The use of prophylactic fluconazole in immunocompetent high-risk surgical patients: a meta-analysis

INTRODUCTION: High-risk surgical patients are at increased risk of fungal infections and candidaemia. Evidence from observational and small randomised controlled studies suggests that prophylactic fluconazole may be effective in reducing fungal infection and mortality. We evaluated the effects of prophylactic fluconazole on the incidence of candidaemia and hospital mortality in immunocompetent high-risk surgical patients. METHODS: Randomised controlled studies involving the use of fluconazole in immunocompetent high-risk surgical patients from the Cochrane Controlled Trial Register (2005, issue 1) and from the EMBASE and MEDLINE databases (1966–30 April 2005), without any language restriction, were included. Two reviewers reviewed the quality of the studies and performed data extraction independently. RESULTS: Seven randomised controlled studies with a total of 814 immunocompetent high-risk surgical patients were considered. The use of prophylactic fluconazole was associated with a reduction in the proportion of patients with candidaemia (relative risk [RR] = 0.21, 95% confidence interval [CI] = 0.06–0.72, P = 0.01; I(2 )= 0%) and fungal infections other than lower urinary tract infection (RR = 0.39, 95% CI = 0.24–0.65, P = 0.0003; I(2 )= 0%), but was associated with only a trend towards a reduction in hospital mortality (RR = 0.82, 95% CI = 0.62–1.08, P = 0.15; I(2 )= 7%). The proportion of patients requiring systemic amphotericin B as a rescue therapy for systemic fungal infection was lower after prophylactic use of fluconazole (RR = 0.35, 95% CI = 0.17–0.72, P = 0.004; I(2 )= 0%). The proportion of patients colonised with or infected with fluconazole-resistant fungi was not significantly different between the fluconazole group and the placebo group (RR = 0.66, 95% CI = 0.22–1.96, P = 0.46; I(2 )= 0%). CONCLUSION: The use of prophylactic fluconazole in immunocompetent high-risk surgical patients is associated with a reduced incidence of candidaemia but with only a trend towards a reduction in hospital mortality

Reliability of fibre Bragg gratings in polymer optical fibre

In this paper we report on investigations of some of the factors that have a bearing on the reliability and repeatability of polymer fibre Bragg gratings. The main issues discussed are the fibre preform composition, the fibre drawing conditions and the thermal history of the fibre grating

Tawney and the third way

From the 1920s to the 1950s R. H. Tawney was the most influential socialist thinker in Britain. He articulated an ethical socialism at odds with powerful statist and mechanistic traditions in British socialist thinking. Tawney's work is thus an important antecedent to third way thinking. Tawney's religiously-based critique of the morality of capitalism was combined with a concern for detailed institutional reform, challenging simple dichotomies between public and private ownership. He began a debate about democratizing the enterprise and corporate governance though his efforts fell on stony ground. Conversely, Tawney's moralism informed a whole-hearted condemnation of market forces in tension with both his concern with institutional reform and modern third way thought. Unfortunately, he refused to engage seriously with emergent welfare economics which for many social democrats promised a more nuanced understanding of the limits of market forces. Tawney's legacy is a complex one, whose various elements form a vital part of the intellectual background to current third way thinking

Grating and interferometric devices in POF

To date, much of the development work associated with polymer optical fibre (POF) applications has been aimed at exploiting the potential of the technology to provide low cost solutions. Here we argue that, in the sensing area at least, POF offers a number of other, more relevant advantages. In this paper we describe work on a range of devices based on photoinscribed gratings and on fibre interferometers, which are designed to take advantage of the unique properties of POF

Global utilization of low-dose corticosteroids in severe sepsis and septic shock: a report from the PROGRESS registry

The benefits and use of low-dose corticosteroids (LDCs) in severe sepsis and septic shock remain controversial. Surviving sepsis campaign guidelines suggest LDC use for septic shock patients poorly responsive to fluid resuscitation and vasopressor therapy. Their use is suspected to be wide-spread, but paucity of data regarding global practice exists. The purpose of this study was to compare baseline characteristics and clinical outcomes of patients treated or not treated with LDC from the international PROGRESS (PROmoting Global Research Excellence in Severe Sepsis) cohort study of severe sepsis.Journal ArticleMulticenter StudyResearch Support, Non-U.S. Gov'tSCOPUS: ar.jinfo:eu-repo/semantics/publishe

Commensurability and beyond: from Mises and Neurath to the future of the socialist calculation debate

Mises' 'calculation argument' against socialism argues that monetary calculation is indispensable as a commensurable unit for evaluating factors of production. This is not due to his conception of rationality being purely 'algorithmic,' for it accommodates non-monetary, incommensurable values. Commensurability is needed, rather, as an aid in the face of economic complexity. The socialist Neurath's response to Mises is unsatisfactory in rejecting the need to explore possible non-market techniques for achieving a certain degree of commensurability. Yet Neurath's contribution is valuable in emphasizing the need for a balanced, comparative approach to the question of market versus non-market that puts the commensurability question in context. These central issues raised by adversaries in the early socialist calculation debate have continued relevance for the contemporary discussion

Patterning and process parameter effects in 3D suspension near-field electrospinning of nanoarrays

The extracellular matrix (ECM) contains nanofibrous proteins and proteoglycans. Nanofabrication methods have received growing interest in recent years as a means of recapitulating these elements within the ECM. Near-field electrospinning (NFES) is a versatile fibre deposition method, capable of layer-by-layer nano-fabrication. The maximum layer height is generally limited in layer-by-layer NFES as a consequence of electrostatic effects of the polymer at the surface, due to residual charge and polymer dielectric properties. This restricts the total volume achievable by layer-by-layer techniques. Surpassing this restriction presents a complex challenge, leading to research innovations aimed at increasing patterning precision, and achieving a translation from 2D to 3D additive nanofabrication. Here we investigated a means of achieving this translation through the use of 3D electrode substrates. This was addressed by in-house developed technology in which selective laser melt manufactured standing pillar electrodes were combined with a direct suspension near-field electrospinning (SNFES) technique, which implements an automated platform to manoeuvre the pillar electrodes around the emitter in order to suspend fibres in the free space between the electrode support structures. In this study SNFES was used in multiple operation modes, investigating the effects of varying process parameters, as well as pattern variations on the suspended nanoarrays. Image analysis of the nanoarrays allowed for the assessment of fibre directionality, isotropy, and diameter; identifying optimal settings to generate fibres for tissue engineering applications