The Management of septic abortion at Groote Schuur hospital

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Corrosion of industrial ironwork

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Intensive care in labour: a preliminary appraisal

This is a preliminary investigation into the value, function and practicability of an intensive care labour unit for highrisk cases. All the equipment necessary can be mounted on two standard theatre trolleys which can be moved to the patient's bedside, but there is no place at present for this equipment outside a teaching unit. The investigation reports on continuous foetal heart monitoring of 36 patients and simultaneous foetal scalp pH estimations on 16 of them. A high proportion of babies with low Apgar scores showed one of two (or both) characteristic foetal heart patterns during labour: (a) the well-known type 2 dip, (b) a steppe pattern not previously described as such. The latter is of importance because it is impossible to detect using only clinical methods.There was poor correlation between foetal pH values and Apgar rating, and between foetal pH values and monitor patterns. Moreover, the pH values of foetal scalp blood and foetal umbilical arterial and venous blood samples bore varying relations to one another. However, for practical purposes, a foetal scalp blood of pH less than 7·20 when associated with a maternofoetal pH difference of 0·250 or more should be regarded with anxiety. The place and value of intensive care are discussed

Identifying which septic patients have increased mortality risk using severity scores:a cohort study

Background: Early aggressive therapy can reduce the mortality associated with severe sepsis but this relies on prompt recognition, which is hindered by variation among published severity criteria. Our aim was to test the performance of different severity scores in predicting mortality among a cohort of hospital inpatients with sepsis. Methods: We anonymously linked routine outcome data to a cohort of prospectively identified adult hospital inpatients with sepsis, and used logistic regression to identify associations between mortality and demographic variables, clinical factors including blood culture results, and six sets of severity criteria. We calculated performance characteristics, including area under receiver operating characteristic curves (AUROC), of each set of severity criteria in predicting mortality. Results: Overall mortality was 19.4% (124/640) at 30 days after sepsis onset. In adjusted analysis, older age (odds ratio 5.79 (95% CI 2.87-11.70) for ≥80y versus <60y), having been admitted as an emergency (OR 3.91 (1.31-11.70) versus electively), and longer inpatient stay prior to sepsis onset (OR 2.90 (1.41-5.94) for >21d versus <4d), were associated with increased 30 day mortality. Being in a surgical or orthopaedic, versus medical, ward was associated with lower mortality (OR 0.47 (0.27-0.81) and 0.26 (0.11-0.63), respectively). Blood culture results (positive vs. negative) were not significantly association with mortality. All severity scores predicted mortality but performance varied. The CURB65 community-acquired pneumonia severity score had the best performance characteristics (sensitivity 81%, specificity 52%, positive predictive value 29%, negative predictive value 92%, for 30 day mortality), including having the largest AUROC curve (0.72, 95% CI 0.67-0.77). Conclusions: The CURB65 pneumonia severity score outperformed five other severity scores in predicting risk of death among a cohort of hospital inpatients with sepsis. The utility of the CURB65 score for risk-stratifying patients with sepsis in clinical practice will depend on replicating these findings in a validation cohort including patients with sepsis on admission to hospital

Systematic review of antimicrobial drug prescribing in hospitals.

Prudent antibiotic prescribing to hospital inpatients has the potential to reduce the incidences of antimicrobial resistance and healthcare-associated infection. We reviewed the literature from January 1980 to November 2003 to identify rigorous evaluations of interventions to improve hospital antibiotic prescribing. We identified 66 studies with interpretable data of which 16 reported 20 microbiological outcomes: Gram negative resistant bacteria (GNRB), 10 studies; Clostridium difficile associated diarrhoea (CDAD), 5 studies; vancomycin resistant enterococci (VRE), 3 studies and methicillin resistant Staphylococcus aureus (MRSA), 2 studies. Four studies provide good evidence that the intervention changed microbial outcomes with low risk of alternative explanations, eight studies provide less convincing evidence and four studies were negative. The strongest and most consistent evidence was for CDAD but we were able to analyse only the immediate impact of interventions because of nonstandardised durations of follow up. The ability to compare results of studies could be substantially improved by standardising methodology and reporting

