layman mod maker 1-3 2-4 betting system

arena betting ws

The most popular bet you can have. Simply pick the runner that you think will finish 1st in a race. Placing your bet 1. Mark the race venue allocated to the meeting 3.

Layman mod maker 1-3 2-4 betting system betting difference between accumulator and folds of the flag

Layman mod maker 1-3 2-4 betting system

Simply the reasoning that thousands of people smarter than me declared this to be true, therefore it is unlikely that I would prove them wrong. However, I would like to make a point. Consider an infinitely small particle. AS far as anyone can observe, it does not exist. It can not be measured by modern human means, however, we "know" it exists.

As zero represents non-existence, there is a difference between the two. While numerically this particle may equal zero, to say that it equaled zero would be to deny its existence, which would contradict logic since we "know" it exists. Therefore, since the particle exists, a single arbitrary unit, "1" minus this particle is different than the original unit.

However, if we assume that "1" is made up of an infinite number of particles, then in "particle units" this is equivalent to [infinity] - 1, which by the conventional standards of math, is equal to infinity, which would prove that this particle is zero, thus proving that it does not exist. Here comes the dirty trick: 0. So we have an inconsistent triad. One of them must be false by definition of an inconsistent triad, so, so 1 must be false. These are true because someone said so.

If I become king of the world, I can change any of these. Observational truths have nothing to do with humans. Humans can discover them, but they would remain true even if humans never existed. What kind of truth is. I have always thought that all math was observational.

No one invented Pi, or passed a law establishing the distributive property. But you are saying that "if mathematicians say 0. That is clearly declaratory - which means that any mathematical "proof" you may come up with is simply an excuse to justify what mathematicians have already decided.

It would seem that all I need to do is build up enough political power and I could alter mathematical reality! Given the number of people that you admit reject. I find this very disturbing - it flatly contradicts what I've always understood math to be. Algr talk , 21 March UTC. Mdwh, the reason I wrote "The sun rises in that direction. But you went through the whole thing anyway. This suggests that you don't understand the question, and are simply substituting a different question that you DO know the answer to.

The actual article is guilty of this too. It brings out "unique decimal expansion" 4 times before it even gets to the Proofs section, yet ignores serious practical problems like how to define exclusive ranges. However, in the real world,. The world's greatest mathematicians can write a treatise on it and I still would disagree. Common sense shows me that.

Without "proving" they are equal using equations, there is no proof. It comes down to the fact that. It is certainly not 1. It's VERY close, but not close enough. Also, I am not being a troll; I truly know that they are not the same number. Do we have any good evidence that there are actually people who seriously doubt 0. In between 0 and 1, there are infinite numbers. Any number in between 0 and 1 is not going to be equal to 0 or 1, no matter how close.

Functionally, mathematically, and formulaically, it acts and functions as 1. I've had to endure a number of very rude and insulting comments from people who insist that. Consider this:. If you walked into a conversation at this point, would you expect the other side to respond positively to this? Algr talk , 27 March UTC. Mini, if I have "chosen to ignore" anything, it is because there are six different people here making different points, and I can't respond to them all.

But you have all chosen to ignore my response to the argument that U-N was not zero, and gone on to make the same points again. Please go back and read that. The tactic that I keep running into here is that people will throw unjustified assumptions into their opponent's views so that they can "disprove" them when those assumptions prove false. It is like this argument:. It's a perfect "proof" for those who want to believe it.

But the hidden assumption is that if cars have any similarity to horses, then they must equal them in all ways. The Pro-one crowd here has done this on at least two occasions:. Also, again on the troll point - there's a world of difference between "I've read through all of these proofs, but I'm still not convinced that they haven't made some hidden error somewhere" and "I don't care how many proofs you show me, common sense says 0.

You can see how the second one sounds a lot more troll-y than the first, much in the same way "I don't understand how life could have formed out of a random amalgamation of chemicals" is less trolly than "I ain't kin to no ape! Confusing Manifestation Say hi! In the discussions of whether 0. The specific expression I've seen on more than one occasion is something like "0.

Before I weigh in, there's a few suggestions I'd like to make for those of you who want to participate:. Even though this page is meant for discussion of. As this is a discussion of math, the debate should mostly be carried out through proofs, equations, and logic.

Arguments based on simple contradiction, vague philosophical notions, and stubbornness will not persuade anyone who doesn't already happen to agree with you. If you know, right now, that no proof or argument will change your mind, then you really shouldn't spend your time reading proofs and arguments - or replying to them.

You should probably reconsider why you're even here. Personally, I would love to be proven totally, irrefutably wrong; it would be a mind-opening experience! Let's keep the discussion limited to the set of real numbers. I'd rather not bring in alternative numbering systems if I can help it.

I don't use them, you see, and I doubt you do either. It is my observation that any real value can be expressed as a decimal number. However, not every value may be expressed as a finite decimal value. Pi is a great example. We will never know the precise value of pi expressed in decimal, because it would require infinite space to express; as it happens, we don't actually need to know its precise value to work with it. It is a symbol for the ratio of a circle's diameter to its circumference.

Enough about pi. If you long-divide 1 by 3, your answer will at first be 0, and then 0. You and I both agree that no matter how long you keep dividing, you'll just see more 3's at the end. There isn't going to be a surprise 4 that pops up after a while. We don't have to divide until the end of time in order to know that 1 divided by 3 results in an infinite amount of 3's following a decimal point. Division does not produce approximations. I await your replies eagerly. I beleive that we can prove that 0.

I think this is enough to prove that 0. Before you say anything about my flawed representations. I used those because I don't know the notation. What I mean by. I also realize there is no real "end" to. It's quite amusing to read the arguments going back and forth throughout these Talk pages. Before I even found the 0. I think the inability to accept the equality of 0. Every "argument" against the equality on these Talk pages makes the assumption that there is some small distance — however small — which separates 1 and 0.

However, because the number of nines in 0. So what people are really refusing to accept is that infinite is truly not finite. For those who think about it as a process, the argument that 0. And this is the crux: if you indeed had an infinite amount of time to write nines, would you ever finally write a number which was exactly equal to 1? If one truly understands the concept of Infinity, the answer is, of course, yes.

Why yes? Because there is no "finally" in infinite time. You would never stop writing, and by doing so you would write a number equal to 1. Even some of you who agree with the equality may find yourself skeptical of this, but if you read it carefully, you'll find it is exactly the same equality, just translated into a physical action rather than an abstract concept.

Your same difficulty in comprehending actually "reaching one" after infinite time is the same concept others struggle with in comprehending a decimal of infinite length. You would never reach one, because reaching one implies an end, or finite time. Given infinite time, you would write a number equal to 1.

For many with a sound background in mathematics, it is much easier to accept that a string of numbers goes on forever without end. Those same individuals may find it much more difficult to accept that an infinite amount of time is truly time going on forever without end, rather than a very-large-as-to-be-incomprehensible yet still finite amount of time.

The point of this post at last! The trouble with "common sense" is that it can sometimes err. There are number systems in which 0. These are, of course, not the real numbers. But real numbers are not necessarily the most common sense system available. In principle, one could perform an infinite number of tasks in a finite time see supertasks.

In such situations, it is perfectly acceptible to consider the "next" task afterwards. Goldkingbot talk , 22 April UTC. I'll do one more thing: I'll present here a different proof of the equality I've dug up from the archives. If there is any step you think is invalid, say so and we'll continue from there.

No one would ever go to the bar and ask for. No one EVER says. If someone stumbles across the symbols. Although they likely won't know the name, and hence will probably ask some confusing questions. The logical thing to do with such a person is tell them about Hyperreal numbers and infinitesimals. It is obnoxious to instead lock the discussion into a number set that is defined as being incapable of supporting the property they have discovered. That statement is true - if you refuse to look outside of natural numbers.

You can similarly force. But when you do these things, all you are doing is blinding yourself to the intent of the question. In my board game, I used hyperreal numbers, and everyone understood what I meant without my having to explain anything. No one was confused by those rules, and if someone had tried to pull out the Archimedean property to claim that 2. Real numbers don't matter. Real people doing real things is what matters.

Listen to them. Algr talk , 8 May UTC. Why don't you guys spend some time off as well and catch some air? Algr talk. Take a calculator. Then press "x" "3". With many calculators you will not get 1. Not sure if this is worth mentioning in the article, since it's more a lesson on knowing the limitations of your methods, but Then we must answer following questions. If the number system we use has 'nice' topology, we can expect following answers: 1.

If one of the sequences converge, so does the other. If one of the limits is unique, so is the other. R is a non-negative number smaller than any positive rational number, in other words R is non-negative infinitesimal. For different number systems, we get different answers.

Tlepp talk , 11 May UTC. At last, someone who can talk sense! Why can't you just put what Tlepp said in the introduction rather then acting like hyperreals are forbidden knowledge corrupting our youth? Algr talk , 11 May UTC. I think we are making progress here. The article should simply say this. But in terms of number sets, I question if "usual" means "appropriate".

If someone says ". If they then say "A number that is almost, but not quite one. That rules out the Real set. You can still talk about. So what I am saying is that the article should bring up hyperreals in the introduction, and give them equal weight to the Reals throughout. Algr talk , 12 May UTC. Proof 1: 1 is one 1 per definition, and 0. Proof 3: There is actually a number slightly less than 1 and bigger than zero 0 one number is 0. Another is 0. Even if you make the 9s infinite it will never be actually 1, just a little smaller than 1.

The different inflammatory markers showed no predicting value towards the risk of mortality. Introduction: Ventilator-associated pneumonia VAP is one of the leading infection in critically ill patients.

The study was approved by the Ethics Committee of our institution. Patients next of kin provided written informed consent. Introduction: Immunological dysfunction is common in critically ill patients but the optimal method to measure it and its clinical significance are unknown. Methods: A secondary analysis of a phase 2 randomized, multi-centre, double-blinded placebo controlled trial [1]. There were no differences in allocation groups; all the patients were analyzed as one cohort.

The primary outcome was the development of NIs; secondary outcomes included day mortality. Results: Data was available for patients. Baseline characteristics and outcomes are reported in Tables 1 and 2. Both comparisons showed no difference between NIs and clinical outcomes between tertiles. Conclusions: Admission ex-vivo stimulated TNF-a level is not associated with the occurrence of NIs or clinical outcomes. Further study is required to evaluate the ability of this assay to quantify immune function over the course of critical illness.

Introduction: We believe traditional ventilator associated pneumonia VAP is limited by its complexity, subjectivity and marginal attributable mortality. It generates debate but not a matrix. Methods: Inclusion Criteria: All patients intubated for at least 48 hours. Exclusion Criteria: All elective post-cardiac surgery. Follow Up: Extubation or death. Results: A total of patients were enrolled between 3rd September to 20th October in The major reason for this reduction is decrease in percentage of ventilated patients 45 vs 40 as well as slight reduction in length of stay on ventilator 3 vs 2.

Introduction: There is limited information about sepsis in very old patients hospitalized with community-acquired pneumonia CAP. Methods: We conducted a retrospective study using data that were prospectively collected at the Hospital Clinic of Barcelona. We aimed to investigate the prevalence, etiology, risk factors and clinical outcomes of this population, comparing patients with and without sepsis defined according to SEPSIS-3 criteria.

Written informed consent was waived because of the non-interventional study design. There was no significant difference in the distribution of pathogens in patients with and without sepsis Figure 1. Male sex OR 1. One-year mortality was higher in very old patients with sepsis compared with those without sepsis Table 1. A propensity-adjusted multivariable analysis showed that risk factors for day mortality in septic patients were chronic renal disease OR 2.

Conclusions: In very old patients hospitalized with CAP, antibiotic therapy before admission was associated with a decreased risk of sepsis, whereas diabetes mellitus was associated with a decreased risk of day mortality.

Introduction: Legionella species may cause life-threatening pneumonia and thus need early treatment. Differentiating Legionella pneumoniae LP from other types of pneumonia including Mycoplasma pneumoniae MP , Steptococcus pneumoniae SP and viral types of community-acquired pneumonia CAP has important implications regarding antibiotic therapy.

Current testing options for LP infection have limited sensitivity leading to time delays in treatment and to usage of empirical broad-spectrum antibiotics. Recently, a Legionella Scoring system based on six parameters has been proposed. We aimed to independently validate this score and investigate whether additional clinical and laboratory parameters would further improve its accuracy. Methods: We analyzed patients hospitalized in a tertiary care hospital between and with CAP and a defined etiology.

Association and discrimination were assessed using logistic regression analysis and area under the receiver operator characteristic curve ROC AUC. Results were similar for subgroups based on each of the different CAP types.

Additionally, we found that a history of nausea further improves the diagnostic accuracy of the legionella score to an AUC of 0. Conclusions: In patients hospitalized with CAP, a high Legionella score on admission strongly predicts LP infection and thereby can optimize the empiric antibiotic management. A clinical history of nausea further improves diagnosis. Systematic use of this scoring system in conjunction with other diagnostic tests may improve the diagnostic and therapeutic management of patients presenting with CAP.

Introduction: Acinetobacter baumannii AcB remains one of the most prevalent ventilator-associate pneumonia VAP causing pathogen. In recent years, share of drug resistant AcB strains across Europe was found to be steadily increasing. Consequently, in , AcB was included in the WHO global priority list of drug-resistant bacteria to highlight the need for the research development. The aim of this study was to identify the relation of risk factors for ventilator-associated pneumonia VAP and mortality with drug resistance profiles of AcB.

Methods: A retrospective cohort study of patients treated in medical-surgical ICUs with drug-resistant strains of AcB as pathogens of VAPover a 2-year period was carried out. The overall in-hospital mortality rate was Thus, timely mechanical ventilation and ICU treatment may reduce the risk of VAP due to higher drug-resistant AcB, especially in more severely ill patients.

Introduction: sepsis following traumatic and surgical intervention increases morbidity, mortality, cost and length of patient stay in hospital. The aim of this study was to identify the major pathogens associated with wounds infection and to review their antimicrobial reactions.

Methods: A 5-year review of nosocomial wound infection and colonization in patients admitted to the intensive care unit of tertiary care Hospital southern region of Saudi Arabia from Jan. Patients of all ages and gender who required ICU attention at some point and defined as nosocomial infection using standard CDC criteria and presented with various degrees of wound and bed sore infections were included in the study.

Results: There were episodes of wound and episodes of bedsore infections. The most common organisms Klebsiella pneumoniae The percentage sensitivity of the organisms to the 51 antimicrobial agents was Conclusions: Data from this and other studies supports the hypothesis that high incidence of gram negative bacilli This requires strong infection control actions to enhance patient care. We aimed to assess the predictive performance of these risk factors.

