis by allowing substitution in response to economic conditions.

A dose intercomparison was carried out by the National Physical Laboratory between the seven radiotherapy centres which contributed the largest number of patients to the British Institute of Radiology fractionation study of three fractions per week versus five fractions per week in clinical cancer treatment. Six of the centres showed remarkable agreement within the acceptable limits of error of the measurements. In one centre there appeared to be a physical dose discrepancy of 2.8% which was materially less than could be detected clinically.

Because of the high incidence and great variety of complications associated with anterior chamber intraocular lenses, we have developed a technique for the implantation of a posterior chamber intraocular lens in the absence of posterior capsular support. The posterior chamber IOL is placed in the ciliary sulcus by suturing the superior haptic to the iris and the inferior haptic to the sclera at the ciliary sulcus. We have used this technique successfully in both complicated extracapsular surgery and secondary intraocular lens implantation.

This paper describes a specific system analytic approach to the coaching and teaching of team sports. Computer technology is used to acquire the sequential history of critical events that occur during competition. A system is described that allows the analyst to enter data directly on a microcomputer and then compute relevant statistics for immediate use by the coach or teacher. The implications for the microcomputer system's use in high performance sports is also discussed.

In transthyretin (TTR) a new mutation (TTR-Thr45) has been identified in a patient with familial amyloidosis characterized clinically by prominent cardiomyopathy and the absence of peripheral neuropathy. Comparative peptide mapping by high-performance liquid chromatography of the patient's plasma TTR together with normal TTR showed the presence of an abnormal tryptic peptide in the patient's TTR. The sequence of this peptide (peptide 6, residues 36-48) demonstrated the presence of a threonine-for-alanine substitution at position 45. This change can be explained by a single base change of adenine for guanine in the Ala-45 codon and was demonstrated directly by DNA sequence analysis of PCR-amplified exon 2 of the TTR gene; allele-specific oligonucleotide hybridization both in the patient and in fixed heart tissue from his aunt confirmed the base change. The TTR-Thr45 mutation is a new variant TTR found associated with cardiomyopathy.

• To avoid the complications associated with anterior chamber intraocular lenses (IOLs), we have developed a technique for the implantation of a posterior chamber IOL in the absence of capsular support. The IOL is secured in the ciliary sulcus by suturing the haptics to the sclera at the ciliary sulcus inferiorly and to the sclera or iris superiorly. We have used this technique for secondary IOL implantation in 16 contact lens-intolerant patients with aphakia with a mean follow-up of 9 months (range, 5 to 20 months) and in eight eyes at the time of IOL removal. All eyes with secondary implants had equal or improved vision postoperatively; none developed persistent angiographic cystoid macular edema. In the 8 patients with IOL exchange, visual acuity improved in five eyes, remained the same in two, and decreased two lines in one. Suturing of an IOL in the ciliary sulcus has enabled us to use a posterior chamber IOL in eyes without a posterior capsule when secondary IOL implantation or IOL exchange is indicated. Secondary posterior chamber IOL implantation is recommended only when satisfactory vision cannot be achieved with glasses or contact lenses, and further follow-up is needed before this procedure can be widely recommended.

Staphylococcus epidermidis accounts for nearly one third of all cases of bacterial keratitis in certain geographic areas. Recently, the sensitivity of this organism has changed dramatically so that nearly half of nosocomially acquired systemic S epidermidis infections are resistant to methicillin sodium, cephalosporins, and aminoglycosides. Methicillin-resistant and gentamicin sulfate-resistant S epidermidis causing infectious blepharoconjunctivitis and endophthalmitis has previously been reported. Two cases of methicillin- and gentamicin-resistant S epidermidis keratitis occurred that were treated successfully with topical vancomycin hydrochloride.

The Handbook of the Politics of China is a comprehensive resource introducing readers to the very latest in research on Chinese politics.

BACKGROUND: Benefits of conversion from calcineurin inhibitor (CNI) to mammalian target of rapamycin inhibitor-based immunosuppression in long-term kidney transplant patients remain uncertain. METHODS: ASCERTAIN was a 24-month, open-label, multicenter study. Kidney transplant patients more than 6 months posttransplant receiving CNI (baseline glomerular filtration rate [GFR] 30-70 mL/min/1.73 m) were randomized to everolimus with CNI elimination (n=127) or CNI minimization (n=144), or continued CNI unchanged (controls, n=123) to assess the effect on measured GFR at month 24 after randomization. RESULTS: Renal function was stable in all groups to month 24. Mean measured GFR at month 24, the primary endpoint, was 48.0±22.0 mL/min/1.73 m, 46.6±21.1 mL/min/1.73 m, and 46.0±20.4 mL/min/1.73 m in the CNI elimination, CNI minimization, and control groups, respectively. Differences between CNI elimination (1.12 mL/min/1.73 m, 95% confidence interval [CI] -3.51 to 5.76, P=0.63) and CNI minimization (0.59 mL/min/1.73 m, 95% CI -3.88 to 5.07, P=0.79) versus controls at month 24 were nonsignificant that is, the primary endpoint was not met. No efficacy endpoint differed significantly between groups. Post hoc analyses showed that patients with baseline creatinine clearance (CrCl) more than 50 mL/min had a significantly greater increase in measured GFR after CNI elimination versus controls (difference 11.4 mL/min/1.73 m, 95% CI 2.1 to 20.8 mL/min/1.73 m, P=0.017). Adverse events resulted in discontinuation in 36 (28.3%) CNI elimination patients, 24 (16.7%) CNI minimization patients, and 5 (4.1%) controls (P