The absence of late Roman archaeology: identification issues in the Flemish archaeological record

In the past two decades, commercial archaeology has increased the known number of Roman sites immensly in Flanders, Belgium. However, this increase is not visible for Late Roman sites. This paper argues that, in addition to a population regression and other societal changes, the state of the archaeological record is influenced by traditional narratives and a way of thinking that limits us in finding more Late Roman archaeology in the area of Flanders. Arguments include the variety of known and retrievable material culture, the 3rd century narrative, and a Germanic bias.

http://ift.tt/2qVRuVu

From commodity to singularity: The production of crossbow brooches and the rise of the Late Roman military elite

The diachronic development of the crossbow brooch was examined for northern Gaul during the Late Roman period (3rd to 5th century) in order to extrapolate changes in production organisation from variation in the copper-alloy composition and shape of the artefacts. A combined method of surface analysis by handheld XRF and dimensional analyses by focussing on variation or similarity was applied and interpreted in a typological framework to confirm and enhance the traditional production model of the crossbow brooch. This led to new insights into the processes of regionality and state-control in Roman metal production in a provincial context. From a simple military commodity to an elite symbol of power and authority, these changes in production and consumption reflect sociocultural changes in the Late Roman West.

http://ift.tt/2qkCCms

I strongly recommend that all practicing physicians consider such a list, and review it occasionally. I wish for the judgement to know what is best for my patients and to weigh the merits of interventions; surgically, medically, and radiotherapeutically. I wish that I can master the complexities of the practice of medicine and be worthwhile as a physician. I wish for the honesty and integrity to objectively assess my competencies and fallibilities. I wish for the intellectual drive to maintain cu

Brazilian Journal of Otorhinolaryngology

Print version ISSN 1808-8694

On-line version ISSN 1808-8686

Braz. j. otorhinolaryngol. vol.83 no.2 São Paulo 

http://ift.tt/2q1gF8X

EDITORIAL

Ethics in the twenty first century otolaryngology☆

Charles W. Cummings1 

1Johns Hopkins University, Baltimore, USA. E-mail: ccumming@jhmi.edu

In the United States, the climate of the practice of Medicine is in transition and under siege by policy revisionists and governmental/political opportunists. Regulatory and legislative hubris has enshrouded the medical arena through formulaic dictums and onerous regulations oft times constructed by individuals who have no clinical experience or knowledge. The art of Medicine is being dismantled by emphasis on outcomes based solely on statistical evidence, with no concern for the human variables. Objective analysis is not inherently bad provided the personal and social factors are properly emphasized in the analysis. Freedom to make clinical decisions MUST be preserved for optimal care.

This phenomenon exerts undue pressure on the clinician leading to professional frustration and anemia of job satisfaction. Also, the environment which enables the best of care is further challenged and compromised.

Never the less, we, as physicians, must continue to acknowledge our calling and respond to the gifts of our profession. It seems appropriate to review the commitments that we have made to ourselves and our patients. Over the years, I have created a wish list concerning the way I want to conduct myself to satisfy my professional goals. What follows are those wishes. I strongly recommend that all practicing physicians consider such a list, and review it occasionally.

I wish for the judgement to know what is best for my patients and to weigh the merits of interventions; surgically, medically, and radiotherapeutically.

I wish that I can master the complexities of the practice of medicine and be worthwhile as a physician.

I wish for the honesty and integrity to objectively assess my competencies and fallibilities.

I wish for the intellectual drive to maintain currency of knowledge.

I wish for the wisdom to assess and maintain appropriate costs for medical care.

I wish for the integrity to avoid marketing my skills and accomplishments unrealistically and erroneously.

I wish for the compassion that allows me to separate my personal problems from the needs of the patients that I serve.

I wish for the courage to challenge the wisdom of those that create policies and regulations that fail to consider the full dimension and scope of medical care.

Please preserve the art of Medicine. We must steward our wonderful calling.

☆Please cite this article as: Cummings CW. Ethics in the twenty first century otolaryngology. Braz J Otorhinolaryngol. 2017;83:119.2

Conflicts of interest

The author declares no conflicts of interest.

© 2017 Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Published by Elsevier Editora Ltda.

 This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

 

Sede da Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico Facial

Av. Indianópolia, 1287

04063-002 São Paulo/SP Brasil

Tel.: (0xx11) 5053-7500

Fax: (0xx11) 5053-7512

revista@aborlccf.org.br

Alexandros Sfakianakis
Anapafseos 5 . Agios Nikolaos
Crete.Greece.72100
2841026182

6948891480

alsfakia@gmail.com

http://ift.tt/2pYUQZL

I strongly recommend that all practicing physicians consider such a list, and review it occasionally. I wish for the judgement to know what is best for my patients and to weigh the merits of interventions; surgically, medically, and radiotherapeutically. I wish that I can master the complexities of the practice of medicine and be worthwhile as a physician. I wish for the honesty and integrity to objectively assess my competencies and fallibilities. I wish for the intellectual drive to maintain currency of knowledge. I wish for the wisdom to assess and maintain appropriate costs for medical care. I wish for the integrity to avoid marketing my skills and accomplishments unrealistically and erroneously. I wish for the compassion that allows me to separate my personal problems from the needs of the patients that I serve. I wish for the courage to challenge the wisdom of those that create policies and regulations that fail to consider the full dimension and scope of medical care. Please p

