Postoperative sepsis in infants below 6 months of age

BACKGROUND: Sepsis is a threatening postoperative complication especially in small infants. Regarding the advances in perinatal medicine, its incidence is unknown to date. We aimed to investigate the incidence, risk factors, laboratory findings and outcome of postoperative sepsis in infants younger than 6 months old. METHODS: We examined postoperative sepsis in babies below 6 months of age during a 4-year period at a tertiary pediatric institution. RESULTS: The rate of postoperative sepsis was 6.9%. Laparotomy with enterotomy, thoracotomy and diaphragmatic hernia repair (P<0.05, respectively) as well as low postnatal age and long operation time (P<0.001, respectively) were correlated with the incidence of sepsis. Significant independent predictors for the development of sepsis were the presence of a central venous catheter and perioperative antibiotic treatment (P<0.001, respectively). Coagulase negative Staphylococci were the major infecting organism associated with postoperative sepsis, accounting for 53% of monomicrobial infections. Complete blood counts with differential were not different between infants with sepsis and controls, who had undergone the same surgical procedures. Outcome was favorable in all cases; however, the length of hospital stay was significantly longer in sepsis patients (P<0.05). CONCLUSIONS: Postoperative sepsis syndrome is a frequent complication in infants below 6 months of age and causes significant prolongation of hospital stay. Adequate prevention and therapeutic strategies warrant further prospective investigations.

Hemostasis management in pediatric mechanical circulatory support

In a 9-year-old boy, bridging to transplantation was successful with an external biventricular device, the Berlin Heart Excor (Berlin Heart, Berlin, Germany), during a 7-month period. Main long-term complications consisted of infection and hypercoagulability with clotting inside the chambers necessitating six pump exchanges, but without thromboembolic events. This report reviews hemostasis monitoring and management of long-term mechanical circulatory support.

Thromboelastometry for the assessment of coagulation abnormalities in early and established adult sepsis: a prospective cohort study

INTRODUCTION: The inflammatory response to an invading pathogen in sepsis leads to complex alterations in hemostasis by dysregulation of procoagulant and anticoagulant factors. Recent treatment options to correct these abnormalities in patients with sepsis and organ dysfunction have yielded conflicting results. Using thromboelastometry (ROTEM(R)), we assessed the course of hemostatic alterations in patients with sepsis and related these alterations to the severity of organ dysfunction. METHODS: This prospective cohort study included 30 consecutive critically ill patients with sepsis admitted to a 30-bed multidisciplinary intensive care unit (ICU). Hemostasis was analyzed with routine clotting tests as well as thromboelastometry every 12 hours for the first 48 hours, and at discharge from the ICU. Organ dysfunction was quantified using the Sequential Organ Failure Assessment (SOFA) score. RESULTS: Simplified Acute Physiology Score II and SOFA scores at ICU admission were 52 +/- 15 and 9 +/- 4, respectively. During the ICU stay the clotting time decreased from 65 +/- 8 seconds to 57 +/- 5 seconds (P = 0.021) and clot formation time (CFT) from 97 +/- 63 seconds to 63 +/- 31 seconds (P = 0.017), whereas maximal clot firmness (MCF) increased from 62 +/- 11 mm to 67 +/- 9 mm (P = 0.035). Classification by SOFA score revealed that CFT was slower (P = 0.017) and MCF weaker (P = 0.005) in patients with more severe organ failure (SOFA >or= 10, CFT 125 +/- 76 seconds, and MCF 57 +/- 11 mm) as compared with patients who had lower SOFA scores (SOFA <10, CFT 69 +/- 27, and MCF 68 +/- 8). Along with increasing coagulation factor activity, the initially increased International Normalized Ratio (INR) and prolonged activated partial thromboplastin time (aPTT) corrected over time. CONCLUSIONS: Key variables of ROTEM(R) remained within the reference ranges during the phase of critical illness in this cohort of patients with severe sepsis and septic shock without bleeding complications. Improved organ dysfunction upon discharge from the ICU was associated with shortened coagulation time, accelerated clot formation, and increased firmness of the formed blood clot when compared with values on admission. With increased severity of illness, changes of ROTEM(R) variables were more pronounced.

Formen aus Stahl, Bauteile aus Titan und Stahl

Die Arcam Technologie setzt erstmals weltweit mit der ‚CAD to Metal®’ Methode einen Elektronenstrahl ein. Mit dieser Methode können homogene Stahlkomponenten und Formen in kürzester Zeit aus einem Metallpulver geschmolzen werden. Die in zunehmendem Maße geforderte Herstellung von Prototypen im Zielwerkstoff, wird mit dem EBM Verfahren erstmals für Stahl- und Titanwerkstoffe ermöglicht. Die Arcam-Methode setzt CAD-Datenmodelle direkt in homogene Metallmodelle um. Mit der Einbringung von konturnahen Kühlkanälen ist es nun auch machbar, Werkzeuge in hochlegierten Stählen im Rapid Prototyping Verfahren herzustellen. So erstellte Werkzeuge können die Zykluszeiten im Spritzguss- und Druckgussprozess um 30% verringern. Die Festigkeiten liegen ohne jegliche Nachbehandlung bei ca. 50 Rockwell. Jede beliebige Formgebung ist sofort in Stahl und neuerdings auch in Titan zu erstellen. Von besonderer Bedeutung ist, dass konturnahe Kühlungen in beliebiger Komplexität integriert werden. Die Arcam Technologie stellt die schnellste Produktionsmöglichkeit von Funktionsprototypen dar, welche in Festigkeit und Temperaturstabilität die gleichen Parameter wie herkömmliche gefertigte Bauteile aufweist. Es stehen Werkzeugstahl (DIN 1.2344), legierte Stähle und Titan (Ti6A14V) zur Verfügung. Die EBM Technologie setzt einen Elektronenstrahl zum Aufschmelzen der Metallpulver ein. Stahl wird z.B. mit einer Temperatur von 1700 °C schichtweise aufgetragen. Ein Verschleiß, wie man ihn von Anlagen mit Lasertechnologie kennt, tritt nicht auf. Neuinvestition in Abständen von 3000 – 4000 Betriebsstunden sind bei dieser Technologie für neue Laser nicht notwendig. Die Arcam-Technologie ist in 24 Ländern patentrechtlich geschützt. Arcam ist ein schwedisches Unternehmen, mit Sitz in Mölndal in der Nähe von Göteborg.

