Associations between social risk factors and surgical site infections after colectomy and abdominal hysterectomy

Importance: Surgical site infection (SSI) is an important patient safety outcome. Although social risk factors have been linked to many adverse health outcomes, it is unknown whether such factors are associated with higher rates of SSI. Objectives: To determine whether social risk factors, including race/ethnicity, insurance status, and neighborhood income, are associated with higher rates of SSI after colectomy or abdominal hysterectomy, 2 surgical procedures for which SSI rates are publicly reported and included in pay-for-performance programs by Medicare and other groups. Design, Setting, and Participants: This cross-sectional study analyzed adults undergoing colectomy or abdominal hysterectomy, as captured in State Inpatient Databases for Arizona, Florida, Iowa, Massachusetts, Maryland, New York, and Vermont. Operations were performed in 2013 through 2014 at general acute care hospitals in the United States. Data analysis was conducted from October 2018 through June 2019. Exposures: Colectomy or hysterectomy. Main Outcomes and Measures: Postoperative complex SSI rates. Results: A total of 149 741 patients met the inclusion criteria, including 90 210 patients undergoing colectomies (mean [SD] age, 63.4 [15.6] years; 49 029 [54%] female; 74% white, 11% black, 9% Hispanic, and 5% other or unknown race/ethnicity) and 59 531 patients undergoing abdominal hysterectomies (mean [SD] age, 49.8 [11.8] years; 100% female; 52% white, 26% black, 14% Hispanic, and 8% other or unknown race/ethnicity). In the colectomy cohort, 34% had private insurance, 52% had Medicare, 9% had Medicaid, and 5% had other or unknown insurance or were uninsured; 24% were from the lowest quartile of median zip code income. In the hysterectomy cohort, 57% had private insurance, 16% had Medicare, 19% had Medicaid, and 3% had other or unknown insurance or were uninsured; 27% were from the lowest-income zip codes. Within 30 days of surgery, SSI rates were 2.55% for the colectomy cohort and 0.61% for the hysterectomy cohort. For colectomy, black race (adjusted odds ratio [AOR], 0.71; 95% CI, 0.61-0.82) was associated with lower odds of SSI, whereas Medicare (AOR, 1.25; 95% CI, 1.10-1.41), Medicaid (AOR, 1.23; 95% CI, 1.06-1.44), and low neighborhood income (AOR, 1.14; 95% CI, 1.01-1.29) were associated with higher odds of SSI. For hysterectomy, no social risk factors that were examined in this study had statistically significant associations with SSI after adjustment for clinical risk. Conclusions and Relevance: Inconsistent associations between social risk factors and SSIs were found. For colectomy, infection prevention programs targeting low-income groups may be important for reducing disparities in this postoperative outcome, and policy makers could consider taking social risk factors into account when evaluating hospital performance

Mrs Barber's beauty : lotononis harveyi rediscovered

South Africa is often thought of as 'well-explored' and 'well-studied'. The exciting thing is that it's not - especially if you add 'biodiversity' and 'mountains' to your search engine. The Cape Midlands Escarpment, for example (comprising the Sneeuberg, Great Winterberg-Amatholes and Stormberg, mostly in the Eastern Cape province, South Africa) has seen numerous plant discoveries and rediscoveries since 2005. This has been the direct result of focused biodiversity exploration in this region.The National Research Foundation, the South African Biosystematics Initiative, the National Geographic Society and the Cape Tercentenary Foundation.http://www.botanicalsociety.org.zaam2016Plant Scienc

Validity of a self-report survey tool measuring the nutrition and physical activity environment of primary schools

Background: Valid tools measuring characteristics of the school environment associated with the physical activity and dietary behaviours of children are needed to accurately evaluate the impact of initiatives to improve school environments. The aim of this study was to assess the validity of Principal self-report of primary school healthy eating and physical activity environments. Methods: Primary school Principals (n = 42) in New South Wales, Australia were invited to complete a telephone survey of the school environment; the School Environment Assessment Tool – SEAT. Equivalent observational data were collected by pre-service teachers located within the school. The SEAT, involved 65 items that assessed food availability via canteens, vending machines and fundraisers and the presence of physical activity facilities, equipment and organised physical activities. Kappa statistics were used to assess agreement between the two measures. Results: Almost 70% of the survey demonstrated moderate to almost perfect agreement. Substantial agreement was found for 10 of 13 items assessing foods sold for fundraising, 3 of 6 items assessing physical activity facilities of the school, and both items assessing organised physical activities that occurred at recess and lunch and school sport. Limited agreement was found for items assessing foods sold through canteens and access to small screen recreation. Conclusions: The SEAT provides researchers and policy makers with a valid tool for assessing aspects of the school food and physical activity environment

