Infection after pediatric liver transplantation

Infektionen sind eine der Hauptursachen für Morbidität und Mortalität bei Kindern nach Lebertransplantation. Ziel die¬ser Studie war es, Infektionen bei lebertransplantierten Kinder am Universitätsklinikum Essen darzustellen, bezüglich der Infektions- und Kolonisationsmuster sowie der Risikofaktoren zu analysieren und mit der Literatur zu vergleichen. Im Rahmen der kontinuierlichen Qualitätskontrolle am Universitätsklinikum Essen sollten Empfehlungen und Strategien für das zukünftige postoperative Management erarbeitet werden. Hierzu wurden die postoperativen Infektionen von 67 lebertransplantierten Kindern im Alter von vier Monaten bis 14 Jahren im Beobachtungszeitraum von Juni 1998 bis Oktober 2003 retrospektiv analysiert (deskriptive Stichprobe). Die einfachtransplantierten Patienten (n=51) wurden bezüglich der Risikofaktoren für Infektionen durch Verfahren der induktiven Statistik analysiert (analytische Stichprobe). Infektionen wurden durch objektive Kriterien („Centers for Disease Control (CDC) definitions for nosocomial infections“ bzw. Kriterien der „International pediatric sepsis consensus conference“) kategorisiert und beschrieben. 91% der Kinder zeigten insgesamt 222 Infektionen (3,3 Infektionen pro Kind). Bakterien waren die häufigsten Erreger (66%), gefolgt von Viren (29%) und Pilzen (5%). In den ersten zwei Wochen war das Infektionsrisiko am größten (1/3 der Infektionen). Bakterielle Infektionen manifestierten sich vornehmlich als Sepsis und Cholangitis, verursacht v.a. durch gram-positive Erreger (52%). Erreger der physiologischen Haut- und Darmflora dominierten, v.a. Staphylokokkus epidermidis (33%). Virale Infektionen waren häufig durch Ebstein-Barr-Virus (45%) und Cytomegalievirus (15%) verursacht. Ein Kind erkrankte an einer Post-Trans¬plant-Lym¬phoproliferativen Erkrankung (PTLD). Pilzinfektionen manifestierten sich als Sepsis, Peritonitis und Pneumonie, verursacht v.a. durch Candida albicans (9 Infektionen). Eine pathologische Kolonisation trat bei 63% der Kinder (1,2 Fälle pro Kind) v.a. als Bakteriämie, an Gefäßkathetern und im Darm auf. Auch hier dominierten Haut- und Darmkeime (Staphylokokkus epidermidis (22%)). In der Analyse der Risikofaktoren konnte für Patienten mit „unphysiologischer Darmkolonisation“ ein erhöhtes Risiko für invasive (bakterielle) Infektionen gezeigt werden (p Die Essener Ergebnisse entsprechen denen vergleichbarer, internationaler Studien. Analoge Keimspektren weisen auf einen Zusammenhang zwischen Kolonisation und Infektion hin. Leitlinien zur Hygiene sollten strikt eingehalten werden und der Kolonisationsstatus eines Patienten sollte bekannt sein, um ggf. eine gezielte Therapie einleiten zu können. Weitere Studien zum Zusammenhang unphysiologische (Darm-) Kolonisation und Infektion sind notwendig. Der Nutzen der selektiven Darmdekontamination wird durch die konsekutive Fehlkolonisation des Darms und das damit verbundene erhöhte Risiko für invasive (bakterielle) Infektionen in Frage gestellt und sollte in weiteren Studien geklärt werden.Background. Despite the great progress in liver transplantation in children and the pre-, peri-and postoperative care, infections remain major complications after liver transplantation. Objective. To describe the infections after liver transplantation in children at the university hospital of Essen and to analyze the infection and colonization patterns and risk factors. Methods. Retrospective Analysis of infections in 67 children who underwent 84 transplantations from June 1998 till October 2003. Results. A total of 222 infections were shown in 91% of the children (3.3 infections/ child). Bacteria were the most common pathogens (66%), followed by viruses (29%) and fungi (5%). Most infections appeared in the first two weeks (28%).The most common bacterial infections were sepsis and cholangitis, caused particularly by gram-positiv pathogens (52%). Staphylococcus epidermidis (33%) and other pathogens of the physiological skin and intestinal flora predominated. Viral infections were often caused by Epstein-Barr virus (45%) and cytomegalovirus (15%). Fungal infections appeared as sepsis, peritonitis and pneumonia, caused mainly by Candida albicans. A pathological colonization occurred in 63% of the children (1.2 cases/ child), particularly as bacteremia, on vascular catheters and intestinal. Skin and intestinal pathogens predominated (staphylococcus epidermidis (22%)). In the analysis of risk factors patients with a "non-physiological intestinal colonization" showed an increased risk of invasive (bacterial) infections (p <0.0001). Conclusion. The results correspond to those of comparable international studies. Similar pattern of pathogens indicate an association between colonization and infection. Hygiene guidelines should be strictly adhered to and the colonization status of a patient should be known in order to launch a targeted therapy. Further studies on the relationship between unphysiological (intestinal) colonization and infection are needed. Because of the failed colonization of the intestine and the associated increased risk of invasive (bacterial) infections the benefit of a selective decontamination of the digestive tract is questionable and should be clarified in further studies

