Evaluation of the Use of Hyperspectral Vegetation Indices for Estimating Mangrove Leaf Area Index in Middle Andaman Island,India

Mangroves are highly productive ecosystems of the coastal environment in tropics and subtropics. The Leaf Area Index (LAI) is a key structural variable of the canopy, useful for estimating the primary productivity of vegetation including mangroves. We evaluated the sensitivity of narrowband spectral indices viz., Simple Ratio, Normalized Difference Vegetation Index, Soil-Adjusted Vegetation Index and Non-Linear Vegetation Index to mangrove LAI, and thereby propose the optimal bands and spectral indices for mangrove LAI estimation. The study was carried out using EO (Earth Observation)-1 Hyperion data in the Middle Andaman Island, situated in the Bay of Bengal, India. We constructed simple, normalized and non-linear band indices from all possible band pairs in the Hyperion image, and correlated them with mangrove LAI, and empirical relationships were validated through a k-fold cross-validation. The 2-D correlation plot analysis indicates that wavebands in Shortwave Infra-Red and Near Infra-Red regions, have a high potential for mangrove LAI estimation. The wavebands at 834 nm, 844 nm, 864 nm, 1034 nm, 1185 nm, 1276 nm, 1296 nm, 1629 nm and 1679 nm were the most sensitive to mangrove LAI. The non-linear vegetation indices performed better than linear indices in predicting LAI of mangrove. The identified indices are expected to improve quantification of spatial variability of mangrove LAI.     

New spectral metrics for mangrove forest identification

This study proposed three spectral metrics, namely spectral match degree (SMD), normalized difference mangrove index (NDMI) and shortwave infrared absorption depth (SIAD), to enhance the separability between mangrove forests and terrestrial vegetation in remote sensing imagery. The Landsat 8 OLI image of an interest area in Beilunhekou National Nature Reserve was used to test the spectral metrics. The derived spectral metrics and raw band reflectance data were classified using a support vector machine classifier. Mangrove forest maps were then identified from the classified images. Identification accuracies were compared and evaluated by determining the user’s accuracy (UA), producer’s accuracy (PA), overall accuracy (OA) and by conducting McNemar’s test. Results showed that the use of spectral metrics (UA = 85%, PA = 94%, OA = 95%) outperformed the use of raw band reflectance data (UA = 72%, PA = 82%, OA = 90%). McNemar’s test confirmed that the spectral metrics were significantly better than the raw band reflectance data (Z = 4.63, p < 0.05). Therefore, the proposed spectral metrics could improve the accuracy of mangrove forest identification.     

Evaluating wood volume estimates derived from Quickbird imagery with GEOBIA for Pinus nigra trees in the Pentalofo forest,northern Greece

The objective of this research was to evaluate wood volume estimates of Pinus nigra trees in forest stands, which were derived utilizing Geographic Object-Based Image Analysis. Information on forest parameters such as wood volume and number of trees is useful for forest management facilitating forest sustainability. Most of the existing approaches used to estimate wood volume of forest trees require field measurements, which are laboursome. In this study, the collected field data were utilized only in order to investigate the results. Wood volume was estimated based on an individual tree crown approach and using monoscopic satellite images in combination with allometric data. The study area is the Pentalofo forest, which is located in Kozani prefecture in western Macedonia, Northern Greece. About 1 plot surface of 0.1143 ha was utilized. During the preprocessing, a pansharpened image was produced from two Quickbird satellite images (one multispectral image of 2.4 m spatial resolution and one panchromatic image of 0.6 m spatial resolution). Bands of this image were utilized single or in combination in order to delineate the tree crowns individually. The allometric equation served in order to calculate the tree Diameter at Breast Height (DBH) utilizing the detected tree crowns. The evaluation was conducted on three levels: (i) number of trees, (ii) DBH class distribution and (iii) wood volume. On the third level, the evaluation procedure was conducted twice; once using field height and once without. The difference between the results and the field data for the wood volume reached a maximum of approximately 30%. The total number of trees was exactly the same as counted in the field and the DBH distribution showed a tendency for the trees to move to a higher DBH class, resulting in an overestimation of the wood volume.     

