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.
In 1962, a unique transport aircraft was built from the parts of 27 Boeing B-377 airliners to provide NASA a means of transporting rocket boosters. With an interior the size of a gymnasium, "The Pregnant Guppy" was the first of six enormous cargo planes built by Aero Spacelines and two built by Union de Transport Aeriens. More than half a century later, the last Super Guppy is still in active service with NASA and the design concept has been applied to next-generation transports. This comprehensive history of expanded fuselage aircraft begins in the 1940s with the military's need for a long-range transport. The author examines the development of competing designs by Boeing, Convair and Douglas, and the many challenges and catastrophic failures. Behind-the-scenes maneuvers of financiers, corporate raiders, mobsters and other nefarious characters provide an inside look at aviation development from the drawing board to the scrap yard.
The St. Paul Center for Biblical Theology and Dr. Scott Hahn present the tenth annual edition of Letter & Spirit with the theme “Christ Our Passover.” The articles, while academic in nature, are easily accessible to the average reader and can be read with great profit, both spiritually and in coming to learn the truths of the Catholic faith more deeply.
Textbook of Critical Care, by Drs. Jean-Louis Vincent, Edward Abraham, Frederick A. Moore, Patrick Kochanek, and Mitchell P. Fink, remains your best source on effective management of critically ill patients. This trusted reference - acclaimed for its success in bridging the gap between medical and surgical critical care - now features an even stronger focus on patient outcomes, equipping you with the proven, evidence-based guidance you need to successfully overcome a full range of practice challenges. Inside, you’ll find totally updated coverage of vital topics, such as coagulation and apoptosis in certain critical care illnesses, such as acute lung injury and adult respiratory distress syndrome; sepsis and other serious infectious diseases; specific organ dysfunction and failure; and many other vital topics. At www.expertconsult.com you can access the complete contents of the book online, rapidly searchable, with regular updates plus new videos that demonstrate how to perform key critical care procedures. The result is an even more indispensable reference for every ICU. Access the complete contents of the book online at www.expertconsult.com, rapidly searchable, and stay current for years to come with regular online updates. Practice with confidence by consulting with a "who’s who" of global experts on every facet of critical care medicine. Implement today’s most promising, evidence-based care strategies with an enhanced focus on patient outcomes. Effectively apply the latest techniques and approaches with totally updated coverage of the importance of coagulation and apoptosis in certain critical care illnesses, such as acute lung injury and adult respiratory distress syndrome; sepsis and other serious infectious diseases; specific organ dysfunction and failure; and many other vital topics. See how to perform key critical care procedures by watching a wealth of new videos online. Focus on the practical guidance you need with the aid of a new, more templated format in which basic science content has been integrated within clinical chapters, and all procedural content has been streamlined for online presentation and paired with videos.
Explore the Ocean State's out-of-the-way attractions, including the annual Ancients and Horribles Parade in Chepachet, cabaret performances at the Sea Horse Grill in South Kingston, and New England's oldest Masonic Temple in Warren.
Fully updated and enhanced, this popular Lange book provides the most current, high-yield information available on orthopedic disorders and diseases Packed with 500 images and meticulously organized for high-impact learning, CURRENT Diagnosis & Treatment Orthopedics, Sixth Edition emphasizes the major diagnostic features of musculoskeletal disease states, the nature of the diseases, the workup required for diagnosis, and all treatment options. It includes pathophysiology, epidemiology, and laboratory and imaging studies to help readers accurate diagnose patients and fully understand treatments. Chapters cover general considerations and imaging in surgery; musculoskeletal trauma, adult reconstructive, hand, foot, ankle, and pediatric surgery; sports medicine; spinal disorders, diseases, and injuries; musculoskeletal oncology; amputations; and rehabilitation and geriatric medicine. Perfect for surgical and emergency medicine residents, orthopedic surgery fellows, internal medicine and family practitioners, medical students, PAs, and nurse practitioner students, CURRENT Diagnosis & Treatment Orthopedics, Sixth Edition provides the knowledge and insights you need to deliver safe, effective treatment to every patient. Featuring a NEW chapter on imaging in orthopedics.
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