Adult patients with no severe immunosuppression and a diagnosis of hospital-acquired pneumonia and ventilator-associated pneumonia with confirmed microbiology were enrolled. Patients or their next of kin provided written informed consent. Introduction: Growing antimicrobial resistance among Gram-negative rod GNR strains is a worldwide issue. Flora monitoring is associated with right first choice of antimicrobial treatment. Among Acinetobacter spp. In multi-variate analysis lethal outcome Conclusions: 7yrs study revealed Acinetobacter spp.

High sensitivity of GNR to carbapenems was found. Introduction: Of great concern is the dissemination in health care environments of multi-drug resistant MDR bacteria, especially Klebsiella pneumoniae carbapenemase KPC -producing enterobactereaceae.

Methods: Our objective is to identify the differences in risk factors and outcomes between patients who did and did not acquire KPC- producing bacteria during their stay in the ICU of an university hospital in Rio de Janeiro, Brazil. We designed a nested case — control study of a retrospective cohort from May to June Three hundred and thirty nine patients were admitted to the ICU. The two groups were compared according to demographic clinical and microbiological data.

Results: There was no significant differences in gender, age, severity scores between the two groups. Patients with KPC- producing bacteria had longer ICU and hospital stays than control patients and they required more life-support such as mechanical ventilation, vasopressor use and dialysis. In hospital mortality rate was higher in KPC- producing bacteria group A multivariate analysis showed that mechanical ventilation OR: 2. Factors associated with in-hospital mortality were: male gender, OR: 3.

Conclusions: Colonization was associated with longer ICU and hospital LOS, more requirements of life-support and higher in-hospital mortality rate. Previous antibiotic use and mechanical ventilation were the most important risk factors for patients becoming colonized. Factors associated with mortality were male gender, Charlson score and mechanical ventilation. Ecological arguments, on the other hand, provide rationale to limit carbapenem use as much as possible.

Clinical cure was defined as stop of antibiotics together with resolution of clinical signs of infection. However, no clear relationship between the use of carbapenem versus non-carbapenem antibiotics and clinical cure was found. Introduction: B. We described the causes of B. Methods: 11 adult patients median age 53 years, 2 males, 9 with permanent vascular access receiving chemotherapy with B.

Results: Sanitary and epidemiological examination revealed the connection between infection and intravenous infusion of dexamethasone performed concurrently with chemotherapy. In 5 patients fever with chills and hypertension developed within 2 hours after infusion of the infected drug; empirical intravenous antibiotic therapy started immediately after collecting blood culture. In 6 patients fever appeared after days outpatiently, so they received antibiotics per os.

All these patients had permanent vascular access, and BSI was detected either the next chemotherapy course when fever reappeared 3 pts while using vascular access, or as a result of a specific examination 3 pts. In all cases empirical antibiotic therapy started on the first day of fever, drug correction was performed in 6 patients according to results of bacteriological research. Septic shock developed in 1 patient, pneumonia in 3 patients. Permanent vascular access was preserved only in 1 case.

All patients were cured and continued to receive antitumor treatment. Conclusions: Detection of more than 1 case of B. A favorable outcome of BSI treatment is associated with the early start of antibiotic therapy and its correction after microbiological examination. Introduction: Shewanella species are emerging opportunistic pathogens that can cause severe soft-tissue, respiratory, hepatobiliary, gastrointestinal infections, and bacteraemia.

Most of the published information for this organism are limited to isolated case reports and small case series. Here we report the largest case series of infections caused by Shewanella species. Methods: Patients admitted to a regional hospital in Hong Kong with Shewanella species infection from 1st Apr, to 30th Sep, were included.

Demographics, antibiotics, microbiology and outcomes were retrospectively analyzed. Results: In an 8. Their median age was 76 IQR Seven patients 9. Conclusions: This large case series suggested that Shewanella infections are commonly associated with underlying comorbidities, especially with malignancy.

Antibiotic resistant isolates are uncommon. Introduction: Despite improvements in early treatment, survival following burn injury remains challenged by sepsis and emergence of Multidrug-Resistant Bacteria MRB. The objective of our study was to assess epidemiological aspects and bacterial resistance patterns of bacteria isolated from intensive burn care unit and to identify risk factors.

Methods: A prospective, monocentric study was conducted from May to September in a burn unit in Tunisia. Results: During the study period, 31 patients were included. The mean age was 35 years. They were 17 men and 14 women. Carbapenemase-encoding genes were detected in 22 patients: 12 at admission and 10 at the first week post admission.

Univariate analysis identified risk factors associated with acquiring ESBLs and CPE were: secondary transfert; indwelling device, antibiotic use of aminosids and amox-clavulanic acid and non-compliance with hygiene measures. So, detection and isolation of these patients and strengthen infection control measures allows us to improve therapeutic efficacy and improves their prognosis.

Despite various researches have been done regarding hospital acquired infections, developing repeated attack still needs further investigation. This research tries to magnify the threats and suggest a way forward. Infection diagnosis was made based on Centers for Disease Control criteria.

Multivariate analysis was used. Results: A total of ninety-four patients were admitted to ICU. Those of who stayed more than two weeks develop repeated attack at a rate of All Patients were having indwelling device. Duration of ICU stay and indwelling device use had positive association with a strong Pearson correlation of 1.

Drug sensitivity test revealed around Conclusions: Despite the low rate of repeated infection, multi-drug resistance pattern is high. The research reveals the need for proper antibiotic stewardship and application of standard infection control measures in ICUs. Introduction: Conflicting results have been found regarding impact of the antibiotic stewardship program ASP on pathogens resistance and clinical outcomes of intensive care unit ICU -acquired bacteremia.

Methods: Prospective interventional single-center study in the period Jan to Dec Intervention onset: The intervention: ASP, including multidisciplinary team building, antimicrobial therapy and prophylaxis protocols, infection control measures, education, internal audit. The data from pre-intervention and intervention periods reports were compared. Results: blood samples were analyzed, Changes of the pathogens, causing ICU-acquired bacteremia are presented in the Table 1.

All consecutive infectious episodes with positive culture for GNB and treated with antibiotic therapy within 24 hours of sample collection were included. All analysis were done after adjusting for disease severity. Results: Of eligible ICU patients Risk-adjusted analysis showed higher odds of mortality for MDR infected patients compared to non-MDR group but this was not statistically significant OR 1.

It is worrying to note emergence of resistance to last line of defence against MDR gram negative infections in regions endemic to Carbapenem resistance. Methods: Retrospective analysis of all patients with Carbapenem resistant Klebsiella pneumoniae blood stream infection BSI was done between January and December Microbiological and clinical variables along with outcomes were analysed.

Aggressive infection control measures were undertaken with successful containment of CR-KP strains along with reduction in overall BSI. Conclusions: Infection control measures form the backbone of patient care in centres showing endemicity for Carbapenem resistant Klebsiella to prevent Colistin resistance and also to reduce occurrence of overall blood stream infections. Introduction: Sepsis due to carbapenem resistant organisms has high mortality; inappropriate empirical antibiotic is one of the main causes of this poor outcome.

So, early diagnosis of resistance pattern carbapenemase genes is crucial. Among positive blood cultures, samples were positive for carbapenemase genes. There was only one false negative diagnosis for carbapenem resistance. Colonization with CPE seems to constitute a risk factor for mortality. The aim of our study was to identify associated risk factors and clinical outcomes among patients with fecal colonization by CPE admitted to a Portuguese tertiary hospital ICU.

Methods: A 2-year retrospective study was performed in patients with previous unknown CPE status colonization or infection , admitted to our ICU. Rectal swabs were performed and analyzed using real-time polymerase chain reaction testing. Clinical records were reviewed to obtain demographic and clinical data.

Results: Of patients admitted, 38 4. The most frequent carbapenemase genes detected were KPC Nine patients developed CPE-related infections during ICU stay 4 pneumonia, 3 urinary tract infections, 1 peritonitis and 1 surgical wound infection. CPE colonization was associated with an increased length of stay Conclusions: Hospitalization was the most important risk factor for CPE colonization.

There seems to be a slightly higher in-hospital mortality rate, even though with no statistical significance. These infections are becoming difficult to treat with available treatment options due to growing antimicrobial resistance in India. Ceftazidime-avibactam has in-vitro activity against Gram-negative organisms producing class A, class C and some class D beta-lactamases. In the RECLAIM study, Indian patients with a diagnosis of cIAI were enrolled in the study and were randomly assigned to receive either ceftazidime-avibactam mg of ceftazidime and mg of avibactam followed by metronidazole mg ; or meropenem mg.

As the Indian subset study was not statistically powered to detect a difference in the sub-group, we descriptively analysed the efficacy results in the Indian population and compared them with the overall results in the global trial. In addition, the study also analysed the safety of CAZ-AVI in the Indian patients by monitoring the number and severity of adverse events. The efficacy results from the Indian subset analysis are summarized in Table 1.

Overall, efficacy and safety outcomes were comparable with the global study. Although there are inherent limitations to this analysis due to the subgroup size, it provides information on clinical efficacy and safety relevant for the intended use of CAZ-AVI in Indian patients.

Introduction: Adequate utilization of vancomycin is essential for achieving therapeutic targets while avoiding clinical failure and development of antimicrobial resistance. Our aim is to determine whether there is a difference in vancomycin therapeutic blood level between surgical and medical patients in intensive care unit ICU post-therapeutic dose. Electronic health records of patients admitted to ICU who have received vancomycin between and were reviewed.

Descriptive analyses were conducted using number and percent. The Fisher exact test was used to compare outcomes across the different ICU services. Statistical analyses were performed using Statistical Analysis Software version 9. Statistical significance was set at a two-sided p-value of 0. Results: A total of 44 surgical ICU patients with mean age Sixteen out of 44 surgical patients Eight out of 44 surgical patients Twenty out of 44 surgical patients Conclusions: Our study showed that a higher percentage of surgical ICU patients have a sub-therapeutic level.

We also noted that a statistically significant higher percentage of medical ICU patients had a supra-therapeutic vancomycin trough levels. Further studies are needed to reach optimal dosage of vancomycin in surgical ICU patient. Our study aims to determine whether the doses of TZP used to treat obese critically ill patients in ICU allow reaching an effective concentration, at the early phase of sepsis 24 hours after initiation.

Data such as treatment modalities, sequential organ failure assessment score, renal clearance and albumin were collected. Four patients achieved the target of 4 MIC. The results are presented in Table 1. Several patients were treated using standard dosing or without loading dose.

Continuous infusion was frequent. It may exist room for improvement in this setting. Considering the risks of underdosing or toxicity, it seems preferable to use therapeutic drug monitoring to adapt TZP dosing in this population. Higher SOFA was associated with correct exposition, but doses used and renal function were different in these patients.

Introduction: Early administration of effective intravenous antimicrobials is recommended for the management of the patients with sepsis. Although Meropenem MEPM is one of the first-line drugs in patients with sepsis because of its broad spectrum, the optimal dose in the critical care settings especially during continuous renal replacement therapy CRRT has not been established since therapeutic drug monitoring of MEPM has not been popular.

One gram of MEPM was administered over 1 hour, every 12 hours, and blood samples at 1, 2, 6, 9 and 12 hours after administration were collected on day 1, 2 and 5. Results: The patients were CRRT was provided at The peak concentration of the first administration of MEPM was In patients with ARC, dose escalation may be appropriate to avoid sub-therapeutic plasma concentration of many drugs.

Methods: We conducted a single centre retrospective cohort study between - Daily CrCl was recorded. The prevalence of ARC was determined, and multiple logistic regression was used to identify risk factors for developing ARC. ARC was more common in males There was no threshold phenomenon with age before which ARC was more likely. Introduction: Meningitis is one of the complications of severe traumatic brain injury, and it is often associated with encephalitis incidence from 1.

The aim of the investigation was to study the dynamics of the concentration of meropenem in serum and cerebrospinal fluid CSF with intravenous and intrathecal administration of meropenem. Methods: In eight patients with bacterial meningoencephalitis blood serum and CSF were studied prior to the administration of meropenem and min, 1, 2. Meropenem infusion was carried out for 30 minutes, 5 mins after it 5 ml of blood and 1 ml of CSF were sampled.

Prior to antibiotics administration blood and CSF were taken for microbiological examination. Results: Microbial growth was not detected in blood samples. Acinetobacter spp. Dynamics of meropenem concentrations: time 0 1. Carbapenems are an attractive choice for empiric therapy but there are concerns about overuse and development of resistance.

To better understand the benefits and risks of using carbapenems in empiric treatment regimens for HAP and VAP, we conducted a systematic review and meta-analysis. We included randomized controlled trials comparing carbapenem versus non-carbapenem regimens. Data were abstracted in duplicate. The primary outcome was all-cause mortality. Secondary outcomes included mortality by proportion of VAP and overall clinical response.

We determined risk ratios RR for each outcome using a random-effects model. Results: Of 14, unique references, 20 trials enrolling a total of patients were included. For the primary outcome of mortality, carbapenem use had a RR of 0. Overall clinical response had a RR of 1. Significant statistical heterogeneity was not found.

However, there were no differences in clinical response rates. Limitations of available data include short-term patient follow up, high levels of potential bias, and heterogenous definitions of clinical response. Additional high-quality studies are needed to determine when the inclusion of carbapenems in empiric regimens is warranted.

Introduction: Klebsiella pneumoniae KP bacteraemia is associated with high short-term mortality. Methods: Adults admitted into a regional hospital in Hong Kong with KP bacteraemia from January to June were retrospectively reviewed. Demographics, antibiotics, microbiology and outcomes were identified and analyzed. Cox regression analysis and propensity score matching methods were used to determine predictors for day mortality. Results: A total of patients with KP bacteremia were identified.

Forty-nine patients Among all patients, 82 Propensity score matching yielded 61 matched pairs patients. Their demographic and disease severity were well balanced Table 2. No significant difference in day mortality was noted between the matched cohorts Fig 1. Cox regression analysis identified only respiratory tract and gastrointestinal tract infection as independent predictors for day mortality while the use of PIP-TAZO was insignificant. Conclusions: With the help of propensity score matching analysis, the apparently higher day mortality among KP bacteremic patients received PIP-TAZO could be explained by their higher disease severity.

This implies that the choice of empirical antibiotic, is affected by disease severity, and does not affect day mortality. Kaplan-Meier Survival Plot showing probability of survival between two patient groups matched cohort. Results: Isolates were recovered from cUTI The agents more active in P. The agents more active in E. It was one of the most potent agents against P. Introduction: Differentiating Mycoplasma pneumoniae MP from Streptococcus pneumoniae SP and viral etiologies of community-acquired pneumonia CAP has important implications regarding empiric antibiotic therapy.

