Aetiology and resistance in bacteraemias among adult and paediatric haematology and cancer patients.

OBJECTIVES: A knowledge of current epidemiology and resistance patterns is crucial to the choice of empirical treatment for bacteraemias in haematology and cancer patients. METHODS: A literature review on bacteraemias in cancer patients considered papers published between January 1st 2005 and July 6th 2011. Additionally, in 2011, a questionnaire on the aetiology and resistance in bacteraemias, and empirical treatment, was sent to participants of the European Conference on Infections in Leukemia (ECIL) meetings; recipients were from 80 haematology centres. RESULTS: For the literature review, data from 49 manuscripts were analysed. The questionnaire obtained responses from 39 centres in 18 countries. Compared with the published data, the questionnaire reported more recent data, and showed a reduction of the Gram-positive to Gram-negative ratio (55%:45% vs. 60%:40%), increased rates of enterococci (8% vs. 5%) and Enterobacteriaceae (30% vs. 24%), a decreased rate of Pseudomonas aeruginosa (5% vs. 10%), and lower resistance rates for all bacteria. Nevertheless the median rates of ESBL-producers (15-24%), aminoglycoside-resistant Gram-negatives (5-14%) and carbapenem-resistant P. aeruginosa (5-14%) were substantial, and significantly higher in South-East vs. North-West Europe. CONCLUSIONS: The published epidemiological data on bacteraemias in haematology are scanty and mostly dated. Important differences in aetiology and resistance exist among centres. Updated analyses of the local epidemiology are mandatory to support appropriate empirical therapy.

Development of Performance Properties of Ternary Mixtures and Concrete Pavement Mixture Design and Analysis (MDA): Effect of Paste Quality on Fresh and Hardened Properties of Ternary Mixtures, TPF-5(117), 2012

The purpose of this study was to investigate the effect of cement paste quality on the concrete performance, particularly fresh properties, by changing the water-to-cementitious materials ratio (w/cm), type and dosage of supplementary cementitious materials (SCM), and airvoid system in binary and ternary mixtures. In this experimental program, a total matrix of 54 mixtures with w/cm of 0.40 and 0.45; target air content of 2%, 4%, and 8%; a fixed cementitious content of 600 pounds per cubic yard (pcy), and the incorporation of three types of SCMs at different dosages was prepared. The fine aggregate-to- total aggregate ratio was fixed at 0.42. Workability, rheology, air-void system, setting time, strength, Wenner Probe surface resistivity, and shrinkage were determined. The effects of paste variables on workability are more marked at the higher w/cm. The compressive strength is strongly influenced by the paste quality, dominated by w/cm and air content. Surface resistivity is improved by inclusion of Class F fly ash and slag cement, especially at later ages. Ternary mixtures performed in accordance with their ingredients. The data collected will be used to develop models that will be part of an innovative mix proportioning procedure.

Busulphan-melphalan is the superior myeloablative therapy (mat) for high risk neuroblastoma: results from the hr-nbl1/siopen trial

Purpose: The HR-NBL1 trial of the European SIOP Neuroblastoma Group randomised 2 MAT regimens to demonstrate superiority based on event free survival (EFS).Method: Response eligibility criteria prior to randomisation after Rapid COJEC Induction (J Clin Oncol, 2010) 3 4 2 courses of TVD (Cancer, 2003) included complete bone marrow remission andA ^ 3, but improved, mIBG positive spots. The MAT regimens were BuMel (oral busulfan till 2006, 4_150 mg/m2 in 4 equal doses, or after 2006 intravenous use according to body weight and melphalan 140 mg/m__/day) and CEM (carboplatin ctn. infusion (4xAUC 4.1 mg/ml.min/day), etoposide ctn. infusion (4_338 mg/m__day or 4_200 mg/m__/ day*), melphalan (3_70 mg/m__/day or 3_60 mg/m__/day*. *reduced if GFR<100 ml/ min/1.73m__)). A minimum of 3_10E6 CD34/kgBW PBSC were requested. VOD prophylaxis included ursadiol, but not prophylactic defibrotide. Local control included surgery and radiotherapy of 21 Gy. A total of 598 high risk neuroblastoma patients were randomised (296 BuMel, 302 CEM). The median age at randomisation was 3 years (1-17.2).Results: A significant difference in EFS in favour of BuMel (3-years EFS 49% vs. 33%) was observed as well as for overall survival (3-years OS 60% vs. 48%, p¼0.004) with a median follow up of 3 years. This difference was mainly related to the relapse and progression incidence, which was significantly (p<0.001) lower with BuMel (48% vs. 60%). The severe toxicity rate up to day 100 (ICU and toxic deaths) was below 10%, but was significantly higher for CEM (p¼0.014). The acute toxic death rate was 3% for BuMel and 5% for CEM (NS). The acute MAT toxicity profile favours the BuMel regimen in spite of a total VOD incidence of 18% (grade 3:5%). Based on these results and following advice from the DMC, the randomisation was closed early.

