James C. McCann

Gastrointestinal complications following cardiac surgery

This study sought to determine which factors influence the mortality rate in patients developing gastrointestinal complications following cardiac surgery. Between July 1988 and January 1992, 2054 patients underwent cardiac surgical procedures at the Boston University Medical Center. Of these, 29 (1.4%) developed postoperative gastrointestinal complications. The overall mortality rate among these patients was 27% (8/29). Those who died following such complications had a higher incidence of New York Heart Association (NYHA) class IV and unstable symptoms (8/8, 100% versus 3/21, 14%; P < 0.0001), and an increased need for preoperative intra-aortic balloon pump support (4/8, 50% versus 1/21, 5%; P < 0.004). The need for gastrointestinal surgical intervention increased the mortality rate significantly compared with patients managed medically (8/18, 44% versus 0/11, 0%; P < 0.01). Patients with ischemic bowel also had a significantly higher mortality (5/5, 100% versus 3/24, 12%; P < 0.001). It is concluded that most patients with gastrointestinal complications following cardiac surgery can be treated, and with acceptable mortality rates. The presence of unstable symptoms, preoperative intra-aortic balloon pump support, ischemic bowel and the need for gastrointestinal surgical intervention adversely affect mortality.

The Plow and the Forest: Narratives of Deforestation in Ethiopia, 1840–1992

A process for improving the elongation of copper base alloys containing about 2 to 4.5% aluminum, 15 to 31% zinc, and a grain refining element such as iron, chromium, zirconium, or cobalt, is carried out through controlled grain coarsening. Such alloys are subjected to a cold reduction of about 15 to 40%, an intermediate anneal at about 625 DEG to 725 DEG C., a final cold reduction of 12 to 45% and a final anneal at about 600 DEG to 725 DEG C. Alternatively, the above sequence may be preceded by a preliminary cold reduction of about 10 to 70% and then a preliminary low temperature anneal at about 400 DEG to 600 DEG C. followed by the above reductions and anneals.

Novel Adhesive Skin Closures Improve Wound Healing Following Saphenous Vein Harvesting

Abstract  Background And Aims : New techniques for skin closure that minimize tissue inflammation and avoid foreign material may decrease morbidity following saphenous vein harvesting. The 3M™ Steri‐Strip™ S surgical skin closure system is a new, noninvasive method of wound closure, which consists of polymeric components coated with a pressure‐sensitive skin adhesive. This prospective, randomized study was undertaken to compare the results of the noninvasive skin closure method to the traditional subcuticular skin closure technique on saphenous vein harvest sites. Methods: Twenty‐six patients undergoing coronary artery bypass surgery with saphenous vein harvesting were prospectively randomized to skin closure using 3M Steri‐Strip S Surgical Skin Closure System or subcuticular suture closure with a skin sealant. Wounds were evaluated on postoperative days 7 and 2l for erythema, edema, pain, cosmesis, and the time taken to close the incision. Results: Skin closure with 3M Steri‐Strip S was significantly faster, resulted in significantly less erythema, edema, and significantly improved cosmesis. Conclusions: 3M Steri‐Strip S Skin Closure improves wound healing of saphenous vein sites, compared to traditional subcuticular skin closure techniques.

Breeding for Africa's new smallholder maize paradigm

This paper describes the evolution of a newly emerging smallholder maize paradigm in southern Africa beginning in 1996. This new paradigm involves the breeding, extension, and adoption of a new generation of open-pollinated ‘flinty’ maize varieties that specifically address the needs of southern African smallholder farmers for seed varieties that can be replanted (recycled) and that resist drought and low fertility problems increasingly common in southern Africa. The described mechanism is the extension and breeding work of the Southern Africa Drought and Low Fertility programme (SADLF) of the Centro Internationale por la Mejoridad de Maize y Trigo (CIMMYT). This paper explains the devolution of southern African maize production in the past two decades from centralized large-scale producers to smallholder farms, signalling a shift in research and plant breeding needs. The research/extension approach described here had profound consequences beyond the technical benefits of screening maize varieties for tolerance to stress; it empowered small-scale farmers to become informed consumers of agricultural technology. The transformation of the smallholder from a passive consumer to one actively seeking the best opportunity and seed to produce food, create economic opportunities and address local social conditions is an important development in the history and sustainability of maize production in southern Africa, and one consistent with modern African history of economic liberalization in the global food economy.

