scholarly journals The effectiveness of ultra-clean air operating theatres in the prevention of deep infection in joint arthroplasty surgery

2018 ◽  
Vol 100-B (10) ◽  
pp. 1264-1269 ◽  
Author(s):  
A. M. Thomas ◽  
M. J. Simmons
Keyword(s):  
Exhaust System ◽  
Deep Infection ◽  
Observational Evidence ◽  
Infection Rates ◽  
The United Kingdom ◽  
Airborne Contamination ◽  
Operating Theatres ◽  
Clean Air ◽  
Contemporary Practice ◽  
The Relationship

Deep infection was identified as a serious complication in the earliest days of total hip arthroplasty. It was identified that airborne contamination in conventional operating theatres was the major contributing factor. As progress was made in improving the engineering of operating theatres, airborne contamination was reduced. Detailed studies were carried out relating airborne contamination to deep infection rates. In a trial conducted by the United Kingdom Medical Research Council (MRC), it was found that the use of ultra-clean air (UCA) operating theatres was associated with a significant reduction in deep infection rates. Deep infection rates were further reduced by the use of a body exhaust system. The MRC trial also included a detailed microbiology study, which confirmed the relationship between airborne contamination and deep infection rates. Recent observational evidence from joint registries has shown that in contemporary practice, infection rates remain a problem, and may be getting worse. Registry observations have also called into question the value of “laminar flow” operating theatres. Observational evidence from joint registries provides very limited evidence on the efficacy of UCA operating theatres. Although there have been some changes in surgical practice in recent years, the conclusions of the MRC trial remain valid, and the use of UCA is essential in preventing deep infection. There is evidence that if UCA operating theatres are not used correctly, they may have poor microbiological performance. Current UCA operating theatres have limitations, and further research is required to update them and improve their microbiological performance in contemporary practice. Cite this article: Bone Joint J 2018;100-B:1264–9.

A National Survey of Ultra Clean Air Theatre Use in Orthopaedic Trauma

2012 ◽  
Vol 94 (5) ◽  
pp. 185-186
Author(s):  
N Jarvis ◽  
S Dheerendra ◽  
D Chappell ◽  
A Goel ◽  
P Pidikiti
Keyword(s):  
Total Joint Replacement ◽  
Trauma Surgery ◽  
Fragility Fractures ◽  
Trauma Patients ◽  
Orthopaedic Trauma ◽  
Infection Rates ◽  
Operating Theatres ◽  
Deep Surgical Site Infection ◽  
Clean Air ◽  
The Cost

The consequences of deep surgical site infection (SSI) following orthopaedic operations can be devastating. Trauma patients, especially those suffering fragility fractures, tend to have less reserve and more co-morbidities than elective patients; infection in their case may be even more catastrophic. It is also expensive: Dreghorn et al calculated that revising infected arthroplasties was up to four times the cost of a primary total joint replacement. Maintaining low infection rates in trauma surgery depends on meticulous surgical technique, peri-operative antibiotics and scrupulous theatre standards, including the use of laminar or ultra clean air (UCA) operating theatres for sterile orthopaedic procedures.

scholarly journals Some aspects of the airborne transmission of infection

2009 ◽  
Vol 6 (suppl_6) ◽  
Author(s):  
Raymond P. Clark ◽  
Mervyn L. de Calcina-Goff
Keyword(s):  
Particle Dispersion ◽  
Orthopaedic Implant ◽  
Healthcare Provision ◽  
Airborne Transmission ◽  
Operating Theatres ◽  
Clean Air ◽  
Hospital Acquired ◽  
Burns Unit ◽  
The Relationship ◽  
Transmission Of Disease