Geostatistical inversion of seismic and GPR reflection images: what can we actually resolve?

Estimation of the spatial statistics of subsurface velocity heterogeneity from surface-based geophysical reflection survey data is a problem of significant interest in seismic and ground-penetrating radar (GPR) research. A method to effectively address this problem has been recently presented, but our knowledge regarding the resolution of the estimated parameters is still inadequate. Here we examine this issue using an analytical approach that is based on the realistic assumption that the subsurface velocity structure can be characterized as a band-limited scale-invariant medium. Our work importantly confirms recent numerical findings that the inversion of seismic or GPR reflection data for the geostatistical properties of the probed subsurface region is sensitive to the aspect ratio of the velocity heterogeneity and to the decay of its power spectrum, but not to the individual values of the horizontal and vertical correlation lengths.

Dynamic Pavement Deflection Measurements, Progress Report, HR-178, 1977

The Road Rater is a dynamic deflection measuring appa-ratus for flexible base pavements. The basic operating principle of the Road Rater is to impart a dynamic loading and measure the resultant movement of the pavement with velocity sensors. This data, when properly adjusted for temperature by use of a nomograph included in this report, can be used to determine pavement life expectancy and estimate overlay thickness required. Road Rater testing will be conducted in the spring, when pave-ments are in their weakest condition, until seasonal correction factors can be developed. The Road Rater does not have sufficient ram weight to effectively evaluate load carrying capacity of rigid pavements. All rigid pavements react similarly to Road Rater testing and generally deflect from 0.65 to 1.30 mils. Research will be continued to evaluate rigid pavements with the Road Rater, however. The Road Rater has proven to be a reliable, trouble free pavement evaluation machine. The deflection apparatus was originally front-mounted, but was rear-mounted during the winter of 1977-78. Since that time, van handling has greatly improved, and front suspension parts are no longer overstressed due to improper weight distribution. The Road Rater provides a fast, economical, nondestructive test method to evaluate flexible pavements. Road Rater test data can be used to predict pavement life, set priorities for asphaltic concrete resurfacing, and design asphaltic concrete overlays. Temperature and seasonal variations significantly affect Road Rater deflection readings and must be considered. A nomograph included in this report adjusts for temperature, but does not correct for seasonal effect. Road Rater testing will be conducted in the spring until seasonal correction factors can be developed. The Road Rater has not successfully evaluated rigid pavements, but research will continue in this area. 1. Recommendations for continuing Road Rater research, evaluation and application are as follows:A computer program should be established to reduce Road Rater raw data (Range and Sensor reading) to HR-178 Road Rater Dynamic Deflections For Determining Structural Rating Of Flexible Pavements mean deflection (mils) and/or structural rating. This computer printout would be similar to present friction testing printouts, and would greatly reduce Road Rater data reduction manpower needs and costs. 2. Seasonal variation study should continue to develop seasonal correction factors. Seasonal test roads will be studied concurrently with routine testing during 1979 to develop this relationship. All Road Rater testing will be conducted in the spring until the seasonal relationship is established. 3. An asphaltic concrete overlay design method should be established based on Road Rater de-flection readings. The AASHTO Interim Guide for Design of Pavement Structures 1972 will be used as a base document for this study. 4. AASHTO Structural numbers should be compared to Road Rater Structural Ratings during 1979 on asphaltic concrete overlay projects. This analysis will enable us to refine Road Rater evaluation of flexible pavements. Roads will be tested before resurfacing and several months

Dynamic Deflections for Determining Structural Rating of Flexible Pavements, HR-178, 1979

