The epidemiology of sepsis during rapid response team reviews in a teaching hospital

In a three-month retrospective study, we assessed the proportion of rapid response team (RRT) calls associated with systemic inflammatory response syndrome (SIRS) and sepsis. We also documented the site of infection (whether it was community- or hospital-acquired), antibiotic modifications after the call and in-hospital outcomes. Amongst 358 RRT calls, two or more SIRS criteria were present in 277 (77.4%). Amongst the 277 RRT calls with SIRS criteria, 159 (57.4%) fulfilled sepsis criteria in the 24 hours before and 12 hours after the call. There were 118 of 277 (42.6%) calls with SIRS criteria but no evidence of sepsis and 62 of 277 (22.3%) calls associated with both criteria for sepsis as well as an alternative cause for SIRS. Hence, 159 (44.4%) of all 358 RRT calls over the three-month study period fulfilled criteria for sepsis and in 97 (159-62) (27.1%) of the 358 calls, there were criteria for sepsis without other causes for SIRS criteria. The most common sites of infection were respiratory tract (86), abdominal cavity (38), urinary tract (26) and bloodstream (26). Infection was hospital-acquired in 91 (57.2%) and community-acquired in 67 (42.1%) cases, respectively. Patients were on antibiotics in 127 of 159 (79.9%) cases before the RRT call and antibiotics were added or modified in 76 of 159 (47.8%) cases after RRT review. The hospital length-of-stay of patients who received an RRT call associated with sepsis was longer than those who did not (16.0 [8.0 to 28.5] versus 10 days [6.0 to 18.0]; P=0.002).

Patients want to know about the 'cardiac blues'

BACKGROUND: Much attention has been given to identifying and supporting the minority of patients who develop severe clinical depression after a cardiac event. However, relatively little has been given to supporting the many patients who experience transient but significant emotional disturbance that we term the 'cardiac blues'. OBJECTIVE: The aim of this study was to investigate patients' preferences regarding information provision about cardiac blues. METHODS: One hundred and sixty consecutive cardiac patients admitted to two Victorian hospitals in Australia were interviewed three times over six months. They were asked about emotional issues, including information provision preferences. RESULTS: Four out of five (81%) patients would like to have received information about the cardiac blues, but only a minority received this information. CONCLUSION: Most patients want to know about cardiac blues. The development and evaluation of resources for health professionals and patients to support recovery through cardiac blues appears warranted.

Promoting clinical reasoning in general practice trainees: role of the clinical teacher

BACKGROUND: Clinical reasoning requires knowledge, cognition and metacognition, and is contextually bound. Clinical teachers can and should play a key role in explicitly promoting clinical reasoning.

CONTEXT: The aim of this article is to relate the clinical reasoning literature to the general practice or family medicine context, and to provide clinical teachers with strategies to promote clinical reasoning.

INNOVATION: It is important that the clinical teacher teaches trainees the specific skills sets of the expert general practitioner (e.g. synthesising skills, recognising prototypes, focusing on cues and clues, using community resources and dealing with uncertainty) in order to promote clinical reasoning in the context of general practice or family medicine. Clinical teachers need to understand their own reasoning processes as well as be able to convey that knowledge to their trainees. They also need to understand the developmental stages of clinical reasoning and be able to nurture each trainee's own expertise. Strategies for facilitating effective clinical reasoning in trainees include adequate exposure to patients, offering the trainees opportunity for reflection and feedback, and coaching on the techniques of reasoning in the general practice context.

IMPLICATIONS: The journey to expertise in clinical reasoning is unique to each clinician, with different skills developing at different rates, depending on content, context and past experience. Doctors enter into general practice training with the building blocks of biomedical and clinical knowledge and a desire to learn how to be a general practitioner. Clinical teachers are integral in the process of helping trainees learn how to 'think like a general practitioner'.

Recommendations for physical activity in older adults

 Older adults find it difficult to meet moderate and vigorous exercise targets. Given that a dose-response exists for physical activity and health benefits, Phillip B Sparling and colleagues argue that a change in message to reduce sedentary time and increase light activities may prove more realistic and pave the way to more intense exercise

Internal Architecture and Population Size of Acromyrmex subterraneus molestans (Hymenoptera, Formicidae) Nests: Comparison Between a Rural and an Urban Area

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Mutagenicity and antimutagenicity of (-)-hinokinin a trypanosomicidal compound measured by Salmonella microsome and comet assays

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Aerial stem and leaf morphoanatomy of some species of Smilax

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Internal standardization and least-squares background correction in high-resolution continuum source flame atomic absorption spectrometry to eliminate interferences on determination of Pb in phosphoric acid

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Evaluation and application of bismuth as an internal standard for the determination of lead in wines by simultaneous electrothermal atomic absorption spectrometry

