Fluid lavage in patients with open fracture wounds (FLOW): an international survey of 984 surgeons

<p>Abstract</p> <p>Background</p> <p>Although surgeons acknowledge the importance of irrigating open fracture wounds, the choice of irrigating fluid and delivery pressure remains controversial. Our objective was to clarify current opinion with regard to the irrigation of open fracture wounds.</p> <p>Methods</p> <p>We used a cross-sectional survey and a sample-to-redundancy strategy to examine surgeons' preferences in the initial management of open fracture wounds. We mailed this survey to members of the Canadian Orthopaedic Association and delivered it to attendees of an international fracture course (AO, Davos, Switzerland).</p> <p>Results</p> <p>Of the 1,764 surgeons who received the questionnaire, 984 (55.8%) responded. In the management of open wounds, the majority of surgeons surveyed, 676 (70.5%), favoured normal saline alone. Bacitracin solution was used routinely by only 161 surgeons (16.8%). The majority of surgeons, 695 (71%) used low pressures when delivering the irrigating solution to the wound. There was, however considerable variation in what pressures constituted high versus low pressure lavage. The overwhelming majority of surgeons, 889 (94.2%), reported they would change their practice if a large randomized controlled trial showed a clear benefit of an irrigating solution – especially if it was different from the solution they used.</p> <p>Conclusion</p> <p>The majority of surgeons favour both normal saline and low pressure lavage for the initial management of open fracture wounds. However, opinions varied as regards the comparative efficacy of different solutions, the use of additives and high versus low pressure. Surgeons have expressed considerable support for a trial evaluating both irrigating solutions and pressures.</p

Factors affecting commencement and cessation of smoking behaviour in Malaysian adults

<p>Abstract</p> <p>Background</p> <p>Tobacco consumption peak in developed countries has passed, however, it is on the increase in many developing countries. Apart from cigarettes, consumption of local hand-rolled cigarettes such as <it>bidi </it>and <it>rokok daun </it>are prevalent in specific communities. Although factors associated with smoking initiation and cessation has been investigated elsewhere, the only available data for Malaysia is on prevalence. This study aims to investigate factors associated with smoking initiation and cessation which is imperative in designing intervention programs.</p> <p>Methods</p> <p>Data were collected from 11,697 adults by trained recording clerks on sociodemographic characteristics, practice of other risk habit and details of smoking such as type, duration and frequency. Smoking commencement and cessation were analyzed using the Kaplan-Meier estimates and log-rank tests. Univariate and multivariate Cox proportional hazard regression models were used to calculate the hazard rate ratios.</p> <p>Results</p> <p>Males had a much higher prevalence of the habit (61.7%) as compared to females (5.8%). Cessation was found to be most common among the Chinese and those regularly consuming alcoholic beverages. Kaplan-Meier plot shows that although males are more likely to start smoking, females are found to be less likely to stop. History of betel quid chewing and alcohol consumption significantly increase the likelihood of commencement (p < 0.0001), while cessation was least likely among Indians, current quid chewers and kretek users (p < 0.01).</p> <p>Conclusions</p> <p>Gender, ethnicity, history of quid chewing and alcohol consumption have been found to be important factors in smoking commencement; while ethnicity, betel quid chewing and type of tobacco smoked influences cessation.</p

A lactococcal pWV01-based integration toolbox for bacteria

A conditionally replicating lactococcal vector system is described, based on pWV01, that is used for chromosomal integration in Lactococcus lactis. The system consists of plasmids that are all based on the broad-host-range lactococcal replicon pWV01 which has been deprived of its gene encoding the replication initiation protein RepA. These so-called pORI plasmids can only replicate if RepA is provided in trans. Special Escherichia coli, Bacillus subtilis and L. lactis helper strains, producing RepA in trans (RepA+), are used as intermediate hosts for the construction of pORI integration plasmids. The presence of a lactococcal chromosomal DNA fragment in a pORI plasmid enables its chromosomal integration by homologous recombination in an L. lactis strain that does not produce RepA (RepA–). A set of special purpose pORI vectors are available: (i) pORI280, designed to mutate or delete genes or to insert new genes in the chromosome in such a way that no heterologous DNA or antibiotic resistance markers are left in the recombinant strain, here designated as silent gene replacement; (ii) pORI19, suitable for random mutagenesis of the chromosome, and (iii) pORI13, constructed to make random single copy transcriptional fusions in the chromosome to search for (environmentally regulated) promoters. Some of these vectors have also been succesfully applied for integration in E. coli and B. subtilis. We strongly believe that the systems described here can be used in various other bacterial species.

The IDEMIX model: Parameterization of internal gravity waves for circulation models of ocean and atmosphere

The IDEMIX conceptIDEMIXconcept is an energetically consistent framework to describe wave effects in circulation models of ocean and atmosphere. It is based on the radiative transfer equation for an internal gravity wave field in physical and wavenumber space and was shown to be successful for ocean applications. An improved IDEMIX model for the ocean will be constructed and extended by a new high-frequency, high vertical wavenumber compartment, forcing by mesoscale eddy dissipation, anisotropic tidal forcing, and wave--mean flow interaction. It will be validated using observational and model estimates. A novel concept for gravity wave parameterization in atmospheric circulation models is developed. As for the ocean, the wave field is represented by the wave energy density in physical and wavenumber space, and its prognostic computation is performed by the radiative transfer equation. This new concept goes far beyond conventional gravity wave schemes which are based on the single-column approximation and, in particular, on the strong assumptions of a stationary mean flow and a stationary wave energy equation. The radiative transfer equation has---to our knowledge---never been considered in the atmospheric community as a framework for subgrid-scale parameterization. The proposed parameterization will, for the first time, (1) include all relevant sources continuously in space and time and (2) accommodate all gravity wave sources (orography, fronts, and convection) in a single parameterization framework. Moreover, the new scheme is formulated in a precisely energy-preserving fashion. The project will contribute to a transfer of knowledge from the oceanic community to the atmospheric community and vice versa. We give a brief description of the oceanic and atmospheric internal wave fields, the most important processes of generation and interactions, and the ingredients of the model IDEMIX