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Since their publication in 1950s and 1980s, respectively, the Commentaries on the Geneva Conventions of 1949 and their Additional Protocols of 1977 have become a major reference for the application and interpretation of these treaties. The International Committee of the Red Cross (ICRC), together with a team of renowned experts, is currently updating these Commentaries in order to document developments and provide up-to-date interpretations. The work on the first updated Commentary, the Commentary on the First Geneva Convention relating to the protection of the wounded and sick in the armed forces, has already been finalized. This article provides an overview of the methodology and process of the update and summarizes the main evolutions in the interpretation of the treaty norms reflected in the updated Commentary.
This article explores the cult of St Nicholas in later eleventh-century Bari, focusing on its importance to the new Norman rulers in the region as well as to their subjects. While acknowledging the influence of earlier expressions of the cult in Normandy and in Byzantine southern Italy, it argues that for numerous reasons Nicholas was, for Bari, an especially important – and appropriate – intercessor. During these years, which witnessed the translation of the saint from Myra, economic developments, church politics and the demands of the First Crusade merged to render Nicholas an ideal patron for the city.
Previous work has shown that daily skin cleansing with Chlorhexidine gluconate (CHG) is effective in preventing infection in the medical intensive care unit (MICU). A colorimetric, semiquantitative indicator was used to measure CHG concentration on skin (neck, antecubital fossae, and inguinal areas) of patients bathed daily with CHG during their MICU stay and after discharge from the MICU, when CHG bathing stopped.
Patients and Setting.
MICU patients at Rush University Medical Center.
Methods.
CHG concentration on skin was measured and skin sites were cultured quantitatively. The relationship between CHG concentration and microbial density on skin was explored in a mixed-effects model using gram-positive colony-forming unit (CFU) counts.
Results.
For 20 MICU patients studied (240 measurements), the lowest CHG concentrations (0–18.75 μg/mL) and the highest gram-positive CFU counts were on the neck (median, 1.07 log10 CFUs; P = .014). CHG concentration increased postbath and decreased over 24 hours (P < .001). In parallel, median log10 CFUs decreased pre- to postbath (0.78 to 0) and then increased over 24 hours to the baseline of 0.78 (P = .001). A CHG concentration above 18.75 μg/mL was associated with decreased gram-positive CFUs (P = .004). In all but 2 instances, CHG was detected on patient skin during the entire interbath (approximately 24-hour) period (18 [90%] of 20 patients). In 11 patients studied after MICU discharge (80 measurements), CHG skin concentrations fell below effective levels after 1–3 days.
Conclusion.
In MICU patients bathed daily with CHG, CHG concentration was inversely associated with microbial density on skin; residual antimicrobial activity on skin persisted up to 24 hours. Determination of CHG concentration on the skin of patients may be useful in monitoring the adequacy of skin cleansing by healthcare workers.
Each year Australian fire and land management agencies deploy Incident Management Teams (IMTs) to manage bushfires. An important question is: what are the key competencies required for IMT personnel? Recent research in high reliability organisations suggests that teamwork-related competencies are likely to be most important because incident management depends critically upon interdependent team members, often operating in dynamic, uncertain, time pressured, and high stakes environments. This study used semi-structured interviews with experienced IMT personnel (N = 15) to identify 12 key competencies important for bushfire IMT roles. Analysis of 30 bushfire incidents described by interviewees confirmed that three competencies (a) interpersonal and communication skills, (b) leadership, and (c) IMT procedural knowledge were central. Potential implications for organisational decision making in emergency contexts in general are outlined.
Controlled studies that took place in medical intensive care units (MICUs) have demonstrated that bathing patients with Chlorhexidine gluconate (CHG) can reduce skin colonization with potential pathogens and can lessen the risk of central venous catheter (CVC)-associated bloodstream infection (BSI).
Objective.
TO examine, without oversight of practice by research study staff, the effectiveness or real-world effect of patient cleansing with CHG on rates of CVC-associated BSI.
Design.
In the fall of 2005, the MICU at Rush University Medical Center discontinued bathing patients daily with soap and water and substituted skin cleansing with no-rinse, 2% CHG-impregnated cloths. This change was a clinical management decision without research input.
Setting.
A 21-bed MICU at Rush University Medical Center.
Patients.
Patients hospitalized in the MICU during the period from September 2004 through October 2006.
Methods.
