One World Surgery: The Evolution of a Locally Run Surgical Mission in Honduras.

ABSTRACT: One World Surgery (OWS) is a medical mission organization that treats a variety of orthopaedic conditions and focuses on local partnerships, education, capacity-building, and high-quality care. OWS runs a Honduran ambulatory surgery center (ASC) with >50 full-time local staff; it operates year-round and accommodates visiting surgical teams bimonthly. Across its 12-year history, 8,703 surgical procedures have been performed and 54,940 total consults have been completed, with increasing autonomy of the local medical staff. From 2009 through 2021, OWS has provided 74 million U.S. dollars in surgical and consult patient care. By addressing global surgical disparities via life-enhancing surgical care in low- and middle-income country (LMIC) settings, the OWS ASC mission model may be a useful blueprint for other medical missions.

Percutaneous native renal biopsy adequacy: a successful interdepartmental quality improvement activity.

BACKGROUND: An adequate renal biopsy is essential for diagnosis and treatment of medical renal disease. OBJECTIVE: We evaluated two initiatives to improve adequacy of renal biopsy samples at our centre. DESIGN: Retrospective determination of renal biopsy adequacy. SETTING: Queen Elizabeth II Health Sciences Centre. PATIENTS: Patients undergoing medical renal biopsies. MEASUREMENTS: Renal biopsy adequacy. METHODS: The first initiative was to restrict the performance of biopsies to a smaller group of radiologists and to include a comment on biopsy adequacy in every pathology report. The second initiative was to introduce on-site adequacy assessment by a medical laboratory technologist. Native renal and allograft biopsy adequacies were calculated for three periods: 1) baseline, October 2005 to September 2006; 2) after implementation of the first initiative, January 2007 to September 2011; and 3) after implementation of the second initiative, October 2011 to September 2012. A subset of native renal biopsies was examined to determine if there was a relationship between adequacy and number of passes. RESULTS: The percentages of adequate native renal biopsies during the first, second, and third periods were 31%, 72% and 90%, respectively. This represents a significant increase (40%, p < 0.0001) in adequacy following the first initiative, and another significant increase (18%, p = 0.0003) following the second initiative. The percentages of adequate renal allograft biopsies during the first, second, and third periods were 75%, 56% and 69%, respectively. These changes in adequacy were not statistically significant. In the subset of native renal biopsies examined, a biopsy comprising more than three cores was not associated with increase in adequacy. LIMITATIONS: The most important limitation is the lack of generally accepted and applied adequacy criteria limiting generalizability of our findings. CONCLUSIONS: Restricting the performance of biopsies to subspecialist operators, including an adequacy statement in the renal biopsy report and on-site adequacy assessment were effective in significantly improving native renal biopsy adequacy. This improvement appeared unrelated to an increase in the number of passes taken with a biopsy needle. Neither initiative improved the low adequacy of allograft biopsies.

CONTEXTE: L'importance que joue la biopsie percutanée dans le diagnostic et le traitement des maladies rénales est un fait bien connu. Un spécimen adéquat est nécessaire pour une interprétation correcte des résultats. La surveillance de la qualité de biopsie reste une pratique importante de contrôle de la qualité. OBJECTIF DE L'ÉTUDE: Deux initiatives visant une meilleure qualité des échantillons rénaux pour la biopsie ont été évaluées à notre centre. TYPE D'ÉTUDE: Détermination rétrospective de la qualité de la biopsie rénale. CONTEXTE: Le Queen Elizabeth II Health Sciences Centre. PATIENTS: Patients subissant des biopsies rénales. MESURES: Qualité de la biopsie rénale. MÉTHODES: La première initiative visait à restreindre la réalisation des biopsies à un petit groupe de radiologues et d'ajouter un commentaire sur la qualité de la biopsie dans chaque rapport de pathologie. La deuxième initiative visait à implanter l'évaluation de cette qualité sur place, par l'intermédiaire d'un technicien de laboratoire médical. La qualité des biopsies de reins natifs et d'allogreffes ont été calculées en trois temps : 1) mesure de référence: d'octobre 2005 à septembre 2006; 2) après l'implantation de la première initiative, de janvier 2007 à septembre 2011; 3) après l'implémentation de la deuxième initiative, d'octobre 2011 à septembre 2012. Un sous-ensemble de biopsies effectuées sur des reins natifs a été examiné afin de déterminer s'il existait un lien entre la qualité et le nombre de ponctions. RÉSULTATS: Les pourcentages d'une qualité adéquate des biopsies de reins natifs des trois phases étaient de 31%, 72% et 90%, respectivement. On remarque des hausses de la qualité des biopsies importantes après la première initiative (40%, p < 0,0001) et après la deuxième (18%, p = 0,0003). Les pourcentages d'une qualité adéquate des biopsies d'allogreffes rénales des trois étapes étaient de 75%, 56% et 69%, respectivement; ces changements n'étaient pas statistiquement significatifs. Dans le sous-ensemble des biopsies de reins natifs, celles de plus de trois échantillons n'étaient pas associées avec une hausse de la qualité. LIMITES DE L'ÉTUDE: Parmi les limites de l'étude, on compte les données lacunaires concernant : les complications postopératoires; l'analyse détaillée des caractéristiques des radiologistes avant et après la première intervention; certaines données permettant de mesurer l'effet de la deuxième intervention indépendamment de son lien avec la première intervention; un consensus sur les critères de la qualité des biopsies de reins natifs et d'allogreffes rénales à des fins de comparaisons entre les différentes institutions, et qui s'est répercuté sur la généralisabilité de nos résultats (provenant d'un seul centre) à d'autres établissements. Le manque de puissance statistique a limité la possibilité de détecter certaines différences entre les sous-groupes. CONCLUSIONS: La restriction de la réalisation des biopsies par une sous-spécialité, l'ajout d'un commentaire sur la qualité de la biopsie rénale dans le rapport, et l'évaluation sur place de la qualité ont eu l'effet d'améliorer de façon significative la proportion de biopsies rénales natives avec une qualité adéquate. Cette amélioration ne semble pas liée à une hausse du nombre de ponctions faites avec une aiguille à biopsie. Aucune des initiatives n'a amélioré la basse qualité des biopsies d'allogreffes.