Hyperspectral remote sensing of salinity stress on red (Rhizophora mangle) and white (Laguncularia racemosa) mangroves on Galapagos Islands

Mangroves are an assemblage of salt-tolerant woody hydrophytes that are the foundational species along tropical and subtropical coastlines, estuaries, lagoons and rivers. Once covering 75% of the world's tropical and subtropical coastlines, mangrove forests have been declining rapidly throughout the world in the last few decades. Monitoring and modelling mangrove forest growth are critical for their conservation. Salinity is one of the primary limiting factors for mangrove forest growth. In this letter, we report the potential of using hyperspectral remotely sensed data collected in the field for monitoring the photosynthesis rate of red (Rhizophora mangle) and white (Laguncularia racemosa) mangroves with regard to salinity gradient. Using photochemical reflectance index (PRI) as proxy for photosynthetic rate, PRI for both species are strongly related to salinity gradient, indicating the potential of monitoring mangrove forest growth on a regional scale using hyperspectral remote sensing.     

Feasibility of using mobile phone to estimate forest Leaf Area Index: a case study in Yunnan Pine

Remotely-sensed Leaf Area Index (LAI) is vital to describe the vegetation canopy and assess plant growth condition and healthy status. However, sufficient instant ground LAI samples are pre-required for calibration or validation, which is generally difficult to collect. We proposed a method, LAI-Mobile, to use mobile phones with low-cost fisheye lens to take fisheye photos and to invert LAIs, which may be popularized for ordinary people to generate big volume of LAI sample data. The feasibility of LAI-Mobile was tested by comparing with LAI?2200 and GF-1 satellite data (GF = high resolution) in a pest-invaded Yunnan pine forest area in Yunnan province of China. Results show significant correlation between LAI-2200 and LAI-Mobile data for forest plots with coefficient of determination (R²) = 0.706 and Root Mean Square Error (RSME) = 0.241, and GF-1 satellite images (R² = 0.659 and RMSE = 0.268). The linear regression shows a good agreement between the Moderate Resolution Imaging Spectroradiometer (MODIS) LAI product and the inverted GF-1 LAI, with R² = 0.649, RMSE = 0.795. Despite larger uncertainty for single fisheye image than LAI-2200, LAI-mobile can provide fast and convenient method to collect large amount of LAI, which will support remote sensing inversion of LAI at large scale.     

Mapping of mangrove forests on the southern coast of São Paulo,Brazil, using synthetic aperture radar data from ALOS/PALSAR

Widespread in the coastal zones of (sub)tropical regions, mangroves are an essential habitat for many animal species and provide subsistence resources for many human coastal communities. Among remote sensing techniques, synthetic aperture radar is a particularly advantageous method to monitor mangroves: images are not dependent on cloud cover and can provide information from forest understory. This article mapped mangrove forests in the southern coast of São Paulo State (Brazil) using frequency-based contextual classification of incoherent attributes derived from a multi-polarized Phased Array L-Band Synthetic Aperture Radar (PALSAR) image. The use of 10 incoherent attributes and only 3 Synthetic Aperture Radar (SAR) vegetation indices as input for digital classification showed the best accuracies with kappa index values of 0.739 and 0.734, respectively. HH polarization and SAR vegetation indices were the attributes that contributed most to the mangrove mapping procedure. The use of L-Band SAR data was effective for mapping mangrove areas, and therefore it is recommended as a tool for coastal management.     

New Record of <Emphasis Type="Italic">Equisetum ramosissimum</Emphasis> subsp. <Emphasis Type="Italic">debile</Emphasis> from Lower Gangetic Plain,West Bengal,India and Conservation Approach

