How to deal with an open abdomen?

Appropriate open abdomen treatment is one of the key elements in the management of patients who require decompressive laparotomy or in whom the abdomen is left open prophylactically. Apart from fluid control and protection from external injury, fluid evacuation and facilitation of early closure are now the goals of open abdomen treatment. Abdominal negative pressure therapy has emerged as the most appropriate method to reach these goals. Especially when combined with strategies that allow progressive approximation of the fascial edges, high closure rates can be obtained. Intra-abdominal pressure measurement can be used to guide the surgical strategy and continued attention to intra-abdominal hypertension is necessary. This paper reviews recent advances as well as identifying the remaining challenges in patients requiring open abdomen treatment. The new classification system of the open abdomen is an important tool to use when comparing the efficacy of different strategies, as well as different systems of temporary abdominal closure

Biotechnological conversion of methane to methanol: evaluation of progress and potential

Sources of methane are numerous, and vary greatly in their use and sustainable credentials. A Jekyll and Hyde character, it is a valuable energy source present as geological deposits of natural gas, however it is also potent greenhouse gas, released during many waste management processes. Gas-to-liquid technologies are being investigated as a means to exploit and monetise non-traditional and unutilised methane sources. The product identified as having the greatest potential is methanol due to it being a robust, commercially mature conversion process from methane and its beneficial fuel characteristics. Commercial methane to methanol conversion requires high temperatures and pressures, in an energy intensive and costly process. In contrast methanotrophic bacteria perform the desired transformation under ambient conditions, using methane monooxygenase (MMO) enzymes. Despite the great potential of these bacteria a number of biotechnical difficulties are hindering progress towards an industrially suitable process. We have identified five major challenges that exist as barriers to a viable conversion process that, to our knowledge, have not previously been examined as distinct process challenges. Although biotechnological applications of methanotrophic bacteria have been reviewed in part, no review has comprehensively covered progress and challenges for a methane to methanol process from an industrial perspective. All published examples to date of methanotroph catalysed conversion of methane to methanol are collated, and standardised to allow direct comparison. The focus will be on conversion of methane to methanol by whole-cell, wild type, methanotroph cultures, and the potential for their application in an industrially relevant process. A recent shift in the research community focus from a mainly biological angle to an overall engineering approach, offers potential to exploit methanotrophs in an industrially relevant biotechnological gas-to-liquid process. Current innovations and future opportunities are discussed

Holocene relative sea-level changes in the Qaqortoq area, southern Greenland

We present results from an investigation of relative sea-level changes in the Qaqortoq area in south Greenland from c. 11 000 cal. yr BP to the present. Isolation and transgression sequences from six lakes and two tidal basins have been identified using stratigraphical analyses, magnetic susceptibility, XRF and macrofossil analyses. Macrofossils and bulk sediments have been dated by AMS radiocarbon dating. Maximum and minimum altitudes for relative sea level are provided from two deglaciation and marine lagoon sequences. Initially, relative sea level fell rapidly and reached present-day level at ∼9000 cal. yr BP and continued falling until at least 8800 cal. yr BP. Between 8000 and 6000 cal. yr BP, sea level reached its lowest level of around 6-8m below highest astronomical tide (h.a.t.). At around 3750 cal. yr BP, sea level has reached above 2.7m below h.a.t. and continued to rise slowly, reaching the present-day level between ∼2000 cal. yr BP and the present. As in the Nanortalik area further south, initial isostatic rebound caused rapid isolation of low elevation basins in the Qaqortoq area. Distinct isolation contacts in the sediments are observed. The late Holocene transgression is less well defined and occurred over a longer time interval. The late Holocene sea-level rise implies reloading by advancing glaciers superimposed on the isostatic signal from the North American Ice Sheet. One consequence of this transgression is that settlements of Palaeo-Eskimo cultures from ∼4000 cal. yr BP may have been transgressed by the sea

Abdominal compliance: A bench-to-bedside review

Abdominal compliance is an important determinant and predictor of available workspace during laparoscopic surgery. Furthermore, critically ill patients with a reduced abdominal compliance are at an increased risk of developing intra-abdominal hypertension and abdominal compartment syndrome both of which are associated with high morbidity and mortality. Despite of this, abdominal compliance is a concept, which has been neglected in the past. Abdominal compliance is defined as a measure of the ease of abdominal expansion, expressed as a change in intra-abdominal volume per change in intra-abdominal pressure: abdominal compliance = delta intra-abdominal volume / delta intra-abdominal pressure. AC is a dynamic variable, dependent on base-line IAV and IAP as well as reshaping and stretching capacity. Whereas abdominal compliance itself can only rarely be measured, it always needs to be considered an important component of intra-abdominal pressure. Patients with decreased abdominal compliance are prone to fulminant development of abdominal compartment syndrome when concomitant risk factors for intra-abdominal hypertension are present. This review aims to clarify the pressure-volume relationship within the abdominal cavity. It highlights how different conditions and pathologies can affect abdominal compliance and which management strategies could be applied to avoid serious consequences of decreased abdominal compliance. We have pooled all available human data to calculate abdominal compliance values in patients acutely and chronically exposed to intra-abdominal hypertension and demonstrated an exponential abdominal pressure-volume relationship. Most importantly, patients with high level of intra-abdominal pressure have a reduced abdominal compliance. In these patients, only small reduction in intra-abdominal volume can significantly increase abdominal compliance and reduce intra-abdominal pressures. A greater knowledge on abdominal compliance may help in selecting a better surgical approach as well as reducing complications related to intra-abdominal hypertension