We investigated parameters upon hospital admission to predict MP infection. Methods: All patients hospitalized in a tertiary care hospital — for CAP with confirmed etiology were analyzed using logistic regression analyses and area under the receiver operator characteristics curves for associations between demographic, clinical and laboratory features and the causative pathogen. Introduction: The prophylactic use of probiotics has emerged as a promising alternative to current strategies viewing to control nosocomial infections in a critically-ill setting.

However, their beneficial role in VAP prevention remains inconclusive. Our aim was to delineate the efficacy of probiotics for both VAP prophylaxis and restriction of ICU-acquired infections in multi-trauma patients. A four-probiotic formula was applied and each patient received two capsules per day from Day1 to Day15 post ICU admission. The content of one capsule was given as an aqueous suspension by nasogastric tube, while the other one was spread to the oropharynx after being mixed up with water-based lubricant.

The follow-up period was 30 days, while ICU stay and mortality were also assessed. Results: The use of probiotics reduced notably the incidence of VAP [ Conclusions: The prophylactic administration of probiotics exerted a positive effect on the incidence of VAP or other ICU- acquired infections and ICU stay in a critically-ill subpopulation being notorious for its high susceptibility to infections, namely multi-trauma patients.

Introduction: The rational use of antibiotics is one of the main strategies to limit the development of bacterial resistance. In this study we aimed to evaluate the effectiveness of a C reactive protein CRP based protocol in reducing antibiotic treatment time in critically ill patients.

Methods: An open randomized clinical trial was conducted in two adult intensive care units of a university hospital in Brazil ClinicalTrials. Patients were randomly allocated to: i intervention - duration of antibiotic therapy guided by CRP levels, and ii control - duration of therapy based on best evidences for rational use of antibiotics.

The primary outcome was days of antibiotic therapy in the index infection episode. Results: patients were included: 64 in the CRP group and 66 in the control group. In the intention to treat analysis, the median Q1-Q3 duration of antibiotic therapy for the index infection episode was 7. In the pre-specified per protocol analysis, with 59 patients allocated in each group, the median duration of antibiotics was 6. Mortality and relapse rates were similar between groups. Conclusions: Daily levels of CRP may aid in reducing the time of antibiotic therapy in critically ill patients, even in a scenario of judicious use of these drugs.

Introduction: The Macrophage Activation Syndrome MAS or hemophagocytic lymphohistiocytosis HLH is a life threatening complication characterized by pancytopenia, liver failure, coagulopathy and neurologic symptoms and is thought to be caused by the activation and uncontrolled proliferation of T lymphocytes and well differentiated macrophages, leading to widespread hemophagocytosis and cytokine overproduction [1,2].

The etiology is unknown, but is considered to have an infectious trigger. The aim of our study is to evaluate the impact of HLH in our 9 beds infectious diseases ICU, during 83 months period We have evaluated the etiology established with cultures, serology, and molecular methods, treatment with corticosteroids, IV immunoglobuline, cyclosporine, etoposide and outcome 2.

Results: patients were admitted to ICU, 15 patients 0. The etiology is more frequent established compared with literature data. Treatment corticosteroids, immunoglobuline, cyclosporine, etoposide is not associated with increased survival. Introduction: Irreversible hemorrhagic shock IHS , a critical condition associated with significant blood loss and poor response to fluid resuscitation, can induce multiple organ failures and rapid death [1].

Determining the patients who are likely to develop IHS in surgeries could greatly help pre-operative assessment of patient outcomes and allocation of clinical resources. Methods: machine learning model of IHS is developed and validated via porcine induced bleed experiment. Arterial, central venous and airway pressures collected at Hz during the blood draw [Fig 1] were used to extract characteristic sequential patterns using Graphs of Temporal Constraints GTC methodology [2], and a decision forest DF model was trained on these patterns to determine subjects at high risk of impending IHS.

This method outperforms logistic regression and random forest models trained on statistically featurized data [Tab 1, Fig 2]. Conclusions: Our results suggest that by leveraging sequential patterns in hemodynamic waveform data observed in pre-operative blood draws, it is possible to predict who are prone to develop IHS resulting from blood loss in the course of surgery.

Future work includes validating the proposed method on data collected from human subjects, and developing a clinically useful screening tool with our investigations. Introduction: The H 2 S and oxytocin Oxy systems are reported to interact with one another [1].

H 2 S plays a major role in the hypothalamic control of Oxy release during hemorrhage [2]. There is scarce information about Oxy receptor OxyR expression in the brain in general and what is there is ambivalent. OxyR has been immunohistochemically IHC detected in the human hypothalamus but not in the hippocampus, in contrast to rodents [3], which underscores the need for additional characterization in relevant animal models.

Thus the aim of this study is to map the expression of the Oxy and H 2 S systems in the porcine brain in a clinically relevant model of hemorrhagic shock HS. Proteins were differentially expressed in the hypothalamus Fig 2 , parietal cortex and cerebellum Fig 1. Cell types positively identified were: magnocellular neurons of the hypothalamus, cerebellar Purkinje cells and granular neurons, and hippocampal pyramidal and granular neurons of the dentate fascia.

Conclusions: Our results confirm the presence of Oxy and OxyR in the hypothalamus similarly to the human brain. The coexpression of OxyR and CSE may link and help better understand neurochemical systems and physiological coping in hemorrhagic shock. Funding: CRC Acute kidney injury AKI frequently occurs and is associated to great morbidity and mortality.

Hemodynamic optimization may reduce the incidence of AKI, but the use of vasopressors to increase mean arterial pressure MAP could have deleterious effect on renal perfusion. Methods: Retrospective study based on prospectively collected data on digital medical records Digistat at our ICU.

Hemodynamic data were analyzed individually as well as in their average, maximum and minimum value and the AUCs were calculated. Results: patients were included. Among these, Conclusions: Average MAP in the first 48 hours in septic shock patients is significantly related to the occurrence of AKI, regardless of the average dose of norepinephrine administrated. This suggests that administering Ang II may help patients with catecholamine-resistant distributive shock to achieve the consensus standard target MAP.

Introduction: Through reduction in venous capacitance, norepinephrine NE increases the mean systemic pressure Psm and increases cardiac preload. This effect may be added to the ones of fluids when both are administered in septic shock. Nevertheless, it could be imagined that NE potentiates in a synergetic way the efficacy of volume expansion on venous return by reducing venous capacitance, reducing the distribution volume of fluids and enhancing the induced increase in stressed blood volume.

The purpose of this study was to test if the increase in Psm induced by a preload challenge were enhanced by NE. Methods: This prospective study had included 30 septic shock adults. To reversibly reproduce a volume expansion and preload increase at different doses of NE, we mimicked fluid infusion through a passive leg raising PLR.

Results: NE dose decreased from 0. This suggests that it may potentiate the effects of fluid in a synergetic way in septic shock patients. This may decrease the amount of administered fluids and contribute to decrease the cumulative fluid balance. However, a subgroup who will response to AVP is unknown.

The purpose of this study was to determine factors which could predict the response to AVP in patients with NE-resistant hypotension. We divided all patients into two groups by response to AVP; responders and non-responders. We conducted univariate and multivariate logistic regression analysis to evaluate the effect of variables on AVP response.

Introduction: The mortality of septic shock refractory to norepinephrine remains high. To improve the management of this subgroup, the knowledge of early indicator is needed. We hypothesize that maximum norepinephrine dosage on the initial day of treatment is useful to predict early death in septic shock. Methods: In this retrospective single-center observational study, septic shock patients admitted to the emergency intensive care unit ICU of an academic medical center between April and March were included.

Cardiac arrest before ICU admission and those with do-not-resuscitate orders before admission were excluded. The maximum dosage of norepinephrine initial 24 hours of ICU admission MD24 was used to assess 7-day mortality. Results: One-hundred-fifty-two patients were included in this study. The higher MD24 predicted 7-day mortality area under curve 0. After adjustment of inverse probability of treatment weighing method using propensity scoring, MD24 higher than 0.

Conclusions: The maximum dosage of norepinephrine higher than 0. Introduction: Septic shock is characterized by myocardial depression and severe vasoplegia. Right ventricle performance could be impaired in sepsis. The effects of norepinephrine on RV performance and afterload in septic shock are not immediately evident.

The aim of the present study was to investigate the effects of norepinephrine on RV systolic function, RV afterload and pulmonary haemodynamics. Methods: Eleven, volume-resuscitated and mechanically ventilated patients with norepinephrine-dependent septic shock were included. Infusion of norepinephrine was randomly and sequentially titrated to target mean arterial pressures MAP of 60, 75 and 90 mmHg. At each target MAP, strain- and conventional echocardiographic were performed.

The pulmonary haemodynamic variables were measured by using a pulmonary artery thermodilution catheter. The RV afterload was assessed by calculating the effective pulmonary arterial elastance Epa and pulmonary vascular resistance index PVRI. Conclusions: The RV function was improved by increasing doses of norepinephrine, as assessed both by strain- and conventional echocardiography. This is explained by an increase of RV preload. Pulmonary vascular resistance is not affected by increased doses of norepinephrine.

Introduction: The potential role of peripheral perfusion as a target for fluid resuscitation FR in septic shock is unknown. We aimed to determine if capillary refill time-targeted FR CRT is superior to a lactate-targeted fluid resuscitation L regarding fluid balances and evolution of tissue-perfusion variables. Hemodynamic and perfusion variables were assessed at 2, 6 and 24h, as well as SOFA scores and fluid balances up to 72h.

Baseline lactate was 3. No differences between groups were observed in macrohemodynamics at baseline. Resuscitation fluids at 6h were not different 1. The results of some perfusion related parameters are shown in Table 1.

Conclusions: This preliminary results suggest that using CRT as a target for FR in septic shock appears to be feasible, and not associated with impairment of tissue perfusion-related parameters as compared to lactate-targeted FR. Introduction: Shock patients often become resistant to catecholamines which often require the addition of a non-catecholamine vasopressor. Preclinical studies suggest that in the presence of a-adrenoceptor antagonism, the renin-angiotensin aldosterone system exerts the major vasopressor influence.

Mean arterial pressure MAP and heart rate were continuously recorded Fig. Results: As shown in Fig. Additional 0. Prior to PHN infusion, a 2. Patients with shock who are resistant to increasing doses of catecholamines may also have vasopressin resistance potentially making angiotensin II a preferred vasopressor for these patients.

The manufacturer recommends heparin 50 units per mL, but supra-therapeutic anticoagulation has been observed with this concentration. The primary outcome evaluated percentage of activated clotting times ACT below therapeutic range, and safety was evaluated by bleeding events, as defined by the Bleeding Academic Research Consortium BARC bleeding criteria.

Secondary objectives included evaluating the incidence of device thrombosis and rate of heparin-induced thrombocytopenia HIT. Results: A total of 18 patients were included. No device thrombosis was observed. Patients showed universal reductions in platelet counts. Conclusions: The use of a lower dose heparin concentration purge solution was not associated with increased device thrombosis although bleeding still occurred.

We will discuss the difficulty performing the procedure and its countermeasure. Results: An year-old woman was transferred to our hospital with shock. Coffee grounds material was found in a nasogastric aspirate after intubation and upper gastrointestinal endoscopy identified a pulsating large duodenum ulcer without active bleeding, for which an elective procedure was planned. She was admitted to our ICU, responded to initial resuscitation, and thereafter extubated.

Her systolic blood pressure SBP suddenly dropped to 40mmHg with massive hematochezia at that night, and did not increase despite resuscitation with blood products, crystalloid and norepinephrine. Following the placement of a sheath in the left femoral artery, we tried to place a 7 Fr intra-aortic balloon occlusion catheter, which unintentionally and repeatedly went into the right common iliac artery because her left femoral artery was tortuous.

It took approximately 60 minutes to successfully place the catheter. Inflation time was 36 minutes and no complications were observed. Introduction: The natural components of the pomegranate fruit may provide additional benefits for endothelial function and microcirculation. We hypothesized that chronic supplementation with pomegranate extract might improve glycocalyx properties and microcirculation during anaerobic condition.

Methods: Eighteen healthy and physically active male volunteers aged 22—28 years were recruited randomly to the pomegranate and control groups 9 in each group. The pomegranate group was supplemented with pomegranate extract for two weeks.

At the beginning and end of the experiment, the participants completed a high intensity sprint interval cycling-exercise anaerobic exercise protocol. The systemic hemodynamics, microcirculation flow and density parameters, glycocalyx markers, and lactate and glucose levels were evaluated before and after the two exercise bouts.

Results: No significant differences in the microcirculation or glycocalyx were found over the course of the study. The lactate levels were significantly higher in both groups after the first and repeated exercise bouts, and were significantly higher in the pomegranate group relative to the control group after the repeated bout: Conclusions: Chronic supplementation with pomegranate extract has no impact on changes to the microcirculation and glycocalyx during anaerobic exercise, although an unexplained increase in blood lactate concentration was observed.

Introduction: Extracorporeal membrane oxygenation in adults in accompanied by high mortality. Our ability to predict who will benefit from ECMO based on currently available clinical and laboratory measures is limited. The advent of single cell sequencing approaches has created the opportunity to identify cell populations and pathophysiological pathways that are associated with mortality without bias from a priori cell type classifications. Identification of such cell populations would provide both an important prognostic markers and key insight into immune response mechanisms and therefore a possibility for advanced drug matching that may impact clinical response to ECMO in these patients.

Methods: Whole genome transcriptomic profiles were generated from a total of 40, peripheral blood monocytes obtained from 37 patients at the time of cannulation for ECMO Fig 1. Differential gene expression analysis was performed with the Monocle package for the R statistical analysis framework. Time-to-event data were analyzed in a survival analysis with a log-rank test for differences. Results: Genes encoding several members of the heat shock family of proteins were up-regulated in cells from non-survivors.

Notably, these genes were expressed by a small fraction of cells 2. Conclusions: The proportion of cells expressing genes encoding members of the heat shock proteins is predictive of survival on ECMO. Introduction: High-risk pulmonary embolism is a life-threatening disorder associated with fatal outcomes. The diagnosis of PE in hemodynamically unstable patients remains a challenge for both intensivists and cardiologists since the clinical presentation is variable and non specific. The aim of this study is to assess the clinical features, electrocardiographic EKG and echocardiographic findings associated with high risk PE, and to describe the management and prognostic of this disease.

Methods: a single-center, cross-sectional descriptive study including all patients admitted for PE confirmed by transthoracic echocardiography or Computed tomography angiography complicated with cardiogenic shock in the cardiology intensive care unit in the Casablanca university hospital, from September to July During the 6 years study period, 69 patients were included. Results: Mean age was All the patients were hemodynamycally unstable at admission, presenting with dyspnea stage III EKG abnormalities were represented by sinus tachycardia in Echocardiographic aspect of acute cor pulmonale was found in all the patients, right atrial thrombus in 15 patients Thrombolytic therapy was performed in 46 patients The mortality rate of our serie was Conclusions: High-risk PE is a severe disorder associated with high mortality and morbidity, thus a multidisciplinary coordination between cardiologists, radiologists and intensivists is crucial for the management of patients with high-risk PE.

