Reducing Surgical Site Infections: A Comparison of Surgical Skin Preparations

Surgical site infections are one of the most common healthcare-associated infections among surgical patients. The use of surgical site preparations can prevent this problem. A literature review was conducted to examine the existing studies in an attempt to determine which surgical site preparation yielded the lowest surgical site infection rate postoperatively. The preparations examined in these studies were parachoroxylenol (PCMX), povidone-iodine, combination povidone-iodine and isopropyl alcohol, chlorhexidine gluconate (CHG), chlorhexidine-alcohol, combination povidone-iodine and CHG, and povidone-iodine with industrial methylated spirit. It was concluded that none of these preparations proved to be superior in all surgeries or facilities. Patient allergies, comorbidities, surgical site, surgeon preference, and availability are some factors that affect the types of preparations used. In order to determine which surgical site skin preparation is superior in reducing infection, more studies on these preparations will need to be conducted

A Cephalometric Study of the Maxillofacial Structure in Obstructive Sleep Apnoea

Sleep is essential for life. We spend somewhere between one quarter and one third of our lives sleeping, depending upon our sleep pattern. Sleep is a normal physiological process, and as with all such processes there are some differences between individuals that are simply variations of normal. Likewise sleep may be associated with variations that are deemed to be outside the boundaries of those considered normal and is therefore considered pathologic. The investigation of a known abnormality of sleep, namely Obstructive Sleep Apnoea (OSA) syndrome, forms the basis of this thesis and an understanding of normal sleep physiology is essential prior to considering the alterations in normal sleep architecture exhibited in this condition. Chapter 1 considers the definition of normal sleep, the diagnosis of pathologic sleep and the characteristic alterations in sleep and wakefulness demonstrated in a person suffering from obstructive sleep apnoea. Obstructive Sleep Apnoea syndrome is a medical condition that has been intensively studied by investigators in various fields of medicine and dentistry since being characterized by Guilleminault et al (1976). The classical description of patients with this syndrome was made by Burwell et al (1976). These patients were said to be obese, suffering from hypersomnolence, periodic breathing with hypoventilation and cor pulmonale. Pickwickian syndrome was the term used in 1918 by Sir William Osler when describing patients with a similar clinical presentation. The research into obstructive sleep apnoea syndrome has revealed pathophysiologic alterations in a variety of bodily systems in these people when compared to non-apnoeic people. These pathophysiologic findings are discussed in Chapter 2. Assessment of the upper airway may be performed clinically, endoscopically, radiographically or using other imaging modalities such as magnetic resonance imaging or manometry. The assessment method evaluated in this thesis is lateral cephalometric radiography. In selecting a method of imaging, it is necessary to have a thorough understanding of the anatomy of the region under examination. Chapter 3 of this thesis outlines the pertinent anatomy of the upper airway and an overview of the available methods of imaging is given. Lateral cephalometric assessment of the upper airway is discussed in particular because it was the modality under investigation. Chapter 4 reviews the literature with respect to known errors using this technology. Although only recently used in relation to obstructive sleep apnoea, lateral cephalometric radiographs have long been utilised by orthodontists and oral and maxillofacial surgeons in the diagnosis and treatment planning of people with malocclusion. Despite a large number of studies reported in the literature regarding lateral cephalometric radiographs and OSA direct comparison between studies is often difficult. Many studies purport to measure the same parameters e.g. pharyngeal airway width but use different landmarks. Some studies use control subjects who are age and/or weight matched, other studies use controls not matched for these parameters. Yet other studies use no control subjects at all. Chapter 5 and Chapter 6 of this thesis provide a review of the literature where lateral cephalometric radiographs have been used to assess subjects with obstructive sleep apnoea syndrome. The imaging of the upper airway is obviously no treatment in itself. One of the problems as with many medical conditions, is the cure may not be acceptable to the patients with the condition. In the case of obstructive sleep apnoea syndrome tracheostomy will cure the patient of the upper airway obstruction however at a personal cost not accepted by most patients. The standard treatment for obstructive sleep apnoea syndrome since 1981 has been nasal continuous positive airway pressure ventilation, reported by Sullivan et al (1981). This modality is reported in the literature to be efficacious however compliance remains an issue. Chapter 7 considers the non-surgical treatment modalities that have been and are used in the treatment of obstructive sleep apnoea syndrome. Surgical treatment for obstructive sleep apnoea syndrome, apart from tracheostomy, has been reported in the literature since 1981 when Fujita reported uvulopalatopharyngoplasty as a surgical technique for the treatment of snoring and obstructive sleep apnoea syndrome. Since that time a number of surgical procedures have been reported with varying degrees of success. These surgical modalities reported in the literature are considered in Chapter 8. On the basis of the literature review, several aims were established using material from the Oral and Maxillofacial Surgery unit, The University of Adelaide and the Thoracic Medicine Unit, The Royal Adelaide Hospital. The objectives of the study were to: 1. Acquire cephalometric data on I 00 consecutive patients undergoing a polysomnographic overnight sleep study for investigation of a suspected sleep breathing disorder as assessed by a thoracic medicine physician. 2. Quantify the airway dimensions of this series of patients using measurements previously reported in the literature. 3. Establish whether BMI has any predictive value for OSA. 4. Establish whether neck circumference is related to BMI or the incidence of OSA. 5. Establish whether age or sex has any influence on the incidence of OSA. 6. Compare airway dimensions measured from the lateral cephalometric radiograph and the severity of OSA to determine if any measurement is predictive for the presence of OSA. 7. Compare airway dimensions measured from lateral cephalometric radiograph and quantify any differences between the study population of OSA patients and simple snorers compared with comparable results reported in the literature. 8. Investigate the sources of error in cephalometry and quantify the error associated with the present study. 9. Quantify the error associated with selected cephalometric variables used in this study. 10. Determine if lateral cephalometric radiographs are a useful adjunct to treatment planning for patients with OSA. Chapter 9 and Chapter 10 report the methodology used in order to achieve the aims of the study. Chapter 11 reports the results of this study. The linear and angular variables measured from the lateral cephalometric radiographs was initially assessed with respect to body mass index (BMI) and respiratory disturbance index (RDI). Subjects were then divided upon the basis of RDI into groups of "snorers" and "obstructive sleep apnoeics". Further statistical evaluation was then performed on the groups. To allow comparison with other results from the literature, the division by RDI was performed three times, at an RDI 10, 15 and 20 events per hour. These results are discussed and compared with the findings in the literature in Chapter 12. Chapter 13 summarises the key findings of this thesis and suggests areas of future investigation to further our understanding of the upper airway changes reported in obstructive sleep apnoeic subjects. A glossary of terms is provided at Chapter 14. The Appendix is a copy of the consent and patient information given to participants prior to their enrolment in this study.Thesis (MDS) -- University of Adelaide, Dept. of Oral and Maxillofacial Surgery, 200

