Search

By drawing on the data and evidence related to a recent annulment, following the complaint of a small local SME, in an Italian administrative court of a large, limited-lots, tender published by the Italian largest Central Purchasing Body, we review the evidence for aggregation and bundling strategies of public procurement tenders in the light of the negative impact they generate on SME participation. We conclude by suggesting that an optimal strategy of centralization, which has several benefits, to survive requires limiting its bundling temptation.

Mamede AP, Vassalo AR, Piga G, Cunha E, Parker SF, Marques MPM, Batista de Carvalho LAE, Gonçalves D. 2018g. Targeting the OH’s within Bone´s Bioapatite by Neutron and Optical Vibrational Spectroscopy. 3rd-7th September. Synchrotron Radiation and Neutrons in Art and Archaeology, Portsmouth, UK.

The lack of prospective, randomized, controlled trial data to guide optimal antibiotic use in bacteraemic critically ill patients has led to a wide variety of strategies and major issues with drug resistance. We therefore prospectively investigated the epidemiology of bacteraemia and fungaemia in intensive care units (ICUs); and the impact of timing, type and appropriateness of antibiotic intervention.We conducted a multinational, multicentre, prospective observational study in 132 ICUs from 26 countries with no interventions.1702 patients [European (69.6%), Australasian (12.2%), South American (8.3%) and Asian (9.9%)] developed 1942 bacteraemic episodes over the study period. Mortality rates were similar for those receiving empirical (40.5%), semi-targeted (37.6%) or fully targeted (33.3%) antibiotic therapy (P=0.40), and in those initially receiving broad- (39.3%) or restricted-spectrum (39.1%) therapy (P=0.94). First-line therapy was effective in terms of the antibiogram (where available) in 70.4% of cases. This in vitro susceptibility ranged from 76.3% for broad-spectrum antibiotics to 46.3% for restricted-spectrum antibiotics (P0.0001). However, no antibiotic policy-associated variable, including in vitro susceptibility (odds ratio 0.89, 95% confidence interval 0.61-1.30), was a statistically significant predictor of mortality.We could not show an impact of antibiotics on mortality in critically ill patients, despite in vitro activity and early commencement. Randomized, multicentre trials are urgently needed to establish the appropriate duration, timing and combinations of antibiotics that will both optimally treat infection and minimize development of resistance and other complications.

Megestrol acetate (MA) is a progestational agent for the treatment of metastatic breast cancer and endometrial cancer. MA has also been used to promote weight gain in malnourished elderly patients, in patients with immunodeficiency virus and in cancer-induced cachexia. In addition to thromboembolic disease, MA may induce hyperglycaemia, osteoporosis, suppression of the gonadal axis, and Cushing's syndrome. MA has also been shown to cause symptomatic suppression of the hypothalamic-pituitary-adrenal (HPA) axis owing to its intrinsic glucocorticoid-like effect. Three additional patients are presented who developed symptomatic adrenal insufficiency while they were receiving 160-320 mg MA daily. The patients were treated with cortisone acetate supplements, had clear evidence of HPA-axis suppression but recovered fully after MA was discontinued. Patients receiving MA might have an inadequate adrenal response during stressful conditions, possibly because 160-320 mg MA daily may not provide adequate protection to prevent the symptoms of adrenal insufficiency. The adverse MA effect on the HPA axis is probably not well recognised in clinical practice, and clinicians need an increased awareness of the endocrine complications secondary to MA treatment.

Los efectos del calor extremo sobre los restos óseos es un tema de gran interés para el mundo forense. La literatura en rápido crecimiento en esta área de las ciencias forenses incluye investigaciones experimentales que analizan la dinámica del impacto térmico sobre la estructura del esqueleto y su morfología. Además de los métodos tradicionales de investigación, la aplicación de técnicas químico-físicas como la difracción de rayos X (DRX) y la espectroscopia de infrarrojos por transformada de Fourier (FT-IR) es cada vez más aceptada en distintos contextos forenses. Los campos de aplicación se refieren principalemente a la capacidad para distinguir entre restos humanos quemados y otros materiales, la determinación de la temperatura, el tiempo de combustión y su intensidad en todo el cuerpo, en diversas situaciones como accidentes, suicidios/homicidios y el estudio de la escena del crimen. The effects of extreme heat on the skeletal remains are a subject of great interest to the forensic world. The rapidly growing literature in this area of forensic science includes experimental investigations that analyze dynamics of thermal impact on the skeletal structure and morphology. In addition to traditional research methods, the application of chemical and physical techniques such as X-ray diffraction (XRD) and, Fourier transform infrared spectroscopy (FT-IR) is increasingly accepted in forensic contexts. The ability to distinguish between burned human remains and other materials, and the determination of the temperature, the combustion time and intensity throughout the body may be important in various situations such as accidents, suicides / homicides and studying the crime scene.

Introduction Recent evidence suggests that choice of fluid used for resuscitation may influence mortality in critically ill patients. Methods We conducted a cross-sectional study in 391 intensive care units across 25 countries to describe the types of fluids administered during resuscitation episodes. We used generalized estimating equations to examine the association between patient, prescriber and geographic factors and the type of fluid administered (classified as crystalloid, colloid or blood products). Results During the 24-hour study period, 1,955 of 5,274 (37.1%) patients received resuscitation fluid during 4,488 resuscitation episodes. The main indications for administering crystalloid or colloid were impaired perfusion (1,526/3,419 (44.6%) of episodes), or to correct abnormal vital signs (1,189/3,419 (34.8%)). Overall, colloid was administered to more patients (1,234 (23.4%) versus 782 (14.8%)) and during more episodes (2,173 (48.4%) versus 1,468 (32.7%)) than crystalloid. After adjusting for patient and prescriber characteristics, practice varied significantly between countries with country being a strong independent determinant of the type of fluid prescribed. Compared to Canada where crystalloid, colloid and blood products were administered in 35.5%, 40.6% and 28.3% of resuscitation episodes respectively, odds ratios for the prescription of crystalloid in China, Great Britain and New Zealand were 0.46 (95% confidence interval (CI) 0.30 to 0.69), 0.18 (0.10 to 0.32) and 3.43 (1.71 to 6.84) respectively; odds ratios for the prescription of colloid in China, Great Britain and New Zealand were 1.72 (1.20 to 2.47), 4.72 (2.99 to 7.44) and 0.39 (0.21 to 0.74) respectively. In contrast, choice of fluid was not influenced by measures of illness severity (for example, Acute Physiology and Chronic Health Evaluation (APACHE) II score). Conclusions Administration of resuscitation fluid is a common intervention in intensive care units and choice of fluid varies markedly between countries. Although colloid solutions are more expensive and may possibly be harmful in some patients, they were administered to more patients and during more resuscitation episodes than crystalloids were.