Risk factors for surgical site infections among patients undergoing major colon surgery in the United States 2007-2009

Background: Surgical site infections (SSIs) after abdominal surgeries account for approximately 26% of all reported SSIs. The Center for Disease Control and Prevention (CDC) defines 3 types of SSIs: superficial incisional, deep incisional, and organ/space. Preventing SSIs has become a national focus. This dissertation assesses several associations with the individual types of SSI in patients that have undergone colon surgery. ^ Methods: Data for this dissertation was obtained from the American College of Surgeons' National Surgical Quality Improvement Program (NSQIP); major colon surgeries were identified in the database that occurred between the time period of 2007 and 2009. NSQIP data includes more than 50 preoperative and 30 intraoperative factors; 40 collected postoperative occurrences are based on a follow-up period of 30 days from surgery. Initially, four individual logistic regressions were modeled to compare the associations between risk factors and each of the SSI groups: superficial, deep, organ/space and a composite of any single SSI. A second analysis used polytomous regression to assess simultaneously the associations between risk factors and the different types of SSIs, as well as, formally test the different effect estimates of 13 common risk factors for SSIs. The final analysis explored the association between venous thromboembolism (VTEs) and the different types of SSIs and risk factors. ^ Results: A total of 59,365 colon surgeries were included in the study. Overall, 13% of colon cases developed a single type of SSI; 8% of these were superficial SSIs, 1.4% was deep SSIs, and 3.8% were organ/space SSIs. The first article identifies the unique set of risk factors associated with each of the 4 SSI models. Distinct risk factors for superficial SSIs included factors, such as alcohol, chronic obstructive pulmonary disease, dyspnea and diabetes. Organ/space SSIs were uniquely associated with disseminated cancer, preoperative dialysis, preoperative radiation treatment, bleeding disorder and prior surgery. Risk factors that were significant in all models had different effect estimates. The second article assesses 13 common SSI risk factors simultaneously across the 3 different types of SSIs using polytomous regression. Then each risk factor was formally tested for the effect heterogeneity exhibited. If the test was significant the final model would allow for the effect estimations for that risk factor to vary across each type of SSI; if the test was not significant, the effect estimate would remain constant across the types of SSIs using the aggregate SSI value. The third article explored the relationship of venous thromboembolism (VTE) and the individual types of SSIs and risk factors. The overall incidence of VTEs after the 59,365 colon cases was 2.4%. All 3 types of SSIs and several risk factors were independently associated with the development of VTEs. ^ Conclusions: Risk factors associated with each type of SSI were different in patients that have undergone colon surgery. Each model had a unique cluster of risk factors. Several risk factors, including increased BMI, duration of surgery, wound class, and laparoscopic approach, were significant across all 4 models but no statistical inferences can be made about their different effect estimates. These results suggest that aggregating SSIs may misattribute and hide true associations with risk factors. Using polytomous regression to assess multiple risk factors with the multiple types of SSI, this study was able to identify several risk factors that had significant effect heterogeneity across the 3 types of SSI challenging the use of aggregate SSI outcomes. The third article recognizes the strong association between VTEs and the 3 types of SSIs. Clinicians understand the difference between superficial, deep and organ/space SSIs. Our results indicate that they should be considered individually in future studies.^

