Transparent Polyurethane Film as an Intravenous Catheter Dressing: A Meta-analysis of the Infection Risks

Objective.—To obtain a quantitative estimate of the impact on infectious complications of using transparent dressings with intravenous catheters. Data Sources.—Meta-analysis of all studies published in the English literature, including abstracts, letters, and reports that examined the primary research question of infection risks associated with transparent compared with gauze dressings for use on central and peripheral venous catheters. Studies were identified by use of the MEDLINE database using the indexing terms occlusive dressings, transparent dressings, and infection and by review of referenced bibliographies. Study Selection.—Seven of the 15 studies (47%) of central venous catheters and seven of 12 studies (58%) of peripheral catheters met our inclusion criteria for analysis. All studies used a prospective cohort design, utilized hospitalized patients, and reported at least one of our defined outcomes. Extraction.—Data for each study were abstracted independently by three investigators. At least three studies were used in the analysis of each outcome. Data Synthesis.—Applying a Mantel-Haenszel χ2 analysis, use of transparent dressings on central venous catheters was significantly associated with an elevated relative risk (RR) of catheter tip infection (RR = 1.78; 95% confidence interval [CI], 1.38 to 2.30). Catheter-related sepsis (RR = 1.69; 95% CI, 0.97 to 2.95) and bacteremia (RR = 1.63; 95% CI, 0.76 to 3.47) were both associated with an elevated RR. Use of transparent dressings on peripheral catheters was associated with an elevated RR of catheter-tip infection (RR=1.53; 95% CI, 1.18 to 1.99) but not phlebitis (RR = 1.02; 95% CI, 0.86 to 1.20), infiltration (RR = 1.12; 95% CI, 0.92 to 1.37), or skin colonization (RR =0.99; 95% CI, 0.90 to 1.09). Conclusion.—The results demonstrated a significantly increased risk of catheter-tip infection with the use of transparent compared with gauze dressings when used with either central or peripheral catheters. An increased risk of bacteremia and catheter sepsis associated with the use of transparent compared with gauze dressings for use on central venous catheters was suggested

Patients’ journeys through multi-level diagnostic imaging referrals

BACKGROUND : Diagnostic imaging plays an integral role in disease diagnosis and patient treatment. The challenge in the context of diagnostic imaging referrals is how to collectively navigate patients through these services, intra- and inter-institutionally. OBJECTIVE : To map the referral processes and procedures that lead to access to diagnostic imaging services within the embedded multi-level medico-clinical pathways up to the point of an ultimate diagnosis as part of a patient’s treatment and management plan. METHODS : This study was part of a larger qualitative study conducted at a district hospital situated in an academic hospital complex. A total of 24 conveniently selected patients were ‘shadowed’ from entry until discharge. Data collection methods included observations of the various types of consultations and individual and focus group interviews with multiple healthcare providers. FINDINGS : Two main themes pertaining to referrals for diagnostic imaging were identified. The first relates to the decisions that a medical officer or specialist has to make about the sequence of activities and procedures related to each patient’s condition. The second theme refers to the multi-level routing of patients. CONCLUSION : The informational interactions between providers that takes place during a patient’s journey inform the mapping approach to referral pathways for diagnostic imaging investigations from a systemic point of view. This process can also enhance the strategic management of the system.http://www.sorsa.org.zaam201

Effect of metformin therapy and dietary supplements on semen parameters in hyperinsulinaemic males

Previous reports indicated that hyperinsulinaemic men may exhibit a higher percentage of poorly compacted DNA in their spermatozoa and less success in an IVF programme (Andrologia, 45, 2003, 18; Andrologia, 2014, doi: 10.1111/ and.12227). The aim of this study was to investigate the effect of metformin (Glucophage ) and antioxidant treatment (StaminoGro ) on the semen parameters of hyperinsulinaemic men. Nineteen hyperinsulinaemic male patients were treated for 3 months with metformin alone (Group A), and fifteen patients used metformin in combination with the nutritional supplement (Group B). Combined data of the two groups (pre- and post-treatment) differ significantly regarding sperm morphology (P = 0.0003) and CMA3 (P < 0.0001) values. The improvement in sperm morphology after treatment was similar for the two respective groups (P < 0.05). The morphological normal sperm forms increased from the mean percentage of 3.9 to 5.5% and from 4.2 to 5.5% for Group A and B respectively. Where a combination of metformin and the supplement were used (Group B), the combination treatment proved to be superior in obtaining enhanced chromatin packaging quality although not statistically significant (P = 0.5929) when compared with the metformin (Group A) group. The chromatin packaging quality in Group B improved with 10% while the improvement in Group A was approximately 8.3%. Therefore, infertile hyperinsulinaemic men can benefit from metformin treatment and should be advised on the use of nutritional supplements with antioxidant properties.http://onlinelibrary.wiley.com/journal/10.1111/(ISSN)1439-02722016-11-30hb2016Clinical Epidemiolog

Attenuation of leukocyte sequestration by selective blockade of PECAM-1 or VCAM-1 in murine endotoxemia