A method for the direct determination of Pb in wines by simultaneous multi-element atomic absorption spectrometry (SIMAAS) using a transversely heated graphite atomizer, Zeeman-effect background corrector and internal standardization is proposed. Bismuth was used as an internal standard and Pd(NO3)(2) plus Mg(NO3)(2) as chemical modifier,to stabilize both the analyte and the internal standard. The implementation of two pyrolysis steps avoided any build-up of carbonaceous residues on the graphite platform. All diluted samples (1 + 1 v/v) in 0.2% v/v HNO3 and reference solutions (5.0-50 mug l(-1) Ph in 0.2% v/v HNO3) were spiked with 25 mug l(-1) Bi. For a 20 mul aliquot dispensed into the graphite tube, a good correlation (r = 0.9997) was obtained between the ratio of the analyte signal to the internal standard signal and the analyte concentration of the reference solutions. The electrothermal behaviour of Pb and Bi in red, white and rose wines were compared. In addition, absorbance variations due to changes in experimental conditions, such as atomizer temperature, integration time, injected sample volume, radiation beam intensity, graphite tube surface, dilution and sample composition, were minimized by using Bi as internal standard. Relative standard deviations of measurements based on integrated absorbance varied from 0.1 to 3.4% and from 0.5 to 7.3% (n = 12) with and without internal standard correction, respectively. Good recoveries (91-104%) for Pb spikes were obtained. The characteristic mass was 45 pg Pb and the limit of detection based on integrated absorbance was 0.9 mug l(-1) Pb. Internal standardization increased the lifetime of the tube by 25%. Direct determinations of Pb in wines with and without internal standardization approaches were in agreement at the 95% confidence level. The repeatability and the tube lifetime were improved when using Bi as internal standard. The improvement in accuracy using an internal standard was only observed when the analytical results were affected by errors.

The tadpole of Scinax catharinae (Anura : Hylidae) with description of the internal oral morphology, and a review of the tadpoles from the Scinax catharinae group

We present a description of the external morphology and internal oral features of the tadpole of Scinax catharinae and comparisons with the known tadpoles of the S. catharinae group. Two characters of the external morphology present some intraspecific variation: the row of submarginal papillae, which can be uniseriate or absent, and the tail tip, which can be large or small, truncated or not. That said, the tadpole of S. catharinae presents some distinguishing features that differentiate it from other tadpoles in the S. catharinae group: i) the marginal row of papillae with alternate disposition, ii) the spiracle opening on the midline of the body, iii) longest snout length, and iv) largest interorbital distance. The studied species were segregated into five ecomorphological guilds, characterized by external morphological features, tadpole habitat use and vegetation formation of species range. The taxonomy of the S. catharinae group is complex, due to the morphological similarities among the adults. Larval characters could help in the resolution of the taxonomic and phylogenetic complexities, since the morphological differences among the tadpoles in this group seem more conspicuous than those found among the adults.

The influence of cervical finish line, internal relief, and cement type on the cervical adaptation of metal crowns

Objective: the aim of this investigation was to evaluate the cervical adaptation of metal crowns under several conditions, namely (1) variations in the cervical finish line of the preparation, (2) application of internal relief inside the crowns, and (3) cementation using different luting materials. Method and Materials: One hundred eighty stainless-steel master dies were prepared simulating full crown preparations: 60 in chamfer (CH), 60 in 135-degree shoulder (OB), and 60 in rounded shoulder (OR). The finish lines were machined at approximate dimensions of a molar tooth preparation (height: 5.5 mm; cervical diameter: 8 mm; occlusal diameter: 6.4 mm; taper degree: 6; and cervical finish line width: 0.8 mm). One hundred eighty corresponding copings with the same finish lines were fabricated. A 30-mu m internal relief was machined 0.5 mm above the cervical finish line in 90 of these copings. The fit of the die and the coping was measured from all specimens (L0) prior to cementation using an optical microscope. After manipulation of the 3 types of cements (zinc phosphate, glass-ionomer, and resin cement), the coping was luted on the corresponding standard master die under 5-kgf loading for 4 minutes. Vertical discrepancy was again measured (L1), and the difference between L1 and L0 indicated the cervical adaptation. Results: Significant influence of the finish line, cement type, and internal relief was observed on the cervical adaptation (P < .001). The CH type of cervical finish line resulted in the best cervical adaptation of the metal crowns regardless of the cement type either with or without internal relief (36.6 +/- 3 to 100.8 +/- 4 mu m) (3-way analysis of variance and Tukey's test, alpha = .05). The use of glass-ionomer cement resulted in the least cervical discrepancy (36.6 +/- 3 to 115 +/- 4 mu m) than those of other cements (45.2 +/- 4 to 130.3 +/- 2 mu m) in all conditions. Conclusion: the best cervical adaptation was achieved with the chamfer type of finish line. The internal relief improved the marginal adaptation significantly, and the glass-ionomer cement led to the best cervical adaptation, followed by zinc phosphate and resin cement.

Leishmania chagasi infection in cats with dermatologic lesions from an endemic area of visceral leishmaniosis in Brazil

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Marginal fit of nickel-chromium copings before and after internal adjustments with duplicated stone dies and disclosing agent.

STATEMENT OF PROBLEM: Despite careful procedures, master stone dies may be damaged during laboratory procedures. The dentist routinely adjusts castings because the marginal fit of casting is not as accurate as on the dies. PURPOSE: This study evaluated the technique of internal adjustment of castings with use of duplicated stone dies and a disclosing agent to improve marginal fit discrepancy. MATERIAL AND METHODS: Thirty-two nickel-chromium copings were fabricated and simulated standard clinical and laboratory procedures with 2 variables: tooth preparation convergence angles of 6 and 18 degrees, with or without internal relief. Master stone dies and their duplicates were selected for coping construction and internal adjustment, respectively. A specimen positioning device was coupled with a Toolmakers microscope to allow reproducibility of measurements. Each coping was evaluated at 8 locations of its marginal perimeter, before and after internal adjustment. RESULTS: Marginal fit discrepancy of copings were significantly reduced with an internal adjustment technique (mean > 52%) for all experimental groups. Tooth preparations with greater convergence and internally relieved castings recorded a better marginal fit. CONCLUSION: The casting internal adjustment technique with use of duplicated stone dies and a disclosing agent substantially reduced marginal fit discrepancy.

Review of Caribbean economic and social performance in the 1980's and 1990's

Includes bibliography

Macroeconomic policies in times of crisis: options and perspectives

Includes bibliography