Daily polynya area and ice production in the North Water polynya region

The North Water (NOW) Polynya is a regularly-forming area of open-water and thin-ice, located between northwestern Greenland and Ellesmere Island (Canada) at the northern tip of Baffin Bay. Due to its large spatial extent, it is of high importance for a variety of physical and biological processes, especially in wintertime. Here, we present a long-term remote sensing study for the winter seasons 1978/1979 to 2014/2015. Polynya characteristics are inferred from (1) sea ice concentrations and brightness temperatures from passive microwave satellite sensors (Advanced Microwave Scanning Radiometer (AMSR-E and AMSR2), Scanning Multichannel Microwave Radiometer (SMMR), Special Sensor Microwave Imager/Sounder (SSM/I-SSMIS)) and (2) thin-ice thickness distributions, which are calculated using MODIS ice-surface temperatures and European Center for Medium-Range Weather Forecasts (ECMWF) atmospheric reanalysis data in a 1D thermodynamic energy-balance model. Daily ice production rates are retrieved for each winter season from 2002/2003 to 2014/2015, assuming that all heat loss at the ice surface is balanced by ice growth. Two different cloud-cover correction schemes are applied on daily polynya area and ice production values to account for cloud gaps in the MODIS composites. Our results indicate that the NOW polynya experienced significant seasonal changes over the last three decades considering the overall frequency of polynya occurrences, as well as their spatial extent. In the 1980s, there were prolonged periods of a more or less closed ice cover in northern Baffin Bay in winter. This changed towards an average opening on more than 85% of the days between November and March during the last decade. Noticeably, the sea ice cover in the NOW polynya region shows signs of a later-appearing fall freeze-up, starting in the late 1990s. Different methods to obtain daily polynya area using passive microwave AMSR-E/AMSR2 data and SSM/I-SSMIS data were applied. A comparison with MODIS data (thin-ice thickness < 20 cm) shows that the wintertime polynya area estimates derived by MODIS are about 30 to 40% higher than those derived using the polynya signature simulation method (PSSM) with AMSR-E data. In turn, the difference in polynya area between PSSM and a sea ice concentration (SIC) threshold of 70% is fairly low (approximately 10%) when applied to AMSR-E data. For the coarse-resolution SSM/I-SSMIS data, this difference is much larger, particularly in November and December. Instead of a sea ice concentration threshold, the PSSM method should be used for SSM/I-SSMIS data. Depending on the type of cloud-cover correction, the calculated ice production based on MODIS data reaches an average value of 264.4 ± 65.1 km**3 to 275.7 ± 67.4 km**3 (2002/2003 to 2014/2015) and shows a high interannual variability. Our achieved long-term results underline the major importance of the NOW polynya considering its influence on Arctic ice production and associated atmosphere/ocean processes.

Minimum water input event for seedling emergence of three native perennial grasses of the Central Monte desert (Argentina) influenced by the effect of shade and the season of the year

In deserts, seedling emergence occurs only after precipitation threshold has been exceeded, however, the presence of trees modifies microenvironmental conditions that might affect the effectiveness of a water pulse. In the Monte desert, Prosopis flexuosa trees generate different micro-environmental conditions that might influence grass seedlings establishment. The objective of this work was: a) to know the effective minimum water input event that triggers the emergence of native perennial grass seedlings; b) to relate this fact with the effect of the shade of P. flexuosa canopy and the seasonal temperatures. Three important forage species of the Monte were studied: Pappophorum caespitosum and Trichloris crinita, with C4, and Jarava ichu, with C3 metabolism. Each season, seeds of these species were sown in pots placed at two light conditions: shade (similar to P. flexuosa cover) and open area, and with seven irrigation treatments (0, 10, 20, 30, 40, 2*10 and 3*10 mm). J. ichu did not emerge in any of the treatments. Significant seedling emergence was registered for P. caespitosum and T. crinita in shade conditions with 40 mm irrigation treatment in summer. Since 40 mm precipitation events are infrequent in the Monte, seedling emergence for these species would be restricted to exceptional rainy years. The facilitating effect of P. flexuosa shade would be important during the hot season.

Properties and faunal abundances of level sea ice and sea-ice ridges in the Chukchi/Beaufort Seas and Canada Basin

The abundances and distribution of metazoan within-ice meiofauna (13 stations) and under-ice fauna (12 stations) were investigated in level sea ice and sea-ice ridges in the Chukchi/Beaufort Seas and Canada Basin in June/July 2005 using a combination of ice coring and SCUBA diving. Ice meiofauna abundance was estimated based on live counts in the bottom 30 cm of level sea ice based on triplicate ice core sampling at each location, and in individual ice chunks from ridges at four locations. Under-ice amphipods were counted in situ in replicate (N=24-65 per station) 0.25 m**2 quadrats using SCUBA to a maximum water depth of 12 m. In level sea ice, the most abundant ice meiofauna groups were Turbellaria (46%), Nematoda (35%), and Harpacticoida (19%), with overall low abundances per station that ranged from 0.0 to 10.9 ind/l (median 0.8 ind/l). In level ice, low ice algal pigment concentrations (<0.1-15.8 µg Chl a /l), low brine salinities (1.8-21.7) and flushing from the melting sea ice likely explain the low ice meiofauna concentrations. Higher abundances of Turbellaria, Nematoda and Harpacticoida also were observed in pressure ridges (0-200 ind/l, median 40 ind/l), although values were highly variable and only medians of Turbellaria were significantly higher in ridge ice than in level ice. Median abundances of under-ice amphipods at all ice types (level ice, various ice ridge structures) ranged from 8 to 114 ind/m**2 per station and mainly consisted of Apherusa glacialis (87%), Onisimus spp. (7%) and Gammarus wilkitzkii (6%). Highest amphipod abundances were observed in pressure ridges at depths >3 m where abundances were up to 42-fold higher compared with level ice. We propose that the summer ice melt impacted meiofauna and under-ice amphipod abundance and distribution through (a) flushing, and (b) enhanced salinity stress at thinner level sea ice (less than 3 m thickness). We further suggest that pressure ridges, which extend into deeper, high-salinity water, become accumulation regions for ice meiofauna and under-ice amphipods in summer. Pressure ridges thus might be crucial for faunal survival during periods of enhanced summer ice melt. Previous estimates of Arctic sea ice meiofauna and under-ice amphipods on regional and pan-Arctic scales likely underestimate abundances at least in summer because they typically do not include pressure ridges.