How does it function? Characterizing long-term trends in production serverless workloads

This paper releases and analyzes two new Huawei cloud serverless traces. The traces span a period of over 7 months with over 1.4 trillion function invocations combined. The first trace is derived from Huawei's internal workloads and contains detailed per-second statistics for 200 functions running across multiple Huawei cloud data centers. The second trace is a representative workload from Huawei's public FaaS platform. This trace contains per-minute arrival rates for over 5000 functions running in a single Huawei data center. We present the internals of a production FaaS platform by characterizing resource consumption, cold-start times, programming languages used, periodicity, per-second versus per-minute burstiness, correlations, and popularity. Our findings show that there is considerable diversity in how serverless functions behave: requests vary by up to 9 orders of magnitude across functions, with some functions executed over 1 billion times per day; scheduling time, execution time and cold-start distributions vary across 2 to 4 orders of magnitude and have very long tails; and function invocation counts demonstrate strong periodicity for many individual functions and on an aggregate level. Our analysis also highlights the need for further research in estimating resource reservations and time-series prediction to account for the huge diversity in how serverless functions behave.Postprin

Food for all? Critically evaluating the role of the Incredible Edible movement in the UK

The practice ofUrbanAgriculture (UA) - the growing of food and/or rearing of livestock within the city context - is on the rise globally (Hardman and Larkham, 2014). Arguments for UA vary, ranging from its potential to contract the food supply chain by relocating production closer to urban consumers, to the poten­ tial for improved social engagement , through bringing communities together on allotments, communal gardens and other growing spaces (Gorgolewski et al., 2011;Wiskereke and Viljoen, 2012). Proponents ofUA often cite Detroit (USA) and Havana (Cuba) as exemplars in which such practiceshave resulted in various positive impacts : regenerating space, feeding people in need and creating sus­ tainable economies (Gi orda, 2012). An emerging argument in Europe surrounds the potential for UA to create a more 'just' food system (Alkon and Agyeman, 2011). Whilst the link between food justice and UA has a nascent research base in North America, there is little exploration elsewhere, particularly in the UK (Tornaghi, 2014). There is also emerging research which focuses on the envir­ onmental benefits derived through UA, particularly its contribution to local ecosystems and usage of urban by-products as growing substrates (Chipungu et al., 2013). Co nversely there are warnings sounded in recent literature about the risks associated with UA, particularly in relation to the contaminated soils and waters and materials use to compose growing substrates (Chipungu et al., 2013)

Relationships among Countermovement Vertical Jump Performance Metrics, Strategy Variables, and Inter-limb Asymmetry in Females

Dependent variables commonly studied during countermovement vertical jump (CMVJ) tests largely stem from male-only studies despite females’ distinct energy storage and reutilization strategies. This could limit progress among females seeking increased CMVJ performance through targeted changes in certain variables. We explored relationships between CMVJ performance metrics (jump height, modified reactive strength index, jump power, and takeoff momentum) and a) temporal and force application variables and b) inter-limb force and yank (i.e., rate of force development) asymmetry in 31 recreationally active females. Participants performed 8 CMVJs while ground reaction force (GRF) data were obtained. Pearson product-moment correlation coefficients assessed the strength and direction of the associations. Twenty-six significant relationships (r≥±0.357; p<0.05) were detected across the CMVJ performance variables. The significantly correlated variables were generally isolated to only one of the four performance metrics. Only the percentage of concentric phase inter-limb force asymmetry was significantly associated with CMVJ performance, specifically jump power and takeoff momentum. Coaches and physical performance professionals should be aware of popular strategy variables’ association or lack of association with commonly studied performance metrics when seeking to understand or improve specific CMVJ jumping abilities in females

Efficacy of a 3% kānuka oil cream for the treatment of moderate-to-severe eczema : a single blind randomised vehicle-controlled trial

