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To explore the association of estimated plasma volume (ePV) and plasma volume status (PVS) as surrogates of volume status with new-onset AKI and in-hospital mortality among hospitalized COVID-19 patients.

Objectives: Peripherally inserted central catheters (PICCs) are increasingly recognized as an alternative to centrally inserted central catheters (CICCs) in critical care, yet the data regarding the safety and feasibility of this choice in septic shock management is growing but still lacking. In this study, we aimed to determine the feasibility, safety, and impact on outcomes of using dedicated vascular access specialist (VAS) teams to insert PICCs versus CICCs on patients admitted to the ICU with septic shock.Design: Retrospective cohort study.Setting: Mayo Clinic Rochester Medical ICU and Mayo Clinic Arizona Multidisciplinary ICU from 2013 to 2016.Patients: All adult patients hospitalized with diagnosis of septic shock excluding patients who declined authorization for review of their medical records, mixed shock states, and readmissions.Interventions: None.Measurement and main results: Comprehensive data regarding septic shock diagnosis and resuscitation were abstracted from electronic medical records. A total of 562 patients with septic shock were included in the study; 215 patients were resuscitated utilizing a PICC and 347 were resuscitated using a CICC. On univariate analysis, the time to central line insertion and time to vasopressor initiation were found to be reduced in those who received PICC at time of ICU admission versus CICC. Other favorable outcomes were also observed in those who received PICC versus CICC including shorter ICU length of stay and lower unadjusted hospital mortality. A multivariable analysis for hospital mortality showed that after adjusting for important covariates, neither the time to central line insertion nor the time to vasopressor initiation was associated with a lower hospital mortality.Conclusions: Across two tertiary referral centers within the same enterprise, use of a dedicated VAS team for insertion of PICCs for initial resuscitation in patients with septic shock was feasible and associated with shorter time to central venous access and initiation of vasopressors; however, adjusted hospital mortality was not different between the two groups.

This study introduces a culturally sensitive educational intervention to households that use open-fire cooking methods in order to improve the acceptance and sustained use of a safer cooking stove. A wood-burning stove with a closed firebox was introduced in two villages in the highlands of Guatemala. Usage rates were measured over a seven-month period after the stoves were built. Although higher initial acceptance rates were seen in the village that received the educational intervention, households in both villages showed acceptance and sustained usage rates of the stoves. This finding supports the premise that culturally sensitive educational interventions as well as community-based programmes lead to higher acceptance of initiatives, and news of these improvements spreads through culturally accepted routes.

To develop and validate an updated lung injury prediction score for coronavirus disease 2019 (COVID-19) (c-LIPS) tailored for predicting acute respiratory distress syndrome (ARDS) in COVID-19.

•GSPDs find profound impact in their development as a leader on the job in their personal development and in using the position as a steppingstone to other roles.•GSPDs see themselves as resident advocates and confidants, being able to assist residents in a vulnerable time in their lives.•Common proficiencies that the GSPD job requires are not always taught before the role but many are developed on the job and acquired through experience.•There are transformational parts of the GSPD job that provide fulfillment and meaning, but there are also transactional parts of the job that contribute to burnout.`

Ventilator-associated pneumonia (VAP) rates are higher in low- and middle-income countries (LMICs) than in high-income countries (HICs).

The black carbon (BC) aerosol is the organic remanence of the incomplete burning of various fuels. The study attempts to analyse the temporal variability of BC over Ranchi, Jharkhand, India using ground based measurements of aethalometer. The diurnal variation reveals two prominent sharp peaks throughout the year, one in the morning hours (0130-0330 UTC) and other in the evening hours (1330-1530 UTC). The results show a marked seasonal variation in BC concentration, with highest value during the pre-monsoon (7.24 µg/m3) and least in the monsoon (2.01 µg/m3) season. The relationship of meteorological variables such as temperature, precipitation, aerosol optical depth (AOD), organic carbon and vegetation represented via Normalized Difference Vegetation Index (NDVI) with BC is also computed using satellite-based measurements. A significant correlation is in the spatial pattern of organic carbon (r= 0.927), AOD (r= 0.86) and temperature (r= 0.748) with BC, whereas precipitation (r= − 0.146) and NDVI (r= − 0.203) shows insignificant correlation with BC. Significantly higher level of BC concentration (11.95 µg/m3) in response to the fog event is observed throughout the day against lower (6.5 µg/m3) BC in winter. The morning peak is increased by 4.71 µg/m3and delayed by two hours on foggy day than the winter mean. During the thunder squall event, mean BC is reduced to 3.84 µg/m3from 7.24 µg/m3in  pre-monsoon. Similar reduction is also observed in mean BC (1.2 µg/m3) in response to a rainy day during monsoon. The variability in BC is key to the changes in AOD that impacts the air quality, energy balance, cloud-precipitation processes, global warming and climate change.

