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Functional gastrointestinal disorders including constipation affect up to 14 % of the world's population. Treatment is difficult and challenging resulting in a need for alternative safe and effective therapies. The present study investigated whether daily consumption of three gold-fleshed kiwifruit could alleviate constipation and improve gastrointestinal discomfort in mildly constipated individuals with and without pain. A total of thirty-two participants were enrolled in a 16-week randomised, single-blind, crossover study. Participants received either three ‘Zesy002’ kiwifruit or 14·75 g Metamucil® (5 g dietary fibre/d (a positive control)) for 4 weeks each with a 4-week washout between treatments. A 2-week washout period was included at the beginning and end of the study. Daily bowel habit diaries were kept throughout the study. The primary outcome measure was differences in the number of complete spontaneous bowel movements (CSBM). Secondary outcome measures were bowel movement frequency and stool form as well as digestive symptoms and comfort. The number of CSBM per week was significantly greater during daily consumption of three kiwifruit compared with the baseline (6·3 v. 3·3; P < 0·05) and the Metamucil® treatment (6·3 v. 4·5; P < 0·05). Stool consistency was also improved, with kiwifruit producing softer stools and less straining (P < 0·05). Gastrointestinal discomfort was also improved compared with baseline for abdominal pain, constipation and indigestion (P < 0·05) during the kiwifruit intervention and constipation during the Metamucil® intervention (P < 0·05). This randomised controlled trial demonstrates that daily consumption of three gold-fleshed kiwifruit is associated with a significant increase of two CSBM per week and reduction in gastrointestinal discomfort in mildly constipated adults.
Foliage from the tropical leguminous tree, Sesbania sesban, is toxic to rumen protozoa in vitro, due to materials present in a saponins-containing extract of the foliage (Newbold et al. 1997). Suppression of protozoal numbers in vivo when S. sesban is added to the diet is either transient or non-existent, however, even though washed protozoa remain sensitive to S. sesban in vitro (Newbold et al. 1997, Odenyo et al. 1997). A possible reason is that saponins are metabolised in rumen fluid (Makkar and Becker 1997). The aims of this study were to determine if the antiprotozoal effect of different accessions of S. sesban was related to their saponins composition, and if conversion of saponins to their sapogenin derivatives was a possible cause of the loss of the antiprotozoal effect in vivo.
There are conflicting reports in the literature about the benefits of defaunation, the removal of ciliate protozoa from the rumen, in ruminant production. Ciliate protozoa are not essential for proper functioning of the rumen nor for the life of the host and that their contribution to microbial protein flowing to the lower gut is small (Williams and Coleman, 1992). Protozoa ingest and digest bacteria in the rumen decreasing the flow of microbial protein from the rumen, and inserting an energy wasting step in the net synthesis of bacterial protein in the rumen (Williams and Coleman, 1992). However, protozoa also play an active role in ruminal fibre digestion and up to 50% of ruminal carboxymethylcellulase activity is associated with the protozoal fraction (Williams and Colemans, 1992). Thus the effect of defaunation on animal productivity will be a balance between the increase in the supply of microbial protein leaving the rumen and any decrease in ruminal fibre digestion. The aim of this work was to determine the effect of defaunation on microbial protein supply and fibre digestion in sheep fed a poor quality tropical diet.
Development of a radio reference frame of very high accuracy has become necessary in order to obtain the required accuracy in spacecraft navigation for current and future planetary missions. The antennas of the NASA Deep Space Network are being utilized on a regular basis to obtain the positions of over 100 compact extragalactic radio sources distributed over the sky down to a declination of −45 degrees with uncertainties of less than 0.005 arcseconds.
Development of a catalogue of approximately 100 radio sources having positional accuracy of ~0.005 arcseconds is one goal of the DSN radio reference frame program. This objective is set by the navigation requirements of the Galileo Project for reconstruction of the probe entry angle into the atmosphere of Jupiter. These radio positions are determined by VLBI observations using the antennas of the NASA Deep Space Network on two intercontinental baselines – California-Spain and California-Australia. Since 1978, measurements have been made simultaneously at 2.3 and 8.4 Ghz. Sixteen to twenty-four hours of data on each of the two baselines are usually obtained within a few days of each other, and since mid-1982 these pairs of observations have been made at approximately six week intervals.
Survey results suggest that prolonged administration of prophylactic antibiotics is common after mastectomy with reconstruction. We determined utilization, predictors, and outcomes of postdischarge prophylactic antibiotics after mastectomy with or without immediate breast reconstruction.
Commercially insured women aged 18–64 years coded for mastectomy from January 2004 to December 2011 were included in the study. Women with a preexisting wound complication or septicemia were excluded.
