BACKGROUND Fever of unknown origin(FUO)remains a diagnostic challenge and was originally defined in 1961.Its classic criteria include fever≥38.3°C(≥101°F)on multiple occasions,fever lasting three weeks or ...BACKGROUND Fever of unknown origin(FUO)remains a diagnostic challenge and was originally defined in 1961.Its classic criteria include fever≥38.3°C(≥101°F)on multiple occasions,fever lasting three weeks or longer,and a diagnosis after one week of inpatient evaluation.However,these criteria may not fully encompass the varied clinical presentations seen in resource-limited settings such as India.The adaptation of FUO definitions to local healthcare contexts is crucial for enhancing diagnostic accuracy and optimizing patient outcomes.AIM To investigate the applicability of revised FUO criteria in a tertiary care setting in India.METHODS This longitudinal-exploratory study at All India Institute of Medical Sciences Rishikesh(January 2018–December 2022)analyzed 228 adult patients with fever≥99.1°F lasting over three days.Patients diagnosed within three days of admission were excluded.Data were collected retrospectively and prospectively using predefined FUO definitions based on durations of nondiagnosis(3-21 days,>21 days),temperature ranges(99.1°F-100.9°F,≥101°F),and hospitalization durations(3-7 days,>7 days).Descriptive statistics and comparative tests(Fisher's exact test,χ2 test)evaluated outcomes across definitions.RESULTS Among the proposed FUO definitions,Definition B(fever lasting 3-21 days,temperatures between 99.1°F-100.9°F,hospitalization>7 days)predominated(40.8%),while only 2.2%met the classical criteria.Notably,36.5%of Definition B patients remained undiagnosed after 7-10 days,despite 94%undergoing diagnostic workups within 21 days.Infection emerged as the leading etiology across definitions,without significant variation in outcomes or mortality during hospitalization(χ2=27.937,P=0.142).CONCLUSION Adapting FUO criteria to local contexts improves diagnostic accuracy and treatment.Definition B(40.8%prevalence)showed practical utility,with higher mortality in patients discharged on empirical'Anti-tuberculosis therapy'.展开更多
BACKGROUND Sepsis is a critical medical condition,and poses a substantial global health burden,with significant morbidity,mortality,and economic costs,particularly pronounced in low-and middle-income countries.Effecti...BACKGROUND Sepsis is a critical medical condition,and poses a substantial global health burden,with significant morbidity,mortality,and economic costs,particularly pronounced in low-and middle-income countries.Effective management of sepsis relies on early recognition and appropriate intervention,underscoring the importance of accurate classification to guide treatment decisions.The correct diagnosis will lead to effective antimicrobial stewardship practices.AIM To assess the distribution of sepsis categories and the use of empirical antibiotics classified by the World Health Organization(WHO)Access,Watch,and Reserve(AWaRe)system in a tertiary care hospital in Northern India and to correlate antibiotic usage with sepsis classifications.METHODS This longitudinal observational study in the Department of General Medicine,in a tertiary care hospital in Northern India,from 2023 to 2024,aimed to assess the use of empirical antibiotics classified by the WHO AWaRe system.The study also aimed to correlate antibiotic usage.Patients were categorized into sepsis classes(Asepsis,Possible Sepsis,Probable Sepsis,Confirmed Sepsis)and followed until discharge or Day-28.Descriptive and inferential statistical analyses were employed to assess sepsis categories and empirical antibiotic usage classified by the WHO AWaRe system.RESULTS A total of 1867 patients admitted with suspected sepsis were screened,with 230 meeting the inclusion criteria.Among the study cohort(mean age 40.70±14.49 years,50.9% female),initial sepsis classification predominantly included probable sepsis(51.3%)and possible sepsis(35.7%),evolving to asepsis(57.8%)upon final classification,but all received antibiotics.Empirical antibiotic use showed a predominance of Watch group antibiotics(72.2%),with ceftriaxone and piperacillin-tazobactam being the most commonly prescribed;however,no statistical association could be established among the different classes of sepsis with the AWaRe groups.CONCLUSION Accurate sepsis classification is pivotal for clinical decision-making,optimizing antibiotic use,and combating antimicrobial resistance.The majority of the asepsis category was labelled as probable or possible sepsis and given antibiotics at initial hospitalization.The high reliance on Watch group antibiotics in empirical therapy signals a need for enhanced diagnostic strategies to refine treatment initiation,potentially reducing unnecessary antibiotic exposure.Future efforts should focus on establishing sepsis classification checklists as in this study and promoting adherence to antimicrobial stewardship principles to mitigate the global threat of antimicrobial resistance.展开更多
