Risk Factors for Sternal Wound Infection After Open Heart Operations Vary According to Type of Operation

BACKGROUND This study evaluated whether risk factors for sternal wound infections vary with the type of surgical procedure in cardiac operations. METHODS This was a university hospital surveillance study of 3,249 consecutive patients (28% women) from 2006 to 2010 (median age, 69 years [interquartile range, 60 to 76]; median additive European System for Cardiac Operative Risk Evaluation score, 5 [interquartile range, 3 to 8]) after (1) isolated coronary artery bypass grafting (CABG), (2) isolated valve repair or replacement, or (3) combined valve procedures and CABG. All other operations were excluded. Univariate and multivariate binary logistic regression were conducted to identify independent predictors for development of sternal wound infections. RESULTS We detected 122 sternal wound infections (3.8%) in 3,249 patients: 74 of 1,857 patients (4.0%) after CABG, 19 of 799 (2.4%) after valve operations, and 29 of 593 (4.9%) after combined procedures. In CABG patients, bilateral internal thoracic artery harvest, procedural duration exceeding 300 minutes, diabetes, obesity, chronic obstructive pulmonary disease, and female sex (model 1) were independent predictors for sternal wound infection. A second model (model 2), using the European System for Cardiac Operative Risk Evaluation, revealed bilateral internal thoracic artery harvest, diabetes, obesity, and the second and third quartiles of the European System for Cardiac Operative Risk Evaluation were independent predictors. In valve patients, model 1 showed only revision for bleeding as an independent predictor for sternal infection, and model 2 yielded both revision for bleeding and diabetes. For combined valve and CABG operations, both regression models demonstrated revision for bleeding and duration of operation exceeding 300 minutes were independent predictors for sternal infection. CONCLUSIONS Risk factors for sternal wound infections after cardiac operations vary with the type of surgical procedure. In patients undergoing valve operations or combined operations, procedure-related risk factors (revision for bleeding, duration of operation) independently predict infection. In patients undergoing CABG, not only procedure-related risk factors but also bilateral internal thoracic artery harvest and patient characteristics (diabetes, chronic obstructive pulmonary disease, obesity, female sex) are predictive of sternal wound infection. Preventive interventions may be justified according to the type of operation.

Balance de las operaciones de interdicción aérea contra el narcotráfico entre Brasil y Colombia durante la administración Uribe I

El problema del tráfico de estupefacientes se ha convertido no solo en un dificultad para los países productores y consumidores, sino también para países de paso que a su vez se convierten en consumidores. Así la frontera entre Brasil y Colombia se ha convertido en objetivo para la lucha contra las drogas, usando herramientas como la interdicción aérea.

Experimental analysis of an electromagnetic zero-sequence suppressor

The intent of this paper is to present contributions focused on the analysis and development of harmonic attenuator devices. Among these, highlights here the so-called electromagnetic zero-sequence suppressor. This arrangement consists of a filter and a blocker, both electromagnetic, whose combined operation provides paths for low and high impedance, respectively, which can be conveniently adjusted to the desired performance. In this context, here are present results related to experimental studies that show the behavior of the equipment in front of different operating conditions. The tests were performed on a low-power prototype (1kVA/220V) and the analysis results show the main motivator aspects for the use of these devices. © 2012 IEEE.

Role of polarisation in automatic target recognition using resonance descriptions

The role of polarisation in late time complex resonance based target identification is investigated numerically for the case of an L-shaped wire. While repeated extraction of the resonances for varying polarisation allows for better signal-to-noise immunity, it is also found that there are preferred polarisations for each complex resonance. The first few of these polarisations are extracted for the sample target.

