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ABSTRACT We report a case of eosinophilic meningitis associated with the ingestion of raw fish (Cichla sp.) from the Brazilian Amazon, likely caused by Gnathostoma. A 36-year-old male visited Juruena river on a fishing trip. After 50 days, the patient presented with an intense frontal headache. A cerebrospinal fluid examination revealed 63% eosinophilia. Another individual who ingested raw fish developed linear dermatitis on the abdominal wall. Anti-Gnathostoma serum antibodies were detected, and the patient made a full recovery after treatment with corticosteroids and albendazole. To date, autochthonous Gnathostoma spp. infections in Latin American countries have only caused linear panniculitis. This report raises awareness of gnathostomiasis-causing meningitis.

Abstract Automated detection of lesions using artificial intelligence creates new standards in medical imaging. For people with epilepsy, automated detection of focal cortical dysplasias (FCDs) is widely used because subtle FCDs often escape conventional neuroradiological diagnosis. Accurate recognition of FCDs, however, is of outstanding importance for affected people, as surgical resection of the dysplastic cortex is associated with a high chance of postsurgical seizure freedom. Here, we make publicly available a dataset of 85 people affected by epilepsy due to FCD type II and 85 healthy control persons. We publish 3D-T1 and 3D-FLAIR, manually labeled regions of interest, and carefully selected clinical features. The open presurgery MRI dataset may be used to validate existing automated algorithms of FCD detection as well as to create new approaches. Most importantly, it will enable comparability of already existing approaches and support a more widespread use of automated lesion detection tools.

Hydrogen peroxide is an environmentally friendly bleaching chemical that is widely used in alkaline media in the pulp and paper industry. In this study, unconventional reaction conditions of the conventional bleaching P-stage were performed to evaluate its effect on cellulose. The objective was to “tailor” the cellulose degradation according to different applications, such as dissolving pulps. Different operating conditions were studied: pH variation (alkaline or acidic medium), as well as the addition of Cu(II) or the Cu(II)-phenanthroline complex. The hypotheses considered were (1) Using H2O2 in unconventional conditions will favor hemicelluloses removal after depolymerization and will lead to the desired cellulose degradation, and (2) H2O2 oxidation carried out under unconventional conditions will favor the dissolving ability of cellulose.

Na Ásia e nas Ilhas do Pacífico, o Gnathostoma spinigerum é a segunda causa principal de meningoencefalite eosinofílica. Espécies congêneres são encontradas como causadoras da síndrome de larva migrans nas Américas, e têm sido relatadas especialmente no México. Os vermes adultos geralmente se desenvolvem em felídeos selvagens, enquanto as larvas infectam peixes e outros invertebrados aquáticos. Este é o primeiro relato de infecção humana do sistema nervoso central na América do Sul. LSN, homem, 36 anos, branco, do estado do Paraná, empresário. Ele relatou uma viagem de pesca em agosto de 2017 para o rio Juruena com parentes e amigos, na fronteira dos estados brasileiros do Amazonas e Mato Grosso. Eles consumiram peixe Tucunaré cru (Cichla spp), preparado na forma de sashimi. Indivíduos co-expostos relataram episódios de diarreia aguda em setembro. 43 dias após a exposição, o paciente desenvolveu fadiga incomum, taquicardia, dispneia associada à atividade física. 50 dias após comer o peixe, o paciente apresentou dor de cabeça frontal intensa e contínua, sem irradiação e resistente a qualquer medicamento analgésico. Não foram observadas febre, calafrios, vômitos, dor abdominal ou diarreia. Devido à piora da dor de cabeça, o paciente procurou o pronto-socorro. No exame físico: sinais vitais normais; prostração, leve rigidez do pescoço. A análise do líquido cefalorraquidiano (LCR) mostrou aumento da celularidade (496 células; RBC: 43 células; e 63% de eosinófilos). A ressonância magnética cerebral foi normal. Com os relatos de episódios de dermatite linear no abdômen de outros indivíduos co-expostos, foi estabelecida a hipótese de infecção por Gnathostoma. Essa hipótese foi posteriormente confirmada (em maio de 2018) pela detecção de anticorpos anti-Gnathostoma no LCR, mas não no soro, com um teste imunocromatográfico. O paciente foi tratado com albendazol 400 mg a cada 8 horas e dexametasona 4 mg a cada 6 horas. Houve melhora da dor de cabeça e o paciente recebeu alta aproximadamente 7-10 dias depois, usando corticosteroides orais por três meses (dexametasona) e albendazol por 21 dias. LSN se recuperou sem nenhuma sequela. Este é o primeiro relato de meningite eosinofílica por Gnathostoma fora da área endêmica na Ásia, a partir dele podem ser propostas medidas para preparar os serviços de saúde para abordar essa possibilidade diagnóstica e para orientar os turistas que pescam na Amazônia a não consumir peixe cru.