A recent survey for pteridophytic flora in the lower Gangetic plain of West Bengal, India reports the natural occurrence of Equisetum ramosissimum Desf. subsp. debile (Roxb. Ex Vauch.) Hauke (Equisetaceae) from alluvial Gangetic zone of North 24 Parganas district (22°55′39.00″N and 88°26′14.94″E) which adds new record to the existing database of pteridophytic flora in the region. Regular observations show that the population of E. ramosissimum is sustained completely by vegetative means due to non-formation of reproductive organ i.e. strobilus in an individual plant in any season. The community analyses through standard ecological methods reveal heterogeneous phyto-assemblages in both winter and rainy seasons, however, seasonal variations are observed in species diversity and frequency. Simpson’s Index of Diversity in both plant communities suggests diverse species richness and evenness in the area. Importance Value Index depicts ecological dominance of E. ramosissimum in both seasons. The plant has significant positive correlation with angiospermic taxa, Mikania micrantha and Typha angustifolia in winter and rainy seasons, respectively but is negatively correlated with Xanthium indicum and Desmostachya bipinnata, correspondingly. These observations may be taken into consideration for in situ conservation of the species. Systematic conservation plan is suggested to protect this newly revealed taxon, E. ramosissimum subsp. debile which demands regular awareness program among local people for continued future sustainability as the area is regularly invaded by human footsteps. Finally, the present investigation may motivate the young workers for field study to explore the nature in better way.     

Renal shear wave elastography for the assessment of nephron hypertrophy: a cross-sectional study in chronic kidney disease

Purpose

To investigate the association of renal elasticity to microscopic findings of nephron hypertrophy and nephrosclerosis.

Methods

Patients who underwent renal biopsy were enrolled. Renal elasticity was measured by acoustic radiation force impulse, and nephron size (glomerular volume, non-sclerotic glomerular density, and mean profile tubular area) and nephrosclerosis (globally sclerotic glomeruli and interstitial fibrosis) were estimated. Nephron hypertrophy was indicated by larger glomerular volume, larger tubular area, and lower non-sclerotic glomerular density. Nephrosclerosis was indicated by a higher percentage of globally sclerotic glomeruli and higher severity of fibrosis.

Results

Renal elasticity was negatively correlated with glomerular volume (r = ? 0.480, P = 0.024) and mean tubular area (r = ? 0.469, P = 0.028), but it was not correlated with non-sclerotic glomerular density (r = 0.205, P = 0.359), percentage of globally sclerotic glomeruli (r = 0.057, P = 0.800), and severity of fibrosis (r = 0.014, P = 0.950). In a multiple linear regression analysis, glomerular volume and mean tubular area were independently associated with renal elasticity (std β = ? 0.454, P = 0.015 and std β = ? 0.577, P = 0.007, respectively).

Conclusion

Renal elasticity was correlated with microstructural findings of nephron hypertrophy. Measuring renal elasticity could help in detecting kidney disease.

     

Estimation of forest stand diameter class using airborne lidar and field data

In this study, a method for estimating the stand diameter at breast height (DBH) classes in a South Korea forest using airborne lidar and field data was proposed. First, a digital surface model (DSM) and digital terrain model (DTM) were generated from the lidar data that have a point density of 4.3 points/m², then a tree canopy model (TCM) was created by subtracting the DTM from the DSM. The tree height and crown diameter were estimated from the rasterized TCM using local maximum points, minimum points and a circle fitting algorithm. Individual tree heights and crown diameters were converted into DBH using the allometric equations obtained from the field survey data. We calculated the proportion of the total number of individual trees belonging to each DBH class in each stand to determine the stand DBH class according to the standard guidelines. More than 60% of the stand DBH classes were correctly estimated by the proposed method, and their area occupied over 80% of the total forest area. The proposed method generated more accurate results compared to the digital forest type map provided by the government.     

Histogram Analysis of T1-Weighted,T2-Weighted,and Postcontrast T1-Weighted Images in Primary CNS Lymphoma: Correlations with Histopathological Findings—a Preliminary Study

Purpose

Previously, some reports mentioned that magnetic resonance imaging (MRI) can predict histopathological features in primary CNS lymphoma (PCNSL). The reported data analyzed diffusion-weighted imaging findings. The aim of this study was to investigate possible associations between histopathological findings, such as tumor cellularity, nucleic areas and proliferation index Ki-67, and signal intensity on T1-weighted and T2-weighted images in PCNSL.

