A stunning research result was reported recently in the New England Journal of Medicine. In the first controlled trial of an approach to treat Parkinson's disease, patients were recruited to participate in research to assess the effectiveness of human fetal nerve cells transplanted into the area of the brain affected by the disease. Unfortunately, the results were not what researchers or subjects expected.
Instead of seeing their symptoms end, many subjects either didn't see any improvement or experienced a worsening of symptoms so severe that they were reduced to lying in bed with their limbs flailing uncontrollably. Even patients who did see some improvement suffered severe side effects.
Researchers need to investigate the reasons for these results, but one possible answer is that the implanted nerve cells were performing too well and producing too much of the brain chemical that's missing in patients with Parkinson's. Unfortunately, once the cells are implanted they can neither be removed nor controlled. Patients who once suffered from the limitations of the disease ended up far more disabled as a result of their research participation.
Focusing on the benefits of research
It is natural that patients with such a disease would clamor to be in research that proposed to cure it, but few expect that they could be grievously harmed in the process. The way the neural cell transplant trial was conducted fueled such expectations. The researchers divided subjects into two groups -- one had the cells injected into their brains through holes drilled in their skulls, while another had the holes drilled, with no cells implanted. This allowed researchers to compare outcomes between the two groups without subjects knowing whether or not they received the transplants. Subjects were promised that if they were randomized into the group that did not receive the implanted cells, at the end of the trial they would be offered the option of having the implants -- an implicit promise that they too, would receive the benefits of the research.
Remembering what research means
The prospective benefits of research are only half of the picture, as the outcome of this research reinforces. In research in general, we don't know whether a new approach will work but we do know that it has risks and side effects -- some of them unknown, all of them uncertain. Research relies not on the willingness of subjects to avail themselves of the benefits it has to offer, but on their willingness to put themselves in harm's way so that others may benefit. If subjects receive some medical benefit in the process, it's frosting on the cake. But prospective subjects often don't see things this way, and having their unreasonably high expectations dashed can undermine support for research.
The story should serve as a wake-up call for the biomedical research community as well as all of us who participate in and benefit from research -- which means just about everyone. Increasingly, cutting edge research doesn't necessarily mean risk-free research, or research that will always work the way we hope and predict. That doesn't mean we shouldn't do research. But we should have more realistic expectations for what benefits research holds and be more realistic about the costs for achieving them.
"Ethics Matters" Archive
where you'll find other columns from Jeffrey Kahn
on a wide range of bioethics topics.
Separated sisters going home
Surgeon strike may be nearing end
Research targets deadly hidden injuries
Bat bite saliva new stroke treatment?
Another artificial heart implanted
Kidneys may hold blood pressure clue
N. Y. plans to heal skyline
Stocks rise on Case departure
Lieberman's presidential announcement today
New arrests may be linked to UK ricin scare
Jordan says farewell for the third time
Shaq could miss playoff game for child's birth
Ex-USOC official says athletes bent drug rules
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The universe--order without design
- Calle, Carlos I.
- Amherst, N.Y. : Prometheus Books, 2009.
- Physical description
- 304 p.,  p. of plates : ill. (some col.) ; 24 cm.
QB981 .C345 2009
- Unknown QB981 .C345 2009
- Includes bibliographical references (p. 287-288) and index.
- Publisher's Summary
- Is the universe designed for life? Physicists have discovered that many seemingly unconnected phenomena, which took place millions of years apart, played a crucial role in the development of life on Earth. Does such evidence reveal a purpose behind the order of the universe? NASA senior research scientist Carlos I Calle explores this tantalizing question and many more in this wide-ranging introduction to the very latest and sundry theories about the origins and evolution of the enormous cosmos. From the big bang to the possibility of a big crunch he renders the complexities of theoretical physics beautifully lucid for the lay reader. Calle begins by reviewing the milestones of 20th-century astrophysics: the confirmation of the big bang theory in the 1960s by the discovery of cosmic background radiation; the inflationary theory of universe expansion, which NASA observations have recently confirmed; the formulation of the essential laws of physics that govern the unfolding of all physical processes, from subatomic fluctuations to the formation of galaxies; and physicists' attempts to unify all the forces of nature. Now, at the start of the 21st century, questions have been raised about the origins of the laws of physics. Do they suggest a Grand Designer, or is their existence a natural outcome of some automatic process? Calle lays out the cosmological models based on M-theory, which suggests that our particular universe may be one of an unimaginable number of universes, each with its own set of physical laws. According to one of the most promising models, the big bang may not be the moment of creation but the bridge to a past filled with endless cycles of universe creation and destruction. Calle also provides an exciting look at Stephen Hawking's fascinating proposal that the universe had no origin and that present-day observers may influence the very nature of reality. Did the universe require a prime mover the Grand Designer to create the planets, the stars, and the galaxies? This book will give you plenty of food for thought.
(source: Nielsen Book Data)
- Publication date
- Carlos I. Calle.


Background: Youth of color from low-income urban communities are crucial participants in research, as their involvement can shape effective, culturally responsive interventions and policy to promote youth health and well-being. These young people, however, are an often-neglected research population, due in part to perceived challenges associated with their inclusion as well as marginalized communities’ justifiable mistrust of research. Objectives: Based on our experience conducting a school-based randomized intervention trial in Baltimore, Maryland, we present strategies for conducting research with low-income, urban youth of color. We discuss strategies in three domains: university-community partnership development, participant recruitment, and participant retention. Methods: We reviewed partnership building and recruitment strategies employed by our team across four years of trial implementation and evaluated success of participant retention at our final survey timepoint. Results: Partnership building was facilitated by selection of a study design that maximized benefits for all participants, promotion of capacity building at partner institutions, and attention to research staff hiring and training practices. Effective study recruitment strategies included personal contact with parents and close cooperation between school personnel and study staff. Providing incentives and collecting multiple types of participant contact information contributed to increased retention rates. On average, those who participated in the final survey timepoint were less likely to be male and Latinx and exhibited more favorable baseline mental health than those who did not, suggesting differential attrition based on youth characteristics. Conclusions: Lessons learned from this school-based trial can be applied more broadly to research with low-income urban youth of color. Researchers should strive to maximize scientific rigor, minimize harm to vulnerable adolescents and their communities, promote positive research experiences for young people, and provide concrete benefits to those who participate.
- Community partnership
- School-based intervention trial
ASJC Scopus subject areas
- Pharmaceutical Science


This week we learned two ways to solving systems of Linear Equations, they are
(an algebraic method of finding solution for systems by substituting one equation into the other)
Step: 1. Choose the simpler equation and express one variable in terms of the other.
2. Substitute the expression from step 1 into the other equation.
3. Solve the single variable equation.
4. Substitute the solution from step 3 into the equation in step 1 to find the variable.
Steps : 1. If necessary, multiply each equation by a constant to obtain coefficients for x (or y) that are identical (except perhaps for the sigh.)
2. Add or subtract the two equations to eliminate one of the variables.
3. Solve the resulting equation to determine the value of one of the variables.
4. Substitute the solution into either of the original equations to determine the value of the other variable.


