Early post-operative mortality after major lower limb amputation: A systematic review of population and regional based studies

OBJECTIVE: Lower limb amputation is often associated with a high risk of early post-operative mortality. Mortality rates are also increasingly being put forward as a possible benchmark for surgical performance. The primary aim of this systematic review is to investigate early post-operative mortality following a major lower limb amputation in population/regional based studies, and reported factors that might influence these mortality outcomes. METHODS: Embase, PubMed, Cinahl and Psycinfo were searched for publications in any language on 30 day or in hospital mortality after major lower limb amputation in population/regional based studies. PRISMA guidelines were followed. A self developed checklist was used to assess quality and susceptibility to bias. Summary data were extracted for the percentage of the population who died; pooling of quantitative results was not possible because of methodological differences between studies. RESULTS: Of the 9,082 publications identified, results were included from 21. The percentage of the population undergoing amputation who died within 30 days ranged from 7% to 22%, the in hospital equivalent was 4-20%. Transfemoral amputation and older age were found to have a higher proportion of early post-operative mortality, compared with transtibial and younger age, respectively. Other patient factors or surgical treatment choices related to increased early post-operative mortality varied between studies. CONCLUSIONS: Early post-operative mortality rates vary from 4% to 22%. There are very limited data presented for patient related factors (age, comorbidities) that influence mortality. Even less is known about factors related to surgical treatment choices, being limited to amputation level. More information is needed to allow comparison across studies or for any benchmarking of acceptable mortality rates. Agreement is needed on key factors to be reported.

Ideological notions in public health care rationing : Case studies from Oregon, New Zealand and Finland

The purpose of this dissertation is to analyze and explicate the ideological content, which is often implicit, in the health care rationing discussion. The phrase "ideological content" refers to viewpoints and assumptions expressed in the rationing discussion that may be widespread and accepted, but without clear evidential support. The study method is philosophical text analysis. The study begins by exploring the literature from the 1970s that affects the present-day rationing discussion. Since ideological contents may have different emphases in realm of health care, three representative cases were studied. The first was a case study of the first and best-known rationing experiment in the American state of Oregon, namely, an experimental rationing plan within the public health program Medicaid, which is designed to provide care for the poor and underprivileged. The second was a study of the only national-level public priority setting that has been conducted in New Zealand. The third examined the Finnish Care Guarantee plan introduced in March 2005. The findings show that several problematic and scientifically mostly unproven concepts have remained largely uncontested in the debate about public health care rationing. Some of these notions already originated decades ago in studies that relied on outdated data or research paradigms. The problematic ideological contents have also been taken up from one publication into another, thereby affecting the rationing debate. The study suggests that before any new public health care rationing experiments are undertaken, these ideological factors should be properly examined, especially in order to avoid repetitious research and perhaps erroneous rationing decisions.

One Word, One Body, One Voice : Studies in Apophatic Theology and Christocentric Anthropology in Gregory of Nyssa

The thesis consists of five international congress papers and a summary with an introduction. The overarching aim of the studies and the summary is to examine the inner coherency of the theological and anthropological thinking of Gregory of Nyssa (331-395). To the issue is applied an "apophatic approach" with a "Christological focus". It is suggested that the coherency is to be found from the Christological concept of unity between "true God" and "true man" in the one person of Jesus Christ. Gregory is among the first to make a full recognition of two natures of Christ, and to use this recognition systematically in his writings. The aim of the studies is pursued by the method of "identification", a combination of the modern critical "problematic method" and Gregory's own aphairetic method of "following" (akolouthia). The preoccupation with issues relating to the so-called Hellenization of Christianity in the patristic era was strong in the twentieth-century Gregory scholarship. The most discussed questions have been the Greek influence in his thought and his philosophical sources. In the five articles of the thesis it is examined how Gregory's thinking stands in its own right. The manifestly apophatic character of his theological thinking is made a part of the method of examining his thought according to the principles of his own method of following. The basic issue concerning the relation of theology and anthropology is discussed in the contexts of his central Trinitarian, anhtropological, Christological and eschatological sources. In the summary the Christocentric integration of Gregory's thinking is discussed also in relation to the issue of the alledged Hellenization. The main conclusion of the thesis concerns the concept of theology in Gregory. It is not indebted to the classical concept of theology as metaphysics or human speculation of God. Instead, it is founded to the traditional Judeo-Christian idea of God who speaks with his people face to face. In Gregory, theologia connotes the oikonomia of God's self-revelation. It may be regarded as the state of constant expression of love between the Creator and his created image. In theology, the human person becomes an image of the Word by which the Father expresses his love to "man" whom he loves as his own Son. Eventually the whole humankind, as one, gives the divine Word a physical - audible and sensible - Body. Humankind then becomes what theology is. The whole humanity expresses divine love by manifesting Christ in words and deeds, singing in one voice to the glory of the Father, the Son and the Holy Spirit.