Muitos países adotam instrumentos regulatórios para a melhoria do desempenho das edificações e a qualidade luminosa é frequentemente abordada em seus escopos. Métodos simplificados facilitam a aplicação de tais instrumentos e a inteligência artificial tem se mostrado útil para esse fim. Assim, o objetivo deste trabalho é a propor um metamodelo, utilizando-se redes neurais artificiais, para verificar o desempenho luminoso de edificações residenciais, considerando o impacto do entorno construído no contexto da revisão da norma brasileira “ABNT NBR 15.575-1 Edificações habitacionais — Desempenho”. Para isto, adotou-se a base de dados simulados para a proposta de revisão da norma, contendo 36.000 casos que relacionam a influência de obstruções externas à edificação ao seu desempenho quanto à suficiência e uniformidade da luz natural. Assim, metamodelos de redes neurais artificias Perceptron Multicamadas foram treinados com dados das cidades de Curitiba, Brasília e Belém. A arquitetura das redes consistiu em 3 camadas, a de entrada, uma oculta e a de saída. Testaram-se aspectos de sua arquitetura e do agrupamento dos parâmetros de entrada, as variáveis da edificação, e de saída, ALNE200lx,50% e ALNE60lx,50%. O seu desempenho global foi considerado aceitável, com erro percentual médio inferior a 10%, sendo necessário o seu refinamento para a redução de discrepantes. Concluiu-se que as RNA podem ser uma alternativa como método simplificado para aplicação na norma, apontando-se como opções de refinamento do metamodelo a variação do algoritmo de aprendizagem, da partição dos conjuntos de treinamento e teste, e a ampliação do seu escopo com outras proporções e transmissões visíveis.

Purtscher-like retinopathy is a rare chorioretinopathy associated with a non-traumatic inciting event including acute pancreatitis, renal failure, long-bone injury, chest compression, connective tissue diseases and hematologic disorders. We present the case of a 33-year-old woman with abdominal pain and visual changes that was diagnosed with acute pancreatitis. Fundoscopic examination revealed bilateral diffuse flame hemorrhages and retinal whitening (Purtscher flecken), which were diagnostic of Purtscher-like retinopathy secondary to acute pancreatitis. The patient improved without intravenous or intravitreal corticosteroid administration. Follow up at 5 and 8 months revealed improved vision, complete resolution of the retinal pathology with residual inner retinal thickening on ocular coherence tomography (OCT), consistent with sustained retinal damage. Given that Purtscher-like retinopathy is associated with higher morbidity and mortality rates in patients with acute pancreatitis, high suspicion of this pathology and a thorough clinical assessment are imperative. Since half of the patients suffer life-long visual changes, further research is required for the development of efficacious treatment options.

Daylight harvesting is a well-known strategy to address building energy efficiency. However, few simplified tools can evaluate its dual impact on lighting and air conditioning energy consumption. Artificial neural networks (ANNs) have been used as metamodels to predict energy consumption with high precision, few input parameters and instant response. However, this approach still lacks the potential to estimate consumption when there is daylight harvesting, at the ambient level, where the effect of orientation can be noted. This study investigates this potential, in order to evaluate the applicability of ANNs as a tool to aid the architectonic design. The ANNs were approached as metamodels trained based on EnergyPlus thermo-energetic simulations. The network configuration focused on determining its simplest feasible form. The input parameters adopted as the main variables of the building envelope were as follows: orientation, window-to-wall ratio and visible transmission. The effects of the encoding of orientation as a network input parameter, the number of examples of each variable for network training and changing the parameters used for the training were evaluated. The networks predicted the individualized consumption according to the end use with errors below 5%, indicating their potential to be applied as a simplified tool to support the design process, considering the elementary variables of the building envelope. The discussion of results focused on guidelines and challenges to achieve this purpose when contemplating the broadening of the metamodel scope.

