Postoperative mortality and complications in patients with and without pre-operative SARS-CoV-2 infection: a service evaluation of 24 million linked records using OpenSAFELY.

Surgical decision-making after SARS-CoV-2 infection is influenced by the presence of comorbidity, infection severity and whether the surgical problem is time-sensitive. Contemporary surgical policy to delay surgery is informed by highly heterogeneous country-specific guidance. We evaluated surgical provision in England during the COVID-19 pandemic to assess real-world practice and whether deferral remains necessary. Using the OpenSAFELY platform, we adapted the COVIDSurg protocol for a service evaluation of surgical procedures that took place within the English NHS from 17 March 2018 to 17 March 2022. We assessed whether hospitals adhered to guidance not to operate on patients within 7 weeks of an indication of SARS-CoV-2 infection. Additional outcomes were postoperative all-cause mortality (30 days, 6 months) and complications (pulmonary, cardiac, cerebrovascular). The exposure was the interval between the most recent indication of SARS-CoV-2 infection and subsequent surgery. In any 6-month window, < 3% of surgical procedures were conducted within 7 weeks of an indication of SARS-CoV-2 infection. Mortality for surgery conducted within 2 weeks of a positive test in the era since widespread SARS-CoV-2 vaccine availability was 1.1%, declining to 0.3% by 4 weeks. Compared with the COVIDSurg study cohort, outcomes for patients in the English NHS cohort were better during the COVIDSurg data collection period and the pandemic era before vaccines became available. Clinicians within the English NHS followed national guidance by operating on very few patients within 7 weeks of a positive indication of SARS-CoV-2 infection. In England, surgical patients' overall risk following an indication of SARS-CoV-2 infection is lower than previously thought.

Dental Extractions under General Anesthesia: New Insights from Process Mining.

INTRODUCTION: Tooth extraction under general anesthetic (GA) is a global health problem. It is expensive, high risk, and resource intensive, and its prevalence and burden should be reduced where possible. Recent innovation in data analysis techniques now makes it possible to assess the impact of GA policy decisions on public health outcomes. This article describes results from one such technique called process mining, which was applied to dental electronic health record (EHR) data. Treatment pathways preceding extractions under general anesthetic were mined to yield useful insights into waiting times, number of dental visits, treatments, and prescribing behaviors associated with this undesirable outcome. METHOD: Anonymized data were extracted from a dental EHR covering a population of 231,760 patients aged 0 to 16 y, treated in the Irish public health care system between 2000 and 2014. The data were profiled, assessed for quality, and preprocessed in preparation for analysis. Existing process mining methods were adapted to execute process mining in the context of assessing dental EHR data. RESULTS: Process models of dental treatment preceding extractions under general anesthetic were generated from the EHR data using process mining tools. A total of 5,563 patients who had 26,115 GA were identified. Of these, 9% received a tooth dressing before extraction with an average lag time of 6 mo between dressing and extraction. In total, 11,867 emergency appointments were attended by the cohort with 2,668 X-rays, 4,370 prescriptions, and over 800 restorations and other treatments carried out prior to tooth extraction. DISCUSSION AND CONCLUSIONS: Process models generated useful insights, identifying metrics and issues around extractions under general anesthetic and revealing the complexity of dental treatment pathways. The pathways showed high levels of emergency appointments, prescriptions, and additional tooth restorations ultimately unsuccessful in preventing extractions. Supporting earlier publications, the study suggested earlier screening, preventive initiatives, guideline development, and alternative treatments deserve consideration. KNOWLEDGE TRANSFER STATEMENT: This study generates insights into tooth extractions under general anesthetic using process mining technologies and methods, revealing levels of extraction and associated high levels of prescriptions, emergency appointments, and restorative treatments. These insights can inform dental planners assessing policy decisions for tooth extractions under general anesthetic. The methods used can be combined with costs and patient outcomes to contribute to more effective decision-making.

