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Lactate is a frequently used biomarker in emergency departments (EDs), especially in critically ill patients. The aim of this study is to investigate the relationship between lactate and lactate clearance with in-hospital mortality in unselected ED patients.
Methods:
This study was carried out retrospectively in the ED of a tertiary hospital. Patients aged 18 years and older whose blood lactate level was obtained in the ED were included in the study. Patients whose lactate value did not have sufficient analytical accuracy, whose lactate value was recorded in the system 180 minutes after admission, who were admitted to the ED as cardiac arrest, and whose ED or hospital outcome was unknown were excluded from the study. According to the first measured lactate value, the patients were divided into three groups: < 2.0mmol/L, 2.0-3.9mmol/L, and ≥ 4.0mmol/L. Lactate clearance was calculated and recorded in patients with one-to-four hours between two lactate values.
Results:
During the five-year study period, a total of 1,070,406 patients were admitted to the ED, of which 114,438 (10.7%) received blood gas analysis. The median age of 81,449 patients included in the study was 58 years (IQR: 30, min: 18–max: 117) and 54.4% were female. The study found that non-trauma patients with a lactate level between 2.0-3.9mmol/L had a 2.5-times higher mortality risk, while those with a lactate level of ≥ 4.0mmol/L had a 20.8-times higher risk, compared to those with a lactate level < 2.0mmol/L. For trauma patients, the mortality risk was three-times higher for those with lactate levels between 2.0-3.9mmol/L and nine-times higher for those with a lactate level of ≥ 4.0mmol/L, compared to those with a lactate level < 2.0mmol/L. Among patients with a first measured lactate value ≥ 4.0mmol/L and a two-hour lactate clearance < 20%, the mortality rate was 19.7%. In addition, lactate, lactate clearance, and age were independent variables for mortality in this patient group.
Conclusion:
The lactate value in unselected patients in the ED is a biomarker that can be used to predict the prognosis of the patients. In addition, lactate, lactate clearance, and age are independent predictors of mortality.
Ebnerite and epiebnerite, both with the ideal formula NH4ZnPO4, are new mineral species from the Rowley mine, Maricopa County, Arizona, USA. They occur in an unusual bat-guano-related, post-mining assemblage of phases. Epiebnerite grows epitactically on ebnerite and replaces it. Ebnerite and epiebnerite are found in intimate association with alunite, halite, mimetite, newberyite, sampleite, struvite and wulfenite on hematite-rich quartz–baryte matrix. Crystals of ebnerite are colourless narrow prisms up to ~0.3 mm in length. The streak is white, lustre is vitreous, Mohs hardness is ~2, tenacity is brittle and fracture is splintery. The density is 2.78(2) g⋅cm–3. Ebnerite is optically uniaxial (–) with ω = 1.585(2) and ɛ = 1.575(2). Epiebnerite occurs as colourless prisms or blades, up to about 10 × 3 × 2 μm, in parallel growth forming ribs with serrated edges epitactic on ebnerite prisms. The streak is white, lustre is vitreous, Mohs hardness is probably ~2, tenacity is brittle. The calculated density is 2.851 g⋅cm–3. Epiebnerite is optically biaxial with all indices of refraction near 1.580. Electron microprobe analysis gave the empirical formula [(NH4)0.89K0.06]Σ0.95(Zn0.96Cu0.07)Σ1.03[(P0.97Si0.03)Σ1.00O4] for ebnerite and [(NH4)0.67K0.28]Σ0.95(Zn0.99Cu0.02)Σ1.02(P1.00O4) for epiebnerite. Ebnerite is hexagonal, P63, with a = 10.67051(16), c = 8.7140(2) Å, V = 859.25(3) Å3 and Z = 8. Epiebnerite is monoclinic, P21, with a = 8.796(16), b = 5.457(16), c = 8.960(16) Å, β = 90.34(6)°, V = 430.1(17) Å3 and Z = 4. The structures of ebnerite (R1 = 0.0372 for 1168 Io > 2σI reflections) and epiebnerite (known from synthetic monoclinic NH4ZnPO4) are zeolite-like frameworks based upon corner-sharing linkages between alternating ZnO4 and PO4 tetrahedra with channels in the frameworks hosting the NH4 groups. The two structures are topologically distinct. Ebnerite belongs to the family of ‘stuffed derivatives’ of tridymite, whereas epiebnerite possesses an ABW-type zeolite structure.
