Summary Background Since December, 2019, Wuhan, China, has experienced an outbreak of coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Epidemiological and clinical characteristics of patients with COVID-19 have been reported but risk factors for mortality and a detailed clinical course of illness, including viral shedding, have not been well described. Methods In this retrospective, multicentre cohort study, we included all adult inpatients (≥18 years old) with laboratory-confirmed COVID-19 from Jinyintan Hospital and Wuhan Pulmonary Hospital (Wuhan, China) who had been discharged or had died by Jan 31, 2020. Demographic, clinical, treatment, and laboratory data, including serial samples for viral RNA detection, were extracted from electronic medical records and compared between survivors and non-survivors. We used univariable and multivariable logistic regression methods to explore the risk factors associated with in-hospital death. Findings 191 patients (135 from Jinyintan Hospital and 56 from Wuhan Pulmonary Hospital) were included in this study, of whom 137 were discharged and 54 died in hospital. 91 (48%) patients had a comorbidity, with hypertension being the most common (58 [30%] patients), followed by diabetes (36 [19%] patients) and coronary heart disease (15 [8%] patients). Multivariable regression showed increasing odds of in-hospital death associated with older age (odds ratio 1·10, 95% CI 1·03–1·17, per year increase; p=0·0043), higher Sequential Organ Failure Assessment (SOFA) score (5·65, 2·61–12·23; p Interpretation The potential risk factors of older age, high SOFA score, and d-dimer greater than 1 μg/mL could help clinicians to identify patients with poor prognosis at an early stage. Prolonged viral shedding provides the rationale for a strategy of isolation of infected patients and optimal antiviral interventions in the future. Funding Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences; National Science Grant for Distinguished Young Scholars; National Key Research and Development Program of China; The Beijing Science and Technology Project; and Major Projects of National Science and Technology on New Drug Creation and Development.

Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study

A comprehensive review on modal parameter-based damage identification methods for beam- or plate-type structures is presented, and the damage identification algorithms in terms of signal processing...

Vibration-based Damage Identification Methods: A Review and Comparative Study:

umans have been familiarwith the term “sepsis” for2,700 yrs (1). Despite a longhistory of this disease, it isstill life-threatening, with a poor out-come. During past decades, the incidenceof sepsis has increased in the UnitedStates (2, 3).The cascade of sepsis may progress tothe development of one or multiple organdysfunctions, which is severe sepsis (4),and death. Varying from 6% to 15% ofthe intensive care unit (ICU) population,patients with severe sepsis consume al-most half of ICU resources (5–7). How-ever, their mortality is extremely high,and Vincent et al. (8) have suggested thatclinical outcome has not improved essen-tially for the past 25 yrs.Consequently, severe sepsis is a majorfactor in the need for critical care re-sources, affecting decisions regarding in-frastructure and equipment and plans formaintaining sufﬁcient human resourcesto care for these patients effectively. Thelatter factor is especially important in lightof already well-publicized predictions of fu-ture shortfalls in the supply of both nursingand physician intensive care practitioners.Therefore, accurate data on the growth ofthis disease is of great importance to gov-ernment agencies, educational institutions,insurance companies, and individual hospi-tals alike.Researchers from various countrieshave reported the incidence, mortality, andresource utilization for severe sepsis,mostly in the ICU, over varying periods oftime (9–19). The most recent nationalanalysis of severe sepsis in the United Stateswas conducted by Angus et al. (5) based onthe data from the year 1995. Using a seven-state administrative database, they identi-ﬁed 750,000 cases of severe sepsis in theUnited States and predicted an increase of1.5% per year. However, actual changes innational rates of hospitalization and mor-tality for severe sepsis have not been re-ported.We have previously reported the ratesof hospitalization and mortality for severesepsis in New Jersey during an 8-yr pe-riod from 1995 to 2002 (20). In that pe-riod, statewide rate of hospitalization forsevere sepsis increased 54.2%, a muchhigher increase than was previously pre-dicted (5). In addition, in contrast to thesuggestion by Vincent et al. (8), we foundthat case fatality rates had decreased dur-ing the same period. Given these discrep-ancies, we were interested in whether thedata from New Jersey reﬂected national

Rapid increase in hospitalization and mortality rates for severe sepsis in the United States: A trend analysis from 1993 to 2003*

Background:In 1992, the first consensus definition of severe sepsis was published. Subsequent epidemiologic estimates were collected using administrative data, but ongoing discrepancies in the definition of severe sepsis produced large differences in estimates.Objectives:We seek to describe the vari

Benchmarking the incidence and mortality of severe sepsis in the United States.