Introduction: Pulmonary embolism PE is one of the major causes of mortality, morbidity and hospitalization in Europe. Haemodynamic benefits of thrombolysis in high risk PE are undeniable, yet use of thrombolytic agents in intermediate risk category is controversial due to lack of evidence and fear of complications. Primary outcome was the complication rate, especially bleeding and secondary the survival rate.

Results: PE comprised 8. F:M ratio was , mean age of Mean PESI was Mean Qanadli score was Conclusions: In our experience, fibrinolytic therapy is safe and effective but in submassive PE should be applied after thorough assessment of risks and benefits on individual basis aiming to patient tailored precision medicine. Introduction: Blood clots of the main veins of the lower extremities are the main cause of pulmonary thromboembolism PE. Floating blood clots in the path from the legs to the pulmonary arteries are a severe form of venous thromboembolism with high early mortality.

Aim of the study: Our surgical experience and prophylaxis of transient pulmonary thromboembolism are demonstrated in the study. All patients were female. The average age of patients was All patients came to us at an early stage with deep vein thrombosis, mainly after the removal of uterine fibroids and inadequate hormone therapy.

In all patients, hypoechoic loose thromb were observed during the examination of the lower limb CDS, and the floating atrial right thrombus was visualized on the echocardiography. All operations were performed under the conditions of artificial blood circulation with sternotomy access.

After connecting the CPB pump, as a rule, the surgery is ended with a thromboembolectomy from the right atrium. On the next stage, inferior vena cava clipping was performed through the retroperitoneal access using the original clip.

In the long-term period of 18 months, mortality was also not noted. The inferior vena cava syndrome was developed in 2 patients. In 4 patients, postthrombotic syndrome was developed during long-term period. Conclusions: Thrombo-embolectomy from the right atrium and inferior vena cava clipping prevents massive pulmonary embolism and prolongs the life of the patients. However it can aggravate the development and course of chronic venous insufficiency.

Introduction: Atrial fibrillation AF is the commonest arrhythmia in critical illness and is associated with mortality. Systemic inflammation and infection have been identified as triggers for fast heart rate and development of new-onset AF NOAF during critical illness. It is unknown, however, if patients with pre-existing AF PEAF who develop a fast heart rate differ from patients with NOAF with regard to organ function, biometric characteristics and disease severity. Methods: This study was performed at a large inner-city University Hospital between January 1st and December 31st Patients who had fast AF during their critical illness were prospectively identified by the research team.

Biometric data, routine blood results, previous medical history, treatment of AF and duration of fast AF were collected. Results: Atrial fibrillation was new-onset in 49 patients In addition, a greater number of NOAF patients were admitted with sepsis, though these differences were not significant. Chronic cardiovascular comorbidities were more frequent in patients with PEAF.

Kidney function was worse in patients with NOAF, platelet counts was lower and prothrombin times higher. Conclusions: As expected, patients with PEAF suffered more often from cardiovascular comorbidities and were older. In contrast NOAF patients were sicker and had worse clotting profiles and kidney function. Our results indicate that patients with PEAF differ with regard to organ function and co-morbidities.

Consequences for treatment remain unclear at this stage. Introduction: The purpose of the study was to evaluate whether a restrictive strategy regarding dobutamine use was non-inferior to a liberal strategy in patients undergoing cardiac surgery. Methods: Clinical trial, randomised, unicentric, controlled, parallel-group, non-inferiority trial. Patients were randomly assigned preoperatively to two distinct dobutamine strategies: a liberal strategy, in which all patients would receive dobutamine after weaning from CPB; or a restrictive strategy, in which the use of dobutamine after CPB weaning would be guided by hemodynamic evidence of low cardiac output.

The primary outcome was composite endpoint of arrhythmias ventricular or supraventricular tachyarrhythmias , acute myocardial infarction, stroke, and death from all causes within 30 days after cardiac surgery. Results: A total of patients were included in the final analysis; 80 assigned to the restrictive strategy and 80 to the liberal strategy. The use of dobutamine was lower in the restrictive group

FOOTBALL BETTING TIPS AND PREDICTIONS

I boldly removed a bunch of different "example programs" which calculated the Collatz conjecture. I feel that the pseudocode is more than sufficient to demonstrate the solution, and it seemed that the examples were not adding anything to the article. This is not an article to discuss the difference between various languages, it is to discuss the Collatz conjecture, and having a bunch of different languages only serves to distract the reader.

Implementing the calculation in a bunch of different languages is very much on topic on Rosetta Code , so I've copied the programs to a page for the Collatz conjecture there. I notice that since the removal, Perhaps a link to the programs on Rosetta Code would be a good compromise? Actually, the series can not converge to 1. Mad props to whomever snuck this in as a rational example!

Metao talk , 5 March UTC. If you do positive integers with this version i. This proves that the conjecture by Collatz is true. Can anyone verify this? A formula, from which he derived the argument for impossibility of a loop was wrong, so this whole approach was insufficient to disprove the possibility of a cycle. Steiner's m-cycle-theorem needs verification by some tag: " fact " I've found the msg in sci. Don't know how to supply that link in the article. There is a reference to this confusing mess in the popular webcomic XKCD.

Someone should make a section in the article detailing all such references that pop up in culture. No, somebody shouldn't make a pop culture section. In Pop Culture sections are lame and contribute nothing to the article. If you think you need to make a pop culture section, you're completely missing the point of that comic. You just want an excuse to put the xkcd strip on this article. There is no reason to add a "references in pop culture" section just for that.

Xkcd fans are already a plague that attempts to include a strip in every Wikipedia page. Flintmecha talk , 12 March UTC. I don't consider it as such because it does not contain an odd number. Furthermore, that notation [7] 18 seems worthless to me, i. Simply knowing how many evens there are isn't good enough, you need to know the distribution of the evens.

For instance, there are a lot of ways to partition 11 evens amongst 7 odds, but only [1, 1, 1, 2, 1, 1, 4] or one of its cyclic permutations will give you a loop cycle. Of course, you would need to know how to exploit the distribution to learn anything, but that's easily doable.

Note that [1, 1, 1, 2, 1, 1, 4] has 7 numbers that sum to One can do calculations similar to the Parity Vector this notation is just a compact version with the restriction that the sequence must begin with an odd number. And once we have the resulting function, we can determine whether the partition is a loop cycle without needing to evaluate the sequence.

Can't do that with [7] I would like to change that to make it useful. Any support? These edits are invalid. Although true that "there is a finite number of integers with infinite divergent trajectories", the finite numer has to be 0. Necessary But Not Sufficient. Likewise, for "there is a finite number of integers with cyclic trajectories", it is only sufficient if that finite number is EXACTLY 1.

The article by M. Bruschi is short, doesn't really add much, and is self-published on Xarchive, not reviewed and published in a journal. This paper is bogus. The statement "our main assumption here is that, at each play, the Syracuse gambler has equal chances of winning or losing a bet," is outright false. Even numbers do indeed always follow odds, but NOT with equal probability.

Even numbers follow the odd integers in a Negative Binomial Geometric distibution so the mean number of consecutive evens wiil be the inverse of the probability, therefore, the mean count of consecutive evens will be 2, and thus, not equal to the odds. There is no point continuing any further since all subsequent calculations are based on a fallacy. Links should be deleted. The last section is about the Syracuse function, but provides no explanation of context.

According to the link, it will, if I read the inline linked source correctly, produce the number or iterations taken for odd number N. Maybe we should explain that, and possibly state how many iterations it must go out to before it becomes efficient to take N mod 2 of every number. Oh, and am I going blind, or does it contain the Mandelbrot set? Do all fractals do that, or is it worth noting?

Why omit the even numbers and have lots of blurb explaining it? It strikes me that for the few numbers required, a simple list is easier to understand and doesn't really take up much space. I offer the section as an example below.

An obvious extension is to include all integers, not just positive integers. Interestingly, there are in this case a total of 5 known cycles, which all integers seem to eventually fall into under iteration of f. These cycles are listed here, starting with the well-known cycle for positive n.

Odd values are listed in bold. Each cycle is listed with its member of least absolute value first - which value is always odd. We follow each cycle with …, its [odd value cycle length] in square brackets and its full cycle length in parentheses. The Generalized Collatz Conjecture is the assertion that every integer, under iteration by f , eventually falls into one of these five cycles.

This section will be for any "proofs" added or argued for being in the article. If the proposal doesn't exist in academia, the discussion may be better sent to the mathematics Reference Desk. In the past we had a published proof in the article which I reverted because the magasine wasn't a proper scientific magasine on the area.

From Wikipedia:Verifiability Exceptional claims require exceptional sources:. So any attempted proof has to be immediately removed until the scientific society accepts it. This is an encyclopedia, not the news nor place to upload original research.

Can someone give a reference where to find more information about the syracuse function? I would be especially interested in a proof of the last statement. We should mention that there is a distributed computing project focused on this conejcture. What does seem to be true is that the difference is always a multiple of 3.

Ok thanks. Anyway, I'm not so sure it really speeds things up, because it trades small-integer operations for bigger ones. At the top of the article, there is an image of a directed graph. I believe this graph is a tree and can be rendered without any intersecting lines, yet the image has many edges that cross each other. Does this serve any special purpose, or is is just suboptimal or even slightly wrong? This is clearly wrong, since:. This invalidates a later point in the proof sketch.

Noldorin talk , 26 January UTC. Ah, fair enough. That should probably be stated explicitly, since it's not 'self-evident'. Noldorin talk , 29 January UTC. I don't see where the article explains why you need to triple the odd numbers before you add or at least give an example of a number that HAS to be tripled to make it work.

The article gives examples using 11 and 27, but both of those numbers can lead to 1 by performing the series without tripling the odd numbers. Aristophanes68 talk , 28 January UTC. If Collatz is indeed the name of the conjecture and not the name of the series - as the opening para states, then why redact a series of changes aimed at making the page more consistent? I'll reinstate the edits if there is no reply in a day or so from the redactor.

I've re-instated my edits. I guess the wiki page on the conjecture is going to be in need of a major overhaul pretty soon. It might be useful, I belive, to say something more about how this equivalence is obtained. The first sentence of the article contains the claim that Collatz formulated the conjecture in , but there is no citation.

This claim was added, together with a link to MathWorld which has an identical unsupported claim on 7 September The Mathematical Gazette paper by Brian Thwaites does contain a claim of priority dating to , and none of the other historical papers cited in this article contradict that claim.

If there is no evidence that Collatz actually originated this conjecture, perhaps it would be safest to follow Lagarias, and say that the origin of this precise conjecture is not completely settled. I was disappointed that there is currently no discussion of Kurtz and Simon's generalization besides the short paragraph in the lede that they used "a generalization" and that generalization is undecidable.

This is wrong, since it is always possible to multiply the number by two in the reverse Collatz process. I changed it into:. I don't know if this is the best way to write the reverse function. Maybe someone knows a better way to write it or explain it. Just FYI for the curious. Where can I find some info about this approach?

But with specifics values,we found, you will always reach 1. It's false you repeat the process until you get specific valuesThe number of repeat give you the size. It 's trivial to get the complementary size from this point to 1. An addition give you the total size. Tanks for your necesary critics — Preceding unsigned comment added by Can someone post the final draft? This is important information that should be included here as it shows that, for example, Let x be an integer.

Here is a trivial function in one part rather than two to calculate the next integer in the series, I am not sure where to add it to the article though. Just looking at the conjecture, but seeing it as an information processing instead of a mathematical problem I'm a programmer not a mathematician , several things seem kind-of evident.

First, though "oneness" is very popular in maths, it seems to be something of noise in the conjecture. Likewise to reach two 2 you must first reach four 4 , so how about "fourness"? To reach four 4 you must first reach eight 8 , so "eightness? Indeed the first point of covariance is reaching the value sixteen 16 which can be guessed, reached from thirty-two 32 or reached from five 5. The entire devide by two term, and the reaching one requirement are just noise, present to complicate at one level and to "keep numbers reasonably representable and workably small".

Doing this "all mathy" I suspect the alternate rewrite would involve a whole number term to the natural log or some such. Again, not a mathematician, so I don't know how to write out the simplification in official math-talk. Sinerely Rob White. It always makes zeros. Playing with the visualizer reveals that there is no real magic to the three 3 or the two 2 , its all tied up with the multiply by odd when odd then coerce to even by adding one.

Some cases outside this are seemingl true as well. This is all tied up with evenness and the domination of evenness when you apply an evenness-corercing term to an odd number, and an even devisor to an even number, and the dominance of even terms occuring in the results. As long as the scaling term isn't too big for the consuming term, you converge on 1. Since the probability of a any number devided by two producing an even number is.

I know there is math-speak for this sort of probability series. Since all terms but the first diminish n, well throw the right magic statistical constant the golden ratio? That's what it's intended to let you visualize. But I think, it is not obviously.

How can one to prove this conjecture? And where is the source of this information? Considering that if parity is odd, then the next number will definitely be even. And in this case it will surely be halved next. And given this, the series will be convergent. Unless one assumes that for a random number the probability of odd parity is higher than of even.

Which is false, given the definition of a random number. Why is the trivial cycle represented as 1, 2 instead of 1, 4, 2? This graph: [2] is misleading. There are many dots that should appear above the 1,, mark but are truncated. In particular, initial numbers of and above can produce highest values greater than 1,, itself produces a maximum of 1,, This result should be described in the body of article, because 1 it is clearly important, 2 it is interesting, and 3 Wikipedia policy s doesn't support including major substantive facts in an introduction unless they appear in the body of the article as well.

In particular, it should be made clear whether the "natural generalization of the Collatz problem" investigated by Kurtz and Simon is the same as the "Generalized Collatz Conjecture" described later in the article. The essence of it appears to be that the conjecture can be reduced to a state deterministic finite state machine. There are only two loops, the loop and a "00" loop, both of which converge to 1.

This should be added to the main article under either the Theorems section or Finite State Machine section. Ascertaining endotoxin levels in the bloodstream is important in targeting patients and determining the appropriate timing for initiation of treatment. It has high sensitivity and specificity for endotoxin, and is considered to be useful in predicting clinical symptoms and determining prognosis.

The usefulness of the EAA has yet to be fully clarified. Methods: A total of patients admitted to the ICU between January and June with suspected sepsis or sepsis were enrolled. The EAA was conducted within 24 hr after admission. The transition of various markers was also examined. Introduction: Common complications following abdominal surgery are intestinal leaks, with subsequent abdominal sepsis. Early diagnosis is important to allow early intervention. The current clinical methods are insufficient for early detection.

