Anesthesia Preoperative Clinic Referral for Elevated Hba1c Reduces Complication Rate in Diabetic Patients Undergoing Total Joint Arthroplasty

Background: Diabetes mellitus (DM) is risk factor for complications after orthopedic surgery. Objectives: We tested the hypothesis that anesthesia preoperative clinic (APC) referral for elevated glycosylated hemoglobin (HbA1c) reduces complication rate after total joint arthroplasty (TJA). Patients and Methods: Patients (n = 203) with and without DM were chosen from 1,237 patients undergoing TJA during 2006 - 12. Patients evaluated in the APC had surgery in 2006 - 8 regardless of HbA1c (uncontrolled). Those evaluated between in subsequent two-year intervals were referred to primary care for HbA1c ≥ 10% and ≥ 8%, respectively, to improve DM control before surgery. Complications and mortality were quantified postoperatively and at three, six, and twelve months. Length of stay (LOS) and patients requiring a prolonged LOS (\u3e 5 days) were recorded. Results: Patients (197 men, 6 women) underwent 71, 131, and 1 total hip, knee, and shoulder replacements, respectively. Patients undergoing TJA with uncontrolled HbA1c and those with HbA1c \u3c 10%, but not those with HbA1c \u3c 8%, had a higher incidence of coronary disease and hypercholesterolemia than patients without DM. An increase in complication rate was observed in DM patients with uncontrolled HbA1c versus patients without DM (P \u3c 0.001); the complication rate progressively decreased with tighter HbA1c control. More DM patients with preoperative HbA1c that was uncontrolled or ≥ 10% required prolonged LOS versus those without DM (P \u3c 0.001 and P = 0.0404, respectively). Conclusions: APC referral for elevated HbA1c reduces complication rate and the incidence of prolonged hospitalization during the first year after surgery in diabetics undergoing TJA

A CNO Dichotomy among O2 Giant Spectra in the Magellanic Clouds

From a survey of the 3400 Å region in the earliest O-type spectra, we have found that two of the four O2 giants observed in the Large Magellanic Cloud have O IV lines there that are stronger than the N IV lines, while the other two have the opposite. A Small Magellanic Cloud counterpart also has N IV stronger than O IV. Inspection of the blue spectra of these stars shows that the former pair have weaker N lines in all ionization states (III, IV, and V) present as well as lines of C IV λ4658, while the latter three have stronger N lines and greater He/H. Space ultraviolet observations of two of the N-strong stars show N V wind profiles substantially stronger than those of C IV, while in the N-weak stars the C IV features are equal to or stronger than the N V. The N-strong stars are now reclassified as ON2 III(f*), newly defining that category. These characteristics strongly suggest a larger fraction of processed material in the atmospheres of the ON2 stars, which we confirm by modeling the optical spectra. In the context of current models, it is in turn implied that the ON2 stars are in a more advanced evolutionary state than the others, and/or that they had higher initial rotational velocities. The recent formulation of the effects of rotation on massive stellar evolution introduces an additional fundamental parameter, which the CNO abundances are in principle able to constrain. We present some illustrative comparisons with current Geneva evolutionary models for rotating massive stars. It is possible that these very hot, nitrogen-rich objects are products of homogeneous evolution. Our results will provide motivation for further physical modeling of the atmospheres and evolutionary histories of the most massive hot stars.Fil: Walborn, Nolan Revere. Space Telescope Science Institute; Estados UnidosFil: Morrell, Nidia Irene. Las campanas observatory; ChileFil: Howarth, Ian D.. University College London; Estados UnidosFil: Crowther, Paul A.. University of Sheffield; Reino UnidoFil: Lennon, Daniel J.. Isaac Newton Group of Telescopes; EspañaFil: Massey, Philip. Lowell Observatory; Estados UnidosFil: Arias, Julia Ines. Universidad Nacional de la Plata. Facultad de Ciencias Astronómicas y Geofísicas; Argentin

IL-10-conditioned dendritic cells, decommissioned for recruitment of adaptive immunity, elicit innate inflammatory gene products in response to danger signals