Structural studies of analgesics and their interactions. II. The crystal structure of a 1:1 complex between antipyrine and salicyclic acid (salipyrine)

The complex crystallizes in the space group P21/c with four formula units in a unit cell of dimensions a= 12.747, b= 7.416, c= 17.894 A and/3= 90.2 °. The structure has been solved by the symbolic addition procedure using three-dimensional photographic data and refined to an R value of 0.079 for 2019 observed reflexions. The pyramidal nature of the two hetero nitrogen atoms in the antipyrine molecule is inter:nediate between that observed in free antipyrine and in some of its metal complexes. The molecule is more polar than that in crystals of free antipyrine but less so compared with that in metal complexes. In the salicylic acid molecule, the hydroxyl group forms an internal hydrogen bond with one of the oxygen atoms in the carboxyl group. The association between the salicylic acid and the antipyrine molecules is achieved through an intermolecular hydrogen bond with the other carboxyl oxygen atom in the salicylic acid molecule as the proton donor and the carboxyl oxygen atom of the antipyrine molecule as the acceptor.

Mossbauer effect studies of the thermal decomposition of iron(II) oxalate in hydrogen

Mössbauer-effect and X-ray studies were carried out on the product samples of the thermogravimetric analysis (TGA) and of the isothermal decomposition of iron(II) oxalate in flowing H2. Two types of sample configurations were employed for isothermal studies between 280 to 420°C for various periods of heating. Low temperature Mossbauer measurements at liquid nitrogen temperature were carried out to examine the superparamagnetic (SPM) contributions. From the spectra of samples decomposed at 340°C, in vertical experiments, the percentage SPM and percentage ferromagnetic (FM) area of Fe3O4 were estimated and an average size (˜167Å) for Fe3O4 was derived. Mossbauer measurements (at high temperatures) were carried out on Fe3C formed in horizontal experiments, for two samples decomposed at ˜320°C for 1 hr and 2 hr. An estimate of SPM and FM Fe3C was obtained by calculating KV, the anisotropy energy for the Fe3C in these two samples and values of 5.07 × 10−16 and 7.02 × 10−16 erg/sec, respectively, were obtained.

Studies on electrical conductivity of insulator-conductor composites

The variation of electrical resistivity of an insulator-conductor composite, namely, wax-graphite composite, with parameters such as volume fraction, grain size, and temperature has been studied. A model is proposed to explain the observed variations, which assumes that the texture of the composite consists of insulator granules coated with conducting particles. The resistivity of these materials is controlled mainly by the contact resistance between the conducting particles and the number of contacts each particle has with its neighbors. The variation of resistivity with temperature has also been explained with the help of this model and it is attributed to the change in contact area. Journal of Applied Physics is copyrighted by The American Institute of Physics.

