Surveillance of Surgical Site Infections following Major Hip and Knee Surgery in Finland

Background and aims. Since 1999, hospitals in the Finnish Hospital Infection Program (SIRO) have reported data on surgical site infections (SSI) following major hip and knee surgery. The purpose of this study was to obtain detailed information to support prevention efforts by analyzing SIRO data on SSIs, to evaluate possible factors affecting the surveillance results, and to assess the disease burden of postoperative prosthetic joint infections in Finland. Methods. Procedures under surveillance included total hip (THA) and total knee arthroplasties (TKA), and the open reduction and internal fixation (ORIF) of femur fractures. Hospitals prospectively collected data using common definitions and written protocol, and also performed postdischarge surveillance. In the validation study, a blinded retrospective chart review was performed and infection control nurses were interviewed. Patient charts of deep incisional and organ/space SSIs were reviewed, and data from three sources (SIRO, the Finnish Arthroplasty Register, and the Finnish Patient Insurance Centre) were linked for capture-recapture analyses. Results. During 1999-2002, the overall SSI rate was 3.3% after 11,812 orthopedic procedures (median length of stay, eight days). Of all SSIs, 56% were detected after discharge. The majority of deep incisional and organ/space SSIs (65/108, 60%) were detected on readmission. Positive and negative predictive values, sensitivity, and specificity for SIRO surveillance were 94% (95% CI, 89-99%), 99% (99-100%), 75% (56-93%), and 100% (97-100%), respectively. Of the 9,831 total joint replacements performed during 2001-2004, 7.2% (THA 5.2% and TKA 9.9%) of the implants were inserted in a simultaneous bilateral operation. Patients who underwent bilateral operations were younger, healthier, and more often males than those who underwent unilateral procedures. The rates of deep SSIs or mortality did not differ between bi- and uni-lateral THAs or TKAs. Four deep SSIs were reported following bilateral operations (antimicrobial prophylaxis administered 48-218 minutes before incision). In the three registers, altogether 129 prosthetic joint infections were identified after 13,482 THA and TKA during 1999-2004. After correction with the positive predictive value of SIRO (91%), a log-linear model provided an estimated overall prosthetic joint infection rate of 1.6% after THA and 1.3% after TKA. The sensitivity of the SIRO surveillance ranged from 36% to 57%. According to the estimation, nearly 200 prosthetic joint infections could occur in Finland each year (the average from 1999 to 2004) after THA and TKA. Conclusions. Postdischarge surveillance had a major impact on SSI rates after major hip and knee surgery. A minority of deep incisional and organ/space SSIs would be missed, however, if postdischarge surveillance by questionnaire was not performed. According to the validation study, most SSIs reported to SIRO were true infections. Some SSIs were missed, revealing some weakness in case finding. Variation in diagnostic practices may also affect SSI rates. No differences were found in deep SSI rates or mortality between bi- and unilateral THA and TKA. However, patient materials between these two groups differed. Bilateral operations require specific attention paid to their antimicrobial prophylaxis as well as to data management in the surveillance database. The true disease burden of prosthetic joint infections may be heavier than the rates from national nosocomial surveillance systems usually suggest.

Response spectrum of non-linear spring mass system subjected to transient disturbances

The transient response spectrum of a cubic spring mass system subjected to a step function input is obtained. An approximate method is adopted where non-linear restoring force characteristic is replaced by two linear segments, so that the mean square error between them is a minimum. The effect of viscous damping on the peak response is also discussed for various values of the damping constant and the non-linearity restoring force parameter.

Fatty acid specificity for the esterification of vitamin A and cholesterol by intestinal and pancreatic enzymes in rats

VITAMIN A and cholesterol esters have been shown to undergo extensive hydrolysis in the lumen of the small intestine during the process of absorption; they are re-esterified to appear in the lymph mostly as esters1,2. However, the vitamin A esters of the lymph, blood and liver of the rat are formed by long-chain fatty acids3 and in the normal rat liver, probably as palmitates4. On the other hand, cholesterol esters are usually made up of poly-unsaturated fatty acids in the lymph and blood of rats5. For the absorption of the two lipid materials, the enzymes of the pancreas have been largely implicated, while not much attention has been paid to the possible role of the mucosal enzymes. From the behaviour of the mucosal enzymes, as presented here, it appears that probably these enzymes play a more important part in the re-esterification of the two lipid materials during their absorption.

Lattice vibrations and specific heat of zinc blende

The dispersion relations, frequency distribution function and specific heat of zinc blende have been calculated using Houston's method on (1) A short range force (S. R.) model of the type employed in diamond by Smith and (2) A long range model assuming an effective charge Ze on the ions. Since the elastic constant data on ZnS are not in agreement with one another the following values were used in these calculations: {Mathematical expression}. As compared to the results on the S. R. model, the Coulomb force causes 1. A splitting of the optical branches at (000) and a larger dispersion of these branches; 2. A rise in the acoustic frequency branches the effect being predominant in a transverse acoustic branch along [110]; 3. A bridging of the gap of forbidden frequencies in the S. R. model; 4. A reduction of the moments of the frequency distribution function and 5. A flattening of the Θ- T curve. By plotting (Θ/Θ0) vs. T., the experimental data of Martin and Clusius and Harteck are found to be in perfect coincidence with the curve for the short range model. The values of the elastic constants deduced from the ratio Θ0 (Theor)/Θ0 (Expt) agree with those of Prince and Wooster. This is surprising as several lines of evidence indicate that the bond in zinc blende is partly covalent and partly ionic. The conclusion is inescapable that the effective charge in ZnS is a function of the wave vector {Mathematical expression}.

