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Assessment of the effectiveness of weight-adjusted antibiotic administration,for reduced duration,in surgical prophylaxis of primary hip and knee arthroplasty

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World Journal of Orthopedics 2024年第2期15卷 170-179页

作者： Tosan Okoro Michael Wan Takura Darlington Mukabeta Ella Malev Marketa Gross Claudia Williams Muhammad Manjra Jan Herman Kuiper John Murnaghan Department of Arthroplasty Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation TrustOswestry SY107AGUnited Kingdom School of Medicine Keele UniversityStaffordshire ST55BGUnited Kingdom St Joseph’s Health Centre Unity Health TorontoToronto M6R 1B5Canada Department of Arthroplasty The Royal London HospitalBarts Health NHS TrustLondon E11BBUnited Kingdom Department of Arthroplasty Sunnybrook Holland Orthopaedic and Arthritis CentreToronto M4Y 1H1Canada Institute for Science and Technology in Medicine Keele UniversityStaffordshire ST51BGUnited Kingdom

BACKGROUND Prophylactic antibiotics have significantly led to a reduction in the risk of postoperative surgical site infections(SSI)in orthopaedic *** aim of using antibiotics for this purpose is to achieve serum and tissue drug levels that exceed,for the duration of the operation,the minimum inhibitory concentration of the likely organisms that are *** antibiotics reduce the rate of SSIs in lower limb arthroplasty from between 4%and 8%to between 1%and 3%.Controversy,however,still surrounds the optimal frequency and dosing of antibiotic *** To evaluate the impact of introduction of a weight-adjusted antibiotic prophylaxis regime,combined with a reduction in the duration of administration of post-operative antibiotics on SSI incidence during the 2 years following primary elective total hip and knee arthroplasty METHODS Following ethical approval,patients undergoing primary total hip arthroplasty(THA)/total knee arthroplasty(TKA)with the old regime(OR)of a preoperative dose[cefazolin 2 g intravenously(IV)],and two subsequent doses(2 h and 8 h),were compared to those after a change to a new regime(NR)of a weight-adjusted preoperative dose(cefazolin 2 g IV for patients120 kg)and a post-operative dose at 2 *** primary outcome in both groups was SSI rates during the 2 years *** A total of n=1273 operations(THA n=534,TKA n=739)were performed in n=1264 *** was no statistically significant difference in the rate of deep(OR 0.74%(5/675)vs NR 0.50%(3/598);fishers exact test P=0.72),nor superficial SSIs(OR 2.07%(14/675)vs NR 1.50%(9/598);chi-squared test P=0.44)at 2 years *** propensity score weighting and an interrupted time series analysis,there was also no difference in SSI rates between both groups[RR 0.88(95%CI 0.61 to 1.30)P=0.46].CONCLUSION A weight-adjusted regime,with a reduction in number of post-operative doses had no adverse impact on S

关键词： Antibiotics Weight-adjusted Hip and knee arthroplasty Surgical site infection

Recent Ventures in Interdisciplinary Arctic Research:The ARCPATH Project

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Advances in Atmospheric Sciences 2024年第8期41卷 1559-1568页

作者： Astrid E.J.OGILVIE Leslie A.KING Noel KEENLYSIDE François COUNILLON Brynhildur DAVIÐSDÓTTIR Níels EINARSSON Sergey GULEV Ke FAN Torben KOENIGK James R.MCGOODWIN Marianne H.RASMUSSON Shuting YANG Institute of Arctic and Alpine Research(INSTAAR) University of ColoradoBoulder CO 80303USA Stefansson Arctic Institute AkureyriÍS-600Iceland royal Roads University BC V9B 5Y2Canada University of Bergen Bergen N-5007Norway Nansen Environmental and Remote Sensing Centre Bergen N-5007Norway University of Iceland Reykjavík 102Iceland Shirshov Institute of Oceanology Moscow 117218Russia Moscow State University Moscow 11991Russia Chinese Academy of Sciences Beijing 100045China Swedish Meteorological and Hydrological Institute SE-60176 NorrköpingSweden Danish Meteorological Institute CopenhagenØ2100Denmark Obukhov Institute of Atmospheric Physics RAS119017MoscowRussia

This paper celebrates Professor Yongqi GAO's significant achievement in the field of interdisciplinary studies within the context of his final research project Arctic Climate Predictions: Pathways to Resilient Sustainable Societies-ARCPATH(https://***/en/projects/finished-projects/arcpath). The disciplines represented in the project are related to climatology, anthropology, marine biology, economics, and the broad spectrum of social-ecological studies. Team members were drawn from the Nordic countries, Russia, China, the United States, and canada. The project was transdisciplinary as well as interdisciplinary as it included collaboration with local knowledge holders. ARCPATH made significant contributions to Arctic research through an improved understanding of the mechanisms that drive climate variability in the Arctic. In tandem with this research, a combination of historical investigations and social, economic, and marine biological fieldwork was carried out for the project study areas of Iceland, Greenland, Norway, and the surrounding seas, with a focus on the joint use of ocean and sea-ice data as well as social-ecological drivers. ARCPATH was able to provide an improved framework for predicting the near-term variation of Arctic climate on spatial scales relevant to society, as well as evaluating possible related changes in socioeconomic realms. In summary, through the integration of information from several different disciplines and research approaches, ARCPATH served to create new and valuable knowledge on crucial issues, thus providing new pathways to action for Arctic communities.

