The use of small Bloodstains in Blood Source Area of Origin Determinations

Due to the increased likelihood of manual measurement error, small bloodstains (≤ 3.0mm long) have rarely been used in three-dimensional blood source area of origin determinations. The advent of computer assisted measurement methods, offering improved levels of accuracy and precision, broadens the range of bloodstain sizes available for selection to determine a blood source area of origin. With inertia, viscosity and surface tension playing important, yet competing, roles in bloodstain formation, the power law relationships that exist between droplet volumes, droplet diameter, and bloodstain width suggest possible non-agreement between experimentally calculated angle of impact values when compared against those values theoretically expected. In order to compare experimental angle of impact calculation trends with angle of impact calculation theory, this preliminary study examines small bloodstains created by blood drops falling vertically onto surfaces offset from the vertical and small bloodstains generated by impact events subsequently deposited on adjacent vertical surfaces. This study shows that an apparent power law relationship may exist between the size of a parent blood droplet and the role of viscous and surface tension forces on subsequent bloodstain formation, particularly on those bloodstains caused by small droplets impacting obliquely with planar surfaces

Deterrent activities in the crude lipophilic fractions of Antarctic benthic organisms: chemical defences against keystone predators

Generalist predation constitutes a driving force for the evolution of chemical defences. In the Antarctic benthos, asteroids and omnivore amphipods are keystone opportunistic predators. Sessile organisms are therefore expected to develop defensive mechanisms mainly against such consumers. However, the different habits characterizing each predator may promote variable responses in prey. Feeding-deterrence experiments were performed with the circumpolar asteroid macropredator Odontaster validus to evaluate the presence of defences within the apolar lipophilic fraction of Antarctic invertebrates and macroalgae. A total of 51% of the extracts were repellent, yielding a proportion of 17 defended species out of the 31 assessed. These results are compared with a previous study in which the same fractions were offered to the abundant circum-Antarctic amphipod Cheirimedon femoratus. Overall, less deterrence was reported towards asteroids (51%) than against amphipods (80.8%), principally in sponge and algal extracts. Generalist amphipods, which establish casual host–prey sedentary associations with biosubstrata (preferentially sponges and macroalgae), may exert more localized predation pressure than sea stars on certain sessile prey, which would partly explain these results. The nutritional quality of prey may interact with feeding deterrents, whose production is presumed to be metabolically expensive. Although optimal defence theory posits that chemical defences are managed and distributed as to guarantee protection at the lowest cost, we found that only a few organisms localized feeding deterrents towards most exposed and/or valuable body regions. Lipophilic defensive metabolites are broadly produced in Antarctic communities to deter opportunistic predators, although several species combine different defensive traits

Surgical site infection after gastrointestinal surgery in children: An international, multicentre, prospective cohort study

Introduction Surgical site infection (SSI) is one of the most common healthcare-associated infections (HAIs). However, there is a lack of data available about SSI in children worldwide, especially from low-income and middle-income countries. This study aimed to estimate the incidence of SSI in children and associations between SSI and morbidity across human development settings. Methods A multicentre, international, prospective, validated cohort study of children aged under 16 years undergoing clean-contaminated, contaminated or dirty gastrointestinal surgery. Any hospital in the world providing paediatric surgery was eligible to contribute data between January and July 2016. The primary outcome was the incidence of SSI by 30 days. Relationships between explanatory variables and SSI were examined using multilevel logistic regression. Countries were stratified into high development, middle development and low development groups using the United Nations Human Development Index (HDI). Results Of 1159 children across 181 hospitals in 51 countries, 523 (45·1%) children were from high HDI, 397 (34·2%) from middle HDI and 239 (20·6%) from low HDI countries. The 30-day SSI rate was 6.3% (33/523) in high HDI, 12·8% (51/397) in middle HDI and 24·7% (59/239) in low HDI countries. SSI was associated with higher incidence of 30-day mortality, intervention, organ-space infection and other HAIs, with the highest rates seen in low HDI countries. Median length of stay in patients who had an SSI was longer (7.0 days), compared with 3.0 days in patients who did not have an SSI. Use of laparoscopy was associated with significantly lower SSI rates, even after accounting for HDI. Conclusion The odds of SSI in children is nearly four times greater in low HDI compared with high HDI countries. Policies to reduce SSI should be prioritised as part of the wider global agenda

