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Major surgery carried out in low- and middle-income countries is associated with a high risk of surgical site infections (SSI), but knowledge is limited regarding contributory factors to such infections. This study explores factors related to patients developing an SSI in a teaching hospital in Ghana. A prospective cohort study of patients undergoing abdominal surgical procedures was conducted at Korle Bu Teaching Hospital. Patient characteristics, procedures and environmental characteristics were recorded. A 30-day daily surveillance was used to diagnose SSI, and Poisson regression analysis was used to test for association of SSI and risk factors; survival was determined by proportional hazard regression methods. We included 358 patients of which 58 (16.2%; 95% CI 12.7–20.4%) developed an SSI. The median number of door openings during an operation was 79, with 81% being unnecessary. Door openings greater than 100 during an operation (P = 0.028) significantly increased a patient's risk of developing an SSI. Such patients tended to have an elevated mortality risk (hazard ratio 2.67; 95% CI 0.75–9.45, P = 0.128). We conclude that changing behaviour and practices in operating rooms is a key strategy to reduce SSI risk.
Globba sect. Nudae subsect. Mediocalcaratae (K.Schum.) K.J.Williams is revised. Nineteen species are recognised. Eight names are lectotypified, three names are newly placed in synonymy, and two names are neotypified. A key to the species and descriptions are provided. Nine new species are described and illustrated: Globba argyrocycnos Sangvir. & M.F.Newman, G. cataractarum Sangvir. & M.F.Newman, G. chrysochila Sangvir. & M.F.Newman, G. decora Sangvir. & M.F.Newman, G. lilacina Sangvir. & M.F.Newman, G. newmanii Sangvir., G. nitens Sangvir. & M.F.Newman, G. pycnostachys Sangvir. & M.F.Newman and G. pyrrhopoikila Sangvir. & M.F.Newman. Six names based on five types from Thailand and the Philippines remain doubtful. Andromonoecy in this subsection is defined. Provisional IUCN conservation assessments of all species are supplied.
To characterize the association of longitudinal changes in maternal anthropometric measures with neonatal anthropometry and to assess to what extent late-gestational changes in maternal anthropometry are associated with neonatal body composition.
In a prospective cohort of pregnant women, maternal anthropometry was measured at six study visits across pregnancy and after birth, neonates were measured and fat and lean mass calculated. We estimated maternal anthropometric trajectories and separately assessed rate of change in the second (15–28 weeks) and third trimester (28–39 weeks) in relation to neonatal anthropometry. We investigated the extent to which tertiles of third-trimester maternal anthropometry change were associated with neonatal outcomes.
Women were recruited from twelve US sites (2009–2013).
Non-obese women with singleton pregnancies (n 2334).
A higher rate of increase in gestational weight gain was associated with larger-birth-weight infants with greater lean and fat mass. In contrast, higher rates of increase in maternal anthropometry measures were not associated with infant birth weight but were associated with decreased neonatal lean mass. In the third trimester, women in the tertile of lowest change in triceps skinfold (−0·57 to −0·06 mm per week) had neonates with 35·8 g more lean mass than neonates of mothers in the middle tertile of rate of change (−0·05 to 0·06 mm per week).
The rate of change in third-trimester maternal anthropometry measures may be related to neonatal lean and fat mass yet have a negligible impact on infant birth weight, indicating that neonatal anthropometry may provide additional information over birth weight alone.
From a physiological-behavioral perspective, it has been shown that fish with a higher density of black eumelanin spots are more dominant, less sensitive to stress, have higher feed intake, better feed efficiency and therefore are larger in size. Thus, we hypothesized that genetic (co)variation between skin pigmentation patterns and growth exists and it is advantageous in rainbow trout. The objective of this study was to determine the genetic relationships between skin pigmentation patterns and BW in a breeding population of rainbow trout. We performed a genetic analysis of pigmentation traits including dorsal color (DC), lateral band (LB) intensity, amount of spotting above (SA) and below (SB) the lateral line, and BW at harvest (HW). Variance components were estimated using a multi-trait linear animal model fitted by restricted maximum likelihood. Estimated heritabilities were 0.08±0.02, 0.17±0.03, 0.44±0.04, 0.17±0.04 and 0.23±0.04 for DC, LB, SA, SB and HW, respectively. Genetic correlations between HW and skin color traits were 0.42±0.13, 0.32±0.14 and 0.25±0.11 for LB, SA and SB, respectively. These results indicate positive, but low to moderate genetic relationships between the amount of spotting and BW in rainbow trout. Thus, higher levels of spotting are genetically associated with better growth performance in this population.