This article examines the last moments of the emperor Theophilos and how his dying moments are related in Byzantine historiography. His religious policy is central here. In fact, Theophilos’ stance on images is what allows us today to categorize narratives of his final moments, based on whether he repented for his iconoclastic policy. Three groups of narratives can be distinguished; those that claim that the emperor repented, those that claim that he did not, and those that are silent on the issue. Death narratives in historical writing constitute a commonplace in Kaiserkritik, and Theophilos’ dying moments are no exception.
We consider the broadest concept of the gradient Yamabe soliton, the conformal gradient soliton. In this paper, we elucidate the structure of complete gradient conformal solitons under some assumption, and provide some applications to gradient Yamabe solitons. These results enhance the understanding gained from previous research. Furthermore, we give an affirmative partial answer to the Yamabe soliton version of Perelman’s conjecture.
This study examines seascape depictions on pottery, including seafaring and sea creature scenes, from the 1896–9 excavations at Phylakopi on Melos, held in the National Archaeological Museum of Athens. This analysis demonstrates that seascape scenes varied in character through time and were typically associated with vessel shapes connected to the pouring of liquids between Early Cycladic (EC) III and Middle Cycladic late and were later focused on basins. A focus on seafaring is evident in EC III, while later the iconographic focus on the sea concentrates on sea creatures. An iconographic interest in the sea, alongside that of birds and floral depictions, is suggestive of an interest in living forms that inhabit different places to humans (i.e., non-domestic) with different corporeality to humans. This research contributes further to the growing debate on human–animal/plant relationships and ontologies in the Aegean Bronze Age.
Non-Archimedean population axiologies – also known as lexical views – claim (i) that a sufficient number of lives at a very high positive welfare level would be better than any number of lives at a very low positive welfare level and/or (ii) that a sufficient number of lives at a very low negative welfare level would be worse than any number of lives at a very high negative welfare level. Such axiologies are popular because they can avoid the (Negative) Repugnant Conclusion and satisfy the adequacy conditions given in the central impossibility result in population axiology due to Gustaf Arrhenius. I provide a novel argument against them which appeals to the way that good and bad lives can intuitively outweigh one another.
In this paper, we apply the theory of algebraic cohomology to study the amenability of Thompson’s group $\mathcal {F}$. We introduce the notion of unique factorization semigroup which contains Thompson’s semigroup $\mathcal {S}$ and the free semigroup $\mathcal {F}_n$ on n ($\geq 2$) generators. Let $\mathfrak {B}(\mathcal {S})$ and $\mathfrak {B}(\mathcal {F}_n)$ be the Banach algebras generated by the left regular representations of $\mathcal {S}$ and $\mathcal {F}_n$, respectively. We prove that all derivations on $\mathfrak {B}(\mathcal {S})$ and $\mathfrak {B}(\mathcal {F}_n)$ are automatically continuous, and every derivation on $\mathfrak {B}(\mathcal {S})$ is induced by a bounded linear operator in $\mathcal {L}(\mathcal {S})$, the weak-operator closed Banach algebra consisting of all bounded left convolution operators on $l^2(\mathcal {S})$. Moreover, we prove that the first continuous Hochschild cohomology group of $\mathfrak {B}(\mathcal {S})$ with coefficients in $\mathcal {L}(\mathcal {S})$ vanishes. These conclusions provide positive indications for the left amenability of Thompson’s semigroup.
