A 2-year-old boy with hemolytic uremic syndrome and pneumocephalus

Clostridium septicum infection following hemolytic uremic syndrome is rare and carries a poor prognosis, especially when the brain is involved. We report a case of a previously healthy 2-year-old boy who presented with two days of anuria and bloody diarrhea. He was admitted to the local children's hospital with a diagnosis of hemolytic uremic syndrome, presumably secondary to E. coli O157. He soon required intubation and was noted to have fixed and dilated pupils. Head CT revealed left frontal subcortical white matter vasogenic edema and scattered pockets of pneumocephalus. The patient expired 14 hours after admission. Antemortem blood cultures grew C. septicum. Gross pathologic examination of the brain revealed a large intraparenchymal cerebral hemorrhage in the left frontal and parietal lobes. There was extensive cystic changes as well. Microscopic examination revealed vacuolization and diffuse colonization with rod-shaped bacteria, but without the expected tissue response. There have been only six previously reported cases of C. septicum infection following hemolytic uremic syndrome, four of which had brain involvement. Mortality rate is high, with the only known survivor among those with brain involvement having a brain abscess rather than diffuse pneumocephalus

Communication issues in design-build project delivery method

Design-Build (D-B) is a project delivery method in which the owner procures both design and construction services in the same contract from a single legal entity referred to as the design-builder. Having both design and construction in the hands of one contractual entity allows for a single point of responsibility and, in turn, provides improved project performance. There is a limited study on how communication among all parties involved influences the success of D-B projects. This paper investigates the modern-day communication issues that affect the D-B delivery method. A questionnaire was developed to collect data from professionals across the nation with an average of 22 years of experience related to D-B in commercial construction projects. The authors conducted five structured interviews to verify and validate the results from the survey questionnaire. The findings of this study indicate that the primary communication issues that have an effect on D-B are: (1) establishing the clear points of contact throughout the D-B communication process, (2) providing clear and understandable information among stakeholders during the D-B process and (3) the timely sharing of information to all stakeholders. It is recommended that further improvement strategies be implemented which include coordinating, clarifying, documenting and decision-making in order to better achieve project success. Understanding these communication issues will help professionals not only mitigate risk and uncertainty, but also enhance the likelihood of the success in D-B contracts.Non UBCUnreviewedFacultyOthe