Injuries to the mesenteric microcirculation due to bacterial translocation

Universidade Federal de São Paulo, Dept Pediat, São Paulo, BrazilUniversidade Federal de São Paulo, Dept Microbiol, São Paulo, BrazilInst Butantan, Intravital Unit, Butantan, BrazilUniversidade Federal de São Paulo, Dept Pediat, São Paulo, BrazilUniversidade Federal de São Paulo, Dept Microbiol, São Paulo, BrazilWeb of Scienc

Advancing Tunnelling – the Victorian Engineering Management Legacy

The Victorians are often held up as giants in civil engineering, able to build, span and tunnel in ways that had never been seen before, and which still provide much of our contemporary infrastructure. Their legacy can be easily seen in the railway networks of Great Britain, which demanded some of the most difficult and challenging civil engineering ever seen. As a consequence of such endeavors, Victorian times also saw the emergence of the ‘celebrity’ engineer. Stellar figures who first experienced the shift away from technical and site-based practices and moved instead towards the management and leadership of construction works, a professional legacy that arguably remains today. Such figures also served to further anonymise the construction workers or Navvies, who were already working in dangerous and unhealthy conditions on projects where loss of life was felt to be inevitable. Unpacking Victorian railway tunneling operations duly acknowledges the spectacular feats of engineering we have inherited from them, but also reveals how their legacy has also contributed to the ways in which we mobilise tunneling operations today. It is argued that such contributions should be recognised and consciously re-balanced if we are take the next steps to improve tunneling operations within the profession of civil engineering today

Evidence-based management and intervention for autism spectrum disorders

info:eu-repo/semantics/publishe

Fungal infections in neutropenic patients: a 8-year prospective study Infecções fúngicas em pacientes neutropênicos: estudo prospectivo de 8 anos

In this paper we report a eight-year prospective study designed to further characterize incidence, epidemiology, specific syndromes, treatment and prognosis associated with fungal infections in neutropenic patients. During the study period 30 fungal infections were diagnosed in 30 patients among 313 episodes of fever and neutropenia (10%). There were 15 cases of candidiasis, 5 pulmonary aspergillosis, 3 sinusitis by Aspergillus fumigatus, 5 infections by Fusarium sp., one infection by Trichosporon sp., and one infection due to Rhodotorula rubra. Blood cultures were positive in 18 cases (60%). The predisposing factors for fungal infection in multivariate analysis were the presence of central venous catheter (p<0.001), longer duration of profound (<100/mm³) neutropenia (p<0.001), the use of corticosteroids (p<0.001), gram-positive bacteremia (p=0.002) and younger age (p=0.03). In multivariate analysis only recovery of the neutropenia (p<0.001) was associated with good prognosis whereas the diagnosis of infection by Fusarium sp. (p=0.006) was strongly associated with a poor outcome. The death rate was 43%. There was no statistically significant difference in the death rate between patients who did receive (52%) or did not receive (50%) antifungal treatment. Identifying patients at risk, specific syndromes and prognostic factors may help to reduce the high mortality associated with disseminated fungal infections in neutropenic patients.<br>Com o objetivo de melhor caracterizar incidência, epidemiologia, síndromes específicas, tratamento e prognóstico associado com infecções fúngicas sistêmicas em pacientes neutropênicos foi feito um estudo prospectivo de 8 anos. Durante este período foram diagnosticadas 30 infecções fúngicas em 30 pacientes neutropênicos febris (10%). Houve 15 casos de candidíase, 5 aspergiloses pulmonares, 3 sinusites por Aspergillus fumigatus, 5 infecções por Fusarium sp., uma infecção por Trichosporon sp., e uma infecção por Rhodotorula rubra. As hemoculturas foram positivas em 18 casos (60%). Os fatores de risco para infecção fúngica em análise multivariada foram: presença de cateter venoso central (p<0,001), duração maior de neutropenia <100/mm³ (p<0,001), uso de corticosteróides (p<0,001), bacteremia por germes gram-positivos (p=0,002) e idade menor (p=0.03). Em análise multivariada apenas recuperação da neutropenia (p<0,001) esteve associada com bom prognóstico, enquanto que o diagnóstico de infecção por Fusarium sp. (p=0,006) se correlacionou com um mau prognóstico. A taxa de óbito foi de 43%. Não houve diferença estatisticamente significante nas taxas de óbito em pacientes que receberam (52%) ou não (50%) terapia anti-fúngica. A identificação de grupos de risco, síndromes específicas e fatores prognósticos pode contribuir para a redução na elevada letalidade das infecções fúngicas em pacientes neutropênicos

The pictures on the greater Jelling stone

The greater Jelling stone, with an informative runic inscription mentioning King Harald Blåtand and the conversion of the Danes, is at the core of a large and important archaeological site of the late tenth century situated in the centre of the Danish peninsula. The stone is thought to have been positioned immediately to the south of some sort of church, and between the two mounds ever since that period. The great boulder has three main surfaces, all closely covered by carving. The first face has most of the inscription, which, unusually for runes, is arranged in parallel lines as for a Latin text. The second face shows an animal entwined with a snake, and the third face has the earliest image in Scandinavia of Christ – these two ‘pictures’ can be compared to a diptych since they share a similar border and are connected by a ‘hinge’. Identifying a diptych implies that the two faces must have compatible not antagonistic subjects. It is suggested that the design and carving was controlled by a missionary party from Ottonian Germany, and that in choosing the motifs they used various sources, mostly in the writings of Pope Gregory the Great. Following these early sources, the animal and snake can be interpreted as God the Father and God the Holy Spirit. It is likely that Christ is shown ascending to heaven in triumph, so that the two pictures show the Trinity united in celebration of the redemption of mankind