Evaluation of Cognitive Architectures for Cyber-Physical Production Systems

Cyber-physical production systems (CPPS) integrate physical and computational resources due to increasingly available sensors and processing power. This enables the usage of data, to create additional benefit, such as condition monitoring or optimization. These capabilities can lead to cognition, such that the system is able to adapt independently to changing circumstances by learning from additional sensors information. Developing a reference architecture for the design of CPPS and standardization of machines and software interfaces is crucial to enable compatibility of data usage between different machine models and vendors. This paper analysis existing reference architecture regarding their cognitive abilities, based on requirements that are derived from three different use cases. The results from the evaluation of the reference architectures, which include two instances that stem from the field of cognitive science, reveal a gap in the applicability of the architectures regarding the generalizability and the level of abstraction. While reference architectures from the field of automation are suitable to address use case specific requirements, and do not address the general requirements, especially w.r.t. adaptability, the examples from the field of cognitive science are well usable to reach a high level of adaption and cognition. It is desirable to merge advantages of both classes of architectures to address challenges in the field of CPPS in Industrie 4.0

A Life Course Approach to Socioeconomic Inequalities in Health: Tracking the Influence of lncome Dynamics on the Health of Children

Socioeconomic inequalities in health research comprises the investigation of the pathways through which differential access to resources affects the distribution of morbidity and mortality in the population. Because many of the factors that influence health are cumulative, researchers have incorporated a life course approach into their work by linking socioeconomic conditions in one stage of the life course to health at a later stage. The childhood period has acquired particular significance due to conflicting theories about the relative importance of early life events for health inequalities during adulthood. Using seven waves of the child component of the National Longitudinal Study of Youth (1986-98), I employ generalized linear mixed models to examine the effect of household income on child physical and mental health over the entire childhood period. The results of this dissertation support the hypothesis that household income influences the physical and mental health of children, both concurrently and over time. In generalized linear mixed models, the stable component of household income, that is, the average household income for a given child over the period in which he or she is observed, exerts a strong influence on risk for child chronic health limitation, child anxiety/depression and antisocial behaviour, and to a lesser extent, child medically attended accident or injury. However, the dynamic component of household income, defined as deviations in household income over time from the observed average of that household, is mostly unrelated to child health. These findings have broader implications for life course theory and for the discipline of sociology as health inequalities researchers track the impact of socially significant events over time and reveal the long term processes underlying the social distribution of health.Doctor of Philosophy (PhD

Native Christian Movements in the Philippine Islands

The story of the Independent Filipino Church is actually the story of one man, Bishop Gregorio Aglipay. It was this man who led the Filipino masses in a break from Rome to get up a truly Filipino national Church, a Church that a Filipino would be proud to claim as his own a church organized end conducted altogether by Filipino people. Therefore, it is necessary that we go into the life and background or this prominent man, Gregorio Aglipay, that we might learn what prompted him to lead his people in a revolt against Rome

Locating Affinity and Making Meaning: Gamelan(ing) in Scotland and Hawai‘i.

Ph.D. Thesis. University of Hawaiʻi at Mānoa 2018

Application of characteristic mode analysis to variable antenna placement on devices operating in the near -resonant range

As antenna sizes on portable wireless devices decrease to the dimensions of the device itself and to that of the operating wavelength, the system begins to operate in the near-resonant frequency range. Currently, a straightforward synthesis approach for determining optimal antenna placement within such near-resonant range systems does not exist. Previously, characteristic mode analysis had only been applied to systems with constant geometry that operated in the near-resonant range and the system had constant characteristic modes independent of the probe location. Successful application of characteristic mode analysis to radiating systems with a constant characteristic mode response suggest that a similar technique may be useful for antenna placement in systems that exhibit a variable characteristic mode response to antenna position. In this research, we investigate system characteristic mode response to variable antenna placement in systems operating in the near-resonant frequency range where the dimensions of the antenna and wireless device are both comparable to a wavelength. To achieve this, new characteristic mode software was developed and a number of dynamic systems composed of a driven dipole antenna positioned close to either a wire or planar arrangement of parallel wires, simulating the antenna/wireless device system, were studied and their computational and experimental results were obtained. The results clearly demonstrate, that as expected, the dominant system characteristic modes are dependent upon antenna position due to the interaction between the antenna and the device. Additionally, these results suggest that a knowledge of the isolated characteristic modes, the geometry of the antenna, and the non-driven portion of the structure may be sufficient to predict the behavior of the characteristic mode response of the system to an antenna repositioned above the non-driven structure. In conclusion, this work establishes the foundation for the development of an antenna placement algorithm for systems operating in the near-resonant range with variable antenna placement by examining the relationship between antenna position and the variation of the system characteristic modes

