Dr. John H. Gibbon, Jr. and Jefferson\u27s Heart-Lung Machine: Commemoration of the World\u27s First Successful Bypass Surgery

On May 6, 1953 at Jefferson Medical College Hospital, Dr. John Heysham Gibbon, Jr., his staff, and with the help of his latest-designed heart-lung machine, “Model II,” closed a very serious septal defect between the upper chambers of the heart of eighteen-year-old Cecelia Bavolek. This was the first successful intercardiac surgery of its kind performed on a human patient. Ms. Bavolek was connected to the device for three-quarters of an hour and for 26 crucial minutes, the patient totally depended upon the machine’s artificial cardiac and respiratory functions. “Jack” Gibbon did not follow this epoch-making event by holding an international press conference or by swiftly publishing his achievements in a major medical journal. In fact he later recalled that it was the first and only time that he did not write his own operative notes (which were supplied by Dr. Robert K. Finley, Jr.). According to a recent biographical review by C. Rollins Hanlon, “Therein lies a hint of the complex, unassuming personality behind the magnificent technical and surgical achievement of this patrician Philadelphia surgeon.”https://jdc.jefferson.edu/jeffhistoryposters/1000/thumbnail.jp

Serological diagnosis of typhoid fever : a review of the limitations of the Widal test

Typhoid fever remains an infectious disease of major importance worldwide. Even in developed countries, sporadic outbreaks continue to occur, often localised around a single origin -an asymptomatic carrier or an infected food source particularly shellfish. The severity of presentation, potential life-threatening complications as well as the serious side-effects of the antibiotics used in its treatment necessitates prompt and accurate diagnosis. The only definite diagnostic investigation remains the isolation of Salmonella typhi from samples of blood, bone marrow, faeces, bile and urine. Nevertheless serological tests are still commonly requested in the form of the Widal reaction.peer-reviewe

Antibiotic sensitivities of urinary tract pathogenes in Maltese patients

A survey of over 1000 bacterial isolates from Maltese patients with urinary tract infection was performed in order to investigate resistance patterns to commonly used oral antibiotics. Resistance was detected in high frequency, particularly for ampicillin, trimethoprim and sulphonamides, in samples originating from both community and hospital. A population comparison to a similar survey conducted in the UK showed local resistance rates to be twice as high.peer-reviewe

Addressing the challenge of antibiotic resistance in Maltese healthcare settings

Antimicrobial resistance results in substantial adverse outcomes and negatively impacts mortality, morbidity and economic expenditure. This review focuses on the costs of antibiotic resistance to both patient as well as health-care settings and highlights interventions proven to be effective in curtailing its continued escalation. These concentrate predominantly on initiatives to improve antibiotic prescribing as well as prevent the spread of multi-resistant organisms, amongst which hand hygiene is of paramount importance. With the prevalence of resistance in Malta, amongst the highest in Europe, such interventions need acceptance and implementation by all stakeholders if the current alarming situation is to be controlled and possibly improved.peer-reviewe

Discrete R Symmetries and Anomalies

We comment on aspects of discrete anomaly conditions focussing particularly on $R$ symmetries. We review the Green-Schwarz cancellation of discrete anomalies, providing a heuristic explanation why, in the heterotic string, only the "model-independent dilaton" transforms non-linearly under discrete symmetries; this argument suggests that, in other theories, multiple fields might play a role in anomaly cancellations, further weakening any anomaly constraints at low energies. We provide examples in open string theories of non-universal discrete anomalies at low energies. We then consider the fact that $R$ symmetries are necessarily broken at low energies. We exhibit dynamical models, in which fields charged under the Standard Model gauge group (for example, a doublet and a triplet) gain roughly equal masses, but where the doublet and the triplet possess different discrete charges and the low-energy anomaly conditions fail.Comment: 13 pages; matches version published in JHEP; references added, expanded discussion about anomaly universality and gauge coupling unificatio

Consumption of antibiotics at St Luke’s Hospital : a critical factor behind the local prevalence of antimicrobial resistance?

The intensity of antibiotic use in hospital settings is recognised as possibly the most important factor for the selection of antimicrobial resistance. Hospitals are therefore being encouraged to undertake surveillance and benchmarking of antimicrobial consumption patterns with a view to identify and rectify possible evidence of overuse or misuse. Use of antibiotics at St. Luke's Hospital, Malta (SLH) was assessed retrospectively for the year 2001 as part of participation in two pan-European antibiotic surveillance networks. Total antibiotic use during the study period averaged 147 Defined Daily Doses (DDD) /100 bed days with the three most common antibiotic groups prescribed being the penicillins, cephalosporins and macrolides. Combinations of penicillin with beta-lactamase inhibitor were the predominant antimicrobials in use and their consumption was twice the median for other participating hospitals in the European ARPAC network. Differences were additionally seen for second generation cephalosporins and macrolides, where consumption was also significantly higher at SLH. These findings would explain one possible factor behind the high prevalence of resistance, particularly in Staphylococcus aureus, at SLH and suggest the need to intensify efforts for improved antibiotic stewardship programmes in hospital prescribing.peer-reviewedpeer-reviewe