Gene transfer into corn earworm (Helicoverpa zea) embryos.

Transposable elements with short inverted repeats at their termini have been identified in a number of diverse insect species and have proven to be useful gene delivery vectors for the transformation of Drosophila melanogaster. In this report we examine the ability of the D. melanogaster hobo element to transpose in lepidopteran species. A Trichoplusia ni (cabbage looper) and a Helicoverpa zea (corn earworm) embryonic cell line were found to be capable of supporting productive transposition of the hobo element as measured by a plasmid-based excision assay. Furthermore, hobo transposition was detected in H. zea embryos in a manner consistent with that seen for the cell line. In both cases, transposition/excision was found to be independent of vector-encoded transposase functions, indicating that endogenous genes are involved in hobo mobility. Finally, we demonstrate the stable insertion of the bacterial lacZ gene into the H. zea genome. These data demonstrate that hobo elements are capable of transgressing species boundaries and functioning in non-drosophilid cellular environments. More importantly, this represents the first description of a genetic transformation system for a lepidopteran species.

Biotechnology and new integrated pest management approaches.

Area-wide pest management technologies will take on new appearances as the drive to eliminate and/or greatly reduce the use of chemical pesticides increases. The use of genetically altered insects has the most potential for successfully displacing certain pesticides, although the development of genetic engineering technologies for agricultural pest species is still in its infancy. Transformation vectors need to be developed as do transformation methodologies. Here we report the possibility of developing an interspecies vector and discuss ways in which such a vector could be used successfully in an integrated pest management system. If such an approach were developed, it could be utilized with other alternative methods, thereby providing a safe, ecologically sound means of controlling insect pests without damaging the agricultural economy.

Rotavirus infection in children presenting with acute gastroenteritis Ibadan, Nigeria.

Faecal samples from 84 children presenting with acute gastroenteritis at the University College Hospital, Ibadan, Nigeria and 28 from a non-diarrhoeal control group were tested for rotavirus by an ELISA. 18 cases (21%) and none of the controls were positive. Hospital in-patients had a higher percentage of positives (25%) than did out-patients (10%). The age distribution of infections showed that the highest infection rate (67%) occurred in children four to six months old. Percentages of positive samples from other age groups was as follows: 0 to 3 months, 13%; 7 to 12 months, 33%; and 13 to 24 months, 16%. None of the faecal extracts from children older than two years was positive for rotavirus.

Embryonic development in house fly eggs fertilized with genetically deficient sperm.

In house flies, Musca domestica L., eggs fertilized with sperm that have chromosome deficiencies and duplications do not hatch, but develop to a stage where a fully differentiated, prehatch larva is formed. Fifteen different chromosome translocations involving most of the 10 arms of the 5 autosomes were studied by crossing male translocation heterozygotes to normal females. Egg hatch was reduced to 36-66% depending on the translocation used. Eggs that did not hatch after 24 hours were fixed, stained, and examined for stage of development. Several translocations involving the right arm of chromosome 4 indicate that the region closest to the centromere contains genes that affect the process of syngamy or early cleavage divisions, but do not reduce the ability of the sperm to compete for egg fertilization. Approximately 70% of the autosomal genes can be absent from sperm (not simultaneously but in different crosses) without inhibiting embryonic development.

Polymorphisms and inheritance patterns of tetrazolium oxidase and octanol dehydrogenase in the house fly.

Zymogram analyses suggested the existence of two autosomal codominant alleles each at loci controlling the production of tetrazolium oxidase (To1) and octanol dehydrogenase (Odh1) in Texas house flies; an additional variant of the To1 locus was detected in a population from South Dakota. The allozymes of both systems may be dimeric as indicated by the presence of possible heteropolymers in flies heterozygous for To1 and Odh1 allels. Apparent nonsegregating isozymes of To and Odh (To2 and Odh2) were also noted in the zymograms of Texas flies. Some banding forms in the Odh gels could not be interpreted genetically.