Procedures

For this study, 18 patients with PCNSL were retrospectively investigated by histogram analysis on precontrast and postcontrast T1-weighted and fluid-attenuated inversion recovery (FLAIR) images. For every patient, histopathology parameters, nucleic count, total nucleic area, and average nucleic area, as well as Ki-67 index, were estimated.

Results

Correlation analysis identified several statistically significant associations. Skewness derived from precontrast T1-weighted images correlated with Ki-67 index (p = ? 0.55, P = 0.028). Furthermore, entropy derived from precontrast T1-weighted images correlated with average nucleic area (p = 0.53, P = 0.04). Several parameters from postcontrast T1-weighted images correlated with nucleic count: maximum signal intensity (p = 0.59, P = 0.017), P75 (p = 0.56, P = 0.02), and P90 (p = 0.52, P = 0.04) as well as SD (p = 0.58, P = 0.02). Maximum signal intensity derived from FLAIR sequence correlated with nucleic count (p = 0.50, P = 0.03).

Conclusion

Histogram-derived parameters of conventional MRI sequences can reflect different histopathological features in PSNCL.

     

In-stent area stenosis on 64-slice multi-detector computed tomography coronary angiography: optimal cutoff value for minimum lumen cross-sectional area of coronary stents compared with intravascular ultrasound

We aimed to prospectively assess the optimal cutoff value for a minimum lumen cross-sectional area (CSA) on a 64-slice multidetector computed tomography (MDCT) compared with an intravascular ultrasound (IVUS). In 39 patients with 43 stents, the minimum lumen diameter, stent diameter, diameter stenosis, minimum lumen CSA, stent CSA, and area stenosis at the narrowest point were measured independently on 64-slice MDCT and IVUS images. For the assessment of diameter and CSA, 64-slice MDCT showed good correlations with IVUS (r = 0.82 for minimum lumen diameter, r = 0.66 for stent diameter, r = 0.79 for minimum lumen CSA, and r = 0.75 for stent CSA, respectively, P < 0.0001). For the assessment of diameter and area stenoses, a 64-slice MDCT showed good correlations with IVUS (r = 0.89 and 0.91, respectively, P < 0.0001). The overall sensitivity, specificity, positive predictive value, and negative predictive value to detect in-stent area restenosis (≥50 % area stenosis) of a 64-slice MDCT were 77, 100, 100, and 91 %, respectively. The cutoff value of a 64-slice MDCT, determined by receiver operator characteristic (ROC) analysis, was 5.0 mm² with 76.5 % sensitivity and 92.3 % specificity for significant in-stent area restenosis; the area under the ROC curve was 0.902 (P < 0.0001). A good correlation was found between a 64-slice MDCT and the IVUS, regarding the assessment of diameter and area stenoses of coronary stents in selected patients implanted with stents of more than 3 mm in diameter. Optimal cutoff value for the minimum lumen CSA of coronary stents on the 64-slice MDCT is 5 mm² to predict a CSA of 4 mm² on IVUS.     

Usefulness of a clinical diagnosis of ICU-acquired paresis to predict outcome in patients with SIRS and acute respiratory failure

Purpose

Neuromuscular abnormalities are common in ICU patients. We aimed to assess the incidence of clinically diagnosed ICU-acquired paresis (ICUAP) and its impact on outcome.

Methods

Forty-two patients with systemic inflammatory response syndrome on mechanical ventilation for ≥48 h were prospectively studied. Diagnosis of ICUAP was defined as symmetric limb muscle weakness in at least two muscle groups at ICU discharge without other explanation. The threshold Medical Research Council (MRC) Score was set at 35 (of 50) points. Activities in daily living were scored using the Barthel Index 28 and 180 days after ICU discharge.

Results

Three patients died before sedation was stopped. ICUAP was diagnosed in 13 of the 39 patients (33%). Multivariate regression analysis yielded five ICUAP-predicting variables (P < 0.05): SAPS II at ICU admission, treatment with steroids, muscle relaxants or norepinephrine, and days with sepsis. Patients with ICUAP had lower admission SAPS II scores [37 ± 13 vs. 49 ± 15 (P = 0.018)], lower Barthel Index at 28 days and lower survival at 180 days after ICU discharge (38 vs. 77%, P = 0.033) than patients without ICUAP. Daily TISS-28 scores were similar but cumulative TISS-28 scores were higher in patients with ICUAP (664 ± 275) than in patients without ICUAP (417 ± 236; P = 0.008). The only independent risk factor for death before day 180 was the presence of ICUAP.

