Respiratory symptoms in preterm infants: burden of disease in the first year of life.

OBJECTIVE: While respiratory symptoms in the first year of life are relatively well described for term infants, data for preterm infants are scarce. We aimed to describe the burden of respiratory disease in a group of preterm infants with and without bronchopulmonary dysplasia (BPD) and to assess the association of respiratory symptoms with perinatal, genetic and environmental risk factors. METHODS: Single centre birth cohort study: prospective recording of perinatal risk factors and retrospective assessment of respiratory symptoms during the first year of life by standardised questionnaires. MAIN OUTCOME MEASURES: Cough and wheeze (common symptoms), re-hospitalisation and need for inhalation therapy (severe outcomes). PATIENTS: 126 preterms (median gestational age 28.7 weeks; 78 with, 48 without BPD) hospitalised at the University Children's Hospital of Bern, Switzerland 1999-2006. RESULTS: Cough occurred in 80%, wheeze in 44%, re-hospitalisation in 25% and long term inhalation therapy in wheezers in 13% of the preterm infants. Using logistic regression, the main risk factor for common symptoms was frequent contact with other children. Severe outcomes were associated with maximal peak inspiratory pressure, arterial cord blood pH, APGAR- and CRIB-Score. CONCLUSIONS: Cough in preterm infants is as common as in term infants, whereas wheeze, inhalation therapy and re-hospitalisations occur more often. Severe outcomes are associated with perinatal risk factors. Preterm infants who did not qualify for BPD according to latest guidelines also showed a significant burden of respiratory disease in the first year of life.

Advanced trauma life support, 8th edition, the evidence for change.

The American College of Surgeons Committee on Trauma's Advanced Trauma Life Support Course is currently taught in 50 countries. The 8th edition has been revised following broad input by the International ATLS subcommittee. Graded levels of evidence were used to evaluate and approve changes to the course content. New materials related to principles of disaster management have been added. ATLS is a common language teaching one safe way of initial trauma assessment and management.

Personality, psychosocial and health-related predictors of quality of life in old age.

OBJECTIVES: Beyond its well-documented association with depressive symptoms across the lifespan, at an individual level, quality of life may be determined by multiple factors: psychosocial characteristics, current physical health and long-term personality traits. METHOD: Quality of life was assessed in two distinct community-based age groups (89 young adults aged 36.2 ± 6.3 and 92 older adults aged 70.4 ± 5.5 years), each group equally including adults with and without acute depressive symptoms. Regression models were applied to explore the association between quality of life assessed with the World Health Organization Quality of Life - Bref (WHOQOL-Bref) and depression severity, education, social support, physical illness, as well as personality dimensions as defined by the Five-Factor Model. RESULTS: In young age, higher quality of life was uniquely associated with lower severity of depressive symptoms. In contrast, in old age, higher quality of life was related to both lower levels of depressive mood and of physical illness. In this age group, a positive association was also found between quality of life and higher levels of Openness to experience and Agreeableness personality dimensions. CONCLUSION: Our data indicated that, in contrast to young cohorts, where acute depression is the main determinant of poor quality of life, physical illness and personality dimensions represent additional independent predictors of this variable in old age. This observation points to the need for concomitant consideration of physical and psychological determinants of quality of life in old age.

Abnormal sensitivity to negative feedback in late-life depression.

AIMS: The purpose of the present study was to probe sensitivity to potentially misleading negative feedback on cognitive tasks as a possible mechanism of cognitive impairment in elderly patients with mild depression. METHODS: A total of 22 mildly depressed elderly subjects were compared to 22 healthy controls, using a computerized Tower-of-London task. RESULTS: Failure and magnitude of failure were significantly worse after negative but not positive feedback. Depression predicted failure after negative feedback but not the magnitude of failure. Neither failure nor magnitude of failure increased as a consequence of repeated negative feedback. CONCLUSIONS: Altered sensitivity to negative feedback occurs in mild late-life unipolar depression and may represent a subtle context-specific phenomenon.

Life cycle of a biologist.

Review of the book : "Lives of a biologist: Adventures in a century of extraordinary science", by J.T. Bonner, Harvard University Press, Cambridge, USA

Use of a renal-specific oral supplement by haemodialysis patients with low protein intake does not increase the need for phosphate binders and may prevent a decline in nutritional status and quality of life.

