Comparison of the quick Sepsis-related Organ Failure Assessment and adult sepsis pathway in predicting adverse outcomes among adult patients in general wards: a retrospective observational cohort study.

BACKGROUND: Quick Sepsis-related Organ Failure Assessment (qSOFA) is recommended for use by the most recent international sepsis definition taskforce to identify suspected sepsis in patients outside the intensive care unit (ICU) at risk of adverse outcomes. Evidence of its comparative effectiveness with existing sepsis recognition tools is important to guide decisions about its widespread implementation. AIM: To compare the performance of qSOFA with the adult sepsis pathway (ASP), a current sepsis recognition tool widely used in NSW hospitals and systemic inflammatory response syndrome criteria in predicting adverse outcomes in adult patients on general wards. METHODS: A retrospective observational cohort study was conducted which included all adults with suspected infections admitted to a Sydney teaching hospital between December 2014 and June 2016. The primary outcome was in-hospital mortality with two secondary composite outcomes. RESULTS: Among 2940 patients with suspected infection, 217 (7.38%) died in-hospital and 702 (23.88%) were subsequently admitted to ICU. The ASP showed the greatest ability to correctly discriminate in-hospital mortality and secondary outcomes. The area under the receiver-operating characteristic curve for mortality was 0.76 (95% confidence interval (CI): 0.74-0.78), compared to 0.64 for the qSOFA tool (95% CI: 0.61-0.67, P < 0.0001). Median time from the first ASP sepsis warning to death was 8.21 days (interquartile range (IQR): 2.29-16.75) while it was 0 days for qSOFA (IQR: 0-2.58). CONCLUSIONS: The ASP demonstrated both greater prognostic accuracy and earlier warning for in-hospital mortality for adults on hospital wards compared to qSOFA. Hospitals already using ASP may not benefit from switching to the qSOFA tool.

Improving actuation efficiency through variable recruitment hydraulic McKibben muscles: modeling, orderly recruitment control, and experiments.

Hydraulic control systems have become increasingly popular as the means of actuation for human-scale legged robots and assistive devices. One of the biggest limitations to these systems is their run time untethered from a power source. One way to increase endurance is by improving actuation efficiency. We investigate reducing servovalve throttling losses by using a selective recruitment artificial muscle bundle comprised of three motor units. Each motor unit is made up of a pair of hydraulic McKibben muscles connected to one servovalve. The pressure and recruitment state of the artificial muscle bundle can be adjusted to match the load in an efficient manner, much like the firing rate and total number of recruited motor units is adjusted in skeletal muscle. A volume-based effective initial braid angle is used in the model of each recruitment level. This semi-empirical model is utilized to predict the efficiency gains of the proposed variable recruitment actuation scheme versus a throttling-only approach. A real-time orderly recruitment controller with pressure-based thresholds is developed. This controller is used to experimentally validate the model-predicted efficiency gains of recruitment on a robot arm. The results show that utilizing variable recruitment allows for much higher efficiencies over a broader operating envelope.

Sediment contact tests as a tool for the assessment of sediment quality in German waters.

A sediment contact test (SCT) battery consisting of five ecotoxicological test systems was applied to 21 native freshwater sediments characterized by a broad variety of geochemical properties and anthropogenic contamination. Higher plants (Myriophyllum aquaticum), nematodes (Caenorhabditis elegans), oligochaetes (Lumbriculus variegatus), zebrafish embryos (Danio rerio), and bacteria (Arthrobacter globiformis), representing various trophic levels and exposure pathways, were used as test organisms. The test battery detected sediment toxicity caused by anthropogenic pollution, whereas the various tests provided site-specific, nonredundant information to the overall toxicity assessment. Based on the toxicity pattern derived from the test battery, the sediments were classified according to a newly proposed classification system for sediment toxicity assessment. The SCT-derived classification generally agreed well with the application of consensus-based sediment quality guidelines (SQGs), especially with regard to sediments with high toxic potential. For sediments with low to medium toxic potential, the SQGs often underestimated the toxicity that was detected by the SCTs, underpinning the need for toxicity tests in sediment quality assessment.

Environmental fate of pharmaceuticals in water/sediment systems.

In recent years there has been growing interest on the occurrence and the fate of pharmaceuticals in the aquatic environment. Nevertheless, few data are available covering the fate of the pharmaceuticals in the water/sediment compartment. In this study, the environmental fate of 10 selected pharmaceuticals and pharmaceutical metabolites was investigated in water/sediment systems including both the analysis of water and sediment. The experiments covered the application of four 14C-labeled pharmaceuticals (diazepam, ibuprofen, iopromide, and paracetamol) for which radio-TLC analysis was used as well as six nonlabeled compounds (carbamazepine, clofibric acid, 10,11-dihydro-10,11-dihydroxycarbamazepine, 2-hydroxyibuprofen, ivermectin, and oxazepam), which were analyzed via LC-tandem MS. Ibuprofen, 2-hydroxyibuprofen, and paracetamol displayed a low persistence with DT50 values in the water/sediment system < or =20 d. The sediment played a key role in the elimination of paracetamol due to the rapid and extensive formation of bound residues. A moderate persistence was found for ivermectin and oxazepam with DT50 values of 15 and 54 d, respectively. Lopromide, for which no corresponding DT50 values could be calculated, also exhibited a moderate persistence and was transformed into at least four transformation products. For diazepam, carbamazepine, 10,11-dihydro-10,11-dihydroxycarbamazepine, and clofibric acid, system DT90 values of >365 d were found, which exhibit their high persistence in the water/sediment system. An elevated level of sorption onto the sediment was observed for ivermectin, diazepam, oxazepam, and carbamazepine. Respective Koc values calculated from the experimental data ranged from 1172 L x kg(-1) for ivermectin down to 83 L x kg(-1) for carbamazepine.