Severe Pelvic Endometriosis Involving the Rectum with Near Complete Bowel Obstruction: A Case Report

Endometriosis is a common gynecological disease among reproductive-age women that can result in chronic pain, severely decreased quality of life, and infertility. We present a case of a 44-year-old female with a known history of endometriosis who presented with constipation, decreased appetite, iron deficiency anemia, and unintentional weight loss for 6 months. Investigation with colonoscopy discovered a partially-obstructing mass in her proximal rectum and no evidence of malignancy on biopsy. The mass was subsequently removed during a combined robotic-assisted total hysterectomy with bilateral salpingo-ophorectomy and low anterior resection with reanastomosis. Surgical pathology determined that the mass was consistent with endometriosis and no malignancy was identified. This case calls attention to a unique manifestation of endometriosis and highlights the importance of maintaining a broad differential diagnosis while utilizing a multidisciplinary team in the management of a rectal mass in reproductive-age women

Factors Influencing Physical and Technical Variability in the English Premier League

Purpose: To investigate match-to-match variability of physical and technical performances in English Premier League players and quantify the influence of positional and contextual factors. Methods: Match data (N = 451) were collected using a multicamera computerized tracking system across multiple seasons (2005–06 to 2012–13). The coefficient of variation (CV) was calculated from match to match for physical and technical performances in selected positions across different match contexts (location, standard, and result). Results: Wide midfielders demonstrated the greatest CVs for total distance (4.9% ± 5.9%) and central midfielders the smallest (3.6% �} 2.0%); nevertheless, all positions exhibited CVs .05, effect size [ES] 0.1–0.3). Central defenders demonstrated the greatest CVs and wide midfielders the lowest for both high-intensity running (20.2% ± 8.8% and 13.7% ± 7.7%, P < .05, ES 0.4–0.8) and sprint distance (32.3% ± 13.8% and 22.6% ± 11.2%, P < .05, ES 0.5–0.8). Technical indicators such as tackles (83.7% ± 42.3%), possessions won (47.2% ± 27.9%), and interceptions (59.1% ± 37.3%) illustrated substantial variability for attackers compared with all other positions (P < .05, ES 0.4–1.1). Central defenders demonstrated large variability for the number of times tackled per match (144.9% ± 58.3%) and passes attempted and received compared with other positions (39.2% ± 17.5% and 46.9% ± 20.2%, P < .001, ES 0.6–1.8). Contextual factors had limited impact on the variability of physical and technical parameters. Conclusions: The data demonstrate that technical parameters varied more from match to match than physical parameters. Defensive players (fullbacks and central defenders) displayed higher CVs for offensive technical variables, while attacking players (attackers and wide midfielders) exhibited higher CVs for defensive technical variables. Physical and technical performances are variable per se regardless of context

Open versus Endovascular Abdominal Aortic Aneurysm Repair in VA Hospitals

Background: Endovascular abdominal aortic aneurysm repair (EVAR), when compared to conventional open surgical repair, has been shown to reduce perioperative morbidity and mortality. A retrospective cohort study was performed with data from the Department of Veterans Affairs to examine outcomes in routine daily practice following EVAR and open surgical repair. Methods: In this study, I examined 30-day mortality, 1-year survival, and postoperative complications in 1957 patients who underwent elective AAA repair (EVAR n=717 (36.6%); open n=l240 (63.4%)) at 123 VA hospitals between May 1, 2001 and September 30, 2003. Also, this review investigated the influence of patient, operative, and hospital variables on outcome, and used propensity scoring to adjust for the nonrandom allocation of patients to either EVAR or open procedures. Results: Patients undergoing EVAR had significantly lower 30 day (3.1% vs. 5.7%, p=0.0079) and 1 year mortality (8.4% vs. 12.0%, p=0.0121) than patients having open repair. EVAR was positively and independently associated with a decrease in 30-day postoperative mortality (adjusted OR=0.58; 95% CI=0.35, 0.97; p=0.0367). The risk of any perioperative complication was much less following EVAR (4.5% vs. 14.2%; p<0.0001; unadjusted OR 0.48; 95% CI =0.37, 0.63; p<0.001). Patients operated on at low volume hospitals (25% of entire cohort) were more likely to have had open repair (31.6% compared to 15.9% EVAR; p <0.001) as well as a two-fold increased adjusted 30-day mortality risk (OR=2.06; 95% CI=1.32, 3.26; p=0.0015). Conclusions: In routine daily practice, patients presenting for elective AAA repair who undergo EVAR have substantially lower perioperative mortality and morbidity rates compared to patients having open repair. The benefits of a minimally invasive approach were readily apparent in this cohort; however, caution should be exercised in choosing EVAR for all elective AAA repairs until longer-term data on device durability are available. Furthermore, widely available screening programs may aid in the early detection of AAA, which would further facilitate timely surgical intervention and, ultimately, improve outcomes.Master of Public Healt