Foodborne illness is a major cause of morbidity and loss of productivity in developed nations. Although low socioeconomic status (SES) is generally associated with negative health outcomes, its impact on foodborne illness is poorly understood. We conducted a systematic review to examine the association between SES and laboratory-confirmed illness caused by eight important foodborne pathogens. We completed this systematic review using PubMed for all papers published between 1 January 1980 and 1 January 2013 that measured the association between foodborne illness and SES in highly developed countries and identified 16 studies covering four pathogens. The effect of SES varied across pathogens: the majority of identified studies for Campylobacter, salmonellosis, and E. coli infection showed an association between high SES and illness. The single study of listeriosis showed illness was associated with low SES. A reporting bias by SES could not be excluded. SES should be considered when targeting consumer-level public health interventions for foodborne pathogens.
A full-term neonate was noted to be cyanotic and rapidly developed severe respiratory distress requiring endotracheal intubation. A chest radiograph (Fig. 31.1a) showed a diffuse pulmonary edema pattern, but a normal sized cardiac silhouette. Echocardiography demonstrated a large atrial septal defect (ASD) and absence of pulmonary veins entering the left atrium; however, it could not identify the drainage pattern of the pulmonary veins. CT angiography of the chest on the same day showed all pulmonary veins converging into a confluence posterior to the left atrium and draining below the diaphragm (Fig. 31.1b, c), consistent with infracardiac total anomalous pulmonary venous return (TAPVR) with obstruction. Prenatal ultrasound examinations had been reported as within normal limits.
TAPVR or total anomalous pulmonary venous connection is a rare congenital cardiovascular malformation (2–3% of all congenital cardiovascular anomalies) in which all four pulmonary veins drain into systemic veins or the right atrium with or without pulmonary venous obstruction. More severe obstruction tends to correlate with both earlier clinical presentation and increased severity of symptoms. TAPVR is classified based on the location of pulmonary venous drainage. In all types, the pulmonary veins tend to form a primary confluence, usually behind the left atrium, which then drains ultimately to a systemic vein and the right atrium. Approximately one-third of TAPVR patients have other complex cardiovascular anomalies including asplenia and pulmonary atresia (Fig. 31.2). All types of TAPVR have shunting through the lungs back to the right side of the heart, and require a right to left shunt for survival. An ASD and/or patent foramen ovale (PFO) are essential to allow for the return of blood to the systemic side.
We have used high-resolution, HST WFC3/IR, near-infrared imaging to conduct a detailed bulge-disk decomposition of the morphologies of ≃ 200 of the most massive (M* > 1011 M⊙) galaxies at 1 < z < 3 in the CANDELS-UDS field. We find that, while such massive galaxies at low redshift are generally bulge-dominated, at redshifts 1<z<2 they are predominantly mixed bulge+disk systems, and by z > 2 they are mostly disk-dominated. Interestingly, we find that while most of the quiescent galaxies are bulge-dominated, a significant fraction (25–40%) of the most quiescent galaxies, have disk-dominated morphologies. Thus, our results suggest that the physical mechanisms which quench star-formation activity are not simply connected to those responsible for the morphological transformation of massive galaxies.
