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To describe the epidemiology of surgical site infections (SSIs) after pediatric ambulatory surgery.
Observational cohort study with 60 days follow-up after surgery.
The study took place in 3 ambulatory surgical facilities (ASFs) and 1 hospital-based facility in a single pediatric healthcare network.
Children <18 years undergoing ambulatory surgery were included in the study. Of 19,777 eligible surgical encounters, 8,502 patients were enrolled.
Data were collected through parental interviews and from chart reviews. We assessed 2 outcomes: (1) National Healthcare Safety Network (NHSN)–defined SSI and (2) evidence of possible infection using a definition developed for this study.
We identified 21 NSHN SSIs for a rate of 2.5 SSIs per 1,000 surgical encounters: 2.9 per 1,000 at the hospital-based facility and 1.6 per 1,000 at the ASFs. After restricting the search to procedures completed at both facilities and adjustment for patient demographics, there was no difference in the risk of NHSN SSI between the 2 types of facilities (odds ratio, 0.7; 95% confidence interval, 0.2–2.3). Within 60 days after surgery, 404 surgical patients had some or strong evidence of possible infection obtained from parental interview and/or chart review (rate, 48 SSIs per 1,000 surgical encounters). Of 306 cases identified through parental interviews, 176 cases (57%) did not have chart documentation. In our multivariable analysis, older age and black race were associated with a reduced risk of possible infection.
The rate of NHSN-defined SSI after pediatric ambulatory surgery was low, although a substantial additional burden of infectious morbidity related to surgery might not have been captured by standard surveillance strategies and definitions.
This study was conducted within the context of the Animal Welfare Indicators (AWIN) project and the underlying scientific motivation for the development of the study was the scarcity of data regarding inter-observer reliability (IOR) of welfare indicators, particularly given the importance of reliability as a further step for developing on-farm welfare assessment protocols. The objective of this study is therefore to evaluate IOR of animal-based indicators (at group and individual-level) of the AWIN welfare assessment protocol (prototype) for dairy goats. In the design of the study, two pairs of observers, one in Portugal and another in Italy, visited 10 farms each and applied the AWIN prototype protocol. Farms in both countries were visited between January and March 2014, and all the observers received the same training before the farm visits were initiated. Data collected during farm visits, and analysed in this study, include group-level and individual-level observations. The results of our study allow us to conclude that most of the group-level indicators presented the highest IOR level (‘substantial’, 0.85 to 0.99) in both field studies, pointing to a usable set of animal-based welfare indicators that were therefore included in the first level of the final AWIN welfare assessment protocol for dairy goats. Inter-observer reliability of individual-level indicators was lower, but the majority of them still reached ‘fair to good’ (0.41 to 0.75) and ‘excellent’ (0.76 to 1) levels. In the paper we explore reasons for the differences found in IOR between the group and individual-level indicators, including how the number of individual-level indicators to be assessed on each animal and the restraining method may have affected the results. Furthermore, we discuss the differences found in the IOR of individual-level indicators in both countries: the Portuguese pair of observers reached a higher level of IOR, when compared with the Italian observers. We argue how the reasons behind these differences may stem from the restraining method applied, or the different background and experience of the observers. Finally, the discussion of the results emphasizes the importance of considering that reliability is not an absolute attribute of an indicator, but derives from an interaction between the indicators, the observers and the situation in which the assessment is taking place. This highlights the importance of further considering the indicators’ reliability while developing welfare assessment protocols.
Exocytosis is the fundamental process by which cells communicate with each other. The events that lead up to the fusion of a vesicle loaded with chemical messenger with the cell membrane were the subject of a Nobel Prize in 2013. However, the processes occurring after the initial formation of a fusion pore are very much still in debate. The release of chemical messenger has traditionally been thought to occur through full distention of the vesicle membrane, hence assuming exocytosis to be all or none. In contrast to the all or none hypothesis, here we discuss the evidence that during exocytosis the vesicle-membrane pore opens to release only a portion of the transmitter content during exocytosis and then close again. This open and closed exocytosis is distinct from kiss-and-run exocytosis, in that it appears to be the main content released during regular exocytosis. The evidence for this partial release via open and closed exocytosis is presented considering primarily the quantitative evidence obtained with amperometry.
