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OBJECTIVES: Evaluate the relationship between endothelial activation, malaria complications, and long-term cognitive outcomes in severe malaria survivors. DESIGN: Prospectively cohort study of children with cerebral malaria, severe malarial anemia, or community children. SETTING: Mulago National Referral Hospital in Kampala, Uganda. SUBJECTS: Children 18 months to 12 years old with severe malaria (cerebral malaria, n = 253 or severe malarial anemia, n = 211) or community children (n = 206) were followed for 24 months. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Children underwent neurocognitive evaluation at enrollment (community children) or a week following hospital discharge (severe malaria) and 6, 12, and 24 months follow-up. Endothelial activation was assessed at admission on plasma samples (von Willebrand factor, angiopoietin-1 and angiopoietin-2, soluble intercellular adhesion molecule-1, soluble vascular cell adhesion molecule-1, soluble E-Selectin, and P-Selectin). False discovery rate was used to adjust for multiple comparisons. Severe malaria was associated with widespread endothelial activation compared with community children (p < 0.0001 for all markers). Acute kidney injury was independently associated with changes in von Willebrand factor, soluble intercellular adhesion molecule-1, soluble E-Selectin, P-Selectin, and angiopoietin-2 (p < 0.0001 for all). A log(10) increase in angiopoietin-2 was associated with lower cognitive z scores across age groups (children < 5, β −0.42, 95% CI, −0.69 to −0.15, p = 0.002; children ≥ 5, β −0.39, 95% CI, −0.67 to −0.11, p = 0.007) independent of disease severity (coma, number of seizures, acute kidney injury) and sociodemographic factors. Angiopoietin-2 was associated with hemolysis (lactate dehydrogenase, total bilirubin) and inflammation (tumor necrosis factor-α, interleukin-10). In children with cerebral malaria who had a lumbar puncture performed, angiopoietin-2 was associated with blood-brain barrier dysfunction, and markers of neuroinflammation and injury in the cerebrospinal fluid (tumor necrosis factor-α, kynurenic acid, tau). CONCLUSIONS: These data support angiopoietin-2 as a measure of disease severity and a risk factor for long-term cognitive injury in children with severe malaria.

One hundred and eighty-eight cases of error in concrete structures, 29 of which resulted in collapse and 118 in distress, deterioration, excessive cracking, spalling, deflection, or settlement, were collected from consulting engineers and government departments across Canada. The survey indicated that about half the errors originated in the design and the other half were due to faulty construction. Most of the collapses occurred during construction, mainly as a result of inadequate formwork or temporary bracing; some were due to detailing errors in design. Most serviceability failures, on the other hand, occurred during use. Many of those failures were due to lack of consideration in design of deflection or of the effects of temperature, shrinkage, and creep.

Fitzgibbons RJ Jr, Giobbie-Hurder A, Gibbs JO, et al. Watchful waiting vs repair of inguinal hernia in minimally symptomatic men: a randomized clinical trial. JAMA 2006;295:285-92. Background: Men presenting with inguinal hernia often have minimal symptoms, if any. Although elective surgery is

Abstract Background Health care professionals (HCPs) use clinical practice guidelines (CPGs) to make evidence-informed decisions regarding patient care. Although a large number of cancer-related CPGs exist, it is unknown which CPG dissemination and implementation strategies are effective for improving HCP behaviour and patient outcomes in a cancer care context. This review aimed to determine the effectiveness of CPG dissemination and/or implementation strategies among HCPs in a cancer care context. Methods A comprehensive search of five electronic databases was conducted. Studies were limited to the dissemination and/or implementation of a CPG targeting both medical and/or allied HCPs in cancer care. Two reviewers independently coded strategies using the Mazza taxonomy, extracted study findings, and assessed study quality. Results The search strategy identified 33 studies targeting medical and/or allied HCPs. Across the 33 studies, 23 of a possible 49 strategies in the Mazza taxonomy were used, with a mean number of 3.25 (SD = 1.45) strategies per intervention. The number of strategies used per intervention was not associated with positive outcomes. Educational strategies (n = 24), feedback on guideline compliance (n = 11), and providing reminders (n = 10) were the most utilized strategies. When used independently, providing reminders and feedback on CPG compliance corresponded with positive significant changes in outcomes. Further, when used as part of multi-strategy interventions, group education and organizational strategies (e.g. creation of an implementation team) corresponded with positive significant changes in outcomes. Conclusions Future CPG dissemination and implementation interventions for cancer care HCPs may benefit from utilizing the identified strategies. Research in this area should aim for better alignment between study objectives, intervention design, and evaluation measures, and should seek to incorporate theory in intervention design, so that behavioural antecedents are considered and measured; doing so would enhance the field’s understanding of the causal mechanisms by which interventions lead, or do not lead, to changes in outcomes at all levels.

