Infection prevention strategies in a stem cell transplant unit: impact of change of care in isolation practice and routine use of high dose intravenous immunoglobulins on infectious complications and transplant related mortality

OBJECTIVE: Nursing in 'live islands' and routine high dose intravenous immunoglobulins after allogeneic hematopoietic stem cell transplantation were abandoned by many teams in view of limited evidence and high costs. METHODS: This retrospective single-center study examines the impact of change from nursing in 'live islands' to care in single rooms (SR) and from high dose to targeted intravenous immunoglobulins (IVIG) on mortality and infection rate of adult patients receiving an allogeneic stem cell or bone marrow transplantation in two steps and three time cohorts (1993-1997, 1997-2000, 2000-2003). RESULTS: Two hundred forty-eight allogeneic hematopoetic stem cell transplantations were performed in 227 patients. Patient characteristics were comparable in the three cohorts for gender, median age, underlying disease, and disease stage, prophylaxis for graft versus host disease (GvHD) and cytomegalovirus constellation. The incidence of infections (78.4%) and infection rates remained stable (rates/1000 days of neutropenia for sepsis 17.61, for pneumonia 6.76). Cumulative incidence of GvHD and transplant-related mortality did not change over time. CONCLUSIONS: Change from nursing in 'live islands' to SR and reduction of high dose to targeted IVIG did not result in increased infection rates or mortality despite an increase in patient age. These results support the current practice.

Gingival recessions and the change of inclination of mandibular incisors during orthodontic treatment

SUMMARY A recent systematic review demonstrated that, overall, orthodontic treatment might result in a small worsening of periodontal status. The aim of this retrospective study was to test the hypothesis that a change of mandibular incisor inclination promotes development of labial gingival recessions. One hundred and seventy-nine subjects who met the following inclusion criteria were selected: age 11-14 years at start of orthodontic treatment (TS), bonded retainer placed immediately after treatment (T₀), dental casts and lateral cephalograms available pre-treatment (TS), post-treatment (T₀), 2 years post-treatment (T₂), and 5 years post-treatment (T₅). Depending on the change of lower incisor inclination during treatment (ΔInc_Incl), the sample was divided into three groups: Retro (N = 34; ΔInc_Incl ≤ -1 degree), Stable (N = 22; ΔInc_Incl > -1 degree and ≤1 degree), and Pro (N = 123; ΔInc_Incl > 1 degree). Clinical crown heights of mandibular incisors and the presence of gingival recessions in this region were assessed on plaster models. Fisher's exact tests, one-way analysis of variance, and regression models were used for analysis of inter-group differences. The mean increase of clinical crown heights (T₀ to T₅) of mandibular incisors ranged from 0.6 to 0.91 mm in the Retro, Stable, and Pro groups, respectively; the difference was not significant (P = 0.534). At T₅, gingival recessions were present in 8.8, 4.5, and 16.3 per cent patients from the Retro, Stable, and Pro groups, respectively. The difference was not significant (P = 0.265). The change of lower incisors inclination during treatment did not affect development of labial gingival recessions in this patient group.

Change of the condyle-position in maximum intercuspidation during digital, clinical occlusal analysis

Digital analysis of the occlusal contacts can be performed with the T-scan device (T Scan III, TekScan, Boston, USA). However, the thickness of the interocclusal T-scan sheet (100 μm) may lead to a displacement of the mandible. Thus, the aim of this study was to investigate the impact of the T-scan sheet on the position of the mandibular condyles in maximum intercuspidation. Twenty dentate subjects with healthy jaw function were enrolled in the study. An ultrasonic axiography device was used to measure the position of the condyles. Ten 3D condyle positions in maximum intercuspidation of the teeth were recorded: first the reference position without the sheet, then 3 times without the sheet, 3 times with the sheet, and finally again 3 times without the sheet. There was a statistically significant difference (Wilcoxon matched pairs test) between the condyle positions with and without the interocclusally positioned T-scan sheet (P < 0.0005). The T-scan device lead to a displacement of the condyles of about 1 mm mainly in ventral direction (P = 0.005). Thus, occlusal analysis is not performed in physiological, maximum intercuspidation. This has to be considered when interpreting the measured contact points.