Predictors of prophylactic antibiotics within 5 days after discharge were identified in women with 1 year of prior insurance enrollment; relative risks (RR) were calculated using generalized estimating equations.
Overall, 12,501 mastectomy procedures were identified; immediate reconstruction was performed in 7,912 of these procedures (63.3%). Postdischarge prophylactic antibiotics were used in 4,439 procedures (56.1%) with immediate reconstruction and 1,053 procedures (22.9%) without immediate reconstruction (P<.001). The antibiotics most commonly prescribed were cephalosporins (75.1%) and fluoroquinolones (11.1%). Independent predictors of postdischarge antibiotics were implant reconstruction (RR, 2.41; 95% confidence interval [CI], 2.23–2.60), autologous reconstruction (RR, 2.17; 95% CI, 1.93–2.45), autologous reconstruction plus implant (RR, 2.11; 95% CI, 1.92–2.31), hypertension (RR, 1.05; 95% CI, 1.00–1.10), tobacco use (RR, 1.07; 95% CI, 1.01–1.14), surgery at an academic hospital (RR, 1.14; 95% CI, 1.07–1.21), and receipt of home health care (RR, 1.11; 95% CI, 1.04–1.18). Postdischarge prophylactic antibiotics were not associated with SSI after mastectomy with or without immediate reconstruction (both P>.05).
Prophylactic postdischarge antibiotics are commonly prescribed after mastectomy; immediate reconstruction is the strongest predictor. Stewardship efforts in this population to limit continuation of prophylactic antibiotics after discharge are needed to limit antimicrobial resistance.
Few studies have validated ICD-9-CM diagnosis codes for surgical site infection (SSI), and none have validated coding for noninfectious wound complications after mastectomy.
To determine the accuracy of International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) diagnosis codes in health insurer claims data to identify SSI and noninfectious wound complications, including hematoma, seroma, fat and tissue necrosis, and dehiscence, after mastectomy.
We reviewed medical records for 275 randomly selected women who were coded in the claims data for mastectomy with or without immediate breast reconstruction and had an ICD-9-CM diagnosis code for a wound complication within 180 days after surgery. We calculated the positive predictive value (PPV) to evaluate the accuracy of diagnosis codes in identifying specific wound complications and the PPV to determine the accuracy of coding for the breast surgical procedure.
The PPV for SSI was 57.5%, or 68.9% if cellulitis-alone was considered an SSI, while the PPV for cellulitis was 82.2%. The PPVs of individual noninfectious wound complications ranged from 47.8% for fat necrosis to 94.9% for seroma and 96.6% for hematoma. The PPVs for mastectomy, implant, and autologous flap reconstruction were uniformly high (97.5%–99.2%).
Our results suggest that claims data can be used to compare rates of infectious and noninfectious wound complications after mastectomy across facilities, even though PPVs vary by specific type of postoperative complication. The accuracy of coding was highest for cellulitis, hematoma, and seroma, and a composite group of noninfectious complications (fat necrosis, tissue necrosis, or dehiscence).
Distribution profiles of radiocarbon in dissolved inorganic carbonate have been measured along two transects in the southern Pacific, east of New Zealand. Use of accelerator mass spectrometry, with its small-sample-size capability, made it possible to sample near-surface waters with a depth resolution of a few tens of meters. Sampling of deeper water was guided by salinity and temperature data transmitted by a conductivity-temperature-depth probe. The measurements, taken over the Chatham Rise, show highly structured profiles that can be correlated with known circulation patterns in this region.
The small group of known Seyfert galaxies (Seyfert 1943) is of interest because it is clear that some violent activity is occurring in the nucleus, and some of the properties suggest a relationship with quasi-stellar sources. The spectrum of a Seyfert galaxy consists of strong, often very broad, emission lines superposed on a continuous spectrum which in some cases shows no absorption-line features. Two of the galaxies, NGC 1068 and 1275, are radio galaxies and the latter is known to be variable at radio frequencies (Dent 1966).