Safety of hospital discharge before return of bowel function after elective colorectal surgery

Background: Ileus is common after colorectal surgery and is associated with an increased risk of postoperative complications. Identifying features of normal bowel recovery and the appropriateness for hospital discharge is challenging. This study explored the safety of hospital discharge before the return of bowel function. Methods: A prospective, multicentre cohort study was undertaken across an international collaborative network. Adult patients undergoing elective colorectal resection between January and April 2018 were included. The main outcome of interest was readmission to hospital within 30 days of surgery. The impact of discharge timing according to the return of bowel function was explored using multivariable regression analysis. Other outcomes were postoperative complications within 30 days of surgery, measured using the Clavien\u2013Dindo classification system. Results: A total of 3288 patients were included in the analysis, of whom 301 (9\ub72 per cent) were discharged before the return of bowel function. The median duration of hospital stay for patients discharged before and after return of bowel function was 5 (i.q.r. 4\u20137) and 7 (6\u20138) days respectively (P < 0\ub7001). There were no significant differences in rates of readmission between these groups (6\ub76 versus 8\ub70 per cent; P = 0\ub7499), and this remained the case after multivariable adjustment for baseline differences (odds ratio 0\ub790, 95 per cent c.i. 0\ub755 to 1\ub746; P = 0\ub7659). Rates of postoperative complications were also similar in those discharged before versus after return of bowel function (minor: 34\ub77 versus 39\ub75 per cent; major 3\ub73 versus 3\ub74 per cent; P = 0\ub7110). Conclusion: Discharge before return of bowel function after elective colorectal surgery appears to be safe in appropriately selected patients

Safety and efficacy of non-steroidal anti-inflammatory drugs to reduce ileus after colorectal surgery

Background: Ileus is common after elective colorectal surgery, and is associated with increased adverse events and prolonged hospital stay. The aim was to assess the role of non-steroidal anti-inflammatory drugs (NSAIDs) for reducing ileus after surgery. Methods: A prospective multicentre cohort study was delivered by an international, student- and trainee-led collaborative group. Adult patients undergoing elective colorectal resection between January and April 2018 were included. The primary outcome was time to gastrointestinal recovery, measured using a composite measure of bowel function and tolerance to oral intake. The impact of NSAIDs was explored using Cox regression analyses, including the results of a centre-specific survey of compliance to enhanced recovery principles. Secondary safety outcomes included anastomotic leak rate and acute kidney injury. Results: A total of 4164 patients were included, with a median age of 68 (i.q.r. 57\u201375) years (54\ub79 per cent men). Some 1153 (27\ub77 per cent) received NSAIDs on postoperative days 1\u20133, of whom 1061 (92\ub70 per cent) received non-selective cyclo-oxygenase inhibitors. After adjustment for baseline differences, the mean time to gastrointestinal recovery did not differ significantly between patients who received NSAIDs and those who did not (4\ub76 versus 4\ub78 days; hazard ratio 1\ub704, 95 per cent c.i. 0\ub796 to 1\ub712; P = 0\ub7360). There were no significant differences in anastomotic leak rate (5\ub74 versus 4\ub76 per cent; P = 0\ub7349) or acute kidney injury (14\ub73 versus 13\ub78 per cent; P = 0\ub7666) between the groups. Significantly fewer patients receiving NSAIDs required strong opioid analgesia (35\ub73 versus 56\ub77 per cent; P < 0\ub7001). Conclusion: NSAIDs did not reduce the time for gastrointestinal recovery after colorectal surgery, but they were safe and associated with reduced postoperative opioid requirement