The bacteriology of cholecystitis appendicitis and peptic ulcer

In the work detailed in this thesis a bacteriological investigation has been made of the three conditions of cholecystitis, appendicitis and peptic ulcer. This was originally undertaken with the', .object of confirming the work of Rosenow in this direction. On the whole, it may be said that his general findings with regard to the nature of the organisms isolated and their presence within tissues has been supported, though a somewhat different incidence has been found which may possibly be due to differences in the type of material examined. Special attention has been paid to the biological characters of the organisms isolated, especially the streptococci, with the object of determining the site of their origin in the body. It has been found that in cholecystitis the organisms present are predominantly of a character similar to those found normally in the bowel. In peptic ulcer less evidence has been available, but on the whole, mouth types of organisms seem to be more frequent.No evidence has been found of any tendency towards "elective localisation" of the organisms isolated. Cholecystitis may be produced relatively easily in rabbits by intravenous injection of coliform organisms, but such action seems to be entirely non-specific, and to occur as readily with organisms isolated from other lesions as with those isolated from cases of cholecystitis. Animal experiments suggest that infection reaches the gall -bladder either through the systemic circulation or by descending infection from the liver in the bile, though in exceptional circumstances it may travel by other routes. Lesions in the appendix have not been produced to any extent with organisms in the present work. Haemorrhages in the stomach and duodenum have been found with great frequency in experimental animals after the intravenois injection of organisms, but it does not seem justifiable to draw any conclusions from these findings as regards the aetiological relationship to peptic ulcer in man of the organisms injected.No evidence has been found so far that in the human subject infection is the primary factor in the production of cholecystitis and gall stones. In the 'early stages of cholecystitis organisms are found with !difficulty, but the incidence rises as complications, such as the formation of stones and the presence of obstruction, occur. In the syndrome of acute obstructive cholecystitis the presence of a secondary anaerobic infection is of great practical importance. It is possible that the organisms isolated in this condition may all play the part of secondary invaders when once some change, toxic or biochemical, has already commenced in the biliary tract.In appendicitis, the primary factor is probably a dietetic one, and the evidence is strongly in favour of this condition being a disease of civilisation. A decreased consumption of cellulose and an increased consumption of protein seem to be the important factors, and they probably act by the encouragement of stasis and the production of catarrh in the appendix, with the passage of organisms through the mucous membrane. In the vast majority of cases the !infection in appendicitis is undoubtedly an enterogenous one, though rarely it may be a haematogenous one arising in some distant focus such as the tonsils. Anatomical factors, such as the position of the appendix and the nature of its blood supply, probably play an important part in the progress of the inflammation. As the inflammation progresses, the incidence and virulence of the organisms present in the appendix rises, and this is specially the case with the anaerobic flora. In obstructive and gangrenous conditions it is the anaerobes which are mainly responsible for the complications and mortality.In the case of peptic ulcer, the evidence is perhaps a little stronger that infection, usually with streptococci, is the primary factor responsible. Once ulceration has occurred, a vicious circle becomes ;established, and a secondary infection may be added. Whether infection originates or maintains the condition, however, its importance is such as to render absolutely necessary in treatment the eradication of all septic foci in the abdomen and elsewhere. In recent years since the "pathology of the living's has been more extensively studied, considerable stress has been layed on the relationship of these three conditions, which have been referred to by Wilkie as the "abdominal triad ". There is definite clinical evidence that in some cases they are related, and that the appendix provides the original focus. In the present work, material from too few cases in which all three lesions have been treated surgically has been examined to justify any conclusion on the nature of the infection present. Till our knowledge about the origin and pathway of infection in these conditions is more definite, however, and till we have determined what is the primary factor, dietetic or otherwise, that allows infection to occur, our therapeutics must continue to rest on the principle that the infection is implanted within the tissues of the organ diseased, and that unless natural resolution can be shown to occur, the continuation of the infection and its spread to other organs can only be prevented by surgical treatment

Twin Threats: The Short-Sighted US Response to Global Climate Change and Pandemics

This thesis examines the failure of the United States government to mitigate global climate change and the COVID-19 pandemic by comparing poor public reactions and governmental administration between the two threats. Using developmental constructs to serve as a framework for assessing public reactions to climate change and pandemics, this thesis implements a content analysis study of American news media from 2000 to 2020; it identifies the rhetoric embedded in communications that has directed the US public’s focus of attention and shaped public opinion on these issues. The results indicate significantly less focus of attention on human health issues than economic issues, and that the risk of climate change and pandemics alike have often been understated. The thesis qualifies the results of this content analysis with supplementary studies on the conditioning factors of this reality, namely political division and bias. By understanding the ways in which the American public has internalized certain biases and applies their values toward public health threats, behaviors and public policy actions that fail to prioritize long-term public health and financial well-being become clearer. Policymakers can adapt to these conditioning factors in order to develop more appropriate strategies for addressing global threats like climate change and pandemics. The thesis examines current approaches to communications and policymaking, acknowledges their shortcomings, and proposes solutions that better interpret the varying reactions to global climate change and pandemics. Several examples are provided of successful and unsuccessful mitigation strategies that incorporate the insights from the analysis of the conditioning factors