Conclusions

A clinical diagnosis of ICUAP was frequently established in this patient group. Despite lower SAPS II scores, these patients needed more resources and had high mortality and prolonged recovery periods after ICU discharge.     

The relationship between the Bispectral Index (BIS) and the Observer Alertness of Sedation Scale (OASS) scores during propofol sedation with and without ketamine: a randomized,double blinded,placebo controlled clinical trial

Prior studies have examined the static effect of intravenous ketamine on the BIS Index for sedation but it remains unknown if the BIS Index is a reliable method to track sedation levels in the presence of ketamine. The major objective of the current investigation was to compare the BIS Vista Index ability to track varying depths of sedation as determined by OASS scores in a standardized anesthetic regimen with and without ketamine. The study was a randomized, double blinded clinical trial. Patients undergoing breast surgery under sedation with propofol were randomized to receive ketamine (1.5 μg kg min^?1) or saline. Infusion data was used to estimate propofol plasma concentrations (Cp). The main outcome of interest was the correlation between the BIS Vista Index with the OASS score. Twenty subjects were recruited and fifteen completed the study. Four hundred fifty-five paired data points were included in the analysis. Model performance (Nagelkerke R²) of the multinomial logistic regression model was 0.57 with the c-statistic of 0.87 (95 % CI 0.82–0.91). Compared to awake the odds ratio for BIS values predicting moderate sedation in the saline/propofol group 1.19 (95 % CI 1.12–1.25) but only 1.06 (95 % CI 1.02–1.1) in the ketamine/propofol group (P = 0.001). There was no difference in the odds for BIS values to predict deep sedation between groups (P = 0.14). The BIS monitor can be used to monitor sedation level even when ketamine is used with propofol as part of the sedation regimen. However, ketamine reduces the value of the BIS in predicting moderate sedation levels.     

Feasibility of using consumer-grade unmanned aerial vehicles to estimate leaf area index in Mangrove forest

As unmanned aerial vehicles (UAVs) become more popular, many studies investigate vegetation based on commercial UAV data. Although compared to satellite data, commercial UAV data can have flexible revisit frequencies, the possibility of using an even cheaper data source, consumer UAVs (red, green, and blue (RGB) only), to study vegetation remains unknown. The purpose of most frequent uses of consumer UAVs is recreation. This paper tests the feasibility of using consumer UAVs for mangrove research and proposed a method for mapping leaf area index (LAI) of mangrove. A commercial UAV image is also used for comparison. RGB-based vegetation indices like Excess Green Vegetation Index (ExG), Negative Excess Red Vegetation Index (NegExR), Green Leaf Index (GLI) and Normalized Green-red Difference Index (NGRDI) were used to build regression models against field measured LAI. The results showed that it was feasible to use consumer UAV data for mapping mangrove forest LAI, and the NegExR achieved the highest coefficient of determination (R²) in predicting LAI among all the indices. This paper showed that researchers who are neither familiar with aerial photogrammetry nor have access to commercial UAV data could perform high spatial resolution vegetation studies at a low cost.     

Utility of combining assessment of right ventricular function and right atrial remodeling as a prognostic factor for patients with pulmonary hypertension