Divide and conquer method for proving gaps of frustration free Hamiltonians

Providing system-size independent lower bounds on the spectral gap of local Hamiltonian is in general a hard problem. For the case of finite-range, frustration free Hamiltonians on a spin lattice of arbitrary dimension, we show that a property of the ground state space is sufficient to obtain such a bound. We furthermore show that such a condition is necessary and equivalent to a constant spectral gap. Thanks to this equivalence, we can prove that for gapless models in any dimension, the spectral gap on regions of diameter $n$ is at most $o\left(\frac{\log(n)^{2+\epsilon}}{n}\right)$ for any positive $\epsilon$.Comment: This is an author-created, un-copyedited version of an article accepted for publication/published in Journal of Statistical Mechanics: Theory and Experiment. IOP Publishing Ltd is not responsible for any errors or omissions in this version of the manuscript or any version derived from it. The Version of Record is available online at http://dx.doi.org/10.1088/1742-5468/aaa793, Journal of Statistical Mechanics: Theory and Experiment, March 201

Consumption of antibiotics within ambulatory care in Malta

Background: Antibiotic use is recognised as the most important driver for the development of antimicrobial resistance in community pathogens. Surveillance is therefore critical for improvement programmes. Methods: Antimicrobial distribution data for the years 2007 to 2009 were collected retrospectively by the National Antibiotic Committee from all licensed wholesale distributors (WSL) in Malta and analysed according the World Health Organization Anatomical Therapeutic Chemical classification (ATC) level 4 criteria. Results: Overall consumption increased from 18.6 defined-daily-doses/1000-inhabitant-days (DID) in 2007 to 22.7 DID in 2008 and reached 24.4 DID in 2009 - an increase of more than 30% over the three years, Penicillins with beta-lactamase inhibitor increased in volume (7.1 to 8.8 DID) but decreased in proportion (38.4% to 36.0%) between 2007 and 2009. On the other hand, second generation cephalosporins increased in both volume and proportion (2.8 to 5.4 DID; 15.0% to 22.0%). The proportion for macrolides remained stable at approximately 16% but the volume of use again increased (2.9 DID to 3.9 DID). Fluoroquinolone proportion decreased from 9.1% to 6.8%, maintaining a stable volume of use in the region of 1.7 DID. Conclusions: Antibiotic consumption in Malta has shown a consistent increasing trend over the past three years, despite a reduction in over-the-counter acquisition. Furthermore, there is evidence of a strong, and possibly unjustified, prescription of wide spectrum antibacterials. This is potentially an important driver for documented resistance in Streptococcus pneumoniae and Escherichia coli and needs to be addressed at a national level.peer-reviewe

Broad-spectrum antibiotic use in Europe : more evidence of cultural influences on prescribing behaviour

Objectives: Sociocultural factors have been hypothesized as important drivers of inappropriate antibiotic prescribing in European ambulatory care. This study sought to assess whether they can also explain the reported variation in broad-spectrum antibiotic (Br-Ab) use among EU/European Economic Area (EEA) countries. Methods: Correlation and regression analysis were performed, using the bootstrap method, between Br-Ab ratios reported from 28 EU countries by the ECDC, and national Hofstede cultural dimensions and control of corruption (CoC) scores. Results: Significant bootstrapping correlation coefficients were identified between Br-Ab ratios and the dimension of uncertainty avoidance (UAI) as well as CoC. However, following both bootstrapping multiple regression and generalized linear modelling, only UAI was retained as the sole predictor. A logarithmic model explained 58.6% of the variation in European Br-Ab variability solely using national UAI scores (P,0.001). Conclusions: Br-Ab prescribing appears to be driven by the level of UAI within the country. Any interventions aimed at reducing Br-Ab in high-consuming EU/EEA countries need to address this cultural perception to maxi-mize their chances of success.peer-reviewe

Antibiotic susceptibility patterns of local strains of Pseudomonas aeruginos

The resistance patterns of 100 local strains of Ps. aeruginosa were investigated using two different methods: (1) Broth Dilution and (2) ε-test. From the seven antibiotics tested, Ps. aeruginosa showed a 100% sensitivity to imipenem (n=30). Among the first-line agents, azlocillin, ceftazidime, and gentamicin showed the highest sensitivity rates, 87%, 93% and 92% respectively. Aztreonam and ciprofloxacin showed the presence of intermediately sensitive strains, with 61% of the isolates tested being fully sensitive to each antibiotic. Only 47% of the strains were found to be sensitive to ceftriaxone. The results obtained were similar to studies carried out abroad.peer-reviewe