Beyond the Pay: Current Illicit Activities of the Armed Forces in Central America

The growth of criminal gangs and organized crime groups has created unprecedented challenges in Central America. Homicide rates are among the highest in the world, countries spend on average close to 10 percent of GDP to respond to the challenges of public insecurity, and the security forces are frequently overwhelmed and at times coopted by the criminal groups they are increasingly tasked to counter. With some 90 percent of the 700 metric tons of cocaine trafficked from South America to the United States passing through Central America, the lure of aiding illegal traffickers through provision of arms, intelligence, or simply withholding or delaying the use of force is enormous. These conditions raise the question: to what extent are militaries in Central America compromised by illicit ties to criminal groups? The study focuses on three cases: Nicaragua, El Salvador, and Honduras. It finds that: Although illicit ties between the military and criminal groups have grown in the last decade, militaries in these countries are not yet “lost’ to criminal groups. Supplying criminal groups with light arms from military stocks is typical and on the rise, but still not common. In general the less exposed services, the navies and air forces, are the most reliable and effective ones in their roles in interdiction. Of the three countries in the study, the Honduran military is the most worrying because it is embedded in a context where civilian corruption is extremely common, state institutions are notoriously weak, and the political system remains polarized and lacks the popular legitimacy and political will needed to make necessary reforms. Overall, the armed forces in the three countries remain less compromised than civilian peers, particularly the police. However, in the worsening crime and insecurity context, there is a limited window of opportunity in which to introduce measures targeted toward the military, and such efforts can only succeed if opportunities for corruption in other sectors of the state, in particular in law enforcement and the justice system, are also addressed. Measures targeted toward the military should include: Enhanced material benefits and professional education opportunities that open doors for soldiers in promising legitimate careers once they leave military service. A clear system of rewards and punishments specifically designed to deter collusion with criminal groups. More effective securing of military arsenals. Skills and external oversight leveraged through combined operations, to build cooperation among those sectors of the military that have successful and clean records in countering criminal groups, and to expose weaker forces to effective best practices.

Steam warfare in the Parana: a narrative of operations, by the combined squadrons of England and France, in forcing a passage up that river,

Sketches of South America, illustrative of allusions in the foregoing narrative, to the geography, natural history, inhabitants, etc., of that part of the world. Extracts translated from Felix de Azara's Voyages dans l'Amérique Méridionale... v.2, p. [121]-287.

The field book of manures; or The American muck book; treating of the nature, properties, sources, history, and operations of all the principal fertilizers and manures in common use, with specific directions for their preparation, preservation, and application to the soil and to crops; as combined with the leading principles of practical and scientific agriculture; drawn from authentic sources, actual experience, and personal observation ...

Mode of access: Internet.

Combined in-fermenter extraction and cross-flow microfiltration for improved inclusion body processing

In this study we demonstrate a new in-fermenter chemical extraction procedure that degrades the cell wall of Escherichia coli and releases inclusion bodies (IBs) into the fermentation medium. We then prove that cross-flow microfiltration can be used to remove 91% of soluble contaminants from the released IBs. The extraction protocol, based on a combination of Triton X-100, EDTA, and intracellular T7 lysozyme, effectively released most of the intracellular soluble content without solubilising the IBs. Cross-flow microfiltration using a 0.2 mum ceramic membrane successfully recovered the granulocyte macrophagecolony stimulating factor (GM-CSF) IBs with removal of 91% of the soluble contaminants and virtually no loss of IBs to the permeate. The filtration efficiency, in terms of both flux and transmission, was significantly enhanced by infermenter Benzonase(R) digestion of nucleic acids following chemical extraction. Both the extraction and filtration methods exerted their efficacy directly on a crude fermentation broth, eliminating the need for cell recovery and re-suspension in buffer. The processes demonstrated here can all be performed using just a fermenter and a single cross-flow filtration unit, demonstrating a high level of process intensification. Furthermore, there is considerable scope to also use the microfiltration system to subsequently solubilise the IBs, to separate the denatured protein from cell debris, and to refold the protein using diafiltration. In this way refolded protein can potentially be obtained, in a relatively pure state, using only two unit operations. (C) 2004 Wiley Periodicals Inc.

Is a Combined School/Public Library Right for Your Community?

This document is intended to assist Iowa communities in making informed decisions on combining school and public library services. It provides decision-makers with a means of assessing the feasibility of establishing a combined library and, if the decision is made to proceed, with a Planning Guide that addresses the many areas of library operations that need to be considered if the combined library is to be successful. Alternatives to combining libraries exist. Contracted services provide one such option. There are many areas where school and public libraries can and should collaborate in order to provide better service to the community. These alternatives are also outlined in this document.