Dynamic Load and Storage Integration

Modern technology combined with the desire to minimize the size and weight of a ship’s power system are leading to renewed interest in more electric or all electric ships. An important characteristic of the emerging ship power system is an increasing level of load variability, with some future pulsed loads requiring peak power in excess of the available steady– state power. This inevitably leads to the need for some additional energy storage beyond that inherent in the fuel. With the current and evolving technology, it appears that storage will be in the form of batteries, rotating machines, and capacitors. All of these are in use on ships today and all have enjoyed significant technological improvements over the last decade. Moreover all are expected to be further enhanced by today’s materials research. A key benefit of storage is that, when it can be justified for a given load, it can have additional beneficial uses such as ride-through capability to restart a gas turbine if there is an unanticipated power loss; alternatively, storage can be used to stabilize the power grid when switching large loads. Knowing when to stage gas turbine utilization versus energy storage is a key subject in this paper. The clear need for storage has raised the opportunity to design a comprehensive storage system, sometimes called an energy magazine, that can combine intermittent generation as well as any or all of the other storage technologies to provide a smaller, lighter and better performing system than would individual storage solutions for each potential application.Center for Electromechanic

Spectral decomposition for the Dirac system associated to the DSII equation

A new (scalar) spectral decomposition is found for the Dirac system in two dimensions associated to the focusing Davey--Stewartson II (DSII) equation. Discrete spectrum in the spectral problem corresponds to eigenvalues embedded into a two-dimensional essential spectrum. We show that these embedded eigenvalues are structurally unstable under small variations of the initial data. This instability leads to the decay of localized initial data into continuous wave packets prescribed by the nonlinear dynamics of the DSII equation

Relational lattices via duality

The natural join and the inner union combine in different ways tables of a relational database. Tropashko [18] observed that these two operations are the meet and join in a class of lattices-called the relational lattices- and proposed lattice theory as an alternative algebraic approach to databases. Aiming at query optimization, Litak et al. [12] initiated the study of the equational theory of these lattices. We carry on with this project, making use of the duality theory developed in [16]. The contributions of this paper are as follows. Let A be a set of column's names and D be a set of cell values; we characterize the dual space of the relational lattice R(D, A) by means of a generalized ultrametric space, whose elements are the functions from A to D, with the P (A)-valued distance being the Hamming one but lifted to subsets of A. We use the dual space to present an equational axiomatization of these lattices that reflects the combinatorial properties of these generalized ultrametric spaces: symmetry and pairwise completeness. Finally, we argue that these equations correspond to combinatorial properties of the dual spaces of lattices, in a technical sense analogous of correspondence theory in modal logic. In particular, this leads to an exact characterization of the finite lattices satisfying these equations.Comment: Coalgebraic Methods in Computer Science 2016, Apr 2016, Eindhoven, Netherland

Factors related to discontinued clinic attendance by patients with podoconiosis in southern Ethiopia: a qualitative study

Background Podoconiosis is a lymphoedema of non-infectious cause which results in long-term ill health in affected individuals. Simple, effective treatment is available in certain parts of Ethiopia, but evidence indicates that not all patients continue collecting treatment supplies from clinic sites once started. We used qualitative techniques to explore factors related to discontinued attendance at outreach clinics of a non-government organization in southern Ethiopia. Methods A cross-sectional qualitative study was conducted in four clinic sites through unstructured in-depth interviews, key informant interviews and focus group discussions with the involvement of 88 study subjects. Results Discontinuation of clinic visits is common among podoconiosis patients. The reasons were: remoteness from the clinic sites, unrealistic expectation of ‘special’ aid, worry about increasing stigma, illness and misconceptions about treatment. Conclusions Several of these factors are remediable through community and individual information and education. Appropriate routes to deliver this information must be identified. Certain factors (such as distance to clinic sites and stigma) require substantial expansion of services or liaison with village-level government health services