In a pre-post study design, we gathered data from administrative and laboratory databases, infection control practitioner logs, and patient medical charts to compare rates of CVC-associated BSI and blood culture contamination between the baseline soap-and-water bathing period (September 2004-October 2005) and the CHG bathing period (November 2005-October 2006). Rates of secondary BSI, Clostridium difficile infection (CDI), ventilator-associated pneumonia (VAP), and urinary tract infection (UTI) served as control variables that were not expected to be affected by CHG bathing.
Results.
Bathing with CHG was associated with a statistically significant decrease in the rate of CVC-associated BSI (from 5.31 to 0.69 cases per 1,000 CVC-days; P = .006) and in the rate of blood culture contamination (from 6.99 to 4.1 cases per 1,000 patient-days; P = .04). Rates of secondary BSI, CDI, VAP, and UTI did not change significantly.
Conclusions.
In our analysis of real-world practice, daily bathing of MICU patients with CHG was effective at reducing rates of CVC-associated BSI and blood culture contamination. Controlled studies are needed to determine whether these beneficial effects extend outside the MICU.
We report the morphogenesis of a new mouse mutant,
Doublefoot (Dbf). The major phenotypic features
involve the limb and craniofacial regions. There is polydactyly of all
4 limbs, with typically 6–8 digits per
limb. All of the digits are triphalangeal; some show bifurcations and
some are not attached to the
carpus/tarsus. The carpus and tarsus are broader than normal, and
their elements are partially fused. There
are also tibial defects. Mutant embryos show a diencephalic bulge on
d 10.0, with older animals exhibiting
broadened and bulbous skulls sometimes with an additional midline
skeletal element, shortened snouts and
bulging eyes. Homozygotes, which do not survive beyond d 15, show
midline facial clefting. In this study of
the embryonic and fetal development of Dbf animals, we focus on
the morphogenesis of the limbs and head,
and discuss the possible molecular developmental mechanisms.
‘I am very conscious of the difficulties confronting social workers and others in obtaining hard evidence, which will stand up when challenged in court, of the maltreatment meted out to children behind closed doors. Cruelty and physical abuse are notoriously difficult to prove.”
‘My Lords, I am anxious that the decision of the House in this case may establish the law in an unworkable form to the detriment of many children at risk.’
Infectious gastroenteritis is a common cause of hospitalization
in the pediatric population. The most frequent cause of
gastroenteritis is viral in origin. The purpose of this study
was to compare a rapid modified negative-staining TEM method
with the conventional pseudoreplica technique in detection of
viral particles in fecal samples from children with viral
gastroenteritis. The modified negative-staining method resulted
in a significantly higher (2.5 ± 0.5, p = 0.02) viral
rating score than that for the conventional pseudoreplica technique
(1.7 ± 0.4). In addition, the preparation time for the
negative-staining method was approximately one fifth that for
the conventional pseudoreplica technique. Rapid diagnosis of
viral gastroenteritis may be made by ultrastructural detection
of viral particles in fecal samples using the negative staining
technique.
A case of erotomania (de Clérambault's syndrome) in a female with Schneider-positive schizophrenia is presented. The factors in her environment which may have precipitated the illness are discussed. The secondary nature of the syndrome is further illustrated by a discussion of the literature. In erotomania, the deluded victim, usually a woman, believes that a man, unattainable because of his social status, is in love with her. The nosological purity of the syndrome, despite its relative rarity, remains a subject of considerable debate. We present a case of erotomania in a female with schneiderian first rank symptoms (FRS) of schizophrenia (Schneider, 1959).
Details of what occurs in the interval between the hatching of amœbulæ from the spores of the Proteus group of amœbæ to the attainment of the adult condition (4–6 months) not hitherto known are described. The method consists in removing mature adults to petri dishes 4 in. in diameter, containing a dilute inorganic fluid which causes sporulation. The subsequent development of the hatching amœbulaæ can be traced in situ by means of a 4·4 mm. water immersion lens, and is seen to consist of feeding and growth alternating with periods of encystment. The time spent in cysts greatly exceeds that of activity.
Some account of what takes place when cultures of the Proteus group, allowed to dry to a brownish dust, and then wetted, is given. Only in the case of A. proteus have the amœbulæ, which hatch out from the spores, been grown to maturity. It has been shown that the dried cultures used may comprise (1) spores, (2) cysts of varying size from which arise amœbulæ likewise varying in size.
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