In this paper,I propose a personal view on the general contents of remote sensing science and technology,which includes sensor research and manufacturing,remotely sensed data acquisition,data processing,information ex...In this paper,I propose a personal view on the general contents of remote sensing science and technology,which includes sensor research and manufacturing,remotely sensed data acquisition,data processing,information extraction and remote sensing applications.Serving as the basis for all these components is radiative transfer process modeling and inversion.Also of importance is the effective visualization of remotely sensed data and their efficient distribution to end users.In all these areas,there are critical research questions.In particular,I consider 4 fundamental areas for improved application of remote sensing.These include the scale and angular issues in remote sensing,removal of topographic effects on the radiance and geometry of remotely sensed imagery and the related question of multisource and multitemporal data registration,integrating knowledge and remotely sensed data into effective information extraction,and four dimensional data assimilation techniques.Strategies of information extraction can be broadly divided into manual visual analysis and computer-based analysis.The computer based information analysis include radiative transfer model inversion,image classification,regression analysis,three dimensional information extraction,shape analysis and change detection.Successful information extraction is the key to the success of remote sensing.There are many important issues that need to be solved including how to make better use of the spatial and temporal data present in remotely sensed data in information extraction.How to effectively combine the strength of both computer analysis and human interpretation?Finally,4D data assimilation is the new direction that allows for the integration of instantaneous observation with process-based climate,hydrological and ecological models.Further work along this direction will enhance the contribution of remote sensing in global change studies.In return,the quality of remotely sensed parameters can be improved.展开更多
Barnes et al.defined thixotropy as“gradual decrease of viscosity under shear followed by a gradual recovery of the structure when the shear rate is removed”.The investigated pigment dispersions,with a gel-sol-gel co...Barnes et al.defined thixotropy as“gradual decrease of viscosity under shear followed by a gradual recovery of the structure when the shear rate is removed”.The investigated pigment dispersions,with a gel-sol-gel conversion,show a decrease in viscosity under shear.After the shear rate is removed,a gradual recovery of the structure occurs with the rest time.It was found that the pigment dispersions follow the thixotropy definition.The systems with shear thinning flow behavior show start-up curves with maximum in experiments with shear rates from the shear thinning region,as a characteristic for thixotropy.After cessation of the shear,a gradual recovery of the structure is not observed,or the second part of the thixotropic definition is not fulfilled.The structure of the systems with plastic flow behavior as well does not recover.We presented a new,second,definition of thixotropy for non-gel-sol-gel systems—when a constant shear deformation is applied,the shear stress or viscosity passes through a maximum and then achieves a steady state value.After the shear deformation is stopped,the stress relaxation begins.The shear stress comes to a steady state value—the residual shear stress.The structure does not recover after cessation of the shear flow.展开更多
文摘BACKGROUND Fever of unknown origin(FUO)remains a diagnostic challenge and was originally defined in 1961.Its classic criteria include fever≥38.3°C(≥101°F)on multiple occasions,fever lasting three weeks or longer,and a diagnosis after one week of inpatient evaluation.However,these criteria may not fully encompass the varied clinical presentations seen in resource-limited settings such as India.The adaptation of FUO definitions to local healthcare contexts is crucial for enhancing diagnostic accuracy and optimizing patient outcomes.AIM To investigate the applicability of revised FUO criteria in a tertiary care setting in India.METHODS This longitudinal-exploratory study at All India Institute of Medical Sciences Rishikesh(January 2018–December 2022)analyzed 228 adult patients with fever≥99.1°F lasting over three days.Patients diagnosed within three days of admission were excluded.Data were collected retrospectively and prospectively using predefined FUO definitions based on durations of nondiagnosis(3-21 days,>21 days),temperature ranges(99.1°F-100.9°F,≥101°F),and hospitalization durations(3-7 days,>7 days).Descriptive statistics and comparative tests(Fisher's exact test,χ2 test)evaluated outcomes across definitions.RESULTS Among the proposed FUO definitions,Definition B(fever lasting 3-21 days,temperatures between 99.1°F-100.9°F,hospitalization>7 days)predominated(40.8%),while only 2.2%met the classical criteria.Notably,36.5%of Definition B patients remained undiagnosed after 7-10 days,despite 94%undergoing diagnostic workups within 21 days.Infection emerged as the leading etiology across definitions,without significant variation in outcomes or mortality during hospitalization(χ2=27.937,P=0.142).CONCLUSION Adapting FUO criteria to local contexts improves diagnostic accuracy and treatment.Definition B(40.8%prevalence)showed practical utility,with higher mortality in patients discharged on empirical'Anti-tuberculosis therapy'.
