Tailored Pre-Operative Antibiotic Prophylaxis to Prevent Post-Operative Surgical Site Infections in General Surgery

The average American today undergoes three inpatient and two outpatient surgical procedures during one’s life, each of which carries with it a risk of post-operative infection. It has long been known that post-operative infections cause significant morbidity in the immediate peri-operative period, but recent evidence suggests that they can have long-term consequences as well, increasing a patient’s risk of infectious complications in unrelated surgeries performed months or even years later. While there are several theories on the origin of this association, including bacterial colonization of a post-operative infectious wound site, antimicrobial resistance from curative courses of antibiotics, subclinical immunosuppression, or the creation of an inflammatory “pathobiome” following an infectious insult, it is ultimately still unclear why patients who experience a single post-operative infection seem to be at a significantly higher risk of experiencing subsequent ones. Regardless, this association has significant implications for the routine use of pre-operative antibiotic prophylaxis. Indeed, while the prescription of antibiotics pre-operatively has dramatically reduced the rate of post-operative infections, the chosen prophylaxis regimens are typically standardized according to national guidelines, are facing increasing antimicrobial resistance patterns, and have been unable to reduce the risk of post-operative infection to acceptably low levels for certain surgeries. As a result, some clinicians have speculated that tailoring pre-operative antibiotic prophylaxis according to a patient’s prior infectious and operative history could improve efficacy and further reduce the rate of post-operative infections. The purpose of this review is to describe the evidence for the link between multiple post-operative infections and explore the efficacy of individualized pre-operative prophylaxis

Infliximab Does Not Promote the Presence of Collagenolytic Bacteria in a Mouse Model of Colorectal Anastomosis

BACKGROUND: Previous work from our group has suggested a pivotal role for collagenolytic bacteria in the development of anastomotic complications. Tumor necrosis factor antagonists are a mainstay of treatment for patients with inflammatory bowel disease. The reported impact of these agents on key surgical outcomes such as anastomotic leak has been inconsistent. The objective of this study is to assess the impact of infliximab on the anastomotic microbiome in a mouse model of colon resection. DESIGN: BALB/c mice underwent colon resection with primary anastomosis. Mice were randomly assigned to receive either an intraperitoneal dose of saline (control) or 10 mg/kg of infliximab for 8 weeks prior to surgery. On postoperative day 7, the animals were sacrificed. Anastomotic tissues were analyzed by histology with TUNNEL staining as a marker of epithelial apoptosis. In order to assess compositional and functional changes of the local microbiome, anastomotic tissues were further analyzed by 16S rRNA V4 region sequencing and for the presence of collagenolytic strains that may impair anastomotic healing. The main outcome measures were microbiome community structure and the presence of collagenolytic bacteria. RESULTS: Infliximab-treated mice demonstrated an increase in epithelial apoptosis, consistent with the expected drug effect. Although infliximab modified the perianastomotic microbiome, no increase in the presence of collagenolytic bacteria was observed. CONCLUSIONS: Infliximab did not promote the emergence of collagenolytic bacteria or demonstrably impair anastomotic healing in a mouse model of colon resection and anastomosis

‘One door closes, a next door opens up somewhere’: The learning of one Olympic synchronised swimmer

Although training in sport is necessary to reach Olympic status, a conditioned body is not the only outcome. Athletes also learn how to be Olympians. This learning involves taking on certain ways of acting, thinking and valuing. Such learning has implications beyond competition, as athletes eventually retire from elite sport and devote their time to other activities. This paper examines processes of learning and transition using the case of Amelia, a former Olympic synchronised swimmer. Through two in-depth interviews, empirical material was generated which focused on the learning that took place during this athlete’s career and after, during her transition to paid employment. A cultural view of learning was used as the theoretical frame to understand the athlete’s experiences. Our reading suggests that the athlete learned in various ways to be productive. Some of these ways of being were useful after retirement; others were less compatible. In fact, Amelia used a two-year period after retirement to reconstruct herself. Key to her eventual successful transition was to distance herself from the sport and to critically reflect upon her sporting experiences. We thus recommend that those involved with high-performance athletes foster a more balanced perspective that acknowledges and promotes ways of being beyond athletic involvement

Criticality Analysis of Activity Networks under Interval Uncertainty

Dedicated to the memory of Professor Stefan Chanas - The extended abstract version of this paper has appeared in Proceedings of 11th International Conference on Principles and Practice of Constraint Programming (CP2005) ("Interval Analysis in Scheduling", Fortin et al. 2005)International audienceThis paper reconsiders the Project Evaluation and Review Technique (PERT) scheduling problem when information about task duration is incomplete. We model uncertainty on task durations by intervals. With this problem formulation, our goal is to assert possible and necessary criticality of the different tasks and to compute their possible earliest starting dates, latest starting dates, and floats. This paper combines various results and provides a complete solution to the problem. We present the complexity results of all considered subproblems and efficient algorithms to solve them

Examining the construction of identity among high performance male and female athletes using photography

This study, adopting a feminist perspective explored two research questions: (1) how do male and female athletes perform an athletic identity through photographic self-representation, and (2) what are the messages they look to convey, as role models, through these images? Eighteen culturally diverse high-performance athletes (12 female, 6 male; mean age = 20.56 years, SD = 2.83) representing a range of sports took part. Following an individual photo session with autonomy over image capture, participants selected their favoured image and provided a caption symbolising the message they wished to convey to others. Participants were then interviewed to obtain their thoughts, feelings and stories with regards image capture and selection. Analysis of photographic data revealed a tendency for participants to select full body action shots, located in the field of play and wearing sports clothing. Captions emphasised hard work, psychological assets, technical precision and encouraged sports participation. Interview data were organised under two broad themes aligned with the research questions; ‘performing an athletic identity’ and ‘intended messages’. Participants typically wanted to appear in action shots, emphasising good technique, displaying a sporting physique and in relevant uniforms. Intended messages reflected how to be a good role model and comprised of ideals of hard work and giving sport a go. Findings suggest that whilst athletes sought to champion their sport and the physical and psychological qualities that participation produces, gendered performances were also evident in production and interpretation of many images, thus highlighting the pervasive nature of gendered sporting participatio