We hypothesized that intraperitoneal microdialysis allows detection of peritonitis prior to changes in standard clinical parameters in a pig model. Methods: Bacterial peritonitis was induced in 5 pigs by bowel perforation and intraperitoneal fecal instillation, one pig underwent sham surgery. Intraperitoneal microdialysis catheters were placed in each abdominal quadrant. The observation time was 10 hours. Intraperitoneal glucose decreased significantly.

Hemodynamics were hardly influenced during the first two hours, and decreased thereafter. Sham surgery did not influence in any of the parameters. Conclusions: A rapid and pronounced increase in intraperitoneal lactate and decrease in intraperitoneal glucose was observed after instillation of intraabdominal feces. Systemic lactate increase was absent, and the hemodynamic response was delayed. Postoperative intraperitoneal microdialysis is applicable in detecting peritonitis earlier than standard clinical monitoring and should be evaluated in a clinical study in order to explore if early intervention based on MD data will reduce ICU length of stay, morbidity and mortality.

Introduction: Procalcitonin PCT is a highly sensitive and specific biomarker for bacterial infection. Results: patients for venous EDTA whole blood and 93 patients for capillary blood fingertip were included in this study. The concordance at the clinical cut-off 0. No significant bias was observed compared to the reference method.

Introduction: Procalcitonin PCT is a serum biomarker suggested by the Surviving Sepsis Campaign to aid in determination of the appropriate duration of therapy in septic patients. Trauma patients have a high prevalence of septic complications, often difficult to distinguish from inflammatory response. PCT values typically declined after 72h from trauma and increased only during secondary systemic bacterial infections. The aims of the study are to evaluate reliability and usefulness of PCT serum concentration in trauma.

Plasma PCT concentration was measured using an automate analyzer Modular E-Brahms on 1st day of antimicrobial therapy and every 48h hours. Antimicrobial therapy was stopped according to a local protocol; however medical judgment was considered the overriding point for therapeutic decision. Results: Median ISS of patients was PCT mean concentration at the starting of antimicrobial treatment was Daily course of PCT was not related to distance from trauma Rho In 21 of 40 patients Conclusions: Our experience suggests that PCT could help physician to optimize duration of antimicrobial therapy in trauma patients.

No standard approach can be recommended at present. Introduction: Long duration of antimicrobial treatment may predispose to colonization and subsequent infections by multidrug-resistant organisms MDRO and Clostridium difficile. Methods: Adult patients with sepsis by the Sepsis-3 classification and any of five infections pneumonia community-acquired; hospital- acquired or ventilator-associated; acute pyelonephritis; primary bacteremia are randomized to PCT-guided treatment or standard of care SOC treatment.

Patients are followed for six months. Serial stool samples are cultured for MDRO and screened for glutamate dehydrogenase antigen and toxins of C. Results: patients have been enrolled so far. Most common diagnoses are community-acquired pneumonia At baseline, Residency in health-care facilities was the only variable associated with C.

MDRO colonization was associated with residency in health-care facilities odds ratio 6. Introduction: Influenza causes deaths per year globally. It caused 80 deaths in the US in There are no blood-based diagnostics able to identify influenza infection and distinguish it from other infections. We have previously described a blood-based gene influenza meta-signature IMS score to differentiate influenza from bacterial and other viral respiratory infections.

Methods: We prospectively validated the IMS in a multi-site validation study by recruiting individuals patients with suspected influenza, 46 healthy controls in 10 community or hospital clinics across Australia. Conclusions: Collectively, our prospective multi-center validation of the IMS demonstrates its potential in diagnosis of influenza infections.

Introduction: Previous findings of our group suggest that patients with Gram-negative hospital-acquired severe sepsis have better prognosis when sepsis is developing after recent multiple trauma through stimulation of favorable interleukin IL responses [1].

Under a similar rationale, we investigated if preceding osteomyelitis may affect experimental osteomyelitis. Methods: Sham or experimental osteomyelitis was induced in 32 male New Zealand white rabbits after drilling a hole at the upper metaphysis of the left tibia and implementing diluent or 5log10 of Staphylococcus aureus using foreign body. After three weeks, the foreign body was removed and experimental pyelonephritis or sham surgery was induced after ligation of the right pelvo-ureteral junction and instillation of 6log10 of Escherichia coli in the renal pelvis.

Survival was recorded and circulating mononuclear cells were isolated and stimulated for the production of tumour necrosis factor-alpha TNFa and IL At death or sacrifice, tissue outgrowth and myeloperoxidase MPO were measured. Results: Four sham-operated rabbits S , 16 rabbits subject to sham surgery and then pyelonephritis SP and 12 rabbits subject to osteomyelitis and then pyelonephritis OP were studied. Survival after 14 days of group SP was Lab findings are shown in Figure 1.

Il production was blunted. Negative correlation between E. Conclusions: Preceding staphylococcal osteomyelitis provides survival benefit to subsequent experimental osteomyelitis through down-regulation of innate immune responses leading to efficient phagocytosis. Introduction: Activation of neutrophils is a mandatory step and a sensitive marker of a systemic inflammatory response syndrome SIRS which is closely related to development of multiple organ failure.

The search for drugs that can prevent SIRS and reduce mortality in critically ill patients remains significant. The aim of this study was to study the anti-inflammatory effect of the synthetic analogue of leu-enkephalin Dalargin on human neutrophils. Methods: The study was conducted on isolated from the blood of healthy donors neutrophils. The statistical significance was estimated using Mann-Whitney test. Results: Synthetic analogue of leu-enkephalin in various concentrations has an anti-inflammatory effect on both intact and pre-activated with bacterial components neutrophils, reducing their activation and degranulation in a dose-dependent manner Figs.

Conclusions: Synthetic analogue of leu-enkephalin prevents neutrophil activation by bacterial compounds. This has a potential of translation into clinical practice for sepsis treatment. Tissue hypoxia during the progression of sepsis is associated with microcirculatory and mitochondrial disturbances. Our aim was to investigate the possible influence of ETAr antagonist, ETBr agonist or combined treatments on oxygen dynamics, microcirculatory and mitochondrial respiration parameters in experimental sepsis.

Invasive hemodynamic monitoring and blood gas analyses were performed during a min observational window. Intestinal microcirculation perfusion rate, red blood cell velocity - RBCV was investigated by intravital videomicroscopy. Results: The septic reaction was characterized by significant hypotension and decreased microperfusion, oxygen extraction and CI - CII-linked OxPhos values. The ETBr agonist treatment prevented the sepsis-induced hypotension, decrease in oxygen extraction, and significantly increased the perfusion rate.

The combined therapy amplified the beneficial mitochondrial and microcirculation effects of selective ETAr antagonist and ETBr agonist compounds. Conclusions: The combination of ETAr antagonism and ETBr agonism may offer a novel tool for a simultaneous microcirculatory and mitochondrial resuscitation strategy in sepsis. Introduction: Sepsis often induces immunosuppression, which is associated with high mortality rates.

Nivolumab is a human IgG-4 antibody directed against the programmed cell death 1 PD-1 immune-checkpoint inhibitor, which disrupts PDmediated signaling and restores antitumor immunity. Nivolumab is an approved anti-cancer drug that may have the potential to improve sepsis-induced immunosuppression.

Results: Five and eight patients were assigned to the and mg groups, respectively. Lymphocyte counts and monocytic human leukocyte antigen DR-1 appeared to increase over time in both groups Figures 1 and 2. Adverse events AEs were observed in four patients in each group.

Drug related-AEs were observed in only one patient in the mg group Table 2. No deaths related to nivolumab occurred. Conclusions: A single dose of mg nivolumab appeared to be well tolerated and sufficient to maintain nivolumab blood concentration in patients with sepsis. Results suggest both and mg nivolumab therapy could improve relevant immune indices.

Introduction: The systemic inflammatory response syndrome SIRS accompanies tissue trauma and infection and, when severe or dysregulated, contributes to multiple organ failure and critical illness. Observational studies in man and animal have shown that low-dose acetyl-salicylic acid promotes resolution of inflammation and might attenuate excessive inflammation by increasing the synthesis of specialised pro-resolving lipid mediators SPMs.

Methods: We randomly assigned patients with SIRS who were expected to stay in ICU for more than 48 hours to receive enteral aspirin mg per day or placebo for 7 days or until death or discharge from the ICU, whichever came first. The primary outcome was IL-6 serum concentration at 48h after randomisation.

The secondary outcomes included safety and feasibility outcomes. There were no significant differences for control vs. There were no between-group differences with respect to ICU or hospital mortality, number of bleeding episodes or requirements for red cell transfusions Table 2. Conclusions: In patients admitted to the ICU with SIRS, low-dose aspirin did not result in a decreased concentration of inflammatory biomarkers compared with placebo.

Introduction: Debilitating muscle weakness and impaired muscle regeneration is prevalent in ICU patients. Remarkably, premorbid obesity has been shown to protect against this weakness in both ICU patients and septic mice, which coincided with markers of elevated ketogenesis [1]. We here assessed whether ketone body supplementation could directly protect the muscle during sepsis. Methods: In a resuscitated, antibiotic-treated mouse model of prolonged 5 days abdominal sepsis cecal ligation and puncture , lean ill mice received standard parenteral nutrition 5.

Markers of muscle weakness and regeneration were assessed. These data identify nutritional 3HB supplementation as a potential preventive therapy for muscle weakness, requiring further investigation. Vitamin C is a cellular antioxidant, it increases eNOS and decreases NF-kB; it has several immune-enhancing effects and is crucial for endogenous vasopressors synthesis.

Vitamin C reserves in sepsis are often as poor as in scurvy [1]. In recent studies, intravenous high Vitamin C dose seems to reduce organ failure and improve outcome in septic shock. We enrolled 24 patients: 13 received Vitamins supplementation, 11 standard of care. Patients with end stage kidney disease were ruled out. We analysed data with Mann-Whitney and Wilcoxon tests.

Mean vasoactive therapy length was quite similar. DAF was No Vit C patient developed oxalate nephropathy nor worsened renal function. Introduction: In the light of new insight on pathogenesis of sepsis and after inconclusive randomized clinical trials RCTs , the benefit of macrolides as adjunctive, low-cost and promising molecules in sepsis, remains to be assessed. Patients are blindly randomized to receive either 1gr of intravenous clarithromycin or placebo once daily for four consecutive days.

The primary endpoint is survival at 28 days. The study is powered for patients. Results: Sixty-nine patients have been enrolled so far. SOFA score on enrollment is Introduction: Toxin-producing gram-positive organisms cause some of the most severe forms of septic shock [1,2].

Adjunctive therapies such as intravenous immunoglobulins IVIG have been proposed for these patients [3,4]. However, at patient presentation, the presence of a toxin-producing organism is most often unknown. IVIG use in these patients was generally safe, with only 1 possible transfusion reaction. Conclusions: IVIG administration can be considered in a selected group of patients presenting with acute and very severe septic shock, as part of a multimodal approach [5].

Introduction: Extra corporeal treatments are used in septic patients to decrease the inflammatory mediators, but definitive conclusions are lacking. The aim of this study is to evaluate in septic patients with AKI: 1- the effect of the adsorbing membrane Oxiris on the immunological response 2- the different response in survivors and non survivors.

Student T test or Mann- Whitney was used to compare values changes. At Table 1 are shown the main results of this study in all the patients. This must be confirmed in a RCT. Introduction: Sepsis is common and often fatal, representing a major public health problem. Hemoadsorption CytoSorb therapy aims to reduce cytokines and stabilise the overall immune response in septic shock patients. All centres followed a common protocol and received ethics committee approval.

Results: A total of 45 patients were administered CytoSorb in addition to standard of care. Also there was reduction in inflammatory markers like Cytokines IL6 in most of the patients. All patients in survivor group showed a significant improvement in MAP No device related adverse effect was observed in any of the patients. Conclusions: In this multi-centered prospective IIS study, we could observe clinical benefits of Hemoadsorption CytoSorb therapy in Septic shock patients if the therapy was initiated early.

Larger randomised study are required to establish the above clinical benefits in larger patient population. Introduction: Sepsis and the multiorgan failure is a leading cause of mortality in the intensive care unit. Promising new therapies continue to be investigated for the management of septic shock. We used it as an adjuvant therapy in our patients with Sepsis due to varied causes. Institutional ethics committee approval was taken before initiating the study.

Results: A total of patients 77 Male and 23 Females with a mean age of A total of 40 patients survived out of patients. All the survivors showed a significant improvement in MAP Conclusions: Retrospective analysis showed significant reduction of vasopressors, Sepsis Score and improvement in MAP in survived group versus non-survived group.

Looking into the positive outcome of this case series, randomized controlled studies are required to define the potential benefits of this new treatment option. Introduction: Septic shock is a life-threatening multiple organ dysfunction that has high morbidity and mortality in critically ill patients, due to a dysregulated host response to infection.

Treatment was combined with ECMO in 8 patients. Procalcitonin Conclusions: Therapeutic cytokine removal applied with CVVHDF in septic shock patients have positive contributions to biochemical parameters and provide survival advantage. Introduction: Recent studies have focused on demonstrating the potential benefits of immunomodulation in the management of septic patients.

Methods: After ethical approval was obtained, we prospectively included 39 patients admitted to the general ICU of Fundeni Clinical Institute. Clinical heart rate, arterial pressure, temperature, Glasgow coma scale and paraclinical data PaO2, serum bilirubin and creatinine, platelet count, white blood cell count, pH, C-reactive protein and procalcitonine , vasopressor support and need for mechanical ventilation were recorded before and after the three sessions.

Mean SOFA score decreased non-significantly from Conclusions: The use of CytoSorb was associated with a slight non-significant improvement in organ function and a decrease of procalcitonine levels. Thrombocytopenia remains one of the most important complications of renal replacement therapy. Introduction: Circulating cell-free neutrophil extracellular traps NETs would induce a microcirculatory disturbance of sepsis. To address this issue, we evaluated the effect of hemoperfusion with a polymyxin B cartridge PMX-DHP; Toray, Japan , which was originally developed for the treatment in patients with Gram-negative bacterial infection, on circulating cell-free NETs in patients with septic shock and in phorbol myristate acetate PMA -stimulated neutrophils obtained from healthy volunteer.

Methods: Ex vivo closed loop hemoperfusion was performed through a circuit formed by connecting the small PMX module to a tube and a peristalsis pump. Whole blood from healthy volunteers incubated with or without PMA or from septic shock patients were applied to circuit and perfused. Blood was collected at 0, 1 and 2 hr after perfusion. Selective removal of circulating components of NETs may improve the remote organ damage in patients with septic shock.

