Season of the year influences infection rates following total hip arthroplasty

To research the influence of season of the year on periprosthetic joint infections. METHODS We conducted a retrospective review of the entire Medicare files from 2005 to 2014. Seasons were classified as spring, summer, fall or winter. Regional variations were accounted for by dividing patients into four geographic regions as per the United States Census Bureau (Northeast, Midwest, West and South). Acute postoperative infection and deep periprosthetic infections within 90 d after surgery were tracked. RESULTS In all regions, winter had the highest incidence of periprosthetic infections (mean 0.98%, SD 0.1%) and was significantly higher than other seasons in the Midwest, South and West (P \u3c 0.05 for all) but not the Northeast (P = 0.358). Acute postoperative infection rates were more frequent in the summer and were significantly affected by season of the year in the West. CONCLUSION Season of the year is a risk factor for periprosthetic joint infection following total hip arthroplasty (THA). Understanding the influence of season on outcomes following THA is essential when risk-stratifying patients to optimize outcomes and reduce episode of care costs. © The Author(s) 2017

L-arginine: A unique amino acid for improving depressed wound immune function following hemorrhage

Objective: To determine whether L-arginine has any salutary effects on wound immune cell function following trauma-hemorrhage. Background. Depressed wound immune function contributes to an increased incidence of wound infections following hemorrhage. Although administration of L-arginine has been shown to restore depressed cell-mediated immune responses following hemorrhage potentially by maintaining organ blood flow, it remains unknown whether Larginine has any salutary effects on the depressed local immune response at the wound site. Methods: Male mice were subjected to a midline laparotomy and polyvinyl sponges were implanted subcutaneously in the abdominal wound prior to hemorrhage (35 +/- 5 mm Hg for 90 min and resuscitation) or sham operation. During resuscitation mice received 300 mg/kg body weight L-arginine or saline (vehicle). Sponges were harvested 24 h thereafter, wound fluid collected and wound immune cells cultured for 24 h in the presence of LPS. Pro- (IL-1beta, IL-6) and anti-inflammatory (IL-10) cytokines were determined in the supernatants and the wound fluid. In addition, wounds were stained for IL-6 immunohistochemically. In a separate set of animals, skin and muscle blood flow was determined by microspheres. Results: The capacity of wound immune cells to release IL-1beta and IL-6 in vitro was significantly depressed in hemorrhaged mice receiving vehicle. Administration of L-arginine, however, improved wound immune cell function. In contrast, in vivo the increased IL-6 release at the wound site was decreased in L-arginine-treated mice following hemorrhage. Moreover, IL-10 levels were significantly increased in the wound fluid in hemorrhaged animals receiving L-arginine compared to vehicle-treated mice. In addition, the depressed skin and muscle blood flow after hemorrhage was restored by L-arginine. Conclusions: Thus, L-arginine might improve local wound cell function by decreasing the inflammatory response at the wound site. Since L-arginine protected wound immune cell function this amino acid might represent a novel and useful adjunct to fluid resuscitation for decreasing wound complications following hemorrhage. Copyright beta 2002 S. Karger AG, Basel

The influence of optimism bias on time and cost on construction projects

The unresolved scholarly debate to curtail cost and time performances in projects has led to alternate solutions, departing from the dominant technical school of thought to include concepts from behavioural sciences. In this paper, we consider the psychological effect, namely optimism bias, as one of the root causes for delays in cost overruns on projects. The research objectives were to determine the level of bias among project participants, rank time and cost overrun causes according to the participants’ bias score and establish a mitigation strategy to curb potential delays and cost overrun impacts based on the bias scores obtained. A literature survey was conducted to determine causal factors contributing to delays and cost overruns linked to optimism bias. Through a pilot survey of three semi-structured interviews, eighty factors obtained from the literature survey were reduced to 24 critical delay and cost overrun factors relevant to Trinidad and Tobago. A questionnaire was subsequently developed seeking construction professionals to rate their bias scores based on an 11-point Likert scale. The research confirms that project planners and decision-makers exhibit moderate levels of optimism bias; however, participants lacked awareness of the impact of optimism bias on projects outcomes. Project location, environmental impacts and historic preservation, and labour disputes are the top three critical factors where project professionals displayed increased optimistic tendencies. It is proposed that contingency “time window” and reference class forecasting be implemented as control mechanisms to mitigate the impacts of time and cost overruns on projects. This research introduces a novel method to account for and measure optimism bias on construction projects. This study adds knowledge into delays and cost overruns causation and provides a foundation for future studies on quantifying psychological effects on projects and enhancing overall project management practices

Spiky strings and single trace operators in gauge theories

We consider single trace operators of the form O_{m_1 ... m_n} = tr D_+^{m_1} F ... D_+^{m_n} F which are common to all gauge theories. We argue that, when all m_i are equal and large, they have a dual description as strings with cusps, or spikes, one for each field F. In the case of N=4 SYM, we compute the energy as a function of angular momentum by finding the corresponding solutions in AdS_5 and compare with a 1-loop calculation of the anomalous dimension. As in the case of two spikes (twist two operators), there is agreement in the functional form but not in the coupling constant dependence. After that, we analyze the system in more detail and find an effective classical mechanics describing the motion of the spikes. In the appropriate limit, it is the same (up to the coupling constant dependence) as the coherent state description of linear combinations of the operators O_{m_1 ... m_n} such that all m_i are equal on average. This agreement provides a map between the operators in the boundary and the position of the spikes in the bulk. We further suggest that moving the spikes in other directions should describe operators with derivatives other than D_+ indicating that these ideas are quite generic and should help in unraveling the string description of the large-N limit of gauge theories.Comment: 23 pages, 5 figures. v2: References and comments adde

Walls talk: Microbial biogeography of homes spanning urbanization.

Westernization has propelled changes in urbanization and architecture, altering our exposure to the outdoor environment from that experienced during most of human evolution. These changes might affect the developmental exposure of infants to bacteria, immune development, and human microbiome diversity. Contemporary urban humans spend most of their time indoors, and little is known about the microbes associated with different designs of the built environment and their interaction with the human immune system. This study addresses the associations between architectural design and the microbial biogeography of households across a gradient of urbanization in South America. Urbanization was associated with households' increased isolation from outdoor environments, with additional indoor space isolation by walls. Microbes from house walls and floors segregate by location, and urban indoor walls contain human bacterial markers of space use. Urbanized spaces uniquely increase the content of human-associated microbes-which could increase transmission of potential pathogens-and decrease exposure to the environmental microbes with which humans have coevolved

Effective Lagrangian for strongly coupled domain wall fermions

We derive the effective Lagrangian for mesons in lattice gauge theory with domain-wall fermions in the strong-coupling and large-N_c limits. We use the formalism of supergroups to deal with the Pauli-Villars fields, needed to regulate the contributions of the heavy fermions. We calculate the spectrum of pseudo-Goldstone bosons and show that domain wall fermions are doubled and massive in this regime. Since we take the extent and lattice spacing of the fifth dimension to infinity and zero respectively, our conclusions apply also to overlap fermions.Comment: 26 pp. RevTeX and 3 figures; corrected error in symmetry breaking scheme and added comments to discussio

Integrating out the heaviest quark in N--flavour ChPT

We extend a known method to integrate out the strange quark in three flavour chiral perturbation theory to the context of an arbitrary number of flavours. As an application, we present the explicit formulae to one--loop accuracy for the heavy quark mass dependency of the low energy constants after decreasing the number of flavours by one while integrating out the heaviest quark in N--flavour chiral perturbation theory.Comment: 18 pages, 1 figure. Text and references added. To appear in EPJ