We tested the hypothesis that the addition of right atrial (RA) remodeling to right ventricular (RV) function enhances the capability of the latter to predict long-term outcome for pulmonary hypertension (PH) patients. We studied 82 PH patients, all of whom underwent echocardiography and right heart catheterization. RV function was calculated by averaging the three regional peak speckle-tracking longitudinal strains from RV free wall (RV-free). RA remodeling was assessed as the RA area traced planimetrically at end-systole. Pre-defined cutoffs for RV dysfunction and RA remodeling were RV-free ≤19.4 % and RA area of >18 cm², respectively. Long-term unfavorable outcome events were tracked for 2.0 years. RA area correlated with mean RA pressure (r = 0.62, p < 0.001), as well as with tricuspid E/E’ (r = 0.38, p = 0.001). Moreover, RA area in patients with RV restrictive filling was significantly larger than that in patients with others (all p < 0.05). Kaplan–Meier analysis revealed that patients with RV-free ≤19.4 % had worse long-term outcomes than those with RV-free >19.4 % (log-rank p = 0.01), as did patients with RA area >18 cm² compared with those with RA area ≤18 cm² (log-rank p < 0.05). For sequential Cox models, a model based on hemodynamic parameters of RV performance (χ2 = 3.11) was improved by addition of brain natriuretic peptide, World Health Organization functional class (χ2 = 9.24; p < 0.05), and RV-free (χ2 = 17.11; p = 0.005), and further improved by addition of RA area (χ2 = 21.36, p < 0.05). In conclusion, the combined assessment of RV function and RA area results in more accurate prediction of long-term outcome, and may well have clinical implications for better management of PH patients.     

Midregional pro-atrial natriuretic peptide: a novel marker of myocardial fibrosis in patients with hypertrophic cardiomyopathy

We aimed to determine the diagnostic performance of biomarkers in predicting myocardial fibrosis assessed by late gadolinium enhancement (LGE) cardiovascular magnetic resonance imaging (CMR) in patients with hypertrophic cardiomyopathy (HCM). LGE CMR was performed in 40 consecutive patients with HCM. Left and right ventricular parameters, as well as the extent of LGE were determined and correlated to the plasma levels of midregional pro-atrial natriuretic peptide (MR-proANP), midregional pro-adrenomedullin (MR-proADM), carboxy-terminal pro-endothelin-1 (CT-proET-1), carboxy-terminal pro-vasopressin (CT-proAVP), matrix metalloproteinase-9 (MMP-9), tissue inhibitor of metalloproteinase-1 (TIMP-1) and interleukin-8 (IL-8). Myocardial fibrosis was assumed positive, if CMR indicated LGE. LGE was present in 26 of 40 patients with HCM (65%) with variable extent (mean: 14%, range: 1.3–42%). The extent of LGE was positively associated with MR-proANP (r = 0.4; P = 0.01). No correlations were found between LGE and MR-proADM (r = 0.1; P = 0.5), CT-proET-1 (r = 0.07; P = 0.66), CT-proAVP (r = 0.16; P = 0.3), MMP-9 (r = 0.01; P = 0.9), TIMP-1 (r = 0.02; P = 0.85), and IL-8 (r = 0.02; P = 0.89). After adjustment for confounding factors, MR-proANP was the only independent predictor associated with the presence of LGE (P = 0.007) in multivariate analysis. The area under the ROC curve (AUC) indicated good predictive performance (AUC = 0.882) of MR-proANP with respect to LGE. The odds ratio was 1.268 (95% confidence interval 1.066–1.508). The sensitivity of MR-proANP at a cut-off value of 207 pmol/L was 69%, the specificity 94%, the positive predictive value 90% and the negative predictive value 80%. The results imply that MR-proANP serves as a novel marker of myocardial fibrosis assessed by LGE CMR in patients with HCM.     

Chromosome Complements of <Emphasis Type="Italic">Isodon</Emphasis> (Family: Lamiaceae–Subfamily: Nepetoideae): Trends in Karyotype Evolution

The use of Isodon in folk medicines has a long tradition. The tetracyclic compound ent-kaurane diterpenoids present in the genus have varied biological activities including antibacterial, anti-inflammatory and antitumor activity and makes it a good candidate in drug research. Being a cosmopolitan and important genus of the family Lamiaceae with considerable taxonomic dispute, a review on chromosome complements and its evolution is of great significance. The prevalence of confusion regarding the members of the genus makes it obligatory to include the synonymised members also. Hence, the review is made inclusive of Rabdosia, Isodon and members of Plectranthus which have now been included under the genus Isodon. The chromosome counts of all the reported species of Isodon have been examined and the haploid chromosome number was found to be n = 12. Except for the two species Isodon lophanthoides and Isodon ramosissimus for which the chromosome counts were reported as 2n = 36 and 2n = 42 respectively, all other species had 2n = 24 as its diploid count. The secondary basic chromosome number of x₂ = 12 prevalent in majority of the taxa might have evolved from the primary base number x₁ = 6 via protoautoploidy.     