A cochlear implant (CI) can partially restore hearing in individuals with profound sensorineural hearing loss. However, electrical hearing with a CI is limited and highly variable. The current study aimed to better understand the different factors contributing to this variability by examining how age affects cognitive functions and cortical speech processing in CI users. Electroencephalography (EEG) was applied while two groups of CI users (young and elderly; N = 13 each) and normal-hearing (NH) listeners (young and elderly; N = 13 each) performed an auditory sentence categorization task, including semantically correct and incorrect sentences presented either with or without background noise. Event-related potentials (ERPs) representing earlier, sensory-driven processes (N1-P2 complex to sentence onset) and later, cognitive-linguistic integration processes (N400 to semantically correct/incorrect sentence-final words) were compared between the different groups and speech conditions. The results revealed reduced amplitudes and prolonged latencies of auditory ERPs in CI users compared to NH listeners, both at earlier (N1, P2) and later processing stages (N400 effect). In addition to this hearing-group effect, CI users and NH listeners showed a comparable background-noise effect, as indicated by reduced hit rates and reduced (P2) and delayed (N1/P2) ERPs in conditions with background noise. Moreover, we observed an age effect in CI users and NH listeners, with young individuals showing improved specific cognitive functions (working memory capacity, cognitive flexibility and verbal learning/retrieval), reduced latencies (N1/P2), decreased N1 amplitudes and an increased N400 effect when compared to the elderly. In sum, our findings extend previous research by showing that the CI users’ speech processing is impaired not only at earlier (sensory) but also at later (semantic integration) processing stages, both in conditions with and without background noise. Using objective ERP measures, our study provides further evidence of strong age effects on cortical speech processing, which can be observed in both the NH listeners and the CI users. We conclude that elderly individuals require more effortful processing at sensory stages of speech processing, which however seems to be at the cost of the limited resources available for the later semantic integration processes.

The German Society of Hospital Hygiene develops guidelines, recommendations and standard operation procedures on a voluntary basis, published on the DGKH-website ().The original German version of this recommendation was published in April 2022 and has now been made available to the international professional public in English. Evaluating the current data on the efficacy of virucidal gargle/mouthwash solutions and nasal sprays against SARS-CoV-2 and in clinical trials, conducted with preventive or therapeutic objectives, recommendations are given for the prevention of COVID-19. The following areas are considered:

Angiostrongylus cantonensis is the main causative agent for eosinophilic meningoencephalitis in humans. Larvae are rarely found in the cerebral spinal fluid (CSF). Consequently, serology and DNA detection represent important diagnostic tools. However, interpretation of the results obtained from these tools requires that more extensive accuracy studies be conducted. The aim of the present study is to update guidelines for diagnosis and case definitions of neuroangiostrongyliasis (NA) as provided by a working group of a recently established International Network on Angiostrongyliasis. A literature review, a discussion regarding criteria and diagnostic categories, recommendations issued by health authorities in China and an expert panel in Hawaii (USA), and the experience of Thailand were considered. Classification of NA cases and corresponding criteria are proposed as follows: minor (exposure history, positive serology, and blood eosinophilia); major (headache or other neurological signs or symptoms, CSF eosinophilia); and confirmatory (parasite detection in tissues, ocular chambers, or CSF, or DNA detection by PCR and sequencing). In addition, diagnostic categories or suspected, probable, and confirmatory are proposed. Updated guidelines should improve clinical study design, epidemiological surveillance, and the proper characterization of biological samples. Moreover, the latter will further facilitate accuracy studies of diagnostic tools for NA to provide better detection and treatment.

Introduction Based on high rates of non-converters to psychosis, especially in children and adolescents, it was suggested that CHR criteria were (1) pluripotential, (2) a transdiagnostic risk factor, or (3) simply a severity marker of mental disorders rather than specifically psychosis-predictive. If any of these three alternative explanatory models were true, their prevalence should differ between persons with and without mental disorders, and their severity should be associated with functional impairment as a measure of severity. Objectives To compare the prevalence and severity of CHR criteria/symptoms in children and adolescents of the community and inpatients. Methods We compared CHR criteria/symptoms in 8-17-year-olds of the community and of inpatients not clinically suspected to develop psychosis. Results The 7.3%-prevalence rate of CHR criteria in community subjects did not differ significantly from the 9.5%-rate in inpatients. Frequency/severity of CHR criteria never differed between the community and the four inpatient groups, while the frequency and severity of CHR symptoms differed only minimally. Group differences were found in only four CHR symptoms: suspiciousness/persecutory ideas of the SIPS, and thought pressure, derealization and visual perception disturbances of the SPI-CY. These were consistent with a transdiagnostic risk factor or dimension, i.e., displayed higher frequency and severity in inpatients. Low functioning, however, was at most weakly related to the severity of CHR criteria/symptoms, with the highest, yet still weak correlation yielded for suspiciousness/persecutory ideas. Conclusions The lack of systematic differences between inpatients and community subjects does not support suggestions that CHR criteria/symptoms are pluripotential or transdiagnostic syndromes, or merely markers of symptom severity Disclosure No significant relationships.

