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Sutures are used to facilitate wound healing and play an important role in ensuring the success of surgical interventions in healthcare facilities. Suture-associated surgical site infection (SSI) may develop when bacterial pathogens colonize the suture surface and establish biofilms that are highly resistant to antibiotic treatment. The outcome of SSI affects postoperative care, leading to high rates of morbidity and mortality, prolonged hospitalization, and increased financial burden. Antimicrobial sutures coated with antiseptics such as triclosan and chlorhexidine have been used to minimize the occurrence of SSI. However, as the efficacy of antiseptic-based sutures may be affected due to the emergence of resistant bacterial strains, new approaches for the development of alternative antimicrobial sutures are necessary. This review provides an update and outlook of various approaches in the design and development of antimicrobial sutures. Attaining a zero SSI rate will be possible with the advancement in suturing technology and implementation of good infection control practice in clinical settings. [ABSTRACT FROM AUTHOR]

BACKGROUND: Acute right heart failure (RHF) after left ventricular assist device implantation remains a major source of morbidity and mortality, yet the definition of RHF and the preimplant variables that predict RHF remain controversial. This study evaluated the ability of (1) INTERMACS (Interagency Registry for Mechanically Assisted Circulatory Support) RHF classification to predict post-left ventricular assist device survival and (2) preoperative characteristics and hemodynamic parameters to predict severe and severe acute RHF. METHODS AND RESULTS: An international, multicenter study at 4 large academic centers was conducted between 2008 and 2016. All subjects with hemodynamics measured by right heart catheterization within 30 days before left ventricular assist device implantation were included. RHF was defined using the INTERMACS definition for RHF. In total, 375 subjects were included (mean age, 57.4±13.2 years, 54% bridge-to-transplant). Mild RHF was most common (34%), followed by moderate RHF (16%), severe RHF (13%), and severe acute RHF (9%). Estimated on-device survival rates at 2 years were 72%, 71%, and 55% in the patients with none, mild-to-moderate, and severe-to-severe acute RHF, respectively (P=0.004). In addition, the independent hazard ratio for mortality was only increased in the patients with severe-to-severe acute RHF (hazard ratio, 3.95; 95% CI, 2.16-7.23; P<0.001). INTERMACS-defined RHF was superior to postimplant inotrope duration alone in the prediction of all-cause mortality. In multivariable analysis, older age, lower INTERMACS classes, and higher pulmonary arterial elastance (ratio of systolic pulmonary artery pressure to stroke volume) before left ventricular assist device, were identified as significant predictors of severe-to-severe acute RHF. Stratifying patients by ratio of systolic pulmonary artery pressure to stroke volume and right atrial pressure significantly improved the discrimination between patients at risk for severe-to-severe acute RHF. CONCLUSIONS: The INTERMACS RHF classification correctly identifies patients at risk for mortality, though this risk is only increased in patients with severe-to-severe acute RHF. Several predictors for RHF were identified, of which ratio of systolic pulmonary artery pressure to stroke volume was the strongest hemodynamic predictor. Coupling ratio of systolic pulmonary artery pressure to stroke volume with right atrial pressure may be most helpful in identifying patients at risk for severe-to-severe acute RHF. [ABSTRACT FROM AUTHOR]

Prediction of P losses from manured agricultural fields through surface runoff and tile drainage is necessary to mitigate widespread eutrophication in water bodies. However, present water quality models are weak in predicting P losses, particularly in tile‐drained and manure‐applied cropland. We developed a field‐scale P management model, the Root Zone Water Quality Model version 2–Phosphorus (RZWQM2‐P), whose accuracy in simulating P losses from manure applied agricultural field is yet to be tested. The objectives of this study were (i) to assess the accuracy of this new model in simulating dissolved reactive phosphorus (DRP) and particulate phosphorus (PP) losses in surface runoff and tile drainage from a manure amended field, and (ii) to identify best management practices to mitigate manure P losses including water table control, manure application timing, and spreading methods by the use of model simulation. The model was evaluated against data collected from a liquid cattle manure applied field with maize (Zea mays L.)–soybean [Glycine max (L.) Merr.] rotation in Ontario, Canada. The results revealed that the RZWQM2‐P model satisfactorily simulated DRP and PP losses through both surface runoff and tile drainage (Nash–Sutcliffe efficiency > 0.50, percentage bias within ±25%, and index of agreement > 0.75). Compared with conventional management practices, manure injection reduced the P losses by 18%, whereas controlled drainage and winter manure application increased P losses by 13 and 23%, respectively. The RZWQM2‐P is a promising tool for P management in manured and subsurface drained agricultural field. The injection of manure rather than controlled drainage is an effective management practice to mitigate P losses from a subsurface‐drained field. Core Ideas: RZWQM2‐P satisfactorily simulated P losses from the manure‐applied field.A field experiment revealed that the nongrowing season dominated the P losses.Particulate P loss dominated the average annual P loss as per the field experiment.RZWQM‐P adequately simulated seasonal P losses and dominant P loss type.Injected manure application was found effective to mitigate P losses. [ABSTRACT FROM AUTHOR]