Inclusive early childhood education : an analysis of 32 European examples

This report is part of the three-year Inclusive Early Childhood Education (IECE) project run by the European Agency for Special Needs and Inclusive Education (the Agency) from 2015 to 2017. The project aims to identify, analyse and subsequently promote the main characteristics of quality inclusive pre-primary education for all children from three years of age to the start of primary education. This report presents the results of a qualitative analysis of 32 descriptions of examples of IECE provisions across Europe. The descriptions were submitted to the project in August 2015. The findings represent European practitioners’ perceptions of and practices for IECE. An inductive thematic data analysis method was used, in that themes or issues were initially derived from reading the descriptions. This inductive process was, however, also intertwined with relevant theory, particularly the Agency’s ‘ultimate vision for inclusive education systems’ that: ... ensure that all learners of any age are provided with meaningful, high‐quality educational opportunities in their local community, alongside their friends and peers(European Agency, 2015, p. 1). In total, 25 subthemes were identified. These were organised into a new Ecosystem Model of Inclusive Early Childhood Education, which is also presented in a comprehensive diagram (Figure 1). Two major perspectives previously used in describing the quality of ECE settings inspired this new model. These are the Outcome-Process-Structure model and the Ecological Systems model. The subthemes were subsequently grouped into five main themes: • Theme 1: The first main and central theme is ‘Child belongingness, engagement and learning’, often generally understood as active participation. This participation is regarded as both the main outcome and process of IECE. • Theme 2: Five major processesinvolving the child’s direct experience in the IECE setting enable this central outcome and process. These processes are: − Positive interaction with adults and peers − Involvement in play and other daily activities − A child-centred approach − Personalised assessment for learning − Accommodations, adaptations and support. • Theme 3: These processes are in turn supported by structural factors, consisting of the physical, social, cultural and educational environment. These factors may operate at different ecological levels. Some operate within the ECE setting and include: − A warm welcome for every child and family − Family involvement within the ECE setting. − A holistic curriculum designed for all children’s needs − An environment designed for all children − Staff who are appropriately qualified for IECE − A culturally-responsive social and physical environment − Inclusive leadership committed to respect and engagement for all individuals − Collaboration and shared responsibility among all stakeholders. • Theme 4: Inclusive processes experienced by the child are also influenced by more distant structural factors in the community surrounding the ECE setting. These include: − Collaboration between the ECE setting and the children’s families − Relevant in-service training for ECE staff − Wider community commitment and support for serving all children − Inter-disciplinary and inter-agency co-operation of services from outside the ECE setting that serve the children in the pre-school − Organising smooth transitions between home and the ECE setting. • Theme 5: Finally, the analysis found a number of structural factors operating at the macro-system level. These factors were not in direct contact with the ECE setting. However, they still influenced inclusive processes in the setting. They are: − A rights-based approach to ECE − Provision of mainstream ECE access for all − Setting up regional/national standards for a holistic IECE curriculum − Availability of initial education for teachers and other staff for IECE − Good governance and funding systems for IECE − Procedures for regular monitoring and evaluation. This overview of the ecosystem of outcomes, processes and structures for IECE is presented in the Results chapter. Five evidence-based chapters, dedicated to each of the five main themes, follow this. Each chapter presents a brief description of each of the outcome, process or structural factors within each main theme. These are accompanied by one to five quotations from each of the 32 example descriptions. The quotations illustrate and provide concrete evidence of what constitutes quality outcomes, processes and structures that are prevalent across Europe. The quotations were chosen both to reflect the different types of IECE concepts and practices, and to reflect the variety of countries and cultures where they occur. They are intended to stimulate inclusive developments in research, policy and practice in Europe and internationally. Finally, the Conclusion highlights the added value that this analysis contributes to IECE research, policy and practice. Four new insights are addressed: 1. The development of the new Ecosystem Model of IECE, inspired by two previous major models, should clarify the understanding of the issues related to quality ECE. 2. The analysis shows how, within an inclusive perspective, IECE’s primary goal is best conceived as that of ensuring quality outcomes for all children in terms of participation. This is described here as belongingness, engagement and learning. 3. The analysis shines a new light on the major processes in which children are directly involved and which mostinfluence each child’s participation and learning. These need to be a major focus of any intervention to improve ECE quality. 4. The analysis clarifies the structural factors needed to support the development of more inclusive ECE settings. It also shows how these factors are related to local and national policies and practices. Situating the structures at the ECE setting, community and regional/national levels isimportant in levering them to bring about the changes needed to enable each child to participate and learn.peer-reviewe