Dendritic cells (DCs) are the professional APCs of the immune system, enabling T cells to perceive and respond appropriately to potentially dangerous microbes, while also being able to maintain T cell tolerance toward self. In part, such tolerance can be determined by IL-10 released from certain types of regulatory T cells. IL-10 has previously been shown to render DCs unable to activate T cells and it has been assumed that this process represents a general block in maturation. Using serial analysis of gene expression, we show that IL-10 pretreatment of murine bone marrow-derived DCs alone causes significant changes in gene expression. Furthermore, these cells retain the ability to respond to Toll-like receptor agonists, but in a manner skewed toward the selective induction of mediators known to enhance local inflammation and innate immunity, among which we highlight a novel CXCR2 ligand, DC inflammatory protein-1. These data suggest that, while the presence of a protolerogenic and purportedly anti-inflammatory agent such as IL-10 precludes DCs from acquiring their potential as initiators of adaptive immunity, their ability to act as initiators of innate immunity in response to Toll-like receptor signaling is enhanced

Technical note: Quantifying uranium-series disequilibrium in natural samples for dosimetric dating – Part 1: gamma spectrometry

Abstract. Dosimetric dating techniques rely on accurate and precise determination of environmental radioactivity. Gamma spectrometry is the method of choice for determining the activity of 238U, 232Th, and 40K. With the aim to standardize gamma-spectrometric procedures for the purpose of determining accurate parent nuclide activities in natural samples, we outline the basics of gamma spectrometry and practical laboratory procedures here. This includes gamma radiation and instrumentation, sample preparation, finding the suitable measurement geometry and sample size for a given detector, and using the most suitable energy peaks in a gamma spectrum. The issue of correct efficiency calibration is highlighted. The procedures outlined are required for estimating contemporary parent nuclide activity. For estimating changing activities during burial specific data analyses are required, and these are also highlighted. </jats:p

Voltage based current compensation converter control for power electronic interfaced distribution networks in future aircraft

Superconductors have a potential application in future turboelectric distributed propulsion (TeDP) aircraft and present significant new challenges for protection system design. Electrical faults and cooling system failures can lead to temperature rises within a superconducting distribution network, which necessitates a reduction or temporary curtailment of current to loads to prevent thermal runaway occurring within the cables. This scenario is undesirable in TeDP aircraft applications where the loads may be flight-critical propulsion motors. This article proposes a power management and control method that exploits the fast-acting measurement and response capabilities of the power electronic interfaces within the distribution network to maximize current supply to critical loads, reducing the impact of a temperature rise event in the superconducting distribution network. This new algorithm uses the detection of a resistive voltage in combination with a model-based controller that estimates the operating temperature of the affected superconducting cable to adapt the output current limit of the associated power electronic converter. To demonstrate the effectiveness of this method and its impact on wider system stability, the algorithm is applied to a simulated voltage-source converter supplied aircraft dc superconducting distribution network with representative propulsion motor loads

Impact of Experimental Hookworm Infection on the Human Gut Microbiota

The interactions between gastrointestinal parasitic helminths and commensal bacteria are likely to play a pivotal role in the establishment of host-parasite cross-talk, ultimately shaping the development of the intestinal immune system. However, little information is available on the impact of infections by gastrointestinal helminths on the bacterial communities inhabiting the human gut. We used 16S rRNA gene amplification and pyrosequencing to characterize, for the first time to our knowledge, the differences in composition and relative abundance of fecal microbial communities in human subjects prior to and following experimental infection with the blood-feeding intestinal hookworm, Necator americanus. Our data show that, although hookworm infection leads to a minor increase in microbial species richness, no detectable effect is observed on community structure, diversity or relative abundance of individual bacterial species

The Effect of wake Turbulence Intensity on Transition in a Compressor Cascade

Direct numerical simulations of separating flow along a section at midspan of a low-pressure V103 compressor cascade with periodically incoming wakes were performed. By varying the strength of the wake, its influence on both boundary layer separation and bypass transition were examined. Due to the presence of small-scale three-dimensional fluctuations in the wakes, the flow along the pressure surface undergoes bypass transition. Only in the weak-wake case, the boundary layer reaches a nearly-separated state between impinging wakes. In all simulations, the flow along the suction surface was found to separate. In the simulation with the strong wakes, separation is intermittently suppressed as the periodically passing wakes managed to trigger turbulent spots upstream of the location of separation. As these turbulent spots convect downstream, they locally suppress separation. © 2014 Springer Science+Business Media Dordrecht