The Road Rater is a dynamic deflection measuring apparatus for flexible base pavements. The Road Rater replaces the Benkelman Beam which was last used by the Iowa DOT in 1977. Road Rater test results correlate reasonably well (correlation coefficient = 0.83) with Benkelman Beam test data. The basic differences between the Road Rater and Benkelman Beam are as follows: 1. The Benkelman Beam uses a static 18,000 lb. load while the Road Rater uses a dynamic 800 to 2,000 lb. loading. 2. The Road Rater tests much faster and more economically than the Benkelman Beam. 3. The Road Rater better simulates a moving truck than the Benkelman Beam. The basic operating principle of the Road Rater is to impart a dynamic loading and measure the resultant movement of the pavement with velocity sensors. This data, when properly adjusted for temperature by use of a nomograph included in this report, can be used to determine pavement life expectancy and estimate overlay thickness required. Road Rater testing will be conducted in the spring, when pavements are in their weakest condition, until seasonal correction factors can be developed. The Road Rater does not have sufficient ram weight to effectively evaluate load carrying capacity of rigid pavements. All rigid pavements react similarly to Road Rater testing and generally deflect from 0.65 to 1.30 mils. Research will be contined to evaluate rigid pavements with the Road Rater, however. The Road Rater has proven to be a reliable, troublefree pavement evaluation machine. The deflection apparatus was originally front-mounted,but was rear-mounted during the winter of 1977-78. Since that time, van handling has greatly improved, and front suspension parts are no longer overstressed due to improper weight distribution.

Twenty-four-hour energy expenditure and resting metabolic rate in obese, moderately obese, and control subjects.

Twenty-four-hour energy expenditure (24-EE), resting metabolic rate (RMR) and body composition were determined in 30 subjects from three groups; control (103 +/- 2% ideal body weight, n = 10), moderately obese (129 +/- 1% ideal body weight, n = 6), and obese (170 +/- 5% ideal body weight, n = 14) individuals. Twenty-four EE was measured in a comfortable airtight respiration chamber. When expressed as absolute values, both RMR and 24-EE were significantly increased in obese subjects when compared to normal weight subjects. The RMR was 7592 +/- 351 kJ/day in the obese, 6652 +/- 242 kJ/day in the moderately obese, and 6118 +/- 405 kJ/day in the controls. Mean 24-EE values were 10043 +/- 363, 9599 +/- 277, and 8439 +/- 432 kJ/day in the obese, moderately obese, and controls, respectively. The larger energy expenditure in the obese over 24 h was mainly due to a greater VO2 during the daylight hours. However, 92% of the larger 24-EE in the obese, compared to the control group, was accounted for by the higher RMR and only 8% by other factors such as the increased cost of moving the extra weight of the obese. The higher RMR and 24-EE in the obese was best related to the increased fat free mass.

Short-term, mixed-diet overfeeding in man: no evidence for "luxuskonsumption".

After 13 days of weight maintenance diet (13,720 +/- 620 kJ/day, 40% fat, 15% protein, and 45% carbohydrate), five young men (71.3 +/- 7.1 kg, 181 +/- 8 cm; means +/- SD) were overfed for 9 days at 1.6 times their maintenance requirements (i.e., +8,010 kJ/day). Twenty-four-hour energy expenditure (24-h EE) and basal metabolic rate (BMR) were measured on three occasions, once after 10 days on the weight-maintenance diet and after 2 and 9 days of overfeeding. Physical activity was monitored throughout the study, body composition was measured by underwater weighing, and nitrogen balance was assessed for 3 days during the two experimental periods. Overfeeding caused an increase in body weight averaging 3.2 kg of which 56% was fat as measured by underwater weighing. After 9 days of overfeeding, BMR increased by 622 kJ/day, which could explain one-third of the increase in 24-h EE (2,038 kJ/day); the remainder was due to the thermic effect of food (which increased in proportion with excess energy intake) and the increased cost of physical activity, related to body weight gain. This study shows that approximately one-quarter of the excess energy intake was dissipated through an increase in EE, with 75% being stored in the body. Under our experimental conditions of mixed overfeeding in which body composition measurements were combined with those of energy balance, it was possible to account for all of the energy ingested in excess of maintenance requirements.

Laparoscopic Gastric Banding Outcomes Do Not Depend on Device or Technique. Long-Term Results of a Prospective Randomized Study Comparing the Lapband® and the SAGB®.

BACKGROUND: Gastric banding still represents one of the most widely used bariatric procedures. It provides acceptable weight loss in many patients, but has frequent long-term complications. Because different types of bands may lead to different results, we designed a randomized study to compare the Lapband® with the SAGB®. We hereby report on the long-term results. METHODS: Between December 1998 and June 2002, 180 morbidly obese patients were randomized between Lapband® or SAGB®. Weight loss, long-term morbidity, and need for reoperation were evaluated. RESULTS: Long-term weight loss did not differ between the two bands. Patients who maintained their band had an acceptable long-term weight loss of between 50 and 60 % EBMIL. In both groups, about half the patients developed long-term complications, with about 50 % requiring major redo surgery. There was no difference in the overall rates of long-term complications or failures between the two groups, but patients who had a Lapband® were significantly more prone to develop band slippage/pouch dilatation (13.3 versus 0 %, p < 0,001). CONCLUSIONS: Although in the absence of complication, gastric banding leads to acceptable weight loss; the long-term complication and major reoperation rates are very high independently from the type of band used or on the operative technique. Gastric banding leads to relatively poor overall long-term results and therefore should not be considered the procedure of choice for the treatment of morbid obesity. Patients should be informed of the limited overall weight loss and the very high complication rates.

