Skin Preparation for Preventing Infection Following Cesarean Section

Abstract Cesarean section (c-section) is becoming a popular option with 32.8% of the population choosing a surgical procedure over a vaginal delivery. Due to the increase of c-sections, infection rates have risen to a rate of 5.4 infections per 100 c-section operations. Surgical site infections are a large risk for any person having an invasive procedure. In our review of literature, we searched for the most advanced methods to reduce the risk of surgical site infections. We searched for various articles comparing iodine and chlorhexidine and found 14 articles that fit our inclusion criteria. The inclusion criteria consisted of any literature that included information about surgical site infections, c-sections and preoperative skin preparation methods, along with literature related to iodine or chlorhexidine. Our exclusion criteria consisted of studies done prior to 2004 and articles that focused on intra-operative or post-operative preventative care. The review of literature was limited by three factors: (1) Multiple articles from other countries have researched chlorhexidine and iodine, but were not specific to the United States (2) Limited overlapping research topics between c-sections and surgical site infections (3) The results of the review of literature were not able to be tested. After studying and comparing the articles, the results showed that chlorhexidine is the most advanced antiseptic for preventing a surgical site infection after a c-section. Based on the review of literature, recommendations for the use of chlorhexidine should be enforced in hospitals that use iodine. Keywords: c-section infection, c-section pre-op, iodine vs. chlorhexidine, iodine preoperative care, iodine skin care, chlorhexidine vs. iodine, skin antiseptics, iodine as antiseptic, chlorhexidine and infection, skin pre

Hot upwelling conduit beneath the Atlas Mountains, Morocco

The Atlas Mountains of Morocco display high topography, no deep crustal root, and regions of localized Cenozoic alkaline volcanism. Previous seismic imaging and geophysical studies have implied a hot mantle upwelling as the source of the volcanism and high elevation. However, the existence, shape, and physical properties of an associated mantle anomaly are debated. Here we use seismic waveform analysis from a broadband deployment and geodynamic modeling to define the physical properties and morphology of the anomaly. The imaged low-velocity structure extends to ~200 km beneath the Atlas and appears ~350 K hotter than the ambient mantle with possible partial melting. It includes a lateral conduit, which suggests that the Quaternary volcanism arises from the upper mantle. Moreover, the shape and temperature of the imaged anomaly indicate that the unusually high topography of the Atlas Mountains is due to active mantle suppor

Co-seismic deformation of deep slabs based on summed CMT data

We assess the co-seismic deformation inferred from earthquake moment tensor solutions for subducting slabs at depths greater than 50 km globally. We rotate each moment tensor into a local slab reference frame, then sum tensors within 50 km depth bins to approximate long term deformation characteristics. This builds upon previous analyses by using the up-to-date global Centroid Moment Tensor catalog, incorporating a more complete slab geometry, and focusing on the 3-D aspects of slab deformation. Results show a general consistency with Isacks and Molnar (1969), who found that most slabs can be divided into intermediate-extensional, intermediate-extensional-deep-compressional, and intermediate to deep-compressional categories. Exceptions to these three categories can be related to slab bending in the top 100 km, plate convergence that is oblique to the trench normal direction, and regions of higher focal mechanism heterogeneity. The regions of higher focal mechanism heterogeneity appear where there are along-strike changes in slab geometry and/or evidence of double-seismic zones. We find that the sense of deformation in the intermediate strain axis direction is opposite to that of the down-dip direction, in agreement with Kuge and Kawakatsu (1993). By quantitative comparison to numerical models of global mantle flow, we show that these observations are consistent with deformation of viscous slabs responding to their own negative buoyancy and an upper to lower mantle viscosity increas

The Impact of Doula-Supported Care on Stress Levels of Women Receiving Opioid Addiction Treatment

Introduction: Mothers suffering from opioid addiction are at high risk for experiencing extreme stress levels which prevents them from providing a healthy and nurturing environment for their family. The aim of this project is to explore if a doula-supported care team alleviates the parenting stress of new mothers participating in opioid addiction rehabilitation. Methods: A total of 35-40 women in treatment at the Montair program for substance use disorder rehabilitation were recruited to participate in the City of Philadelphia’s Community Doula project. The Parenting Stress Index Score (PSI) was recorded and compared to a control group composed of women in the same rehabilitation program who did not utilize the doula services. Additional qualitative interviews were recorded through phone interviews. Results: Parenting women with opioid use disorders experience high levels of stress. We hypothesize that women who utilize the doula program will have significantly lower PSIs than those who do not. Major results of this study show (placeholder). This project originally aimed to explore the effect of the doula program on attachment styles on women participating in substance abuse rehabilitation through a comparison using the Keys to Interactive Parenting Scale (KIPS). However due to limitations imposed by the COVID-19 pandemic this original goal could not be accomplished. Conclusions: We hypothesize that the implementation of doula-supported services will alleviate parenting stress to a significant degree. If our hypothesis is correct the results of this program would support future funding for the continuation and expansion of the City of Philadelphia’s Community Doula program

