Puerperal infection: a clinical and bacteriological study of 130 cases

The conception of Puerperal Fever as an infective disease first suggested by British Obstetricians (Denman, Kirkland, the Whites, Young, Ould and Clarke) at the end of the eighteenth and beginning of the nineteenth centuries has now been fully demonstrated.Agreement is universal that the disease is a special form of wound infection and that it is caused by the entry of micro-organisms or their poisons at the placental site, or through breaches of the surface in the cervix, or body of the uterus, the vagina or the vulva, and that many different organisms including Streptococci, Staphylococci, Bacillus Coli and others are capable of producing the infection.The micro-organisms may act by themselves invading the tissues, or by giving rise to poisons which are absorbed, or in both these ways. In grave cases the organisms probably always gain an entrance from without during or soon after the process of parturition. In spite of increased knowledge and improved methods of prevention and treatment based thereon, little or no progress has been made in the past twenty years regarding Puerperal Sepsis. In support of this statement I may mention a few figures concerning the large mortality among women which is incurred yearly through child-bearing:-1. No fewer than 3,000 British mothers die every year in childbirth. 2. Between 1911 and 1926 inclusive there were 66,421 deaths through childbirth and childbearing. 3. Septic Infection is easily the most important single cause. 4. In 1926 the total maternal mortality for England and Wales was 5.14 and the sepsis mortality 1.60 per 1,000 live births. 5. Dr. Harold Miller's investigations at Pittsburg show that of 1,000 women examined as soon as possible after the sixth week following labour no fewer than 70% showed some degree of cervical erosion. 6. In 80% of fatal cases there has been operative or manipulative treatment.Although the deaths of British mothers every year through child-birth and child-bearing are so numerous, we must consider also the much larger number whose health has become undermined through infection and damage sustained during labour.Of gynaecological cases, 70% to 80% give a history of inflammation dating from some previous confinement or miscarriage. Leucorrhoeas, uterine displacements, uterine haemorrhages, pelvic pains etc., along with common general conditions such as rheumatism, indigestion, debility and neurasthenia may follow a lesion sustained in child-birth.On the other hand a well-organized Maternity Service gives a much lower mortality rate. If we 'take as an example the East End Maternity Hospital in London - this Hospital conducts over 2,000 cases every year. About half the cases are delivered in the Hospital. Most of the cases are attended by midwives; abnormal cases by Doctors on the Hospital staff. The mortality rate is just over 1 per 1,000 cases and this in spite of the fact that the practice is amongst the very poor. For four years in a total of 9,000 cases the mortality rate was only 0.67 per 1,000. The Hospital has a well organized ante-natal system, and I think its excellent record is due to good administration, supervision and a low forceps rate (under 3%).Outside these well organized institutions parturient women have not shared in the benefit and upwards of of the total child-bed mortality is still caused by septic infection from which I have stated on an average some 3,000 die every year in England and Wales.The mortality percentage of cases of puerperal sepsis is uncertain; but ten is probably not wide of the mark. At this rate there will be in England and Wales every year an average of something like 20,000 puerperal infections.The disease has been made notifiable and there are the strongest possible reasons for the community to provide effective means of isolation and treatment

US Capital Purchase Program

During the fall of 2008, the US government was faced with a financial crisis of unprecedented scope. Having already exercised the authority to put Fannie Mae and Freddie Mac into conservatorship in September, the stage was set for the US government to intervene more broadly in strained financial markets. This intervention would ultimately come in the form of the Emergency Economic Stabilization Act of 2008 (EESA), which was passed on October 3, 2008. The main provision of EESA was the Troubled Asset Relief Program, or TARP, a $700 billion program initially designed to purchase troubled assets off the balance sheets of struggling financial institutions. Despite initially campaigning that the program would be used to purchase troubled mortgage-related assets, the worsening stress on the financial system, complexity of creating an asset purchase program, and size of the mortgage market caused the Treasury to announce the Capital Purchase Program (CPP), a program of broad-based capital injections, on October 14, 2008. Initially, the CPP was available to publicly traded US banks, but was expanded shortly after to include privately owned banks, S-corporations, and mutual banks, so long as they were based in the US At its launch, Treasury also solicited nine of the largest commercial and investment banks to enroll in the program to encourage broad adoption for banks across the country. These institutions would issue either preferred stock (public and private banks) or subordinated debt (S-corps and mutual banks) to the Treasury at rates of five percent, which would then increase to nine percent after five years. As subsequent programs to provide credit to low-income areas and small business, such as the Community Development Capital Initiative (CDCI) and Small Business Lending Fund (SBLF) developed, CPP institutions were also able to refinance CPP investments into lower-cost CDCI and SBLF ones. A total of 707 institutions issued$204.9 billion in CPP capital to the Treasury, which has recovered $226.8 billion through repayments; auctions; and income related to dividends, interest, and warrants

Dirac lattice

We study the emergence of Dirac fermionic field in the low energy description of non-relativistic dynamical models on graphs admitting continuum limit. The Dirac fermionic field appears as the effective field describing the excitations above point-like Fermi surface. Together with the Dirac fermionic field an effective space-time metric is also emerging. We analyze the conditions for such Fermi points to appear in general, paying special attention to the cases of two and three spacial dimensions.Comment: 26 pages, 4 figures; typo and grammatical corrections, new reference(s) added, version accepted for publicatio

On the prevalence of bridged macrocyclic pyrroloindolines formed in regiodivergent alkylations of tryptophan.

