Rosa Heckschers identiteter – och det privata brevets potential

Private letters can be very useful in giving information about a person’s expressed identities. In the letters between Rosa Heckscher and her son Eli, that I have read, she gives the reader a good picture of her identities, and her divided feelings for the Jewish collective and the Swedish society at large. Her expressed domestic identity was Jewish, but she longed for the intellectual freedom that men possessed and reacted strongly against patronizing Jewish men and the stupidity of their Jewish wives. She approved of the Christian society, but rejected the duplicity of some of its philanthropic associations, organised by women from the upper middle class. She also rejected the religious aspects of Judaism but lived by its cultural aspects. She found the Swedish society’s preconceived ideas of the Jew in some ways funny and also agreed with it most of the time. But by doing so, put herself outside the actual Jewish group in which she lived. She believed that Jews should take responsibility for their own financial situation, since lapses would affect other Jews – an attitude that agreed badly with her otherwise philanthropic outlook on life

Anesthesia in giraffe

Anestesi på giraff är komplicerat och dödsfall i samband med komplikationer kring sövning är rapporterad till ca 10 %. På grund av giraffens kroppsstorlek och säregna anatomi är sövning på dessa djur därför en stor utmaning. Förberedelser inför immobilisering, underhållet av sövningen och uppvaknandet efter sövning skiljer sig åt mellan vilda giraffer och de i fångenskap. I det vilda är kontrollen av miljö, dos och sövningsförlopp avsevärt mindre. Foder och vätskeintaget kan inte övervakas hos vilda djur och deras vikt och hälsostatus kan inte heller bedömas på samma sätt som hos djur som lever i fångenskap. Immobilisering och inledande sedering leder till att giraffen lägger sig ned. På grund av sin storlek blir fallet då anestesimedlet börjar verka ett mycket riskfyllt moment, ofta med benfrakturer och kräkningar till följd. Foder kan komma upp i matstrupen och sedan andas ned i lungorna och leda till koldioxidretention och aspirationspneumoni. Under hela proceduren bör nacken och halsen stabiliseras för att minska risken för frakturer, muskel- och nervskador. Andningsdepression orsakad av sövningsmedlets opioider är vanligt. För att underlätta andning samt för att underhålla sövningen kan giraffen intuberas. Detta är dock mycket svårt och inte alltid rekommenderat. Giraffer har svårigheter att hålla kroppstemperaturen konstant under sövningen vilket leder till att hjärta och kroppstemperatur påverkas; cirkulationsrubbningar är därmed vanligt. Uppvaknandet efter sövning är även det ett riskmoment då det kan leda till nya fall och trauman. Anestesi på giraffer är komplext och kräver stor kunskap av veterinär och assistenter om anestesimedlets dos och verkan i den enskilda individen.Anesthesia in giraffe is complicated and the mortality rate is 10% due to complications during the procedure. Because of its body size and quaint anatomy anesthesia on a giraffe is a challenge. Preparations for immobilisation, monitor under and the recovery after anesthesia differ between captured and wild giraffes. The control over environment, substances and the sedative process is limited in the field. Neither body size, intake of nutrition or water, nor the health of the giraffe can be evaluated with the same precision as in captured animals. Immobilization and introductory sedation leads to the giraffe lying down. The fall of the giraffe caused by immobilisation substances is a dangerous procedure because of the size of the giraffe, often resulting in bone fractures and regurgitation. Rumen content that ends up in the esophagus can cause secondary inhalation and fatal pneumonia. It is of major importance to support the long neck during the whole procedure to minimize the risk for bone fractures, muscle and neuro damages. Respiratory depression causes by sedative opioides is common. To facilitate the respiration and to maintain the sedation of the giraffe intubation can be used. However, this is complicated and not always recommended. The giraffe has difficulties to maintain its body temperature during anesthesia which can lead to disturbance in circulation and cardiac arrest. Recovering after sedation can cause the giraffe to fall again and cause itself damages. Anesthesia on giraffe is complex and demand great knowledge of the veterinarian and the immobilisation team on effect anesthesia substances and its affect in the individual