The effects of performance status one week before hospital admission on the outcomes of critically ill patients

Purpose

To assess the impact of performance status (PS) impairment 1 week before hospital admission on the outcomes in patients admitted to intensive care units (ICU).

Methods

Retrospective cohort study in 59,693 patients (medical admissions, 67 %) admitted to 78 ICUs during 2013. We classified PS impairment according to the Eastern Cooperative Oncology Group (ECOG) scale in absent/minor (PS = 0–1), moderate (PS = 2) or severe (PS = 3–4). We used univariate and multivariate logistic regression analyses to investigate the association between PS impairment and hospital mortality.

Results

PS impairment was moderate in 17.3 % and severe in 6.9 % of patients. The hospital mortality was 14.4 %. Overall, the worse the PS, the higher the ICU and hospital mortality and length of stay. In addition, patients with worse PS were less frequently discharged home. PS impairment was associated with worse outcomes in all SAPS 3, Charlson Comorbidity Index and age quartiles as well as according to the admission type. Adjusting for other relevant clinical characteristics, PS impairment was associated with higher hospital mortality (odds-ratio (OR) = 1.96 (95 % CI 1.63–2.35), for moderate and OR = 4.22 (3.32–5.35), for severe impairment). The effects of PS on the outcome were particularly relevant in the medium range of severity-of-illness. These results were consistent in the subgroup analyses. However, adding PS impairment to the SAPS 3 score improved only slightly its discriminative capability.

Conclusion

PS impairment was associated with worse outcomes independently of other markers of chronic health status, particularly for patients in the medium range of severity of illness.

     

Disease-related outcomes influence prevalence of falls in people with rheumatoid arthritis

Background

Patients with rheumatoid arthritis (RA) are at increased risk of falls, with potential adverse outcomes. There is a considerable variation across studies regarding the prevalence of falls and its correlation with clinical data, disease-related outcomes and physical performance tests.

Worrisome trends in incidence and mortality of candidemia in intensive care units (Paris area, 2002–2010)

Purpose

To analyze trends in incidence and mortality of candidemia in intensive care units (ICUs) vs. non-ICU hospitalized patients and to determine risk factors for infection by specific species and for death.

Methods

Active hospital-based surveillance program of incident episodes of candidemia due to common species in 24 tertiary care hospitals in the Paris area, France between October 2002 and September 2010.

Results

Among 2,507 adult cases included, 2,571 Candida isolates were collected and species were C. albicans (56 %), C. glabrata (18.6 %), C. parapsilosis (11.5 %), C. tropicalis (9.3 %), C. krusei (2.9 %), and C. kefyr (1.8 %). Candidemia occurred in ICU in 1,206 patients (48.1 %). When comparing ICU vs. non-ICU patients, the former had significantly more frequent surgery during the past 30 days, were more often preexposed to fluconazole and treated with echinocandin, and were less frequently infected with C. parapsilosis. Risk factors and age remained unchanged during the study period. A significant increased incidence in the overall population and ICU was found. The odds of being infected with a given species in ICU was influenced by risk factors and preexposure to fluconazole and caspofungin. Echinocandins initial therapy increased over time in ICU (4.6 % first year of study, to 48.5 % last year of study, p < 0.0001). ICU patients had a higher day-30 death rate than non-ICU patients (odds ratio [OR] 2.12; 95 % confidence interval [CI] 1.66–2.72; p < 0.0001). The day-30 and early (p = 0.001) and 28.7–38.8 % (p = 0.0292), respectively). Independent risk factors for day-30 death in ICU were age, arterial catheter, Candida species, preexposure to caspofungin, and lack of antifungal therapy at the time of blood cultures results (p < 0.05).

Conclusions

The availability of new antifungals and the publication of numerous guidelines did not prevent an increase of candidemia and death in ICU patients in the Paris area.