Impact of the introduction of real-time therapeutic drug monitoring on empirical doses of carbapenems in critically ill burn patients.

PURPOSE: Adequate empirical antibiotic dose selection for critically ill burn patients is difficult due to extreme variability in drug pharmacokinetics. Therapeutic drug monitoring (TDM) may aid antibiotic prescription and implementation of initial empirical antimicrobial dosage recommendations. This study evaluated how gradual TDM introduction altered empirical dosages of meropenem and imipenem/cilastatin in our burn ICU. METHODS: Imipenem/cilastatin and meropenem use and daily empirical dosage at a five-bed burn ICU were analyzed retrospectively. Data for all burn admissions between 2001 and 2011 were extracted from the hospital's computerized information system. For each patient receiving a carbapenem, episodes of infection were reviewed and scored according to predefined criteria. Carbapenem trough serum levels were characterized. Prior to May 2007, TDM was available only by special request. Real-time carbapenem TDM was introduced in June 2007; it was initially available weekly and has been available 4 days a week since 2010. RESULTS: Of 365 patients, 229 (63%) received antibiotics (109 received carbapenems). Of 23 TDM determinations for imipenem/cilastatin, none exceeded the predefined upper limit and 11 (47.8%) were insufficient; the number of TDM requests was correlated with daily dose (r=0.7). Similar numbers of inappropriate meropenem trough levels (30.4%) were below and above the upper limit. Real-time TDM introduction increased the empirical dose of imipenem/cilastatin, but not meropenem. CONCLUSIONS: Real-time carbapenem TDM availability significantly altered the empirical daily dosage of imipenem/cilastatin at our burn ICU. Further studies are needed to evaluate the individual impact of TDM-based antibiotic adjustment on infection outcomes in these patients.

Divergent evolution and purifying selection of the flaA gene sequences in Aeromonas

BACKGROUND: The bacterial flagellum is the most important organelle of motility in bacteria and plays a key role in many bacterial lifestyles, including virulence. The flagellum also provides a paradigm of how hierarchical gene regulation, intricate protein-protein interactions and controlled protein secretion can result in the assembly of a complex multi-protein structure tightly orchestrated in time and space. As if to stress its importance, plants and animals produce receptors specifically dedicated to the recognition of flagella. Aside from motility, the flagellum also moonlights as an adhesion and has been adapted by humans as a tool for peptide display. Flagellar sequence variation constitutes a marker with widespread potential uses for studies of population genetics and phylogeny of bacterial species. RESULTS: We sequenced the complete flagellin gene (flaA) in 18 different species and subspecies of Aeromonas. Sequences ranged in size from 870 (A. allosaccharophila) to 921 nucleotides (A. popoffii). The multiple alignment displayed 924 sites, 66 of which presented alignment gaps. The phylogenetic tree revealed the existence of two groups of species exhibiting different FlaA flagellins (FlaA1 and FlaA2). Maximum likelihood models of codon substitution were used to analyze flaA sequences. Likelihood ratio tests suggested a low variation in selective pressure among lineages, with an omega ratio of less than 1 indicating the presence of purifying selection in almost all cases. Only one site under potential diversifying selection was identified (isoleucine in position 179). However, 17 amino acid positions were inferred as sites that are likely to be under positive selection using the branch-site model. Ancestral reconstruction revealed that these 17 amino acids were among the amino acid changes detected in the ancestral sequence. CONCLUSION: The models applied to our set of sequences allowed us to determine the possible evolutionary pathway followed by the flaA gene in Aeromonas, suggesting that this gene have probably been evolving independently in the two groups of Aeromonas species since the divergence of a distant common ancestor after one or several episodes of positive selection. REVIEWERS: This article was reviewed by Alexey Kondrashov, John Logsdon and Olivier Tenaillon (nominated by Laurence D Hurst).

Accélération de la guérison fracturaire par le tériparatide: série de 22 cas et revue de la littérature [Improvement of fracture healing with teriparatide: series of 22 cases and review of the literature].