Cryosurgery is a technique widely known and used among dermatologists. Intralesional application is already used to treat keloids and has the advantage of restricting the zone of action of low temperatures of liquid nitrogen. The use of contact cryosurgery in vascular lesions is well reported in the literature, but there are no intralesional technique publications on these types of lesions. Here, we report two cases, one of port-wine stain hamartomas in a 61-year-old patient and another of a cherry angioma in a 70-year-old patient, safely and satisfactorily treated with intralesional cryosurgery.

Este ensaio analisa se o lugar da avaliação concreta da universidade pública brasileira se dá em relação à sua referência social ou por ser uma instituição estratégica no desenvolvimento das forças produtivas. Por um lado, há um movimento para que as universidades públicas democratizem o acesso e respondam às demandas sociais. Por outro, há a defesa da formação técnica/profissional e avanço da ciência e tecnologia para a produção e reprodução do capital. A expansão da pesquisa e dos cursos de pós-graduação stricto sensu no Brasil estabeleceu critérios produtivistas de avaliação, os quais passaram a ser um parâmetro para a própria universidade. Esse processo leva à destruição do projeto de universidade socialmente referenciada, substituindo-o por um projeto que expressa a ideologia neoliberal.

Hearing with a cochlear implant (CI) is limited compared to natural hearing. Although CI users may develop compensatory strategies, it is currently unknown whether these extend from auditory to visual functions, and whether compensatory strategies vary between different CI user groups. To better understand the experience-dependent contributions to multisensory plasticity in audiovisual speech perception, the current event-related potential (ERP) study presented syllables in auditory, visual, and audiovisual conditions to CI users with unilateral or bilateral hearing loss, as well as to normal-hearing (NH) controls. Behavioural results revealed shorter audiovisual response times compared to unisensory conditions for all groups. Multisensory integration was confirmed by electrical neuroimaging, including topographic and ERP source analysis, showing a visual modulation of the auditory-cortex response at N1 and P2 latency. However, CI users with bilateral hearing loss showed a distinct pattern of N1 topography, indicating a stronger visual impact on auditory speech processing compared to CI users with unilateral hearing loss and NH listeners. Furthermore, both CI user groups showed a delayed auditory-cortex activation and an additional recruitment of the visual cortex, and a better lip-reading ability compared to NH listeners. In sum, these results extend previous findings by showing distinct multisensory processes not only between NH listeners and CI users in general, but even between CI users with unilateral and bilateral hearing loss. However, the comparably enhanced lip-reading ability and visual-cortex activation in both CI user groups suggest that these visual improvements are evident regardless of the hearing status of the contralateral ear.

A cochlear implant (CI) is an auditory prosthesis which can partially restore the auditory function in patients with severe to profound hearing loss. However, this bionic device provides only limited auditory information, and CI patients may compensate for this limitation by means of a stronger interaction between the auditory and visual system. To better understand the electrophysiological correlates of audiovisual speech perception, the present study used electroencephalography (EEG) and a redundant target paradigm. Postlingually deafened CI users and normal-hearing (NH) listeners were compared in auditory, visual and audiovisual speech conditions. The behavioural results revealed multisensory integration for both groups, as indicated by shortened response times for the audiovisual as compared to the two unisensory conditions. The analysis of the N1 and P2 event-related potentials (ERPs), including topographic and source analyses, confirmed a multisensory effect for both groups and showed a cortical auditory response which was modulated by the simultaneous processing of the visual stimulus. Nevertheless, the CI users in particular revealed a distinct pattern of N1 topography, pointing to a strong visual impact on auditory speech processing. Apart from these condition effects, the results revealed ERP differences between CI users and NH listeners, not only in N1/P2 ERP topographies, but also in the cortical source configuration. When compared to the NH listeners, the CI users showed an additional activation in the visual cortex at N1 latency, which was positively correlated with CI experience, and a delayed auditory-cortex activation with a reversed, rightward functional lateralisation. In sum, our behavioural and ERP findings demonstrate a clear audiovisual benefit for both groups, and a CI-specific alteration in cortical activation at N1 latency when auditory and visual input is combined. These cortical alterations may reflect a compensatory strategy to overcome the limited CI input, which allows the CI users to improve the lip-reading skills and to approximate the behavioural performance of NH listeners in audiovisual speech conditions. Our results are clinically relevant, as they highlight the importance of assessing the CI outcome not only in auditory-only, but also in audiovisual speech conditions.