The relationship between the human body and the dissemination of potentially pathogenic particles and droplets is described. Airborne transmission of infection in operating theatres and a burns unit and the part played by the human microclimate and its interaction with ventilating air flows is discussed. The mechanisms by which different garment assemblies used for surgery can enhance particle dispersion are illustrated and the way that floor cleaning can increase the concentration of airborne organisms is described. The development of the successful use of ultra-clean air systems in orthopaedic implant surgery is reviewed. Relationships between contact and airborne transmission of disease are explored and ways by which containment strategies and metrics used in pharmaceutical and electronics manufacturing can be applied to the design and monitoring of healthcare areas is discussed. It is suggested that currently available techniques involving architectural, ventilation and operational aspects of healthcare provision, when properly applied, can markedly improve treatment outcomes that may otherwise be compromised by hospital-acquired infections involving both bacteria and viruses.

scholarly journals Insurance related problems in bareboat charter agreements

2021 ◽  
Vol 6 (1) ◽  
Author(s):  
Albano Gilabert Gascón
Keyword(s):  
United Kingdom ◽  
Supreme Court ◽  
Third Parties ◽  
Insurance Contract ◽  
The United Kingdom ◽  
The Supreme Court ◽  
The One ◽  
The Baltic ◽  
The Relationship

AbstractIn 2017, the majority of the United Kingdom Supreme Court held in its judgment in the Gard Marine and Energy v China National Chartering (The Ocean Victory) case that, in bareboat charters under the ‘BARECON 89’ form, if both the owner and the charterer are jointly insured under a hull policy, the damages caused to the vessel by the charterer cannot be claimed by the insurer by way of subrogation after indemnifying the owner. The interpretation of the charter party leads to the conclusion that the liability between the parties is excluded. Faced with the Supreme Court’s decision, the Baltic and International Maritime Council (BIMCO) adopted a new standard bareboat charter agreement only a few months later, the ‘BARECON 2017’ form, which amends, among other clauses, the one related to insurance. The present paper analyses (i) the new wording of the clause mentioned above and (ii) its incidence on the relationship between the parties of both the charter agreement and the insurance contract and its consequences for possible third parties. Despite BIMCO’s attempt to change the solution adopted by the Supreme Court and his willingness to allow the insurer to claim in subrogation against the person who causes the loss, the consequences, as it will be seen, do not differ much in practice when the wrongdoer is the co-insured charterer. On the contrary, when the loss is caused by a time charter or a sub-charter, in principle, there will be no impediment for the insurer to sue him.

scholarly journals The Effect of Vaccination Rates on the Infection of COVID-19 under the Vaccination Rate below the Herd Immunity Threshold

2021 ◽  
Vol 18 (14) ◽  
pp. 7491
Author(s):  
Yi-Tui Chen
Keyword(s):  
Infection Rate ◽  
Herd Immunity ◽  
The United States ◽  
Vaccination Rate ◽  
Infection Rates ◽  
Vaccination Rates ◽  
The United Kingdom ◽  
The World ◽  
Almost All ◽  
The Impact

Although vaccination is carried out worldwide, the vaccination rate varies greatly. As of 24 May 2021, in some countries, the proportion of the population fully vaccinated against COVID-19 has exceeded 50%, but in many countries, this proportion is still very low, less than 1%. This article aims to explore the impact of vaccination on the spread of the COVID-19 pandemic. As the herd immunity of almost all countries in the world has not been reached, several countries were selected as sample cases by employing the following criteria: more than 60 vaccine doses per 100 people and a population of more than one million people. In the end, a total of eight countries/regions were selected, including Israel, the UAE, Chile, the United Kingdom, the United States, Hungary, and Qatar. The results find that vaccination has a major impact on reducing infection rates in all countries. However, the infection rate after vaccination showed two trends. One is an inverted U-shaped trend, and the other is an L-shaped trend. For those countries with an inverted U-shaped trend, the infection rate begins to decline when the vaccination rate reaches 1.46–50.91 doses per 100 people.

scholarly journals The Authoritarian Dynamic During the COVID-19 Pandemic: Effects on Nationalism and Anti-Immigrant Sentiment

2021 ◽  
pp. 194855062097802
Author(s):  
Todd K. Hartman ◽  
Thomas V. A. Stocks ◽  
Ryan McKay ◽  
Jilly Gibson-Miller ◽  
Liat Levita ◽  
...  
Keyword(s):  
Social Order ◽  
Situational Factors ◽  
Right Wing ◽  
Right Wing Authoritarianism ◽  
The United Kingdom ◽  
The Social ◽  
Political Outcomes ◽  
Nationally Representative ◽  
Using Data ◽  
The Relationship