文摘BACKGROUND Sepsis is a critical medical condition,and poses a substantial global health burden,with significant morbidity,mortality,and economic costs,particularly pronounced in low-and middle-income countries.Effective management of sepsis relies on early recognition and appropriate intervention,underscoring the importance of accurate classification to guide treatment decisions.The correct diagnosis will lead to effective antimicrobial stewardship practices.AIM To assess the distribution of sepsis categories and the use of empirical antibiotics classified by the World Health Organization(WHO)Access,Watch,and Reserve(AWaRe)system in a tertiary care hospital in Northern India and to correlate antibiotic usage with sepsis classifications.METHODS This longitudinal observational study in the Department of General Medicine,in a tertiary care hospital in Northern India,from 2023 to 2024,aimed to assess the use of empirical antibiotics classified by the WHO AWaRe system.The study also aimed to correlate antibiotic usage.Patients were categorized into sepsis classes(Asepsis,Possible Sepsis,Probable Sepsis,Confirmed Sepsis)and followed until discharge or Day-28.Descriptive and inferential statistical analyses were employed to assess sepsis categories and empirical antibiotic usage classified by the WHO AWaRe system.RESULTS A total of 1867 patients admitted with suspected sepsis were screened,with 230 meeting the inclusion criteria.Among the study cohort(mean age 40.70±14.49 years,50.9% female),initial sepsis classification predominantly included probable sepsis(51.3%)and possible sepsis(35.7%),evolving to asepsis(57.8%)upon final classification,but all received antibiotics.Empirical antibiotic use showed a predominance of Watch group antibiotics(72.2%),with ceftriaxone and piperacillin-tazobactam being the most commonly prescribed;however,no statistical association could be established among the different classes of sepsis with the AWaRe groups.CONCLUSION Accurate sepsis classification is pivotal for clinical decision-making,optimizing antibiotic use,and combating antimicrobial resistance.The majority of the asepsis category was labelled as probable or possible sepsis and given antibiotics at initial hospitalization.The high reliance on Watch group antibiotics in empirical therapy signals a need for enhanced diagnostic strategies to refine treatment initiation,potentially reducing unnecessary antibiotic exposure.Future efforts should focus on establishing sepsis classification checklists as in this study and promoting adherence to antimicrobial stewardship principles to mitigate the global threat of antimicrobial resistance.
基金National Natural Science Foundation of China(30590370)National High-Tech Program(2006AA12Z112)National Scientific Support program(2006BAJ01B02)
文摘In this paper,I propose a personal view on the general contents of remote sensing science and technology,which includes sensor research and manufacturing,remotely sensed data acquisition,data processing,information extraction and remote sensing applications.Serving as the basis for all these components is radiative transfer process modeling and inversion.Also of importance is the effective visualization of remotely sensed data and their efficient distribution to end users.In all these areas,there are critical research questions.In particular,I consider 4 fundamental areas for improved application of remote sensing.These include the scale and angular issues in remote sensing,removal of topographic effects on the radiance and geometry of remotely sensed imagery and the related question of multisource and multitemporal data registration,integrating knowledge and remotely sensed data into effective information extraction,and four dimensional data assimilation techniques.Strategies of information extraction can be broadly divided into manual visual analysis and computer-based analysis.The computer based information analysis include radiative transfer model inversion,image classification,regression analysis,three dimensional information extraction,shape analysis and change detection.Successful information extraction is the key to the success of remote sensing.There are many important issues that need to be solved including how to make better use of the spatial and temporal data present in remotely sensed data in information extraction.How to effectively combine the strength of both computer analysis and human interpretation?Finally,4D data assimilation is the new direction that allows for the integration of instantaneous observation with process-based climate,hydrological and ecological models.Further work along this direction will enhance the contribution of remote sensing in global change studies.In return,the quality of remotely sensed parameters can be improved.
文摘Barnes et al.defined thixotropy as“gradual decrease of viscosity under shear followed by a gradual recovery of the structure when the shear rate is removed”.The investigated pigment dispersions,with a gel-sol-gel conversion,show a decrease in viscosity under shear.After the shear rate is removed,a gradual recovery of the structure occurs with the rest time.It was found that the pigment dispersions follow the thixotropy definition.The systems with shear thinning flow behavior show start-up curves with maximum in experiments with shear rates from the shear thinning region,as a characteristic for thixotropy.After cessation of the shear,a gradual recovery of the structure is not observed,or the second part of the thixotropic definition is not fulfilled.The structure of the systems with plastic flow behavior as well does not recover.We presented a new,second,definition of thixotropy for non-gel-sol-gel systems—when a constant shear deformation is applied,the shear stress or viscosity passes through a maximum and then achieves a steady state value.After the shear deformation is stopped,the stress relaxation begins.The shear stress comes to a steady state value—the residual shear stress.The structure does not recover after cessation of the shear flow.