To advance the on-going debate on Securitisation Theory (ST), we argue that the important questions of audience and attention can be addressed through careful historical study. In an analysis of the securitising moves concerning the American military base on Diego Garcia, we are able to demonstrate that the Copenhagen and Paris Schools are not methodologically incompatible, and empirically that public attention for security issues has a tendency to dissipate without continual discursive investment.
To assess the ability of Medicare claims to identify US hospitals with high rates of surgical site infection (SSI) after hip arthroplasty.
Retrospective cohort study.
Acute care US hospitals.
Fee-for-service Medicare patients 65 years of age and older who underwent hip arthroplasty in US hospitals from 2005 through 2007.
Hospital rankings were derived from claims codes suggestive of SSI, adjusted for age, sex, and comorbidities, while using generalized linear mixed models to account for hospital volume. Medical records were obtained for validation of infection on a random sample of patients from hospitals ranked in the best and worst deciles of performance. We then calculated the risk-adjusted odds of developing a chart-confirmed SSI after hip arthroplasty in hospitals ranked by claims into worst- versus best-performing deciles.
Among 524,892 eligible Medicare patients who underwent hip arthroplasty at 3,296 US hospitals, a patient who underwent surgery in a hospital ranked in the worst-performing decile based on claims-based evidence of SSI had 2.9-fold higher odds of developing a chart-confirmed SSI relative to a patient with the same age, sex, and comorbidities in a hospital ranked in the best-performing decile (95% confidence interval, 2.2-3.7).
Medicare claims successfully distinguished between hospitals with high and low SSI rates following hip arthroplasty. These claims can identify potential outlier hospitals that merit further evaluation. This strategy can also be used to validate the completeness of public reporting of SSI.
The impact of slowly digestible sugars in reducing the risk of developing obesity and related metabolic disorders remains unclear. We hypothesised that such carbohydrates (CHO), resulting in a lower glycaemic and insulinaemic response, may lead to greater postprandial fat oxidation rates in subjects with impaired glucose tolerance (IGT). The present study intends to compare the postprandial metabolic responses to the ingestion of glucose (GLUC) v. trehalose (TRE) and sucrose (SUC) v. isomaltulose (IMU). In a randomised, single-blind, cross-over design, ten overweight IGT subjects were studied four times, following ingestion of different CHO drinks either at breakfast or in combination with a mixed meal at lunch. Before and 3 h after CHO ingestion, energy expenditure, substrate utilisation and circulating metabolite concentrations were determined. Ingestion of CHO drinks with a meal resulted in an attenuated rise in GLUC ( − 33 %) and insulin ( − 14 %) concentrations following TRE when compared with GLUC and following IMU, an attenuation of 43 and 34 % when compared with SUC ingestion, respectively. Additionally, there was less inhibition of the rise in NEFA concentrations and less decline in postprandial fat oxidation (22 %) after IMU when compared with SUC, whereas TRE did not differ from GLUC. The attenuated rise in GLUC and insulin concentrations following IMU ingestion attenuated the postprandial inhibition of fat oxidation compared with SUC when co-ingested with a meal. This suggests that exchange of SUC in the diet for IMU may result in a more favourable metabolic response and may help to reduce the risks associated with obesity and type 2 diabetes.
We used Raman and photoluminescence (PL) spectroscopy to study the relationship between the material properties and the solar cell performance of hydrogenated nanocrystalline silicon (nc-Si:H). The crystalline volume fraction (fc) was deduced from the Raman spectrum. Generally, a high fc leads to a high short circuit current density and a low open circuit voltage. PL spectra were measured using 632.8-nm and 442-nm laser lines. There are two distinguished PL peaks at 80 K, one at ∼1.4 eV originating from the amorphous region, while the other at = 0.9 eV from the nanocrystalline grain boundary regions. Generally, the intensity fraction of this low energy PL peak, IPLc/(IPLa+IPLc), was larger for 442-nm than 632.8-nm excitation, indicating an increase in crystallinity along the growth direction. However, for the best initial performance cells obtained by H2 dilution profiling and the i/p buffer layer, the intensity fraction IPLc/(IPLa+IPLc) decreased from the bulk to the topi/p interface. The Raman and PL results give insight into the correlation between the microstructures and the cell performance, and verified that properly-controlled crystallinity in the intrinsic layer and buffer layer at the i/p interface layer are important for optimizing nc-Si:H solar cells.
