6,834 research outputs found

    Animal bite wounds and their management in tropical Australia

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    Objective: To define the microbiologic characteristics of animal bites in tropical Australia and the appropriateness of current Australian antimicrobial guidelines for their management. Methods: This retrospective audit examined hospitalizations in tropical Australia after an animal bite or animal-associated penetrating injury between 2013 and 2020. The primary outcome was a composite of death, intensive care unit admission, amputation, quaternary center transfer, or unplanned rehospitalization. Results: A wide variety of animals were implicated, but snakes (734/1745, 42%), dogs (508/1745, 29%), and cats (153/1745, 9%) were the most common. Hospital presentation after 24 hours (odds ratio (OR) (95% confidence interval (CI)): 68.67 (42.10-112.01)) and a cat-related injury (OR (95% CI): 22.20 (11.18-44.08)) were independently associated with an increased risk of infection. A pathogen not covered by the relevant antimicrobial regimen recommended in Australian guidelines was identified in only 12/1745 (0.7%) cases. The primary outcome occurred in 107/1745 (6%) and was independently associated with tissue trauma (OR (95% CI): 9.29 (6.05-14.25), p<0.001), established deep infection at presentation (OR (95% CI): 2.95 (1.31-6.61), p=0.009) and hospital presentation after 24 hours (OR (95% CI): 1.77 (1.12-2.79), p=0.01). Conclusions: A wide variety of animals bite humans in tropical Australia, but empiric antimicrobial regimens recommended in current national guidelines cover almost all the microbiologic isolates from the resulting wounds

    Care provision during termination of pregnancy following diagnosis of a severe congenital anomaly – a qualitative study of what is important to parents.

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    Objective: To understand the experiences of women and their partners following the decision to terminate a pregnancy affected by a severe congenital anomaly Design: Qualitative semi-structured interviews with a purposive sample of women and their partners who underwent a termination of pregnacy following diagnosis of a severe congenital anomaly. Setting: Women referred to four fetal medicine centres across two hospital trusts. Analysis: Data analysis was based on the constant comparative approach. Findings: The over-arching theme emerging from the data was that of ‘falling through the gap’, where the care received did not adequately meet the needs of women and their partners. This was particularly salient at three specific points in the care pathway: enacting the decision to have a termination of pregnancy and subsequent initiation of the process; care during labour and birth, where parents describe being caught in ‘no-man’s land’ between the antenatal and postnatal settings; and post-birth, where parents made sense of and came to terms with their decision. Conclusions: The diagnosis of a severe congenital anomaly and the subsequent pathway that parents face is a traumatic event. Responsibility for the decision to terminate the pregnancy intensifies emotions and adds to the complexity of caring for this group. These findings point to the need for a specific care pathway for parents undergoing this difficult experience. Recommendations include the need for a greater understanding of the views of midwives caring for these parents, review of specific training needs, and examination of processes to better support both parents

    The use of 1320nm Nd:YAG laser for the treatment of acne scar in Asians

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    Comparison of ethnic group classification using naming analysis and routinely collected data: application to cancer incidence trends in children and young people

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    Objective: Inpatient Hospital Episode Statistics (HES) ethnicity data are available but not always collected and data quality can be unreliable. This may have implications when assessing outcomes by ethnicity. An alternative method for assigning ethnicity is using naming algorithms. We investigate if the association between ethnicity and cancer incidence varied dependent upon how ethnic group was assigned. Design: Population-based cancer registry cohort study Setting: Yorkshire, UK Participants: Cancer registrations from 1998-2009 in children and young people (0-29 years) from a specialist cancer register in Yorkshire, UK (N=3998) were linked to inpatient HES data to obtain recorded ethnicity. Patient?s names, recorded in the cancer register, were matched to an ethnic group using the naming algorithm software Onomap. Each source of ethnicity was categorised as White, South Asian (SA) or Other and a further two indicators were defined based on the combined ethnicities of HES and Onomap, one prioritising HES results, the other prioritising Onomap. Outcomes: Incidence rate ratios (IRR) between ethnic groups were compared using Poisson regression for all cancers combined, leukaemia, lymphoma and central nervous system (CNS) tumours. Results: Depending on the indicator used, 7.1% to 8.6% of the study population were classified as SA. For all cancers there were no statistically significant differences between White and SA groups using any indicator, however for lymphomas significant differences were only evident using one of the ?Combined? indicators (IRR=1.36 (95%CI 1.08, 1.71)) and for CNS tumours incidence was lower using three of the four indicators. For the other ethnic group the IRR for all cancers ranged from 0.78 (0.65, 0.94) to 1.41 (1.23, 1.62). Conclusions: Using different methods of assigning ethnicity can result in different estimates of ethnic variation in cancer incidence. Combining ethnicity from multiple sources results in a more complete estimate of ethnicity than the use of one single source

    Human cytomegalovirus-specific cytotoxic T cells. Relative frequency of stage-specific CTL recognizing the 72-kD immediate early protein and glycoprotein B expressed by recombinant vaccinia viruses.

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    CTL are held to be an important host defense mechanism in persistent herpes-virus infections. We have therefore studied the nature and specificity of human cytomegalovirus (HCMV)-specific CTL in normal persistently infected individuals. This was achieved by using vaccinia recombinants encoding viral genes expressed at different stages of the virus replicative cycle, a structural glycoprotein gB (vac.gB) and the major 72-kD immediate early nonstructural protein (vac.IE) of HCMV, combined with limiting dilution analysis of the CTL response. In two subjects, 43 and 58% of HCMV CTL precursors (CTLp) lysed vac.IE-infected cells, in contrast to less than 6% lysing gB-infected cells. HCMV-specific CTL could also be generated by secondary in vitro stimulation with vac.gB- but not vac.IE-infected autologous fibroblasts. The high frequency of 72-kD IE protein-specific CTL suggests that this is at least a major recognition element for the HCMV-specific CTL response in asymptomatic persistently infected individuals, and CTL with this specificity may be important in maintaining the normal virus/host equilibrium

    The origin of [C II] 157 μm emission in a five-component interstellar medium : the case of NGC 3184 and NGC 628

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    With its relatively low ionization potential, C+ can be found throughout the interstellar medium (ISM) and provides one of the main cooling channels of the ISM via the [C II] 157 mu m emission. While the strength of the [C II] line correlates with the star formation rate, the contributions of the various gas phases to the [C II] emission on galactic scales are not well established. In this study we establish an empirical multi-component model of the ISM, including dense H II regions, dense photon dissociation regions (PDRs), the warm ionized medium (WIM), low density and G(0). surfaces of molecular clouds (SfMCs), and the cold neutral medium (CNM). We test our model on ten luminous regions within the two nearby galaxies NGC 3184 and NGC 628. on angular scales of 500-600 pc. Both galaxies are part of the Herschel. key program. KINGFISH,. and are complemented by a large set of ancillary ground-and space-based data. The five modeled phases together reproduce the observed [C II] emission quite well, overpredicting the total flux slightly (about 45%) averaged over all regions. We find that dense PDRs are the dominating component, contributing 68% of the [C II] flux on average, followed by the WIM and the SfMCs, with mean contributions of about half of the contribution from dense PDRs, each. CNM and dense H II regions are only minor contributors with less than 5% each. These estimates are averaged over the selected regions, but the relative contributions of the various phases to the [C II] flux vary significantly between these regions
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