Each values were also compared to EAA levels. EAA levels were significantly increased in gram-negative bacteremia patients compared to the patients with gram-positive bacteremia or fungemia. Introduction: Numerous inconclusive randomized clinical trials RCTs in sepsis in the past years suggest a need to re-think trial design to improve resource allocation and facilitate policy adoption decisions.

We aim to compare the original one-shot trial with an alternative sequential design that balances trial costs and value of information. Methods: Adult patients with sepsis, respiratory failure and total SOFA score of at least 7, are randomized to receive intravenous clarithromycin or placebo adjunctive to standard-of-care therapy.

Fixed and variable costs of trial execution including administrative, insurance, supplies, tests are calculated; hospitalization cost is extracted from patient records; medical care beyond day 28 is recorded; cost of adoption in the general population is estimated. Known incidence of sepsis with respiratory failure allows estimation of the population to benefit from trial decision. A Bayesian model is used to determine the sequential design that maximizes trial value.

Results: We will compare the performance of the sequential trial design with the one-shot design of INCLASS trial in terms of sample size, cost, social-welfare, and probability of correctly identifying the best treatment.

Conclusions: In this protocol we validate a Bayesian model for sequential clinical trials and assess the benefits for the patient population and health care system. Introduction: CytoSorb-Adsorption has been described as an effective way for hemodynamic stabilisation in septic shock [1].

Aim of this study was to examine whether the adsorption-therapy could influence patient-outcome with catecholamine resistant septic shock CRSS and acute renal failure ARV. Furhtermore we tried to identify clinical constellations that would predict an effective use of adsorbers. The efficacy was assesed by means of laboratory tests, catecholamine dependency and outcome. Calculations were done with non-parametric-tests depicted as median values [Q25, Q75].

Length of intensive care unit stay LOS did differ significantly 13 days [4,24] vs 22 days [19,29]. Conclusions: IL-6 can be reduced with adsorption. Patients with catecholamine-reduction did not differ in regard to their initial IL LOS was shorter for patients treated with adsorption.

According to our experience adsorption can be taken into consideration when CRSS is beginning. The aim of this study was to determine the adequate starting period of expanded application to the contact precautions in the scheduled surgical patients in the mixed ICU. Methods: We performed retrospective observational study on patients who were admitted to our ICU after planed surgery from May to Dec. We detected the patients who acquired BD newly and investigated the relation to the length of ICU stay.

Finally, we made the logistic regression model of each cutoff day day1 to 7 and compared Odds Ratio OR and AUC of each models using stata. Results: Category day 2 or more, especially day 4 or more had significantly higher detection rate of DB compared to day 1 Table 1. Similar results were observed in OR according to logistic regression. According to each cutoff day models of logistic regression, the day 4 model had the highest OR Introduction: The objective of this study was to evaluate the incidence density of urinary tract infection associated with bladder catheter in neurological intensive care unit and identification of actions that were related to low prevalence.

Methods: A retrospective analysis of the hospitalized patients from December to January was carried out, considering the patients who used the bladder catheter and the cases of urinary tract infection, correlating with improvement actions implemented in the period. Results: In the analyzed period, patients were hospitalized in the unit, with mean age of Of these, 27 had a urinary tract infection, which represented 1. During the analyzed period, urological physiotherapy was monitored, daily check of the urinary tract infection prevention bundle, analysis of all cases of infection with search of barriers breaking through Ishikawa methodology, feedback to the multiprofessional team of indicators related to the presence of invasive device, monthly monitoring of the mean time of bladder catheter with established goals.

Conclusions: It is possible to guarantee low prevalence of urinary tract infection, in a complex profile of patients, through a multiprofessional approach, accompanied by structured management of data analysis and monitoring. Introduction: Surgical site infection SSI is a risk in every operation wound, as it negatively impacts patient morbidity and mortality, and also increases financial demands, such as prolonged hospital stay, further antibiotics and surgical procedures.

The aim of this study was to analyse SSI and its risk factors after thoracic and lumbar surgery. Methods: A six-year monocentric observation prospective cohort study monitored the incidence of SSI, wound complications and further risk factors in consecutive patients after planned thoracic and lumbar surgery for degenerative disease, trauma and tumour. All patients received short antibiotic prophylaxis before and during long operations. All wound complications and SSI were monitored up to 30 days and 1 year after operations.

We searched for risk factors for SSI in multivariate logistic regression analysis. Results: We recorded 22 incidences of SSI 8. Predictor of SSI in multivariate logistic regression analysis was hospital wound complications OR Conclusions: Contrary to the prevailing literature, our study did not identify corticoids, diabetes mellitus or transfusions as risk factors for the development of SSI, but only wound complications and warm seasons.

There are different education measures written material with reminders, continuous feedback, interventions involving novel equipment on performance of hand hygiene. In the present study, we assessed the impact of immediate verbal feedback on performance of hand hygiene by health care workers using a new Continuous Closed-circuit Television Monitoring CCTV method and direct, overt analog observation method.

Methods: This is an interventional study. We conducted overt — direct observations and covert - CCTV observational sessions to measure hand hygiene compliance before and after interventional measures of health care workers HCWs in our ICU. As interventional measures, we used personal verbal immediate feedback at the end of the overt observational session, performed by infection control nurse. Results: Overall, opportunities to perform hand hygiene. We believe that it needs additional scrutiny and combining additional intervention strategies to improve hand hygiene compliance.

Introduction: Cytomegalovirus CMV has been recognized as an important pathogen in immunocompromised individuals for as long time. In recent years, some studies have focused on CMV infection among immunocompetent intensive care patients. The results are inconsistent and the impact of this virus on the prognosis of these patients is not solved. Our purpose were to determine the prevalence, the risk factors and the consequence of CMV infection in immunocompetent intensive care unit patients.

Methods: Observational retrospective case-control study comparing two groups of intensive care patients: CMV-positive and CMV-negative. Patients suspected of developing CMV infection were included. CMV impact on prognosis was judged by the complications developed and mortality. Another comparison among infected patients between the deceased and the living was carried out in order to determine CMV morbidity and mortality factors.

No significant differences in age, sex, comorbidities, severity, ventilation, use of amines and corticosteroids were found. CMV was not associated with significant morbidity and mortality. Conclusions: CMV infection is common in immunocompetent intensive care patients.

Transfusion history is a risk factor of infection. CMV is a marker of the severity of the underlying disease of patients rather than a cause of morbidity and mortality. Introduction: Necrotizing soft tissue infections NSTI are characterised by extensive tissue necrosis, triggering an overwhelming inflammatory response like sepsis or septic shock [1].

The mortality rate is high and the search for predicting factors has brought conflicting results. We hypothesized that inflammation parameters and organ dysfunctions in the first 24h may correlate with mortality on the intensive care unit ICU. Methods: We analysed retrospectively electronic data from patients who were admitted to our University Hospital during For the statistical analysis we used SPSS, version Results: 59 patients with NSTI were admitted during the study period.

There were 41 males Plotting a receiver operator characteristic curve for the SOFA score against mortality, we obtained an area under the curve of 0. Both kidney and liver dysfunction were significantly linked to a higher risk of mortality.

An association of four or more organ dysfunctions increased the risk of death by a factor of 8. Conclusions: SOFA score and presence of liver or kidney dysfunction respectively in the first 24h correlated well with an increased risk of death. The different inflammatory markers showed no predicting value towards the risk of mortality. Introduction: Ventilator-associated pneumonia VAP is one of the leading infection in critically ill patients. The study was approved by the Ethics Committee of our institution.

Patients next of kin provided written informed consent. Introduction: Immunological dysfunction is common in critically ill patients but the optimal method to measure it and its clinical significance are unknown. Methods: A secondary analysis of a phase 2 randomized, multi-centre, double-blinded placebo controlled trial [1].

There were no differences in allocation groups; all the patients were analyzed as one cohort. The primary outcome was the development of NIs; secondary outcomes included day mortality. Results: Data was available for patients. Baseline characteristics and outcomes are reported in Tables 1 and 2.

Both comparisons showed no difference between NIs and clinical outcomes between tertiles. Conclusions: Admission ex-vivo stimulated TNF-a level is not associated with the occurrence of NIs or clinical outcomes. Further study is required to evaluate the ability of this assay to quantify immune function over the course of critical illness.

Introduction: We believe traditional ventilator associated pneumonia VAP is limited by its complexity, subjectivity and marginal attributable mortality. It generates debate but not a matrix. Methods: Inclusion Criteria: All patients intubated for at least 48 hours. Exclusion Criteria: All elective post-cardiac surgery.

Follow Up: Extubation or death. Results: A total of patients were enrolled between 3rd September to 20th October in The major reason for this reduction is decrease in percentage of ventilated patients 45 vs 40 as well as slight reduction in length of stay on ventilator 3 vs 2. Introduction: There is limited information about sepsis in very old patients hospitalized with community-acquired pneumonia CAP.

Methods: We conducted a retrospective study using data that were prospectively collected at the Hospital Clinic of Barcelona. We aimed to investigate the prevalence, etiology, risk factors and clinical outcomes of this population, comparing patients with and without sepsis defined according to SEPSIS-3 criteria. Written informed consent was waived because of the non-interventional study design. There was no significant difference in the distribution of pathogens in patients with and without sepsis Figure 1.

Male sex OR 1. One-year mortality was higher in very old patients with sepsis compared with those without sepsis Table 1. A propensity-adjusted multivariable analysis showed that risk factors for day mortality in septic patients were chronic renal disease OR 2. Conclusions: In very old patients hospitalized with CAP, antibiotic therapy before admission was associated with a decreased risk of sepsis, whereas diabetes mellitus was associated with a decreased risk of day mortality.

Introduction: Legionella species may cause life-threatening pneumonia and thus need early treatment. Differentiating Legionella pneumoniae LP from other types of pneumonia including Mycoplasma pneumoniae MP , Steptococcus pneumoniae SP and viral types of community-acquired pneumonia CAP has important implications regarding antibiotic therapy. Current testing options for LP infection have limited sensitivity leading to time delays in treatment and to usage of empirical broad-spectrum antibiotics.

Recently, a Legionella Scoring system based on six parameters has been proposed. We aimed to independently validate this score and investigate whether additional clinical and laboratory parameters would further improve its accuracy. Methods: We analyzed patients hospitalized in a tertiary care hospital between and with CAP and a defined etiology.

Association and discrimination were assessed using logistic regression analysis and area under the receiver operator characteristic curve ROC AUC. Results were similar for subgroups based on each of the different CAP types. Additionally, we found that a history of nausea further improves the diagnostic accuracy of the legionella score to an AUC of 0. Conclusions: In patients hospitalized with CAP, a high Legionella score on admission strongly predicts LP infection and thereby can optimize the empiric antibiotic management.

A clinical history of nausea further improves diagnosis. Systematic use of this scoring system in conjunction with other diagnostic tests may improve the diagnostic and therapeutic management of patients presenting with CAP. Introduction: Acinetobacter baumannii AcB remains one of the most prevalent ventilator-associate pneumonia VAP causing pathogen. In recent years, share of drug resistant AcB strains across Europe was found to be steadily increasing.

Consequently, in , AcB was included in the WHO global priority list of drug-resistant bacteria to highlight the need for the research development. The aim of this study was to identify the relation of risk factors for ventilator-associated pneumonia VAP and mortality with drug resistance profiles of AcB. Methods: A retrospective cohort study of patients treated in medical-surgical ICUs with drug-resistant strains of AcB as pathogens of VAPover a 2-year period was carried out.

The overall in-hospital mortality rate was Thus, timely mechanical ventilation and ICU treatment may reduce the risk of VAP due to higher drug-resistant AcB, especially in more severely ill patients. Introduction: sepsis following traumatic and surgical intervention increases morbidity, mortality, cost and length of patient stay in hospital. The aim of this study was to identify the major pathogens associated with wounds infection and to review their antimicrobial reactions. Methods: A 5-year review of nosocomial wound infection and colonization in patients admitted to the intensive care unit of tertiary care Hospital southern region of Saudi Arabia from Jan.

Patients of all ages and gender who required ICU attention at some point and defined as nosocomial infection using standard CDC criteria and presented with various degrees of wound and bed sore infections were included in the study.

Results: There were episodes of wound and episodes of bedsore infections. The most common organisms Klebsiella pneumoniae The percentage sensitivity of the organisms to the 51 antimicrobial agents was Conclusions: Data from this and other studies supports the hypothesis that high incidence of gram negative bacilli This requires strong infection control actions to enhance patient care.

We aimed to assess the predictive performance of these risk factors. Adult patients with no severe immunosuppression and a diagnosis of hospital-acquired pneumonia and ventilator-associated pneumonia with confirmed microbiology were enrolled.

Patients or their next of kin provided written informed consent. Introduction: Growing antimicrobial resistance among Gram-negative rod GNR strains is a worldwide issue. Flora monitoring is associated with right first choice of antimicrobial treatment. Among Acinetobacter spp. In multi-variate analysis lethal outcome Conclusions: 7yrs study revealed Acinetobacter spp.

High sensitivity of GNR to carbapenems was found. Introduction: Of great concern is the dissemination in health care environments of multi-drug resistant MDR bacteria, especially Klebsiella pneumoniae carbapenemase KPC -producing enterobactereaceae. Methods: Our objective is to identify the differences in risk factors and outcomes between patients who did and did not acquire KPC- producing bacteria during their stay in the ICU of an university hospital in Rio de Janeiro, Brazil.

We designed a nested case — control study of a retrospective cohort from May to June Three hundred and thirty nine patients were admitted to the ICU. The two groups were compared according to demographic clinical and microbiological data.

Results: There was no significant differences in gender, age, severity scores between the two groups. Patients with KPC- producing bacteria had longer ICU and hospital stays than control patients and they required more life-support such as mechanical ventilation, vasopressor use and dialysis. In hospital mortality rate was higher in KPC- producing bacteria group A multivariate analysis showed that mechanical ventilation OR: 2.

Factors associated with in-hospital mortality were: male gender, OR: 3. Conclusions: Colonization was associated with longer ICU and hospital LOS, more requirements of life-support and higher in-hospital mortality rate. Previous antibiotic use and mechanical ventilation were the most important risk factors for patients becoming colonized. Factors associated with mortality were male gender, Charlson score and mechanical ventilation.

Ecological arguments, on the other hand, provide rationale to limit carbapenem use as much as possible. Clinical cure was defined as stop of antibiotics together with resolution of clinical signs of infection. However, no clear relationship between the use of carbapenem versus non-carbapenem antibiotics and clinical cure was found.

Introduction: B. We described the causes of B. Methods: 11 adult patients median age 53 years, 2 males, 9 with permanent vascular access receiving chemotherapy with B. Results: Sanitary and epidemiological examination revealed the connection between infection and intravenous infusion of dexamethasone performed concurrently with chemotherapy. In 5 patients fever with chills and hypertension developed within 2 hours after infusion of the infected drug; empirical intravenous antibiotic therapy started immediately after collecting blood culture.

