Safety of overlapping inpatient orthopaedic surgery: A multicenter study

BackgroundAlthough overlapping surgery is used to maximize efficiency, more empirical data are needed to guide patient safety. We conducted a retrospective cohort study to evaluate the safety of overlapping inpatient orthopaedic surgery, as judged by the occurrence of perioperative complications.MethodsAll inpatient orthopaedic surgical procedures performed at 5 academic institutions from January 1, 2015, to December 31, 2015, were included. Overlapping surgery was defined as 2 skin incisions open simultaneously for 1 surgeon. In comparing patients who underwent overlapping surgery with those who underwent non-overlapping surgery, the primary outcome was the occurrence of a perioperative complication within 30 days of the surgical procedure, and secondary outcomes included all-cause 30-day readmission, length of stay, and mortality. To determine if there was an association between overlapping surgery and a perioperative complication, we tested for non-inferiority of overlapping surgery, assuming a null hypothesis of an increased risk of 50%. We used an inverse probability of treatment weighted regression model adjusted for institution, procedure type, demographic characteristics (age, sex, race, comorbidities), admission type, admission severity of illness, and clustering by surgeon.ResultsAmong 14,135 cases, the frequency of overlapping surgery was 40%. The frequencies of perioperative complications were 1% in the overlapping surgery group and 2% in the non-overlapping surgery group. The overlapping surgery group was non-inferior to the non-overlapping surgery group (odds ratio [OR], 0.61 [90% confidence interval (CI), 0.45 to 0.83]; p < 0.001), with reduced odds of perioperative complications (OR, 0.61 [95% CI, 0.43 to 0.88]; p = 0.009). For secondary outcomes, there was a significantly lower chance of all-cause 30-day readmission in the overlapping surgery group (OR, 0.67 [95% CI, 0.52 to 0.87]; p = 0.003) and shorter length of stay (e, 0.94 [95% CI, 0.89 to 0.99]; p = 0.012). There was no difference in mortality.ConclusionsOur results suggest that overlapping inpatient orthopaedic surgery does not introduce additional perioperative risk for the complications that we evaluated. The suitability of this practice should be determined by individual surgeons on a case-by-case basis with appropriate informed consent.Level of evidenceTherapeutic Level III. See Instructions for Authors for a complete description of levels of evidence

The Cost of Annual versus Biannual Community-Directed Treatment of Onchocerciasis with Ivermectin: Ghana as a Case Study

BACKGROUND: It has been proposed that switching from annual to biannual (twice yearly) mass community-directed treatment with ivermectin (CDTI) might improve the chances of onchocerciasis elimination in some African foci. However, historically, relatively few communities have received biannual treatments in Africa, and there are no cost data associated with increasing ivermectin treatment frequency at a large scale. Collecting cost data is essential for conducting economic evaluations of control programmes. Some countries, such as Ghana, have adopted a biannual treatment strategy in selected districts. We undertook a study to estimate the costs associated with annual and biannual CDTI in Ghana. METHODOLOGY: The study was conducted in the Brong-Ahafo and Northern regions of Ghana. Data collection was organized at the national, regional, district, sub-district and community levels, and involved interviewing key personnel and scrutinizing national records. Data were collected in four districts; one in which treatment is delivered annually, two in which it is delivered biannually, and one where treatment takes place biannually in some communities and annually in others. Both financial and economic costs were collected from the health care provider's perspective. PRINCIPAL FINDINGS: The estimated cost of treating annually was US Dollars (USD) 0.45 per person including the value of time donated by the community drug distributors (which was estimated at USD 0.05 per person per treatment round). The cost of CDTI was approximately 50–60% higher in those districts where treatment was biannual than in those where it was annual. Large-scale mass biannual treatment was reported as being well received and considered sustainable. CONCLUSIONS/SIGNIFICANCE: This study provides rigorous evidence of the different costs associated with annual and biannual CDTI in Ghana which can be used to inform an economic evaluation of the debate on the optimal treatment frequency required to control (or eliminate) onchocerciasis in Africa

Ethnicity, voter alignment and political party affiliation - an African case: Zambia