Frequency of Use and Perceived Credibility of Information Sources and Variations by Socioeconomic Factors among Savannah River Stakeholders

The authors examine the factors effecting credibility of risk communication in the communities surrounding the Savannah River Nuclear Weapons Site

Collective Bargaining and Wage Equalization in Canada’s Iron & Steel Industry, 1939-1964

Dans sa publication de 1948,Trade Union Wage Policy, Arthur M. Ross attirait l'attention autour de l'impact des salaires définis par voie de négociation collective sur les théories traditionnelles de détermination des salaires 1. La raison principale de cet intérêt provient de l'incapacité de la théorie actuelle à fournir des réponses satisfaisantes aux cinq questions suivantes.1. Comment se fait-il que l'importance du mouvement relatif des salaires soit plus cruciale que le salaire qui en résulte ?2. Pourquoi les taux de salaires ne sont-ils pas égalisés sur le marché local du travail ?3. Comment expliquer les fréquents arrêts de travail consécutifs à des différences mineures, pour ne pas dire ridicules entre les parties ?4. Pourquoi plusieurs syndicats insistent-ils sur l'uniformité du taux de salaire pour toute leur unité de juridiction lorsque la théorie économique suggère qu'en situation de monopole, il est possible de maximiser le revenu en faisant de la discrimination entre les acheteurs ?5. Pourquoi cet effort par les syndicats de consolider leurs structures de négociation ?Toutes ces questions reflètent les relations entre les taux de salaire occupationnels ou entre le résultat de deux différentes négociations de salaires. De façon plus globale, elles mettent en évidence le caractère et la fonction de deux tendances « égalisantes » dans la détermination des salaires par négociation collective. Dans la théorie économique traditionnelle, il n'y a pas de réponse à ce problème.Il y a très peu d'études qui fournissent une réponse satisfaisante malgré tous les travaux qui ont été faits. Cependant, on a beaucoup plus insisté sur l'identification et la description des processus institutionnels qui causent ces tendances « égalisantes ». De façon générale, trois approches sont utilisées :a) la coopération entre employeurs 2 ;b) la négociation-type 3 ;c) l'élargissement des unités de négociation 4.lusqu'à quel point les conclusions présentées pour la situation américaine sont-elles valables pour la négociation collective canadienne ?L'industrie canadienne du fer et de l'acier fut l'une des industries considérées pour étude du cas canadien. Dans ce cas précis, l'existence de ces tendances « égalisantes » serait le résultat de négociations-type ou de la coopération entre employeurs ; probablement plus le premier facteur que le second. Contrairement au cas américain, l'industrie canadienne du fer et de l'acier n'a connu aucun élargissement d'unité de négociation. Presque toute la négociation dans cette industrie est faite au niveau local.Quelques conclusions1. Depuis 1939, la politique de négociation collective des Métallos s'est dirigée vers l'établissement de conventions uniformes à travers l'industrie.2. Les efforts syndicaux dirigés vers l'uniformisation de l'industrie de l'acier ont été secondés par les contrôles de salaire du gouvernement fédéral durant la dernière guerre.3. En 1946, les syndicats atteignaient leur objectif d'uniformité des taux de salaire de base et étaient en voie de l'atteindre pour les autres classes d'emploi.4. La négociation-type d'après-guerre a contribué à conserver l'uniformité acquise durant le conflit mondial.5. L'effort d'extension de l'uniformité des taux de salaire par le « Coopérative Wage Study Plan » a échoué en 1952. Deux ans plus tard, on obtenait l'uniformité pour des classes similaires d'emploi.6. Le succès dans l'industrie de l'acier primaire a été le modèle syndical de négociation dans les secteurs de l'acier non-primaire. Cependant le succès fut très limité.7. L'échec relatif de la tentative d'étendre des unités de négociation dans les industries canadiennes de l'acier primaire et le succès marqué de la négociation-type indiquent qu'il n'y a pas qu'une méthode dont un syndicat puisse se servir pour obtenir l'uniformité dans les conventions collectives.8. Dans le cas canadien, la négociation est fragmentée mais en même temps on retrouve une grande uniformité entre les différents accords. Il n'y a donc pas de preuve solide à la cause de ceux qui relient directement l'un à l'autre dans l'industrie canadienne de l'acier primaire.1 Voir les références à l'original anglais.This paper is one in a series being prepared by the Labour-Management Section of the Federal Department of Labour's Economies and Research Branch. It has three purposes. First, to highlight significant developments and characteristics in collective bargaining in the industry. Second, to determine the extent to which wage equalization is present in the industry. Third, to identify the influences that have contributed to these equalizing tendencies

