Abnormal movements in critical care patients with brain injury: a diagnostic approach

Abnormal movements are frequently encountered in patients with brain injury hospitalized in intensive care units (ICUs), yet characterization of these movements and their underlying pathophysiology is difficult due to the comatose or uncooperative state of the patient. In addition, the available diagnostic approaches are largely derived from outpatients with neurodegenerative or developmental disorders frequently encountered in the outpatient setting, thereby limiting the applicability to inpatients with acute brain injuries. Thus, we reviewed the available literature regarding abnormal movements encountered in acutely ill patients with brain injuries. We classified the brain injury into the following categories: anoxic, vascular, infectious, inflammatory, traumatic, toxic-metabolic, tumor-related and seizures. Then, we identified the abnormal movements seen in each category as well as their epidemiologic, semiologic and clinicopathologic correlates. We propose a practical paradigm that can be applied at the bedside for diagnosing abnormal movements in the ICU. This model seeks to classify observed abnormal movements in light of various patient-specific factors. It begins with classifying the patient’s level of consciousness. Then, it integrates the frequency and type of each movement with the availability of ancillary diagnostic tests and the specific etiology of brain injury

From Creating Spaces for Civic Discourse to Creating Resources for Action

In this paper, we investigate the role of technology to address the concerns of a civil society group carrying out community-level consultation on the allocation of £1 million of community funds. We explore issues of devolved decision-making through the evaluation of a sociodigital system designed to foster deliberative virtues. We describe the ways in which this group used our system in their consultation practices. Our findings highlight how they adopted our technology to privilege specific forms of expression, ascertain issues in their community, make use of and make sense of community data, and create resources for action within their existing practices. Based on related fieldwork we discuss the impacts of structuring and configuring tools for ‘talk-based’ consultation in order to turn attention to the potential pitfalls and prospects for designing civic technologies that create resources for action for civil society

Cidadania mediada : processos de democratização da política municipal no Brasil

This article discusses the notion that the persistence of &ldquo;traditional&rdquo; political practices weakens Brazil&rsquo;s democracy.Drawing on the cases of three Brazilian municipalities administered by the Workers&rsquo; Party (PT), the author examines the space between &ldquo;traditional&rdquo; and &ldquo;modern&rdquo; and argues that successful democratization does not eradicate practices such as clientelism and patronage, but it tends to incorporate and build on these traditional political elements. Moreover, the article maintains that the democratization of municipal politics is inextricably bound up with the eradication of poverty and the construction of a responsive, state-based social safety net.<br /

Sanctions, Benefits, and Rights: Three Faces of Accountability

As countries throughout the world democratize and decentralize, citizen participation in public life should increase. In this paper, I suggest that democratic participation in local government is enhanced when citizens can reply affirmatively to at least three questions about their ability to hold local officials accountable for their actions: Can citizens use the vote effectively to reward and punish the general or specific performance of local public officials and/or the parties they represent? Can citizens generate response to their collective needs from local governments? Can citizens be ensured of fair and equitable treatment from public agencies at local levels? The findings of a study of 30 randomly selected municipalities in Mexico indicate that, over the course of a decade and a half, voters were able to enforce alternation in power and the circulation of elites, but not necessarily to transmit unambiguous messages to public officials or parties about performance concerns. More definitively, citizens were able to build successfully on prior political experiences to extract benefits from local governments. At the same time, the ability to demand good performance of local government as a right of citizenship lagged behind other forms of accountability

Agency, design and ‘slow democracy’

Can democracy be resilient in an increasingly ‘high-speed society’? Social acceleration, some critics argue, poses a serious threat to the idea and practice of democracy. Others invoke but do not develop the idea of ‘slow democracy’ as one important response to this threat. Despite its importance, the critique and response lack analytical depth. In this context, and in an effort to rebuild the debate on a stronger and more fruitful base, the article underscores the potential of political agency to shape democracy’s temporality and reframes ‘slow democracy’ as a challenge of democratic design

Human Dectin-1 Deficiency Impairs Macrophage-Mediated Defense Against Phaeohyphomycosis

Subcutaneous phaeohyphomycosis typically affects immunocompetent individuals following traumatic inoculation. Severe or disseminated infection can occur in CARD9 deficiency or after transplantation, but the mechanisms protecting against phaeohyphomycosis remain unclear. We evaluated a patient with progressive, refractory Corynespora cassiicola phaeohyphomycosis and found that he carried biallelic deleterious mutations in CLEC7A encoding the CARD9-coupled, β-glucan-binding receptor, Dectin-1. The patient\u27s PBMCs failed to produce TNF-α and IL-1β in response to β-glucan and/or C. cassiicola. To confirm the cellular and molecular requirements for immunity against C. cassiicola, we developed a mouse model of this infection. Mouse macrophages required Dectin-1 and CARD9 for IL-1β and TNF-α production, which enhanced fungal killing in an interdependent manner. Deficiency of either Dectin-1 or CARD9 was associated with more severe fungal disease, recapitulating the human observation. Because these data implicated impaired Dectin-1 responses in susceptibility to phaeohyphomycosis, we evaluated 17 additional unrelated patients with severe forms of the infection. We found that 12 out of 17 carried deleterious CLEC7A mutations associated with an altered Dectin-1 extracellular C-terminal domain and impaired Dectin-1-dependent cytokine production. Thus, we show that Dectin-1 and CARD9 promote protective TNF-α- and IL-1β-mediated macrophage defense against C. cassiicola. More broadly, we demonstrate that human Dectin-1 deficiency may contribute to susceptibility to severe phaeohyphomycosis by certain dematiaceous fungi

A Critical Reappraisal of Prolonged Neutropenia as a Risk Factor for Invasive Pulmonary Aspergillosis

Prolonged neutropenia is generally thought to be the major factor for invasive pulmonary aspergillosis (IPA). In the present study, we characterize the frequency, severity, and duration of neutropenia that immediately precedes IPA. Prolonged neutropenia was identified in only one third of all IPA cases and occurred exclusively in hematologic patients