Nodular onchocercosis in red deer (Cervus elaphus) in Sweden

Släktet Onchocerca är globalt spridda vektoröverförda filaroida parasiter som främst infekterar olika vilda och domesticerade hovdjur. Även hund och människa kan infekteras av enstaka arter. Europeisk kronhjort, Cervus elaphus, är huvudvärd för minst fyra arter av Onchocerca varav två påträffas inuti subkutana noduli. Förekomsten av subkutan nodulär onchocercos undersöktes post mortem hos 151 kronhjortar (8 kalvar, 99 ungdjur, 44 vuxna djur) i huvudsak från hjorthägn under perioden 1 oktober - 30 december 2015 i mellersta och södra Sverige. Subkutana noduli (parasitknölar) påträffades hos 56 % av djuren (84/151) varav 96 % hade parasiter lokaliserade till ländryggen. Sammanlagt 35 % av de infekterade djuren hade dessutom noduli på andra ställen av kroppen såsom bakdel, bröst och framdel. Majoriteten (98 %) av individerna med knölförekomst hade mindre än 50 stycken och två tredjedelar av alla infekterade hade mellan 1- 10 stycken knölar. Signifikant skillnad i prevalens av individer med knölar sågs mellan vuxna hjortar (81 %) och ungdjur under två år (45 %)(p<0,0001) och även mellan hondjur (72 %) och handjur (48 %) (p=0,0072). Artbestämning av parasiter från 14 slumpvist utvalda noduliprover från lika många hjortindivider från sju olika hägn gjordes genom sekvensering av 12S- och 16S generna samt ND5 regionen i parasitens mitokondriella DNA. Samtliga DNA-sekvenser var identiska med tidigare publicerade sekvenser av Onchocerca flexuosa. Den höga prevalensen samt utbredning av nodulär onchocercos orsakad av O. flexuosa hos svenska kronhjortar i denna studie tyder på att vektorförhållandena och miljöbetingelser i de undersökta delarna av mellersta och södra Sverige är gynnsamma för parasitens spridning. Parasitens artidentitet har verifierats genom DNA-sekvensering. Den här studien är den första som beskriver utbredningen av O. flexuosa hos kronhjort i mellersta och södra Sverige.Vector transmitted parasites of the genus Onchocerca have a worldwide distribution infecting wild and domesticated ungulates. A few species also infect canids and humans. European red deer, Cervus elaphus, host at least four species of Onchocerca of which two are found in subcutaneous nodules. The prevalence of subcutaneous nodular onchocercosis was investigated post mortem in 151 red deer (8 calves, 99 young and 44 adults) between 1st October - 30th December 2015. The animals mainly originating from enclosures in the middle and the southern parts of Sweden. The prevalence of subcutaneous nodules was 56% (84 of 151 individuals) and 96% of the parasitized animals had nodules located in the dorsal region of back. A total of 38% of the infected also had parasites in other locations on the body, such as rump, thorax and front legs and neck. The majority (98%) of the infected cervids had less than 50 noduli and two-thirds of the infected animals had between 1-10. Significant differences in prevalence of nodules were found between adult red deer (81%) and young individuals under two years (45%) (p = 0.0001) and also between males (48 %) and females (72 %) (p = 0.0072). Species identification was done in 14 randomly selected samples from the same number of individuals by sequencing the mitochondrial 12S, 16S and ND5 fragments. The sequences were identical to those of previously published sequences for Onchocerca flexuosa. The high prevalence of nodular onchocercosis caused by O. flexuosa in the red deer in Sweden in this report shows that the investigated areas in middle and southern part of Sweden have favourable vector conditions and suitable environment for the parasite’s distribution. The parasite species was confirmed by DNA sequencing. This is the first study of O. flexuosa prevalence in red deer in Sweden

The Spectrum of Angiographic Findings in Transitional Cell Carcinoma of the Kidney

The spectrum of angiographic finding in 20 patients with transitional cell carcinomas of the kidney is described. In 15 of 20 patients (75%), prospective diagnosis of transitional cell carcinomas were made because of a combination of the angiographic findings; tumour vessels, tumour stain, prominent pelviureteric arteries and arterial encasement. In 4 patients with negative angiograms the lesions were relatively small in size and were situated within the renal parenchyma, primarily involving the calyces. The use of pharmacoangiographic agents such as epine-phrine and priscoline improved the angiographic visualization of transitional cell carcinomas of the kidney. For the past several years angiography has had a central role in the evaluation of patients with hematuria and renal masses 1 . 5,6,7,8. Although the use of diagnostic ultrasound and renal puncture have eliminated angiography from the diagnosis of renal cysts, most renal masses which are solid or which have equivocal findings at ultrasound still undergo angiography. At the same time, the decreasing use of retrograde urography has resulted in more frequent angiography in patients with unilateral nonfunctioning kidneys. Transitional cell carcinomas of the renal pelvis are an important cause of both hematuria and non-functioning kidneys. We have therefore reviewed our material to reassess the angiographic abnormalities caused by the transitional cell carcinomas and the overall accuracy of the angiography in the diagnosis of these lesions.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/73228/1/j.1440-1673.1977.tb03191.x.pd

The contrast-enhanced Doppler ultrasound with perfluorocarbon exposed sonicated albumin does not improve the diagnosis of renal artery stenosis compared with angiography