This paper identifies some of the more important diseases at the wildlife–livestock interface and the role wildlife plays in disease transmission. Domestic livestock, wildlife and humans share many similar pathogens. Pathogens of wild or domestic animal origin that can cause infections in humans are known as zoonotic organisms and the converse are termed as anthroponotic organisms. Seventy-seven percent of livestock pathogens and 91% of domestic carnivore pathogens are known to infect multiple hosts, including wildlife. Understanding this group of pathogens is critical to public health safety, because they infect a wide range of hosts and are most likely to emerge as novel causes of infection in humans and domestic animals. Diseases at the wildlife–livestock interface, particularly those that are zoonotic, must be an area of focus for public health programs and surveillance for emerging infectious diseases. Additionally, understanding wildlife and their role is a vital part of understanding the epidemiology and ecology of diseases. To do this, a multi-faceted approach combining capacity building and training, wildlife disease surveillance, wildlife–livestock interface and disease ecology studies, data and information sharing and outbreak investigation are needed.
Influenza A (H1N1) viruses when initially isolated in mammalian cell cultures (MDCK cells) had different agglutination reactions with chicken and guinea-pig erythrocytes compared to the same viruses after passage. On first isolation the virus HA resembled the ‘O’ phase viruses described originally by Burnet and Bull and agglutinated mammalian but not avian erythrocytes. After passage, the virus HA resembled a classical ‘D’ phase virus and agglutinated both avian and mammalian erythrocytes. Monoclonal and polyclonal antisera detected antigenic differences between the HAs of the viruses in the ‘O’ and ‘D’ phases. The ‘O’ phase virus HA reacted preferentially with antibodies in post infection human antisera. Viruses in the ‘O’ phase replicated poorly in the allantoic cavity of embryonated hens' eggs whilst ‘D’ phase virus replicated in both MDCK cells and in embryonated hens' eggs. At least three distinguishable subpopulations of influenza A (H1N1) viruses may co-exist in clinical throat swab material, including viruses possessing HAs in the ‘O’ and ‘D’ phases and other ‘D’ phase viruses cultivable in embryonated hens' eggs but antigenically distinguishable from the corresponding ‘D’ phase virus in MDCK cells.
In 1985 an outbreak of ornithosis affected 13 of 80 (16%) workers in a duck-processing plant. New employees were three times more likely to become cases than established employees. The highest attack rate was in those on the production line. Following the outbreak, an occupational health scheme was set up to monitor the health of new recruits to the company. Serological evidence of recent infection was demonstrated in 18 of 37 (49%) new employees tested in the first 3 months of employment. Five (14%) also had clinical evidence of ornithosis. Veterinary investigation of the ducks demonstrated a high proportion with asymptomatic chlamydial infection. It is suggested that ornithosis may be more common in duck processors than ins processors than is currently supposed. Strategies to reduce occupational risks are discussed.
The first recognized outbreak of haemorrhagic colitis due to Escherichia coli O 157. H7 in the United Kingdom affected at least 24 persons living in East Anglia over a 2-week period. Theillnesses were characterized by severe abdominal pain and bloody diarrhoea of short duration. Eleven patients were admitted to hospital and there was one death. Patients were mainly adult women who had not eaten out of the home in the 2 weeks before onset. Unlike previously reported outbreaks hamburgers were not the vehicle of infection, and a case-control study suggested that handling vegetables, and particularly potatoes, was the important risk factor.
Skeletal patterning in the vertebrate limb,
i.e., the spatiotemporal regulation of cartilage differentiation
(chondrogenesis) during embryogenesis and regeneration, is one
of the best studied examples of a multicellular developmental process.
Recently [Alber et al., The morphostatic limit for a model of
skeletal pattern formation in the vertebrate limb, Bulletin of
Mathematical Biology, 2008, v70, pp. 460-483], a simplified two-equation
reaction-diffusion system was developed to describe the interaction of two of
the key morphogens: the activator and an activator-dependent inhibitor of
precartilage condensation formation. A discontinuous Galerkin (DG)
finite element method was applied to solve this nonlinear system on complex
domains to study the effects of domain geometry on the pattern generated [Zhu et
al., Application of Discontinuous Galerkin Methods for reaction-diffusion
systems in developmental biology, Journal of Scientific Computing, 2009, v40,
pp. 391-418]. In this paper, we extend these previous results and develop a DG
finite element model in a moving and deforming domain for skeletal pattern
formation in the vertebrate limb. Simulations reflect the actual dynamics of
limb development and indicate the important role played by the geometry
of the undifferentiated apical zone.