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364 results on '"Uhl T"'

1. Nondestructive Testing of Ceramic Hip Joint Implants with Laser Spot Thermography

Author

Roemer J., Pieczonka L., Juszczyk M., and Uhl T.

Subjects
laser spot thermography, damage detection, ceramic materials, hip joint implants, Mining engineering. Metallurgy, TN1-997, Materials of engineering and construction. Mechanics of materials, TA401-492
Abstract

The paper presents an application of laser spot thermography for damage detection in ceramic samples with surface breaking cracks. The measurement technique is an active thermographic approach based on an external heat delivery to a test sample, by means of a laser pulse, and signal acquisition by an infrared camera. Damage detection is based on the analysis of surface temperature distribution near the exciting laser spot. The technique is nondestructive, non-contact and allows for full-field measurements. Surface breaking cracks are a very common type of damage in ceramic materials that are introduced in the manufacturing process or during the service period. This paper briefly discusses theoretical background of laser spot thermography, describes the experimental test rig and signal processing methods involved. Damage detection results obtained with laser spot thermography are compared with reference measurements obtained with vibrothermography. This is a different modality of active thermography, that has been previously proven effective for this type of damage. We demonstrate that both measurement techniques can be effectively used for damage detection and quality control applications of ceramic materials.

Published
2017
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2. Time-variant system analysis using wavelet-based transmissibility

Author

Dziedziech, Kajetan, Staszewski, Wieslaw J., Uhl, T., Ceccarelli, Marco, Series Editor, Hernandez, Alfonso, Editorial Board Member, Huang, Tian, Editorial Board Member, Takeda, Yukio, Editorial Board Member, Corves, Burkhard, Editorial Board Member, Agrawal, Sunil, Editorial Board Member, and Uhl, Tadeusz, editor

Published
2019
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3. Design and Operation of FACT -- The First G-APD Cherenkov Telescope

Author

Anderhub, H., Backes, M., Biland, A., Boccone, V., Braun, I., Bretz, T., Buß, J., Cadoux, F., Commichau, V., Djambazov, L., Dorner, D., Einecke, S., Eisenacher, D., Gendotti, A., Grimm, O., von Gunten, H., Haller, C., Hildebrand, D., Horisberger, U., Huber, B., Kim, K. -S., Knoetig, M. L., K"ohne, J. H., Kr"ahenb"uhl, T., Krumm, B., Lee, M., Lorenz, E., Lustermann, W., Lyard, E., Mannheim, K., Meharga, M., Meier, K., Montaruli, T., Neise, D., Nessi-Tedaldi, F., Overkemping, A. -K., Paravac, A., Pauss, F., Renker, D., Rhode, W., Ribordy, M., R"oser, U., Stucki, J. -P., Schneider, J., Steinbring, T., Temme, F., Thaele, J., Tobler, S., Viertel, G., Vogler, P., Walter, R., Warda, K., Weitzel, Q., and Z"anglein, M.

Subjects
Astrophysics - Instrumentation and Methods for Astrophysics, Physics - Instrumentation and Detectors
Abstract

The First G-APD Cherenkov Telescope (FACT) is designed to detect cosmic gamma-rays with energies from several hundred GeV up to about 10 TeV using the Imaging Atmospheric Cherenkov Technique. In contrast to former or existing telescopes, the camera of the FACT telescope is comprised of solid-state Geiger-mode Avalanche Photodiodes (G-APD) instead of photomultiplier tubes for photo detection. It is the first full-scale device of its kind employing this new technology. The telescope is operated at the Observatorio del Roque de los Muchachos (La Palma, Canary Islands, Spain) since fall 2011. This paper describes in detail the design, construction and operation of the system, including hardware and software aspects. Technical experiences gained after one year of operation are discussed and conclusions with regard to future projects are drawn., Comment: Corresponding authors: T. Bretz and Q. Weitzel

Published
2013
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31. New or Progressive Multiple Organ Dysfunction Syndrome in Pediatric Severe Sepsis: A Sepsis Phenotype With Higher Morbidity and Mortality

Author

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

Subjects
Male, medicine.medical_specialty, Adolescent, Cross-sectional study, Multiple Organ Failure, Vascular damage Radboud Institute for Health Sciences [Radboudumc 16], Prevalence, children, epidemiology, multiple organ dysfunction syndrome, severe sepsis, Pediatrics, Perinatology and Child Health, Critical Care and Intensive Care Medicine, 030204 cardiovascular system & hematology, Global Health, Intensive Care Units, Pediatric, Pediatrics, Article, Sepsis, 03 medical and health sciences, 0302 clinical medicine, Internal medicine, Epidemiology, medicine, Humans, Hospital Mortality, Prospective Studies, 030212 general & internal medicine, Child, Intensive care medicine, Prospective cohort study, Septic shock, business.industry, Infant, Newborn, Infant, Perinatology and Child Health, Prognosis, medicine.disease, Clinical trial, Cross-Sectional Studies, Phenotype, Child, Preschool, Disease Progression, Female, Multiple organ dysfunction syndrome, business
Abstract

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.