IMPORTANCE: There is limited evidence for therapeutic options for pediatric COVID-19 outside of multisystem inflammatory syndrome in children (MIS-C). OBJECTIVE: To determine whether the use of steroids within 2 days of admission for non–MIS-C COVID-19 in children is associated with hospital length of stay (LOS). The secondary objective was to determine their association with intensive care unit (ICU) LOS, inflammation, and fever defervescence. DESIGN, SETTING, AND PARTICIPANTS: This cohort study analyzed data retrospectively for children (<18 years) who required hospitalization for non–MIS-C COVID-19. Data from March 2020 through September 2021 were provided by 58 hospitals in 7 countries who participate in the Society of Critical Care Medicine Discovery Viral Infection and Respiratory Illness Universal Study (VIRUS) COVID-19 registry. EXPOSURE: Administration of steroids within 2 days of admission. MAIN OUTCOMES AND MEASURES: Length of stay in the hospital and ICU. Adjustment for confounders was done by mixed linear regression and propensity score matching. RESULTS: A total of 1163 patients met inclusion criteria and had a median (IQR) age of 7 years (0.9-14.3). Almost half of all patients (601/1163, 51.7%) were male, 33.8% (392/1163) were non-Hispanic White, and 27.9% (324/1163) were Hispanic. Of the study population, 184 patients (15.8%) received steroids within 2 days of admission, and 979 (84.2%) did not receive steroids within the first 2 days. Among 1163 patients, 658 (56.5%) required respiratory support during hospitalization. Overall, patients in the steroids group were older and had greater severity of illness, and a larger proportion required respiratory and vasoactive support. On multivariable linear regression, after controlling for treatment with remdesivir within 2 days, country, race and ethnicity, obesity and comorbidity, number of abnormal inflammatory mediators, age, bacterial or viral coinfection, and disease severity according to ICU admission within first 2 days or World Health Organization ordinal scale of 4 or higher on admission, with a random intercept for the site, early steroid treatment was not significantly associated with hospital LOS (exponentiated coefficient, 0.94; 95% CI, 0.81-1.09; P = .42). Separate analyses for patients with an LOS of 2 days or longer (n = 729), those receiving respiratory support at admission (n = 286), and propensity score–matched patients also showed no significant association between steroids and LOS. Early steroid treatment was not associated with ICU LOS, fever defervescence by day 3, or normalization of inflammatory mediators. CONCLUSIONS AND RELEVANCE: Steroid treatment within 2 days of hospital admission in a heterogeneous cohort of pediatric patients hospitalized for COVID-19 without MIS-C did not have a statistically significant association with hospital LOS.

There have been conflicting results on the association of asthma with the severity of coronavirus disease 2019 (COVID-19). Poor metabolic health has been previously associated with both severe COVID-19 and inflammation in asthma.

ABSTRACTObjectivesThe COVID-19 pandemic severely restricted in-person learning. As a result, many educational institutions switched to online platforms to continue teaching. COVID-19 webinars have been useful for rapidly disseminating information to frontline healthcare workers. While conducting COVID-19 webinars through online platforms is a popular method to train medical professionals, their effectiveness has never been investigated. Our aim was to ascertain the usefulness of COVID-19 webinars during the pandemic.MethodsWe conducted an online survey of about 400 frontline healthcare workers. 112 people responded to the survey (response rate = 28%). In it, we asked several questions to determine whether webinars had been a useful resource to help deal with COVID-19 patients.ResultsWe found that a majority of healthcare worker respondents had favorable opinions of online education during the pandemic as around 78% of respondents either agreed or highly agreed that webinars are a useful source of knowledge. A significant proportion (34%) did not participate in webinars and gave time constraints as their main reason for not participating.ConclusionOur results indicated that while online education is a great way to disseminate information quickly to a large amount of people, it also comes with its disadvantages. As we transition into a post-pandemic world, we need to make sure that online teaching is designed with the best interests of the healthcare workers in mind to ensure that we get the most out of it.