As mudanças impostas pela pandemia do novo coronavírus são desafiadoras. Isolamento social, novas medidas de biossegurança e condições diferentes de viver levantam questões sobre o futuro da forma de habitar e usufruir as cidades e seus espaços. Diante disso, desenvolveu-se uma pesquisa exploratória visando apreender a percepção das pessoas quanto à sua relação, satisfação e expectativas para com o espaço livre público urbano, com o bairro e com a sua moradia durante e após a pandemia, dadas as modificações em suas rotinas. O presente trabalho trata-se de um recorte dessa pesquisa, tendo como objetivo compreender o nível de satisfação das pessoas em relação ao bairro em que moravam e aos espaços abertos da cidade durante a quarentena, bem como suas expectativas de futuro. Para isso, foi aplicado um questionário online, divulgado por meio de redes sociais, através do qual foram coletadas 1858 respostas válidas. Entre os resultados obtidos, destaca-se: i. que o impacto do enclausuramento foi menos sentido por quem tinha na própria residência um espaço ao ar livre; ii. que 44,85% dos respondentes sentiam falta de áreas livres em seus bairros; iii. que entre os elementos dos quais os respondentes sentiam falta em seus bairros, a praça foi o mais votado; e iv. que, comparativamente, ao avaliar-se a vontade das pessoas de frequentar espaços ao ar livre durante e após a quarentena, observou-se uma tendência de aumento do uso dos espaços livres públicos após a quarentena acabar. Os aspectos conclusivos incluíram discussões a respeito dos espaços abertos de interação social, como ruas, praças e parques, que ganharam ainda mais importância durante esse período, evidenciando que há um desafio para as cidades quanto à qualidade ambiental desses espaços durante e após a pandemia.

Esse trabalho verificou o potencial da utilização do Fator de Luz Diurna temporal para a estimativa do consumo de iluminação de ambientes com diferentes volumetrias, tipos de aberturas e distribuição de fotosensores[1]. Tal potencial foi verificado frente à simulação computacional anual baseada no clima, por meio de um estudo de caso para Florianópolis. Avaliaram-se seis cenários paramétricos cujas variações contemplaram a profundidade do ambiente, o tamanho da abertura e a área de atuação dos fotosensores. O método assume a premissa de que um único ponto de análise, associado à zona de controle do fotosensor e localizado na parcela da zona mais distante da abertura, é adotado para estimar o consumo de iluminação. A escolha desse ponto mostrou-se válida, dependendo da profundidade da área de abrangência do sensor e do tamanho da janela. Em geral, os resultados subestimaram o aproveitamento da luz natural. Concluiu-se que o método tem potencial para ser aplicado com erros de ~10%, definindo-se uma área mínima de abertura e limitando-se a profundidade das zonas em ~1,5 X a altura da verga. Assim, recomenda-se como trabalhos futuros a sua validação com base em um maior número de variáveis. [1] Neste trabalho, o termo fotosensor foi utilizado para caracterizar dispositivos de controle do sistema de iluminação em função da luz natural.

In community studies, both attenuated psychotic symptoms (APS) and basic symptoms (BS) were more frequent but less clinically relevant in children and adolescents compared to adults. In doing so, they displayed differential age thresholds that were around age 16 for APS, around age 18 for perceptive BS, and within the early twenties for cognitive BS. Only the age effect has previously been studied and replicated in clinical samples for APS. Thus, we examined the reported age effect on and age thresholds of 14 criteria-relevant BS in a patient sample at clinical-high risk of psychosis (N = 261, age 15–40 yrs.), recruited within the European multicenter PRONIA-study. BS and the BS criteria, “Cognitive Disturbances” (COGDIS) and “Cognitive-perceptive BS” (COPER), were assessed with the “Schizophrenia Proneness Instrument, Adult version” (SPI-A). Using logistic regressions, prevalence rates of perceptive and cognitive BS, and of COGDIS and COPER, as well as the impact of social and role functioning on the association between age and BS were studied in three age groups (15–18 years, 19–23 years, 24–40 years). Most patients (91.2%) reported any BS, 55.9% any perceptive and 87.4% any cognitive BS. Furthermore, 56.3% met COGDIS and 80.5% COPER. Not exhibiting the reported differential age thresholds, both perceptive and cognitive BS, and, at trend level only, COPER were less prevalent in the oldest age group (24–40 years); COGDIS was most frequent in the youngest group (15–18 years). Functional deficits did not better explain the association with age, particularly in perceptive BS and cognitive BS meeting the frequency requirement of BS criteria. Our findings broadly confirmed an age threshold in BS and, thus, the earlier assumed link between presence of BS and brain maturation processes. Yet, age thresholds of perceptive and cognitive BS did not differ. This lack of differential age thresholds might be due to more pronounced the brain abnormalities in this clinical sample compared to earlier community samples. These might have also shown in more frequently occurring and persistent BS that, however, also resulted from a sampling toward these, i.e., toward COGDIS. Future studies should address the neurobiological basis of CHR criteria in relation to age.