The Perioperative Effect of Increased Body Mass Index on Peripheral Nerve Blockade: an Analysis of 528 Ultrasound Guided Interscalene Blocks

SummaryBackground and objectivesObese patients can pose a unique perioperative anesthetic challenge, making regional anesthetic techniques an intriguing means of providing analgesia for this population. Ultrasound guidance has been touted recently as being beneficial for this population in which surface landmarks can become obscured. In this study, the effect of increased Body Mass Index (BMI) on ultrasound guided interscalene peripheral nerve blockade is investigated.Material and methodsThis study is a retrospective review of 528 consecutive patients who received preoperative ultrasound-guided interscalene nerve blocks at the University of Wisconsin Hospital and Clinics. We examined the association between BMI and the following parameters: time required for block placement; presence of Postoperative Nausea and Vomiting (PONV); postoperative Post Anesthesia Care Unit (PACU) pain scores; volume of local anesthetic injected; acute complications; and opioid administration preoperatively, intraoperatively, and postoperatively. Univariate and multivariate least squares and logistic regression models were used.ResultsAn elevated BMI was associated with an increased: time required for block placement (p-value=0.025), intraoperative fentanyl administration (p-value<0.001), peak PACU pain scores (p-value<0.001), PACU opioid administration (p-value<0.001), PACU oral opioid administration (p-value<0.001), total PACU opioid administration (p-value<0.001) and incidence of PACU nausea (p-value=0.025)ConclusionsUltrasound guided interscalene nerve blocks for perioperative analgesia can be safely and effectively performed in the obese patient but they may be more difficult to perform and analgesia may not be as complete

Low bone mineral density is found in low weight female youth with avoidant/restrictive food intake disorder and associated with higher PYY levels

BACKGROUND: Avoidant/restrictive food intake disorder (ARFID) is a restrictive eating disorder commonly associated with medical complications of undernutrition and low weight. In adolescence, a critical time for bone accrual, the impact of ARFID on bone health is uncertain. We aimed to study bone health in low-weight females with ARFID, as well as the association between peptide YY (PYY), an anorexigenic hormone with a role in regulation of bone metabolism, and bone mineral density (BMD) in these individuals. We hypothesized that BMD would be lower in low-weight females with ARFID than healthy controls (HC), and that PYY levels would be negatively associated with BMD. METHODS: We performed a cross-sectional study in 14 adolescent low-weight females with ARFID and 20 HC 10–23 years old. We assessed BMD (total body, total body less head and lumbar spine) using dual x-ray absorptiometry (DXA) and assessed fasting total PYY concentration in blood. RESULTS: Total body BMD Z-scores were significantly lower in ARFID than in HC (− 1.41 ± 0.28 vs. − 0.50 ± 0.25, p = 0.021). Mean PYY levels trended higher in ARFID vs. HC (98.18 ± 13.55 pg/ml vs. 71.40 ± 5.61 pg/ml, p = 0.055). In multivariate analysis within the ARFID group, PYY was negatively associated with lumbar BMD adjusted for age (β = -0.481, p = 0.032). CONCLUSION: Our findings suggest that female adolescents with low-weight ARFID may have lower BMD than healthy controls and that higher PYY levels may be associated with lower BMD at some, but not all, sites in ARFID. Further research with larger samples will be important to investigate whether high PYY drives bone loss in ARFID

Friendly competition: evidence for a dilution effect among competitors in a planktonic host–parasite system

