Does bariatric surgery improve adipose tissue function?

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/134250/1/obr12429_am.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/134250/2/obr12429.pd

Standardising practices improves ambulatory diabetic foot management and reduces amputations: the Queensland Diabetic Foot Innovation Project, 2006 – 2009

Background Diabetic foot complications are recognised as the most common reason for diabetic related hospitalisation and lower extremity amputations. Multi-faceted strategies to reduce diabetic foot hospitalisation and amputation rates have been successful. However, most diabetic foot ulcers are managed in ambulatory settings where data availability is poor and studies limited. The project aimed to develop and evaluate strategies to improve the management of diabetic foot complications in three diverse ambulatory settings and measure the subsequent impact on ospitalisation and amputation. Methods Multifaceted strategies were implemented in 2008, including: multi-disciplinary teams, clinical pathways and training, clinical indicators, telehealth support and surveys. A retrospective audit of consecutive patient records from July 2006 – June 2007 determined baseline clinical indicators (n = 101). A clinical pathway teleform was implemented as a clinical record and clinical indicator analyser in all sites in 2008 (n = 327) and followed up in 2009 (n = 406). Results Prior to the intervention, clinical pathways were not used and multi-disciplinary teams were limited. There was an absolute improvement in treating according to risk of 15% in 2009 and surveillance of the high risk population of 34% and 19% in 2008 and 2009 respectively (p 92% in perfusion, ulcer depth, infection assessment and management, offloading and education. Hospitalisation impacts recorded reductions of up to 64% in amputation rates / 100,000 population (p < 0.001) and 24% average length of stay (p < 0.001) Conclusion These findings support the use of multi-faceted strategies in diverse ambulatory services to standardise practice, improve diabetic foot complications management and positively impact on hospitalisation outcomes. As of October 2010, these strategies had been rolled out to over 25 ambulatory sites, representing 66% of Queensland Health districts, managing 1,820 patients and 13,380 occasions of service, including 543 healed ulcer patients. It is expected that this number will rise dramatically as an incentive payment for the use of the teleform is expanded

Effects of salt water on the ballistic protective performance of bullet-resistant body armour

Bullet-resistant body armour is used by law enforcement agencies and military personnel worldwide, often in inclement weather. Some fibre types used in body armour perform poorly when wet, resulting in a reduced level of protection; this is why most body armour protective elements are water-repellent treated and/or protected by a water-resistant cover. Some of the users operate in the maritime environment. The effect of salt water on body armour performance has not been previously reported. In this work the effect of soaking body armour in salt water and exposing body armour for up to 10 soaking and drying cycles in salt water was investigated. The effectiveness of the water-resistant cover was investigated by considering three cover conditions: (i) intact, (ii) cut and (iii) removed. Wet armour was heavier and provided significantly less protection from 9 mm Luger FMJ ammunition when compared to not-exposed armour irrespective of cover condition. A degradation in performance of armours exposed to soaking and drying cycles was noted, but this was similar across all regimes considered (one, three, five and ten cycles) and not as great as for wet armours

Increased Risk of Chronic Wasting Disease in Rocky Mountain Elk Associated With Decreased Magnesium and Increased Manganese in Brain Tissue

Chronic wasting disease (CWD) is a transmissible spongiform encephalopathy (TSE) of Rocky Mountain elk in North America. Recent studies suggest that tissue and blood mineral levels may be valuable in assessing TSE infection in sheep and cattle. The objectives of this study were to examine baseline levels of copper, manganese, magnesium, zinc, selenium, and molybdenum in the brains of Rocky Mountain elk with differing prion genotypes and to assess the association of mineral levels with CWD infection. Elk with leucine at prion position 132 had significantly lower magnesium levels than elk with 2 copies of methionine. Chronic wasting disease-positive elk had significantly lower magnesium than control elk. The incorporation of manganese levels in addition to magnesium significantly refined explanatory ability, even though manganese alone was not significantly associated with CWD. This study demonstrated that mineral analysis may provide an additional disease correlate for assessing CWD risk, particularly in conjunction with genotype