After the lockdown and the end of the summer holidays, day-cares and schools need to be reopened and (despite the continued circulation of the new coronavirus SARS-CoV-2) kept open. The need for opening up arises from the right of children to education, participation, support and care. This is possible if appropriate hygiene measures are implemented and community transmission remains stable. In addition, the safety of educators, teachers and carers must be a priority and needs to be addressed by appropriate measures. Finally, the needs of families must also be taken into account. The following document describes in detail how these objectives can be achieved.

In the opinion of the medical societies of hygiene and pediatrics undersigning the present statement, the analyses published to date regarding transmission of SARS-CoV-2 and the course of CoVid-19 show that children play a much less significant role in the spread of the virus than do adults.According to the findings available to date, not only do children and adolescents less frequently fall ill with CoVid-19, they also generally become less severely ill than do adults. The vast majority of infections in children and adolescents are asymptomatic or oligosymptomatic. Even the first analyses from China demonstrated that children and adolescents play a subordinate role in the transmission of the virus – not only to other children and adolescents, but also to adults.Taking into account regional infection rates and available resources, daycare centers, kindergartens and elementary schools promptly should be reopened. For children, this should be possible without excessive restrictions, such as clustering into very small groups, implementation of barrier precautions, maintaining appropriate distance from others or wearing masks. A factor more decisive than individual group size is the issue of sustaining the constancy of respective group members and the avoidance of intermixing. Children can be taught basic rules of hygiene such as handwashing and careful hygiene behavior when coming into contact with others during mealtimes and/or when using sanitary facilities. Independent of the prevention measures implemented for children and adolescents, the protection of teachers, educators and caregivers is crucial, (e.g., the maintenance of appropriate distance from others, use of medical masks, situation-dependent hand disinfection, when necessary, supported by regular pool testing). Children over the age of 10 and adolescents up to school graduation age are more capable of actively understanding and conforming to specific hygiene rules. For this group, maintaining appropriate distance from others (1.5 meters), wearing a mouth-and-nose protection (whenever they are not sitting in their assigned classroom seats) and consistent education regarding the basic rules of infection prevention may provide increased options for normalizing teaching activities. Children and adolescents suspected of infection with SARS-CoV-2 should be tested immediately in order to either confirm or rule out such an infection. Evidence of individual infections in children or students must not automatically lead to the closure of the entire daycare center or school. A detailed analysis of the chain of infection is a prerequisite for a balanced approach to infection control. The opening of schools and children’s facilities should be accompanied by specifically structured, model surveillance studies that further clarify outstanding questions about infectious disease events and hygiene control. These prospective, concomitant examinations will be essential for the purpose of evaluating and verifying the effectiveness of the required hygiene measures.

This is the fourteenth chapter of the guideline “Calculated initial parenteral treatment of bacterial infections in adults – update 2018” in the 2 updated version. The German guideline by the Paul-Ehrlich-Gesellschaft für Chemotherapie e.V. (PEG) has been translated to address an international audience.Bacterial gastrointestinal infections are still the leading cause of death worldwide. The chapter describes the etiology of bacterial gastrointestinal infections in Germany and their frequency. Recommendations are given for the calculated therapy of these infections and for targeted antibiotic therapy for known pathogens. Particular attention is paid to . The diagnostic and therapeutic options of antibiotic therapy of the various infection patterns in this pathogen are discussed.

This is the fifteenth chapter of the guideline “Calculated initial parenteral treatment of bacterial infections in adults – update 2018” in the 2 updated version. The German guideline by the Paul-Ehrlich-Gesellschaft für Chemotherapie e.V. (PEG) has been translated to address an international audience.Multimorbidity, an atypical symptomatology of infections in combination with multimedication, the associated interaction risks and serious consequences of synergistic side effects characterize the conditions when deciding on the use of antibiotics in old age. Strict decision regarding the indication itself, choice of the best antibiotic even considering rare side effects which may be dangerous in the elderly, determining the correct dose, dosing interval and the shortest possible duration according to the physiological status of the patient as well as monitoring effectiveness and toxicity detect expected and unexpected side effects early. Recommendations must reflect the peculiarities of antibiotic treatment in elderly patients.

In recent years, there has been an ongoing discussion about the value of laminar airflow (LAF=low turbulence displacement ventilation) in the operating room for prevention of surgical site infections (SSI). Some publications, e.g., from the WHO, issued the demand to no longer build LAF ceilings in operating rooms. The present statement deals critically with this position and justifies the use of LAF ceilings in different ways:Thus, this paper recommends building LAF ceilings in the future as well, depending on the operations intended.Further, this paper gives an overview of possible reasons for surgical site infections and highlights the importance of discipline in the operating theatre.