A Friedel-Crafts alkylation is described that efficiently transforms tryptophan-containing peptides into macrocycles of varying ring connectivity. Factors are surveyed that influence the distribution of regioisomers, with a focus on indole C3-alkylations leading to bridged endo-pyrroloindolines. We probe the stability and stereochemistry of these pyrroloindolines, study their rearrangement to C2-linked indolic macrocycles, and demonstrate a scalable, stereoselective synthesis of this compound class. Placing the macrocyclization in sequence with further template-initiated annulation leads to extraordinary polycyclic products and further demonstrates the potential for this chemistry to drive novel peptidomimetic lead discovery programs

Can ABC be Used for Model Selection?

Over the past ten years, Approximate Bayesian Computation (ABC) has become hugely popular to estimate the parameters of a model when the likelihood function cannot be computed in a reasonable amount of time. ABC can in principle be used also to perform Bayesian model comparison, but this raises the question of which summary statistic should be used for such applications. Here we present a general method for constructing a summary statistic that is sufficient for the model choice problem. We apply this construction to models from the exponential family. Unfortunately, in more complex models, our construct often results in statistics with too high dimensionality to use in ABC. We therefore discuss the possibility of applying ABC with non-sufficient statistics

Personality Factors that Influence Truthfulness and Deception

Identifying personality traits that coincide with everyday deception is crucial to understanding how individual differences relate to antisocial tendencies. The current study tested the hypothesis that sensation seeking and psychopathy can predict everyday deception. Seventy-nine undergraduate students participated in an online study to assess these personality traits. A linear regression analysis found disinhibition psychopathy to be a strong predictor of everyday deception, with impulsive sensation seeking as the only other significant predictor

Recognition of Concealed Information with Behavioral and Spectral Analyses

The main thesis of this project was that individuals who have concealed information can be detected using a combined behavioral and psychophysiological approach. This study examined the similarities and differences that characterize the behavioral and power spectra responses in truthful and deceptive subjects. Half of the subjects participated in a mock crime while the other half participated in a non-crime scenario. The participants responded during their session to words related and not related to the scenarios they enacted. Although the participants in the crime group were instructed to deny anything related to their scenario, the behavioral and spectral data demonstrate that they actually possess concealed information. Therefore, behavioral and spectral indices elicited by concealed information in deceptive subjects can reflect some aspects of deceit

A study of the natural history of hepatitis C infection within a geographically determined population (Trent HCV study)

The epidemiology and natural history of Hepatitis C has been studied in a large geographically determined population (Trent HCV study). It has previously been suggested that patients with Hepatitis C and a persistently normal Alanine aminotransferase (PNALT) represent a group of patients with mild disease and at low risk of disease progression. Patients with PNALT were, therefore, compared to those with an elevated ALT. The majority of patients initially fulfilling the definition of a PNALT had an abnormal ALT within 3 years of follow-up. They also demonstrated similar rates of fibrosis progression as a sub-group of HCV infected patients with an elevated ALT who were re-biopsied prior to any institution of therapy. They, therefore, warrant the same consideration with regard to treatment. The morbidity and mortality associated with Hepatitis C with severe fibrosis was assessed in a group of patients with a liver biopsy demonstrating Ishak fibrosis stage 4. A worse prognosis than previously reported was observed for this patient population. Once decompensation develops, HCV infection is associated with a high mortality rate. Indicators of poor synthetic liver function and hypergammaglobulinaemia were important prognostic factors for mortality, while combination antiviral therapy was associated with improved survival. The majority of HCV infected patients (75%) diagnosed with hepatocellular carcinoma (HCC) were known to have cirrhosis at least 6 months prior to diagnosis of HCC and were, therefore, amenable to surveillance. There was a variable application of surveillance, however, and no significant improvement in survival was demonstrated. Age, duration of infection and immunoglobulin G levels were associated with an increased risk of HCC in cirrhotic patients in the univariate analysis. Achieving an SVR was associated with a reduced risk. No variable in cirrhotic patients was shown to be independently associated with HCC in the multivariate analysis. A comparison of disease progression and treatment outcome in White and Asian (Indian subcontinent) patients was made. Asian patients generally presented at an older age and with more severe disease on biopsy. The patient’s ethnic group was not associated with the likelihood of either an SVR or completion of therapy. Instead cirrhosis and a raised GGT were associated with a failure to achieve SVR in the multivariate analysis. The platelet count is a surrogate marker for the severity of liver fibrosis and correlates with the Ishak fibrosis stage. An analysis of factors associated with an SVR was performed. In the multivariate model, age at start of treatment was the only independent predictor of SVR in Genotype 1, while estimated duration of infection and Ishak stage were predictors in genotype 2/3 patients. The platelet count was not an independent predictor of SVR or completion of therapy