Studies on microbial biohydrogenation of fatty acids in the rumen are of importance as this process lowers the availability of nutritionally beneficial unsaturated fatty acids for incorporation into meat and milk but also might result in the accumulation of biologically active intermediates. The impact was studied of adsorption of 22:6n-3 (DHA) to particulate material on its disappearance during 24 h in vitro batch incubations with rumen inoculum. Four adsorbants were used in two doses (1 and 5 mg/ml of mucin, gum arabic, bentonite or silicic acid). In addition, the distribution of 22:6n-3 in the pellet and supernatant of diluted rumen fluid was measured. Bentonite and silicic acid did not alter the distribution of 22:6n-3 between pellet and supernatant nor increased the disappearance of 22:6n-3 during the incubation. Both mucin and gum arabic increased the recovery of 22:6n-3 in the supernatant, indicating that these compounds lowered the adsorption of the fatty acid to ruminal particles. This was associated with an increased disappearance of 22:6n-3, when initial 22:6n-3 was 0.06 or 0.10 mg/ml, and an increased formation of 22:0, when initial 22:6n-3 was 0.02 mg/ml, during the 24 h batch culture experiment. Addition of gum arabic to pure cultures of Butyrivibrio fibrisolvens or Butyrivibrio proteoclasticus did not negate the inhibitory effect of 22:6n-3 on growth. As both mucin and gum arabic provide fermentable substrate for ruminal bacteria, an additional experiment was performed in which mucin and gum arabic were replaced by equal amounts of starch, cellulose or xylan. No differences in disappearance of 22:6n-3 were observed, suggesting that the stimulatory effect of mucin and gum arabic on disappearance of 22:6n-3 most probably is not due to provision of an alternative site of adsorption but related to stimulation of bacterial growth. A relatively high proportion of 22:6n-3 can be reduced to 22:0 provided the initial concentration is low.
We present the results of two 2.3 μm near-infrared (NIR) radial velocity (RV) surveys to detect exoplanets around 36 nearby and young M dwarfs. We use the CSHELL spectrograph (R ~ 46,000) at the NASA InfraRed Telescope Facility (IRTF), combined with an isotopic methane absorption gas cell for common optical path relative wavelength calibration. We have developed a sophisticated RV forward modeling code that accounts for fringing and other instrumental artifacts present in the spectra. With a spectral grasp of only 5 nm, we are able to reach long-term radial velocity dispersions of ~20–30 m s−1 on our survey targets.
The Wisconsin Plasma Astrophysics Laboratory (WiPAL) is a flexible user facility designed to study a range of astrophysically relevant plasma processes as well as novel geometries that mimic astrophysical systems. A multi-cusp magnetic bucket constructed from strong samarium cobalt permanent magnets now confines a
, fully ionized, magnetic-field-free plasma in a spherical geometry. Plasma parameters of
provide an ideal testbed for a range of astrophysical experiments, including self-exciting dynamos, collisionless magnetic reconnection, jet stability, stellar winds and more. This article describes the capabilities of WiPAL, along with several experiments, in both operating and planning stages, that illustrate the range of possibilities for future users.
The National Healthcare Safety Network classifies breast operations as clean procedures with an expected 1%–2% surgical site infection (SSI) incidence. We assessed differences in SSI incidence following mastectomy with and without immediate reconstruction in a large, geographically diverse population.
Retrospective cohort study
Commercially insured women aged 18–64 years with ICD-9-CM procedure or CPT-4 codes for mastectomy from January 1, 2004 through December 31, 2011
Incident SSIs within 180 days after surgery were identified by ICD-9-CM diagnosis codes. The incidences of SSI after mastectomy with and without immediate reconstruction were compared using the χ2 test.
From 2004 to 2011, 18,696 mastectomy procedures among 18,085 women were identified, with immediate reconstruction in 10,836 procedures (58%). The incidence of SSI within 180 days following mastectomy with or without reconstruction was 8.1% (1,520 of 18,696). In total, 49% of SSIs were identified within 30 days post-mastectomy, 24.5% were identified 31–60 days post-mastectomy, 10.5% were identified 61–90 days post-mastectomy, and 15.7% were identified 91–180 days post-mastectomy. The incidences of SSI were 5.0% (395 of 7,860) after mastectomy only, 10.3% (848 of 8,217) after mastectomy plus implant, 10.7% (207 of 1,942) after mastectomy plus flap, and 10.3% (70 of 677) after mastectomy plus flap and implant (P<.001). The SSI risk was higher after bilateral compared with unilateral mastectomy with immediate reconstruction (11.4% vs 9.4%, P=.001) than without (6.1% vs 4.7%, P=.021) immediate reconstruction.
SSI incidence was twice that after mastectomy with immediate reconstruction than after mastectomy alone. Only 49% of SSIs were coded within 30 days after operation. Our results suggest that stratification by procedure type facilitates comparison of SSI rates after breast operations between facilities.
Many astrophysical disks, such as protoplanetary disks, are in a regime where non-ideal, plasma-specific magnetohydrodynamic (MHD) effects can significantly influence the behaviour of the magnetorotational instability (MRI). The possibility of studying these effects in the plasma Couette experiment (PCX) is discussed. An incompressible, dissipative global stability analysis is developed to include plasma-specific two-fluid effects and neutral collisions, which are inherently absent in analyses of Taylor–Couette flows (TCFs) in liquid metal experiments. It is shown that with boundary driven flows, a ion-neutral collision drag body force significantly affects the azimuthal velocity profile, thus limiting the flows to regime where the MRI is not present. Electrically driven flow (EDF) is proposed as an alternative body force flow drive in which the MRI can destabilize at more easily achievable plasma parameters. Scenarios for reaching MRI relevant parameter space and necessary hardware upgrades are described.