In 6 patients fever appeared after days outpatiently, so they received antibiotics per os. All these patients had permanent vascular access, and BSI was detected either the next chemotherapy course when fever reappeared 3 pts while using vascular access, or as a result of a specific examination 3 pts. In all cases empirical antibiotic therapy started on the first day of fever, drug correction was performed in 6 patients according to results of bacteriological research.

Septic shock developed in 1 patient, pneumonia in 3 patients. Permanent vascular access was preserved only in 1 case. All patients were cured and continued to receive antitumor treatment. Conclusions: Detection of more than 1 case of B. A favorable outcome of BSI treatment is associated with the early start of antibiotic therapy and its correction after microbiological examination.

Introduction: Shewanella species are emerging opportunistic pathogens that can cause severe soft-tissue, respiratory, hepatobiliary, gastrointestinal infections, and bacteraemia. Most of the published information for this organism are limited to isolated case reports and small case series.

Here we report the largest case series of infections caused by Shewanella species. Methods: Patients admitted to a regional hospital in Hong Kong with Shewanella species infection from 1st Apr, to 30th Sep, were included. Demographics, antibiotics, microbiology and outcomes were retrospectively analyzed. Results: In an 8. Their median age was 76 IQR Seven patients 9. Conclusions: This large case series suggested that Shewanella infections are commonly associated with underlying comorbidities, especially with malignancy.

Antibiotic resistant isolates are uncommon. Introduction: Despite improvements in early treatment, survival following burn injury remains challenged by sepsis and emergence of Multidrug-Resistant Bacteria MRB. The objective of our study was to assess epidemiological aspects and bacterial resistance patterns of bacteria isolated from intensive burn care unit and to identify risk factors. Methods: A prospective, monocentric study was conducted from May to September in a burn unit in Tunisia.

Results: During the study period, 31 patients were included. The mean age was 35 years. They were 17 men and 14 women. Carbapenemase-encoding genes were detected in 22 patients: 12 at admission and 10 at the first week post admission. Univariate analysis identified risk factors associated with acquiring ESBLs and CPE were: secondary transfert; indwelling device, antibiotic use of aminosids and amox-clavulanic acid and non-compliance with hygiene measures.

So, detection and isolation of these patients and strengthen infection control measures allows us to improve therapeutic efficacy and improves their prognosis. Despite various researches have been done regarding hospital acquired infections, developing repeated attack still needs further investigation.

This research tries to magnify the threats and suggest a way forward. Infection diagnosis was made based on Centers for Disease Control criteria. Multivariate analysis was used. Results: A total of ninety-four patients were admitted to ICU. Those of who stayed more than two weeks develop repeated attack at a rate of All Patients were having indwelling device. Duration of ICU stay and indwelling device use had positive association with a strong Pearson correlation of 1.

Drug sensitivity test revealed around Conclusions: Despite the low rate of repeated infection, multi-drug resistance pattern is high. The research reveals the need for proper antibiotic stewardship and application of standard infection control measures in ICUs. Introduction: Conflicting results have been found regarding impact of the antibiotic stewardship program ASP on pathogens resistance and clinical outcomes of intensive care unit ICU -acquired bacteremia.

Methods: Prospective interventional single-center study in the period Jan to Dec Intervention onset: The intervention: ASP, including multidisciplinary team building, antimicrobial therapy and prophylaxis protocols, infection control measures, education, internal audit. The data from pre-intervention and intervention periods reports were compared. Results: blood samples were analyzed, Changes of the pathogens, causing ICU-acquired bacteremia are presented in the Table 1.

All consecutive infectious episodes with positive culture for GNB and treated with antibiotic therapy within 24 hours of sample collection were included. All analysis were done after adjusting for disease severity. Results: Of eligible ICU patients Risk-adjusted analysis showed higher odds of mortality for MDR infected patients compared to non-MDR group but this was not statistically significant OR 1.

It is worrying to note emergence of resistance to last line of defence against MDR gram negative infections in regions endemic to Carbapenem resistance. Methods: Retrospective analysis of all patients with Carbapenem resistant Klebsiella pneumoniae blood stream infection BSI was done between January and December Microbiological and clinical variables along with outcomes were analysed.

Aggressive infection control measures were undertaken with successful containment of CR-KP strains along with reduction in overall BSI. Conclusions: Infection control measures form the backbone of patient care in centres showing endemicity for Carbapenem resistant Klebsiella to prevent Colistin resistance and also to reduce occurrence of overall blood stream infections. Introduction: Sepsis due to carbapenem resistant organisms has high mortality; inappropriate empirical antibiotic is one of the main causes of this poor outcome.

So, early diagnosis of resistance pattern carbapenemase genes is crucial. Among positive blood cultures, samples were positive for carbapenemase genes. There was only one false negative diagnosis for carbapenem resistance. Colonization with CPE seems to constitute a risk factor for mortality. The aim of our study was to identify associated risk factors and clinical outcomes among patients with fecal colonization by CPE admitted to a Portuguese tertiary hospital ICU.

Methods: A 2-year retrospective study was performed in patients with previous unknown CPE status colonization or infection , admitted to our ICU. Rectal swabs were performed and analyzed using real-time polymerase chain reaction testing. Clinical records were reviewed to obtain demographic and clinical data. Results: Of patients admitted, 38 4. The most frequent carbapenemase genes detected were KPC Nine patients developed CPE-related infections during ICU stay 4 pneumonia, 3 urinary tract infections, 1 peritonitis and 1 surgical wound infection.

CPE colonization was associated with an increased length of stay Conclusions: Hospitalization was the most important risk factor for CPE colonization. There seems to be a slightly higher in-hospital mortality rate, even though with no statistical significance. These infections are becoming difficult to treat with available treatment options due to growing antimicrobial resistance in India.

Ceftazidime-avibactam has in-vitro activity against Gram-negative organisms producing class A, class C and some class D beta-lactamases. In the RECLAIM study, Indian patients with a diagnosis of cIAI were enrolled in the study and were randomly assigned to receive either ceftazidime-avibactam mg of ceftazidime and mg of avibactam followed by metronidazole mg ; or meropenem mg.

As the Indian subset study was not statistically powered to detect a difference in the sub-group, we descriptively analysed the efficacy results in the Indian population and compared them with the overall results in the global trial. In addition, the study also analysed the safety of CAZ-AVI in the Indian patients by monitoring the number and severity of adverse events.

The efficacy results from the Indian subset analysis are summarized in Table 1. Overall, efficacy and safety outcomes were comparable with the global study. Although there are inherent limitations to this analysis due to the subgroup size, it provides information on clinical efficacy and safety relevant for the intended use of CAZ-AVI in Indian patients.

Introduction: Adequate utilization of vancomycin is essential for achieving therapeutic targets while avoiding clinical failure and development of antimicrobial resistance. Our aim is to determine whether there is a difference in vancomycin therapeutic blood level between surgical and medical patients in intensive care unit ICU post-therapeutic dose.

Electronic health records of patients admitted to ICU who have received vancomycin between and were reviewed. Descriptive analyses were conducted using number and percent. The Fisher exact test was used to compare outcomes across the different ICU services. Statistical analyses were performed using Statistical Analysis Software version 9. Statistical significance was set at a two-sided p-value of 0. Results: A total of 44 surgical ICU patients with mean age Sixteen out of 44 surgical patients Eight out of 44 surgical patients Twenty out of 44 surgical patients Conclusions: Our study showed that a higher percentage of surgical ICU patients have a sub-therapeutic level.

We also noted that a statistically significant higher percentage of medical ICU patients had a supra-therapeutic vancomycin trough levels. Further studies are needed to reach optimal dosage of vancomycin in surgical ICU patient. Our study aims to determine whether the doses of TZP used to treat obese critically ill patients in ICU allow reaching an effective concentration, at the early phase of sepsis 24 hours after initiation.

Data such as treatment modalities, sequential organ failure assessment score, renal clearance and albumin were collected. Four patients achieved the target of 4 MIC. The results are presented in Table 1. Several patients were treated using standard dosing or without loading dose. Continuous infusion was frequent. It may exist room for improvement in this setting. Considering the risks of underdosing or toxicity, it seems preferable to use therapeutic drug monitoring to adapt TZP dosing in this population.

Higher SOFA was associated with correct exposition, but doses used and renal function were different in these patients. Introduction: Early administration of effective intravenous antimicrobials is recommended for the management of the patients with sepsis. Although Meropenem MEPM is one of the first-line drugs in patients with sepsis because of its broad spectrum, the optimal dose in the critical care settings especially during continuous renal replacement therapy CRRT has not been established since therapeutic drug monitoring of MEPM has not been popular.

One gram of MEPM was administered over 1 hour, every 12 hours, and blood samples at 1, 2, 6, 9 and 12 hours after administration were collected on day 1, 2 and 5. Results: The patients were CRRT was provided at The peak concentration of the first administration of MEPM was In patients with ARC, dose escalation may be appropriate to avoid sub-therapeutic plasma concentration of many drugs. Methods: We conducted a single centre retrospective cohort study between - Daily CrCl was recorded.

The prevalence of ARC was determined, and multiple logistic regression was used to identify risk factors for developing ARC.

Точно bovada live betting football tips Вами

Learn More. Chain Saws. Cleaning Tools. Combo Kits. Hedge Trimmers. Pressure Washers. Snow Blowers. Metalworking Tools. Plumbing Tools. Tile Tools. Woodworking Tools. Featured Products. We all support shaped recipe, craft recipe and furnace recipe. Feel free to craft everything with your unlimited ideas. What if we kill an enderman then it drop 99 diamonds and 99 zombies upon death?

Is that COOL?? Remember we only accept these size x, x64, 64x64, 64x32, 32x32, 16x16 - Weapons particle and effects. Swords can burn with flame and armors can help you gain invisibility and many more. Lucky block script already implemented. Auto add custom items in both Creative and Survival mode. With this app there is no limit for your creativity. Don't forget to share this app with your friend or YouTube channel. Your support will encourage us to implement more advanced functions in the future.

This is an unofficial application for Minecraft Pocket Edition. This application is not affiliated in any way with Mojang AB. All rights reserved. Mod Maker for Minecraft PE Mod Maker for Minecraft PE 1. More Apps from Ultimate Mobile. VideoBuddy - Youtube Downloader 1.

Tiles Hop 3.

BINARY OPTIONS ACCEPTS USA NO DEPOSIT BONUS

X 3 would equal. For the digit manipulation proof, take it from the side of a non-believer. When you multiply. Maybe it's not clear, but intuitively it pretty much makes sense. Most of the other proofs involve buried assumptions that infinitesimal differences don't count. That's really the essential question, of infinitesimals count.

Unfortunately for the non-believer, standard mathematics theory includes the "archimedean property" as a property of the real numbers. If it's more or less an axiom of the accepted mathematical system, doesn't that turn the argument into one of whether or not infinitesimal differences SHOULD count, whether or not the Archimedean property SHOULD describe the set of rational numbers.

I personally think it should, because it makes calculus and repeating decimals SOOO much easier to work with. But all the proofs rely on the same principle, and only vary in complication. Doesn't it make more sense to skip past the proofs which only make the argument more obscure, straight to the fundamental issue of how much mathematics needs to parallel intuition? I've tried explaining this to people before, and they always get caught up in the proofs. I care more about the "archimedean property" bit.

Does it make sense at all? Thanks in advance. Timeeeee talk , 26 November UTC. Did you lie when you omit commutativity from the proof? No, but you left a gap in the proof. In your analogy the gap in the proof is very small. Almost everybody agrees that commutativity of real numbers is intuitive and obviously true.

Same can't be said about archimedean property. Intuition about anything infinite can't be trusted. There is no 0. Omission of archimedean property from the proof is significant. Acceptable at high school level, but blatant error at graduate level. Tlepp talk , 17 June UTC. Does anyone know if. If no than I would think that would mean that no repeating decimals of any kind hold a distinct location or that there would be oddly placed gaps in the coninuum.

If yes, which I believe it does, than I would think that. The hole point here is that 0. So, there is a distinct location for the real number most commonly represented by the symbol "1" in the number line. And you can represent the same number as "0. This do not change the position if this same number in the line.

What about this theory? This is such a popular topic, I think I'll add a bit of fuel. Did you know See paragraphs 2 and 3 of Evenness of zero Teachers' knowledge. There are also plenty of anecdotes on the Internet of teachers claiming that 0 isn't even, or disagreeing amongst themselves. Is this worse than confusion over 0. Melchoir talk , 13 December UTC.

I agree with Tango. I had teachers teach false information before, or made careless mistakes. Even blatant contradictions in the same sentence, which makes you scratch your head and say WTF? A teacher really should be evaluated before allowed to teach children.

I am currently studying Calculus 2 and Physics 3 both Advanced Placement at my high school. While I have no experience with real analysis, I like to think that I understand logic fairly well. My experience with "simple" logic is that it does not always apply, and can often create paradoxes, i. Thus, I don't want to be sucked into the automatic assumption that this is not true.

Simply the reasoning that thousands of people smarter than me declared this to be true, therefore it is unlikely that I would prove them wrong. However, I would like to make a point. Consider an infinitely small particle. AS far as anyone can observe, it does not exist. It can not be measured by modern human means, however, we "know" it exists. As zero represents non-existence, there is a difference between the two. While numerically this particle may equal zero, to say that it equaled zero would be to deny its existence, which would contradict logic since we "know" it exists.

Therefore, since the particle exists, a single arbitrary unit, "1" minus this particle is different than the original unit. However, if we assume that "1" is made up of an infinite number of particles, then in "particle units" this is equivalent to [infinity] - 1, which by the conventional standards of math, is equal to infinity, which would prove that this particle is zero, thus proving that it does not exist.

Here comes the dirty trick: 0. So we have an inconsistent triad. One of them must be false by definition of an inconsistent triad, so, so 1 must be false. These are true because someone said so. If I become king of the world, I can change any of these. Observational truths have nothing to do with humans. Humans can discover them, but they would remain true even if humans never existed. What kind of truth is. I have always thought that all math was observational. No one invented Pi, or passed a law establishing the distributive property.

But you are saying that "if mathematicians say 0. That is clearly declaratory - which means that any mathematical "proof" you may come up with is simply an excuse to justify what mathematicians have already decided. It would seem that all I need to do is build up enough political power and I could alter mathematical reality!

Given the number of people that you admit reject. I find this very disturbing - it flatly contradicts what I've always understood math to be. Algr talk , 21 March UTC. Mdwh, the reason I wrote "The sun rises in that direction.