Wavelet Based Fractal Analysis of Airborne Pollen

The most abundant biological particles in the atmosphere are pollen grains and spores. Self protection of pollen allergy is possible through the information of future pollen contents in the air. In spite of the importance of airborne pol len concentration forecasting, it has not been possible to predict the pollen concentrations with great accuracy, and about 25% of the daily pollen forecasts have resulted in failures. Previous analysis of the dynamic characteristics of atmospheric pollen time series indicate that the system can be described by a low dimensional chaotic map. We apply the wavelet transform to study the multifractal characteristics of an a irborne pollen time series. We find the persistence behaviour associated to low pollen concentration values and to the most rare events of highest pollen co ncentration values. The information and the correlation dimensions correspond to a chaotic system showing loss of information with time evolution.Comment: 11 pages, 7 figure

Casting Light Upon The Great Endarkenment

While the Enlightenment promoted thinking for oneself independent of religious authority, the ‘Endarkenment’ (Millgram 2015) concerns deference to a new authority: the specialist, a hyperspecializer. Non-specialists need to defer to such authorities as they are unable to understand their reasoning. Millgram describes how humans are capable of being serial hyperspecializers, able to move from one specialism to another. We support the basic thrust of Millgram’s position, and seek to articulate how the core idea is deployed in very different ways in relation to extremely different philosophical areas. We attend to the issue of the degree of isolation of different specialists and we urge greater emphasis on parallel hyperspecialization, which describes how different specialisms can be embodied in one person at one time

Cough-generated aerosols of Pseudomonas aeruginosa and other Gram-negative bacteria from patients with cystic fibrosis

Background: Pseudomonas aeruginosa is the most common bacterial pathogen in cystic fibrosis (CF) patients. Current infection control guidelines aim to prevent transmission via contact and respiratory droplet routes and do not consider the possibility of airborne transmission. We hypothesized that with coughing, CF subjects produce viable, respirable bacterial aerosols. Methods: Cross-sectional study of 15 children and 13 adults with CF, 26 chronically infected with P. aeruginosa. A cough aerosol sampling system enabled fractioning of respiratory particles of different size, and culture of viable Gram negative non-fermentative bacteria. We collected cough aerosols during 5 minutes voluntary coughing and during a sputum induction procedure when tolerated. Standardized quantitative culture and genotyping techniques were used. Results: P. aeruginosa was isolated in cough aerosols of 25 (89%) subjects of whom 22 produced sputum samples. P. aeruginosa from sputum and paired cough aerosols were indistinguishable by molecular typing. In 4 cases the same genotype was isolated from ambient room air. Approximately 70% of viable aerosols collected during voluntary coughing were of particles ≤ 3.3 microns aerodynamic diameter. P. aeruginosa, Burkholderia cenocepacia Stenotrophomonas maltophilia and Achromobacter xylosoxidans were cultivated from respiratory particles in this size range. Positive room air samples were associated with high total counts in cough aerosols (P=0.003). The magnitude of cough aerosols were associated with higher FEV1 (r=0.45, P=0.02) and higher quantitative sputum culture results (r=0.58, P=0.008). Conclusion: During coughing, CF patients produce viable aerosols of P. aeruginosa and other Gram negative bacteria of respirable size range, suggesting the potential for airborne transmission

Computational Method for Phase Space Transport with Applications to Lobe Dynamics and Rate of Escape

Lobe dynamics and escape from a potential well are general frameworks introduced to study phase space transport in chaotic dynamical systems. While the former approach studies how regions of phase space are transported by reducing the flow to a two-dimensional map, the latter approach studies the phase space structures that lead to critical events by crossing periodic orbit around saddles. Both of these frameworks require computation with curves represented by millions of points-computing intersection points between these curves and area bounded by the segments of these curves-for quantifying the transport and escape rate. We present a theory for computing these intersection points and the area bounded between the segments of these curves based on a classification of the intersection points using equivalence class. We also present an alternate theory for curves with nontransverse intersections and a method to increase the density of points on the curves for locating the intersection points accurately.The numerical implementation of the theory presented herein is available as an open source software called Lober. We used this package to demonstrate the application of the theory to lobe dynamics that arises in fluid mechanics, and rate of escape from a potential well that arises in ship dynamics.Comment: 33 pages, 17 figure