Exploring stakeholders\u27 perceptions of the acceptability, usability, and dissemination of the australian 24-hour movement guidelines for the early years

Background: Australian 24-Hour Movement Guidelines for the Early Years were recently developed. To maximize the uptake of the guidelines, perceptions of key stakeholders were sought. Methods: Thirty-five stakeholders (11% Aboriginal or Torres Strait Islander descent) participated in focus groups or key informant interviews. Stakeholders included parents of children aged 0-5 years, early childhood educators, and health and policy professionals, recruited using convenience and snowballing techniques. Focus groups and interviews were audio-recorded and transcribed verbatim. Data were analyzed inductively using thematic analysis. Results: There was general acceptance of the Movement Guidelines. The stakeholders suggested that the Guidelines were highly aspirational and needed to be carefully messaged, so parents did not feel guilty if their child was not meeting them. Stakeholders identified that the messaging needed to be culturally appropriate and visually appealing. Dissemination strategies differed depending on the stakeholder. Conclusion: Seeking stakeholder perceptions is an important process in the development of national Movement Guidelines. This study successfully examined stakeholders\u27 perceptions regarding the acceptability, usability, and dissemination of the Australian 24-Hour Movement Guidelines. Effective and innovative strategies for maximizing compliance and uptake of the Guidelines should be prioritized