Published
2017
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35. Acoustic emission source characterisation using evolutionary optimisation

Author

Worden, K., Spencer, A.B., Packo, P., Staszewski, W.J., Uhl, T., and Pierce, S.G.

Abstract

When a crack initiates and grows in a metal or composite structure, for example, due to high cycle fatigue, the crack propagation gives rise to acoustic emissions (AE)-ultrasonic waves travelling through the structure. Because the presence and rate of growth of any cracks are important pieces of information about the condition or health of the structure, the monitoring of AE activity using sensors mounted on its surface is a potentially useful technique of structural health monitoring. In tests, acoustic emissions are often simulated by breaking a pencil lead against the surface of the structure in a standardised way (a "Hsu-Nielsen" source), but the forces that this imparts are not well understood at present. The current paper proposes a new evolutionary optimisation-based approach to source characterisation. The principle is to introduce a parametrised representation of a general source and then identify the parameters that allow the source to best match responses measured elsewhere on the structure. The predicted responses are modelled using a local interaction simulation approach (LISA) algorithm to simulate the propagation of the ultrasonic waves. The approach is validated here using experiments on AE propagation in thin plate-like structures, where the ultrasound propagates as Lamb waves. Three separate case studies are proposed here. In the first case, an idealised point source is simulated using laser-generated ultrasound, and the optimisation algorithm uses a two-dimensional LISA model. A differential evolution optimisation scheme is used to find the optimal profile of forcing to match the simulation with experiment. In the second case, the two-dimensional LISA approach is used to characterise the forces associated with standard pencil lead breaks. The final study addresses the full three-dimensional wave propagation. Because of the computational expense of the latter calculation, the LISA algorithm is implemented using a CUDA graphics card computer system.

Published
2018

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

Author

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

Published
2019
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43. Cost of Safety

Author

Mann, Uhl T. and Griffin, Guy E.

Published
1964

49. Comparison of Pediatric Severe Sepsis Managed in U.S. and European ICUs

Author

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

Subjects
Male, Pediatrics, Cross-sectional study, shock, Critical Care and Intensive Care Medicine, Severity of Illness Index, 0302 clinical medicine, Prevalence, Hospital Mortality, Prospective Studies, 030212 general & internal medicine, Practice Patterns, Physicians', Child, Prospective cohort study, Pediatric intensive care unit, Perinatology and Child Health, Europe, Treatment Outcome, Child, Preschool, outcome, children, management, pediatric intensive care unit, Pediatrics, Perinatology and Child Health, Female, medicine.symptom, medicine.medical_specialty, Adolescent, Critical Care, Intensive Care Units, Pediatric, Sepsis, 03 medical and health sciences, Intensive care, Severity of illness, medicine, Humans, Healthcare Disparities, business.industry, Organ dysfunction, Infant, Newborn, Infant, 030208 emergency & critical care medicine, Health Status Disparities, medicine.disease, United States, Clinical trial, Cross-Sectional Studies, Multivariate Analysis, Emergency medicine, business
Abstract

Copyright © 2016 by the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies.Objectives: Pediatric severe sepsis remains a significant global health problem without new therapies despite many multicenter clinical trials. We compared children managed with severe sepsis in European and U.S. PICUs to identify geographic variation, which may improve the design of future international studies. Design: We conducted a secondary analysis of the Sepsis PRevalence, OUtcomes, and Therapies study. Data about PICU characteristics, patient demographics, therapies, and outcomes were compared. Multivariable regression models were used to determine adjusted differences in morbidity and mortality. Setting: European and U.S. PICUs. Patients: Children with severe sepsis managed in European and U.S. PICUs enrolled in the Sepsis PRevalence, OUtcomes, and Therapies study. Interventions: None. Measurements and Main Results: European PICUs had fewer beds (median, 11 vs 24; p < 0.001). European patients were younger (median, 1 vs 6 yr; p < 0.001), had higher severity of illness (median Pediatric Index of Mortality-3, 5.0 vs 3.8; p = 0.02), and were more often admitted from the ward (37% vs 24%). Invasive mechanical ventilation, central venous access, and vasoactive infusions were used more frequently in European patients (85% vs 68%, p = 0.002; 91% vs 82%, p = 0.05; and 71% vs 50%; p < 0.001, respectively). Raw morbidity and mortality outcomes were worse for European compared with U.S. patients, but after adjusting for patient characteristics, there were no significant differences in mortality, multiple organ dysfunction, disability at discharge, length of stay, or ventilator/vasoactive-free days. Conclusions: Children with severe sepsis admitted to European PICUs have higher severity of illness, are more likely to be admitted from hospital wards, and receive more intensive care therapies than in the United States. The lack of significant differences in morbidity and mortality after adjusting for patient characteristics suggests that the approach to care between regions, perhaps related to PICU bed availability, needs to be considered in the design of future international clinical trials in pediatric severe sepsis.

Published
2016

50. Comparison of Pediatric Severe Sepsis Managed in US and European ICUs

Author

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

Published
2016

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