Background: Molecular mechanisms regulating leukocyte sequestration into the tissue during endotoxemia and/or sepsis are still poorly understood. This in vivo study investigates the biological role of murine PECAM-1 and VCAM-1 for leukocyte sequestration into the lung, liver and striated skin muscle. Methods: Male BALB/c mice were injected intravenously with murine PECAM-1 IgG chimera or monoclonal antibody (mAb) to VCAM-1 ( 3 mg/kg body weight); controls received equivalent doses of IgG2a ( n = 6 per group). Fifteen minutes thereafter, 2 mg/kg body weight of Salmonella abortus equi endotoxin was injected intravenously. At 24 h after the endotoxin challenge, lungs, livers and striated muscle of skin were analyzed for their myeloperoxidase activity. To monitor intravital leukocyte-endothelial cell interactions, fluorescence videomicroscopy was performed in the skin fold chamber model of the BALB/c mouse at 3, 8 and 24 h after injection of endotoxin. Results: Myeloperoxidase activity at 24 h after the endotoxin challenge in lungs (12,171 +/- 2,357 mU/g tissue), livers ( 2,204 +/- 238 mU/g) and striated muscle of the skin ( 1,161 +/- 110 mU/g) was significantly reduced in both treatment groups as compared to controls, with strongest attenuation in the PECAM-1 IgG treatment group. Arteriolar leukocyte sticking at 3 h after endotoxin (230 +/- 46 cells x mm(-2)) was significantly reduced in both treatment groups. Leukocyte sticking in postcapillary venules at 8 h after endotoxin ( 343 +/- 69 cells/mm(2)) was found reduced only in the VCAM-1-mAb-treated animals ( 215 +/- 53 cells/mm(2)), while it was enhanced in animals treated with PECAM-1 IgG ( 572 +/- 126 cells/mm(2)). Conclusion: These data show that both PECAM-1 and VCAM-1 are involved in endotoxin-induced leukocyte sequestration in the lung, liver and muscle, presumably through interference with arteriolar and/or venular leukocyte sticking. Copyright (C) 2004 S. Karger AG, Basel

Response of vegetation to fire disturbance: short-term dynamics in two savanna physiognomies

Fire is a constitutive ecological force in savanna ecosystems, but few studies have monitored its short-term effects on plant community dynamics. This study investigated changes in plant diversity in the South American savanna (Cerrado) after severe disturbance by fire. We monitored 30 permanent plots (10 m × 5 m) distributed in two Cerrado physiognomies (típico: more forested; ralo: grass-dominated), being 10 plots in the area disturbed by fire, and five in a preserved control area (undisturbed). From August 2010 to June 2011, we evaluated changes in species richness, abundance and composition of savanna vegetation. Monitoring started one week after the fire; disturbed plots were surveyed monthly, while control plots were surveyed every two months. We observed rapid reassembling in both physiognomies: plots affected by fire showed rapid increase in species richness and plant density during the first four months after the disturbance. Concerning species composition, disturbed plots in the cerrado típico tended to converge to control plots after one year, but each local assemblage followed particular temporal trajectories. A different pattern characterized cerrado ralo plots, which showed heterogeneous trajectories and lack of convergence between disturbed and control plots; the structure of these assemblages will likely change in next years. In conclusion, our results showed that fire significantly affected plant diversity in the two savanna physiognomies (cerrado típico and ralo), but also indicated that community reassembling is fast, with different dynamics between Cerrado physiognomies

DN interaction from meson exchange

A model of the DN interaction is presented which is developed in close analogy to the meson-exchange KbarN potential of the Juelich group utilizing SU(4) symmetry constraints. The main ingredients of the interaction are provided by vector meson (rho, omega) exchange and higher-order box diagrams involving D*N, D\Delta, and D*\Delta intermediate states. The coupling of DN to the pi-Lambda_c and pi-Sigma_c channels is taken into account. The interaction model generates the Lambda_c(2595) resonance dynamically as a DN quasi-bound state. Results for DN total and differential cross sections are presented and compared with predictions of an interaction model that is based on the leading-order Weinberg-Tomozawa term. Some features of the Lambda_c(2595) resonance are discussed and the role of the near-by pi-Sigma_c threshold is emphasized. Selected predictions of the orginal KbarN model are reported too. Specifically, it is pointed out that the model generates two poles in the partial wave corresponding to the Lambda(1405) resonance.Comment: 14 pages, 8 figure

Biological and geophysical feedbacks with fire in the Earth system

Roughly 3% of the Earth's land surface burns annually, representing a critical exchange of energy and matter between the land and atmosphere via combustion. Fires range from slow smouldering peat fires, to low-intensity surface fires, to intense crown fires, depending on vegetation structure, fuel moisture, prevailing climate, and weather conditions. While the links between biogeochemistry, climate and fire are widely studied within Earth system science, these relationships are also mediated by fuels—namely plants and their litter—that are the product of evolutionary and ecological processes. Fire is a powerful selective force and, over their evolutionary history, plants have evolved traits that both tolerate and promote fire numerous times and across diverse clades. Here we outline a conceptual framework of how plant traits determine the flammability of ecosystems and interact with climate and weather to influence fire regimes. We explore how these evolutionary and ecological processes scale to impact biogeochemical and Earth system processes. Finally, we outline several research challenges that, when resolved, will improve our understanding of the role of plant evolution in mediating the fire feedbacks driving Earth system processes. Understanding current patterns of fire and vegetation, as well as patterns of fire over geological time, requires research that incorporates evolutionary biology, ecology, biogeography, and the biogeosciences