Brazilian Journal of Otorhinolaryngology

Print version ISSN 1808-8694

On-line version ISSN 1808-8686

Braz. j. otorhinolaryngol. vol.83 no.2 São Paulo 

http://dx.doi.org/10.1016/j.bjorl.2017.01.001 

EDITORIAL

Ethics in the twenty first century otolaryngology☆

Charles W. Cummings1 

1Johns Hopkins University, Baltimore, USA. E-mail: ccumming@jhmi.edu

In the United States, the climate of the practice of Medicine is in transition and under siege by policy revisionists and governmental/political opportunists. Regulatory and legislative hubris has enshrouded the medical arena through formulaic dictums and onerous regulations oft times constructed by individuals who have no clinical experience or knowledge. The art of Medicine is being dismantled by emphasis on outcomes based solely on statistical evidence, with no concern for the human variables. Objective analysis is not inherently bad provided the personal and social factors are properly emphasized in the analysis. Freedom to make clinical decisions MUST be preserved for optimal care.

This phenomenon exerts undue pressure on the clinician leading to professional frustration and anemia of job satisfaction. Also, the environment which enables the best of care is further challenged and compromised.

Never the less, we, as physicians, must continue to acknowledge our calling and respond to the gifts of our profession. It seems appropriate to review the commitments that we have made to ourselves and our patients. Over the years, I have created a wish list concerning the way I want to conduct myself to satisfy my professional goals. What follows are those wishes. I strongly recommend that all practicing physicians consider such a list, and review it occasionally.

I wish for the judgement to know what is best for my patients and to weigh the merits of interventions; surgically, medically, and radiotherapeutically.

I wish that I can master the complexities of the practice of medicine and be worthwhile as a physician.

I wish for the honesty and integrity to objectively assess my competencies and fallibilities.

I wish for the intellectual drive to maintain currency of knowledge.

I wish for the wisdom to assess and maintain appropriate costs for medical care.

I wish for the integrity to avoid marketing my skills and accomplishments unrealistically and erroneously.

I wish for the compassion that allows me to separate my personal problems from the needs of the patients that I serve.

I wish for the courage to challenge the wisdom of those that create policies and regulations that fail to consider the full dimension and scope of medical care.

Please preserve the art of Medicine. We must steward our wonderful calling.

☆Please cite this article as: Cummings CW. Ethics in the twenty first century otolaryngology. Braz J Otorhinolaryngol. 2017;83:119.2

Conflicts of interest

The author declares no conflicts of interest.

© 2017 Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Published by Elsevier Editora Ltda.

 This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

 

Sede da Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico Facial

Av. Indianópolia, 1287

04063-002 São Paulo/SP Brasil

Tel.: (0xx11) 5053-7500

Fax: (0xx11) 5053-7512

revista@aborlccf.org.br

Alexandros Sfakianakis
Anapafseos 5 . Agios Nikolaos
Crete.Greece.72100
2841026182

6948891480

alsfakia@gmail.com

Regional anaesthesia for ophthalmic surgery

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http://ift.tt/2qLQl5B

Acute respiratory distress syndrome

<span class="paragraphSection"><div class="boxedTextSection">Key points<ul><li class="bullet">Acute respiratory distress syndrome (ARDS) is commonly encountered in the critical care population and is associated with a high mortality of between 27% and 45%.</li><li class="bullet">ARDS is diagnosed according to the Berlin definition and is characterized as mild, moderate, or severe depending on the <span style="font-style:italic;">P</span>a<span style="text-transform:lowercase;font-variant:small-caps;">O</span>₂/<span style="font-style:italic;">FI</span><span style="text-transform:lowercase;font-variant:small-caps;">O</span>₂ ratio.</li><li class="bullet">Accepted management strategies include lung protective ventilation with tidal volumes limited to 6 ml kg⁻¹, positive end expiratory pressure increasing in line with oxygen requirement, and prone positioning in severe cases.</li><li class="bullet">Steroids, statins, inhaled nitric oxide, and high-frequency oscillation ventilation do not have a role in the routine management of adults with ARDS.</li><li class="bullet">Adverse functional and neuropsychological outcomes are increasingly recognized in long-term ARDS survivors.</li></ul></div></span>

http://ift.tt/2ppJev3

Streptococcus mutans membrane lipid composition: Virulence factors and structural parameters

Publication date: September 2017
Source:Archives of Oral Biology, Volume 81
Author(s): M.A. Bojanich, R.O. Calderón
ObjectiveThe aim of the present work was to analyze whether the location of the dental biofilm was associated with shifts in the membrane fatty acid profile, and whether such shifts could affect certain virulence factors of strains of Streptococcus mutans.DesignAn experimental study was conducted to assess the behavior of S. mutans strains isolated from dental biofilm collected from sound and carious smooth and occlusal surfaces of the oral cavity of children. The lipid composition of the bacterial membrane, structural membrane parameters, acid survival, and ATPase activity were tested at pH 7 and 5.ResultsAt pH 5, an increase in both the unsaturated and the long chain fatty acids as well as in proton ATPase hydrolytic activity was observed in strains isolated from carious smooth surface biofilm but not in carious occlusal surface strains. The observed changes correlated with the studied structural parameters, and were found to be associated with membrane organization. The changes correlated with a decreased in ΔC (sn-1 and sn-2 acyl chain inequivalence), indicative of increased acyl chain interaction.ConclusionsThe obtained results suggest that the acidic environment (pH 5) of smooth surface caries affects membrane organization, inducing a shift in membrane lipid profile, which would likely induce better protein/lipid hydrophobic matching, resulting in increased ATPase activity and higher acid survival.



http://ift.tt/2ptVNpU