Daily programmer challenge #102 was to create a program that counted the number of unique characters in a list of words and output the total number that were below a number you give it. My version does that and works like a command line program by passing system arguments. The file it takes should be a text file that can have multiple words on a line.
./102_intermediate.py file.txt 4
Total words with unique characters under or equal to 4 is 10442


[MUSIC PLAYING] We're going to take a look at a few different terms in this lesson. First of all, the word sacred. This word as an adjective comes from the French word "sacre." And it means consecrated or acceptable to a deity. It was first used in English in around 1380. And it was used to apply to the Eucharistic elements of bread and wine.
Next, the word "transcendent," used as both an adjective and a noun. This word makes its way over from Latin, where it was used in philosophical and theological treatises. Especially in the work of Duns Scotus, who was a famous medieval theologian.
Transcendent in this context means beyond the ordinary limits or excelling. It first appears in English in 1598 in works of philosophy and theology. So it stayed pretty close to its origins in Latin as a technical term in philosophy and theology.
Next, let's take a look at the concept of summum bonum-- the highest good. This term comes from Aristotle, who said that the highest good for humanity is happiness. The Greek term for happiness is "eudaimonia--" having a good spirit, a good life, or a blessed life.
Saint Thomas Aquinas in the medieval period adopts Aristotle for the Catholic Church in Catholic theology. And Saint Thomas Aquinas wrote of an order of loves-- love of God and love of neighbor. Saint Thomas Aquinas conceded that love of God was rather difficult to wrap our minds around and that it actually requires some pretty sophisticated thinking to arrive at the love of God. But it's much easier to love our neighbor who is right in front of our faces.
Next, the same idea of the summum bonum appears also in other religions. For now, sticking with the Abrahamic religions. So Rabbi Hillel, a very important figure in Judaism. He's seen as the ideal Jewish person.
He lived just before the Christian era. And he said, that which is despicable to you, do not do to your fellow. This is the whole Torah and the rest is commentary. Go and learn it. So a version of what Christians call The Golden Rule.
Moving on to Muhammad. In one of the hadith-- the sayings of Muhammad, Muhammad says, that which you want for yourself seek for mankind. So two other Abrahamic religions and also the same idea of the summum bonum, which is to care about other people before yourself.
Let's just go over the terms that we've talked about so far. The word sacred comes from the French "sacre," which means set apart from the ordinary, the worldly, and the mundane. The term "transcendent," makes its way into English from medieval Latin. And it means that which is beyond the ordinary. And summum bonum is the Latin for highest good.
That which is set apart from the ordinary, the worldly, and the mundane.
Latin for "highest good."
That which is beyond the ordinary.


Voice and Memory: Indigenous Imagination and Expression is a companion volume to Indigeneity: Culture and Representation. The essays present a critical enquiry into the cultures and literatures of indigenous communities. They deal with their stories of colonial experience, their marginalization and their struggles to avert the decline of their socio-cultural status, and the emergence of their voice in the respective national literature. Rather than seeking succour from a human rights regime, Aboriginal peoples have consistently looked for lessons of environmental balance and social regeneration in their own literature, knowledge systems and cultural traditions.
The essays in this volume show how these groups have acknowledged, internalized and adapted to their own idiom, linguistic and cultural nuances and expressions left behind as a relic of colonial presence. Further, in their endeavour to analyze the reasons behind their alienation, they have consistently been self critical, holding the white colonists responsible for their current situation, but recognizing and narrating instances of complicity of Aboriginal elders in the persecution of their women.
Running through the volume is the view that the indigenous people are agents rather than objects of change. They have the capacity to classify, codify and present their knowledge and perceive and evaluate changes in the environment. The essays also highlight the rejection by Aboriginal groups of the prevailing view of their cultural heritage as a “social problem”, at odds with the imperatives of contemporary existence.
This book is a celebration of indigenous cultures rooted in their physical and cultural environment rather than an archival repository or a museum gallery. Bringing together scholars from across the world, this volume will be of invaluable interest to students and scholars of sociology, anthropology, tribal studies, colonial studies, literature and linguistics.


