Floodplain connectivity, disturbance and change: a palaeoentomological investigation of floodplain ecology from south-west England

1. Floodplain environments are increasingly subject to enhancement and restoration, with the purpose of increasing their biodiversity and returning them to a more 'natural' state. Defining such a state based solely upon neoecological data is problematic and has led several authors to suggest the use of a palaeoecological approach.2. Fossil Coleopteran assemblages recovered from multiple palaeochannel fills in south-west England were used to investigate past floodplain and channel characteristics during the mid- to late-Holocene. Ordination of coleopteran data was performed using Detrended Correspondence Analysis (DCA) and produced clear and discrete clustering. This clustering pattern is related to the nature of the environment in which assemblages were deposited and hence channel configuration and dynamics.3. The DCA clustering pattern is strongly related to measures of ecological evenness, and a strong relationship between these indices and the composition of the water beetle assemblage within samples was revealed. Repeating the ordination with presence–absence data results in a similar pattern of clustering, implying that assemblage composition is crucial in determining cluster placement.4. As assemblage composition is primarily a function of floodplain topography and hence disturbance regime, we attempt to relate these data to the Intermediate Disturbance Hypothesis (IDH). A significant positive correlation was found between ecological diversity (Shannon's H') and Axis 1 of all ordinations in predominantly aquatic assemblages

The evidence base for pilonidal sinus surgery is the pits

Background Pilonidal sinus arises in the hair follicles in the buttock cleft. The estimated incidence is 26 per 100,000, people, affecting men twice as often as women. These chronic discharging wounds cause pain and impact upon quality of life. Surgical strategies centre on excision of the sinus tracts followed by primary closure and healing by primary intention or leaving the wound open to heal by secondary intention. There is uncertainty as to whether open or closed surgical management is more effective. Objectives To determine the relative effects of open compared with closed surgical treatment for pilonidal sinus on the outcomes of time to healing, infection and recurrence rate. Selection criteria All randomised controlled trials (RCTs) comparing open with closed surgical treatment for pilonidal sinus. Exclusion criteria were: non‐RCTs, children aged younger than 14 years and studies of pilonidal abscess. Main results For this update, 8 additional trials were identified giving a total of 26 included studies (n = 2530). Seventeen studies compared open wound healing with surgical closure. Healing times were faster after surgical closure compared with open healing. Surgical site infection (SSI) rates did not differ between treatments; recurrence rates were lower in open healing than with primary closure (RR 0.60, 95% CI 0.42–0.87). Six studies compared surgical midline with off‐midline closure. Healing times were faster after off midline closure (MD 5.4 days, 95% CI 2.3–8.5). SSI rates were higher after midline closure (RR 3.72, 95% CI 1.86–7.42) and recurrence rates were higher after midline closure (Peto OR 4.54, 95% CI 2.30–8.96). Authors’ conclusions No clear benefit was shown for open healing over surgical closure. A clear benefit was shown in favour of off midline rather than midline wound closure. When closure of pilonidal sinuses is the desired surgical option, off‐midline closure should be the standard management

Resource variation in colorectal surgery; a national centre-level analysis.

BACKGROUND: Delivery of quality colorectal surgery requires adequate resources. We set out to assess the relationship between resources and outcomes in English colorectal units. METHODS: Data was extracted from the ACPGBI resource questionnaire to profile resources. This was correlated with Hospital Episode Statistics (HES) outcome data including 90-day mortality and readmissions. Patient satisfaction measures were extracted from the Cancer Experience Patient Survey (CEPS) and compared at unit level. Centres were divided by workload into low, middle, and top tertile. RESULTS: Completed questionnaires were received from 75 centres in England. Service resources were similar between low and top tertiles in access to CEPOD theatre, level 2 or 3 beds per 250,000 population or likelihood of having a dedicated colorectal ward. There was no difference in staffing levels per 250,000 unit of population. Each 10% increase in the proportion of cases attempted laparoscopically, was associated with reduced 90-day unplanned readmission (RR 0.94, 95% CI 0.91 to 0.97, p<0.001). The presence of a dedicated colorectal ward (RR 0.85, 95% CI 0.73 to 0.99, p =0.040) was also associated with a significant reduction in unplanned readmissions. There was no association between staffing or service factors and patient satisfaction. DISCUSSION AND CONCLUSIONS: Resource levels do not vary based on unit of population. There is benefit associated with increased use of laparoscopy and a dedicated surgical ward. Alternative measures to assess the relationship between resources and outcome, such as failure to rescue, should be explored in UK practice. This article is protected by copyright. All rights reserved

Prognostic factors affecting outcomes in fistulating perianal Crohn's disease: a systematic review.

