Early identification of wound infection: understanding wound odour

Malodorous wounds can be distressing for patients and their families, negatively impacting on quality-of-life outcomes. For health professionals malodorous wounds can also cause distress manifesting in feelings of disgust when faced with a wound emitting an unpleasant or repulsive odour. There has been investigation into the management of controlling odour particularly in relation to fungating wounds. However, there is limited research that explores techniques for early identification and recognition of wound odours that may be indicative of infection. Electronic nose technology has received some attention, but to date has not been integrated into either diagnostics of infection in wounds or education of health professionals to prepare them for the realities of clinical practice

Anarchy in the UK('s most famous fortress): comradeship and cupidity in Gibraltar and neighbouring Spain, 1890-1902

This article is the first to investigate the growth of anarchist ideology and tactics in Gibraltar and the surrounding Spanish region, the Campo de Gibraltar, in the period 1890-1902. We draw upon hitherto unused material from both The National Archives in London and the Gibraltar Government Archives. By doing so, we demonstrate that during this period Gibraltarian and Spanish workers came together, not only to defend and advance their interests by direct action, such as strikes and attacks on employers, but also to advance educational and social causes too. Indeed, by 1898-9 the appeal of this movement was so strong that an attempt by the British Social Democratic Federation to establish a more constitutionalist approach to industrial relations failed. By 1902, the power of anarchist movements and tactics concerned employers in Gibraltar so greatly that they engineered a lock-out – styled a general strike by local workers – and successfully smashed the organising power of the local movement. Meanwhile, on the Spanish side of the frontier a massacre engineered by the local Spanish authorities resulted in the deaths of a number of activists and a hiatus in the movement that would last until the Great War of 1914-18

Comparison between superdarn flow vectors and equivalent ionospheric currents from ground magnetometer arrays

[1] Equivalent ionospheric currents obtained with the spherical elementary current systems (SECS) method and derived from nearly 100 ground magnetometers spread over North America and Greenland are compared with ionospheric flow vectors measured by the SuperDARN radars during both the summer and winter seasons. This comparison is done over a range of spatial separations, magnetic latitudes, magnetic local times, and auroral electrojet activity to investigate under what conditions the vectors are anti-parallel to one another. Our results show that in general the equivalent ionospheric currents are anti-parallel to the flows and the best results are achieved within the auroral oval during active geomagnetic conditions in the dawn, dusk and noon sectors in the northern hemisphere summer. These results indicate the best anti-parallel alignment occurs when the currents and flows are large and well defined. Factors that may influence the alignment include ionospheric conductivity gradients and quiet time backgrounds. Our results can be used to approximate the macroscopic ($1000 km) ionospheric convection patterns. The SECS maps represent a value-added product from the raw magnetometer database and can be used for contextual interpretation; they can help with our understanding of magnetosphere-ionosphere coupling mechanisms using ground arrays and the magnetospheric spacecraft data, and they can be used as input for other techniques

Socioeconomic deprivation and mortality after emergency laparotomy: an observational epidemiological study

Background: Socioeconomic circumstances can influence access to healthcare, the standard of care provided, and a variety of outcomes. This study aimed to determine the association between crude and risk-adjusted 30-day mortality and socioeconomic group after emergency laparotomy, measure differences in meeting relevant perioperative standards of care, and investigate whether variation in hospital structure or process could explain any difference in mortality between socioeconomic groups. / Methods: This was an observational study of 58 790 patients, with data prospectively collected for the National Emergency Laparotomy Audit in 178 National Health Service hospitals in England between December 1, 2013 and November 31, 2016, linked with national administrative databases. The socioeconomic group was determined according to the Index of Multiple Deprivation quintile of each patient's usual place of residence. / Results: Overall, the crude 30-day mortality was 10.3%, with differences between the most-deprived (11.2%) and least-deprived (9.8%) quintiles (P<0.001). The more-deprived patients were more likely to have multiple comorbidities, were more acutely unwell at the time of surgery, and required a more-urgent surgery. After risk adjustment, the patients in the most-deprived quintile were at significantly higher risk of death compared with all other quintiles (adjusted odds ratio [95% confidence interval]: Q1 [most deprived]: reference; Q2: 0.83 [0.76–0.92]; Q3: 0.84 [0.76–0.92]; Q4: 0.87 [0.79–0.96]; Q5 [least deprived]: 0.77 [0.70–0.86]). We found no evidence that differences in hospital-level structure or patient-level performance in standards of care explained this association. / Conclusions: More-deprived patients have higher crude and risk-adjusted 30-day mortality after emergency laparotomy, but this is not explained by differences in the standards of care recorded within the National Emergency Laparotomy Audit

Prenatal hypoxia induces increased cardiac contractility on a background of decreased capillary density.

Background: Chronic hypoxia in utero (CHU) is one of the most common insults to fetal development and may be associated with poor cardiac recovery from ischaemia-reperfusion injury,yet the effects on normal cardiac mechanical performance are poorly understood. Methods: Pregnant female wistar rats were exposed to hypoxia (12% oxygen, balance nitrogen)for days 10–20 of pregnancy. Pups were born into normal room air and weaned normally. At 10 weeks of age, hearts were excised under anaesthesia and underwent retrograde 'Langendorff' perfusion. Mechanical performance was measured at constant filling pressure (100 cm H2O) with intraventricular balloon. Left ventricular free wall was dissected away and capillary density estimated following alkaline phosphatase staining. Expression of SERCA2a and Nitric Oxide Synthases (NOS) proteins were estimated by immunoblotting. Results: CHU significantly increased body mass (P < 0.001) compared with age-matched control rats but was without effect on relative cardiac mass. For incremental increases in left ventricular balloon volume, diastolic pressure was preserved. However, systolic pressure was significantly greater following CHU for balloon volume = 50 μl (P < 0.01) and up to 200 μl (P < 0.05). For higher balloon volumes systolic pressure was not significantly different from control. Developed pressures were correspondingly increased relative to controls for balloon volumes up to 250 μl (P < 0.05).Left ventricular free wall capillary density was significantly decreased in both epicardium (18%; P <0.05) and endocardium (11%; P < 0.05) despite preserved coronary flow. Western blot analysis revealed no change to the expression of SERCA2a or nNOS but immuno-detectable eNOS protein was significantly decreased (P < 0.001) in cardiac tissue following chronic hypoxia in utero. Conclusion: These data offer potential mechanisms for poor recovery following ischaemia, including decreased coronary flow reserve and impaired angiogenesis with subsequent detrimental effects of post-natal cardiac performance