DOI: 10.1890/08-0838.1© Ecological Society of AmericaThe “dilution effect” concept in disease ecology offers the intriguing possibility that clever manipulation of less competent hosts could reduce disease prevalence in populations of more competent hosts. The basic concept is straightforward: host species vary in suitability (competence) for parasites, and disease transmission decreases when there are more incompetent hosts interacting with vectors or removing free-living stages of a parasite. However, host species also often interact with each other in other ecological ways, e.g., as competitors for resources. The net result of these simultaneous, multiple interactions (disease dilution and resource competition) is challenging to predict. Nonetheless, we see the signature of both roles operating concurrently in a planktonic host–parasite system. We document pronounced spatiotemporal variation in the size of epidemics of a virulent fungus (Metschnikowia bicuspidata) in Midwestern U.S. lake populations of a dominant crustacean grazer (Daphnia dentifera). We show that some of this variation is captured by changes in structure of Daphnia assemblages. Lake-years with smaller epidemics were characterized by assemblages dominated by less suitable hosts (“diluters,” D. pulicaria and D. retrocurva, whose suitabilties were determined in lab experiments and field surveys) at the start of epidemics. Furthermore, within a season, less suitable hosts increased as epidemics declined. These observations are consistent with a dilution effect. However, more detailed time series analysis (using multivariate autoregressive models) of three intensively sampled epidemics show the signature of a likely interaction between dilution and resource competition between these Daphnia species. The net outcome of this interaction likely promoted termination of these fungal outbreaks. Should this outcome always arise in “friendly competition” systems where diluting hosts compete with more competent hosts? The answers to this question lie at a frontier of disease ecology

The impact of FADS genetic variants on ω6 polyunsaturated fatty acid metabolism in African Americans

<p>Abstract</p> <p>Background</p> <p>Arachidonic acid (AA) is a long-chain omega-6 polyunsaturated fatty acid (PUFA) synthesized from the precursor dihomo-gamma-linolenic acid (DGLA) that plays a vital role in immunity and inflammation. Variants in the Fatty Acid Desaturase (<it>FADS</it>) family of genes on chromosome 11q have been shown to play a role in PUFA metabolism in populations of European and Asian ancestry; no work has been done in populations of African ancestry to date.</p> <p>Results</p> <p>In this study, we report that African Americans have significantly higher circulating levels of plasma AA (p = 1.35 × 10^-48) and lower DGLA levels (p = 9.80 × 10^-11) than European Americans. Tests for association in N = 329 individuals across 80 nucleotide polymorphisms (SNPs) in the Fatty Acid Desaturase (<it>FADS</it>) locus revealed significant association with AA, DGLA and the AA/DGLA ratio, a measure of enzymatic efficiency, in both racial groups (peak signal p = 2.85 × 10^-16in African Americans, 2.68 × 10^-23in European Americans). Ancestry-related differences were observed at an upstream marker previously associated with AA levels (rs174537), wherein, 79-82% of African Americans carry two copies of the G allele compared to only 42-45% of European Americans. Importantly, the allelic effect of the G allele, which is associated with <it>enhanced </it>conversion of DGLA to AA, on enzymatic efficiency was similar in both groups.</p> <p>Conclusions</p> <p>We conclude that the impact of <it>FADS </it>genetic variants on PUFA metabolism, specifically AA levels, is likely more pronounced in African Americans due to the larger proportion of individuals carrying the genotype associated with increased FADS1 enzymatic conversion of DGLA to AA.</p

Differential comorbidity profiles in avoidant/restrictive food intake disorder and anorexia nervosa: Does age play a role?

Objective: Research comparing psychiatric comorbidities between individuals with avoidant/restrictive food intake disorder (ARFID) and anorexia nervosa (AN) is limited. ARFID often develops in childhood, whereas AN typically develops in adolescence or young adulthood. Understanding how age may impact differential psychological comorbidity profiles is important to inform etiological conceptualization, differential diagnosis, and treatment planning. We aimed to compare the lifetime frequency of psychiatric comorbidities and suicidality between females with ARFID (n = 51) and AN (n = 40), investigating the role of age as a covariate. Method: We used structured interviews to assess the comparative frequency of psychiatric comorbidities/suicidality. Results: When age was omitted from analyses, females with ARFID had a lower frequency of depressive disorders and suicidality compared to AN. Adjusting for age, only suicidality differed between groups. Discussion: This is the first study to compare comorbidities in a similar number of individuals with ARFID and AN, and a structured clinical interview to confer ARFID and comorbidities, covarying for age, and the first to compare suicidality. Although suicidality is at least three times less common in ARFID than AN, observed differences in other psychiatric comorbidities may reflect ARFID's relatively younger age of presentation compared to AN. Public Significance: Our results highlight that, with the exception of suicidality, which was three times less common in ARFID than AN irrespective of age, observed differences in psychiatric comorbidities in clinical practice may reflect ARFID's younger age at clinical presentation compared to AN