Powell’s Journey Through Desolation Canyon – The 1869 Expedition
By Kim Cassels • December 9, 2020
Powell’s Journey Through Desolation Canyon – The 1869 Expedition
Powell’s expedition through Desolation Canyon. This is part two of a three-part series re-tracing John Wesley Powell’s 3-month expedition down the Green and Colorado Rivers; a series and story that we will tell in a style akin to Powell’s own descriptions of the expedition. Powell’s 1869 trip was a government-sponsored expedition to explore the rivers of the west, including the first government-sponsored passage of the Grand Canyon. In this part, we explore the challenges Powell and his crew faced as they traveled through the same canyons our multi-day trips travel down to this day. For this second part of the series, we recount the journey through Desolation Canyon on the Green River. In part three we will explore what happened on Powell’s expedition through Cataract Canyon.
On June 27th, Split Mountain finally spit out the 1869 Powell Expedition with Desolation Canyon soon to come. Desolation remains nearly as remote today as it was in 1869, cutting through the largest wilderness area in the contiguous United States. It’s western Utah at arguably its gnarliest, and most beauteous.
By then they were three weeks into surveying the country’s last unexplored river canyons of “The Great Unknown.”
Already a third of their 10-month food supply— including the boat that carried it— belonged to the Green River. The crew, who began as a rugged-looking bunch, now had a new rabid makeover.
Their skin was sanded down as far as their patience, with beards and mutton chops cooked from a campfire gone wrong— although they had a good laugh about that particular mishap. They very much looked like the terrible work of carrying boats more than rowing them for 60 miles.
It was a widely publicized endeavor across the nation even before the expedition pushed off from Green River, Wyoming. And while it was certainly turning out to be a novel, the stories kept rolling in, despite the 10 men being indubitably far from any reporter’s reach.
This is part two of our series re-tracing the John Wesley Powell expedition through the canyons of Lodore, Desolation, and Cataract. For the previous chapter about the expedition’s chaotic beginnings, read here.
July 3, “Fearful Disaster. Reported Loss of the Powell Expedition Confirmed.”
John Risdon, if that was even his real name, told a particularly colorful tale to the Chicago Tribune about his supposed experience with the revered expedition.
He recalled all but two of the 21 crew members’ names — middle initials included— who drowned in the rapids of the Colorado River on May 16th or 18th. Risdon survived because, for some reason, he had stayed behind to make lunch.
The reporter, who apparently missed word of the actual expedition leaving on May 24th, said Risdon had “the appearance of an honest, reliable man” and rapidly jotted down his account;
“Risdon stood on the shore waving his hat, and said: ‘You must be back in time for dinner, for I will have a good lunch for you when you return.’
They cried back in reply, ‘Good-bye Jack; you will never see us again.’
A moment later, Risdon saw the boat commence whirling around, and like a living thing dive down with its living freight, Major Powell standing at his post, and that was the last Risdon saw of this noble and ill-fated expedition…”
The story was published on July 3rd while Powell and a few others were at a reservation near the Uinta River sending letters, trading supplies, and learning about the Utes. Of course, once Powell’s letters got back to his wife in Illinois— who already knew Risdon’s story was bologna, the newspaper published them as a remedy.
July 4, Goodman out
Frank Goodman, who had joined the group who went to the reservation, decided to throw in the towel. It turned out that nearly drowning, getting caught on fire, carrying oak boats over rocks, and eating rancid bacon wasn’t how he wanted to spend his summer anymore.
Powell wrote, “As our boats are rather heavily loaded, I am content that he should leave, although he has been a faithful man.”
Meanwhile back at base camp on the Green River, George Bradley was in a reflective mood that Independence evening. He had joined the expedition to get out of the military, which proved to be more of a tribulation than he’d expected.
“But those green flowery graves on a hillside far away seem to answer for me, and with moistened eyes I seek again my tent were engaged with my own thoughts, I pass hours with my friends at home, sometimes laughing, sometimes weeping until sleep comes and dreams bring me into the apparent presence of those I love.”
July 6, “Potato tops are not good greens on the sixth day of July.” – Jack Sumner
The crew is reunited and promptly flowing again with the Green River. Shortly into the drift, they came to an island near the White River where Powell suspected a garden.
John Wesley had camped in the White River Valley the winter prior and met an interpreter who was planning to do some planting on the Green. When he learned of Powell’s upcoming journey, he told the Major to help himself to what sprouts.
Sure enough, the fleet found it. Not much had succeeded except for some potato tops, which 18-year-old Andy Hall said were fine eats. They were for a stew, which immediately poisoned everyone but George Bradley and Seneca Howland who had decided to pass on account of the taste.
Powell wrote, “Emetics are administered to those who are willing to take them, and about the middle of the afternoon we are all rid of the pain.”
Despite their temporary tummy aches, the men still managed to make 37 miles and kill four geese along the way according to Jack Sumner’s journal entry that day.
July 7, Enter the Canyon of Desolation
As the walls began to close again on the Green River, the men stopped to survey the cliffs first thing that morning. Many took an appreciative note of the new, colossal scenery rising before them.
“In these quiet curves vast amphitheaters are formed, now in vertical rocks, now in steps,” Powell wrote.
“There are also side canons coming in every quarter of a mile making the top of the Plateau look like a vast field of honeycomb,” from a usually blunt Jack Sumner.
George Bradley had his own special experience as they climbed the plateau. Not noticing it at first, he scrambled over an ancient dwelling hidden among the eroding sandstone. He stopped and fixed the inflicted bricks, then secured the structure with a larger rock, and left his sign of the expedition.
“It is the first time I left my name in this country for we have been in a part that white men may have been before, but we are now below their line of travel, and we shall not probably see any more evidence of them until we get to White River no. 2 below here.”
Back in the boats, they ran the next lot of rapids successfully, covering 40 miles according to Bradley, or 34 according to Sumner, or 26 according to Powell.
July 8, Desolation Blows
During the day, Powell had made mention of the annoying, multi-current head gales holding up the crew’s progress. But those daytime breezes were only an introduction to Desolation’s “gusto.”
In a long, fun-shaped chasm like Desolation Canyon, cold air mixing with hot becomes, as Bradley put it, “…music fit for the infernal regions. We needed only a few flashes of lightning to meet Milton’s most vivid conceptions of Hell.”
With winds whipping up to 70 mph, the beaches where the men camped were resurrected to bounce between the walls that made them.
July 10, Bustified like a Forty Pounder
Today would be the highest climb yet as Powell and Oramel Howland ascended 4,000 feet to the canyon rim. At the top, Howland scampered off in hopes to snag a deer while Powell summited a nearby peak where “a fine view [was] obtained.”
Meanwhile in camp, Bradley was rewriting his soaked journal entries and listening to Andy Hall belt out “… a song that will no doubt someday rank with America and other national anthems,” he said.
“When he put his arm around her she bustified like a forty pounder, look away, look away, look away in Dixie’s land.”
The surveyors, still 4,000 feet up, met again at sunset. Since Howland was unsuccessful and night was falling, they began bounding down the walls and “leaping over ledges” until they were unable to see.
Luckily, the camp had kept the fire blazing to which they followed as Powell recalled: “in a long, slow, anxious descent.”
July 11, Em sends ‘Em Swimming
The pilot boat, Emma Dean, was promptly oarless after the first rapid of the day. And without an obliging forest nearby, the boys decide they needed to float a little farther to find timber.
Soon after the river would cut sharply to the left with a pompous swing of rapids. In their attempt to avoid becoming one with the canyon wall, Powell, Sumner, and Bill Dunn were rinsed and flipped from their steerless skiff. Despite his one-armed stroke, Powell wrote in his journal that he had no trouble swimming.
Jack Sumner clarified in 1907 (five years after Powell had passed) that the Major did in fact wear an inflatable flotation device through bad rapids. It was the only life preserver on the trip and most likely saved Powell from drowning in multiple circumstances such as this.
After the three landed the boat and came to shore with the others, they counted their new losses which included a barometer, two rifles, and most of the blankets.
Powell salvaged one blanket as it floated by, but deduced with yet another dwindling necessity, “…sometimes hereafter we may sleep cold.” And they would.
July 12, Bradley’s Quick Dip
Breakfast delivered mostly easy whitewater, until, of course, an “old roarer” as Bradley described emerged beside an overhanging cliff.
Having already portaged 10 rapids, the crew decided to run it. The plan was to keep to the left to avoid certain death, or at least a very good boat bonk, on the right.
All succeeded, except for the Kitty Clyde’s Sister which slipped into a chute which then delivered it to the danger zone on a silver platter.
Powell recounted as the crew watched the boat become manhandled in the waves, “Bradley is knocked over the side, but his foot catching under the seat, he is dragged along in the water, with his head down; making great exertion, he seizes the gunwale with his left hand, and can lift his head above water now and then.”
While water-boarded Bradley was preoccupied, William Powell took to the oars and pulled like a mad man away from the cliff. He prevailed, and then quickly pulled Bradley back into the boat, making him the understated badass of the day.
After a quick portage, it was business as usual and the crew floated into Coal Canyon (later renamed Gray Canyon) that they creatively named after finding some coal beds.
That night, Powell noted, “The wind blows a hurricane” and the boys once again slept buried in sandbanks.
July 13, Company at White River no. 2
“About two hours from noon camp, we discover an Indian crossing, where a number of rafts, rudely constructed of logs and bound together by withes, are floating against the bank. On landing, we see evidence that a party of Indians has crossed within a very few days. This is the place where the lamented Gunnison crossed, in the year 1853, when making an exploration for a railroad route to the Pacific coast.”
John W. Gunnison had previous success in resolving disputes with Native Americans. But when he and his group of explorers reached the Sevier River, they were immediately murdered their first night in camp.
The killings were attributed presumably to the Paiute tribe; an indigenous group that resisted Mormon settlements throughout Utah in the 19th century.
July 14, Enter Labyrinth Canyon
They greet a perpendicular canyon starkly unfamiliar to the stair-step escarpments where they’d just spent their week. In the winding stillness of Labyrinth Canyon, thoughts simmered in the crew like the sun against the orange sandstone.
Bradley wrote, “Hardly a bird, save the ill-omened raven, or the occasional eagle screaming over us; one feels a sense of loneliness as he looks on the little party, only three boats and nine men, hundreds of miles from civilization, bound on an errand the issue of which everybody declares must be disastrous.”
But Powell and the rest of the men seemed to be enjoying the labyrinth, quietly admiring the caves and alcoves, its symmetrical walls, and the disorienting reflections belying the glassy waters.
Still enjoying the peacefulness on July 15, Powell wrote, “…the badinage of the men is echoed from wall to wall. Now and then we whistle, or shout, or discharge a pistol, to listen to the reverberations among the cliffs.”
July 17, Toom’-pin wu-near’ Tu-iveap’
As the men exit Stillwater Canyon, it would mark the utmost anticipated, momentous meeting with the Colorado River, and thus, the oncoming calamity of Cataract Canyon.


