Methods for identifying surgical wound infection after discharge from hospital: a systematic review.

Background: Wound infections are a common complication of surgery that add significantly to the morbidity of patients and costs of treatment. The global trend towards reducing length of hospital stay post-surgery and the increase in day case surgery means that surgical site infections (SSI) will increasingly occur after hospital discharge. Surveillance of SSIs is important because rates of SSI are viewed as a measure of hospital performance, however accurate detection of SSIs post-hospital discharge is not straightforward. Methods: We conducted a systematic review of methods of post discharge surveillance for surgical wound infection and undertook a national audit of methods of post-discharge surveillance for surgical site infection currently used within United Kingdom NHS Trusts. Results: Seven reports of six comparative studies which examined the validity of post-discharge surveillance methods were located; these involved different comparisons and some had methodological limitations, making it difficult to identify an optimal method. Several studies evaluated automated screening of electronic records and found this to be a useful strategy for the identification of SSIs that occurred post discharge. The audit identified a wide range of relevant post-discharge surveillance programmes in England, Scotland and Wales and Northern Ireland; however, these programmes used varying approaches for which there is little supporting evidence of validity and/or reliability. Conclusion: In order to establish robust methods of surveillance for those surgical site infections that occur post discharge, there is a need to develop a method of case ascertainment that is valid and reliable post discharge. Existing research has not identified a valid and reliable method. A standardised definition of wound infection ( e. g. that of the Centres for Disease Control) should be used as a basis for developing a feasible, valid and reliable approach to defining post discharge SSI. At a local level, the method used to ascertain post discharge SSI will depend upon the purpose of the surveillance, the nature of available routine data and the resources available

Automated methods for surveillance of surgical site infections.

Automated data, especially from pharmacy and administrative claims, are available for much of the U.S. population and might substantially improve both inpatient and postdischarge surveillance for surgical site infections complicating selected procedures, while reducing the resources required. Potential improvements include better sensitivity, less susceptibility to interobserver variation, more uniform availability of data, more precise estimates of infection rates, and better adjustment for patients' coexisting illness

Epidemiology of and surveillance for postpartum infections.

We screened automated ambulatory medical records, hospital and emergency room claims, and pharmacy records of 2,826 health maintenance organization (HMO) members who gave birth over a 30-month period. Full-text ambulatory records were reviewed for the 30-day postpartum period to confirm infection status for a weighted sample of cases. The overall postpartum infection rate was 6.0%, with rates of 7.4% following cesarean section and 5.5% following vaginal delivery. Rehospitalization; cesarean delivery; antistaphylococcal antibiotics; diagnosis codes for mastitis, endometritis, and wound infection; and ambulatory blood or wound cultures were important predictors of infection. Use of automated information routinely collected by HMOs and insurers allows efficient identification of postpartum infections not detected by conventional surveillance

Coherent States for Particle Beams in the Thermal Wave Model

In this paper, by using an analogy among {\it quantum mechanics}, {\it electromagnetic beam optics in optical fibers}, and {\it charge particle beam dynamics}, we introduce the concept of {\it coherent states} for charged particle beams in the framework of the {\it Thermal Wave Model} (TWM). We give a physical meaning of the Gaussian-like coherent structures of charged particle distribution that are both naturally and artificially produced in an accelerating machine in terms of the concept of coherent states widely used in quantum mechanics and in quantum optics. According to TWM, this can be done by using a Schr\"{o}dinger-like equation for a complex function, the so-called {\it beam wave function} (BWF), whose squared modulus is proportional to the transverse beam density profile, where Planck's constant and the time are replaced by the transverse beam emittance and by the propagation coordinate, respectively. The evolution of the particle beam, whose initial BWF is assumed to be the simplest coherent state (ground-like state) associated with the beam, in an infinite 1-D quadrupole-like device with small sextupole and octupole aberrations, is analytically and numerically investigated.Comment: 21 pages, Late

Mediating boundaries between knowledge and knowing: ICT and R4D praxis

Research for development (R4D) praxis (theory-informed practical action) can be underpinned by the use of Information and Communication Technologies (ICTs) which, it is claimed, provide opportunities for knowledge working and sharing. Such a framing implicitly or explicitly constructs a boundary around knowledge as reified, or commodified – or at least able to be stabilized for a period of time (first order knowledge). In contrast ‘third-generation knowledge’ emphasizes the social nature of learning and knowledge-making; this reframes knowledge as a negotiated social practice, thus constructing a different system boundary. This paper offers critical reflections on the use of a wiki as a data repository and mediating technical platform as part of innovating in R4D praxis. A sustainable social learning process was sought that fostered an emergent community of practice among biophysical and social researchers acting for the first time as R4D co-researchers. Over time the technologically mediated element of the learning system was judged to have failed. This inquiry asks: How can learning system design cultivate learning opportunities and respond to learning challenges in an online environment to support R4D practice? Confining critical reflection to the online learning experience alone ignores the wider context in which knowledge work took place; therefore the institutional setting is also considered