Subarachnoid hemorrhage (SAH) is an acute cerebrovascular event which can have devastating effects on the central nervous system as well as a profound impact on several other organs SAH patients are routinely admitted to an intensive care unit and are cared for by a multidisciplinary team A lack of high quality data has led to numerous approaches to management and limited guidance on choosing among them Existing guidelines emphasize risk factors, prevention, natural history, and prevention of rebleeding, but provide limited discussion of the complex critical care issues involved in the care of SAH patients The Neurocritical Care Society organized an international, multidisciplinary consensus conference on the critical care management of SAH to address this need Experts from neurocritical care, neurosurgery, neurology, interventional neuroradiology, and neuroanesthesiology from Europe and North America were recruited based on their publications and expertise A jury of four experienced neurointensivists was selected for their experience in clinical investigations and development of practice guidelines Recommendations were developed based on literature review using the GRADE system, discussion integrating the literature with the collective experience of the participants and critical review by an impartial jury Recommendations were developed using the GRADE system Emphasis was placed on the principle that recommendations should be based not only on the quality of the data but also tradeoffs and translation into practice Strong consideration was given to providing guidance and recommendations for all issues faced in the daily management of SAH patients, even in the absence of high quality data

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Critical Care Management of Patients Following Aneurysmal Subarachnoid Hemorrhage: Recommendations from the Neurocritical Care Society’s Multidisciplinary Consensus Conference

Crack identification in beams using wavelet analysis

Crack identification in plates using wavelet analysis

In this paper the dynamic behaviour of a cantilever beam with a breathing crack is investigated both theoretically and experimentally. The primary aim is to reveal the nonlinear behaviour of the system by using time frequency methods as an alternative to Fourier analysis methodology. A simple single-degree-of freedom lumped system is employed to simulate the dynamic behaviour of the beam. The time varying stiffness is modelled using a simple periodic function. Both simulated and experimental response data are analysed by applying empirical mode decomposition and Hilbert transform and the instantaneous frequency (IF) is obtained. It is shown that the IF oscillates between the frequencies corresponding to open and closed states revealing the physical process of crack breathing. The variation of the IF follows definite trends and therefore can be used as an indicator of the crack size. It allows an efficient and accurate description of the nonlinearities caused by the presence of a breathing crack. Consequently, it can be used to improve vibration based crack detection techniques.

Time–frequency analysis of the free vibration response of a beam with a breathing crack

Crack identification in double-cracked beams using wavelet analysis

The metabolic support of the critically ill patient is a relatively new target of active research and little is as yet known about the effects of critical illness on metabolism. The nonthyroidal illness syndrome, also known as the low T3 syndrome or euthyroid sick syndrome, describes a condition characterized by abnormal thyroid function tests encountered in patients with acute or chronic systemic illnesses. The laboratory parameters of this syndrome include low serum levels of triiodothyronine (T3) and high levels of reverse T3, with normal or low levels of thyroxine (T4) and normal or low levels of thyroid-stimulating hormone (TSH). This condition may affect 60 to 70% of critically ill patients. The changes in serum thyroid hormone levels in the critically ill patient seem to result from alterations in the peripheral metabolism of the thyroid hormones, in TSH regulation, in the binding of thyroid hormone to transport-protein and in receptor binding and intracellular uptake. Medications also have a very important role in these alterations. Hormonal changes can be seen within the first hours of critical illness and, interestingly, these changes correlate with final outcome. Data on the beneficial effect of thyroid hormone treatment on outcome in critically ill patients are so far controversial. Thyroid function generally returns to normal as the acute illness resolves.

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Evangelia Douka

Papers

Crack identification in beams using wavelet analysis

Crack identification in plates using wavelet analysis

Time–frequency analysis of the free vibration response of a beam with a breathing crack

Crack identification in double-cracked beams using wavelet analysis

Thyroid function during critical illness.