Synchronous Change of Atmospheric CO₂ and Antarctic Temperature During the Last Deglacial Warming

Understanding the role of atmospheric CO2 during past climate changes requires clear knowledge of how it varies in time relative to temperature. Antarctic ice cores preserve highly resolved records of atmospheric CO2 and Antarctic temperature for the past 800,000 years. Here we propose a revised relative age scale for the concentration of atmospheric CO2 and Antarctic temperature for the last deglacial warming, using data from five Antarctic ice cores. We infer the phasing between CO2 concentration and Antarctic temperature at four times when their trends change abruptly. We find no significant asynchrony between them, indicating that Antarctic temperature did not begin to rise hundreds of years before the concentration of atmospheric CO2, as has been suggested by earlier studies.

The Contested Floodplain. Institutional Change of the Commons in the Kafue Flats, Zambia

The Contested Floodplain tells the story of institutional changes in the management of common pool resources (pasture, wildlife, and fisheries) among Ila and Balundwe agro-pastoralists and Batwa fishermen in the Kafue Flats, in southern Zambia. It explains how and why a once rich floodplain area, managed under local common property regimes, becomes a poor man’s place and a degraded resource area. Based on social anthropological field research, the book explains how well working institutions in the past, regulating communal access to resources, have turned into state property and open access or privatization. The study focuses on the historic developments taking place since pre-colonial and colonial times up to today. Haller shows how the commons had been well regulated by local institutions in the past, often embedded in religious belief systems. He then explains the transformation from common property to state property since colonial times. When the state is unable to provide well-functioning institutions due to a lack in financial income, it contributes to de facto open access and degradation of the commons. The Zambian copper-based economy has faced crisis since 1975, and many Zambians have to look for economic alternatives and find ways to profit from the lack of state control (a paradox of the present-absent state). And while the state is absent, external actors use the ideology of citizenship to justify free use of resources during conflicts with local people. Also within Zambian communities, floodplain resources are highly contested, which is illustrated through conflicts over a proposed irrigation scheme in the area.

Towards mapping the late Quaternary vegetation change of Europe

The number of well-dated pollen diagrams in Europe has increased considerably over the last 30 years and many of them have been submitted to the European Pollen Database (EPD). This allows for the construction of increasingly precise maps of Holocene vegetation change across the continent. Chronological information in the EPD has been expressed in uncalibrated radiocarbon years, and most chronologies to date are based on this time scale. Here we present new chronologies for most of the datasets stored in the EPD based on calibrated radiocarbon years. Age information associated with pollen diagrams is often derived from the pollen stratigraphy itself or from other sedimentological information. We reviewed these chronological tie points and assigned uncertainties to them. The steps taken to generate the new chronologies are described and the rationale for a new classification system for age uncertainties is introduced. The resulting chronologies are fit for most continental-scale questions. They may not provide the best age model for particular sites, but may be viewed as general purpose chronologies. Taxonomic particularities of the data stored in the EPD are explained. An example is given of how the database can be queried to select samples with appropriate age control as well as the suitable taxonomic level to answer a specific research question.

Morphology Change of C60 Islands on Organic Crystals Observed by Atomic Force Microscopy

Organic-organic heterojunctions are nowadays highly regarded materials for light-emitting diodes, field-effect transistors, and photovoltaic cells with the prospect of designing low-cost, flexible, and efficient electronic devices.1-3 However, the key parameter of optimized heterojunctions relies on the choice of the molecular compounds as well as on the morphology of the organic-organic interface,4 which thus requires fundamental studies. In this work, we investigated the deposition of C60 molecules at room temperature on an organic layer compound, the salt bis(benzylammonium)bis(oxalato)cupurate(II), by means of noncontact atomic force microscopy. Three-dimensional molecular islands of C60 having either triangular or hexagonal shapes are formed on the substrate following a "Volmer-Weber" type of growth. We demonstrate the dynamical reshaping of those C60 nanostructures under the local action of the AFM tip at room temperature. The dissipated energy is about 75 meV and can be interpreted as the activation energy required for this migration process.