There are no studies investigating the effect of the contrast infusion on the sensitivity and specificity of the main Doppler criteria of renal artery stenosis (RAS). Our aim was to evaluate the accuracy of these Doppler criteria prior to and following the intravenous administration of perfluorocarbon exposed sonicated albumin (PESDA) in patients suspected of having RAS. Thirty consecutive hypertensive patients (13 males, mean age of 57 ± 10 years) suspected of having RAS by clinical clues, were submitted to ultrasonography (US) of renal arteries before and after enhancement using continuous infusion of PESDA. All patients underwent angiography, and haemodynamically significant RAS was considered when ≥50%. At angiography, it was detected RAS ≥50% in 18 patients, 5 with bilateral stenosis. After contrast, the examination time was slightly reduced by approximately 20%. In non-enhanced US the sensitivity was better when based on resistance index (82.9%) while the specificity was better when based on renal aortic ratio (89.2%). The predictive positive value was stable for all indexes (74.0%–88.0%) while negative predictive value was low (44%–51%). The specificity and positive predictive value based on renal aortic ratio increased after PESDA injection respectively, from 89 to 97.3% and from 88 to 95%. In hypertensives suspected to have RAS the sensitivity and specificity of Duplex US is dependent of the criterion evaluated. Enhancement with continuous infusion of PESDA improves only the specificity based on renal aortic ratio but do not modify the sensitivity of any index

Methodology of calculation of construction and hydrodynamic parameters of a foam layer apparatus for mass-transfer processes

Промислова реалізація методу стабілізації газорідинного шару дозволяє значно розширити галузь застосування пінних апаратів і відкриває нові можливості інтенсифікації технологічних процесів з одночасним створенням маловідходних технологій. У статті встановлені основні параметри, що впливають на гідродинаміку пінних апаратів, розглянуті основні конструкції та режими роботи пінних апаратів. Виявлено зв'язок гідродинамічних параметрів. Розглянуто гідродинамічні закономірності пінного шару. Вказані фактори, що впливають на процес масообміну, як в газовій, так і в рідкій фазах. Проведений аналіз ряду досліджень показав, що перспективним напрямком інтенсифікації процесу масообміну є розробка апаратів з трифазним псевдозрідженим шаром зрошуваної насадки складних форм із сітчастих матеріалів. Отже, необхідне проведення спеціальних досліджень гідродинамічних режимів роботи апарату з сітчастою насадкою і визначенням параметрів, що впливають на швидкість переходу насадки з одного режиму в інший.Industrial implementation of the stabilization method of the gas-liquid layer can significantly expand the field of use of foaming apparatus and opens up new opportunities for intensifying technological processes with the simultaneous creation of low-waste technologies. The article establishes the basic parameters influencing the hydrodynamics of foam apparatus, considers the basic constructions and operating modes of foam apparatus. The connection of hydrodynamic parameters is revealed. The hydrodynamic laws of the foam layer are considered. The indicated factors affecting the process of mass transfer, both in the gas and in the liquid phases. The conducted analysis of a number of studies showed that the perspective direction of intensification of the mass transfer process is the development of apparatuses with a three-phase fluidized bed of an irrigated nozzle of complex forms with mesh materials

Laparoscopy in management of appendicitis in high-, middle-, and low-income countries: a multicenter, prospective, cohort study.

BACKGROUND: Appendicitis is the most common abdominal surgical emergency worldwide. Differences between high- and low-income settings in the availability of laparoscopic appendectomy, alternative management choices, and outcomes are poorly described. The aim was to identify variation in surgical management and outcomes of appendicitis within low-, middle-, and high-Human Development Index (HDI) countries worldwide. METHODS: This is a multicenter, international prospective cohort study. Consecutive sampling of patients undergoing emergency appendectomy over 6 months was conducted. Follow-up lasted 30 days. RESULTS: 4546 patients from 52 countries underwent appendectomy (2499 high-, 1540 middle-, and 507 low-HDI groups). Surgical site infection (SSI) rates were higher in low-HDI (OR 2.57, 95% CI 1.33-4.99, p = 0.005) but not middle-HDI countries (OR 1.38, 95% CI 0.76-2.52, p = 0.291), compared with high-HDI countries after adjustment. A laparoscopic approach was common in high-HDI countries (1693/2499, 67.7%), but infrequent in low-HDI (41/507, 8.1%) and middle-HDI (132/1540, 8.6%) groups. After accounting for case-mix, laparoscopy was still associated with fewer overall complications (OR 0.55, 95% CI 0.42-0.71, p < 0.001) and SSIs (OR 0.22, 95% CI 0.14-0.33, p < 0.001). In propensity-score matched groups within low-/middle-HDI countries, laparoscopy was still associated with fewer overall complications (OR 0.23 95% CI 0.11-0.44) and SSI (OR 0.21 95% CI 0.09-0.45). CONCLUSION: A laparoscopic approach is associated with better outcomes and availability appears to differ by country HDI. Despite the profound clinical, operational, and financial barriers to its widespread introduction, laparoscopy could significantly improve outcomes for patients in low-resource environments. TRIAL REGISTRATION: NCT02179112