To investigate whether operative factors are associated with risk of surgical site infection (SSI) after hernia repair.
Retrospective cohort study.
Commercially insured enrollees aged 6 months-64 years with International Classification of Diseases, Ninth Revision, Clinical Modification procedure or Current Procedural Terminology, fourth edition, codes for inguinal/femoral, umbilical, and incisional/ventral hernia repair procedures from January 1, 2004, through December 31, 2010.
SSIs within 90 days after hernia repair were identified by diagnosis codes. The χ2 and Fisher exact tests were used to compare SSI incidence by operative factors.
A total of 119,973 hernia repair procedures were analyzed. The incidence of SSI differed significantly by anatomic site, with rates of 0.45% (352/77,666) for inguinal/femoral, 1.16% (288/24,917) for umbilical, and 4.11% (715/17,390) for incisional/ventral hernia repair. Within anatomic sites, the incidence of SSI was significantly higher for open versus laparoscopic inguinal/femoral (0.48% [295/61,142] vs 0.34% [57/16,524], P=.020) and incisional/ventral (4.20% [701/16,699] vs 2.03% [14/691], P=.005) hernia repairs. The rate of SSI was higher following procedures with bowel obstruction/necrosis than procedures without obstruction/necrosis for open inguinal/femoral (0.89% [48/5,422] vs 0.44% [247/55,720], P<.001) and umbilical (1.57% [131/8,355] vs 0.95% [157/16,562], P<.001), but not incisional/ventral hernia repair (4.01% [224/5,585] vs 4.16% [491/11,805], P=.645).
The incidence of SSI was highest after open procedures, incisional/ventral repairs, and hernia repairs with bowel obstruction/necrosis. Stratification of hernia repair SSI rates by some operative factors may facilitate accurate comparison of SSI rates between facilities.
The results of an investigation into the Mortality and Marriage Experience of the five Scottish Banks whose head offices are in Edinburgh during the period of 1923-1943 are presented. The general lines of the investigation follow those adopted by Mr. Fraser in his similar investigation for the period 1903-1923.
The rates of mortality and marriage have been taken out separately for bachelors and widowers, and rates of mortality separately for married men, wives and widows. The relative ages of husband and wife at marriage have also been examined. Comparisons are made between the rates of mortality and marriage shown in the period 1923-1943 with those given by Mr. Fraser for the period 1903-1923. To ascertain the financial effects of the new rates of mortality and marriage, monetary functions required in the valuation of widows' funds by the reversionary method of valuation have been calculated at 3% interest. These monetary functions have been compared with the equivalent functions deduced by Mr. Fraser for the 1903-1923 period. Finally, a valuation of one of the widows' funds concerned has been made at 3% interest, using Mr. Fraser's tables and also the tables based on the 1923-1943 experience.
International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) diagnosis codes are increasingly used to identify healthcare-associated infections, often with insufficient evidence demonstrating validity of the codes used. Absent medical record verification, we sought to confirm a claims algorithm to identify surgical site infections (SSIs) by examining the presence of clinically expected SSI treatment.
We performed a retrospective cohort study, using private insurer claims data from persons less than 65 years old with ICD-9-CM procedure or Current Procedure Terminology (CPT-4) codes for anterior cruciate ligament (ACL) reconstruction from January 2004 through December 2010. SSIs occurring within 90 days after ACL reconstruction were identified by ICD-9-CM diagnosis codes. Antibiotic utilization, surgical treatment, and microbiology culture claims within 14 days of SSI codes were used as evidence to support the SSI diagnosis.
Of 40,702 procedures, 401 (1.0%) were complicated by SSI, 172 (0.4%) of which were specifically identified as septic arthritis. Most SSIs were associated with an inpatient admission (232/401 [58%]), and/or surgical procedure(s) for treatment (250/401 [62%]). Temporally associated antibiotics, surgical treatment procedures, and cultures were present for 84% (338/401), 61% (246/401), and 59% (238/401), respectively. Only 5.7% (23/401) of procedures coded for SSI after the procedure had no antibiotics, surgical treatments, or cultures within 14 days of the SSI claims.
More than 94% of patients identified by our claims algorithm as having an SSI received clinically expected treatment for infection, including antibiotics, surgical treatment, and culture, suggesting that this algorithm has very good positive predictive value. This method may facilitate retrospective SSI surveillance and comparison of SSI rates across facilities and providers.