Fatal delayed diagnosis in a patient with falciparum malaria

This is a classical case of blackwater fever which is one of the most serious hematologic complications of falciparum malaria. The clinical manifestations of this acute intravascular hemolityc anemia are fulminating and delayed diagnosis is an important cause of mortality

Multiproxy records of climate variability for Kamchatka for the past 400 years

International audienceTree rings, ice cores and glacial geologic histories for the past several centuries offer an opportunity to characterize climate variability and to identify the key climate parameters forcing glacier expansions. A newly developed larch ring-width chronology is presented for Kamchatka that is sensitive to past summer temperature variability. This record provides the basis to compare with other proxy records of inferred temperature and precipitation change from ice core and glacier records, and to characterize climate for the region over the past 400 years. Individual low growth years in the larch record are associated with several known and proposed volcanic events that have been observed in other proxy records from the Northern Hemisphere. Comparison of the tree-rings with an ice core record of melt feature index for Kamchatka's Ushkovsky volcano confirms a 1?3 year dating accuracy for this ice core series over the late 18th to 20th centuries. Decadal variations of low summer temperatures (tree-ring record) and high annual precipitation (ice core record) are broadly consistent with intervals of positive mass balance measured and estimated at several glaciers, and with moraine building, provides a basis to interpret geologic glacier records

Restorative Justice-Informed Moral Acquaintance: Resolving the Dual Role Problem in Correctional and Forensic Practice

The issue of dual roles within forensic and correctional fields has typically been conceptualized as dissonance—experienced by practitioners— when attempting to adhere to the conflicting ethical requirements associated with client well-being and community protection. In this paper, we argue that the dual role problem should be conceptualized more broadly; to incorporate the relationship between the offender and their victim. We also propose that Restorative Justice (RJ) is able to provide a preliminary ethical framework to deal with this common ethical oversight. Furthermore, we unite the RJ framework with that of Ward’s (2013) moral acquaintance model to provide a more powerful approach—RJ informed moral acquaintance—aimed at addressing the ethical challenges faced by practitioners within forensic and correctional roles

Influence of Different Dry-Mixing Techniques on the Mechanical, Thermal and Electrical Behavior of Ultra High Molecular Weight Polyethylene/Exhausted Tire Carbon Composites

The mechanical, thermal and electrical behavior of ultra high molecular weight (UHMWPE) composites containing different amount of pyrolyzed exhausted tire carbon (ETC) is investigated. Composites were obtained by dry-mixing the powders with a homogenizer and an impact mill. The results clearly indicate that, by changing the mixing method, it is possible to tune the rheological and morphological characteristics of the composites and in turn their mechanical, thermal and electrical properties. Better performances were observed for the composites obtained with the impact mill, which showed improved Young modulus, reduced electrical and thermal resistance with respect to those of homogenized counterparts. All the composites exhibited a relevant decrease of electrical resistivity

Estimating the Thickness of Sea Ice Snow Cover in the Weddell Sea from Passive Microwave Brightness Temperatures

Passive microwave satellite observations have frequently been used to observe changes in sea ice cover and concentration. Comiso et al. showed that there may also be a direct relationship between the thickness of snow cover (h(sub s)) on ice and microwave emissivity at 90 GHz. Because the in situ experiment of experiment of Comiso et al. was limited to a single station, the relationship is re-examined in this paper in a more general context and using more extensive in situ microwave observations and measurements of h from the Weddell Sea 1986 and 1989 winter cruises. Good relationships were found to exist between h(sub s) sand the emissivity at 90 GHz - 10 GHz and the emissivity at 90 GHz - 18.7 GHz when the standard deviation of h(sub s) was less than 50% of the mean and when h(sub s) was less than 0.25 m. The reliance of these relationships on h(sub s) is most likely caused by the limited penetration through the snow of radiation at 90 GHz. When the algorithm was applied to the Special Sensor Microwave/Imager (SSM/I) satellite data from the Weddell Sea, the resulting mean h(sub s) agreed within 5% of the mean calculated from greater than 1400 in situ observations

Efficacy of adalimumab as second-line therapy in a pediatric cohort of crohn’s disease patients who failed infliximab therapy: The Italian society of pediatric gastroenterology, hepatology, and nutrition experience

Background: Adalimumab (Ada) treatment is an available option for pediatric Crohn’s disease (CD) and the published experience as rescue therapy is limited. Objectives: We investigated Ada efficacy in a retrospective, pediatric CD cohort who had failed previous infliximab treatment, with a minimum follow-up of 6 months. Methods: In this multicenter study, data on demographics, clinical activity, growth, laboratory values (CRP) and adverse events were collected from CD patients during follow-up. Clinical remission (CR) and response were defined with Pediatric CD Activity Index (PCDAI) score ≤10 and a decrease in PCDAI score of ≥12.5 from baseline, respectively. Results: A total of 44 patients were consecutively recruited (mean age 14.8 years): 34 of 44 (77%) had active disease (mean PCDAI score 24.5) at the time of Ada administration, with a mean disease duration of 3.4 (range 0.3–11.2) years. At 6, 12, and 18 months, out of the total of the enrolled population, CR rates were 55%, 78%, and 52%, respectively, with a significant decrease in PCDAI scores (P<0.01) and mean CRP values (mean CRP 5.7 and 2.4 mL/dL, respectively; P<0.01) at the end of follow-up. Steroid-free remission rates, considered as the total number of patients in CR who were not using steroids at the end of this study, were 93%, 95%, and 96% in 44 patients at 6, 12, and 18 months, respectively. No significant differences in growth parameters were detected. In univariate analysis of variables related to Ada efficacy, we found that only a disease duration >2 years was negatively correlated with final PCDAI score (P<0.01). Two serious adverse events were recorded: 1 meningitis and 1 medulloblastoma. Conclusion: Our data confirm Ada efficacy in pediatric patients as second-line biological therapy after infliximab failure. Longer-term prospective data are warranted to define general effectiveness and safety in pediatric CD patients