Bullous Contagious Livipetigo of the newly born (Pemphigus Neonatorum)

The disease known as pemphigus neonatorum or bullous contagious staphylococcic impetigo of the newly born has shown in most countries a tendency to increase in incidence since the war. Almost all maternity hospitals and wards that have been open for any length of time have had at least one epidemic in the last ten years. Brennemann (1928) writes: °Hospitals in which impetigo neonatorum does not occur either have no maternity wards or else do not recognise the disease.The disease is perhaps recognised more often than. it was, and some stress has been laid on it in the Central Midwives Board Reports, 1927 and 1934. Attention has been drawn to it much more in the last ten years in American literature. However, the significance of a few bullous spots on an otherwise normal, healthy baby a few days old is often missed, and before the resulting epidemic has ceased one or more deaths may have occurred. As a disease entity it is really only seen by the personnel of the ward nursery. Paediatricians and dermatologists see relatively few cases. This paper is an attempt to summarise the more recent literature, and to stress the significance of the first lesion appearing in the ward nursery. A practitioner seeing a child with healing lesions discharged one or two days before from hospital will know that the wards of that hospital are dangerous to babies born there in the next few days or weeks.. Irwin Rubell (1931) noted that in private practice cases were frequently encountered coming from various hospitals, and he states that epidemics are more common than one would suppose as so many are hushed up. In this country the midwife in attendance is bound to notify the infected case to the local supervising authority at once, and to disinfect herself and her appliances to the satisfaction of that authority. The disease, however, still seems to be increasing, and the probable reasons are (a) failure to recognise the nature of the disease, (b) inadequate cleanliness and sterility in the maternity department, (c) failure to recognise the significance of the first case, even if diagnosed, and (d) the tendency to hush the whole thing up. More and more cases go to maternity hospitals nowadays, and often the attendance has increased while the building has not. Overcrowding is a very definite predisposing factor.The two epidemics here described are of interest in that they present most of the usual features of the disease, and also bring out a few points hitherto inadequately stressed

Modulation instability, Akhmediev Breathers and continuous wave supercontinuum generation

Numerical simulations of the onset phase of continuous wave supercontinuum generation from modulation instability show that the structure of the field as it develops can be interpreted in terms of the properties of Akhmediev Breathers. Numerical and analytical results are compared with experimental measurements of spectral broadening in photonic crystal fiber using nanosecond pulsesComment: 22 pages, 6 figure

The type and frequency of interactions that occur between staff and children outside in Early Years Foundation Stage settings during a fixed playtime period when there are tricycles available

This study reports on an investigation into adult and child interactions observed in the outdoor play environment in four Local Authority early years foundation stage settings in England. In this instance the common two features across the settings were the presence of tricycles and a timetabled outdoor play period. In total, across the four schools, there were 204 children. The study aimed to gain an understanding of the nature of the dialogues between staff and children, that is, the types of exchange that occurred when either the child approached an adult or the adult approached a child. The most frequent type of utterance was also analysed. The study concludes that adults in these settings spoke more than children and the greatest type of utterance was that of the adult about domestic matters. When the child initiated the conversation there were more extended child utterances than domestic utterances. This may suggest that children wish to be involved in conversations of depth and meaning and that staff need to become aware of how to develop this conversational language with children

Implementing a new mathematics curriculum in England: district Research Lesson Study as a driver for student learning, teacher learning and professional dialogue.

Against a backdrop of a transformation in teacher professional development and learning and state school organisation in England this century, this chapter describes a project which harnessed six cycles of Research Lesson Study at school and district level over two years to tailor the implementation of a new statutory curriculum in England to address the professional development needs of teachers and classroom learning needs of London students. It also reports the findings of research carried out during the project into how these teachers learned and developed this new curricular expertise and practice- knowledge through lesson study dialogues that supported student learning. It concludes by proposing future directions for teacher professional learning research and practice

Design of price incentives for adjunct policy goals in formula funding for hospitals and health services

Background. Hospital policy involves multiple objectives: efficiency of service delivery, pursuit of high quality care, promoting access. Funding policy based on hospital casemix has traditionally been considered to be only about promoting efficiency. Discussion. Formula-based funding policy can be (and has been) used to pursue a range of policy objectives, not only efficiency. These are termed 'adjunct' goals. Strategies to incorporate adjunct goals into funding design must, implicitly or explicitly, address key decision choices outlined in this paper. Summary. Policy must be clear and explicit about the behaviour to be rewarded; incentives must be designed so that all facilities with an opportunity to improve have an opportunity to benefit; the reward structure is stable and meaningful; and the funder monitors performance and gaming

Prognostic model to predict postoperative acute kidney injury in patients undergoing major gastrointestinal surgery based on a national prospective observational cohort study.

Background: Acute illness, existing co-morbidities and surgical stress response can all contribute to postoperative acute kidney injury (AKI) in patients undergoing major gastrointestinal surgery. The aim of this study was prospectively to develop a pragmatic prognostic model to stratify patients according to risk of developing AKI after major gastrointestinal surgery. Methods: This prospective multicentre cohort study included consecutive adults undergoing elective or emergency gastrointestinal resection, liver resection or stoma reversal in 2-week blocks over a continuous 3-month period. The primary outcome was the rate of AKI within 7 days of surgery. Bootstrap stability was used to select clinically plausible risk factors into the model. Internal model validation was carried out by bootstrap validation. Results: A total of 4544 patients were included across 173 centres in the UK and Ireland. The overall rate of AKI was 14·2 per cent (646 of 4544) and the 30-day mortality rate was 1·8 per cent (84 of 4544). Stage 1 AKI was significantly associated with 30-day mortality (unadjusted odds ratio 7·61, 95 per cent c.i. 4·49 to 12·90; P < 0·001), with increasing odds of death with each AKI stage. Six variables were selected for inclusion in the prognostic model: age, sex, ASA grade, preoperative estimated glomerular filtration rate, planned open surgery and preoperative use of either an angiotensin-converting enzyme inhibitor or an angiotensin receptor blocker. Internal validation demonstrated good model discrimination (c-statistic 0·65). Discussion: Following major gastrointestinal surgery, AKI occurred in one in seven patients. This preoperative prognostic model identified patients at high risk of postoperative AKI. Validation in an independent data set is required to ensure generalizability

Finishing the euchromatic sequence of the human genome

The sequence of the human genome encodes the genetic instructions for human physiology, as well as rich information about human evolution. In 2001, the International Human Genome Sequencing Consortium reported a draft sequence of the euchromatic portion of the human genome. Since then, the international collaboration has worked to convert this draft into a genome sequence with high accuracy and nearly complete coverage. Here, we report the result of this finishing process. The current genome sequence (Build 35) contains 2.85 billion nucleotides interrupted by only 341 gaps. It covers ∼99% of the euchromatic genome and is accurate to an error rate of ∼1 event per 100,000 bases. Many of the remaining euchromatic gaps are associated with segmental duplications and will require focused work with new methods. The near-complete sequence, the first for a vertebrate, greatly improves the precision of biological analyses of the human genome including studies of gene number, birth and death. Notably, the human enome seems to encode only 20,000-25,000 protein-coding genes. The genome sequence reported here should serve as a firm foundation for biomedical research in the decades ahead