Respiration and ingestion rates of calanoid copepod in the northern Benguela Current System measured ex situ during the RSS Discovery D356 cruise in 2010

Respiration rates of 16 calanoid copepod species from the northern Benguela upwelling system were measured on board RRS Discovery in September/October 2010 to determine their energy requirements and assess their significance in the carbon cycle. Copepod species were sampled by different net types. Immediately after the hauls, samples were sorted to species and stages (16 species; females, males and C5 copepodids) according to Bradford-Grieve et al. (1999). Specimens were kept in temperature-controlled refrigerators for at least 12 h before they were used in experiments. Respiration rates of different copepod species were measured onboard by optode respirometry (for details see Köster et al., 2008) with a 10-channel optode respirometer (PreSens Precision Sensing Oxy-10 Mini, Regensburg, Germany) under simulated in situ conditions in temperature-controlled refrigerators. Experiments were run in gas-tight glass bottles (12-13 ml). For each set of experiments, two controls without animals were measured under exactly the same conditions to compensate for potential bias. The number of animals per bottle depended on the copepods size, stage and metabolic activity. Animals were not fed during the experiments but they showed natural species-specific movements. Immediately after the experiments, all specimens were deep-frozen at - 80 °C for later dry mass determination (after lyophilisation for 48 h) in the home lab. The carbon content (% of dry mass) of each species was measured by mass-spectrometry in association with stable isotope analysis and body dry mass was converted to units of carbon. For species without available carbon data, the mean value of all copepod species (44% dry mass) was applied. For the estimation of carbon requirements of copepod species, individual oxygen consumption rates were converted to carbon units, assuming that the expiration of 1 ml oxygen mobilises 0.44 mg of organic carbon by using a respiratory quotient (RQ) of 0.82 for a mixed diet consisting of proteins (RQ = 0.8-1.0), lipids (RQ = 0.7) and carbohydrates (RQ = 1.0) (Auel and Werner, 2003). The carbon ingestion rates were calculated using the energy budget and the potential maximum ingestion rate approach. To allow for physiological comparisons of respiration rates of deep- and shallow-living copepod species without the effects of ambient temperature and different individual body mass, individual respiration rates were temperature- (15°C, Q10=2) and size-adjusted. The scaling coefficient of 0.76 (R2=0.556) is used for the standardisation of body dry mass to 0.3 mg (mean dry mass of all analysed copepods), applying the allometric equation R= (R15°C/M0.76)×0.30.76, where R is respiration and M is individual dry mass in mg.

Daily ice production and polynya area in the Laptev Sea region during 1979-2009

Polynyas in the Laptev Sea are examined with respect to recurrence and interannual wintertime ice production.We use a polynya classification method based on passive microwave satellite data to derive daily polynya area from long-term sea-ice concentrations. This provides insight into the spatial and temporal variability of open-water and thin-ice regions on the Laptev Sea Shelf. Using thermal infrared satellite data to derive an empirical thin-ice distribution within the thickness range from 0 to 20 cm, we calculate daily average surface heat loss and the resulting wintertime ice formation within the Laptev Sea polynyas between 1979 and 2008 using reanalysis data supplied by the National Centers for Environmental Prediction, USA, as atmospheric forcing. Results indicate that previous studies significantly overestimate the contribution of polynyas to the ice production in the Laptev Sea. Average wintertime ice production in polynyas amounts to approximately 55 km3 ± 27% and is mostly determined by the polynya area, wind speed and associated large-scale circulation patterns. No trend in ice production could be detected in the period from 1979/80 to 2007/08.