An international study has shown that short-term blood sugar control in patients with diabetes has a limited effect on their risk of cardiovascular problems, such as heart disease and stroke.
Conventional belief has been that high blood sugar is a major factor in cardiovascular disease. However, this latest research adds to a growing body of evidence that risk of cardiovascular disease in patients with diabetes cannot be managed meaningfully by controlling blood sugar alone.
The study, led by researchers at Harvard Medical School, USA, and Hadassah Medical Centre, Israel, supported by other global institutions, including St George's, University of London, examined the effect of the drug saxagliptin, a new class of medicine used to reduce blood sugar levels, in patients with Type 2 diabetes.
There are 280 million people worldwide suffering with Type 2 diabetes, a disease defined by high levels of blood sugar. Diabetes doubles the risk of heart attack and stroke and can reduce life expectancy by up to six years. Recognised long-term effects of the condition include blindness, kidney failure, stroke and heart attack.
More than 16,000 patients were studied for over two years to test saxagliptin's cardiovascular safety and also measure whether it could reduce the risk of cardiovascular and kidney damage.
Researchers found that the drug was as safe as existing glucose-controlling medicines. By lowering blood sugar it also successfully reduced the damage diabetes causes to kidney function.
Importantly, however, despite control of blood sugar levels researchers found no significant reduction in the risk of major cardiovascular events such as heart attack or stroke.
Professor Kausik Ray, the study's UK national lead from St George's, University of London, said: "Through this trial we studied the effects of a glucose reducing drug on patients over a two-year period and observed that there was no significant benefit from lowering blood sugar levels with respect to the large blood vessels, which contribute to heart attacks and strokes. We did, though, observe a benefit on smaller vessels that contribute to kidney disease. This trial tells us that cardiovascular risk among diabetes patients must be managed through other mechanisms.
"Controlling blood sugar in the short term certainly doesn't present a very meaningful benefit to a patient at risk of cardiovascular problems, although there could be gains over a much longer period. The most effective way to manage cardiovascular disease is through established interventions such as reducing blood pressure, managing cholesterol and encouraging healthier lifestyles.
"It is clear to us now that, in patients with diabetes, there are effective therapies that will reduce their risk of kidney failure and there are separate therapies that will help reduce their risk of cardiovascular problems. More research is needed if we are to find new ways to manage cardiovascular risk in future."
The study, published by the New England Journal of Medicine on Monday 2 September 2013, is the largest diabetes trial ever carried out, conducted at 788 sites across 26 countries. It is also the first since the Federal Drug Administration in the US and European Medicines Agency revised regulations to give more robust assurance of cardiovascular safety in glucose reducing therapies, following concern that these may cause negative side effects on patient health.
Professor Ray added: "This study also provides reassurance about the safety of a new class of drug in a large number of patients, disproving data from smaller studies about potential safety concerns."
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Catholic Activity: St. Lucy's Day
Here is a brief explanation of the beloved Swedish custom on St. Lucy's (or Lucia) Day, as well as the history behind this tradition.
On December 13 people in Sweden celebrate St. Lucy's Day. They remember how Lucia, a young girl, brought food to persecuted Christians hiding in the catacombs in Rome during the time of Emperor Diocletian. In order that she could carry the food and see where she was going in the dark, Lucia wore candles on her head. On St. Lucy's Day each year by tradition one of the daughters of the family is chosen to be St. Lucy. She gets up early and takes coffee and 'Lucia' buns (Saffronsbrod) to the rest of the family who are still in bed. She dresses in a white robe with a scarlet sash and wears on her head a crown of green leaves with five candles in it. Sometimes she is escorted by boys dressed in long white shirts and pointed hats, called star boys.
Activity Source: Feasting for Festivals by Jan Wilson, Lion Publishing Corporation, Batavia, Illinois, 1990


|Substitutional Quantification: the substitutional quantification is concerned with the determination of whether linguistic expressions can be formed for a situation. E.g. "There is a true sentence that ...". In contrast, the referential quantification - the form of quantification normally used in predicate logic - tells us something about objects. E.g. "There is at least one object x with the property ..." or "For all objects x applies ...". The decisive difference between the two types of quantification is that, in the case of the possible replacement of a linguistic expression by another expression, a so-called substitution class must be assumed which cannot exist in the case of objects since the everyday subject area is not classified into classes is. E.g. you can replace a table by some box, but you cannot replace the word table by any available word. See also referential quantification, quantification, substitution, inference, implication, stronger/weaker, logic, systems, semantic rise._____________Annotation: The above characterizations of concepts are neither definitions nor exhausting presentations of problems related to them. Instead, they are intended to give a short introduction to the contributions below. – Lexicon of Arguments. |
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Substitutional quantification/sQ/HintikkaVsSQ/HintikkaVsSubstitutional Quantification/Hintikka: substitutional quantification is a pseudo-paradise, at most of formal interest, there has never been a satisfactory explanation for it.
Description/Knowledge/Russell: Knowledge by description: E.g. we do not know Bismarck. We wish that the object itself is a constituent of our proposition, but this does not work here. We know, however, that there is an object called Bismarck (existence).
Russell: We also know about this Bismarck that he is a clever diplomat.
Solution/Russell: then we can describe the proposition we want to claim, namely, "B was a clever diplomat," where B is the object that is Bismarck. (> Logical form).
(15) (Eb) (b = Bismarck & we judge that b was a clever diplomat)
"B": this variable has then actual objects (objects from the actual world) as values.
Russell/Hintikka: that shows that he has not chosen the solution (i).
However, on another occasion Russell says:
Description/Knowledge/Russell/Hintikka. Knowledge by description: here we know propositions about the "so-and-so" without knowing who or what so-and-so is._____________Explanation of symbols: Roman numerals indicate the source, arabic numerals indicate the page number. The corresponding books are indicated on the right hand side. ((s)…): Comment by the sender of the contribution.
Merrill B. Hintikka
The Logic of Epistemology and the Epistemology of Logic Dordrecht 1989
J. Hintikka/M. B. Hintikka
Untersuchungen zu Wittgenstein Frankfurt 1996


In the event of a fire, you may only have seconds to escape safely. Take the safest exit route, but if you must escape through smoke, remember to crawl low, under the smoke and keep your mouth covered. Once you have moved from the building, call 9-1-1. Never go back into a burning building for any reason. If someone is missing, tell the firefighters right away. They are equipped to perform rescues safely. Once you have called 9-1-1, contact security so they may assist with evacuation and directing emergency personnel.
Portable fire extinguishers are valuable for immediate use on small fires. They contain a limited amount of extinguishing material and need to be properly used so that this material is not wasted. For example, when a pan initially catches fire, it may be safe to turn off the burner, place a lid on the pan, and use an extinguisher. By the time the fire has spread, however, these actions will not be adequate. Only trained firefighters can safely extinguish such fires.
Use a fire extinguisher only if:
- You have alerted other occupants and someone has called the fire department
- The fire is small and contained to a single object, such as a wastebasket
- You have a means of escape identified and the fire is not between you and the escape route
If all of these conditions are NOT present, you should NOT try to use a fire extinguisher. Alert other occupants, leave the building and call 9-1-1 from a cell phone or the security kiosk. Once you have called 9-1-1, contact security so they may assist with evacuation and directing emergency personnel.
Most fire extinguishers operate using the following P.A.S.S. technique:
- PULL: Pull the pin. This will also break the tamper seal.
- AIM: Aim low, pointing the extinguisher nozzle (or its horn or hose) at the base of the fire. Note: Do not touch the plastic discharge horn on CO2 extinguishers, it gets very cold and may damage skin.
- SQUEEZE: Squeeze the handle to release the extinguishing agent.
- SWEEP: Sweep from side to side at the base of the fire until it appears to be out. Watch the area.
If the fire re-ignites, repeat steps 2-4.