Chronic subjective tinnitus is an auditory phantom phenomenon characterized by abnormal neuronal synchrony in the central auditory system. As shown computationally, acoustic coordinated reset (CR) neuromodulation causes a long-lasting desynchronization of pathological synchrony by downregulating abnormal synaptic connectivity. In a previous proof of concept study acoustic CR neuromodulation, employing stimulation tone patterns tailored to the dominant tinnitus frequency, was compared to noisy CR-like stimulation, a CR version significantly detuned by sparing the tinnitus-related pitch range and including substantial random variability of the tone spacing on the frequency axis. Both stimulation protocols caused an acute relief as measured with visual analogue scale scores for tinnitus loudness (VAS-L) and annoyance (VAS-A) in the stimulation-ON condition (i.e. 15min after stimulation onset), but only acoustic CR neuromodulation had sustained long-lasting therapeutic effects after 12weeks of treatment as assessed with VAS-L, VAS-A scores and a tinnitus questionnaire (TQ) in the stimulation-OFF condition (i.e. with patients being off stimulation for at least 2.5h). To understand the source of the long-lasting therapeutic effects, we here study whether acoustic CR neuromodulation has different electrophysiological effects on oscillatory brain activity as compared to noisy CR-like stimulation under stimulation-ON conditions and immediately after cessation of stimulation. To this end, we used a single-blind, single application, cross over design in 18 patients with chronic tonal subjective tinnitus and administered three different 16-minute stimulation protocols: acoustic CR neuromodulation, noisy CR-like stimulation and low frequency range (LFR) stimulation, a CR type stimulation with deliberately detuned pitch and repetition rate of stimulation tones, as control stimulation. We measured VAS-L and VAS-A scores together with spontaneous EEG activity pre-, during- and post-stimulation. Under stimulation-ON conditions acoustic CR neuromodulation and noisy CR-like stimulation had similar effects: a reduction of VAS-L and VAS-A scores together with a decrease of auditory delta power and an increase of auditory alpha and gamma power, without significant differences. In contrast, LFR stimulation had significantly weaker EEG effects and no significant clinical effects under stimulation-ON conditions. The distinguishing feature between acoustic CR neuromodulation and noisy CR-like stimulation were the electrophysiological after-effects.Acoustic CR neuromodulation caused the longest significant reduction of delta and gamma and increase of alpha power in the auditory cortex region. Noisy CR-like stimulation had weaker and LFR stimulation hardly any electrophysiological after-effects. This qualitative difference further supports the assertion that long-term effects of acoustic CR neuromodulation on tinnitus are mediated by a specific disruption of synchronous neural activity. Furthermore, our results indicate that acute electrophysiological after-effects might serve as a marker to further improve desynchronizing sound stimulation. Keywords: Alpha band activity, Coordinated reset neuromodulation, Delta band activity, Electroencephalography, Gamma band activity

The copper–phenanthroline complex CuI(Phen)2 was the first artificial nuclease studied in biology. The mechanism responsible for this activity involves CuII(Phen)2 and H2O2. Even if H2O2/Cu systems have been extensively studied in biology and oxidative chemistry, most of these studies were carried out at physiological pH only, and little information is available on the generation of radicals by the H2O2/CuII-Phen system. In the context of paper pulp bleaching to improve the bleaching ability of H2O2, this system has been investigated, mostly at alkaline pH, and more recently at near-neutral pH in the case of dyed cellulosic fibers. Hence, this paper aims at studying the production of radicals with the H2O2/CuII-Phen system at near-neutral and alkaline pHs. Using the EPR/spin-trapping method, HO• formation was monitored to understand the mechanisms involved. DMPO was used as a spin-trap to form DMPO–OH in the presence of HO•, and two HO• scavengers were compared to identify the origin of the observed DMPO–OH adduct, as nucleophilic addition of water onto DMPO leads to the same adduct. H2O2 decomposition was enhanced by the addition of CuII–Phen (and only slightly by addition of CuSO4), reaching a level similar to the Fenton reagent at near-neutral pH. This evidences the role of Phen, which improves the effect of CuII by tuning the electronic structure and structural properties of the corresponding CuII complexes.