But you went through the whole thing anyway. This suggests that you don't understand the question, and are simply substituting a different question that you DO know the answer to. The actual article is guilty of this too. It brings out "unique decimal expansion" 4 times before it even gets to the Proofs section, yet ignores serious practical problems like how to define exclusive ranges. However, in the real world,.

The world's greatest mathematicians can write a treatise on it and I still would disagree. Common sense shows me that. Without "proving" they are equal using equations, there is no proof. It comes down to the fact that. It is certainly not 1. It's VERY close, but not close enough. Also, I am not being a troll; I truly know that they are not the same number. Do we have any good evidence that there are actually people who seriously doubt 0. In between 0 and 1, there are infinite numbers.

Any number in between 0 and 1 is not going to be equal to 0 or 1, no matter how close. Functionally, mathematically, and formulaically, it acts and functions as 1. I've had to endure a number of very rude and insulting comments from people who insist that. Consider this:. If you walked into a conversation at this point, would you expect the other side to respond positively to this? Algr talk , 27 March UTC. Mini, if I have "chosen to ignore" anything, it is because there are six different people here making different points, and I can't respond to them all.

But you have all chosen to ignore my response to the argument that U-N was not zero, and gone on to make the same points again. Please go back and read that. The tactic that I keep running into here is that people will throw unjustified assumptions into their opponent's views so that they can "disprove" them when those assumptions prove false.

It is like this argument:. It's a perfect "proof" for those who want to believe it. But the hidden assumption is that if cars have any similarity to horses, then they must equal them in all ways. The Pro-one crowd here has done this on at least two occasions:. Also, again on the troll point - there's a world of difference between "I've read through all of these proofs, but I'm still not convinced that they haven't made some hidden error somewhere" and "I don't care how many proofs you show me, common sense says 0.

You can see how the second one sounds a lot more troll-y than the first, much in the same way "I don't understand how life could have formed out of a random amalgamation of chemicals" is less trolly than "I ain't kin to no ape! Confusing Manifestation Say hi! In the discussions of whether 0. The specific expression I've seen on more than one occasion is something like "0. Before I weigh in, there's a few suggestions I'd like to make for those of you who want to participate:.

Even though this page is meant for discussion of. As this is a discussion of math, the debate should mostly be carried out through proofs, equations, and logic. Arguments based on simple contradiction, vague philosophical notions, and stubbornness will not persuade anyone who doesn't already happen to agree with you. If you know, right now, that no proof or argument will change your mind, then you really shouldn't spend your time reading proofs and arguments - or replying to them.

You should probably reconsider why you're even here. Personally, I would love to be proven totally, irrefutably wrong; it would be a mind-opening experience! Let's keep the discussion limited to the set of real numbers. I'd rather not bring in alternative numbering systems if I can help it. I don't use them, you see, and I doubt you do either.

It is my observation that any real value can be expressed as a decimal number. However, not every value may be expressed as a finite decimal value. Pi is a great example. We will never know the precise value of pi expressed in decimal, because it would require infinite space to express; as it happens, we don't actually need to know its precise value to work with it.

It is a symbol for the ratio of a circle's diameter to its circumference. Enough about pi. If you long-divide 1 by 3, your answer will at first be 0, and then 0. You and I both agree that no matter how long you keep dividing, you'll just see more 3's at the end. There isn't going to be a surprise 4 that pops up after a while. We don't have to divide until the end of time in order to know that 1 divided by 3 results in an infinite amount of 3's following a decimal point.

Division does not produce approximations. I await your replies eagerly. I beleive that we can prove that 0. I think this is enough to prove that 0. Before you say anything about my flawed representations. I used those because I don't know the notation.

What I mean by. I also realize there is no real "end" to. It's quite amusing to read the arguments going back and forth throughout these Talk pages. Before I even found the 0. I think the inability to accept the equality of 0. Every "argument" against the equality on these Talk pages makes the assumption that there is some small distance — however small — which separates 1 and 0.

However, because the number of nines in 0. So what people are really refusing to accept is that infinite is truly not finite. For those who think about it as a process, the argument that 0. And this is the crux: if you indeed had an infinite amount of time to write nines, would you ever finally write a number which was exactly equal to 1?

If one truly understands the concept of Infinity, the answer is, of course, yes. Why yes? Because there is no "finally" in infinite time. You would never stop writing, and by doing so you would write a number equal to 1. Even some of you who agree with the equality may find yourself skeptical of this, but if you read it carefully, you'll find it is exactly the same equality, just translated into a physical action rather than an abstract concept.

Your same difficulty in comprehending actually "reaching one" after infinite time is the same concept others struggle with in comprehending a decimal of infinite length. You would never reach one, because reaching one implies an end, or finite time.

Given infinite time, you would write a number equal to 1. For many with a sound background in mathematics, it is much easier to accept that a string of numbers goes on forever without end. Those same individuals may find it much more difficult to accept that an infinite amount of time is truly time going on forever without end, rather than a very-large-as-to-be-incomprehensible yet still finite amount of time. The point of this post at last! The trouble with "common sense" is that it can sometimes err.

There are number systems in which 0. These are, of course, not the real numbers. But real numbers are not necessarily the most common sense system available. In principle, one could perform an infinite number of tasks in a finite time see supertasks.

Not being sure of the answers to these questions, I'll leave the article alone for now. E-Mail discussion with Jeff Lagarias :. Therefor, no link to peter Schorer's wrong article. Mario23 talk , 25 August UTC. Bruckman, P. This program halts when the sequence reaches 1, Now try telling us something we don't know.

If progress on the Collatz conjecture has practical applications or implications outside of mathematics, it should be mentioned in the article. So what's the story? Where did I -- and the other guys on the webpages listed above -- go wrong? Or are the figures in the quotations from the main article wrong? BTW in case it's useful for anybody, here is my cross-platform Windows, Linux source code suitable for 64 bit systems:.

Sorry this is the first time I've ever edited an Wikipedia talk page So I figured out what the problem is. One refers to 'steps' and the other refers to 'cycle length' This makes it a bit confusing Yeah, ya gotta be careful about what you read on the Internet. I boldly removed a bunch of different "example programs" which calculated the Collatz conjecture. I feel that the pseudocode is more than sufficient to demonstrate the solution, and it seemed that the examples were not adding anything to the article.

This is not an article to discuss the difference between various languages, it is to discuss the Collatz conjecture, and having a bunch of different languages only serves to distract the reader. Implementing the calculation in a bunch of different languages is very much on topic on Rosetta Code , so I've copied the programs to a page for the Collatz conjecture there.

I notice that since the removal, Perhaps a link to the programs on Rosetta Code would be a good compromise? Actually, the series can not converge to 1. Mad props to whomever snuck this in as a rational example! Metao talk , 5 March UTC. If you do positive integers with this version i.

This proves that the conjecture by Collatz is true. Can anyone verify this? A formula, from which he derived the argument for impossibility of a loop was wrong, so this whole approach was insufficient to disprove the possibility of a cycle. Steiner's m-cycle-theorem needs verification by some tag: " fact " I've found the msg in sci.

Don't know how to supply that link in the article. There is a reference to this confusing mess in the popular webcomic XKCD. Someone should make a section in the article detailing all such references that pop up in culture. No, somebody shouldn't make a pop culture section. In Pop Culture sections are lame and contribute nothing to the article. If you think you need to make a pop culture section, you're completely missing the point of that comic.

You just want an excuse to put the xkcd strip on this article. There is no reason to add a "references in pop culture" section just for that. Xkcd fans are already a plague that attempts to include a strip in every Wikipedia page. Flintmecha talk , 12 March UTC.

I don't consider it as such because it does not contain an odd number. Furthermore, that notation [7] 18 seems worthless to me, i. Simply knowing how many evens there are isn't good enough, you need to know the distribution of the evens. For instance, there are a lot of ways to partition 11 evens amongst 7 odds, but only [1, 1, 1, 2, 1, 1, 4] or one of its cyclic permutations will give you a loop cycle. Of course, you would need to know how to exploit the distribution to learn anything, but that's easily doable.

Note that [1, 1, 1, 2, 1, 1, 4] has 7 numbers that sum to One can do calculations similar to the Parity Vector this notation is just a compact version with the restriction that the sequence must begin with an odd number. And once we have the resulting function, we can determine whether the partition is a loop cycle without needing to evaluate the sequence. Can't do that with [7] I would like to change that to make it useful. Any support?

These edits are invalid. Although true that "there is a finite number of integers with infinite divergent trajectories", the finite numer has to be 0. Necessary But Not Sufficient. Likewise, for "there is a finite number of integers with cyclic trajectories", it is only sufficient if that finite number is EXACTLY 1.

The article by M. Bruschi is short, doesn't really add much, and is self-published on Xarchive, not reviewed and published in a journal. This paper is bogus. The statement "our main assumption here is that, at each play, the Syracuse gambler has equal chances of winning or losing a bet," is outright false. Even numbers do indeed always follow odds, but NOT with equal probability. Even numbers follow the odd integers in a Negative Binomial Geometric distibution so the mean number of consecutive evens wiil be the inverse of the probability, therefore, the mean count of consecutive evens will be 2, and thus, not equal to the odds.

There is no point continuing any further since all subsequent calculations are based on a fallacy. Links should be deleted. The last section is about the Syracuse function, but provides no explanation of context. According to the link, it will, if I read the inline linked source correctly, produce the number or iterations taken for odd number N.

Maybe we should explain that, and possibly state how many iterations it must go out to before it becomes efficient to take N mod 2 of every number. Oh, and am I going blind, or does it contain the Mandelbrot set? Do all fractals do that, or is it worth noting? Why omit the even numbers and have lots of blurb explaining it?

It strikes me that for the few numbers required, a simple list is easier to understand and doesn't really take up much space. I offer the section as an example below. An obvious extension is to include all integers, not just positive integers. Interestingly, there are in this case a total of 5 known cycles, which all integers seem to eventually fall into under iteration of f. These cycles are listed here, starting with the well-known cycle for positive n. Odd values are listed in bold.

Each cycle is listed with its member of least absolute value first - which value is always odd. We follow each cycle with …, its [odd value cycle length] in square brackets and its full cycle length in parentheses. The Generalized Collatz Conjecture is the assertion that every integer, under iteration by f , eventually falls into one of these five cycles. This section will be for any "proofs" added or argued for being in the article. If the proposal doesn't exist in academia, the discussion may be better sent to the mathematics Reference Desk.

In the past we had a published proof in the article which I reverted because the magasine wasn't a proper scientific magasine on the area. From Wikipedia:Verifiability Exceptional claims require exceptional sources:. So any attempted proof has to be immediately removed until the scientific society accepts it. This is an encyclopedia, not the news nor place to upload original research. Can someone give a reference where to find more information about the syracuse function? I would be especially interested in a proof of the last statement.

We should mention that there is a distributed computing project focused on this conejcture. What does seem to be true is that the difference is always a multiple of 3. Ok thanks. Anyway, I'm not so sure it really speeds things up, because it trades small-integer operations for bigger ones. At the top of the article, there is an image of a directed graph. I believe this graph is a tree and can be rendered without any intersecting lines, yet the image has many edges that cross each other.

Does this serve any special purpose, or is is just suboptimal or even slightly wrong? This is clearly wrong, since:. This invalidates a later point in the proof sketch. Noldorin talk , 26 January UTC. Ah, fair enough.

That should probably be stated explicitly, since it's not 'self-evident'. Noldorin talk , 29 January UTC. I don't see where the article explains why you need to triple the odd numbers before you add or at least give an example of a number that HAS to be tripled to make it work.

The article gives examples using 11 and 27, but both of those numbers can lead to 1 by performing the series without tripling the odd numbers. Aristophanes68 talk , 28 January UTC. If Collatz is indeed the name of the conjecture and not the name of the series - as the opening para states, then why redact a series of changes aimed at making the page more consistent?

I'll reinstate the edits if there is no reply in a day or so from the redactor. I've re-instated my edits. I guess the wiki page on the conjecture is going to be in need of a major overhaul pretty soon. It might be useful, I belive, to say something more about how this equivalence is obtained. The first sentence of the article contains the claim that Collatz formulated the conjecture in , but there is no citation.

This claim was added, together with a link to MathWorld which has an identical unsupported claim on 7 September The Mathematical Gazette paper by Brian Thwaites does contain a claim of priority dating to , and none of the other historical papers cited in this article contradict that claim.

If there is no evidence that Collatz actually originated this conjecture, perhaps it would be safest to follow Lagarias, and say that the origin of this precise conjecture is not completely settled. I was disappointed that there is currently no discussion of Kurtz and Simon's generalization besides the short paragraph in the lede that they used "a generalization" and that generalization is undecidable. This is wrong, since it is always possible to multiply the number by two in the reverse Collatz process.

I changed it into:. I don't know if this is the best way to write the reverse function. Maybe someone knows a better way to write it or explain it. Just FYI for the curious. Where can I find some info about this approach? But with specifics values,we found, you will always reach 1. It's false you repeat the process until you get specific valuesThe number of repeat give you the size. It 's trivial to get the complementary size from this point to 1. An addition give you the total size.

Tanks for your necesary critics — Preceding unsigned comment added by Can someone post the final draft? This is important information that should be included here as it shows that, for example, Let x be an integer. Here is a trivial function in one part rather than two to calculate the next integer in the series, I am not sure where to add it to the article though. Just looking at the conjecture, but seeing it as an information processing instead of a mathematical problem I'm a programmer not a mathematician , several things seem kind-of evident.

First, though "oneness" is very popular in maths, it seems to be something of noise in the conjecture. Likewise to reach two 2 you must first reach four 4 , so how about "fourness"? To reach four 4 you must first reach eight 8 , so "eightness? Indeed the first point of covariance is reaching the value sixteen 16 which can be guessed, reached from thirty-two 32 or reached from five 5.

The entire devide by two term, and the reaching one requirement are just noise, present to complicate at one level and to "keep numbers reasonably representable and workably small". Doing this "all mathy" I suspect the alternate rewrite would involve a whole number term to the natural log or some such.

Again, not a mathematician, so I don't know how to write out the simplification in official math-talk. Sinerely Rob White. It always makes zeros. Playing with the visualizer reveals that there is no real magic to the three 3 or the two 2 , its all tied up with the multiply by odd when odd then coerce to even by adding one. Some cases outside this are seemingl true as well. This is all tied up with evenness and the domination of evenness when you apply an evenness-corercing term to an odd number, and an even devisor to an even number, and the dominance of even terms occuring in the results.

As long as the scaling term isn't too big for the consuming term, you converge on 1. Since the probability of a any number devided by two producing an even number is. I know there is math-speak for this sort of probability series.

Since all terms but the first diminish n, well throw the right magic statistical constant the golden ratio? That's what it's intended to let you visualize.