Oceanographical and meterological observations in the Westafrican area of upwelling during the 'Deutsche Nordatlantische Expedition' 1937

In 1937 the "Meteor" performed the cruises of the first part of the "Deutsche Nordatlantische Expedition". This publication treats seven stations of three-day-anchoring occupied during that time, five of which are located on the shelf, one on the continental slope and one on a ridge between the Capverde islands. The Bohnecke current meter, an instrument developed for the expedition, is described briefly and it's accuracy studied by comparing the measurements of two instruments which operated simultaneously at the same depth. It is shown that it is very sensitive for movements of the anchored ship because of the very short measuring intervall (2 minutes). The influence of the ship's movements could not be eliminated completely, the mode of using the instrument at different depths being unsuitable for this. Considering the stratification the accuracy of it's representation by the mean temperature and salinity distributionis studied. It is shown that under certain conditions a distribution estimated from observed values gives more exact results. This especially applies to the TS-diagram. Station Meteor336, located on the shelf near Cape Juby, shows temperatures 4 °C less than the open ocean and so belongs to the area of upwelling. During the observation period, however, internal tides are prominent. The diurnal component is of considerable influence, the distinction from inertial oscillations (25.5 hours) not being possible, however. Station Meteor341, on the shelf off Spanish-Sahara, gives an excellent example of the movements in the centre of the area of upwelling. Changing it's direction by 45° at the beginning of the measurements, the wind causes a change of current direction at all depths which, after some inertial oscillations (period 28.3 hours), settles down to a final value. At the beginning and the end of the observations the current at the upper depths is directed off-shore, the angle between current and wind being 22°, while at the lower depths it is orientated towards the shore. The depth of the upper homogenous layer gives the origin of the water transported upwards When during the inertial oscillations the current goes offshore at all depths temporarily, a sudden disturbance occurs in the temperature measurements. Station Meteor311 is located similar to station Meteor341 but was occupied one month earlier. At that time the wind situation was unnormal, the usual wind direction of 45° occuring at the end of the station. Therefore an unnormally high vertical shear of current speed and direction has been observed, the current vector being directed off-shore at the surface and near the bottom, towards the coast inbetween. The TS-diagram shows that the bottom water is replaced first so that upwelling does not occur during observation time. The state reached at the end of the station does not seem to be stable. Station Meteor369, on the continental slope, is governed by internal waves. Besides the internal tide of 12.4 hours a wave of 6.5 hour period is observed, being possibly amplified by the large bottom slope. In 40 - 60 m depth, where the thermocline is located, a wave with 3.3 hour period is observed which is argued to be an internal boundary wave. Station Meteor334 is located on the shelf NW of the mouth of the Senegal river. A marked temperature stratification, associated with large disturbances, and nearly constant salinity have been found there. The current was going slowly towards S or SW in the upper 20 - 30 m, towards N underneath. At the boundary of the current systems intense turbulence developed,including as it seems a water type of less salinity which is transported from the Senegal river by the lower current. Station Meteor327, located at 100 m depth between two of the Capverde islands, shows oceanic characteristics. The semidiurnal tide is found mainly, the diurnal component having considerable influence. Furtheron an internal wave of 6 hour period is seen the maximum amplitude of which is moving slowly downwards. Two possibilities of explaining it are discussed. Station Meteor366 is found in the area of ceasing winds off the coast of upper Guinea. The temperature there depends strongly on the depth, the salinity being nearly constant. The currents are divided into an upper and a lower system with large variations in both of them. A change of wind direction of nearly 90° is supposed to be the reason. The variations in salinity accordingly are interpreted as the influence of fresh water outflow from land which is felt in a different way at different wind directions. In the last section the daily changes in air and water temperature are studied. The upwelling having large influence on these, a centre of the area of upwelling can be located at about 100 miles north of Cape Blanc (Station Meteor311). The semidiurnal tidal component is compared with previous results for the Atlantic Ocean yielding considerable differences for the direction and time of occurence of the current maximum which might be due to the topographical influences around the shelf.