Conventional wisdom holds that ethnicity provides the social cleavage for voting behav-iour and party affiliation in Africa. Because this is usually inferred from aggregate data of national election results, it might prove to be an ecological fallacy. The evidence based on individual data from an opinion survey in Zambia suggests that ethnicity matters for voter alignment and even more so for party affiliation, but it is certainly not the only factor. The analysis also points to a number of qualifications which are partly methodology-related. One is that the degree of ethnic voting can differ from one ethno-political group to the other depending on various degrees of ethnic mobilisation. Another is that if smaller eth-nic groups or subgroups do not identify with one particular party, it is difficult to find a significant statistical correlation between party affiliation and ethnicity - but that does not prove that they do not affiliate along ethnic lines.Wahlverhalten und Mitgliedschaft in politischen Parteien Afrikas ist nur wenig untersucht worden. Gewöhnlich wird argumentiert, dass Ethnizität als soziale Konfliktlinie das Wahlverhalten und die Parteienmitgliedschaft strukturiert. Da dieses Argument auf hoch aggregierten Wahldaten beruht, kann hier ein ökologischer Fehlschuss vorliegen. Die vorliegende Analyse beruht deshalb auf individuellen Umfragedaten aus Sambia. Das Ergebnis ist, dass Ethnizität tatsächlich eine Rolle für das Wahlverhalten und die Parteienmitgliedschaft spielt, aber keineswegs den einzigen Erklärungsfaktor darstellt. Die Analyse offenbart zudem eine Reihe von Einschränkungen und Qualifizierungen, die teilweise methodischer Natur sind. Eine ist, dass ethnisches Wahlverhalten und Parteienmitgliedschaft von einer ethnischen Gruppe zur anderen unterschiedlich ist, dass, wenn sich kleinere ethnische Gruppen oder Untergruppen mit keiner Partei identifizieren, es schwierig wird, statistisch signifikante Korrelationen zu finden - was indessen noch nicht beweist, dass Ethnizität keine Rolle spielt

The transcriptional response of Caenorhabditis elegans to ivermectin exposure identifies novel genes involved in the response to reduced food intake

We have examined the transcriptional response of Caenorhabditis elegans following exposure to the anthelmintic drug ivermectin (IVM) using whole genome microarrays and real-time QPCR. Our original aim was to identify candidate molecules involved in IVM metabolism and/or excretion. For this reason the IVM tolerant strain, DA1316, was used to minimise transcriptomic changes related to the phenotype of drug exposure. However, unlike equivalent work with benzimidazole drugs, very few of the induced genes were members of xenobiotic metabolising enzyme families. Instead, the transcriptional response was dominated by genes associated with fat mobilization and fatty acid metabolism including catalase, esterase, and fatty acid CoA synthetase genes. This is consistent with the reduction in pharyngeal pumping, and consequential reduction in food intake, upon exposure of DA1316 worms to IVM. Genes with the highest fold change in response to IVM exposure, cyp-37B1, mtl-1 and scl-2, were comparably up-regulated in response to short–term food withdrawal (4 hr) independent of IVM exposure, and GFP reporter constructs confirm their expression in tissues associated with fat storage (intestine and hypodermis). These experiments have serendipitously identified novel genes involved in an early response of C. elegans to reduced food intake and may provide insight into similar processes in higher organisms

Deletion of parasite immune modulatory sequences combined with immune activating signals enhances vaccine mediated protection against filarial nematodes