[SADE] A Maple package for the Symmetry Analysis of Differential Equations

We present the package SADE (Symmetry Analysis of Differential Equations) for the determination of symmetries and related properties of systems of differential equations. The main methods implemented are: Lie, nonclassical, Lie-B\"acklund and potential symmetries, invariant solutions, first-integrals, N\"other theorem for both discrete and continuous systems, solution of ordinary differential equations, reduction of order or dimension using Lie symmetries, classification of differential equations, Casimir invariants, and the quasi-polynomial formalism for ODE's (previously implemented in the package QPSI by the authors) for the determination of quasi-polynomial first-integrals, Lie symmetries and invariant surfaces. Examples of use of the package are given

Congenital Syringocystadenoma Papilliferum

O siringocistoadenoma papílifero é uma neoplasia anexial benigna incomum, que se localiza preferencialmente no couro cabeludo e face, e está associado ao nevo sebáceo em 40% dos casos. Embora rara, a transição para carcinoma basocelular e carcinoma ductal pode ocorrer. Os autores descrevem o caso de um paciente do sexo masculino, de 7 anos de idade, com dermatose papulosa linear do pescoço desde o nascimento. Apresentava, no exame dermatológico, pápulas eritematosas, crateriformes, confluentes, dispostas em faixa, de 3 x 2 cm na região cervical. Foi realizada a exérese da lesão e o exame histopatológico demonstrou invaginação cística epidérmica e projeções papilares revestidas por epitélio glandular, com secreção de decapitação e infiltrado linfo-plasmocitário abundante. Os achados clínicos e histológicos foram compatíveis com o diagnóstico de siringocistoadenoma papílifero. Apesar da variabilidade clínica desta entidade, a histopatologia é característica e o tratamento consiste na exérese da lesão.Papillary syringocystoadenoma is an uncommon benign adnexal neoplasm, which is preferentially located on the scalp and face, and is associated with sebaceous nevus in 40% of cases. Although rare, its transition to basal cell carcinoma and ductal carcinoma may occur. The authors describe the case of a 7-year-old male patient with a linear papular dermatosis in the neck from birth. Dermatological examination showed erythematous, crateriform, confluent papules, arranged in a band, 3 x 2 cm in the cervical region. The lesion was excised for therapeutic and diagnostic purposes. Histopathology demonstrated epidermal cystic invagination and papillary projections surface by glandular epithelium, with decapitation secretion and abundant lymphoplasmocytic infiltrate. The clinical and histological findings were compatible with the diagnosis of papillary syringocystoadenoma. Despite the clinical variability of this entity, the histopathology is characteristic and the treatment consists in the excision of the lesion

Xantogranuloma Juvenil Cutâneo Disseminado: Relato de Caso

Juvenile xanthogranuloma (JXG) is a benign self-limiting histiocytosis, currently classified as a disorder derived from dendrocytes and previously classified as non-Langerhans cell histiocytosis. It usually manifests as a solitary and asymptomatic lesion occurring most often in patients younger than one year of age and most cases resolve completely in three to six years, but systemic involvement may occur. The authors report a case of juvenile xanthogranuloma with an uncommon clinical presentation with disseminated lesions confirmed by the dermatoscopic, histopathologic, and immunohistochemical patterns that allowed the exclusion of possible differential diagnosis.O xantogranuloma juvenil (XGJ) é uma histiocitose de caráter benigno e autolimitado atualmente classificada como desordem de comportamento biológico variável derivada dos dendrócitos e anteriormente classificada como histiocitose de células não Langerhans. Em geral manifesta-se como uma lesão solitária e assintomática que ocorre na maioria das vezes em pacientes menores de um ano de idade com resolução em três a seis anos, mas o envolvimento sistêmico pode ocorrer. Os autores relatam um caso com apresentação clínica incomum com lesões disseminadas por todo o tegumento compatíveis com xantogranuloma juvenil confirmadas por meio dos padrões dermatoscópico, histopatológico e imunohistoquímico, que permitiram a exclusão de possíveis diagnósticos diferenciais

Longitudinal cohort study investigating neurodevelopmental and socioemotional outcomes in school-entry aged children after open heart surgery in Australia and New Zealand: the NITRIC follow-up study protocol