关键词： Recent Ventures in Interdisciplinary Arctic Research:The ARCPATH Project

An investigation of roof runoff during rain events at the royal Military College of canada and potential discharge to Lake Ontario

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Journal of Environmental Sciences 2011年第7期23卷 1072-1078页

作者： David G. Kelly Ron D. Weir Steven D. White Analytical Sciences Group & SLOWPOKE-2 Facility at RMC Department of Chemistry and Chemical Engineering Royal Military College of Canada 11 General Crerar Crescent

The royal Military College of canada, located on the north eastern shore of Lake Ontario, possesses an abundance of copper roofs and lacks surface water treatment prior to discharge into Lake Ontario. Rainwater, roof runoff and soil samples were collected and analyzed for copper and other parameters. Copper was consistently detected in runoff samples with average concentrations of 3200 ± 2100 μg/L. Multivariable linear regression analysis for a dependant copper runoff concentration yielded an adjusted R 2 value of 0.611, based on an independent variable model using minimum temperature, maximum temperature, total precipitation, and wind speed. Lake water samples taken in the vicinity of storm water outfalls draining areas with copper roofs ranged from 2.0 to 40 μg/L copper. Such data exceed the 2.0 μg/L Canadian Water Quality Guidelines for the Protection of Aquatic Life as outlined by the Canadian Council of Ministers of the Environment （CCME）. Analysis of raw, filtered and digested forms suggested that the majority of copper present in runoff and lake water samples was in a dissolved form. The majority of soils taken in this study displayed copper concentrations below the 63 μg/g CCME residential/parkland land use limits. These findings suggested that ion exchange processes between runoff water and soil do not occur to a sufficient extent to elevate copper levels in soil. It may therefore be concluded that the eventual fate of copper, which is not discharged via storm water outfalls, is lost to the water table and Lake Ontario through the sub-soil.

关键词： copper roof runoff Lake Ontario Canadian water quality guidelines for the protection of aquatic life

Improved Synergetic Current Control for Grid-connected Microgrids and Distributed Generation Systems

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Journal of Modern Power Systems and Clean Energy 2022年第5期10卷 1302-1313页

作者： A.Elnady A.Noureldin A.A.Adam Department of Electrical Engineering University of SharjahSharjahUnited Arab Emirates Department of Electrical and Computer Engineering Royal Military CollegeKingstonCanada Department of Electrical and Computer Engineering Queens UniversityKingstonCanada

This paper presents the development of improved synergetic current control for the injected current of an inverter in the grid-connected microgrid and the distributed generation system(DGS). This paper introduces new formulas of the macro-variable functions for integral synergetic control(SC)and integral fast terminal SC, which both have an integral term to guarantee zero steady-state error. The proposed integral SC and integral fast terminal SC achieve a seamless performance such as the fast convergence, minimal overshoot, zero steady-state error, and chattering-free operation. To demonstrate the meritorious performance of the proposed scheme for injected current control, it is compared with the performance of a proportional-integral(PI) controller and advanced exponential sliding mode control(SMC). Finally, the practicality of the proposed scheme is justified by experimental results obtained through rapid control prototyping(RCP) using the dSPACESCALEXIO platform.

关键词： Integral synergetic control(SC) current control integral fast terminal SC advanced exponential sliding mode control(SMC) proportional-integral(PI)control microgrid distributed generation system(DGS)

Rescue from complications after pancreaticoduodenectomies at a low-volume Caribbean center:Value of tailored peri-pancreatectomy protocols

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World Journal of Gastrointestinal Surgery 2024年第3期16卷 681-688页