BACKGROUND: Protein-energy wasting is a frequent and debilitating condition in maintenance dialysis. We randomly tested if an energy-dense, phosphate-restricted, renal-specific oral supplement could maintain adequate nutritional intake and prevent malnutrition in maintenance haemodialysis patients with insufficient intake. METHODS: Eighty-six patients were assigned to a standard care (CTRL) group or were prescribed two 125-ml packs of Renilon 7.5(R) daily for 3 months (SUPP). Dietary intake, serum (S) albumin, prealbumin, protein nitrogen appearance (nPNA), C-reactive protein, subjective global assessment (SGA) and quality of life (QOL) were recorded at baseline and after 3 months. RESULTS: While intention to treat analysis (ITT) did not reveal strong statistically significant changes in dietary intake between groups, per protocol (PP) analysis showed that the SUPP group increased protein (P < 0.01) and energy (P < 0.01) intakes. In contrast, protein and energy intakes further deteriorated in the CTRL group (PP). Although there was no difference in serum albumin and prealbumin changes between groups, in the total population serum albumin and prealbumin changes were positively associated with the increment in protein intake (r = 0.29, P = 0.01 and r = 0.27, P = 0.02, respectively). The SUPP group did not increase phosphate intake, phosphataemia remained unaffected, and the use of phosphate binders remained stable or decreased. The SUPP group exhibited improved SGA and QOL (P < 0.05). CONCLUSION: This study shows that providing maintenance haemodialysis patients with insufficient intake with a renal-specific oral supplement may prevent deterioration in nutritional indices and QOL without increasing the need for phosphate binders.

Is the absence of spiritual well-being at the facit-sp equivalent to spiritual distress in older patients?

Objective: Although initially developed to assess spiritual well-being,the FACIT-Sp is increasingly used to assess the other end of the spectrum,i.e. spiritual distress. This study intends to investigate whether theFACIT-Sp could really contribute to this aim in older patients. Method:Patients (N=135, 81.47.1 years, 68.3% women) aged 65 years and over,with MMSE score>19, admitted consecutively in post-acute rehabilitationwere enrolled. The FACIT-Sp (12 items, score 0 to 48, high spiritualwell-being defined as score_36) was administered and commentswere systematically retrieved. Results: Overall, 32(23.7%) patients hadhigh spiritual well-being. FACIT-Sp internal consistency was good(Cronbach's 0.85) and a confirmatory factorial analysis was consistentwith Meaning and Faith proposed subscales. Qualitative analysisshowed that negative answers (score=0) to "My illness has strengthenedmy faith or spiritual beliefs" (N=76/135) could equally reflect theabsence of impact (49/76, 64.5%) or a negative impact (religious struggle,27/76, 35.5%) of illness on faith. However, former patients had significantlyhigher FACIT-Sp scores than the latter (30.35.6 vs 20.97.9,P<.001). Similarly, among patients (N=73/135) with negative answers(score<3) to "I feel a sense of purpose in my life" those mentioning their"old age" to explain their answer (N=34/73, 46.6%) had higher FACITSpscores than those who did not (26.47.7 vs 22.58.1,P=.02). Conclusion:The FACIT-Sp identifies older people with high spiritual wellbeingbut could underestimate well-being in some older patients. Lowscores on some items could have very different meanings and interpretationof FACIT-Sp global scores below the usual cut-off should becautious.

Holy harlots : authority, gender, and the body in medieval English hagiography

This doctoral dissertation aims at describing the representation of holy harlots (Mary Magdalene, Mary of Egypt, Pelagia, Thai's, Afra of Augsburg) in medieval English hagiography. These saints are unique representatives that combine both extremes of the feminine in the medieval imaginaire: she is both, as a saint, the Virgin Mary, the pure and virtuous woman, and, in her past as a prostitute, Eve, the evil female tempter who led all mankind to destruction. The initial question of this thesis is how did hagiographers negotiate the representation of a formerly sinful, sexually active, long- living woman as an authoritative saint? This thesis aims at finding elements of answer to this question, investigating the intersections between gender and authority in the saints' lives of repentant prostitutes in all the vernaculars of medieval England: Old English, Anglo-Norman, and Middle English. It posits that the portrayal of holy harlots' authority and gender is dependent upon social, religious and literary shifts during the medieval period. My contention is that the harlot's gender portrayal changes over the course of the eleventh and twelfth centuries, due notably to the rise of affective piety and the important influence of the romance genre over hagiography. In Anglo-Saxon England, the harlot's gender changes with the saint's conversion: a woman beforehand, her gender is portrayed after her repentance as ambiguous in order for her to become a saint. Her authority derives from her own sanctity in this case. From the twelfth century onward, however, the harlot, now often turned into a beautiful and landed romance lady, is more and more represented as a woman throughout her life, and becomes after her conversion a Bride of Christ. In this way, the dangerously free woman who roamed the streets and prostituted her body becomes less threatening after her conversion, being (re-)inscribed within the male dominated institution of marriage. She now draws her authoritative stance from her gendered intimacy with Christ: although she submits to Christ as his bride, she also gains greater authority than before by way of her privileged relationship with the Savior.