<p>Background: Filarial nematodes are tissue-dwelling parasites that can be killed by Th2-driven immune effectors, but that have evolved to withstand immune attack and establish chronic infections by suppressing host immunity. As a consequence, the efficacy of a vaccine against filariasis may depend on its capacity to counter parasite-driven immunomodulation.</p> <p>Methodology and Principal Findings: We immunised mice with DNA plasmids expressing functionally-inactivated forms of two immunomodulatory molecules expressed by the filarial parasite Litomosoides sigmodontis: the abundant larval transcript-1 (LsALT) and cysteine protease inhibitor-2 (LsCPI). The mutant proteins enhanced antibody and cytokine responses to live parasite challenge, and led to more leukocyte recruitment to the site of infection than their native forms. The immune response was further enhanced when the antigens were targeted to dendritic cells using a single chain Fv-αDEC205 antibody and co-administered with plasmids that enhance T helper 2 immunity (IL-4) and antigen-presenting cell recruitment (Flt3L, MIP-1α). Mice immunised simultaneously against the mutated forms of LsALT and LsCPI eliminated adult parasites faster and consistently reduced peripheral microfilaraemia. A multifactorial analysis of the immune response revealed that protection was strongly correlated with the production of parasite-specific IgG1 and with the numbers of leukocytes present at the site of infection.</p> <p>Conclusions: We have developed a successful strategy for DNA vaccination against a nematode infection that specifically targets parasite-driven immunosuppression while simultaneously enhancing Th2 immune responses and parasite antigen presentation by dendritic cells.</p&gt

Analyzing the health implications of rising income inequality: What does the data say?

Does income inequality worsen a country's health outcomes? In this study, we examine the effect of income inequality and redistribution on health outcomes using a panel dataset for a global sample of 154 countries from 1990 to 2020, and the instrumental variable method. The evidence from the empirical analyses revealed that, on average, higher income inequality is associated with poor health outcomes. On the other hand, this study documented that, on average, countries with higher income redistribution have better health outcomes. From regional analyses, we documented that income inequality strongly worsens health outcomes in South Asia, the Middle East and North Africa, sub-Saharan Africa and the Caribbean and Latin America. We found that education, environmental pollution, health expenditure and GDP per capita are the potential channels through which income inequality affects health outcomes. The findings established in this study suggest that a political environment that supports better income distribution would lead to better health outcomes

Effect of Cu Additions on Scale Structure and Descaling Efficiency of Low C Steel Reheated in a Combustion Gas Atmosphere

Modern EAF steelmaking employs scrap as its primary source of raw material. Different sources of scrap have varying levels of residuals, which can negatively influence product properties, performance, and surface quality. The presence of some residuals, such as Cu and Ni in controlled quantities, can also positively impact steel performance for some applications. It is also well known that interactions between residuals and alloying elements in steel can modify the structure of scale formed during slab reheating prior to hot rolling. These changes in the scale structure can influence scale removability. In this study, the effect of varying Cu concentrations in a low alloyed Mn and Si containing steel was examined to investigate its impact on scale removability. Laboratory studies were performed with simulated reheating and descaling conditions that mimic the conditions used in industrial practices. The scale structure that formed during reheating in the combustion atmosphere was investigated using SEM/EDX analysis. A special laboratory water jet descaling device was used to evaluate scale removability at three different hydraulic impact factors. The results showed that Cu at different levels significantly modified scale structure that formed, particularly the internal scale layers, which affected scale removability at different applied descaling impact factors. The effects of Cu level and descaling impact factor on scale removability is discussed

Effect of Cu Additions on Scale Structure and Descaling Efficiency of Low C Steel Reheated in a Combustion Gas Atmosphere

Modern EAF steelmaking employs scrap as its primary source of raw material. Different sources of scrap have varying levels of residuals, which can negatively influence product properties, performance, and surface quality. The presence of some residuals, such as Cu and Ni in controlled quantities, can also positively impact steel performance for some applications. It is also well known that interactions between residuals and alloying elements in steel can modify the structure of scale formed during slab reheating prior to hot rolling. These changes in the scale structure can influence scale removability. In this study, the effect of varying Cu concentrations in a low alloyed Mn and Si containing steel was examined to investigate its impact on scale removability. Laboratory studies were performed with simulated reheating and descaling conditions that mimic the conditions used in industrial practices. The scale structure that formed during reheating in the combustion atmosphere was investigated using SEM/EDX analysis. A special laboratory water jet descaling device was used to evaluate scale removability at three different hydraulic impact factors. The results showed that Cu at different levels significantly modified scale structure that formed, particularly the internal scale layers, which affected scale removability at different applied descaling impact factors. The effects of Cu level and descaling impact factor on scale removability is discussed