BACKGROUND: One in three patients with Crohn's disease will develop a perianal fistulae, and one third of these will achieve long-term healing or closure. A barrier to conducting well-designed clinical trials for these patients is a lack of understanding of prognostic factors. This systematic review sets out to identify factors associated with prognosis of perianal Crohn's fistulae. METHODS: This review was registered on the PROSPERO database (CRD42016050316) and conducted in line with PRISMA guidelines along a predefined protocol. English-language studies assessing baseline factors related to outcomes of fistulae treatment in adult patients were included. Searches were performed on MEDLINE and Embase databases. Screening of abstracts and full texts for eligibility was performed prior to extraction of data into predesigned forms. Bias was assessed using the QUIPS tool. RESULTS: Searches identified 997 papers. Following removal of duplicates and secondary searches, 923 were screened for inclusion. Forty-seven papers were reviewed at full-text level and 13, 2 of which were randomised trials, were included in the final qualitative review. Two studies reported distribution of Crohn's disease as a prognostic factor for healing. Two studies found that CARD15 mutations decreased response of fistulae to antibiotics. Complexity of fistulae anatomy was implicated in prognosis by 4 studies. CONCLUSIONS: This systematic review has identified potential prognostic markers, including genetic factors and disease behaviour. We cannot, however, draw robust conclusions from this heterogeneous group of studies; therefore, we recommend that a prospective cohort study of well-characterised patients with Crohn's perianal fistulae is undertaken

Center of mass integral in canonical general relativity

For a two-surface B tending to an infinite--radius round sphere at spatial infinity, we consider the Brown--York boundary integral H_B belonging to the energy sector of the gravitational Hamiltonian. Assuming that the lapse function behaves as N \sim 1 in the limit, we find agreement between H_B and the total Arnowitt--Deser--Misner energy, an agreement first noted by Braden, Brown, Whiting, and York. However, we argue that the Arnowitt--Deser--Misner mass--aspect differs from a gauge invariant mass--aspect by a pure divergence on the unit sphere. We also examine the boundary integral H_B corresponding to the Hamiltonian generator of an asymptotic boost, in which case the lapse N \sim x^k grows like one of the asymptotically Cartesian coordinate functions. Such an integral defines the kth component of the center of mass for a Cauchy surface \Sigma bounded by B. In the large--radius limit, we find agreement between H_B and an integral introduced by Beig and O'Murchadha. Although both H_B and the Beig--O'Murchadha integral are naively divergent, they are in fact finite modulo the Hamiltonian constraint. Furthermore, we examine the relationship between H_B and a certain two--surface integral linear in the spacetime Riemann curvature tensor. Similar integrals featuring the curvature appear in works by Ashtekar and Hansen, Penrose, Goldberg, and Hayward. Within the canonical 3+1 formalism, we define gravitational energy and center--of--mass as certain moments of Riemann curvature.Comment: 52 pages, revtex4, uses amsmath and amssym

Thermal Decay of the Cosmological Constant into Black Holes

We show that the cosmological constant may be reduced by thermal production of membranes by the cosmological horizon, analogous to a particle ``going over the top of the potential barrier", rather than tunneling through it. The membranes are endowed with charge associated with the gauge invariance of an antisymmetric gauge potential. In this new process, the membrane collapses into a black hole, thus the net effect is to produce black holes out of the vacuum energy associated with the cosmological constant. We study here the corresponding Euclidean configurations ("thermalons"), and calculate the probability for the process in the leading semiclassical approximation.Comment: 14 pages, 6 figures. Minor correction

Study of electrokinetic effects to quantify groundwater flow

An experimental study of electrokinetic effects (streaming potential) in earth materials was undertaken. The objective was to evaluate the measurement of electrokinetic effects as a method of monitoring and predicting the movement of groundwater, contaminant plumes, and other fluids in the subsurface. The laboratory experiments verified that the electrokinetic effects in earth materials are prominent, repeatable, and can be described well to first order by a pair of coupled differential equations