Surgery and granulocyte transfusions for life-threatening infections in chronic granulomatous disease.

We report two patients with chronic granulomatous disease (CGD) and life-threatening infections: a 10 10/12-year-old boy had Aspergillus fumigatus spondylitis with destruction of the 11th vertebral body and paravertebral abscess formation, and an 8 5/12-year-old boy had multiple Staphylococcus aureus hepatic abscesses with subphrenic abscess formation. Both patients failed to respond to intense antimicrobial therapy but showed a remarkable recovery following surgical drainage combined with granulocyte transfusions. These results suggest that antimicrobial therapy and surgical drainage followed by granulocyte transfusions may be the ideal mode of treatment for severe infections in patients with CGD.

Life histories and distribution of ostracods with depth in western Lake Geneva (Petit-Lac), Switzerland: A reconnaissance study

Because environmental conditions within a given basin are different for each season and at different water depth, knowledge of the life history and depth distribution of target species is important for environmental and palaeoenvironmental interpretations based on ostracod species assemblages and/or the geochemical compositions of their valves. In order to determine the distribution of species with depth as well as the life history of species from Lake Geneva, a one year sampling campaign of living ostracods was conducted at five sites (2, 5, 13, 33 and 70 m water depth) on a monthly basis in the Petit-Lac (western basin of Lake Geneva, Switzerland). Based on the results, the different species can be classified into three groups. Littoral taxa are found at 2 and 5 m water depth and include, in decreasing numbers of individuals, Cypridopsis vidua (O. F.Müller, 1776), Pseudocandona compressa (Koch, 1838), Limnocythere inopinata (Baird, 1843), Herpetocypris reptans (Baird, 1835), Potamocypris smaragdina (Vávra, 1891), Potamocypris similis (G. W. Müller, 1912), Plesiocypridopsis newtoni (Brady & Robertson, 1870), Prionocypris zenkeri (Chyzer & Toth, 1858) and Ilyocypris sp. Brady & Norman, 1889. Sublittoral species are found in a majority at 13 m water depth and to a lesser extend at 33 m water depth and include, in decreasing numbers of individuals, Fabaeformiscandona caudata (Kaufmann, 1900), Limnocytherina sanctipatricii, Candona candida (O. F. Müller, 1776) and Isocypris beauchampi (Paris, 1920). Profundal species are found equally at 13, 33 and 70 m water depth and includes, in decreasing numbers of individuals, Cytherissa lacustris (Sars, 1863), Candona neglecta Sars, 1887 and Cypria lacustris Lilljeborg, 1890. The occurrence of Limnocytherina sanctipatricii (Brady & Robertson, 1869) is restricted from late winter to late spring when temperatures are low, while C. vidua, L. inopinata, P. smaragdina, P. similis, P. newtoni and Ilyocypris sp. occur predominantly from spring to early autumn when temperatures are high. Individuals of C. neglecta, C. candida, F. caudata, P. compressa, C. lacustris, H. reptans and Cp. lacustris occur throughout the year with juveniles and adults occurring during the same period (C. neglecta at 70 m, C. lacustris at 13, 33 and 70 m, and H. reptans at 2, 5 and 13 m water depth) or with juveniles occurring during a different period of the year than adults (C. neglecta at 13 and 33 m and C. candida, F. caudata and P. compressa at their respective depth of occurrence). Among the environmental parameters investigated, an estimate of the relationship between ostracod autoecology and environmental parameters suggests that in the Petit-Lac: (i) water temperature and substrate characteristics are important factors controlling the distribution of species with depth, (ii) water temperature is also important for determining the timing of species development and, hence, its specific life history, and (iii) water oxygen and sedimentary organic matter content is less important compared to the other environmental parameter monitored.