Avoid Licorice While Pregnant
New research from Finland has confirmed that women should avoid consuming large amounts of licorice (or liquorice) during pregnancy. However the limit for safe consumption is still unknown.The study, which was carried out by the University of Helsinki, the National Institute for Health, Welfare, the Helsinki and Uusimaa hospital, looked at 378 children around 13 years of age whose mothers had consumed either “large amounts” or “little/no” licorice during pregnancy.
The study defined a large amount as over 500 mg of glycyrrhizin per week — the main constituent of licorice — and little or no licorice as less than 249 mg glycyrrhizin per week.A total of 500 mg of glycyrrhizin corresponds on average to 250 g of licorice. Glycyrrhizin is already known to cause higher blood pressure and shorter pregnancies, however previous studies have not proven any long-lasting effects on the fetus until now.To look at these long-tern effects participants were asked to complete cognitive reasoning tests carried out by a psychologist.
The team found that those children who were exposed to large amounts of licorice in the womb had lower test results than those who were exposed to smaller amounts or no licorice — a difference equivalent to approximately seven IQ points. In addition children exposed to high levels of licorice also showed lower tests results in tasks measuring memory capacity. Parents also reported that these children showed more ADHD-type problems than others, and in girls puberty also started earlier and advanced further.
In Finland the National Institute for Health and Welfare already places licorice in the ‘not recommended’ category for pregnant women, but states that occasional consumption of small amounts of licorice, such as a portion of licorice ice cream or a few licorice sweets, poses no danger. The researchers now advise that both pregnant women and those planning on becoming pregnant should be made more aware of the harmful effects that glycyrrhizin-containing products — such as licorice and salty licorice — may have on their unborn child.
The results can be found online published in the American Journal of Epidemiology.


Legislation on Trademark and Design
Japan’s trademark system provides for the protection of the marks and logos that are used in commerce on goods or services. By enabling trademarks to identify the source of goods or services, and to identify their qualities and publicize them, the trademark system protects the commercial reputation of persons using trademarks, thereby contributing to the development of Japan’s industries and protecting the interests of consumers. Japan’s trademark system is regulated by the Trademark Law.
Japan’s Trademark System
Equality for both Japanese and Foreign Nationals
Japan’s Trademark Law offers equal protection for both Japanese and foreign nationals. The same trademark registration process and conditions apply to those residents in Japan and overseas. Therefore, by offering proper trademark protection to people who do not currently live in Japan and companies presently without head offices or branches in the country, Japan’s trademark system encourages future expansion into the Japanese market by overseas businesses.
Trademarks do not have to be currently in use (either in Japan or overseas) in order to be registered in Japan. If the trademark owner has the intention of using the trademark in the future, it can be registered in Japan as long as certain criteria are met. Thus, it is very important for any foreign business that thinks it might expand into Japan at some time in the future to consider applying for registration of trademarks in Japan before entering the Japanese market. Note, however, that trademarks must be used within three years after registration, or they may be nullified. Using your trademark just once within those three years is enough to prevent your trademark rights from being cancelled.


Saylor.org's Ancient Civilizations of the World/Peoples of the Americas< Saylor.org's Ancient Civilizations of the World
Civilizations in the Americas emerged separately from other major civilizations in the world. The indigenous people of the Americas are believed to have been immigrants from Asia, who crossed over to America during the Ice Age, approximately 20,000 years ago. These new immigrants quickly spread throughout the Americas, in small and culturally distinct groups. The development of agriculture in the Americas five thousand years ago led to the flourish of new culturally advanced societies and innovations. Pre-Columbian American civilizations, such as the Mayas, Aztecs, Incas, and Olmecs were socially stratified and technologically advanced.
In this unit, we will see that civilizations developed in two main regions of the Americas: Mesoamerica and the Peruvian highlands. In fact, we will see that the entire area that stretched from central Mexico to Chile formed a continuous chain of developing civilizations.


On the Terminology of Key Chord vs Key Combo
i hated the term “key-chord”. When writing about keyboarding, I use “key combination” or “key combo” instead. But now, i think i'm going to adopt the term “key chord” in my writings. It is simply more popular and well-understood.
note: “key chord” isn't a good term, because it came from analogy of piano chord of playing several notes, and that came from music chord, which basically means combination of several notes played at once.
chord means that from “accord”, as in harmony, because chords are typically harmony. (as opposed to cacophony, discord.)
[etymology of chord https://www.etymonline.com/word/chord]
«“related notes in music,” 1590s, ultimately a shortening of accord (or borrowed from a similar development in French) and influenced by Latin chorda “catgut, a string” of a musical instrument (see cord (n.)). Spelling with an h first recorded c.1600, from confusion with chord (n.2). Originally two notes; of three or more from 18c.»
pressing Ctrl+x isn't anything about chord or harmony, it's just pressing keys together. (and in a strange way, because you have to press one of the key and hold it first, and also release the other first. Quite strange and convoluted if you think about it. (it is that way due to history. Yes, all your keyboarding pains came from history, the freaking mechanical type writer and emacs hacker idiots. (warning: the previous statement may be offensive.)))
So, “key combination” or key combo is a better term. (Now the comic relief: think of video fighting games, you have a Combo hit!)
but i'm giving up that term, yielding to consideration of popular status quo.
If you have a question, put $5 at patreon and message me.