Practical strategies for identifying groundwater discharges into sediment and surface water with fiber optic temperature measurement.

Identifying or ruling out groundwater discharges into sediment and surface waters is often critical for evaluating impacts and for planning remedial actions. Information about subsurface structure and groundwater can be helpful, but imperfect information, heterogeneous materials, and the likelihood of preferential pathways make it difficult to locate seeps without direct seep monitoring. We present the practical application of a method that uses fiber optic temperature measurement to provide high-resolution, sensitive, and dynamic monitoring of seepage from sediments over large areas: distributed temperature sensing to identify groundwater discharge (DTSID). First, we introduce a stochastic Monte Carlo method for designing DTSID installation based on site characteristics and the required probability of detecting particular size seeps. We then present practical methods for analysing DTSID results to prioritize locations for further investigation used at three industrial locations. Summer conditions generally presented greater difficulty in the method due to stronger environmentally-driven temperature fluctuations and thermal stratification of surface water. Tidal fluctuations were shown to be helpful in seepage detection at some locations by creating a dynamic temperature pattern that likely reflects changing seepage with varying water levels. At locations with suitable conditions for the application of DTSID, it can provide unique information regarding likely seep locations, enhancing an integrated site investigation.

Porcine endogenous retroviruses in xenotransplantation--molecular aspects.

In the context of the shortage of organs and other tissues for use in human transplantation, xenotransplantation procedures with material taken from pigs have come under increased consideration. However, there are unclear consequences of the potential transmission of porcine pathogens to humans. Of particular concern are porcine endogenous retroviruses (PERVs). Three subtypes of PERV have been identified, of which PERV-A and PERV-B have the ability to infect human cells in vitro. The PERV-C subtype does not show this ability but recombinant PERV-A/C forms have demonstrated infectivity in human cells. In view of the risk presented by these observations, the International Xenotransplantation Association recently indicated the existence of four strategies to prevent transmission of PERVs. This article focuses on the molecular aspects of PERV infection in xenotransplantation and reviews the techniques available for the detection of PERV DNA, RNA, reverse transcriptase activity and proteins, and anti-PERV antibodies to enable carrying out these recommendations. These methods could be used to evaluate the risk of PERV transmission in human recipients, enhance the effectiveness and reliability of monitoring procedures, and stimulate discussion on the development of improved, more sensitive methods for the detection of PERVs in the future.

Mitral valve reconstruction: experience related to early and late mortality and reoperation.

BACKGROUND AND AIM OF THE STUDY: The present authors' experience with mitral valve reconstruction was reviewed to determine the influence of anatomical and functional abnormalities on mortality and reoperation. METHODS: Between 1991 and 2001, a total of 397 patients (mean age 59.0 +/- 13.4 years) underwent mitral valve reconstruction at the authors' institution. Patients were grouped according to the Carpentier functional classification as follows: type I, n = 88 (mean age 57.4 years; range: 24-81 years); type II, n = 169 (mean age 59.8 years; range: 16-81 years); type IIIa, n = 44 (mean age 52.8 years; range: 22-78 years); type IIIb, n = 85 (mean age 65.1 years; range: 33-82 years); and congenital (C), n = 11 (mean age 36.2 years; range: 18-65 years). RESULTS: The total follow up was 1,485.8 patient-years (pt-yr). Early mortality was: type I, 3.4% (n = 3); type II, 0; type IIIa; 2.3% (n = 1); type IIIb, 9.4% (n = 8); and C, 0 (p = 0.0028, IIIb > II and C). The late mortality was: type I, 2.1%/pt-yr (n = 6); type II, 1.1%/pt-yr (n = 7); type IIIa, 1.8%/pt-yr (n = 4); type IIIb, 4.3%/pt-yr (n = 12); and C, 1.7%/pt-yr (n = 1) (p = 0.0035 IIIb > II). The overall survival at 10 years was 79.6 +/- 4.2% (p <0.001, II > IIIb; p = 0.029, I > IIIb; p = 0.046, II > I). The reoperations were: type I, 1.4%/pt-yr (n = 4); type II, 1.9%/pt-yr (n = 12); type IIIa, 0.9%/pt-yr (n = 2); type IIIb, 0.4%/pt-yr (n = 1); and C, 0 (p = 0.0435 II > IIIb). Among the 19 reoperations there were 17 replacements, one re-repair, and one annuloplasty. The failures were predominantly type II, posterior (n = 5) and anterior (n = 5), or a combination (n = 2). The overall freedom from reoperation was 92.0 +/- 2.2% (p = NS between groups). CONCLUSION: Mitral valve reconstruction can be performed in all four functional categories with generally satisfactory results, except possibly for functional ischemic disease. The results of surgery for degenerative disease afford the opportunity for early surgical management, if proven techniques are adhered to in order to minimize the risk of reoperation. The repair of ischemic disease due primarily to ventricular dysfunction is in a state of evolution.