Evidence-based guidelines for managing patients with intra-abdominal infection were prepared by an Expert Panel of the Surgical Infection Society and the Infectious Diseases Society of America. These ...updated guidelines replace those previously published in 2002 and 2003. The guidelines are intended for treating patients who either have these infections or may be at risk for them. New information, based on publications from the period 2003–2008, is incorporated into this guideline document. The panel has also added recommendations for managing intra-abdominal infection in children, particularly where such management differs from that of adults; for appendicitis in patients of all ages; and for necrotizing enterocolitis in neonates.
Kidney donation results in reductions in kidney function and lasting perturbations in phosphate homeostasis, which may lead to adverse cardiovascular sequelae. However, the acute effects of kidney ...donation on bone mineral parameters including regulators of calcium and phosphate metabolism are unknown. We conducted a prospective observational controlled study to determine the acute effects of kidney donation on mineral metabolism and skeletal health. Biochemical endpoints were determined before and after donation on days 1, 2 and 3, 6 weeks and 12 months in donors and at baseline, 6 weeks and 12 months in controls. Baseline characteristic of donors (n = 34) and controls (n = 34) were similar: age (53±10 vs 50±14 years, p = 0.33), BMI (26.3±2.89 vs 25.9±3.65, p = 0.59), systolic BP (128±13 vs 130±6 mmHg, p = 0.59), diastolic BP (80±9 vs 81±9 mmHg, p = 0.68) and baseline GFR (84.4±20.2 vs 83.6±25.2 ml/min/1.73m2, p = 0.89). eGFR reduced from 84.4±20.2 to 52.3±17.5 ml/min/1.73m2 (p<0.001) by day 1 with incomplete recovery by 12 months (67.7±22.6; p = 0.002). Phosphate increased by day 1 (1.1(0.9-1.2) to 1.3(1.1-1.4) mmol/L, p <0.001) but declined to 0.8(0.8-1.0) mmol/L (p<0.001) before normalizing by 6 weeks. Calcium declined on day 1 (p = 0.003) but recovered at 6 weeks or 12 months. PTH and FGF-23 remained unchanged, but α-Klotho reduced by day 1 (p = 0.001) and remained low at 6 weeks (p = 0.02) and 1 year (p = 0.04). In this study, we conclude that kidney donation results in acute disturbances in mineral metabolism characterised by a reduced phosphate and circulating α-Klotho concentration without acute changes in the phosphaturic hormones FGF23 and PTH.
Despite this year's trivalent flu vaccine not containing the circulating B Yamagata strain, 1 it could still provide some cross protection with the B/Victoria strain. BMJ 2018; 360: k78. ...10.1136/bmj.k78 29305384 2 Pebody R Warburton F Ellis J. Effectiveness of seasonal influenza vaccine for adults and children in preventing laboratory-confirmed influenza in primary care in the United Kingdom: 2015/16 end-of-season results.
Healthcare workers (n = 803) with mild symptoms were tested for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (n = 90 positive) and asked to complete a symptom questionnaire. Anosmia, ...muscle ache, ocular pain, general malaise, headache, extreme tiredness and fever were associated with positivity. A predictive model based on these symptoms showed moderate discriminative value (sensitivity: 91.2%; specificity: 55.6%). While our models would not justify presumptive SARS-CoV-2 diagnosis without molecular confirmation, it can contribute to targeted screening strategies.
The Hypogeum of the Aurelii: A new interpretation as the collegiate tomb of professional scribae' examines the frescoes of one of the most enigmatic funerary monuments of ancient Rome. The three ...chambers of the Hypogeum of the Aurelii, so-named from an mosaic inscription in one of the surviving chambers, contain a varied series of images that have long been considered an example of early Christian or Gnostic iconography. One hundred years after the monument’s discovery Dr Bradley challenges earlier theories and concludes that far from having religious significance the pictures reveal a world of professional pride among a group of what we might today call ‘white collar workers’. Although not among the rich and famous of Imperial Rome, the deceased nevertheless rose from a state of slavery to positions within the bureaucracy at the centre of an empire at its height. Although part of a strictly hierarchical, and male-dominated, society the community to which the Aurelii belonged provided an environment of comparative equality: a community that acknowledged the contribution and expertise of both women and children in their profession. The pride in their achievement is reflected in the decoration of the tomb in which they expected to spend eternity. This study, the first in modern times to examine all the extant images in detail, will be of interest, not only to historians of ancient Roman art, but also to social historians who wish to more fully understand the lives of those who helped support the running of an empire.