Research has demonstrated that situational factors such as perceived threats to the social order activate latent authoritarianism. The deadly COVID-19 pandemic presents a rare opportunity to test whether existential threat stemming from an indiscriminate virus moderates the relationship between authoritarianism and political attitudes toward the nation and out-groups. Using data from two large nationally representative samples of adults in the United Kingdom ( N = 2,025) and Republic of Ireland ( N = 1,041) collected during the initial phases of strict lockdown measures in both countries, we find that the associations between right-wing authoritarianism (RWA) and (1) nationalism and (2) anti-immigrant attitudes are conditional on levels of perceived threat. As anxiety about the COVID-19 pandemic increases, so too does the effect of RWA on those political outcomes. Thus, it appears that existential threats to humanity from the COVID-19 pandemic moderate expressions of authoritarianism in society.

scholarly journals Separation of Church and State, American Exceptionalism, and the Contemporary Social Moment: Viewing Church–State Separation from the Priority of Slavery

Religions ◽  
2021 ◽  
Vol 12 (1) ◽  
pp. 34
Author(s):  
Joseph Prud'homme
Keyword(s):  
Church And State ◽  
American Exceptionalism ◽  
The United States ◽  
Antebellum South ◽  
Racial Justice ◽  
The United Kingdom ◽  
Institutional Forces ◽  
Governmental Institutions ◽  
Religious Establishment ◽  
The Relationship

The contemporary social moment in the United States has affirmed the critical importance of racial justice, and especially claims to justice informed by the contributions of structural and institutional forces connected with the nation’s original sin of slavery. In this paper, I examine the contributions of strict church–state separationism to the maintenance of slavery in the antebellum South in comparison to the contributions various forms of religious establishment made to the successful abolition of slavery in the United Kingdom and the British Empire. Developing a deeper historical understanding of the ways the relationship between religious and governmental institutions influenced the abolition and maintenance of slavery can assist the contemporary quest for racial justice.

scholarly journals Exploring the Relationship Between Palatal Cleft Type and Width With the Use of Relieving Incisions in Primary Repair

2021 ◽  
pp. 105566562110196
Author(s):  
Alex Davies ◽  
Amy Davies ◽  
Yvonne Wren ◽  
Scott Deacon ◽  
Alistair R.M. Cobb ◽  
...  
Keyword(s):  
Oral Mucosa ◽  
Primary Repair ◽  
Fistula Formation ◽  
The United Kingdom ◽  
Using Data ◽  
The Uk ◽  
The Relationship ◽  
Soft Edge ◽  
Intravelar Veloplasty ◽  
Pierre Robin

Objective: The mainstay of palatal repair in the United Kingdom is the intravelar veloplasty (IVVP). It is not always possible to align the oral mucosa in the midline to achieve tension-free repair. The addition of lateral relieving incisions may aid transposition of the oral mucosa to allow closure. The aim of this study was to explore cleft features that may predispose to a requirement for relieving incisions in order to allow palate closure. Design: We performed a national multiinstitutional retrospective study using data from the UK Cleft Collective cohort study. Patients: The study sample consisted of 474 patients who had undergone IVVP at the time of palatal closure across all 16 of the UK cleft units. Results: We found strong evidence for the requirement for relieving incisions in patients with an increased degree of clefting per the Veau classification ( P < .001), increasing palatal soft-edge width ( P < .001) and moderate evidence of an associated use in patients with Pierre Robin sequence ( P = .015). Insufficient data were available to explore the relationship between intertuberosity distance and the presence of fistula formation with the use of relieving incisions. Conclusions: The results of this study identify cleft features that increase the likelihood for requiring lateral relieving incisions to allow palatal closure. The degree to which the addition of relieving incisions to IVVP affects maxillary growth and speech outcomes is unknown. Further study is required to answer this important question.