Background: Māori, the indigenous people of New Zealand, have traditionally used the kānuka tree as part of their healing system, Rongoā Māori, and the oil from the kānuka tree has demonstratable anti-inflammatory and anti-bacterial properties. This trial investigated the efficacy and safety of a 3% kānuka oil (KO) cream compared to vehicle control (VC) for the topical treatment of eczema. The trial was conducted through a nationwide community pharmacy research network. Methods: This single-blind, parallel-group, randomised, vehicle-controlled trial was undertaken in 11 research trained community pharmacies across New Zealand. Eighty adult participants with self-reported moderate-to-severe eczema, assessed by Patient Orientated Eczema Measure (POEM) were randomised by blinded investigators to apply 3% KO cream or VC topically, twice daily, for six weeks. Randomisation was stratified by site and eczema severity, moderate versus severe. Primary outcome was difference in POEM scores at week six between groups by intention to treat. The study is registered on the Australian New Zealand Clinical Trial Registry (ANZCTR) reference number, ACTRN12618001754235. Findings: Eighty participants were recruited between 17 May 2019 and 10 May 2021 (41 KO group, 39 VC group). Mean POEM score (standard deviation) improved between baseline and week six for KO group, 18·4 (4·4) to 6·8 (5·5), and VC group, 18·7 (4·5) to 9·8 (6·5); mean difference between groups (95% confidence interval) was -3·1 (-6·0 to -0·2), p = 0·036. There were three adverse events reported in the KO group related to the intervention and two in the control group. Interpretation: The KO group had a significant improvement in POEM score compared to VC. Rates of adverse events and withdrawals were similar between groups with no serious adverse events reported. Treatment acceptability was high for both groups across all domains. Our results suggest that in adults with moderate-to-severe eczema, the addition of KO to a daily emollient regimen led to a reduction in POEM score compared to VC. KO may represent an effective, safe, and well tolerated treatment for moderate-to-severe eczema in adults

Towards a more-than-human approach to tree health

New ways of working and thinking in relation to tree health and plant biosecurity are required. The climate is changing and the number of pests and diseases is increasing. A review of the social science literature on plant health reveals that scholars are not quite sure what this ‘new thinking’ might entail. In this chapter, we begin the process of re-imagining tree health by starting with the trees and our research engagement with them. Trees are acknowledged in this chapter as never static, but rather fluid, shape-shifters, translated across time and space. Health and disease are revealed as relational, and a fixed approach to tree health management won’t work. In a world of rapid change, this way of working is not just relevant for trees

Validation of Melanoma Immune Profile (MIP), a Prognostic Immune Gene Prediction Score for Stage II–III Melanoma

Purpose: Biomarkers are needed to stratify patients with stage II–III melanoma for clinical trials of adjuvant therapy because, while immunotherapy is protective, it also confers the risk of severe toxicity. We previously defined and validated a 53-immune gene melanoma immune profile (MIP) predictive both of distant metastatic recurrence and of disease-specific survival (DSS). Here, we test MIP on a third independent population. Experimental Design: A retrospective cohort of 78 patients with stage II–III primary melanoma was analyzed using the NanoString assay to measure expression of 53 target genes, and MIP score was calculated. Statistical analysis correlating MIP with DSS, overall survival, distant metastatic recurrence, and distant metastasis-free interval was performed using ROC curves, Kaplan–Meier curves, and standard univariable and multivariable Cox proportional hazards models. Results: MIP significantly distinguished patients with distant metastatic recurrence from those without distant metastatic recurrence using ROC curve analysis (AUC = 0.695; P = 0.008). We defined high- and low-risk groups based on the cutoff defined by this ROC curve and find that MIP correlates with both DSS and overall survival by ROC curve analysis (AUC = 0.719; P = 0.004 and AUC = 0.698; P = 0.004, respectively). Univariable Cox regression reveals that a high-risk MIP score correlates with DSS (P = 0.015; HR = 3.2). Conclusions: MIP identifies patients with low risk of death from melanoma and may constitute a clinical tool to stratify patients with stage II–III melanoma for enrollment in clinical trials

Implementing microbicides in low-income countries.

The magnitude of the global human immunodeficiency virus (HIV) epidemic is determined by women from lower income countries, specifically sub-Saharan Africa. Microbicides offer women who are unable to negotiate safe sex practices a self-initiated HIV prevention method. Of note, is its potential to yield significant public health benefits even with relatively conservative efficacy, coverage and user adherence estimates, making microbicides an effective intervention to invest scarce healthcare resources. Existing healthcare delivery systems provide an excellent opportunity to identify women at highest risk for infection and to also provide an access point to initiate microbicide use. Innovative quality improvement approaches, which strengthen existing sexual reproductive health services and include HIV testing, and linkages to care and treatment services, provide an opportunity to lay the foundations for wide-scale provision of microbicides. The potential to enhance health outcomes in women and infants and potentially affect rates of new HIV infection may soon be realised