An investigation of the purpose and mutual relations of the Johannine Epistles

Bibliography: pages 300-314.The series of questions which is often grouped under the heading "the Johannine Problem" is perhaps the most intractable of all those which confront New Testament scholars. Many of these questions cannot be avoided, no matter which of the five traditional "Johannine" books is studied. On one side there is the complex of queries surrounding the Fourth Gospel: its authorship, historicity, milieu, nature and date. In another direction is to be found the formidable set of challenges associated with the Johannine Apocalypse. No less difficult are the questions posed by the Epistles of John. First there is the question of authorship. Did one writer pen all three works? What is the relationship of the writer/s of the Epistles to the author/s of the Fourth Gospel and the Apocalypse of John? There is also the problem of timing - even leaving aside the Gospel and Apocalypse, is it possible to come to any conclusion concerning the priority of one or other of the three Epistles? Were they written at the same time? What is the answer to the peculiar absence of contemporary names in l and 2 John? What, in fact, is the nature and intention of each book? What is one to make of the current church situation, of the elusive personalities and their movements? The hypothesis advanced here suggests that the three Johannine Epistles came from the same hand, the author of these also being the author of the Fourth Gospel

Implementing a Multicomponent Intervention to Improve Nursing Knowledge of Delirium and Interprofessional Communication of Delirium in Intensive Care Patients

PURPOSE: The purpose of this project is to evaluate the implementation of a standardized delirium education program, delirium assessment protocol, and a standardized CAM-ICU reporting method. The goal of the project is to improve nursing delirium knowledge, CAM-ICU documentation compliance, and interdisciplinary discussion of patient’s delirium status during Multidisciplinary Rounds (MDR). This project has four distinct objectives. 1) Implement a standardized delirium assessment and communication protocol within the Lexington VAHCS ICU. 2) Increase the nursing knowledge and self-confidence of assessing ICU delirium, by 50% using a multifaceted educational approach. 3) Achieve a 90% documentation compliance rate for the CAM-ICU delirium screening tool. 4) Increase healthcare provider discussion of CAM-ICU assessment by 50%, through the utilization of the “FASTHUGSBID” and “Brain Road Map” for Interdisciplinary Communication during MDR. METHODS: This is an evidence-based quality improvement project with a pre- and post-implementation design to determine the impact of delirium education and policy implementation on nursing perception and knowledge. The study also includes a pre and post electronic chart review to evaluate for delirium screening and documentation compliance post project implementation. RESULTS: Nursing knowledge of delirium and understanding of how to properly screen for delirium using the CAM-ICU increased compared to the pre-education knowledge assessment. The data revealed the nurses showed knowledge improvement in 6 of 11 knowledge assessment questions (pThe post-implementation data also showed the attending physicians’ leading MDR rounds gave the nurses the opportunity to report on their patients using the FASTHUGSBID rounding tool 93% (65/70) (p CONCLUSION: The findings from this QA/QI project support the implementation of a standardized delirium communication protocol using a multifaceted delirium education approach. As a result of this project’s implementation, nursing knowledge of delirium, CAM-ICU documentation compliance, as well as the interprofessional communication of patient’s delirium status have all improved

Methodology for Sampling Women at High Maternal Risk in Administrative Data

Background: In population level studies, the conventional practice of categorizing women into low and high maternal risk samples relies upon ascertaining the presence of various comorbid conditions in administrative data. Two problems with the conventional method include variability in the recommended comorbidities to consider and inability to distinguish between maternal and fetal risks. High maternal risk sample selection may be improved by using the Obstetric Comorbidity Index (OCI), a system of risk scoring based on weighting comorbidities associated with maternal end organ damage. The purpose of this study was to compare the net benefit of using OCI risk scoring vs the conventional risk identification method to identify a sample of women at high maternal risk in administrative data. Methods: This was a net benefit analysis using linked delivery hospitalization discharge and vital records data for women experiencing singleton births in Georgia from 2008 to 2012. We compared the value identifying a sample of women at high maternal risk using the OCI score to the conventional method of dichotomous identification of any comorbidities. Value was measured by the ability to select a sample of women designated as high maternal risk who experienced severe maternal morbidity or mortality. Results: The high maternal risk sample created with the OCI had a small but positive net benefit (+ 0.6), while the conventionally derived sample had a negative net benefit indicating the sample selection performed worse than identifying no woman as high maternal risk. Conclusions: The OCI can be used to select women at high maternal risk in administrative data. The OCI provides a consistent method of identification for women at risk of maternal morbidity and mortality and avoids confounding all obstetric risk factors with specific maternal risk factors. Using the OCI may help reduce misclassification as high maternal risk and improve the consistency in identifying women at high maternal risk in administrative data

Quick Guide To Quattro Pro for Windows: For Mouse Users

Research Methods/ Statistical Methods,

Do Elections Encourage Public Actors To Be More Responsive?

In the U.S. many public services are provided by individuals who are selected in local elections. We ask whether elections encourage public actors to be responsive to citizens. We design a novel field experiment where we send an information request to a random sample of prosecutor offices. Whether someone replies to the request is our measurement of responsiveness. We show that offices whose head is up for re-election are more likely to respond. We also show that offices in states that appoint their local prosecutors are substantially less likely to respond than a matched set of offices with elected leadership