Stretching the spines of gymnasts: a review

Gymnastics is noted for involving highly specialized strength, power, agility and flexibility. Flexibility is perhaps the single greatest discriminator of gymnastics from other sports. The extreme ranges of motion achieved by gymnasts require long periods of training, often occupying more than a decade. Gymnasts also start training at an early age (particularly female gymnasts), and the effect of gymnastics training on these young athletes is poorly understood. One of the concerns of many gymnastics professionals is the training of the spine in hyperextension-the ubiquitous 'arch' seen in many gymnastics positions and movements. Training in spine hyperextension usually begins in early childhood through performance of a skill known as a back-bend. Does practising a back-bend and other hyperextension exercises harm young gymnasts? Current information on spine stretching among gymnasts indicates that, within reason, spine stretching does not appear to be an unusual threat to gymnasts' health. However, the paucity of information demands that further study be undertaken

From a certain point of view: sensory phenomenological envisionings of running space and place

The precise ways in which we go about the mundane, repetitive, social actions of everyday life are central concerns of ethnographers and theorists working within the traditions of the sociology of the mundane and sociological phenomenology. In this article, we utilize insights derived from sociological phenomenology and the newly developing field of sensory sociology to investigate a particular, mundane, and embodied social practice, that of training for distance running in specific places: our favored running routes. For, despite a growing body of ethnographic studies of particular sports, little analytic attention has been devoted to the actual, concrete practices of “doing” or “producing” sporting activity, particularly from a sensory ethnographic perspective. Drawing upon data from a 2-year joint autoethnographic research project, here we explore the visual dimension, focusing upon three key themes in relation to our runners’ visualization of, respectively, (1) hazardous places, (2) performance places, (3) the time–space–place nexus

Genomic analysis reveals new integrative conjugal elements and transposons in gbs conferring antimicrobial resistance

Streptococcus agalactiae or group B streptococcus (GBS) is a leading cause of neonatal sepsis and increasingly found as an invasive pathogen in older patient populations. Beta-lactam antibiotics remain the most effective therapeutic with resistance rarely reported, while the majority of GBS isolates carry the tetracycline resistance gene tet(M) in fixed genomic positions amongst five predominant clonal clades. In the UK, GBS resistance to clindamycin and erythromycin has increased from 3% in 1991 to 11.9% (clindamycin) and 20.2% (erythromycin), as reported in this study. Here, a systematic investigation of antimicrobial resistance genomic content sought to fully characterise the associated mobile genetic elements within phenotypically resistant GBS isolates from 193 invasive and non-invasive infections of UK adult patients collected during 2014 and 2015. Resistance to erythromycin and clindamycin was mediated by erm(A) (16/193, 8.2%), erm(B) (16/193, 8.2%), mef(A)/msr(D) (10/193, 5.1%), lsa(C) (3/193, 1.5%), lnu(C) (1/193, 0.5%), and erm(T) (1/193, 0.5%) genes. The integrative conjugative elements (ICEs) carrying these genes were occasionally found in combination with high gentamicin resistance mediating genes aac(6′)-aph(2″), aminoglycoside resistance genes (ant(6-Ia), aph(3′-III), and/or aad(E)), alternative tetracycline resistance genes (tet(O) and tet(S)), and/or chloramphenicol resistance gene cat(Q), mediating resistance to multiple classes of antibiotics. This study provides evidence of the retention of previously reported ICESag37 (n = 4), ICESag236 (n = 2), and ICESpy009 (n = 3), as well as the definition of sixteen novel ICEs and three novel transposons within the GBS lineage, with no evidence of horizontal transfer

Relationship of Sedentary Behavior and Physical Activity to Incident Cardiovascular Disease Results From the Women's Health Initiative

ObjectivesThe aim of this study was to examine the independent and joint associations of sitting time and physical activity with risk of incident cardiovascular disease (CVD).BackgroundSedentary behavior is recognized as a distinct construct beyond lack of leisure-time physical activity, but limited data exist on the interrelationship between these 2 components of energy balance.MethodsParticipants in the prospective Women’s Health Initiative Observational Study (n = 71,018), 50 to 79 years of age and free of CVD at baseline (1993 to 1998), provided information on sedentary behavior, defined as hours of sitting/day, and usual physical activity at baseline and during follow-up through September 2010. First CVD (coronary heart disease or stroke) events were centrally adjudicated.ResultsSitting ≥10 h/day compared with ≤5 h/day was associated with increased CVD risk (hazard ratio: 1.18, 95% confidence interval: 1.09 to 1.29) in multivariable models including physical activity. Low physical activity was also associated with higher CVD risk (p for trend < 0.001). When women were cross-classified by sitting time and physical activity (p for interaction = 0.94), CVD risk was highest in inactive women (≤1.7 metabolic equivalent task-h/week) who also reported ≥10 h/day of sitting. Results were similar for coronary heart disease and stroke when examined separately. Associations between prolonged sitting and risk of CVD were stronger in overweight versus normal weight women and women 70 years of age and older compared with younger women.ConclusionsProlonged sitting time was associated with increased CVD risk, independent of leisure-time physical activity, in postmenopausal women without a history of CVD. A combination of low physical activity and prolonged sitting augments CVD risk