Pediatric community-acquired pneumonia in pre-school aged children is a common diagnosis, frequently treated with antibiotics although most often caused by viruses. An accurate assessment of ...treatment-related clinical outcomes is dependent on identifying the pathogen(s) and their susceptibility to treatment interventions.
Treatment of pediatric AHO requires antibiotic/surgical management. Considerable clinical experience exists, but with current knowledge of antibiotic pharmacokinetics and pharmacodynamics, ...recommendations for dosages for old or new antibiotics should be based on current standards for drug development whenever possible.
Posaconazole (POS) is a potent triazole antifungal agent approved in adults for treatment and prophylaxis of invasive fungal infections (IFIs). The objectives of this study were to evaluate the ...pharmacokinetics (PK), safety, and tolerability of POS oral suspension in pediatric subjects with neutropenia.
This was a prospective, multicenter, sequential dose-escalation study. Enrolled subjects were divided into 3 age groups: AG1, 7 to <18 years; AG2, 2 to <7 years; and AG3, 3 months to <2 years. AG1 and AG2 were divided into 3 dosage cohorts: DC1, 12 mg/kg/day divided twice daily (BID); DC2, 18 mg/kg/day BID; and DC3, 18 mg/kg/day divided thrice daily (TID). AG3 was also divided into DC1 and DC2; however, no subjects were enrolled in DC2. Subjects received 7-28 days of POS oral suspension. PK samples were collected at predefined time points. The POS PK target was predefined as ~90% of subjects with Cavg (AUC /dosing interval) between 500 and 2500 ng/mL, with an anticipated mean steady state Cavg exposure of ~1200 ng/mL.
The percentage of subjects meeting the PK target was <90% across all age groups and dosage cohorts (range: 31% to 80%). The percentage of subjects that achieved the Cavg target of 500 to 2500 ng/mL on Day 7 ranged from 31% to 80%, with the lowest proportion in subjects 2 to <7 years receiving 12 mg/kg/day BID (AG2/DC1) and the highest proportion in subjects 7 to <18 years receiving 18 mg/kg/day TID (AG1/DC3). At all three dose levels (12 mg/kg/day BID, 18 mg/kg/day BID and 18 mg/kg/day TID), subjects in AG1 (7 to <18 years old) had higher mean PK exposures at steady state than those in AG2. High variability in exposures was observed in all groups. POS oral suspension was generally well tolerated and most of the reported adverse events were related to the subjects' underlying diseases.
The POS PK target of 90% of subjects with Cavg between 500 and 2500 ng/mL was not achieved in any of the age groups across the different dosage cohorts. New formulations of the molecule with a greater potential to achieve the established PK target are currently under investigation.
ClinicalTrials.gov identifier: NCT01716234.
Purpose - The purpose of this research is to investigate the impact of team climate and empowering leadership on team members' knowledge-sharing behavior.Design methodology approach - A research ...model was developed based on prior knowledge management studies. Survey data were collected from 434 college students at a major US university, who took courses that required team projects. The partial least squares technique was applied to test the research model.Findings - Team climate and empowering leadership significantly influence individuals' knowledge-sharing behavior by affecting their attitude toward knowledge sharing. These two constructs also have significant direct effects on the knowledge-sharing behavior.Research limitations implications - The student sample and US setting might limit the generalizability of the findings. Nonetheless, this study is based on and extends prior research, which provides a deepened understanding of knowledge sharing in the team context.Practical implications - This research has practical implications for how to design teams to facilitate knowledge sharing. It suggests that cohesive, innovative teams with members trusting one another and led by empowering leaders will have a higher level of knowledge sharing.Originality value - This research originally examines the effects of both team climate and empowering leadership on knowledge sharing. Little prior research has carried out such an integrated analysis. This paper will have significant value for organizations trying to redesign teams to enhance knowledge management.
In 2013 this journal published the paper ‘Integrity in Higher Education Marketing: A typology of misleading data-based claims in the university prospectus.’ It argued that UK universities were using ...data and statistics in a misleading way in their advertising and proposed a nine-part typology to describe such claims. The present paper describes the subsequent responses in national media and academic writing. It then analyses recent developments in the regulation of university marketing in the UK, where the Advertising Standards Authority has publically rebuked universities and issued new guidance. Rulings against six UK universities are analysed and the paper considers the extent to which the new guidance addresses the nine types of misleading claims. The paper goes on to consider how issues such as this come to be addressed by regulators and what incentives will encourage universities to ensure the integrity of their marketing.
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