作者： Shamir O Cawich Elijah Dixon Parul J Shukla Shailesh V Shrikhande Rahul R Deshpande Fawwaz Mohammed Neil W Pearce Wesley Francis Shaneeta Johnson Johann Bujhawan Department of Surgery University of the West IndiesSt Augustine 000000Trinidad and Tobago Department of Surgery Faculty of MedicineUniversity of CalgaryCalgaryAlberta T2N2T9Canada Department of Surgery Weill Cornell Medical CollegeNew YorkNY 10065United States Department of Surgical Oncology Tata Memorial CenterHomi Bhabha National UniversityMumbai 400012India Department of Surgery Manchester Royal InfirmaryManchester M139WLUnited Kingdom University Surgical Unit Southampton General HospitalSouthampton SO166YDUnited Kingdom Department of Surgery University of the West IndiesNassau N-1184Bahamas Department of Surgery Morehouse School of MedicineAtlantaGA 30310United States Department of Surgery General Hospital in Port of SpainPort of Spain 000000Trinidad and Tobago

BACKGROUND Pancreaticoduodenectomy(PD)is a technically complex operation,with a re-latively high risk for *** ability to rescue patients from post-PD complications is as a recognized quality *** protocols were instituted at our low volume facility in the year *** To document the rate of rescue from post-PD complications with tailored protocols in place as a measure of *** A retrospective audit was performed to collect data from patients who experienced major post-PD complications at a low volume pancreatic surgery unit in Trinidad and Tobago between January 1,2013 and June 30,***-dardized definitions from the International Study Group of Pancreatic Surgery were used to define post-PD complications,and the modified Clavien-Dindo classification was used to classify post-PD *** Over the study period,113 patients at a mean age of 57.5 years(standard deviation[SD]±9.23;range:30-90;median:56)underwent PDs at this *** complications were recorded in 33(29.2%)patients at a mean age of 53.8 years(SD:±7.9).Twenty-nine(87.9%)patients who experienced major morbidity were salvaged after aggre-ssive treatment of their ***(3.5%)died from bleeding pseudoaneurysm(1),septic shock secondary to a bile leak(1),anastomotic leak(1),and myocardial infarction(1).There was a significantly greater salvage rate in patients with American society of Anesthesiologists scores≤2(93.3%vs 25%;P=0.0024).CONCLUSION This paper adds to the growing body of evidence that volume alone should not be used as a marker of quality for patients requiring *** low volumes at our facility,we demonstrated that 87.9%of patients were rescued from major *** attributed this to several factors including development of rescue protocols,the competence of the pancreatic surgery teams and continuous,and adaptive learning by the entire institution,cul-minating in the development of tailored peri-pancreatectomy protoc

关键词： Pancreas Complication Rescue Failure Morbidity Mortality Pancreaticoduodenectomy

Predictors of the placebo response in a nutraceutical randomized controlled trial for depression

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Journal of Integrative Medicine 2024年第1期22卷 46-53页

作者： Rosemary Arnold Jenifer Murphy-Smith Chee H.Ng David Mischoulon Gerard J.Byrne Chad A.Bousman Con Stough Michael Berk Jerome Sarris Professorial Unit the Melbourne ClinicDepartment of PsychiatryUniversity of MelbourneRichmond 3121Australia Depression Clinical and Research Program Department of PsychiatryMassachusetts General HospitalHarvard Medical SchoolBostonMA 02115USA Faculty of Medicine Discipline of PsychiatryCentre for Clinical ResearchRoyal Brisbane&Women’s HospitalHerstonthe University of QueenslandBrisbane 4006Australia Departments of Medical Genetics PsychiatryPhysiology&Pharmacology and Community Health SciencesUniversity of CalgaryCalgaryAB T2N 1N4Canada Department of Psychiatry the University of MelbourneMelbourne 3052Australia Centre for Human Psychopharmacology Swinburne UniversityMelbourne 3122Australia The Institute for Mental and Physical Health and Clinical Translation School of MedicineBarwon HealthDeakin UniversityGeelong 3220Australia The Centre of Excellence in Youth Mental Health the University of MelbourneParkville 3052Australia Florey Institute of Neuroscience and Mental Health the University of MelbourneParkville 3052Australia NICM Health Research Institute Western Sydney UniversityWestmeadNSW 2145Australia

Objective The placebo response in depression studies is the change in symptoms amongst those who receive an inactive *** well-designed randomized controlled trials(RCTs)of depression have a high proportion of placebo responders,with little understanding as to *** present study assesses characteristics associated with the placebo response in a nutraceutical trial with a large proportion of placebo *** This is a secondary analysis of a nutraceutical depression RCT which identified no overall treatment benefit relative to placebo(n=69 in placebo group).We investigated participant characteristics such as socio-demographics,clinical features,and recruitment methods,and their association with the placebo *** genetic polymorphisms were also *** response was measured based on change in Montgomery-Asberg Depression Rating Scale *** association of these hypothesis-driven variables of interest and the placebo response was examined using linear mixed effects *** Greater levels of education,particularly pursuing post-high school education,better self-reported general health,marriage/de facto,greater improvement in the first trial week,and more failed antidepressant therapies in the current depressive episode were associated with greater placebo *** increased placebo response was not found in those recruited via social media nor in those with concomitant antidepressant *** nucleotide polymorphisms from the tryptophan hydroxylase 1(TPH1)gene(A779C and A218C)were weakly associated with greater placebo response,although the evidence was attenuated after accounting for multiple *** This is,to our knowledge,the first study within nutraceutical research for depression to assess the association between participant characteristics and variation in the placebo *** variables appeared to predict the placebo *** findings may encourage future trial design