Building upon existing research conducted in face-to-face universities, our research explored whether, in the context of a distance learning institution, the positive association between subjective socioeconomic status and academic performance can be explained by students’ sense of belonging. To that end, we conducted a three-wave correlational study with 2,261 students enrolled in Social Psychology in a distance learning university. At the start of the academic year, we measured participants’ subjective socioeconomic status relative to other students alongside their initial expectations in terms of time investment and grades and other relevant covariates. Midway through the course, we assessed their sense of belonging to the university and, at the end, we recorded their grades. Results suggested that sense of belonging potentially serves as a mediating factor in the positive relationship between subjective socioeconomic status and grades even after accounting for variables like initial grade expectations, time commitment, gender, age, and employment situation. These findings emphasize the pivotal role of students’ psychological connection to the university in shaping their academic achievement, even within the expanding landscape of distance education.
Opioid use disorder is a cause of significant morbidity and mortality. In order to reverse opioid overdose as quickly as possible, many institutions and municipalities have encouraged people with no professional medical training to carry and administer naloxone. This study sought to provide preliminary data for research into the rates of adverse effects of naloxone when administered by bystanders compared to Emergency Medical Services (EMS) personnel, since this question has not been studied previously.
Methods:
This was a retrospective cohort study performed at an urban, tertiary, academic medical center that operates its own EMS service. A consecutive sample of patients presenting to EMS with opioid overdose requiring naloxone was separated into two groups based on whether naloxone was administered by bystanders or by EMS personnel. Each group was analyzed to determine the incidence of four pre-specified adverse events.
Results:
There was no significant difference in the rate of adverse events between the bystander (19%) and EMS (16%) groups (OR = 1.23; 95% CI, 0.63 - 2.32; P = .499) in this small sample. Based on these initial results, a study would need a sample size of 6,188 in order to reach this conclusion with 80% power. Similarly, there were no significant differences in the rates of any of the individual adverse events. Secondary analysis of patients’ demographics showed differences between the two groups which generate hypotheses for further investigation of disparities in naloxone administration.
Conclusions:
This preliminary study provides foundational data for further investigation of naloxone administration by bystanders. Adverse events after the prehospital administration of naloxone are rare, and future studies will require large sample sizes. These preliminary data did not demonstrate a statistically significant difference in adverse event rates when comparing naloxone administration by bystanders and EMS clinicians. This study provides data that will be useful for conducting further research on multiple facets of this topic.
The current study investigates the global linear stability of a two-layer channel flow with a train of solid particles flowing near the liquid–liquid interface. Three different mechanisms of instability (shear, interfacial and migration modes) are identified, and their interactions are examined. The interfacial instability, associated with the viscosity jump at the liquid–liquid interface, is found to be coupled to the migration of the particle. The stability of the flow configuration is evaluated for various governing parameters, including fluid viscosities and flow rate ratios, particle position, inter-particle distance, and Reynolds and capillary numbers. Our numerical results are compared with the particle-free flow configuration, indicating that the presence of the particle in the more viscous fluid promotes the destabilization of the interface. Remarkably, under certain flow parameters, the presence of the particle stabilizes the interface when flowing in the less viscous liquid. The impact of particles is more significant as the capillary number increases or the Reynolds number decreases.
We surveyed members of the Emerging Infections Network about Candida auris screening practices at US healthcare facilities. Only 37% of respondents reported conducting screening; among these, 75% reported detection of at least 1 C. auris case in the last year. Increased screening could improve C. auris detection and prevent spread.