The Welsh Eating Disorder Service Review 2018, Scottish Eating Disorder Service Review 2021 and recommendations of best practice in comorbid eating disorders and diabetes

2021 ◽  
pp. 135910452110138
Author(s):  
Jacinta Tan ◽  
Gemma Johns
Keyword(s):  
Eating Disorders ◽  
United Kingdom ◽  
Eating Disorder ◽  
High Mortality ◽  
Best Practice ◽  
Service Development ◽  
The United Kingdom ◽  
Scottish Government ◽  
The Relationship ◽  
Service Change

Background: Diabetes and eating disorders are frequently comorbid. This particular comorbidity is not only often poorly recognised, but is difficult to treat and has a high mortality. Method: In this article, we will briefly review the relationship between diabetes and eating disorders. We will review the current NICE and other guidance and reports concerning both diabetes and eating disorders in the United Kingdom. We will then describe the recommendations of the 2018 Welsh Government Eating Disorder Service Review and the 2021 the Scottish Government Eating Disorder Service Review regarding diabetes and eating disorders, which will lead to service change. Conclusions: We conclude that this is a relatively underdeveloped but important area where there needs to be further service development and more collaboration between diabetes and eating disorder services.

External Ventricular Drain Infection

2007 ◽  
Vol 107 (1) ◽  
pp. 248 ◽  
Author(s):  
George K. C. Wong ◽  
Wayne W. S. Poon
Keyword(s):  
Major Trauma ◽  
Independent Predictor ◽  
External Ventricular Drain ◽  
Significant Risk ◽  
Significant Risk Factor ◽  
External Ventricular Drainage ◽  
Infection Rates ◽  
The Mean ◽  
The Relationship ◽  
Shed Light

Object The authors explored the relationship among the duration of external ventricular drainage, revision of external ventricular drains (EVDs), and cerebrospinal fluid (CSF) infection to shed light on the practice of electively revising these drains. Methods In a retrospective study of 199 patients with 269 EVDs in the intensive care unit at a major trauma center in Australasia, the authors found 21 CSF infections. Acinetobacter accounted for 10 (48%) of these infections. Whereas the duration of drainage was not an independent predictor of infection, multiple insertions of EVDs was a significant risk factor. Second and third EVDs in previously uninfected patients were more likely to become infected than first EVDs. An EVD infection was initially identified a mean of 5.5 ±0.7 days postinsertion (standard error of the mean); these data—that is, the number of days—were normally distributed. Conclusions This pattern of infection is best explained by EVD-associated CSF infections being acquired by the introduction of bacteria on insertion of the drain rather than by subsequent retrograde colonization. Elective EVD revision would be expected to increase infection rates in light of these results, and thus the practice has been abandoned by the authors' institution.

Lament and Revenge in the Hekabe of Euripides

2007 ◽  
Vol 23 (1) ◽  
pp. 49-57 ◽  
Author(s):  
Christian M. Billing
Keyword(s):  
Social Control ◽  
Early Modern ◽  
Fifth Century ◽  
Historical Evidence ◽  
Funerary Practices ◽  
The United Kingdom ◽  
The Usa ◽  
The University ◽  
The Relationship ◽  
Female Lament

In this article Christian M. Billing considers the relationship between female lament and acts of vengeance in fifth-century Athenian society and its theatre, with particular emphasis on the Hekabe of Euripides. He uses historical evidence to argue that female mourning was held to be a powerfully transgressive force in the classical period; that considerable social tensions existed as a result of the suppression of female roles in traditional funerary practices (social control arising from the move towards democracy and the development of forensic processes as a means of social redress); and that as a piece of transvestite theatre, authored and performed by men to an audience made up largely, if not entirely, of that sex, Euripides' Hekabe demonstrates significant gender-related anxiety regarding the supposedly horrific consequences of allowing women to speak at burials, or to engage in lament as part of uncontrolled funerary ritual. Christian M. Billing is an academic and theatre practitioner working in the fields of ancient Athenian and early modern English and European drama. He has worked extensively as a director and actor and has also taught at a number of universities in the United Kingdom and the USA. He is currently Lecturer in Drama at the University of Hull.

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