Animal bite wounds and their management in tropical Australia

Objective: To define the microbiologic characteristics of animal bites in tropical Australia and the appropriateness of current Australian antimicrobial guidelines for their management. Methods: This retrospective audit examined hospitalizations in tropical Australia after an animal bite or animal-associated penetrating injury between 2013 and 2020. The primary outcome was a composite of death, intensive care unit admission, amputation, quaternary center transfer, or unplanned rehospitalization. Results: A wide variety of animals were implicated, but snakes (734/1745, 42%), dogs (508/1745, 29%), and cats (153/1745, 9%) were the most common. Hospital presentation after 24 hours (odds ratio (OR) (95% confidence interval (CI)): 68.67 (42.10-112.01)) and a cat-related injury (OR (95% CI): 22.20 (11.18-44.08)) were independently associated with an increased risk of infection. A pathogen not covered by the relevant antimicrobial regimen recommended in Australian guidelines was identified in only 12/1745 (0.7%) cases. The primary outcome occurred in 107/1745 (6%) and was independently associated with tissue trauma (OR (95% CI): 9.29 (6.05-14.25), p<0.001), established deep infection at presentation (OR (95% CI): 2.95 (1.31-6.61), p=0.009) and hospital presentation after 24 hours (OR (95% CI): 1.77 (1.12-2.79), p=0.01). Conclusions: A wide variety of animals bite humans in tropical Australia, but empiric antimicrobial regimens recommended in current national guidelines cover almost all the microbiologic isolates from the resulting wounds

The use of 1320nm Nd:YAG laser for the treatment of acne scar in Asians

published_or_final_versio

The use of 1320nm Nd:YAG laser for the treatment of acne scar in Asians

published_or_final_versio

Human cytomegalovirus-specific cytotoxic T cells. Relative frequency of stage-specific CTL recognizing the 72-kD immediate early protein and glycoprotein B expressed by recombinant vaccinia viruses.

CTL are held to be an important host defense mechanism in persistent herpes-virus infections. We have therefore studied the nature and specificity of human cytomegalovirus (HCMV)-specific CTL in normal persistently infected individuals. This was achieved by using vaccinia recombinants encoding viral genes expressed at different stages of the virus replicative cycle, a structural glycoprotein gB (vac.gB) and the major 72-kD immediate early nonstructural protein (vac.IE) of HCMV, combined with limiting dilution analysis of the CTL response. In two subjects, 43 and 58% of HCMV CTL precursors (CTLp) lysed vac.IE-infected cells, in contrast to less than 6% lysing gB-infected cells. HCMV-specific CTL could also be generated by secondary in vitro stimulation with vac.gB- but not vac.IE-infected autologous fibroblasts. The high frequency of 72-kD IE protein-specific CTL suggests that this is at least a major recognition element for the HCMV-specific CTL response in asymptomatic persistently infected individuals, and CTL with this specificity may be important in maintaining the normal virus/host equilibrium

The origin of [C II] 157 μm emission in a five-component interstellar medium : the case of NGC 3184 and NGC 628

With its relatively low ionization potential, C+ can be found throughout the interstellar medium (ISM) and provides one of the main cooling channels of the ISM via the [C II] 157 mu m emission. While the strength of the [C II] line correlates with the star formation rate, the contributions of the various gas phases to the [C II] emission on galactic scales are not well established. In this study we establish an empirical multi-component model of the ISM, including dense H II regions, dense photon dissociation regions (PDRs), the warm ionized medium (WIM), low density and G(0). surfaces of molecular clouds (SfMCs), and the cold neutral medium (CNM). We test our model on ten luminous regions within the two nearby galaxies NGC 3184 and NGC 628. on angular scales of 500-600 pc. Both galaxies are part of the Herschel. key program. KINGFISH,. and are complemented by a large set of ancillary ground-and space-based data. The five modeled phases together reproduce the observed [C II] emission quite well, overpredicting the total flux slightly (about 45%) averaged over all regions. We find that dense PDRs are the dominating component, contributing 68% of the [C II] flux on average, followed by the WIM and the SfMCs, with mean contributions of about half of the contribution from dense PDRs, each. CNM and dense H II regions are only minor contributors with less than 5% each. These estimates are averaged over the selected regions, but the relative contributions of the various phases to the [C II] flux vary significantly between these regions

Clinicians’ perspectives of parental decision-making following diagnosis of a severe congenital anomaly: a qualitative study.

ABSTRACT Objective: To explore clinicians’ perspectives on supporting parents’ decision-making following diagnosis of a severe congenital anomaly, and how this is shaped by current policy. Methods: This paper reports data collated as part of a larger project examining parents’ decision-making following antenatal diagnosis. The focus of this paper is the data arising from semi-structured interviews conducted with 18 clinicians, with findings further supported by data generated from consultations between clinicians and parents. All interviews and consultations were audio-recorded and transcribed verbatim, with analysis based on the constant comparative approach. Results: Three key themes emerged which together shape the practice of clinicians working in this area. First, the law governing termination of pregnancy (TOP) and how clinicians believe this influences the context in which decisions about whether to terminate or continue an affected pregnancy are made. Second, approaches to the management of cases seen as particularly challenging. Third, how clinicians understand their role when working with parents. These themes combine to create a strong desire on the part of clinicians for parents to engage in a particular ‘rational’ form of decision-making and to be able to demonstrate the enactment of this. This is seen as important in order to ensure the ‘right’ decision has been reached and, particularly when the decision is to terminate, will withstand possible scrutiny. Conclusions: The policy context in which these decisions are made strongly shapes how clinicians practise and what they want to see from the parents with whom they work. The ways in which they seek to overcome the difficulties in interpreting the law may result in variations in the offer of late TOP, both between and within units. This may inadvertently affect the options available to women least able to engage in this idealised form of decision-making. Keywords: Decision-making, Congenital anomaly, Clinicians, Qualitative, Policy, Antenata