关键词： Randomized controlled trial Placebo Depression Nutraceutical Psychiatry

A barrier to metal movement: Synchrotron study of iron plaque on roots of wetland plants

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Journal of Environmental Sciences 2016年第6期28卷 1-3页

作者： Iris Koch Michelle M.Nearing royal Military College of canada

A wetland with attractive plants hosting birds and other wildlife is an esthetically pleasing prospect that is gaining popularity as a way of stabilizing or remediating metalcontaminated soils and sediment（Weber and ... 详细信息

关键词： Wetland plants Metal contamination Urban brownfield sites X-ray microtomography and microfluorescence Copper Iron Lead Zinc

Uptake and transformation of arsenic during the reproductive life stage of Agaricus bisporus and Agaricus campestris

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Journal of Environmental Sciences 2016年第11期28卷 140-149页

作者： Michelle M.Nearing Iris Koch Kenneth J.Reimer Environmental Sciences Group Royal Military College of Canada

Fruiting bodies from the Agaricus genus have been found to contain non-toxic arsenobetaine（AB） as a major compound. It is unknown whether AB is formed during the vegetative or reproductive life stages of the fungus, or by the surrounding microbial community, but AB＇s structural similarity to glycine betaine has led to the hypothesis that AB may be adventitiously accumulated as an osmolyte. To investigate the potential formation of AB during the reproductive life stage of Agaricus species, growth substrate and fungi were collected during the commercial growth of Agaricus bisporus and analyzed for arsenic speciation using HPLC-ICP-MS. AB was found to be the major arsenic compound in the fungus at the earliest growth stage of fruiting（the primordium）. The growth substrate mainly contained arsenate（As（V））. The distribution of arsenic in an A. bisporus primordium grown on As（V） treated substrate, and in a mature Agaricus campestris fruiting body collected from arsenic contaminated mine tailings, was mapped using two dimensional XAS imaging. The primordium and stalk of the mature fruiting body were both found to be growing around pockets of substrate material containing higher As concentrations, and AB was found exclusively in the fungal tissues. In the mature A. campestris the highest proportion of AB was found in the cap, supporting the AB as an osmolyte hypothesis. The results have allowed us to pinpoint the fungus life stage at which AB formation takes place,namely reproduction, which provides a direction for further research.

关键词： Arsenobetaine Arsenic Agaricus Fungi HPLC-ICP-MS XAS imaging

Artificial intelligence and machine learning for hemorrhagic trauma care

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Military Medical Research 2023年第5期10卷 680-698页

作者： Henry T.Peng MMusaab Siddiqui Shawn G.Rhind Jing Zhang Luis Teodoro da Luz Andrew Beckett Defence Research and Development canada Toronto Research CentreTorontoON M3K 2C9Canada Sunnybrook Health Sciences Centre TorontoON M4N 3M5Canada St.Michael’s Hospital TorontoON M5B 1W8Canada royal Canadian Medical Services Ottawa K1A 0K2Canada

Artificial intelligence(AI),a branch of machine learning(ML)has been increasingly employed in the research of trauma in various *** is the most common cause of trauma-related *** better elucidate the current role of AI and contribute to future development of ML in trauma care,we conducted a review focused on the use of ML in the diagnosis or treatment strategy of traumatic hemorrhage.A literature search was carried out on PubMed and Google *** and abstracts were screened and,if deemed appropriate,the full articles were *** included 89 studies in the *** studies could be grouped into five areas:(1)prediction of outcomes;(2)risk assessment and injury severity for triage;(3)prediction of transfusions;(4)detection of hemorrhage;and(5)prediction of *** analysis of ML in comparison with current standards for trauma care showed that most studies demonstrated the benefits of ML ***,most studies were retrospective,focused on prediction of mortality,and development of patient outcome scoring *** studies performed model assessment via test datasets obtained from different *** models for transfusions and coagulopathy have been developed,but none is in widespread ***-enabled ML-driven technology is becoming integral part of the whole course of trauma *** and application of ML algorithms using different datasets from initial training,testing and validation in prospective and randomized controlled trials are warranted for provision of decision support for individualized patient care as far forward as possible.

关键词： Artificial intelligence Hemorrhage Machine learning Trauma Injury