Hartmut Meister,1 Sebastian Rählmann,1 Martin Walger,2 Sabine Margolf-Hackl,3 Jürgen Kießling3 1Jean Uhrmacher Institute for Clinical ENT-Research, University of Cologne, Cologne, Germany; 2Department of Otorhinolaryngology, Head and Neck Surgery, University of Cologne, Cologne, Germany; 3Department of Othorhinolaryngology, Head and Neck Surgery, University of Giessen, Giessen, Germany Purpose: To examine the association of cognitive function, age, and hearing loss with clinically assessed hearing aid benefit in older hearing-impaired persons.Methods: Hearing aid benefit was assessed using objective measures regarding speech recognition in quiet and noisy environments as well as a subjective measure reflecting everyday situations captured using a standardized questionnaire. A broad range of general cognitive functions such as attention, memory, and intelligence were determined using different neuropsychological tests. Linear regression analyses were conducted with the outcome of the neuropsychological tests as well as age and hearing loss as independent variables and the benefit measures as dependent variables. Thirty experienced older hearing aid users with typical age-related hearing impairment participated.Results: Most of the benefit measures revealed that the participants obtained significant improvement with their hearing aids. Regression models showed a significant relationship between a fluid intelligence measure and objective hearing aid benefit. When individual hearing thresholds were considered as an additional independent variable, hearing loss was the only significant contributor to the benefit models. Lower cognitive capacity – as determined by the fluid intelligence measure – was significantly associated with greater hearing loss. Subjective benefit could not be predicted by any of the variables considered.Conclusion: The present study does not give evidence that hearing aid benefit is critically associated with cognitive function in experienced hearing aid users. However, it was found that lower fluid intelligence scores were related to higher hearing thresholds. Since greater hearing loss was associated with a greater objective benefit, these results strongly support the advice of using hearing aids regardless of age and cognitive function to counter hearing loss and the adverse effects of age-related hearing impairment. Still, individual cognitive capacity might be relevant for hearing aid benefit during an initial phase of hearing aid provision if acclimatization has not yet taken place. Keywords: fluid intelligence, working memory, experience

O escopo do presente trabalho aborda a influência das reflexões internas na iluminação natural do ambiente construído. Discute-se como a geometria do espaço interno, as propriedades das superfícies e a área, a posição e a distribuição das aberturas influenciam nos valores e na distribuição atribuídos à iluminação refletida interna. O conhecimento dessas relações possibilita estabelecer o comportamento da luz refletida diante de modificação das mencionadas variáveis, de modo a preencher uma lacuna na bibliografia existente. Os métodos simplificados, previstos e utilizados pelas legislações vigentes para avaliação do ambiente luminoso, não consideram as componentes básicas da luz que atingem o interior do mesmo. Fato que prejudica a previsão do comportamento da luz. A contribuição da iluminação natural em um ambiente depende diretamente da componente celeste, da luz refletida nas superfícies externas e nas superfícies internas, fazendo, do conhecimento dessas, imprescindível para um bom entendimento do ambiente luminoso. Propõe-se a implementação de um método gráfico e outro analítico, buscando delinear o comportamento da luz refletida no interior das edificações. Esses métodos permitem a verificação e a comparação entre geometrias e entre conceitos de iluminação natural propostos, ou para verificar a qualidade e eficiência do projeto de iluminação em relação ao aproveitamento das reflexões da luz. Assim sendo, os métodos adotados se propõem a manipular os parâmetros dos elementos que influenciam a iluminação refletida, de modo a assegurar a qualidade do ambiente luminoso.

Recovered papers contain several chromophores, such as wood lignin and dyes. These have to be eliminated during paper recycling in order to produce white paper. Hydrogen peroxide under alkaline conditions is generally used to decolorize lignin, but its effect on dyes is limited. Copper(II)-phenanthroline (Cu-Phen) complexes can activate the oxidation of lignin by hydrogen peroxide. Hydrogen peroxide may also be activated during recycled fiber bleaching, thus enhancing its color-stripping efficiency towards unoxidizable azo dyes. The purpose of this paper was to determine the effect of Cu-Phen complexes on a model azo dye, Direct Red 81 (DR81), in aqueous solution. Different Cu-Phen solutions (with different initial Cu:Phen molar ratios) were prepared and mixed with the dye at different pHs. The geochemical computer program PHREEQC allowed precise calculation of the theoretical distribution between different possible coordinates (CuPhenOH+, Cu(Phen)22+, CuPhen(OH)2, Cu(Phen)32+, etc.) depending on pH and initial concentrations. UV-vis spectroscopic measurements were correlated with the major species theoretically present in each condition. The UV absorbance of the system was mainly attributed to the Cu-Phen complex and the visible absorbance was only due to the dye. Cu-Phen appeared to reduce the color intensity of the DR81 dye aqueous solution under specific conditions (more effective at pH 10.7 with Cu:Phen = 1:1), probably owing to the occurrence of a coordination phenomenon between DR81 and Cu-Phen. Hence, the ligand competition between phenanthroline and hydroxide ions would be disturbed by a third competitor, which is the dye molecule. Further investigation proved that the DR81 dye is able to form a complex with copper-phenanthroline, leading to partial color-stripping. This new “color-stripping effect” may be a new opportunity in paper and textile industries for wastewater treatment.