Studies on nucleotidases in plants Dimerization of the crystalline mung bean nucleotide pyrophosphatase by 5-adenosine monophosphate and the properties of the dimerized enzyme

The addition of AMP to the crystalline and homogeneous mung bean nucleotide pyrophosphatase [EC 3.6.1.9]altered its electrophoretic mobility. AMP was tightly bound to the enzyme and was not removed on passage through a column of Sephadex G-25 or on electrophoresis. The molecular weight of the native and AMP-modified enzymes were 65,000 and 136,000, respectively. The properties of the native enzyme such as the pH (9.4) and temperature (49 °C) optima, inhibition by EDTA, reversal of EDTA-inhibition by Zn2+ and Co2+, were not altered on dimerization by AMP. The AMP-modified enzyme had a linear time-course of reaction, unlike the native enzyme which exhibited a biphasic time-course of reaction. The AMP-modified enzyme was irreversibly denatured by urea. AMP concentrations larger than 100 μM inhibited linearly the activity of the AMP-modified enzyme. ADP and ATP inhibited the activity in a sigmoidal manner. Km and V of the native and AMP-modified enzymes were, 0.25 mImage and 0.58 mImage ; and 3.3 and 2.5, respectively.

Chemical modification studies on Abrus agglutinin Involvement of tryptophan residues in sugar binding

The galactose-binding lectin from the seeds of the jequirity plant (Abrus precatorius) was subjected to various chemical modifications in order to detect the amino acid residues involved in its binding activity. Modification of lysine, tyrosine, arginine, histidine, glutamic acid and aspartic acid residues did not affect the carbohydratebinding activity of the agglutinin. However, modification of tryptophan residues carried out in native and denaturing conditions with N-bromosuccinimide and 2- hydroxy-5-nitrobenzyl bromide led to a complete loss of its carbohydrate-binding activity. Under denaturing conditions 30 tryptophan residues/molecule were modified by both reagents, whereas only 16 and 18 residues/molecule were available for modification by N-bromosuccinimide and 2-hydroxy-5-nitrobenzyl bromide respectively under native conditions. The relative loss in haemagglutinating activity after the modification of tryptophan residues indicates that two residues/molecule are required for the carbohydrate-binding activity of the agglutinin. A partial protection was observed in the presence of saturating concentrations of lactose (0.15 M). The decrease in fluorescence intensity of Abrus agglutinin on modification of tryptophan residues is linear in the absence of lactose and shows a biphasic pattern in the presence of lactose, indicating that tryptophan residues go from a similar to a different molecular environment on saccharide binding. The secondary structure of the protein remains practically unchanged upon modification of tryptophan residues, as indicated by c.d. and immunodiffusion studies, confirming that the loss in activity is due to modification only.

Rocket Propellant Combustion Studies in a Constant Volume Bomb

A constant volume window bomb has been used to measure the characteristic velocity (c*) of rocket propellants. Analysis of the combustion process inside the bomb including heat losses has been made. The experiments on double base and composite propellants have revealed some (i) basic heat transfer aspects inside the bomb and (ii) combustion characteristics of Ammonium Perchlorate-Polyester propellants. It has been found that combustion continues even beyond the peak pressure and temperature points. Lithium Fluoride mixed propellants do not seem to indicate significant differences in c*) though the low pressure deflagration limit is increased with percentage of Lithium Fluoride.

Dielectric and Electron Spin Resonance Spectroscopic Studies of Glassy Crystalline States of Organic Compounds

Dielectric studies of the glassy crystalline states of cyclohexanol, cyclohexanone, and camphor obtained by upercooling the plastic crystalline phase demonstrate the presence of characteristic a- and p-relaxations. The parameters of the a-relaxation fit the Vogel-Tammann-Fulcher (VTF) equation. ESR spin-probe studies of the glassy crystalline phase of cyclohexanol show that there is a marked decrease in the correlation time above the glasslike transition temperature. The present studies suggest the similarity between glassy crystals having long-range orientational disorder and glasses which are known to betra nslationally disordered.

Preparation, IR and nuclear magnetic resonance studies on the rare-earth perchlorate complexes of 3-methylpyridine-1-oxide

THE COMPLEXES of pyridine-l-oxide and 2- and 4-substituted pyridine-l-oxides have been investigated previously[l]. The complexes of 3-substituted pyfidine-l-oxides, however, have received little attention. The rare-earth complexes of pyridine-Ioxide[l, 2], 4-methylpyridine- l-oxide [1] and 2,6- dimethylpyfidine-l-oxide[3,4] have been reported earlier. The present paper deals with the isolation and characterisation of 3-methylpyridine-l-oxide (3-Picoline-N-oxide, 3-PicNO) complexes with rare-earth perchlorates.