- Open Access
How to treat fungal infections in ICU patients
BMC Infectious Diseases volume 15, Article number: 205 (2015)
Fungal infections represent a major burden in the critical care setting with increasing morbidity and mortality. Candidiasis is the leading cause of such infections, with C. albicans being the most common causative agent, followed by Aspergillosis and Mucormycosis. The diagnosis of such infections is cumbersome requiring increased clinical vigilance and extensive laboratory testing, including radiology, cultures, biopsies and other indirect methods. However, it is not uncommon for definitive evidence to be unavailable. Risk and host factors indicating the probability of infections may greatly help in the diagnostic approach. Timely and adequate intervention is important for their successful treatment. The available therapeutic armamentarium, although not very extensive, is effective with low resistance rates for the newer antifungal agents. However, timely and prudent use is necessary to maximize favorable outcomes.
Fungal infections represent a major burden in the critical care setting with increasing morbidity and mortality. Candida infections, Aspergillus infections and Mucormycosis caused by members of the Mucorales order are the most common ones. Each one of them requires a different, although similar, diagnostic and therapeutic approach. The purpose of this review is to provide a practical guide on the basic aspects of each of these infections in the critical care setting.
Candidiasis is the leading cause of fungal infections in Intensive Care Unit (ICU) patients, with C. albicans being the most common causative agent [1,2]. Even though Candida species is a part of the normal human flora, a small percentage can cause disease: 1) Candidaemia with or without endophthalmitis, 2) Disseminated haematogenous infections with deep organ involvement 3) Chronic disseminated candidiasis, most commonly found in haematological patients [3,4]. Candida bloodstream infections (BSIs) are a great proportion of nosocomial fungal infections and represent an important cause of morbidity and mortality in ICU patients [5,6]. Additionally, the true incidence of invasive candidiasis may be higher than estimated because of the small percentage of positive cultures obtained and the difficulty in making a diagnosis of invasive candidiasis without candidaemia [7,8]. There are several risk factors for the development of invasive disease (Table 1), such as the colonization of the gastrointestinal tract, disruption of the mucosa, neutropenia or immunosuppression, the increased use of medical procedures, and poor hygiene of the health care personnel .
The most common pathogenic Candida spp is C. albicans followed by C. parapsilosis, C. glabrata and C. tropicalis. Less common pathogenic species are C. krusei, C. dublinensis, C. guiillermondi, C. kefir, C. lusitaniae and C. rugosa. A shift was recently observed to non-albicans species and an expanding list of former non-pathogenic species because of the increase in the number of vulnerable population and the ability of isolation of new species in the laboratory [10-12].
Undoubtedly, the early diagnosis and treatment of invasive candidiasis is important but is often not an easy task because of the comorbidities and the delay in obtaining positive cultures. Candida colonization is referred to as a risk factor for developing invasive candidiasis [13,14]. Several studies have presented the use of several clinical scores by using risk factors alone or in combination with sites of colonization in an attempt to identify patients at risk who might benefit from antifungal prophylaxis treatment. The widely used Candida Colonization Index (CCI) defined as the ratio of the number of culture positive surveillance sites for Candida spp. over the number of sites cultured. If the CCI is greater than 0.4 preemptive antifungal therapy should be commenced . Additionally, a recent study presented the Candida Score (CS), which is based on the following risk factors: surgery upon admission, total parenteral nutrition, severe sepsis and multifocal colonization. A CS above 2.5 identifies high-risk patients who might benefit from antifungal prophylaxis treatment .
There are various laboratory methods aiming at early and accurate diagnosis of invasive candidiasis. Blood cultures have a sensitivity of up to 70%, but they have a long incubation time and they are often negative in deep-sited candidiasis and when fluconazole prophylaxis is used. Serological tests using components of the fungal cell wall such as galactomannan and 1,3-B-d-glucan or antibodies against galactomannan antigen are specific but they lack in sensitivity. Real time polymerase chain reaction, although it has a sensitivity of 60% in diagnosing candidemia, it is invaluable in diagnosing deep-sited candidiasis with a negative blood culture. Lately, newer diagnostic tools were introduced such as matrix-assisted laser desorption ionization time of flight mass spectrometry, molecular detection of fungi in blood and fluorescence in situ hybridization promising an accurate and faster diagnosis [17-19]. Regarding invasive candidiasis, antigen and antibody assays against mannan are used and recommended by the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) guidelines . It should be noted that the MALDI-TOF currently is the most promising method for rapid identification once a fungal organism has been isolated.
Empirical and preemptive treatment
It is difficult to recommend the early antifungal therapy to all patients even though it may lead to improved clinical outcomes due to increased costs, toxicity and ecological pressure for antifungal resistance. Antifungal prophylaxis may be useful where there are risk factors or increased local incidence rates. Patients that may benefit from antifungal prophylactic treatment with fluconazole against invasive candidiasis are those who recently underwent abdominal surgery and had recurrent gastrointestinal perforations or anastomotic leakage . In patients with multifocal candida colonization who have clinical risk factors for infection but are in stable condition, preemptive therapy is currently not indicated. In patients with refractory fever receiving broad-spectrum antibacterial therapy, empirical antifungal therapy may be administered and a thorough search for alternate causes should be performed .
Antifungal drugs for the treatment of candidiasis include polyenes (amphotericin B deoxycholate, liposomal amphotericin B), triazoles (fluconazole, itraconazole, voriconazole, posaconazole), echinocandins (caspofungin, anidulafungin, micafungin) and flucytosine (administered mostly by oral formulation; however it is also available as intravenous formulation in some countries).
Amphotericin B deoxycholate possesses fungicidal properties by interacting with the membrane sterol, increasing the permeability of the cell membrane and allowing leakage of the fungus cell components resulting to its death. It demonstrates high minimum inhibitory concentrations for C. glabrata and C. kruzei and it has got a narrow therapeutic window. Its lipid formulations retain the activity of the parent drug, exhibit better safety profile, but they more costly. The main adverse events include nephrotoxicity, hepatotoxicity, anemia, and thrombocytopenia. Nephrotoxicity and acute infusion related reactions are the most prominent and the most frequent adverse events. The recommended dosages are 0.5-1 mg/kg daily for amphotericin B and 3–5 mg/kg daily for its liposomal formulations.
All triazoles are fungistatic and they inhibit cytochrome P450 enzymes. Fluconazole has the greatest penetration into the CSF and the vitreous body. Voriconazole is not recommended in patients with clearance lower than 50 ml/min or under hemodialysis due to possible accumulation of cyclodextrin and posaconazole is not available in intravenous formulation and can be used in neutropenic patients with leukemia. They interact with several drugs increasing their concentrations (such as cyclosporine, warfarin, tacrolimus, carbamazepine) and they also increase also the serum levels of fentanyl and midazolam through competitive inhibition. The recommended intravenous dosages are a loading dose of 12 mg/kg followed by a daily dose of 6 mg/kg for fungustatin and 2 loading doses of 6 mg/kg every 12 hours followed by 3-4 mg/kg every 12 hours for voriconazole. Dose adjustments in renal failure should be done. Itraconazole and posaconazole, although active against Candida, they have no label against invasive candidiasis.
Echinocandins (caspofungin, micafungin, anidulafungin) inhibit the synthesis of 1,3-B glucan and they are fungicidal against Candida spp. The active drug is not excreted in urine, thus they are not used in patients with candiduria, and it presents high MIC for C. parapsilosis. They possess a favorable therapeutic profile with few drug interactions and minor toxicity. The recommended dosing regimens are a loading dose of 70 mg followed by 50 mg daily for caspofungin, a loading dose of 200 mg followed by 100 mg daily for anidulafungin and 100 mg daily for micafungin [22,23]. It should be noted that caspofungin should not be used for the prophylaxis against invasive candidiasis, as it was not found to be superior to placebo in a recent multicenter double blind randomized controlled trial .
Candida infections in the ICU may be i) suspected or ii) documented usually by obtaining positive cultures.
Suspected candidiasis: if the patient has risk factors for candida infection, prophylaxis treatment may be initiated usually with fluconazole. Risk factors in combination with positive serological markers may indicate patients eligible for pre-emptive treatment.
Documented candidiasis: therapy should be commenced at the moment the blood cultures show the growth of yeast without waiting for the species identification and the results of susceptibility testing. Recent ESCMID guidelines suggest the use of echinocandins first, especially in unstable patients. (Table 2) . Current IDSA guidelines suggest the use of fluconazole, echinocandins and amphotericin B or its lipid formulations.
In the presence of candida infection, consecutive blood cultures should be obtained and the length of treatment is defined to 14 days after the last positive blood culture. It is recommended that central venous catheters or implanted devices (pacemakers and implantable defibrillators) should be removed and a fundoscopic examination should be performed in order to exclude endocular infection. In the presence of localized candidiasis the suggested treatment, according to IDSA guidelines, is presented in Table 3 .
Aspergillus is a fungal genus encompassing hundreds of molds, the most clinically important of which are A. fumigatus, A. flavus, A. terreus, A. niger, and A. nidulans. Recently, Neosartorya udagawae has also emerged with increased clinical impact [26,27]. It has a wide environmental distribution, it may be found in the soil, water, air and decomposing organic matter, and may colonize or cause infection mostly in immunocompromised patients.
Epidemiology, incidence and outcomes
In the critical care setting, Aspergillus may harbor in the ICU ventilation and water systems that have been poorly maintained, as well as in various equipment. However, there is a difficulty in discriminating between colonization and infection when they are isolated from the patient. Incidence varies depending on the immune status of the patients. Virtually any organ may be affected by Aspergillus species, with sinopulmonary involvement as invasive pulmonary aspergillosis being the most common . The lowest incidence for invasive aspergillosis (IA) is reported in patients with HIV and in patients with hematologic malignancy, which is 0.4% . The incidence in patients with solid organ transplants vary from 0.1 to 2.4%, while in patients with stem cell transplants, vary from 0.5 to 3.8% . In patients with hematopoietic stem cell transplantation incidence rates are about 5% for autologous and 5-10% for allogeneic transplantation, respectively [31,32].