The synthesis of poly(lactic-co-glycolic acid) (PLGA) by the ring opening copolymerization of D, L-lactide and glycolide was performed at 110 °C to 130 °C using Sn(Oct)2 as catalyst, 1, 10-decanediol as initiator in a supercritical sc-CO2 expanded medium at pressures of up to 3, 500 psi. Due to the limited monomer solubility in sc-CO2 at low temperatures (70 °C), only Mn = 2, 500 is typically obtained. However, molecular weight increases with both temperature and sc-CO2 pressure. Thus, Mn = 13, 000 (PDI = 1.28) was obtained at 110 °C - 130 °C even in the absence of fluorinated surfactants. Biodegradable drug delivery nanocomposites based on dexamethasone and poly(lactic acid) (PLA) and poly(lactide-co-glycolide) (PLGA) were prepared by the rapid expansion of the corresponding supercritical CHClF2 solutions (110 °C, 200-300 bar) in air (RESS) and in toluene (RESOLV). The RESS process leads to a broad particle size distribution (100-500 nm) while the RESOLV generates a narrower distribution centered around 100 nm and is accompanied by the formation of a few large particles, most likely due to aggregation.
ZnO, a well-known piezoelectric material, is used to develop micro-scale Surface Acoustic Wave (SAW) delay line sensor. In this work, SAW delay line Devices are fabricated employing ZnO films that are deposited by RF sputtering technique. Films are characterized prior to device fabrication by X-Ray Diffraction (XRD) for film crystalline quality, UV-visible transmission spectroscopy for optical characteristics, and Atomic Force Microscopy (AFM) for surface morphology. Interdigital electrodes producing surface acoustic waves in the hundreds of MHz are developed by photolithography and metalization techniques. SAW delay line device testing, measurement and characteristics on RF sputtered ZnO films are presented and compared.
To test the association between clinical allergic sensitisation to pollens and the profile and load of those pollens, in Ankara, Turkey.
Materials and methods:
Forty-three patients with seasonal allergic rhinitis were included. Clinical sensitisation to various pollens was compared with 10-year counts of the same pollens. The ratios of sensitisation to various pollen groups, and the association between clinical sensitisation and pollen load, were investigated.
Grass pollen allergy was the leading cause of seasonal allergic rhinitis, followed by tree pollen allergy. In Ankara, the most common type of airborne tree pollen was salicacea; however, the commonest clinical tree pollen allergies were due to the betulaceae and fagaceae families.
Higher concentrations of airborne pollens may not always result in a higher prevalence of clinical allergy to those pollens.
The impact of slow digestible sources of dietary carbohydrate in reducing the risk of developing obesity and related metabolic disorders is unclear. The aim of the present study was to compare the postprandial metabolic response to the ingestion of sucrose v. isomaltulose. We hypothesised that the reduced digestion and absorption rate of isomaltulose would result in lower glycaemic and insulinaemic responses when compared with the ingestion of sucrose, leading to greater postprandial fat oxidation rates. In a randomised, single-blind, cross-over study, ten overweight subjects ingested two different carbohydrate drinks (sucrose and isomaltulose, 75 g carbohydrate equivalents) following an overnight fast (08.40 hours) and with a standardised meal (12.30 hours, 25 % of total energy content was provided as either a sucrose or isomaltulose drink). Blood samples were taken before ingestion and every 30 min thereafter for a period of 3 h, substrate use was assessed by indirect calorimetry and breath samples were collected. Ingestion of carbohydrates with a mixed meal resulted in a lower peak glucose and insulin response and a lower change in area under the curve (ΔAUC) following isomaltulose when compared with sucrose. Together with the lower glucose and insulin responses, postprandial fat oxidation rates were higher (14 %) with isomaltulose when compared with sucrose when ingested with a mixed meal (P = 0·02). The attenuated rise in glucose and insulin concentrations following isomaltulose results in reduced inhibition of postprandial fat oxidation. The metabolic response to isomaltulose co-ingestion suggests that this may represent an effective nutritional strategy to counteract overweight-induced metabolic disturbances.
