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Infective endocarditis is a microbial infection of the endothelial surface of the heart, predominantly the heart valves, that is associated with high mortality and morbidity. Few contemporary data exist regarding affected children in our context.
Aims and Objectives:
We aimed to describe the profile and treatment outcomes of infant and childhood endocarditis at our facilities.
This is a retrospective analysis of infants and children with endocarditis at two public sector hospitals in the Western Cape Province of South Africa over a 5-year period. Patients with “definite” and “possible” endocarditis according to Modified Duke Criteria were included in the review.
Forty-nine patients were identified for inclusion; 29 had congenital heart disease as a predisposing condition; 64% of patients met “definite” and 36% “possible” criteria. The in-hospital mortality rate was 20%; 53% of patients underwent surgery with a post-operative mortality rate of 7.7%. The median interval from diagnosis to surgery was 20 days (interquartile range, 9–47 days). Valve replacement occurred in 28% and valve repair in 58%. There was a significant reduction in valvular dysfunction in patients undergoing surgery and only a marginal improvement in patients treated medically. Overall, 43% of patients had some degree of residual valvular dysfunction.
Endocarditis is a serious disease with a high in-hospital mortality and presents challenges in making an accurate diagnosis. Despite a significant reduction in valvular dysfunction, a portion of patients had residual valvular dysfunction. Early surgery is associated with a lower mortality rate, but a higher rate of valve replacement compared with delayed surgery.
Maternal mental health during pregnancy and postpartum predicts later emotional and behavioural problems in children. Even though most perinatal mental health problems begin before pregnancy, the consequences of preconception maternal mental health for children's early emotional development have not been prospectively studied.
We used data from two prospective Australian intergenerational cohorts, with 756 women assessed repeatedly for mental health problems before pregnancy between age 13 and 29 years, and during pregnancy and at 1 year postpartum for 1231 subsequent pregnancies. Offspring infant emotional reactivity, an early indicator of differential sensitivity denoting increased risk of emotional problems under adversity, was assessed at 1 year postpartum.
Thirty-seven percent of infants born to mothers with persistent preconception mental health problems were categorised as high in emotional reactivity, compared to 23% born to mothers without preconception history (adjusted OR 2.1, 95% CI 1.4–3.1). Ante- and postnatal maternal depressive symptoms were similarly associated with infant emotional reactivity, but these perinatal associations reduced somewhat after adjustment for prior exposure. Causal mediation analysis further showed that 88% of the preconception risk was a direct effect, not mediated by perinatal exposure.
Maternal preconception mental health problems predict infant emotional reactivity, independently of maternal perinatal mental health; while associations between perinatal depressive symptoms and infant reactivity are partially explained by prior exposure. Findings suggest that processes shaping early vulnerability for later mental disorders arise well before conception. There is an emerging case for expanding developmental theories and trialling preventive interventions in the years before pregnancy.
X-ray diffraction angles are measured precisely, conveniently, and automatically by a specially designed instrument, the automatic precision X-ray goniometer connected on line to an Elliott 903B data processor. A monitor program controls two such instruments and two diffractometers simultaneously and allows a comprehensive set of experiments to be performed. The sensitivity is such that, when translated into terms of changes in the crystal-lattice parameter, a precision of 1 part in 10,000,000 is being attained, and indications are that absolute measurements are almost as good. The procedures, instrument, and automatic control are described, and the results of performance tests and some applications are given.
The prevalence of burnout and distress among palliative care professionals has received much attention since research suggests it negatively impacts the quality of care. Although limited, research suggests low levels of burnout or distress among healthcare chaplains; however, there has been no research among chaplains working in specific clinical contexts, including palliative care.
This study explored the distress, self-care, and debriefing practices of chaplains working in palliative care.
Exploratory, cross-sectional survey of professional chaplains. Electronic surveys were sent to members of four professional chaplaincy organizations between February and April 2015. Primary measures of interest included Professional Distress, Distress from Theodicy, Informal Self-care, Formal Self-care, and debriefing practices.
More than 60% of chaplains working in palliative care reported feeling worn out in the past 3 months because of their work as a helper; at least 33% practice Informal Self-care weekly. Bivariate analysis suggested significant associations between Informal Self-care and both Professional Distress and Distress from Theodicy. Multivariate analysis also identified that distress decreased as Informal and Formal Self-care increased.
Significance of results
Chaplains working in palliative care appear moderately distressed, possibly more so than chaplains working in other clinical areas. These chaplains also use debriefing, with non-chaplain palliative colleagues, to process clinical experiences. Further research is needed about the role of religious or spiritual beliefs and practices in protecting against stress associated with care for people at the end of life.
The forces on an object impacting the water are extreme in the early moments of water entry and can cause structural damage to biological and man-made bodies alike. These early-time forces arise largely from added mass, peaking when the submergence is much less than one body length. We experimentally investigate a means of reducing impact forces on a rigid sphere by placing the sphere inside a jet of water so that the jet strikes the quiescent water surface prior to entry of the sphere into the pool. The water jet accelerates the pool liquid and forms a cavity into which a sphere falls. Through on-board accelerometer measurements and high-speed imaging, we quantify the force reduction compared to the case of a sphere entering a quiescent pool. Finally, we find the emergence of a critical jet volume required to maximize force reduction; the critical volume is rationalized using scaling arguments informed by near-surface particle image velocimetry (PIV) data.
Though the Italianate Englishman is a well-known figure in the Elizabethan literary scene, our picture of him is drawn generally from plays and satires after 1590. a generation after Roger Ascham introduced the epithet. Moreover, each portraitist in turn strove to outdo the other in vehemence, as we judge from the broadening range of Greene, Lodge, Marston, Jonson, for example, who had themselves not traveled to Italy and might not therefore be able to judge whether their victim, the ‘affectate traveller’, had learned his vice or folly in Italy or France or Spain, or only at home. Presumably the Elizabethans did not care how far out of bounds the term went in describing extremes of cruelty or baseness.
The Literary remains of Christophe de Longueil (Longolius, ca. 1490-1522) were published by Junta in Florence in December 1524. The volume had no collective title, but may be listed as Orationes. It included the writing which Longueil did in Padua during his stay there 1520-1522: 'Orationes duae pro defensione sua in crimen lese maiestatis,' or, as the title appeared over the work itself, 'Perduellionis rei defensio,' a third version of his answer to the charge of treason to the Roman people.