During the Middle Horizon (AD 600–1000), obsidian was transported in greater quantities and distances than ever before identified in the Andes, in part by the expansionary Wari state. Two of the three major obsidian sources used in the south-central Andes are located in the modern department of Arequipa, Peru. Arequipa was a region of intense Wari influence and intrusive presence; however, little is known about regional obsidian use. Portable X-ray fluorescence (pXRF) and laser ablation-inductively coupled plasma-mass spectrometry (LA-ICP-MS) were used to analyze 383 obsidian artifacts recovered from 10 archaeological sites in Arequipa. Results highlight diachronic and spatial patterning related to obsidian procurement strategies, state versus bottom-up exchange networks, and local participation within the Wari realm. A wide variety of geological obsidian sources, including nonlocal obsidians originating from Wari's Ayacucho heartland, were used. By the late Middle Horizon, the Wari had consolidated regional resources with the sole use of Alca-1 and Alca-4 bedrock obsidians, the largest-sized and highest-quality sources in the area. We assess related models of obsidian procurement and exchange related to state political economy, long-distance caravan activity, and the role of local ceremonial/waystation centers that facilitated the flow of ideas, goods, and people across Arequipa.
This study examines how protesters’ gender shapes public reactions to protests and protest repression. Using an original survey experiment, I demonstrate that protests involving extensive participation by women are perceived as less violent and meriting of repression than male-dominated protests. But perceptions of female protesters vary. Patriarchy-defiant female protesters like feminists are deemed more deserving of repression despite being perceived as equally likely to be peaceful as female protesters who emphasize patriarchy-compliant femininities, such as women who highlight their roles as mothers and wives. This, I show, is because patriarchy-defiant women are viewed as more immoral, which renders their protest accounts less trustworthy when they clash with government propaganda seeking to legitimize repression. These findings underscore the value of disaggregating the binary category of man or woman when examining sentiments toward political agents and of considering stereotypes when studying perceptions, and ultimately the risks and effectiveness, of protest movements.
The Malaysian Government has initiated the National COVID-19 Immunisation Programme, known as PICK, to be a national strategy for addressing the spread of the coronavirus disease (COVID-19) pandemic across the country. Although the government intensified public awareness to increase program registration, the total number that registered in the state of Sabah, located in East Malaysia, was relatively low during August 2021, accounting for only 42.9% as compared to that of Peninsular Malaysia. Therefore, this paper examines the public perception toward the PICK program in Sabah based on 4 main components: safety, communication, psychology, and milieu. This study is based on the empirical findings drawn from 1024 respondents across Sabah using online Google Form surveys. This study adopts 5 methodologies for data analysis by using K-means clustering, mean score, Mann–Whitney U test, spatial analysis, and frequency analysis. It has been revealed that the percentage of respondents (categorized as Cluster 1) who have a negative perception toward the vaccination program is higher (55.9%) than those who have a positive perception (44.1%). This study further discovered that Cluster 1 has shown high skepticism regarding the vaccination program, which can be explained through the communication component (M = 3.33, SD = 0.588), especially Co2, Co3, Co1, and Co4. Following the communication factor, a chain of negative perceptions also affects other components such as safety, psychology, and milieu among Cluster 1, all of which contribute to poor participation in the PICK program. The study outcomes are extremely useful for informing local authorities to establish policies related to public interests, primarily in the areas of public health. Understanding the community’s perspectives and their obstacles in participating in such programs may assist local authorities in developing or implementing public policies and campaigns that ensure such related public programs can be conducted more effectively in the future.
Two new species of the genus Lecidella, one with a North American-maritime Antarctic distribution and one with a so far exclusively southern South American-maritime Antarctic distribution, are described using molecular and morphological tools. Lecidella ayazii is a species growing on soil and also on mosses and has so far been found on the Antarctic Peninsula, as well as in the alpine areas of the La Sal Mountains, Utah, USA and in the Kivalliq Region (Nunavut) in the north of Canada, whereas L. drakensis occurs mainly on siliceous rocks, rarely on mosses, and has been recorded on both sides of the Drake Passage in southern Patagonia and the Antarctic Peninsula. Phylogenetic analysis of the nrITS sequence data shows that both species belong in the L. elaeochroma clade, each forming a highly supported and distinct group. Furthermore, they also differ in morphological and chemical characters from the species described so far in this clade. In addition, five further accessions were recorded from the maritime Antarctic, which were placed in the cosmopolitan and heterogeneous L. stigmatea clade, of which one could be assigned to the bipolar species L. siplei.