Influencia de los medios de comunicación y de los grupos sociales en la percepción de la imagen corporal en pacientes con anorexia neviosa

La anorexia nerviosa es un trastorno de la conducta alimentaria que se caracteriza por unapérdida de peso superior al saludablemente recomendado, conductas para perder peso y evitarel aumento de peso, miedo a la obesidad y distorsión de la imagen corporal. Tanto la incidenciacomo la prevalencia de este tipo de trastornos ha aumentado considerablemente en las últimasdécadas, son varios los estudios que afirman que hay una estrecha relación entre la influencia delos factores socioculturales y el grado de distorsión de la imagen corporal en este tipo depacientes.El objetivo de este estudio es analizar la influencia que ejercen los medios de comunicación ylos grupos sociales en la distorsión de la imagen corporal de pacientes con anorexia nerviosa.Para lograr este objetivo se realizará un estudio fenomenológico con pacientes de 16 a 21 añosque se visiten en un hospital de día de trastornos de la conducta alimentaria. Los datos serecogerán mediante de una entrevista semiestructurada basada en los ítems del cuestionario deinfluencia de los modelos estéticos corporales (CIMEC). El análisis de los datos obtenidos serápor edición, transcribiendo la entrevista, identificando los segmentos significativos paraposteriormente poderlos analizar.En relación con las consideraciones finales, es un estudio que dentro de la subjetividad podríaser realmente útil para conocer desde el punto de vista del paciente cómo influyen los medios decomunicación y las relaciones sociales en la anorexia nerviosa, permitiendo la propuesta deacciones futuras que ayuden a estos adolescentes y adultos jóvenes a hacer frente a la presiónque ejerce la sociedad.

New reference tables and user-friendly Internet application for predicted heart weights.

BACKGROUND: Knowledge of normal heart weight ranges is important information for pathologists. Comparing the measured heart weight to reference values is one of the key elements used to determine if the heart is pathological, as heart weight increases in many cardiac pathologies. The current reference tables are old and in need of an update. AIMS: The purposes of this study are to establish new reference tables for normal heart weights in the local population and to determine the best predictive factor for normal heart weight. We also aim to provide technical support to calculate the predictive normal heart weight. METHODS: The reference values are based on retrospective analysis of adult Caucasian autopsy cases without any obvious pathology that were collected at the University Centre of Legal Medicine in Lausanne from 2007 to 2011. We selected 288 cases. The mean age was 39.2 years. There were 118 men and 170 women. Regression analyses were performed to assess the relationship of heart weight to body weight, body height, body mass index (BMI) and body surface area (BSA). RESULTS: The heart weight increased along with an increase in all the parameters studied. The mean heart weight was greater in men than in women at a similar body weight. BSA was determined to be the best predictor for normal heart weight. New reference tables for predicted heart weights are presented as a web application that enable the comparison of heart weights observed at autopsy with the reference values. CONCLUSIONS: The reference tables for heart weight and other organs should be systematically updated and adapted for the local population. Web access and smartphone applications for the predicted heart weight represent important investigational tools.

Comparació del servei en curt i en llarg del porter dins de la fase ofensiva del joc

En el procés ofensiu de la majoria d’equips de futbol, es pot distingir una tendència a jugar en base a dos estils de joc. Un estil basat en un joc en curt, per tal de poder mantenir la possessió de la pilota, i estar durant més temps atacant la porteria contraria. I un altre estil que prefereix buscar la profunditat en les seves accions, anant d’una forma més directe cap a la porteria rival. En aquest treball es pretén analitzar quin dels dos estils és millor perquè un equip encadeni un total de 6 accions, tenint com a referència en l’inici de la jugada al porter. Per tal d’aconseguir-ho s’analitzaran els 24 partits de la fase de grups de l’Eurocopa 2012 a través d’una metodologia pròpia, que ens permetrà saber a través de quines situacions rep la pilota el porter abans de posar la pilota en joc, i a través de quines accions, l’equip no és capaç d’assolir el nombre d’encadenaments marcat.

Marked increase of venlafaxine enantiomer concentrations as a consequence of metabolic interactions: a case report.