The proposed impact of slowly digestible sources of dietary carbohydrate in reducing the risk of developing obesity and related metabolic disorders remains unclear. The aim of the present study was to compare the postprandial metabolic response to the ingestion of glucose v. trehalose. We hypothesised that the reduced digestion and absorption rate of trehalose is accompanied by an attenuated glycaemic and insulinaemic response, leading to a less inhibited postprandial fat oxidation rate. In a randomised, single-blind, cross-over study, ten overweight subjects ingested two carbohydrate drinks (75 g carbohydrate equivalents of trehalose or glucose) following an overnight fast (08.40 hours) and together with a standardised mixed meal (12.30 hours; 25 % total energy content was provided as either glucose or trehalose). Blood samples were collected before ingestion and every 30 min thereafter for a period of 3 h; substrate use was assessed by indirect calorimetry and expired breath samples were collected. Ingestion of carbohydrates with a mixed meal resulted in a lower peak glucose response and a lower change in area under the curve (ΔAUC) following trehalose when compared with glucose. Differences in peak insulin response and ΔAUC were observed with trehalose when compared with glucose during the morning and afternoon. These differences were accompanied with a reduced carbohydrate oxidation after trehalose when ingested as a drink, whilst no significant differences in fat oxidation between drink were observed.
This Challenge paper identifies priorities for disease control as an input into the 2008 Copenhagen Consensus project (hereafter, CC08). As such, it updates the evidence and differs somewhat in its conclusions from the communicable disease paper (Mills and Shilcutt 2004) prepared for the 2004 Copenhagen Consensus, which Lomborg (2006) summarizes.
Our analysis builds on the results of the Disease Control Priorities Project (DCPP). The DCPP engaged over 350 authors and among its outputs were estimates of the cost-effectiveness of 315 interventions. These estimates vary a good deal in their thoroughness and in the extent to which they provide region-specific estimates of both cost and effectiveness. Taken as a whole, however, they represent a comprehensive canvas of disease control opportunities. Some interventions are clearly low priority. Others are attractive and worth doing, but either address only a relatively small proportion of disease burden or are simply not quite as attractive as a few key interventions. This chapter identifies seven priority interventions in terms of their cost-effectiveness, the size of the disease burden they address, and other criteria. Separate but related papers for CC08 deal with malnutrition (Horton et al. 2008, see chapter 6 in this volume), with water and sanitation (Hutton 2007), with air pollution (Larsen et al. 2008, see chapter 1 in this volume), and with education (Orazem et al., 2008, see chapter 4 in this volume).
Hydro-distilled essential oils from fruits, aerial parts (without fruits) and roots of Pimpinellaspecies native to Turkey and their phylogenetic relationships to one another were examined. Phytochemical investigation of the essential oils of 19 species resulted in isolation of 16 phenylpropanoids, four sesquiterpenes and two azulene-type norsesquiterpenes. The structures of the isolated compounds were determined primarily from 1D- and 2D-NMR experiments as well as liquid chromatography–mass spectrometry and gas chromatography–mass spectrometry. Phylogenetic relationships among 26 species were evaluated using ITS 1, ITS 4 nuclear rDNA and psbA-trnH cpDNA sequences. In this study, significance and occurrence of phenylpropanoids, azulenes and geijerenes are discussed from a phylogenetic, chemical and biosynthetic perspective. The distribution of different classes of compounds and their putative associations with one another as per current knowledge of their biosynthetic pathways indicates that this information, in conjunction with the phylogeny, could provide valuable information regarding the presence and perhaps evolution of the different classes of compounds. Analysis of the phenylpropanoid components indicates that (E)-anethole is an obligatory intermediate of this pathway. The various Pimpinellaspecies differ primarily in their ability to acylate anethole, suggesting that while the pathway leading to anethole is common to this genus, species differ in their enzymatic machinery leading to acylate. The relationship between azulenes and geijerenes is not as intuitive, but all Pimpinellaspecies analysed in this study have the biochemical machinery required to synthesize these chemical classes.