Deposition of ZnO Films by Combustion Flame Pyrolysis of Solution Precursors

The structural features,including preferred orientation and surface morphology of zinc oxide (ZnO) films deposited by combustion flame pyrolysis were investigated as a function of process parameters, which include precursor solution concentration, substrate-nozzle (S-N) distance, gas flow rate, and duration of deposition. In this technique, the precursor droplets react within the flame and form a coating on an amorphous silica substrate held in or near the flame. Depending on the process parameters, the state of decomposition at which the precursor arrives on the substrate varies substantially and this in turn dictates the orientation and microstructure of the films.

The Impact of FDI on International Portfolio Investments

Some empirical research has argued that part of the reason for the observed "home bias" is that investors are able to indirectly achieve internationally diversified portfolios via domestically listed multinational firms. Another branch of this research attributes the "home bias" and country allocations to more deeply rooted informational causes. Using a four-year annual panel of Finnish international portfolios and Foreign Direct Investments in twenty-five countries, I provide evidence consistent with an information asymmetry explanation

Structure of 1 lct-Hydroxyeon-1,4,18-trienine-3-one

C21H27NO2, Mr=325.5 , orthorhombic,P21212,, a = 7.516 (2), b = 13.430 (2), c =18.047 (2) A, U= 1821.79 A 3, Z = 4, D x =1.186 Mg m -a, 2(Cu Ka) = 1.5418 A, # = 0.56 mm -1, F(000) = 704, T= 293 K, final R = 0.04 for 1892 reflections with I _> 3a(I). Ring A is planar, and rings B and C adopt a chair conformation. Rings D and E are envelopes, with C(14) and C(17) displaced from their respective planes by 0.643 (3) and 0.482 (3)A. The ring system A/B shows quasi-trans fusion, whilst ring systems B/C and C/D are trans fused about C(8)-C(9) and C(13)-C(14) respectively. The D/E junction shows cis fusion.

A lock-type cell for NMR studies at high hydrostatic pressures and low temperatures

Details of a simple and convenient high-pressure cell for continuous-wave, wide-line nuclear magnetic resonance investigation at high pressures and low temperatures are described. Experimental results obtained with the cell at 14*108 Pa and 77K for ammonium iodide are presented briefly.

Electroless nickel hydroxide: synthesis and characterization

An electroless method of nickel hydroxide synthesis through the complexation-precipitation route which yields a fine particle material having a specific surface area of 178 m2 g–1 has been described. The morphology of this material as revealed by electron microscopy is distinctly different from the turbostratic nature of electrosynthesized nickel hydroxide. While the long range structure as shown by the X-ray diffraction pattern is similar to that of beta-Ni(OH)2, the short range structure as revealed by infrared spectroscopy incorporates characteristics similar to that of agr-Ni(OH)2. Cyclic voltammetry studies show that the electroless nickel hydroxide has a higher coulombic efficiency (>90%), a more anodic reversible potential and a higher degree of reversibility compared to the electrosynthesized nickel hydroxide and conventionally prepared nickel hydroxide.

Carbon-13 NMR studies of lipid mobilization pattern in germinating groundnut (Arachis hypogaea L.) seeds

The products of lipid mobilization in groundnut (Arachis hypogaea L.) seeds as a function of time immediately after imbibition are monitored by 13C NMR. Different parts of the embryonic axis, namely,the radicle, hypocotyl, and plumule, exhibit characteristic time dependent 13C NMR spectra observed at 24-h intervals after imbibition. The various stages in the transformation of storage lipids present in different parts of the embryonic axis are clearly demonstrated. The transformaton of storage lipids is completed first in the radicle followed by the hypocotyl and finally the plumule. A mechanism of the transformation of the storage lipids is discussed.

Organometallic chemistry of diphosphazanes. Part 7. Platinum(II), palladium-(o), -(I) and -(II) complexes of RN[P(OPh)2]2(R = Me or Ph)

The reactions of [MCl2(cod)](M = Pd or Pt, cod = cycloocta-1,5-diene) with RN[P(OPh)2]2[R = Me (L1) or Ph (L2)] afford the chelate complexes [MCl2L1] and [MCl2L2]. The dinuclear palladium(O) complex, [Pd2L13] has been synthesized by starting from [Pd2(dba)3](dba = dibenzylideneacetone). Redox condensation of [Pd2(dba)3] and [PdCl2(PhCN)2] in the presence of the diphosphazane ligands gives the dinuclear palladium(I) complexes [Pd2Cl2L12] and [Pd2Cl2L22]. The structures of the complexes have been deduced from 1H and 31P NMR spectroscopic data. Single-crystal X-ray diffraction studies confirm the structures of [Pd2L13] and [Pd2Cl2L22].

Synthetic Studies Towards Prismanes - Rearrangements In Some Pentacyclic Precursors And X-Ray Crystal-Structure Of A Novel Heptacyclic Ether

In order to gain access to the heptacyclic tetraone 3, efforts were directed towards the utilisation of the major 'unwanted' [4 + 2]-adduct 11 of tetrachlorodimethoxycyclopentadiene and norbornenobenzoquinone. Epoxides derived from the diol and dimethoxy derivatives of the adduct 11 undergo facile Wagner-Meerwein rearrangement resulting in the required endo, syn, endo stereochemistry as well as methano-bridge functionalisation to deliver 18 and 24, respectively. However, intramolecular ether formation, occurring via the capture of carbocation intermediate with the transannularly poised oxygen functionality, is a more facile process. Attempts to cleave the ether linkage resulted in the formation of a novel transannularly cyclised twisted bowl shape heptacyclic compound 30 and its structure has been established through X-ray crystallography.