On three occasions, unusually high trough plasma concentrations of venlafaxine were measured in a patient phenotyped and genotyped as being an extensive CYP2D6 metabolizer and receiving 450 mg/day of venlafaxine and multiple comedications. Values of 1.54 and of 0.60 mg/l of venlafaxine and O-desmethylvenlafaxine, respectively, were determined in the first blood sample, giving an unusually high venlafaxine to O-desmethylvenlafaxine ratio. This suggests an impaired metabolism of venlafaxine to O-desmethylvenlafaxine, and is most likely due to metabolic interactions with mianserin (240 mg/day) and propranolol (40 mg/day). Concentration of (S)-venlafaxine measured in this blood sample was almost twice as high as (R)-venlafaxine ((S)/(R) ratio: 1.94). At the second blood sampling, after addition of thioridazine (260 mg/day), which is a strong CYP2D6 inhibitor, concentrations of venlafaxine were further increased (2.76 mg/l), and concentrations of O-desmethylvenlafaxine decreased (0.22 mg/l). A decrease of the (S)/(R)-venlafaxine ratio (-20%) suggests a possible stereoselectivity towards the (R)-enantiomer of the enzyme(s) involved in venlafaxine O-demethylation at these high venlafaxine concentrations. At the third blood sampling, after interruption of thioridazine, concentrations of venlafaxine and O-desmethylvenlafaxine were similar to those measured in the first blood sample. This case report shows the importance of performing studies on the effects of either genetically determined or acquired deficiency of metabolism on the kinetics of venlafaxine.

Diagnostic potential of neutrophil elastase inhibitor complex in the routine care of critically ill newborn infants.

It has been suggested that determination of the neutrophil elastase alpha1-proteinase inhibitor complex (E-alpha1PI) improves the diagnosis of bacterial infection in newborns. We evaluated the use of E-alpha1PI measurements in 143 newborns, consecutively admitted to a tertiary intensive care unit, employing a new random access assay and a sampling procedure that minimises post-collection artefacts. The 95% range for noninfected newborns was 20-110 microg/l up to the 5th day of life and 20-85 microg/l thereafter. The sensitivity as to the diagnosis of culture-proven bloodstream infection was 80% for E-alpha1PI, 86% for the immature to total neutrophil ratio, 64% for C-reactive protein and 37% for the total white blood cell count. The corresponding specificity amounted to 97%, 85%, 85% and 86%, respectively. E-alpha1PI increases preceded elevations of C-reactive protein by 18 h. Like C-reactive protein, E-alpha1PI levels did not distinguish between bloodstream infection and non-bacterial inflammatory responses. Results of E-alpha1PI became available within 1 h of collection and usually 2-3 h before manual leucocyte counts. CONCLUSION: Determination of neutrophil elastase alpha1-proteinase inhibitor levels yields diagnostic advantages comparable to those of manual differential counts but provide faster turnaround times.

The fallacy of slimming products: a case analysis in Switzerland

Introduction: Many people desire to lose weight. This favors the marketing of "miracle" products with overemphasized slimming capacities. To our knowledge, no study regarding the claimed performances of slimming products has ever been conducted in Switzerland. Objectives: To assess weight loss claims of slimming products available in Switzerland by analyzing their corresponding advertisements. Methods: Between May 2008 and February 2013, 31 advertisements for 13 different slimming products from a single producer were collected. Weight loss claims and text of the advertisement were analyzed. Results: Weight loss claims ranged between 7 and 31 kg, with an estimated daily weight loss ranging between 300 g and 1 kg. 84% of the advertisements targeted women (by including the photograph of a woman), 61% showed a picture of a person before and after using the product, and 51% claimed that the product had improved marital relationships. The terms "natural", "miracle/extraordinary" and "scientific" were present in 92%, 77%, and 31% of the products, respectively. Free gifts were provided to buyers for 69% of the products. Cost was very similar for all 13 products (range: 49 to 59 CHF, with 8 products costing the same amount) and no correlation was found between cost of the product and weight loss claims. No differences were found for weight loss claims according to presence or absence of a picture or of the terms ".natural", ".miracle/extraordinary" and ".scientific" Finally, the yearly costs for advertising such products (French-speaking Switzerland) ranged between 56,000 and 126,000 CHF, suggesting that the gains obtained were higher than this value. Conclusion: In Switzerland, advertisements for slimming products use positive and reassuring terms to attract consumers, which are lured by unreachable, false promises of rapid and easy weight loss. Taking into account the costs of advertising, the gains obtained appear to be significant. Legislation on advertising of such products is urgently needed.