La pseudarthrose est définie comme une fracture qui ne guérit pas sans intervention additionnelle neuf mois après le traumatisme et en l'absence de progression radiologique pendant les trois derniers mois. Les fractures ostéoporotiques sont à plus grand risque de complications chirurgicales. On se pose de plus en plus souvent la question d'ajouter un traitement médicamenteux pour accélérer le processus de guérison fracturaire. Il existe des données montrant que le tériparatide (anabolisant osseux issu de l'hormone parathyroïdienne) accélère la guérison osseuse et améliore le devenir fonctionnel, avec ou sans chirurgie, dans des situations de fractures typiques ou atypiques. Les risques liés à ce traitement sont faibles, mais la prescription nécessite l'accord de l'assurance-maladie dans cette indication. Nous rapportons notre expérience sur l'utilisation de cette molécule, hors indication officielle, dans des cas complexes de non-guérison fracturaire. Pseudoarthrosis is defined as a non healing fracture 9 months after trauma and without radiological progression within the last three months. Osteoporotic fractures have a greater risk of chirurgical complications. The question of giving a medical treatment in the purpose of accelerating fracture healing is an increasing concern. There are data showing that with teriparatide (bone anabolic treatment derived from the parathyroid hormone) bone healing and functional status are improved, with or without surgery, in the case of either typical or atypical fractures. The risks of this treatment are low but health insurance agreement is needed in this indication. We report our experience with the use of this molecule, out of the official indication, in complex situations of non healing fractures.

Measuring the effects through time of the influence of visuomotor and visuotactile synchronous stimulation on a virtual body ownership illusion

Previous studies have examined the experience of owning a virtual surrogate body or body part through specific combinations of cross-modal multisensory stimulation. Both visuomotor (VM) and visuotactile (VT) synchronous stimulation have been shown to be important for inducing a body ownership illusion, each tested separately or both in combination. In this study we compared the relative importance of these two cross-modal correlations, when both are provided in the same immersive virtual reality setup and the same experiment. We systematically manipulated VT and VM contingencies in order to assess their relative role and mutual interaction. Moreover, we present a new method for measuring the induced body ownership illusion through time, by recording reports of breaks in the illusion of ownership ("breaks") throughout the experimental phase. The balance of the evidence, from both questionnaires and analysis of the breaks, suggests that while VM synchronous stimulation contributes the greatest to the attainment of the illusion, a disruption of either (through asynchronous stimulation) contributes equally to the probability of a break in the illusion.

The Role of the Delay Time in the Modeling of Biological Range Expansions

The time interval between successive migrations of biological species causes a delay time in the reaction-diffusion equations describing their space-time dynamics. This lowers the predicted speed of the waves of advance, as compared to classical models. It has been shown that this delay-time effect improves the modeling of human range expansions. Here, we demonstrate that it can also be important for other species. We present two new examples where the predictions of the time-delayed and the classical (Fisher) approaches are compared to experimental data. No free or adjustable parameters are used. We show that the importance of the delay effect depends on the dimensionless product of the initial growth rate and the delay time. We argue that the delay effect should be taken into account in the modeling of range expansions for biological species

The effect of the birth hospital and the time of birth on the outcome of Finnish very preterm infants

The purpose of this study was to evaluate the effect of the birth hospital and the time of birth on mortality and the long-term outcome of Finnish very low birth weight (VLBW) or very low gestational age (VLGA) infants. This study included all Finnish VLBW/VLGA infants born at <32 gestational weeks or with a birth weight of ≤1500g, and controls born full-term and healthy. In the first part of the study, the mortality of VLBW/VLGA infants born in 2000–2003 was studied. The second part of the study consisted of a five-year follow-up of VLBW/VLGA infants born in 2001–2002. The study was performed using data from parental questionnaires and several registers. The one-year mortality rate was 11% for live-born VLBW/VLGA infants, 22% for live-born and stillborn VLBW/VLGA infants, and 0% for the controls. In live-born and in all (including stillbirths) VLBW/VLGA infants, the adjusted mortality was lower among those born in level III hospitals compared with level II hospitals. Mortality rates of live-born VLBW/VLGA infants differed according to the university hospital district where the birth hospital was located, but there were no differences in mortality between the districts when stillborn infants were included. There was a trend towards lower mortality rates in VLBW/VLGA infants born during office hours compared with those born outside office hours (night time, weekends, and public holidays). When stillborn infants were included, this difference according to the time of birth was significant. Among five-year-old VLBW/VLGA children, morbidity, use of health care resources, and problems in behaviour and development were more common in comparison with the controls. The health-related quality of life of the surviving VLBW/VLGA children was good but, statistically, it was significantly lower than among the controls. The median and the mean number of quality-adjusted life-years were 4.6 and 3.6 out of a maximum five years for all VLBW/VLGA children. For the controls, the median was 4.8 and the mean was 4.9. Morbidity rates, the use of health care resources, and the mean quality-adjusted life-years differed for VLBW/VLGA children according to the university hospital district of birth. However, the time of birth, the birth hospital level or university hospital district were not associated with the health-related quality of life, nor with behavioural and developmental scores of the survivors at the age of five years. In conclusion, the decreased mortality in level III hospitals was not gained at the expense of long-term problems. The results indicate that VLBW/VLGA deliveries should be centralized to level III hospitals and the regional differences in the treatment practices should further be clarified. A long-term follow-up on the outcome of VLBW/VLGA infants is important in order to recognize the critical periods of care and to optimise the care. In the future, quality-adjusted life-years can be used as a uniform measure for comparing the effectiveness of care between VLBW/VLGA infants and different patient groups