Introduction: Despite growing awareness of neurodevelopmental impairments in children with congenital heart disease (CHD), there is a lack of large, longitudinal, population-based cohorts. Little is known about the contemporary neurodevelopmental profile and the emergence of specific impairments in children with CHD entering school. The performance of standardised screening tools to predict neurodevelopmental outcomes at school age in this high-risk population remains poorly understood. The NITric oxide during cardiopulmonary bypass to improve Recovery in Infants with Congenital heart defects (NITRIC) trial randomised 1371 children <2 years of age, investigating the effect of gaseous nitric oxide applied into the cardiopulmonary bypass oxygenator during heart surgery. The NITRIC follow-up study will follow this cohort annually until 5 years of age to assess outcomes related to cognition and socioemotional behaviour at school entry, identify risk factors for adverse outcomes and evaluate the performance of screening tools. Methods and analysis: Approximately 1150 children from the NITRIC trial across five sites in Australia and New Zealand will be eligible. Follow-up assessments will occur in two stages: (1) annual online screening of global neurodevelopment, socioemotional and executive functioning, health-related quality of life and parenting stress at ages 2–5 years; and (2) face-to-face assessment at age 5 years assessing intellectual ability, attention, memory and processing speed; fine motor skills; language and communication; and socioemotional outcomes. Cognitive and socioemotional outcomes and trajectories of neurodevelopment will be described and demographic, clinical, genetic and environmental predictors of these outcomes will be explored. Ethics and dissemination: Ethical approval has been obtained from the Children’s Health Queensland (HREC/20/QCHQ/70626) and New Zealand Health and Disability (21/NTA/83) Research Ethics Committees. The findings will inform the development of clinical decision tools and improve preventative and intervention strategies in children with CHD. Dissemination of the outcomes of the study is expected via publications in peer-reviewed journals, presentation at conferences, via social media, podcast presentations and medical education resources, and through CHD family partners.Trial registration numberThe trial was prospectively registered with the Australian New Zealand Clinical Trials Registry as ‘Gene Expression to Predict Long-Term Neurodevelopmental Outcome in Infants from the NITric oxide during cardiopulmonary bypass to improve Recovery in Infants with Congenital heart defects (NITRIC) Study – A Multicentre Prospective Trial’. Trial registration: ACTRN12621000904875

Development of a Quantitative Bead Capture Assay for Soluble IL-7 Receptor Alpha in Human Plasma

IL-7 is an essential cytokine in T-cell development and homeostasis. It binds to the IL-7R receptor, a complex of the IL-7Rα (CD127) and common γ (CD132) chains. There is significant interest in evaluating the expression of CD127 on human T-cells as it often decreased in medical conditions leading to lymphopenia. Previous reports showed the usefulness of CD127 as a prognostic marker in viral infections such as HIV, CMV, EBV and HCV. A soluble CD127 (sCD127) is released in plasma and may contribute to disease pathogenesis through its control on IL-7 activities. Measuring sCD127 is important to define its role and may complement existing markers used in lymphopenic disease management. We describe a new quantitative assay for the measurement of sCD127 in plasma and report sCD127 concentrations in healthy adults.We developed a quantitative bead-based sCD127 capture assay. Polyclonal CD127-specific antibodies were chosen for capture and a biotinylated monoclonal anti-CD127 antibody was selected for detection. The assay can detect native sCD127 and recombinant sCD127 which served as the calibrator. The analytical performance of the assay was characterized and the concentration and stability of plasma sCD127 in healthy adults was determined. The assay's range was 3.2–1000 ng/mL. The concentration of plasma sCD127 was 164±104 ng/mL with over a log variation between subjects. Individual sCD127 concentrations remained stable when measured serially during a period of up to one year.This is the first report on the quantification of plasma sCD127 in a population of healthy adults. Soluble CD127 plasma concentrations remained stable over time in a given individual and sCD127 immunoreactivity was resistant to repeated freeze-thaw cycles. This quantitative sCD127 assay is a valuable tool for defining the potential role of sCD127 in lymphopenic diseases

Atopic Eczema Simulating Mammary Paget’s Disease in an Adult: Case Report

An atopic breast eczema is usually bilateral, with intense pruritus and good response to corticosteroids. The differential diagnosis with mammary Paget’s disease is fundamental, mainly in unilateral clinical manifestations, since it is frequently associated to adjacent breast tumors. The aim of the present report was to present a clinical condition of an atopic breast eczema through an exuberant and unilateral clinical presentation, emphasizing the need of the differential diagnosis for malignant diseases at this location