The initial design criteria in the choice of indwelling materials for medical and dental purposes may be pragmatic, and based on the necessary mechanical properties required to fashion a functional device. Orthopedic implants require strong materials for weight-bearing, and articulating surfaces such as joints require durability and resistance to wear. Stents and shunts require flexibility and patency, and sutures require a high tensile strength yet also must be flexible enough for intricate manipulation. As the devices became more sophisticated and developments in materials science provided more options for manufacture, implants are being used more frequently and with longer anticipated lifetimes. Concurrently, the design process increasingly incorporated biocompatibility and comfort into the design criteria. However, with longer lifetimes, the more frequent use of invasive surgical procedures involving indwelling devices and biologically-friendly materials, there has been a rise in the number of incidences of device-related infection. Urinary catheters have been estimated to account for 30% of all nosocomial infections [1]. Between 66 and 88% of these occur after urinary catheterization [2]. It is also reported that almost 100% of catheterized patients develop an infection in an openly draining indwelling catheter which has been in place for four days or more [2]. For some procedures, such as orthopedic joint arthroplasties, the diagnosed surgical site infection rates are relatively low (between 1% and 2%; [3]); however, the increasing number of patients undergoing joint-replacement surgery translates to large numbers of patients afflicted with the consequences of complicating infections per year. Furthermore, infection of artificial joints can be devastating, since oral or IV antibiotic therapy frequently fails to resolve the infection, with the only remaining course of action being surgical debridement or partial or total revision. These two examples, the first with very high numbers of patients but of lesser severity in terms of impact to the individual, and the second, low numbers but severe patient impact, reflect the incentive to pursue a third design criteria—that of infection resistance—into materials and devices [4]. In the following sections we will discuss the role of bacterial biofilms in infection, and the growing literature highlighting biofilms as an important cause of device-related infection.
The initial design criteria in the choice of indwelling materials for medical and dental purposes may be pragmatic, and based on the necessary mechanical properties required to fashion a functional device. Orthopedic implants require strong materials for weight-bearing, and articulating surfaces such as joints require durability and resistance to wear. Stents and shunts require flexibility and patency, and sutures require a high tensile strength yet also must be flexible enough for intricate manipulation. As the devices became more sophisticated and developments in materials science provided more options for manufacture, implants are being used more frequently and with longer anticipated lifetimes. Concurrently, the design process increasingly incorporated biocompatibility and comfort into the design criteria. However, with longer lifetimes, the more frequent use of invasive surgical procedures involving indwelling devices and biologically-friendly materials, there has been a rise in the number of incidences of device-related infection. Urinary catheters have been estimated to account for 30% of all nosocomial infections [1]. Between 66 and 88% of these occur after urinary catheterization [2]. It is also reported that almost 100% of catheterized patients develop an infection in an openly draining indwelling catheter which has been in place for four days or more [2]. For some procedures, such as orthopedic joint arthroplasties, the diagnosed surgical site infection rates are relatively low (between 1% and 2%; [3]); however, the increasing number of patients undergoing joint-replacement surgery translates to large numbers of patients afflicted with the consequences of complicating infections per year. Furthermore, infection of artificial joints can be devastating, since oral or IV antibiotic therapy frequently fails to resolve the infection, with the only remaining course of action being surgical debridement or partial or total revision. These two examples, the first with very high numbers of patients but of lesser severity in terms of impact to the individual, and the second, low numbers but severe patient impact, reflect the incentive to pursue a third design criteria—that of infection resistance—into materials and devices [4]. In the following sections we will discuss the role of bacterial biofilms in infection, and the growing literature highlighting biofilms as an important cause of device-related infection.
History has largely forgotten the writings, both public and private, of early nineteenth-century America’s legal scholars. However, Ellen Holmes Pearson argues that the observers from this era had a unique perspective on the young nation and the directions in which its legal culture might go. Remaking Custom draws on the law lectures, treatises, speeches, and papers of the early republic’s legal scholars to examine the critical role that they played in the formation of American identities. As intermediaries between the founders of America’s newly independent polities and the next generation of legal practitioners and political leaders, the nation’s law educators expressed pride in the retention of the "republican parts" of England’s common law while at the same time identifying some of the central features that distinguished American law from that of Britain. From their perspective, the new nation’s blending of tradition and innovation produced a superior national character. Because American law educators interpreted both local and national legal trends, Remaking Custom reveals how national identities developed through Americans’ articulation of their local customs and identities. Pearson examines the innovations that legists could celebrate, such as constitutional changes that placed the people at the center of their governments and more egalitarian property laws that accompanied America’s abundant supply of land. The book also deals with innovations that presented uncomfortable challenges to law educators as they sought creative ways to justify the legal cultures that grew up around slavery and Anglo-Americans’ hunger for land occupied by Native Americans.
One of the finest historians of her generation, Jan Ellen Lewis (1949-2018) transformed our understanding of the early U.S. Republic. Her groundbreaking essays defined the emerging fields of gender and emotions history and reframed traditional understandings of the founding fathers and the U.S. Constitution. As significant as her work was within each of these subfields, her most remarkable insights came from the connections she drew among them. Gender and race, slavery and freedom, feelings and politics ran together in the hearts, minds, and lives of the men and women she studied. Lewis's brilliant research revealed these long-buried connections and illuminated their importance for America's past and present. Family, Slavery, and Love in the Early American Republic collects thirteen of Lewis's most important essays. Distinguished scholars shed light on the historical and historiographical contexts in which Lewis and her peers researched, wrote, and argued. But the real star of this volume is Lewis herself: confident, unconventional, erudite, and deeply imaginative.
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