Thermal decomposition and stability in a series of heterobimetallic carbonyl compounds of the type [Fe(CO)4(HgX)2] (X=Cl, Br, I)

Heterobimetallic carbonyl compounds of the type [Fe(CO)4(HgX)2] (X= Cl, Br, I), which have metal-metal bonds, have been prepared in order to study their thermal stabilities as a function of the halogen coordinated to mercury atoms. The characterization of the above complexes was carried out by elemental analysis, IR and NMR spectroscopies. Their thermal behaviour has been investigated and the final product was identified by IR spectroscopy and by X-ray powder diffractogram.

A fluorescence probe study of gemini surfactants in aqueous solution: a comparison between n-2-n and n-6-n series of the alkanediyl-a,w-bis (dimethylalkylammonium bromides)

Two series of alkanediyl-a,w-bis (dimethylalkylammonium bromide (n-2-n and n-6-n; n=8, 10,12, and 16) have been synthesized and their micelles properties studied in aqueous solution using pyrene, pyrenecarboxaldehyde (PCA) and 1,8 anilinonaphtalene sulfonic acid sodium salt (ANS) as fluorescent probes. The micelles from these surfactants have been characterized on the basis of the information provided by micelle-solubilized fluorescent probes. The obtained results indicated that the surfactant concentration at which a marked decrease in l max parameter of pyrenecarboxaldehyde (PCA) occurs corresponds to the CMC determined by conductimetric measurements. Changes in the emission spectra of ANS and PCA observed in the submicellar range for both surfactants series (n-2-n and n-6-n) were interpreted as formation of pre-aggregates. It was found that the dimeric surfactants with long spacer (s= 6) form more hydrated aggregates when compared with those formed by the n-2-n and CnTAB surfactants series. This was attributed to a more difficult packing of n-6-n surfactant molecules to form micelles.

Political philosophy, ethnology, and time: a study of the notion of historical handicap

This article starts by identifying the crucial importance of the notion of historical handicap for the present-day social sciences of Latin America. Such notion is not an original invention made by Latinamericanists. On the contrary, I demonstrate that the genealogy of the notion of historical handicap must be sought in the tradition of Western political philosophy. Such genealogy must take into account the way it was integrated into ethnological descriptions. When and how did the Other become the backward, the primitive? While this relation was secondary for ancient Greek thought, theories of historical development became the main source of ethnological categories in the modern era. Interestingly enough, this modern synthesis suited the practical purpose of justifying two successive waves of European imperialistic: the era of discoveries, and 19th century colonialism. The article concludes by raising questions about the present role and application of the social sciences.