Global economic burden of unmet surgical need for appendicitis

Background: There is a substantial gap in provision of adequate surgical care in many low-and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. Methods: Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism. Results: Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality was US $92 492 million using approach 1 and$73 141 million using approach 2. The economic burden of not providing surgical care to the standards of high-income countries was $95 004 million using approach 1 and$75 666 million using approach 2. The largest share of these costs resulted from premature death (97.7 per cent) and lack of access (97.0 per cent) in contrast to lack of quality. Conclusion: For a comparatively non-complex emergency condition such as appendicitis, increasing access to care should be prioritized. Although improving quality of care should not be neglected, increasing provision of care at current standards could reduce societal costs substantially

Pooled analysis of WHO Surgical Safety Checklist use and mortality after emergency laparotomy

Background The World Health Organization (WHO) Surgical Safety Checklist has fostered safe practice for 10 years, yet its place in emergency surgery has not been assessed on a global scale. The aim of this study was to evaluate reported checklist use in emergency settings and examine the relationship with perioperative mortality in patients who had emergency laparotomy. Methods In two multinational cohort studies, adults undergoing emergency laparotomy were compared with those having elective gastrointestinal surgery. Relationships between reported checklist use and mortality were determined using multivariable logistic regression and bootstrapped simulation. Results Of 12 296 patients included from 76 countries, 4843 underwent emergency laparotomy. After adjusting for patient and disease factors, checklist use before emergency laparotomy was more common in countries with a high Human Development Index (HDI) (2455 of 2741, 89.6 per cent) compared with that in countries with a middle (753 of 1242, 60.6 per cent; odds ratio (OR) 0.17, 95 per cent c.i. 0.14 to 0.21, P <0001) or low (363 of 860, 422 per cent; OR 008, 007 to 010, P <0.001) HDI. Checklist use was less common in elective surgery than for emergency laparotomy in high-HDI countries (risk difference -94 (95 per cent c.i. -11.9 to -6.9) per cent; P <0001), but the relationship was reversed in low-HDI countries (+121 (+7.0 to +173) per cent; P <0001). In multivariable models, checklist use was associated with a lower 30-day perioperative mortality (OR 0.60, 0.50 to 073; P <0.001). The greatest absolute benefit was seen for emergency surgery in low- and middle-HDI countries. Conclusion Checklist use in emergency laparotomy was associated with a significantly lower perioperative mortality rate. Checklist use in low-HDI countries was half that in high-HDI countries.Peer reviewe

Mortality of emergency abdominal surgery in high-, middle- and low-income countries

Background: Surgical mortality data are collected routinely in high-income countries, yet virtually no low- or middle-income countries have outcome surveillance in place. The aim was prospectively to collect worldwide mortality data following emergency abdominal surgery, comparing findings across countries with a low, middle or high Human Development Index (HDI). Methods: This was a prospective, multicentre, cohort study. Self-selected hospitals performing emergency surgery submitted prespecified data for consecutive patients from at least one 2-week interval during July to December 2014. Postoperative mortality was analysed by hierarchical multivariable logistic regression. Results: Data were obtained for 10 745 patients from 357 centres in 58 countries; 6538 were from high-, 2889 from middle- and 1318 from low-HDI settings. The overall mortality rate was 1⋅6 per cent at 24 h (high 1⋅1 per cent, middle 1⋅9 per cent, low 3⋅4 per cent; P < 0⋅001), increasing to 5⋅4 per cent by 30 days (high 4⋅5 per cent, middle 6⋅0 per cent, low 8⋅6 per cent; P < 0⋅001). Of the 578 patients who died, 404 (69⋅9 per cent) did so between 24 h and 30 days following surgery (high 74⋅2 per cent, middle 68⋅8 per cent, low 60⋅5 per cent). After adjustment, 30-day mortality remained higher in middle-income (odds ratio (OR) 2⋅78, 95 per cent c.i. 1⋅84 to 4⋅20) and low-income (OR 2⋅97, 1⋅84 to 4⋅81) countries. Surgical safety checklist use was less frequent in low- and middle-income countries, but when used was associated with reduced mortality at 30 days. Conclusion: Mortality is three times higher in low- compared with high-HDI countries even when adjusted for prognostic factors. Patient safety factors may have an important role. Registration number: NCT02179112 (http://www.clinicaltrials.gov)