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Hydrocarbons are of significance for economic and environmental standpoints. Hydrocarbon microseepage alters the surface properties of land. Here, the detection of potential hydrocarbon microoseepage zone based on vegetation stress is carried out in the north-eastern Indian states of Assam and Meghalaya. A weighted overlay model, fed by 11 spectral wide and narrow band vegetation indices (VIs), is used to determine the effective VIs for detecting vegetation stress. Mineral alteration indices are also employed as proxies to detect potential hydrocarbon microseepage sites. Mineral alteration zones exhibiting vegetation stress are speculated to be potential hydrocarbon microseepage sites. VIs such as Red Edge Normalized Difference Vegetation Index (RENDVI), Normalized Difference Vegetation Index (NDVI), Lichtenthaler Index 1 (LIC1) and Simple Ratio Index (SRI) are more effective in detecting vegetation stress as they are sensitive to minor variations in chlorophyll content. The predominant vegetation stress is detected in south-east region of the study area in Jowai around Jaintia hills. The mineral alteration indices confirms that it is a potential hydrocarbon microseepage zone. Thus, remote sensing data can serve the dual purpose of fuel resource exploration and pollution source detection at once being cost effective, hazard free and convenient.

Orography of Himalaya governs the regional weather system and monsoon of Indian sub-continent. The intense persistent precipitation in the form of rainfall during monsoon season causes landslides which are the most frequent naturally occurring hazards in the Himalaya. This study attempts to investigate the spatio-temporal variability of precipitation and their effect on precipitation triggered landslides during monsoon season (June–September) in relation to relief in Himalayan region by utilizing satellite-derived precipitation products (GPM) over the span of 2000–2018 in addition to NASA Landslide Viewer, Global Landslide Catalog and Global Risk Data Platform data for landslides and ASTER DEM for elevation. The results exhibit that the Eastern Himalayas received the highest amount of precipitation of 2385 mm with intensity of 19.5 mm/day, followed by the Central Himalayas with 1860 mm and intensity of 17.5 mm/day and the least in the Western Himalayas with 1400 mm and intensity of 15 mm/day, respectively. The monsoon precipitation in the lower elevations (below 2600 m) are mostly responsible for causing a vast majority of the precipitation induced landslide events with a maximum of 68.66% in the Central Himalayas followed by the Western Himalayas at 62.23% and the least in the Eastern Himalayas at 41.16%. The overall accumulated precipitation and intensity during monsoon season and landslide distribution were strongly correlated with relief pattern. This comprehensive study signifies how relief regulated the occurrences of landslides in monsoon season and recommends vegetation cover and least interference of human-induced land use to alleviate the landslides.

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ABSTRACTThe COVID-19 pandemic caused the United States to hit record numbers of COVID-19 cases: peak unemployment of 14.7%, an increase in $4 trillion in national debt, and an estimated 3.4% GDP decline. The current socio-economic environment the pandemic created is just an earthquake that can create a tsunami that is bound to hit the healthcare system and can be felt around the globe. This tsunami is composed of a post-pandemic increase in healthcare facilities admission of indigent patients, decrease in medical reimbursement, and high operating costs to maintain healthcare workers, which can cause a synergistic effect that can lead to healthcare facilities experiencing significant negative total revenue. Time is of the essence, and it is imperative to make a collective effort from all healthcare professionals and legislatures to shift the nation’s attention to the issue at hand that can threaten the closure of many healthcare facilities post-pandemic.

ABSTRACTRene Laennec came up with the idea of a stethoscope in 1816 to avoid the embarrassment of performing immediate auscultation on women. Soon many doctors around the world started using this tool because of its increased accuracy and ease of use. Stethoscopes hold great significance in the medical community. However, is the importance placed on stethoscopes justified today? We now have devices like portable ultrasound machines that make it much easier to visualize the body. These devices offset their higher initial cost by reducing downstream costs due to their greater accuracy and their capability of detecting diseases at an earlier stage. Also, because of the COVID-19 pandemic, new ways are being investigated to reduce the transmission of diseases. Stethoscopes being a possible vector for infectious agents coupled with the advent of newer devices that can visualize the body with greater accuracy put into question the continued use of stethoscopes today. With that said, the use of stethoscopes to diagnose diseases is still crucial in places where buying these new devices is not yet possible. The stethoscope is a great symbol of medicine, but its use needs to be in line with what is best for the patient.

The Checklist for Early Recognition and Treatment of Acute Illness and iNjury program is a well-established, interactive, and simulation-based program designed to improve the quality of care delivered in intensive care units. The COVID-19 pandemic created an overwhelming surge of critically ill patients worldwide, and infection control concerns limited healthcare providers' access to in-person and hands-on simulation training when they needed it the most. Virtual simulation offers an alternative to in-person training but is often complex and expensive. We describe our successful development and initial implementation of an inexpensive, simulation-based virtual Checklist for Early Recognition and Treatment of Acute Illness and iNjury program to address the pressing need for effective critical care training in various resource-limited settings both within and outside of the United States. The overall satisfaction rate (“excellent” or “very good” responses) was 94.4% after the virtual simulation workshop. Our initial experience suggests that virtual interactions can be engaging and build strong relationships, like in-person continuing professional education, even using relatively simple technology. This knowledge-to-practice improvement platform can be readily adapted to other disciplines beyond critical care medicine.

