A Response to Burt Neuborne

In this response to Burt Neuborne\u27s Who\u27s Afraid of the Human Rights Commission, the author views Neuborne\u27s proposal as representing an inevitable shift in the Commission\u27s limited resources to more preventative measures in combating discrimination. This article argues that Neuborne\u27s approach sacrifices the interests of individual victims of discrimination by focusing Commission resources on employer-centered plans for rights discrimination. The article outlines six drawbacks of the Neuborne model, and concludes that more minor changes will allow a proper balance between allocating resources for post- and pre- event occurrences of discrimination

Cultivo dual in vitro de cepas nativas de Trichoderma spp. frente a Botrytis sp. patógeno de Passiflora ligularis Juss

El objetivo de la investigación fue evaluar el cultivo dual in vitro de cepas nativas. Se evaluó mediante el método del cultivo dual en placas Petri con Papa Dextrosa Agar (PDA), donde se observó crecimiento radial, competencia por espacio y nutrientes, micoparasitismo y grado de inhibición. En consecuencia, se hizo dos instalaciones del diseño completamente aleatorio, con 9 tratamientos y 4 repeticiones. Los resultados del enfrentamiento de las cepas de Trichoderma spp. vs Botrytis sp. mostraron un superior crecimiento radial. Por otro lado, todos los tratamientos de Trichoderma spp. lograron restringir el desarrollo de Botrytis sp., con respecto a su testigo. En la competencia por espacio y nutrientes, las cepas nativas evaluadas de Trichoderma pueden ser un recurso valioso para su evaluación en el control biológico de otras enfermedades en el cultivo de granadilla, como también en el establecimiento de dosis efectivas de las cepas de Trichoderma spp. para el control preventivo de plántulas de granadilla a nivel de invernadero y campo

Rendimiento y composición bromatológica de Setaria sphacelata cv Nandi, en tres edades de rebrote

El objetivo del trabajo de investigación fue evaluar el efecto de la edad de rebrote en el rendimiento y composición bromatológica del pasto Setaria sphacelata, en dos condiciones de fertilidad del suelo. El experimento se realizó en un área de 361 m² de pasto establecido en un suelo de textura franco arenosa, con un pH fuertemente acido (5.15), y un nivel alto de materia orgánica (7.09 %). Se usó un Diseño Completamente Randomizado con arreglo factorial 3 x 2 y tres repeticiones, donde los factores en estudio fueron 3 edades de rebrote y 2 niveles de fertilización. Se obtuvieron 6 tratamientos con tres repeticiones, que recibieron riego por aspersión para mantener una humedad del suelo constante durante el estudio. Las variables evaluadas fueron el rendimiento de materia fresca (MF), materia seca (MS), proteína cruda (PC), fibra cruda (FC) y Cenizas. Los resultados evidenciaron que hubo efectos de la edad de rebrote y la fertilización p ≤ 0.05, mas no así para la interacción de la edad por fertilización. Los mayores rendimientos de MF y MS (7987.1 y 1639.4 kg/ha) se obtuvieron con el tratamiento fertilizado y cosechado a los 60 días, mientras que el menor rendimiento fue para el tratamiento sin fertilización y cosechado a los 30 días con 1973.7 Kg/MF/Ha y 469.8 Kg/MS/Ha. Los valores más altos de proteína se registraron en los pastos cosechados a los 30 días (14.8 y 12.2 % PC) para el pasto fertilizado y sin fertilizaciónque disminuyeron significativamente (p ≤ 0.05) a medida que avanzó la edad. Asimismo, los valores de fibra cruda se incrementaron notablemente (p ≤ 0.05) al transcurrir los días de rebrote y se obtuvieron los porcentajes más altos a los 60 días con 24.9 y 25.3 % para los pastos fertilizados y sin fertilización. La edad de rebrote no causó efecto en los valores de cenizas. Sin embargo, la fertilización manifestó un efecto significativo en el porcentaje de cenizas a los 45 días en los pastos fertilizados y sin fertilizar. Se concluye que, a medida que avanza la edad del pasto Setaria sphacelata, el rendimiento de materia fresca y seca tienden a incrementarse, pero su valor nutricional se ve afectado en la disminución de los valores de proteína (PC) y el aumento del valor de fibra (FC). Además, la fertilización produce efectos en la producción de materia fresca y seca que incrementan los rendimientos significativamente, pero reduce el porcentaje de cenizas

The Effect of Tear Supplementation on Ocular Surface Sensations during the Interblink Interval in Patients with Dry Eye.