(Table 1) Lipid content and organohalogen contaminant concentration in plasma of incubating glaucous gulls (Larus hyperboreus) from Bjørnøya, Norwegian Arctic in 2006

The factors influencing prolactin (PRL) variation in birds and in wildlife in general have rarely been investigated with respect to the physiological impacts of exposure to environmental contaminants. We investigated the associations between circulating baseline PRL levels and concentrations of eight persistent organohalogen contaminant (OHC) classes (i.e., major organochlorines and brominated flame retardants, and associated metabolic products) in blood (plasma) of free-ranging glaucous gulls (Larus hyperboreus), a top predator in the Norwegian Arctic, engaged in the process of incubation. We further examined whether plasma OHC concentrations were associated with the variation of PRL in glaucous gulls exposed to a standardized capture/restraint protocol. Plasma OHC concentrations in male glaucous gulls were 2-to 3-fold higher relative to females. Baseline PRL levels tended to be higher in females compared to males, although not significantly (p = 0.20). In both males and females, the 30-min capture/restraint protocol led on average to a 26% decrease in PRL levels, which resulted in a rate of PRL decrease of 0.76 ng/mL/min. The baseline PRL levels and the rate of decrease in PRL levels tended to vary negatively with plasma OHC concentrations in males, but not in females, although several of these associations did not adhere with the criterion of significance (alpha = 0.05). Present results suggest that in highly OHC-exposed male glaucous gulls, the control of PRL release may be affected by the direct or indirect modulating actions of OHCs and/or their metabolically derived products. We conclude that potentially OHC-mediated impact on PRL secretion in glaucous gulls (males) may be a contributing factor to the adverse effects observed on the reproductive behavior, development and population size of glaucous gulls breeding in the Norwegian Arctic.

Growth increments of the recent brachiopod Magellania venosa mechanically marked in Paso Comau and Comau Fjord, Chile, 2011/2012

Magellania venosa, the largest recent brachiopod, occurs in clusters and banks in population densities of up to 416 ind/m**2 in Comau Fjord, Northern Chilean fjord region. Below 15 m, it co-occurs with the mytilid Aulacomya atra and it dominates the benthic community below 20 m. To determine the question of why M. venosa is a successful competitor, the in situ growth rate of the brachiopod was studied and its overall growth performance compared with that of other brachiopods and mussels. The growth in length was measured between February 2011 and March 2012 after mechanical tagging and calcein staining. Settlement and juvenile growth were determined from recruitment tiles installed in 2009 and from subsequent photocensus. Growth of M. venosa is best described by the general von Bertalanffy growth function, with a maximum shell length (Linf) of 71.53 mm and a Brody growth constant (K) of 0.336/year. The overall growth performance (OGP index = 5.1) is the highest recorded for a rynchonelliform brachiopod and in the range of that for Mytilus chilensis (4.8-5.27), but lower than that of A. atra (5.74). The maximal individual production (PInd) is 0.29 g AFDM/ind/year at 42 mm shell length and annual production ranges from 1.28 to 89.25 g AFDM/year/m**2 (1-57% of that of A. atra in the respective fjords). The high shell growth rate of M. venosa, together with its high overall growth performance may explain the locally high population density of this brachiopod in Comau Fjord. However, the production per biomass of the population (P/B-ratio) is low (0.535) and M. venosa may play only a minor role in the food chain. Settling dynamics indicates that M. venosa is a pioneer species with low juvenile mortality. The coexistence of the brachiopod and bivalve suggests that brachiopod survival is affected by neither the presence of potential brachiopod predators nor that of space competitors (i.e. mytilids).

Pollen analysis of sediment cores from the mouth of the river Congo to Walvis Bay and Lüderitz

The distribution of pollen in marine sediments is used to record vegetation changes over the past 30,000 years on the adjacent continent. A transect of marine pollen sequences from the mouth of the river Congo (~5°S) to Walvis Bay and Lüderitz (~25°S) shows vegetation changes in Congo, Angola and Namibia from the last glacial period into the Holocene. The comparison of pollen records from different latitudes provides information about the latitudinal shift of open forest and savannahs (Poaceae pollen), the extension of lowland forest (rain forest pollen) and Afromontane forest (Podocarpus pollen), and the position of the desert fringe (pollen of Caryophyllaceae, Chenopodiaceae and Amaranthaceae). High Cyperaceae pollen percentages in sediments from the last glacial period off the mouth of the river Congo suggest the presence of open swamps rather than savannah vegetation in the Congo Basin. Pollen from Restionaceae in combination with Stoebe-type pollen (probably from Elytropappus) indicates a possible northwards extension of winter rain vegetation during the last glacial period. The record of Rhizophora (mangrove) pollen is linked to erosion of the continental shelf and sea-level rise. Pollen influx is highest off river mouths (10-2000 grains year**-1 cm**-2), close to the coast (300-6000 grains year**-1 cm**-2), but is an order of magnitude lower at sites situated far from the continent (<10 grains year**-1 cm**-2).