Breathing exercises have been reported to have positive physiological effects on the body. The incidence of hypertension has become a major risk factor for cardiac complications leading to higher morbidity and mortality. Our aim was to conduct a systematic review and meta-analysis to study the effect of breathing exercises on blood pressure (BP) and heart rate (HR).

The use of electronic cigarettes, known as vaping, has become increasingly popular over the past decade, particularly in the adolescent and young adult population, often exposing users to harmful chemicals. Vaping has been associated with a heterogeneous group of pulmonary disease. Recently, a multistate epidemic has emerged surrounding vaping-related acute lung injury, prompting the Centers for Disease Control and Prevention to list an official health advisory. In this review, we describe the current literature on the epidemiology, clinical significance, as well as recommended evaluation and treatment of vaping-related lung injury.

To assess the risk of hemorrhagic complications in patients taking novel oral anticoagulants (NOACs) and/or clopidogrel who underwent an ultrasound-guided thoracentesis.

We introduce PULSEDYN, a particle dynamics program written in C++, to solve the equations of motion of many-body nonlinear systems in one dimension. PULSEDYN contains a suite of commonly used potentials (Fermi–Pasta–Ulam–Tsingou, Toda, Morse and Lennard-Jones) and solvers (velocity-Verlet and Gear 5th order predictor–corrector) for particle dynamics. PULSEDYN is designed to perform scientifically accurate simulations using these calculations. For accessing the built-in features of PULSEDYN, no knowledge of programming is expected, apart from the creation of a parameter file using predefined commands for running the executable. Therefore, simulations for research projects can be performed with minimal code writing using PULSEDYN. PULSEDYN is distributed under the GNU GPL v3 license and the source code and the executable are available on Github. The writing style emphasizes organization and legibility. Therefore, we anticipate that it would serve as a good template for users who may wish to adapt the code to their specific needs. In this manuscript, we first discuss PULSEDYN and its features in detail. Then, we show results reproduced from literature using PULSEDYN for the following cases (i) Soliton propagation and collisions in the (integrable) Toda lattice (ii) Recurrence phenomena, decay of localized excitations and solitary wave collision in the Fermi–Pasta–Ulam–Tsingou lattice and (iii) Solitary wave propagation in the Morse and Lennard-Jones lattices. Finally, we present a new result on a problem of fundamental historical importance using PULSEDYN. We show by means of explicit specific heat calculations, that in the limit of strong nonlinearity, the quartic Fermi–Pasta–Ulam–Tsingou system approaches equipartition at late times. Program Title: PULSEDYN Program Files doi: http://dx.doi.org/10.17632/fc8483t7jz.1 Licensing provisions: GNU General Public License 3 (GPL) Programming Language: C++ Supplementary Material: user manual, documentation Nature of problem: We solve a Newtonian particle dynamics problem in one dimension for a variety of commonly used nonlinear manybody systems. The goal is that the user should be able to run scientifically accurate simulations with minimal effort. Benchmarking should also be easy to perform by different users running simulations across different platforms. Solution method: The code uses a parameter file interface with a set of commands for a range of pre-built functionalities. By providing the code and the needed parameter file to the user we hope to make scientifically accurate simulations easier to perform. We provide the Gear 5th order predictor–corrector algorithm as well as the velocity-Verlet algorithm and the following potentials — the Toda potential, Morse Potential, Lennard-Jones Potential and a polynomial potential up to 4th order. To make benchmarking consistent we release the software as open source and free to distribute. [ABSTRACT FROM AUTHOR]

To investigate age-related differences in outcomes of critically ill patients with sepsis around the world.

The newly proposed septic shock definition has provoked a substantial controversy in the emergency and critical care communities. We aim to compare new (SEPSIS-III) versus old (SEPSIS-II) definitions for septic shock in a contemporary cohort of critically ill patients.

The association of pulmonary hypertension (PH) in patients with sepsis is lesser understood.

AbstractAntimicrobial resistance is a major problem in India with limited understanding of whether this issue is related to systems, prescriber characteristics, patient characteristics, or diagnostic technologies. In our survey, most of the issues lie in the easy availability of antimicrobials and the lack of electronic storage of medical and microbiological records.