Adhesive Strips Versus Subcuticular Suture for Mediansternotomy Wound Closure

Abstract  Background and Aim: This prospective randomized study was undertaken to compare the use of the 3M™ Steri‐Strip™ S Surgical Skin closure system with a running absorbable subcuticular suture technique for skin closure following a mediansternotomy for cardiac surgical procedures. Methods: Thirty‐six patients undergoing a mediansternotomy for a cardiac surgical procedure were prospectively randomized to either Steri‐Strip S or subcuticular suture for wound closure. The wounds were evaluated on postoperative days 7 and 21 for erythema, edema, pain, cosmesis, and the time taken to close the incision. Results: Skin closure with Steri‐Strip S was faster (5.33 ± 1.32 minutes steri‐strips vs. 6.07 ± 0.91 sutures; p = 0.06) and resulted in significantly less erythema and edema, but no difference in pain or cosmesis after seven days. Following 21 days, there was no difference in pain, edema, or cosmesis between the groups. However, patients receiving steri‐strips continue to have less erythema. Conclusions: Both Steri‐Strip S and absorbable sutures are effective techniques for skin closure following a mediansternotomy incision for cardiac surgical procedures. Steri‐Strip S can decrease the amount of erythema, but results in no significant difference in pain, cosmesis, or edema compared to the traditional subcuticular wound closure technique. (J Card Surg 2011;26:344‐347)

Literacy, Orality, and Property: Church Documents in Ethiopia

Manuscript documents produced by the Ethiopian church are valuable historical sources about the relations of property and politics. Historians, however, should consider them as part of a political culture in which orality and literacy operated jointly to convey meaning and political validity.

The Empire of Nature: Hunting, Conservation, and British Imperialism.

Hunting - themes and variations the 19th-century hunting world hunting and African societies hunting and settlement in southern Africa game and imperial rule in Central Africa exploration, conquest and game in East Africa the imperial hunt in India from preservation to conservation - legislation and the international dimension reserves and the tsetse controversy national parks in Africa and Asia shikar and safari - hunting and conservation in the British empire. Appendices: the game legislation of the African colonies and India a colonoal game law - Northern Rhodesia, 1925 the membership of the Society for the Preservation of the Fauna of the Empire game and the independent African state - the Arusha manifesto, 1961.

Harnessing University Strengths in Multi-Sectoral Collaborations for Planetary Health

Abstract Although significant achievements in human health have been made globally, progress has been made possible, in part, through unconstrained use of natural resources. As the health of our planet worsens, human health is also endangered. Scholars and policymakers from diverse disciplines highlighted complex, multisectoral approaches for addressing poor dietary intake, over- and undernutrition, and chronic diseases in sub-Saharan Africa at the Agriculture, Nutrition, Health, and the Environment in Africa Conference held at Harvard University on 6–7 November 2017. A planetary health approach to addressing these challenges offers a unique opportunity to advance solutions for environmental and social factors that influence agriculture, nutrition, and overall health in the larger context of rapid population growth and transitions in food systems and livelihoods. This paper outlines 3 key avenues for universities to promote science at the intersection of public health and the environment in sub-Saharan Africa.

Bahir Dar and the Lake Tana Basin: Historical Phases of Growth and Ecology

This essay sets out five distinct periods of economic, demographic, and spatial change that transformed the physical landscape and its effect on the region’s hinterland on a local, national and international level – that would form the “urbanscape” of the early twenty first century. Lake Tana is at the Blue Nile’s first major outflow and is the heartbeat of the watershed, registering its seasonal pulse. Lake Tana and its surrounding ecologies is the font of the Blue Niles waters, sitting at 1800 meters above sea level from where it frames much of the watershed. The Blue Nile watershed’s agriculture and its relationship with human settlement had evolved over many generations of smallholder agriculture and its regional role in trade. The Blue Nile basin, its geology and its geographies simultaneously shaped the cultures of several distinctive peoples. The ethnographic landscape included Christian highland farmers and aristocrats, Cushitic-speaking Agaw farmers, Muslim traders (who spoke Amharic), and Omotic-speaking Shinasha. These cultures traded places and bodies of knowledge on the local ecologies over time, resulting in a cereal-based agro-economy that supported livestock and small farms that managed them.

Accelerated allograft degeneration after aortic valve endocarditis

Early calcification of aortic allografts is usually seen in children less than 3 years of age. We describe a case of a 22-year-old intravenous drug user who developed calcific aortic valve stenosis less than 3 years after an allograft root replacement for endocarditis.