Breast cancer is the leading cause of cancer death in women and the second most common cancer in the Jamaican population. Additionally, Jamaican women have a significant incidence of locally advanced cancer that has been shown to be associated with significant morbidity and inferior treatment outcomes. Delays in presentation and diagnosis further contribute to this treatment dilemma. On this background, a consensus group of healthcare practitioners involved in breast cancer care was convened by a joint initiative of the University of the West Indies and the Association of Surgeons in Jamaica. The objective of this body was to outline management guidelines to assist Jamaican physicians with management of patients with breast cancer. These guidelines are published below and are divided into four main headings: Screening, Making the diagnosis, Treatment and Aftercare. This document is aimed at both specialist and non-specialist physicians and includes an easy-to-follow algorithm as a brief summary of the treatment recommendations. [ABSTRACT FROM AUTHOR]

Copyright of West Indian Medical Journal is the property of West Indian Medical Journal (WIMJ) and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Due to the considerable advances and tangible benefits of information technology (IT), almost all top-tier firms invest heavily in IT applications. However, the phenomenon of the "IT productivity paradox" prevents firms from investing in IT freely. Despite the number of studies exploring the relationship between IT investment and business performance, the value of IT investment remains difficult to justify. Specifically, evidence of a payoff from massive IT investments is still very limited. Added to the complexity is a wide range of key performance indicators that target different aspects of business performance. According to previous studies, the reasons behind the IT productivity paradox may be a shortage of accurate and timely data, a failure of considering the time-lag effect, and the application of inappropriate data analysis techniques. To address the aforementioned symptoms, this study developed a system to examine the influence of IT investment on two categories of performance indicators, namely cost efficiency and profit effectiveness. Specifically, we collected actual enterprise operating data, applied two different data analysis techniques (i.e., regression analysis and artificial neural networks), and conducted analysis using data collected over a period of four years. The results indicate that: (1) the higher the ratio of maintenance costs, the poorer business performance will be; (2) the higher the ratio of IT investment, the better the business performance and the lower the operating cost will be; (3) we also found that the time lag effects of IT investment on business performance for a period of two to three years; (4) regarding the estimation of the influence of IT investment on business performance, artificial neural networks are superior to regression analysis for their explanatory power. [ABSTRACT FROM AUTHOR]

Copyright of West Indian Medical Journal is the property of West Indian Medical Journal (WIMJ) and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of West Indian Medical Journal is the property of West Indian Medical Journal (WIMJ) and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Abstract: This paper examines the determinants of automatic teller machine (ATM), a kind of information technology (IT), in the Taiwanese banking industry. The lessons learned from Taiwan''s banking industry can be applied to China''s banking industry to facilitate the understanding of the IT adoption strategies of Chinese financial institutions. Factors that are expected to have impact on IT investment in general and on ATM investment in particular are identified from three perspectives, namely operating scale perspective, deposit service perspective, and operating cost perspective. The results of this study indicate that operating scale, banking deposit service and operating cost are all significant determinants of ATM investment in the Taiwan banking industry. The results are useful for those banks and financial institutions outside of China in deciding their ATM investment strategies in China when trying to enter and penetrate the Chinese banking market. [Copyright &y& Elsevier]

In a companion paper the piezo-poppet (PZP) valve was examined for its operational flexibility principally in the steady outflow (flow-to-open) and to a lesser extent inflow (flow-to-close) conical head 90° seat configurations. Outflow form experimental results were used partially to verify a computational fluid dynamics (CFD) analysis of the situation and to substantiate a basis for a simple sizing technique. The present paper goes on from that juncture by using CFD to investigate the tolerancing problems on the low-lift PZP valve in respect of deviations of the centre-line of the poppet from that of its inlet port and of the modification of the seat itself - by chamfering. Finally, the unsteady performance of the arrangement is computed, for standardized conditions, to give an assessment of control performance when the poppet is (a) theoretically adjusted quickly at the same pressure drop or (b) hypothetically experiences a pressure surge. In (a) the CFD is verified by experiment. From these tasks arise the prospect of innovative non-isothermal, unsteady flow modelling of hydraulic devices employing moving orthogonal boundaries, and three-dimensional CFD analysis. All of these tasks were performed on the outflow valve. [ABSTRACT FROM AUTHOR]

The thermofluid mechanics of inflow (flow-to-close) and outflow (flow-to-open) conical poppet head valves is investigated for the range of small and controllable openings made available from the employment of a practical piezo-electric stack driver. A computational fluid dynamics (CFD) package suite is applied to the above task, the results from which are verified experimentally for several outflow slave valve (a valve with a non-electrical stand-in for the piezo stack) poppet lifts, cone angles, and pressure drops for the steady, non-isothermal flow of a test liquid (Tellus R37). Finally, the inflow valve performance is examined and a simple sizing technique consolidated. The results are compared, as far as is possible (quantitatively), with the findings of previous workers. This is done in order further to justify the use of CFD for the design of valves of small but potentially greater displacement than available from the contemporary piezo drivers and to underpin design exercises that are intended to optimize low lift valves for real operating conditions. In a companion paper unsteady/moving boundary and transient flow is tackled using a fast and precise piezo stack to actuate the same poppet head variations (as in the steady state case) as are the effects of manufacturing tolerances on poppet eccentricity, angular misalignment, and seat chamfering for small displacements. [ABSTRACT FROM AUTHOR]

Discusses the association between fungal contamination and sick building syndrome. Fungal allergies and allergenic respiratory diseases caused by indoor fungi; Production of volatile organic compounds and mycotoxins; Ecological factors that led to the presence of fungi indoors.