Mortality rates also vary. The overall mortality rates of Aspergillosis are about 17%, based on US national data, but mortality is higher in cases of Aspergillus pneumonia and in immunocompromised patients with IA . Specifically, in Aspergillus pneumonia mortality rises to 25%, while in patients with blood and lymphoid tissue malignancies, bone marrow transplant recipients, and liver transplant recipients, mortality rates of IA are 49%, 80%, and 90%, respectively [33,34].
It should be noted that the immune status of critically ill patients, as well as other underlying conditions, are important determinants of the type of fungal infection they may develop and it is usually of the invasive form. Thus, patients receiving steroids are in increased risk of having cavitating lesions and aspergillomas, and neutropenic patients develop angioinvasive aspergillosis, as neutrophils play a major role in the clearance of Aspergillus [35,36]. Patients who received lung transplantation are often colonized with Aspergillus due to their primary lung disease  and are more likely to present with aspergillosis around the anastomoses . Also, involvement of other foci including endocarditis and osteomyelitis has been reported [39,40].
Neutropenia was the first risk factor to be recognized for invasive aspergillosis more than forty years ago . The absolute neutrophil number per se is not the sole determinant, as the overall neutrophil functional status plays a major role in the pathogenesis of Aspergillus. However, one should keep in mind that neutropenia and compromised immune functional status usually concur in several conditions.
Following this rough categorization, common neutropenic conditions that may lead to the development of invasive aspergillosis are hematologic malignancies and myeloablative chemotherapy in stem cell recipients . Prolonged duration and degree of neutropenia are important factors of developing the disease. Solid organ transplantation recipients, especially of lung, are at increased risk for invasive aspergillosis, as they receive immunosuppressive therapy and are subjected to environmental exposure to Aspergillus.
Regarding the deterioration of the immune system’s functionality, steroid therapy is a major risk factor as it may be administered either as anti-inflammatory drug in the course of infections or as immunosuppressive treatment during transplantations [43-46]. Other similar conditions associated with invasive aspergillosis are prior antibiotic treatment, AIDS, H1N1 infection, chronic obstructive pulmonary disease, chronic granulomatous disease, and acute renal failure [43,44,47-50]. It is interesting that patients receiving immuno-modulatory drugs, namely TNF-a inhibitors, are also at increased risk for invasive aspergillosis .
The diagnosis is based on a triplet consisting of (i) risk and host factors (the latter not being identical to risk factors), (ii) clinical and radiological signs and symptoms that are indicative of the disease and (iii) laboratory testing that proves the existence of Aspergillus either directly or indirectly.
According to the definitions published by the European Organization for Research and Treatment of Cancer/Mycosis Study Group (EORTC/MSG), the utilization of these criteria classify the diagnosis of invasive aspergillosis in proven, probable and possible . For a proven infection, it is required to have a positive culture of an otherwise sterile site or a positive histopathologic or cytopathologic examination. It should be noted that, although very useful in the diagnostic process, clinical symptoms and signs and risk and host factors are not mandatory when the presence of Aspergillus has been demonstrated. For a probable infection, all elements of the aforementioned triplet are required to be positive. However, mycological evidence retrieved from various sites not essentially sterile may be used including bronchoalveolar lavage, bronchial specimens retrieved with brush, sinus aspirates, sputum etc. For a possible infection, a diagnosis can be done when there are appropriate risk/host factors and clinical symptoms and signs, but mycological evidence is lacking.
It should be noted that these definitions were based on the study of immunosuppressed patient. As such, they may not be fully applicable in critically ill patients, who are a different population, although immunosuppressed patients may represent a subset of them. It has been supported that the presence of Aspergillus in that patient setting, irrespective of infection or colonization, indicates a poor prognostic marker . The use of appropriate clinical algorithms may offer further aid in diagnosing invasive aspergillosis and discriminating between infection and colonization with relatively high sensitivity and specificity .
The radiological tests that may be used are chest x-rays and CT scanning. The most common signs that may be found are consolidations, and infiltrates and nodules . However, the pathognomonic sign is the “halo sign”, which is found in CT scans as a nodule with a dense center surrounded by ground glass opacity. It should be noted that the latter is mostly found in neutropenic patients, while relevant findings of non-neutropenic patients are nonspecific .
Laboratory testing used for the detection of Aspergillus includes biopsies, cultures, detection of galactomannan and β-D-glucan and PCR. As noted before, the isolation of Aspergillus from cultures depends on whether the site of isolation is otherwise sterile, since a positive culture from respiratory tract secretions, irrespective of the method used for isolation, may represent colonization rather than infection . Galactomannan is detected in body fluids and depending on its concentration galactomannan index is calculated. When a certain threshold is surpassed, then a diagnosis of invasive aspergillosis is likely. Although the sensitivity of the method in the serum is limited , it seems that galactomannan detection in bronchoscopic material, such as bronchoalveolar lavage, has superior accuracy and is not affected by the immune status of the patient . β-D-glucan is, like galactomannan, a cell wall component, which is also found in body fluids and its presence indicates the probability of infection. PCR, although it is a method with high sensitivity and specificity, is cumbersome and lacks in discrimination power between colonization and infection [60,61]. Quantitative real time PCR may pose as a useful alternative in the diagnosis of invasive aspergillosis .
Treatment of aspergillosis may be classified in empirical, preemptive and definitive. Empirical treatment is the one administered to neutropenic patients at risk with a prolonged febrile period, who have already received broad antibiotic coverage. Preemptive therapy is the one administered when there is evidence of fungal existence without a developed infection. However, its benefit has been questioned compared to empirical treatment . Definitive treatment is the one administered when infection has developed and it is based on antibiogram data. When definitive treatment with a single agent is not successful, combination treatment may be used in the salvage setting . Prophylactic treatment, although administered in neutropenic patients, has not found its place in the critical care setting. Adjunctive therapies including Granulocyte-Colony Stimulating Factor and interferon-gamma may be used. Surgical treatment for the resection of Aspergillus lesion may be an alternative option in selected cases .
Although amphotericin B, azoles and echinocandins may be used for the treatment of Aspergillosis, voriconazole is considered as the first line treatment, especially for the invasive pulmonary form. It is administered intravenously in a dosage of 6 mg/kg twice daily as a loading dose and then the dose is lowered to 4 mg/kg twice daily. Amphotericin B is administered intravenously as liposomal amphotericin in a dosage of 3 to 5 mg/kg/day or as its lipid complex in a dosage of 5 mg/kg/day, but has lost its predominance due to the nephrotoxicity it may confer and the newer therapeutic alternatives that have been found . A paradox regarding its reduced toxicity when administered in high doses, although without a subsequent improvement in outcomes, should be noted . From the echinocandin class, only caspofungin has been approved for the treatment of Aspergillosis, but is used when treatment with other agents is not successful or not allowed due to adverse events. It is used mostly when other antifungals have failed and it is administered in combination with amphotericin . It is administered intravenously in a dosage of 70 mg/day as a loading dose and 50 mg/day thereafter . When administered in combination with calcineurin pathway inhibitors, it was found to have increased in vitro activity . Itraconazole and posaconazole is considered second-line treatment option. Posaconazole has been approved as salvage treatment of invasive aspergillosis in the European Union only.
The duration of treatment varies depending on the patient’s immune status. In non-immunosuppressed patients it should last for a minimum of 6 to 12 weeks. In immunosuppressed patients, treatment should be administered as long as the patient is immunosuppressed and should not be stopped until the clinical and radiological resolution of symptoms and signs. Laboratory testing to certify the eradication of the fungus is not suggested. Relapses due to incomplete eradication and lack of sterilization of underlying foci may occur.
Mucorales are saprophytes causing a disease known as mucormycosis. The most common genera include Rhizopus, Mucor and Rhizomucor. Risk factors in the critical care setting include neutropenia, diabetes, malignancy, desferoxamine therapy, renal failure, hematopoietic stem cell transplantation and penetrating trauma . Mortality is high ranging from 35% when no underlying condition is present to 66% in patients with malignancy.
Methods for the diagnosis of mucormycosis are limited. Practically, the sole approach that may provide evidence of Mucorales presence is through histopathology using hematoxylin-eosin, Grocott-methanamine-silver and periodic acid-Schiff stains. PCR use has also been described, but it is not routinely used. Radiological testing rarely provides specific findings .
Treatment options are also limited. The mainstay of treatment is amphotericin B in its deoxycholate, lipid complex or liposomal form. The respective dosages are 1 to 1.5 mg/kg/day, 5 to 7.5 mg/kg/day and 5 to 10 mg/kg/day. It should be noted that the deoxycholate form, although the most toxic and with the poorest penetration in the central nervous system, is the only formulation approved for the treatment of mucormycosis. Limited data regarding combination treatment of lipid amphotericin with echinocandins are also available . The combination of deferasirox with lipid amphotericin was found to be highly fungicidal in animal models . However, a recent small phase II trial found that patients with mucormycosis treated with deferasirox had a higher mortality rate at 90 days and did not support a role for initial, adjunctive deferasirox therapy for mucormycosis . Surgical debridement may also be used as adjunctive therapy .
The duration of treatment for mucormycosis is not established and should be individualized for each patient. It should be continued until there is resolution of clinical signs and symptoms, radiological findings, if any, and of immunosuppression.
Fungal infections, although of great importance, are not easy to diagnose and treat in the critical care setting. To limit the mortality toll of such infections, increased clinical vigilance and a multifaceted diagnostic approach is mandatory. The therapeutic armamentarium, although not very extensive, is effective with low resistance rates for the newer antifungal agents. However, timely and prudent use is necessary to maximize favorable outcomes.
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The authors declare that they have no competing interests.
All authors agreed on the focus and structure of the paper. DKM and TC conducted the literature search and drafted the first version of the manuscript, and GC contributed substantially to the final version. All authors read and approved the final manuscript.
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Matthaiou, D.K., Christodoulopoulou, T. & Dimopoulos, G. How to treat fungal infections in ICU patients. BMC Infect Dis 15, 205 (2015). https://doi.org/10.1186/s12879-015-0934-8
- Critical Care
- Fungal infections