PURPOSE: To investigate the characteristics of ocular surface sensations and corneal sensitivity during the interblink interval before and after tear supplementation in dry eye patients. METHODS: Twenty subjects (41.88+/-14.37 years) with dry eye symptoms were included in the dry eye group. Fourteen subjects (39.13+/-11.27 years) without any clinical signs and/or symptoms of dry eye were included in the control group. Tear film dynamics was assessed by non-invasive tear film breakup time (NI-BUT) in parallel with continuous recordings of ocular sensations during forced blinking. Corneal sensitivity to selective stimulation of corneal mechano-, cold and chemical receptors was assessed using a gas esthesiometer. All the measurements were made before and 5 min after saline and hydroxypropyl-guar (HP-guar) drops. RESULTS: In dry eye patients the intensity of irritation increased rapidly after the last blink during forced blinking, while in controls there was no alteration in the intensity during the first 10 sec followed by an exponential increase. Irritation scores were significantly higher in dry eye patients throughout the entire interblink interval compared to controls (p0.05). CONCLUSION: Ocular surface irritation responses due to tear film drying are considerably increased in dry eye patients compared to normal subjects. Although tear supplementation improves the protective tear film layer, and thus reduce unpleasant sensory responses, the rapid rise in discomfort is still maintained and might be responsible for the remaining complaints of dry eye patients despite the treatment

Topical antibiotics as a major contextual hazard toward bacteremia within selective digestive decontamination studies: a meta-analysis

BACKGROUND: Among methods for preventing pneumonia and possibly also bacteremia in intensive care unit (ICU) patients, Selective Digestive Decontamination (SDD) appears most effective within randomized concurrent controlled trials (RCCT’s) although more recent trials have been cluster randomized. However, of the SDD components, whether protocolized parenteral antibiotic prophylaxis (PPAP) is required, and whether the topical antibiotic actually presents a contextual hazard, remain unresolved. The objective here is to compare the bacteremia rates and patterns of isolates in SDD-RCCT’s versus the broader evidence base. METHODS: Bacteremia incidence proportion data were extracted from component (control and intervention) groups decanted from studies investigating antibiotic (SDD) or non-antibiotic methods of VAP prevention and summarized using random effects meta-analysis of study and group level data. A reference category of groups derived from purely observational studies without any prevention method under study provided a benchmark incidence. RESULTS: Within SDD RCCTs, the mean bacteremia incidence among concurrent component groups not exposed to PPAP (27 control; 17.1%; 13.1-22.1% and 12 intervention groups; 16.2%; 9.1-27.3%) is double that of the benchmark bacteremia incidence derived from 39 benchmark groups (8.3; 6.8-10.2%) and also 20 control groups from studies of non-antibiotic methods (7.1%; 4.8 – 10.5). There is a selective increase in coagulase negative staphylococci (CNS) but not in Pseudomonas aeruginosa among bacteremia isolates within control groups of SDD-RCCT’s versus benchmark groups with data available. CONCLUSIONS: The topical antibiotic component of SDD presents a major contextual hazard toward bacteremia against which the PPAP component partially mitigates. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s12879-014-0714-x) contains supplementary material, which is available to authorized users

Canagliflozin and renal outcomes in type 2 diabetes and nephropathy

BACKGROUND Type 2 diabetes mellitus is the leading cause of kidney failure worldwide, but few effective long-term treatments are available. In cardiovascular trials of inhibitors of sodium–glucose cotransporter 2 (SGLT2), exploratory results have suggested that such drugs may improve renal outcomes in patients with type 2 diabetes. METHODS In this double-blind, randomized trial, we assigned patients with type 2 diabetes and albuminuric chronic kidney disease to receive canagliflozin, an oral SGLT2 inhibitor, at a dose of 100 mg daily or placebo. All the patients had an estimated glomerular filtration rate (GFR) of 30 to <90 ml per minute per 1.73 m2 of body-surface area and albuminuria (ratio of albumin [mg] to creatinine [g], >300 to 5000) and were treated with renin–angiotensin system blockade. The primary outcome was a composite of end-stage kidney disease (dialysis, transplantation, or a sustained estimated GFR of <15 ml per minute per 1.73 m2), a doubling of the serum creatinine level, or death from renal or cardiovascular causes. Prespecified secondary outcomes were tested hierarchically. RESULTS The trial was stopped early after a planned interim analysis on the recommendation of the data and safety monitoring committee. At that time, 4401 patients had undergone randomization, with a median follow-up of 2.62 years. The relative risk of the primary outcome was 30% lower in the canagliflozin group than in the placebo group, with event rates of 43.2 and 61.2 per 1000 patient-years, respectively (hazard ratio, 0.70; 95% confidence interval [CI], 0.59 to 0.82; P=0.00001). The relative risk of the renal-specific composite of end-stage kidney disease, a doubling of the creatinine level, or death from renal causes was lower by 34% (hazard ratio, 0.66; 95% CI, 0.53 to 0.81; P<0.001), and the relative risk of end-stage kidney disease was lower by 32% (hazard ratio, 0.68; 95% CI, 0.54 to 0.86; P=0.002). The canagliflozin group also had a lower risk of cardiovascular death, myocardial infarction, or stroke (hazard ratio, 0.80; 95% CI, 0.67 to 0.95; P=0.01) and hospitalization for heart failure (hazard ratio, 0.61; 95% CI, 0.47 to 0.80; P<0.001). There were no significant differences in rates of amputation or fracture. CONCLUSIONS In patients with type 2 diabetes and kidney disease, the risk of kidney failure and cardiovascular events was lower in the canagliflozin group than in the placebo group at a median follow-up of 2.62 years

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Correction to: Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

The original version of this article unfortunately contained a mistake

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat