Intensive care in severe malaria: report from the task force on tropical diseases by the World Federation of Societies of Intensive and Critical Care Medicine

Severe malaria is common in tropical countries in Africa, Asia, Oceania and South and Central America. It may also occur in travelers returning from endemic areas. Plasmodium falciparum accounts for most cases, although P vivax is increasingly found to cause severe malaria in Asia. Cerebral malaria is common in children in Africa, manifests as coma and seizures, and has a high morbidity and mortality. In other regions, adults may also develop cerebral malaria but neurological sequelae in survivors are rare. Acute kidney injury, liver dysfunction, thrombocytopenia, disseminated intravascular coagulopathy (DIC) and acute respiratory distress syndrome (ARDS) are also common in severe malaria. Metabolic abnormalities include hypoglycemia, hyponatremia and lactic acidosis. Bacterial infection may coexist in patients presenting with shock or ARDS and this along with a high parasite load has a high mortality. Intravenous artesunate has replaced quinine as the antimalarial agent of choice. Critical care management as per severe sepsis is also applicable to severe malaria. Aggressive fluid boluses may not be appropriate in children. Blood transfusions may be required and treatment of seizures and raised intracranial pressure is important in cerebral malaria in children. Mortality in severe disease ranges from 8 to 30% despite treatment

The Comedy of Errors

This earliest of Shakespeare’s comedies is set in the ancient Greek town of Ephesus, where two sets of brothers had been separated in infancy during a tragic shipwreck long ago. Antipholus of Syracuse and his servant Dromio arrive in town, not knowing that it is the home of Antipholus of Ephesus and his servant, Dromio. Ephesian law forbids anyone from Syracuse to come into the town, and if caught doing so, will be put to death unless able to pay an enormous ransom. Egeon, father of the Antipholus twins, convinces the ruler of Ephesus to give him one day to find his long lost son. He is granted the time, and comic misadventures unfold as themes of mistaken identity, romantic disasters, false accusations and confusion take place. The befuddlement of the characters is even more fun for the audience to watch since we can tell the twins apart, but the characters cannot!https://digitalcommons.cedarville.edu/theatre_productions/1044/thumbnail.jp

The Beams Are Creaking

The inspiring, powerful, true story of Dietrich Bonhoeffer, the German theologian who defied the Nazis and ultimately led an assassination attempt against Hitler. Part political thriller, part love story, and leavened with moments of humor, it is filled with a compassion that reaffirms one’s faith in man.https://digitalcommons.cedarville.edu/theatre_productions/1052/thumbnail.jp

Meet Me in St. Louis

It is the summer of 1903, and the Smith family eagerly anticipates the opening of the 1904 World’s Fair. Memorable musical numbers include Have Yourself a Merry Little Christmas, The Boy Next Door, The Trolley Song, and Whenever I’m with You. A delightful show for all ages!https://digitalcommons.cedarville.edu/theatre_productions/1051/thumbnail.jp

Sepsis in tropical regions: Report from the task force on tropical diseases by the World Federation of Societies of Intensive and Critical Care Medicine

Sepsis and septic shock in the tropics are caused by a wide array of organisms. These infections are encountered mainly in low and middle-income countries (LMIC) where a lack of infrastructure and medical facilities contribute to the high morbidity and mortality. Published sepsis guidelines are based on studies primarily performed in high income countries and as such recommendations may or may not be relevant to practice in the tropics. Failure to adhere to guidelines, particularly among non-intensive care specialists even in high-income countries, is an area of concern for sepsis management. Additionally, inappropriate use of antimicrobials has led to significant antimicrobial resistance. Access to rapid, low-cost, and accurate diagnostic tests is critical in countries where tropical diseases are prevalent to facilitate early diagnosis and treatment. Implementation of performance improvement programs may improve outcomes for patients with sepsis and the addition of resuscitation and treatment bundles may further reduce mortality. Associated co-morbidities such as malnutrition and HIV influence outcomes and must be considered

Kaon photoproduction: background contributions, form factors and missing resonances

The photoproduction p(gamma, K+)Lambda process is studied within a field-theoretic approach. It is shown that the background contributions constitute an important part of the reaction dynamics. We compare predictions obtained with three plausible techniques for dealing with these background contributions. It appears that the extracted resonance parameters drastically depend on the applied technique. We investigate the implications of the corrections to the functional form of the hadronic form factor in the contact term, recently suggested by Davidson and Workman (Phys. Rev. C 63, 025210). The role of background contributions and hadronic form factors for the identification of the quantum numbers of ``missing'' resonances is discussed.Comment: 11 pages, 7 eps figures, submitted to Phys. Rev.

Spring–summer net community production, new production, particle export and related water column biogeochemical processes in the marginal sea ice zone of the Western Antarctic Peninsula 2012–2014

New production (New P, the rate of net primary production (NPP) supported by exogenously supplied limiting nutrients) and net community production (NCP, gross primary production not consumed by community respiration) are closely related but mechanistically distinct processes. They set the carbon balance in the upper ocean and define an upper limit for export from the system. The relationships, relative magnitudes and variability of New P (from 15NO3– uptake), O2 : argon-based NCP and sinking particle export (based on the 238U : 234Th disequilibrium) are increasingly well documented but still not clearly understood. This is especially true in remote regions such as polar marginal ice zones. Here we present a 3-year dataset of simultaneous measurements made at approximately 50 stations along the Western Antarctic Peninsula (WAP) continental shelf in midsummer (January) 2012–2014. Net seasonal-scale changes in water column inventories (0–150 m) of nitrate and iodide were also estimated at the same stations. The average daily rates based on inventory changes exceeded the shorter-term rate measurements. A major uncertainty in the relative magnitude of the inventory estimates is specifying the start of the growing season following sea-ice retreat. New P and NCP(O2) did not differ significantly. New P and NCP(O2) were significantly greater than sinking particle export from thorium-234. We suggest this is a persistent and systematic imbalance and that other processes such as vertical mixing and advection of suspended particles are important export pathways