Big data reference architecture for industry 4.0: including economic and ethical Implications

El rápido progreso de la Industria 4.0 se consigue gracias a las innovaciones en varios campos, por ejemplo, la fabricación, el big data y la inteligencia artificial. La tesis explica la necesidad de una arquitectura del Big Data para implementar la Inteligencia Artificial en la Industria 4.0 y presenta una arquitectura cognitiva para la inteligencia artificial - CAAI - como posible solución, que se adapta especialmente a los retos de las pequeñas y medianas empresas. La tesis examina las implicaciones económicas y éticas de esas tecnologías y destaca tanto los beneficios como los retos para los países, las empresas y los trabajadores individuales. El "Cuestionario de la Industria 4.0 para las PYME" se realizó para averiguar los requisitos y necesidades de las pequeñas y medianas empresas. Así, la nueva arquitectura de la CAAI presenta un modelo de diseño de software y proporciona un conjunto de bloques de construcción de código abierto para apoyar a las empresas durante la implementación. Diferentes casos de uso demuestran la aplicabilidad de la arquitectura y la siguiente evaluación verifica la funcionalidad de la misma.The rapid progress in Industry 4.0 is achieved through innovations in several fields, e.g., manufacturing, big data, and artificial intelligence. The thesis motivates the need for a Big Data architecture to apply artificial intelligence in Industry 4.0 and presents a cognitive architecture for artificial intelligence – CAAI – as a possible solution, which is especially suited for the challenges of small and medium-sized enterprises. The work examines the economic and ethical implications of those technologies and highlights the benefits but also the challenges for countries, companies and individual workers. The "Industry 4.0 Questionnaire for SMEs" was conducted to gain insights into smaller and medium-sized companies’ requirements and needs. Thus, the new CAAI architecture presents a software design blueprint and provides a set of open-source building blocks to support companies during implementation. Different use cases demonstrate the applicability of the architecture and the following evaluation verifies the functionality of the architecture

Unraveling local tissue changes within severely injured skeletal muscles in response to MSC-based intervention using MALDI Imaging mass spectrometry

Pre-clinical and clinical studies are now beginning to demonstrate the high potential of cell therapies in enhancing muscle regeneration. We previously demonstrated functional benefit after the transplantation of autologous bone marrow mesenchymal stromal cells (MSC-TX) into a severe muscle crush trauma model. Despite our increasing understanding of the molecular and cellular mechanisms underlying MSC's regenerative function, little is known about the local molecular alterations and their spatial distribution within the tissue after MSC-TX. Here, we used MALDI imaging mass spectrometry (MALDI-IMS) in combination with multivariate statistical strategies to uncover previously unknown peptide alterations within severely injured skeletal muscles. Our analysis revealed that very early molecular alterations in response to MSC-TX occur largely in the region adjacent to the trauma and only to a small extent in the actual trauma region. Using "bottom up" mass spectrometry, we subsequently identified the proteins corresponding to the differentially expressed peptide intensity distributions in the specific muscle regions and used immunohistochemistry to validate our results. These findings extend our current understanding about the early molecular processes of muscle healing and highlights the critical role of trauma adjacent tissue during the early therapeutic response upon treatment with MSC

The benefits of a 5-day dysphagia intensive placement

Finding practical dysphagia opportunities for students pre-qualification is challenging. Discussions with clinicians led to the development of a new placement model. The placement was just five days and had an accompanying workbook. The current study aimed to evaluate the benefits of the placement. Data were analysed from 40 students who attended an adult dysphagia placement and 13 who attended a paediatric dysphagia placement. Measures included a pre and post self-rating questionnaire, qualitative feedback from clinical educators and students and a pre and post measure of knowledge using concept maps. Student self-rating data indicated gains in experience, awareness, knowledge, clinical skills, competence, confidence and interest in dysphagia. Clinical educators and students also reported a range of benefits from this placement. Students who undertook a placement that focused on adult dysphagia significantly increased their knowledge of adult dysphagia, but this did not generalize to paediatric dysphagia. Despite reporting that they felt they had gained in knowledge of dysphagia, the students who did a paediatric dysphagia placement did not significantly increase their knowledge of dysphagia. The study raises a number of important considerations when designing placements including length, timing, intensity, how best to encourage generalization of knowledge, and how best to measure learning