Unca Don and Unca Scrooge’s Guide to History. Representations of the Past in the Disney Comics of Don Rosa

This thesis studies the various forms and layers of representations of the past that can be found in the Disney comics of Don Rosa. To stay true to the legacy of renowned comic book artist Carl Barks, Rosa has stopped time in the duck universe to the 1950’s: the decade when Barks created his most noted stories. There is a special feel of historicalness in Rosa’s duck stories, as his characters recall events that occurred in both Rosa’s own stories as well as Barks’. Rosa has shed new light to the past of the characters by writing and illustrating the history of Scrooge McDuck, one of the most beloved Disney characters. Rosa is also adamant that the historical facts used in his stories are always correct and based on thorough research. The methodological tools used in the analysis of the comics come from the fields of comic book studies, film theory, and history culture. Film and comics are recognized by many scholars as very similar media, which share elements that make them comparable in many ways. This thesis utilizes studies on historical film, narrative and genre, which provide valuable insight and comparisons for analysis. The thesis consists of three main chapters, the first of which deconstructs the duck universe in the stories in order to understand how the historicalness in them is created,and which outside elements might affect them, including the genre of Disney comics, publishers, and the legacy of Barks. The next chapter focuses on The Life and Times of Scrooge McDuck series, i.e. the stories which are located in the past. Such stories feature similar representations of history as for example Westerns. They also compress and alter history to meet the restrictions of the medium of comics. The last part focuses on the adventure stories which draw inspiration from for example mythology, and take the characters to strange and mystical, but yet historical worlds. Such treasure-hunting stories show similarity to the action-adventure genre in film and for example their stereotypical representations of foreign cultures. Finally, the chapter addresses the problematic of historical fiction and its capability to write history.

Economic Geographical Analysis of The Finnish Paper Industry

The purpose of this academic economic geographical dissertation is to study and describe how competitiveness in the Finnish paper industry has developed during 2001–2008. During these years, the Finnish paper industry has faced economically challenging times. This dissertation attempts to fill the existing gap between theoretical and empirical discussions concerning economic geographical issues in the paper industry. The main research questions are: How have the supply chain costs and margins developed during 2001–2008? How do sales prices, transportation, and fixed and variable costs correlate with gross margins in a spatial context? The research object for this case study is a typical large Finnish paper mill that exports over 90 % of its production. The economic longitudinal research data were obtained from the case mill’s controlled economic system and, correlation (R2) analysis was used as the main research method. The time series data cover monthly economic and manufacturing observations from the mill from 2001 to 2008. The study reveals the development of prices, costs and transportation in the case mill, and it shows how economic variables correlate with the paper mills’ gross margins in various markets in Europe. The research methods of economic geography offer perspectives that pay attention to the spatial (market) heterogeneity. This type of research has been quite scarce in the research tradition of Finnish economic geography and supply chain management. This case study gives new insight into the research tradition of Finnish economic geography and supply chain management and its applications. As a concrete empirical result, this dissertation states that the competitive advantages of the Finnish paper industry were significantly weakened during 2001–2008 by low paper prices, costly manufacturing and expensive transportation. Statistical analysis expose that, in several important markets, transport costs lower gross margins as much as decreasing paper prices, which was a new finding. Paper companies should continuously pay attention to lowering manufacturing and transporting costs to achieve more profitable economic performance. The location of a mill being far from markets clearly has an economic impact on paper manufacturing, as paper demand is decreasing and oversupply is pressuring paper prices down. Therefore, market and economic forecasting in the paper industry is advantageous at the country and product levels while simultaneously taking into account the economic geographically specific dimensions.

Spatio-temporal modelling of the duration of the cotton cycle in the State Of Goiás, Brazil

The objective of this work was to develop and validate a mathematical model to estimate the duration of cotton (Gossypium hirsutum L. r. latifolium hutch) cycle in the State of Goiás, Brazil, by applying the method of growing degree-days (GD), and considering, simultaneously, its time-space variation. The model was developed as a linear combination of elevation, latitude, longitude, and Fourier series of time variation. The model parameters were adjusted by using multiple-linear regression to the observed GD accumulated with air temperature in the range of 15°C to 40°C. The minimum and maximum temperature records used to calculate the GD were obtained from 21 meteorological stations, considering data varying from 8 to 20 years of observation. The coefficient of determination, resulting from the comparison between the estimated and calculated GD along the year was 0.84. Model validation was done by comparing estimated and measured crop cycle in the period from cotton germination to the stage when 90 percent of bolls were opened in commercial crop fields. Comparative results showed that the model performed very well, as indicated by the Pearson correlation coefficient of 0.90 and Willmott agreement index of 0.94, resulting in a performance index of 0.85.