The interplay between the surface and bottom water environment within the Benguela Upwelling System over the last 70 ka

The Benguela Upwelling System (BUS), located between 30 and 20°S, is one of the fundamentalhigh-productivity systems of the world ocean. The BUS has previously been studied in terms of primaryproductivity and ecology over glacial-interglacial timescales; however, the response and coupling with thebenthic environment have received little attention. Here, for the ?rst time, we present a high-resolutionreconstruction of the BUS highlighting the link between surface and benthic productivity and their responseto climatic and oceanographic changes over the last 70 ka. The study is based on benthic foraminiferal faunalanalysis together with analyses of diatom assemblages, grain size of the terrigenous fraction, and stable Oand C isotopic and bulk biogenic components of core GeoB3606-1. We reveal signi?cant shifts in benthicforaminiferal assemblage composition. Tight coupling existed between the surface and bottom waterenvironment especially throughout marine isotope stages 4 and 3 (MIS4 and MIS3). Due to the high exportproduction, the site has essentially experienced continuous low oxygen conditions; however, there are timeperiods where the hypoxic conditions were even more notable. Two of these severe hypoxic periods wereduring parts of MIS4 and MIS3 where we ?nd an inverse relationship between diatom and benthicforaminifera accumulation, meaning that during times of extremely high phytodetritus export we notestrongly suppressed benthic productivity. We also stress the importance of food source for the benthosthroughout the record. Shifts in export productivity are attributed not only to upwelling intensity and?lament front position, but also, regional-global climatic and oceanographic changes had signi?cant impacton the BUS dynamics

Inclusive early childhood education new insights and tools – contributions from a European study

Quality in early childhood education is a prominent concern for policy-makers, and has recently become a priority concern for many international and European organisations. These include the OECD, UNESCO, UNICEF, the European Commission, Eurydice and the European Agency for Special Needs and Inclusive Education, among others. Over the past three years (2015–2017), the European Agency for Special Needs and Inclusive Education (the Agency) has examined the latest policy documents and relevant research in this field. This has been a springboard for exploring the main characteristics of quality inclusive early childhood education (IECE) for all children from three years of age to the start of primary education. The project data from across Europe has provided an opportunity to closely examine how, within the inclusion perspective, early childhood education provisions are addressing the quality principles set out by the European Commission and the OECD. Sixty-four inclusive early childhood education experts from across Europe contributed to the project. They participated in data collection and analysis through descriptions of example provisions, as well as observations and discussions during field work and case study visits. This report first sets out the main policy and practice developments towards inclusive early childhood education, with particular reference to European policy issues (Chapters 2–3). It then presents the project’s three new contributions towards improving quality inclusive early childhood education (Chapters 4–6). These are: 1. A clear rationale for and an analysis of the implications of adopting an inclusive vision and goals as the main standards of inclusive early childhood policy and provision. The project found that high-quality services that benefited all children were guided by an inclusive vision and worked towards inclusive goals. As their primary outcome, they sought to ensure each child’s belongingness, engagement and learning. This reflects the changes in early childhood intervention in recent decades. The focus has shifted from ‘working with the child’ towards a holistic approach that creates an inclusive environment for all children’s engagement and learning. The report thus refers to quality early childhood education (ECE) as ‘inclusive early childhood education’ (IECE). It only uses the terms ‘early childhood education’ (ECE) or ‘early childhood education and care’ (ECEC) when referring to the literature. 2. A new Self-Reflection Tool for improving inclusive early childhood education settings. This enables practitioners to review their service’s quality in terms of the inclusiveness of the physical, social and other learning environments it offers to children and families. The tool has been validated by project experts and additional ecological studies. It is ready for use by practitioners in inclusive early childhood education settings in different education systems and countries across Europe and beyond. 3. A new Ecosystem Model of Inclusive Early Childhood Education for policy-makers and other stakeholders wishing to collaborate towards effective action in this field. This model can support policy-makers and practitioners to collaborate in planning, reviewing and improving quality IECE services. The model is founded on the project data. It is inspired by three major frameworks for quality IECE, namely: (1) The structure-process-outcome framework used by European and international policy-makers (European Commission, 2014; OECD, 2015; European Agency, 2009) (2) The ecological systems framework (Bronfenbrenner and Morris, 2006) (3) The inclusive education perspective (European Agency, 2015). It incorporates all the principles of the EU and OECD frameworks for quality early childhood education. However, it enhances their applicability by locating them at different ecological levels (inclusive early childhood education setting, home/community and regional/national levels). Finally, the report gives an account of the lessons learned during the three-year project and the resulting recommendations (Chapter 7). These are presented within the framework of the new Ecosystem Model of IECE. They are mainly directed at policy- makers, but they also point to the implications for practitioners. Indeed, they are formulated in terms of how policy-makers can support practitioners to ensure quality provisions.peer-reviewe