Surgical Site Infection following Emergency Caesarean Section – incidence and associated risk factors

Aim: The aims of this study were to 1) quantify the incidence of Surgical Site Infection (SSI) in patients who have had an emergency Caesarean Section (CS); 2) identify the risk factors and associated factors that play a major role in the development of those SSI’s. Methods: A retrospective cohort study with data collected from Mid Yorkshire Trust Pinderfields General Hospital, Wakefield. The study sample consisted of 206 patients (101 SSI patients and 105 non-SSI patients) who had emergency CSs carried out between January and December 2017. Simple logistic regression and multiple logistic regression were then carried out to determine any significant risk factors. Results: From the period between January and December 2017 there were 105 SSIs for patients who had undergone an emergency CS. Patient BMI (kg/m2) was a statistically significant predictor at the 5% significance level for SSI occurrence (p<0.001). The odds ratio of 1.17 indicated that a unit change in BMI was associated with raised odds of SSI of 17%. Other risk factors including: patient age had a P value of 0.102 and O.R. 1.05, Recoded diabetes status had a P value of 0.142 and O.R. 2.10 and Pre-operative vaginal swab taken had a P value of 0.114 and O.R. 0.594 making them all non-significant risk factors. Conclusion: This study was carried in order to help add knowledge to an area currently lacking it, as at the time of writing there are no studies that have investigated SSI and its associated risk factors for emergency CS. Advances in this area of study would allow for the improving of guidelines and thus patient care, giving medical professionals the information they need to reduce SSI’s in patients and therefore reduce patient suffering. This study identified BMI (kg/m2) as the only significant risk factor for the development of an SSI in emergency CS. Further research will be needed to be conducted however, to strengthen this study’s findings and improve upon the lack of knowledge for emergency CS and its associated risk factors

Indentation Plastometry for Study of Anisotropy and Inhomogeneity in Maraging Steel Produced by Laser Powder Bed Fusion

This work concerns the use of profilometry-based indentation plastometry (PIP) to obtain mechanical property information for maraging steel samples produced via an additive manufacturing route (laser powder bed fusion). Bars are produced in both “horizontal” (all material close to the build plate) and “vertical” (progressively increasing distance from the build plate) configurations. Samples are mechanically tested in both as-built and age-hardened conditions. Stress–strain curves from uniaxial testing (tensile and compressive) are compared with those from PIP testing. Tensile test data suggest significant anisotropy, with the horizontal direction harder than the vertical direction. However, systematic compressive tests, allowing curves to be obtained for both build and transverse directions in various locations, indicate that there is no anisotropy anywhere in these materials. This is consistent with electron backscattered diffraction results, indicating that there is no significant texture in these materials. It is also consistent with the outcomes of PIP testing, which can detect anisotropy with high sensitivity. Furthermore, both PIP testing and compression testing results indicate that the changing growth conditions at different distances from the build plate can lead to strength variations. It seems likely that what has previously been interpreted as anisotropy in the tensile response is in fact due to inhomogeneity of this type

Provision of antiretroviral treatment in conflict settings: the experience of Médecins Sans Frontières

ABSTRACT: INTRODUCTION: Many countries ravaged by conflict have substantial morbidity and mortality attributed to HIV/AIDS yet HIV treatment is uncommonly available. Universal access to HIV care cannot be achieved unless the needs of populations in conflict-affected areas are addressed. METHODS: From 2003 Médecins Sans Frontières introduced HIV care, including antiretroviral therapy, into 24 programmes in conflict or post-conflict settings, mainly in sub-Saharan Africa. HIV care and treatment activities were usually integrated within other medical activities. Project data collected in the Fuchia software system were analysed and outcomes compared with ART-LINC data. Programme reports and other relevant documents and interviews with local and headquarters staff were used to develop lessons learned. RESULTS: In the 22 programmes where ART was initiated, more than 10,500 people were diagnosed with HIV and received medical care, and 4555 commenced antiretroviral therapy, including 348 children. Complete data were available for adults in 20 programmes (n = 4145). At analysis, 2645 (64%) remained on ART, 422 (10%) had died, 466 (11%) lost to follow-up, 417 (10%) transferred to another programme, and 195 (5%) had an unclear outcome. Median 12-month mortality and loss to follow-up were 9% and 11% respectively, and median 6-month CD4 gain was 129 cells/mm 3.Patient outcomes on treatment were comparable to those in stable resource-limited settings, and individuals and communities obtained significant benefits from access to HIV treatment. Programme disruption through instability was uncommon with only one program experiencing interruption to services, and programs were adapted to allow for disruption and population movements. Integration of HIV activities strengthened other health activities contributing to health benefits for all victims of conflict and increasing the potential sustainability for implemented activities. CONCLUSIONS: With commitment, simplified treatment and monitoring, and adaptations for potential instability, HIV treatment can be feasibly and effectively provided in conflict or post-conflict settings

The re-discovery of contemplation through science : with Tom McLeish, “The Re-Discovery of Contemplation through Science: Boyle Lecture 2021”; Rowan Williams, “The Re-Discovery of Contemplation through Science: A Response to Tom McLeish”; Fraser Watts, “Discussion of the Boyle Lecture 2021”; and Tom McLeish, “Response to Boyle Lecture 2021 Panel and Participant Discussion.”

Some of the early-modern changes in the social framing of science, while often believed to be essential, are shown to be contingent. They contribute to the flawed public narrative around science today, and especially to the misconceptions around science and religion. Four are examined in detail, each of which contributes to the demise of the contemplative stance that science both requires and offers. They are: (1) a turn from an immersed subject to the pretense of a pure objectivity, (2) a turn from imagination as a legitimate pathway to knowledge, (3) a turn from shared and participative science to a restricted professionalism, and (4) an overprosaic reading of the metaphor of the “Book of Nature.” All four, but especially the imperative to consider reading nature as poetry, and a deeper examination of the entanglements between poetry and theoretical science, draw unavoidably on theological ideas, and contribute to a developing “theology of science.”

Comment letters to the National Commission on Commission on Fraudulent Financial Reporting, 1987 (Treadway Commission) Vol. 2

https://egrove.olemiss.edu/aicpa_sop/1662/thumbnail.jp