As emergency physicians with a subspecialty in aviation medicine, we agree with Dr. Rieb’s response[1][1] to an analysis article by Kodama and colleagues[2][2] that having naloxone on board is a necessary tool to treat the increasingly common medical emergency of opioid intoxication. Some airlines

Dans son oeuvre intitulée Franciados libri duo, le jésuite Laurent Le Brun personnifie la Nouvelle-France (Nova Gallia). La déesse adresse quatorze élégies rédigées en latin à de puissantes personnalités françaises : ces lettres-poèmes présentent les difficultés auxquelles doivent faire face les Premières Nations en Nouvelle-France, en décrivant la vie des autochtones d’un point de vue topographique et ethnographique. L’ouvrage n’a jusqu’à présent reçu que peu d’attention. Pourtant, la manière dont l’auteur utilise les figures latines classiques et les topoï afin de rendre cet « autre » Canadien compréhensible à un public européen et humaniste mérite d’être étudiée. Parmi ses nombreuses allusions aux poètes classiques, la Franciade entretient un long dialogue intertextuel avec les Tristes et les Pontiques d’Ovide. Ce dialogue permet à Le Brun de transformer l’appel individuel d’un exilé à la clémence impériale en un plaidoyer pour la rédemption universelle d’un monde non civilisé. In his work entitled Franciados libri duo, the Jesuit Laurent Le Brun attributes personality to New France (Nova Gallia). The goddess addresses fourteen elegies written in Latin to powerful French figures: these letter-poems present the difficulties faced by the First Nations in New France by describing aboriginal life from a topographic and ethnographic perspective. The work has received little attention to date, but merits study for the author’s use of classical Latin figures and topoï to render these “other” Canadians comprehensible to a European and humanist public. Among its many allusions to the classical poets, the Franciad maintains a long intertextual dialogue with Ovid’s Tristia and Epistulae ex Ponto. This dialogue allows Le Brun to transform an exile’s personal appeal for imperial clemency into a plea for the universal redemption of an uncivilized world.

We compared demographic and clinical features, including outcome defined by a failure time analysis of disability, in 143 patients with a family history of multiple sclerosis (familial MS) compared with 956 patients without such a history (sporadic MS). Patients with familial MS did not differ from those with sporadic MS even when patients with 1st-degree relatives or multiple relatives with MS were considered separately. An intraclass correlation analysis of 13 pairs of affected 1st-degree relatives, both members of which were followed in our clinic, failed to reveal heterogeneity among different families. We were unable to find any support for differences between familial and sporadic MS.

The binding of genetically engineered Family II cellulose binding domains (CBDs) of Cellumonas fimi cellulases to cotton fabrics was studied and possible textile applications were investigated. Family II CBDs bound to cotton cellulose increased dye affinity, especially for acid dyes, but with very poor washing fastness. Ironing of the protein bound fabrics before dyeing increases dye affinity, which is probably due to protein denaturation and thus increases exposition of ionic groups. For desorption of CBD proteins from the cotton fabric, high levels of mechanical agitation and alkaline conditions (pH >7) are necessary. Binding of Family II CBDs to cellulose releases fine particles, whereas migration and desorption did not. Long time storage of cotton fabrics with adsorbed CBD proteins did not cause changes in their physical properties and did not damage cotton cellulose. The presence of water on the surface of cellulose was found to be essential for the interfabric migration of Family II CBDs. The double binding cellulose domain binds strongly on cotton and their interfabric migration is smaller. (C) 1999 Elsevier Science Inc. All rights reserved.