What is the Relation between Human Practical Action and an Accompanying Discourse? Discussing the Status of Practical Theory

The article discusses the function of an accompanying discourse in relation to the genesis of human practical action. On the one side, theory cannot be taken as the ground for practical action; practical action is not a realisation of intentions. On the other hand, human practical action is accompanied by series of explanations, justifications, declarations of intent, pre‑ and post-rationalisations, motivations etc. These accompanying discourses seem in one way or the other to be necessary for the actual realisation of human practical action. Following Pierre Bourdieu, it is suggested that an accompanying discourse cannot in a meaningful manner be separated from the human practical action, that practical theory should be regarded not as theory but as part of practice, and that practical theory first of all provides a common language for talking about practice and hence for reproducing a fundamentally arbitrary idea of the genesis of human practical action. Parallels are drawn to the education/formal training of semi-professionals.

VHB-JOURQUAL2: Method, Results, and Implications of the German Academic Association for Business Research's Journal Ranking

VHB-JOURQUAL represents the official journal ranking of the German Academic Association for Business Research. Since its introduction in 2003, the ranking has become the most influential journal evaluation approach in German-speaking countries, impacting several key managerial decisions of German, Austrian, and Swiss business schools. This article reports the methodological approach of the ranking’s second edition. It also presents the main results and additional analyses on the validity of the rating and the underlying decision processes of the respondents. Selected implications for researchers and higher-education institutions are discussed.

DMG-Lib - The Digital Mechanism and Gear Library

Motion systems are important parts of technical products. Those are mostly composed of mechanisms and gears. Today mechanism and gear technology is essential for the whole industry and it will become even more important due to the introduction of new technologies and respective new fields of applications.

High plant species richness indicates management-related disturbances rather than the conservation status of forests

There is a wealth of smaller-scale studies on the effects of forest management on plant diversity. However, studies comparing plant species diversity in forests with different management types and intensity, extending over different regions and forest stages, and including detailed information on site conditions are missing. We studied vascular plants on 1500 20 m × 20 m forest plots in three regions of Germany (Schwäbische Alb, Hainich-Dün, Schorfheide-Chorin). In all regions, our study plots comprised different management types (unmanaged, selection cutting, deciduous and coniferous age-class forests, which resulted from clear cutting or shelterwood logging), various stand ages, site conditions, and levels of management-related disturbances. We analyzed how overall richness and richness of different plant functional groups (trees, shrubs, herbs, herbaceous species typically growing in forests and herbaceous light-demanding species) responded to the different management types. On average, plant species richness was 13% higher in age-class than in unmanaged forests, and did not differ between deciduous age-class and selection forests. In age-class forests of the Schwäbische Alb and Hainich-Dün, coniferous stands had higher species richness than deciduous stands. Among age-class forests, older stands with large quantities of standing biomass were slightly poorer in shrub and light-demanding herb species than younger stands. Among deciduous forests, the richness of herbaceous forest species was generally lower in unmanaged than in managed forests, and it was even 20% lower in unmanaged than in selection forests in Hainich-Dün. Overall, these findings show that disturbances by management generally increase plant species richness. This suggests that total plant species richness is not suited as an indicator for the conservation status of forests, but rather indicates disturbances.

Aseptic intussuscepted incidental appendectomy: three successful cases

BACKGROUND: Incidental appendectomy remains a controversial issue. We aimed to collect experience using a modified surgical technique that could be applied securely in infants. METHODS: We performed aseptic intussuscepted incidental appendectomy (AIIA) in three patients using a technique that is thought to assure appendix necrosis along with intact cecal wall. RESULTS: There was no perioperative morbidity due to AIIA in the three patients. In two infants the necrotic appendix was found in the diaper. One infant died secondary to diaphragmatic hernia. Autopsy with histological examination revealed that the cecum was intact along with appendix necrosis. CONCLUSIONS: Modified AIIA could securely be performed in the 3 reported cases. We advocate prospective evaluation of the method.

Continental-scale temperature variability during the past two millennia

Past global climate changes had strong regional expression. To elucidate their spatio-temporal pattern, we reconstructed past temperatures for seven continental-scale regions during the past one to two millennia. The most coherent feature in nearly all of the regional temperature reconstructions is a long-term cooling trend, which ended late in the nineteenth century. At multi-decadal to centennial scales, temperature variability shows distinctly different regional patterns, with more similarity within each hemisphere than between them. There were no globally synchronous multi-decadal warm or cold intervals that define a worldwide Medieval Warm Period or Little Ice Age, but all reconstructions show generally cold conditions between ad 1580 and 1880, punctuated in some regions by warm decades during the eighteenth century. The transition to these colder conditions occurred earlier in the Arctic, Europe and Asia than in North America or the Southern Hemisphere regions. Recent warming reversed the long-term cooling; during the period ad 1971–2000, the area-weighted average reconstructed temperature was higher than any other time in nearly 1,400 years.