University of Cambridge scientists have broken a decade-old superconducting record by packing a 17.6 Tesla magnetic field into a golf ball-sized hunk of crystal -- equivalent to about three tons of force. The team used high-temperature superconductors that work at minus 320 degrees F or so -- not exactly balmy, but less frigid than the minus 460 degrees F needed for regular superconductors. With zero resistance, superconducting materials can carry up to 100 times more current than copper wires, but the resulting magnetic fields create huge internal forces. Since the cuprate materials used for the record are as fragile as dried pasta, they can actually explode under the strain. To get around it, the team modified the material's microstructure and "shrink-wrapped" it in stainless steel. That produced the largest magnetic field ever trapped in a standalone material at any temperature, according to the team. The research might eventually lead to more secure and efficient power transmission, better scanners and yes, levitating monorails.
[Image credit: University of Cambridge]


It is important to include zinc in your diet so as to improve your overall health and well-being. Zinc has been known to improve the immune system mainly, but it has numerous advantages. It is essential because it is found in every tissue in the body hence it is involved in cell division directly. Deficiency of zinc may bring about complications like infertility in men and women, low libido and accelerated aging. This article articulates the importance of zinc in our bodies;
Improves Cardiovascular Health
Zinc is essential when it comes to maintaining the health of cardiovascular cells and endothelium. The endothelium is a thin layer of cells that lines blood vessels and aids in the circulation of the blood. When the body lacks zinc, there could be a deficiency in the endothelial barrier thus leading to building up of cholesterol which is harmful to the heart. Adequate zinc intake will inhibit the progression of heart disease as well have a protective effect on it.
Promotes Reproductive Health And Fertility
In women, the growth process of the egg requires zinc. If there is a deficiency of zinc in the body, the egg will not maturely well, and that is an impediment to ovulation thus infertility. Enough zinc causes the women to use estrogen efficiently, and that promotes reproductive health.
Elevates Moods And Prevents Depression
Studies have not been clear about the relationship between zinc deficiency and depression. However, it is connected to the role of zinc that involves the production of neurotransmitters and hormones. Zinc regulates the production of dopamine partly which is a chemical that boosts energy, moods, and reward-driven learning. Statistics have shown that zinc deficiency causes more depression in women than men. They are therefore advised to take zinc supplements instead of medication that they will have to take every day of their lives.
Promotes The Health Of The Brain
Zinc has been shown to help the body to eliminate heavy metal from the mind so that they don’t build up and damage it. That promotes the maintenance of cellular homeostasis of brain cells. The combination helps to prevent neurodegeneration and development of Alzheimer’s disease.
It is an antioxidant; therefore, it is useful in getting rid of free radicals that are harmful to the cells by bonding with them and eliminating them. It is particularly good at countering the damaging effects of excess iron in the body. Zinc also targets free radicals that cause inflammation in the body.