Emerging trends in aquaculture value chain research

This paper introduces a special issue of Aquaculture that brings together the largest collection of research on aquaculture value chains compiled to date, comprising 19 individual papers and this introductory review. The introduction identifies five themes emerging from research on aquaculture value chains in the special issue, namely: multi-polarity, diversity and scale, dynamics of transformation, performance and equity, and technical and institutional innovation. Contrary to much research to date, the papers addressing these themes show how the expansion of aquaculture has resulted highly diverse configurations of production for consumption in the global South. Collectively, the papers highlight the need for greater attention to neglected value chain segments and categories of actor, modes of production, regulation, and innovation, and patterns of access to benefits. The papers synthesized also affirm the need for more rigorous and diverse future value chain research to illuminate the aquaculture sector's ongoing development, and contribute to the sustainable expansion as an increasingly important component of the global food system

φxANES: In vivo imaging of metal-protein coordination environments

© 2016, Nature Publishing Group. All rights reserved. We have developed an X-ray absorption near edge structure spectroscopy method using fluorescence detection for visualizing in vivo coordination environments of metals in biological specimens. This approach, which we term fluorescence imaging XANES (φXANES), allows us to spatially depict metal-protein associations in a native, hydrated state whilst avoiding intrinsic chemical damage from radiation. This method was validated using iron-challenged Caenorhabditis elegans to observe marked alterations in redox environment

Medicare fraud, waste and abuse

In 2014, the U.S. spent approximately $3 trillion on health care. Medicare accounted for$554 billion of these costs and around $60 billion were squandered due to incorrect billing methods, abuse, and fraud. Types of fraud included: kickbacks, up coding, and organized fraudulent crimes. To reduce the financial burden associated with these activities, the U.S. has created various fraud prevention programs. The purpose of this study was to identify methods of Medicare fraud, examine the various programs implemented by the U.S. government to combat fraud and abuse, and determine the effectiveness of these programs. While fraud prevention strategies have proven to be effective, the furtherance of these strategies is imperative in order to continually combat rising healthcare expenditures in the U.S. Benefits of increased fraud prevention and detection are discussed in detail

High-resolution complementary chemical imaging of bio-elements in Caenorhabditis elegans

© 2016 The Royal Society of Chemistry. Here, we present a sub-μm multimodal approach to image essential elements in Caenorhabditis elegans. A combination of chemical imaging technologies reveals total metal concentration, chemical state and the protein to which an element is associated. This application of distinct yet complementary chemical imaging techniques provided unique insight into essential and trace elements at the subcellular level

Assessing the effect of reducing agents on the selective catalytic reduction of NO<inf>x</inf> over Ag/Al<inf>2</inf>O<inf>3</inf> catalysts

The selective catalytic reduction (SCR) of NOx in the presence of different reducing agents over Ag/Al2O3 prepared by wet impregnation was investigated by probing catalyst activity and using NMR relaxation time analysis.We gratefully acknowledge funding for this work from the EPSRC CASTech grant (EP/G012156/1). Carmine D’Agostino would like to acknowledge Wolfson College, Cambridge, for supporting his research activities. The authors would also like to thank Dr Jonathan Mitchell for useful discussions.This is the final version of the article. It first appeared from RSC via http://dx.doi.org/10.1039/C5CY01508

Fast imaging of laboratory core floods using 3D compressed sensing RARE MRI.

Three-dimensional (3D) imaging of the fluid distributions within the rock is essential to enable the unambiguous interpretation of core flooding data. Magnetic resonance imaging (MRI) has been widely used to image fluid saturation in rock cores; however, conventional acquisition strategies are typically too slow to capture the dynamic nature of the displacement processes that are of interest. Using Compressed Sensing (CS), it is possible to reconstruct a near-perfect image from significantly fewer measurements than was previously thought necessary, and this can result in a significant reduction in the image acquisition times. In the present study, a method using the Rapid Acquisition with Relaxation Enhancement (RARE) pulse sequence with CS to provide 3D images of the fluid saturation in rock core samples during laboratory core floods is demonstrated. An objective method using image quality metrics for the determination of the most suitable regularisation functional to be used in the CS reconstructions is reported. It is shown that for the present application, Total Variation outperforms the Haar and Daubechies3 wavelet families in terms of the agreement of their respective CS reconstructions with a fully-sampled reference image. Using the CS-RARE approach, 3D images of the fluid saturation in the rock core have been acquired in 16min. The CS-RARE technique has been applied to image the residual water saturation in the rock during a water-water displacement core flood. With a flow rate corresponding to an interstitial velocity of vi=1.89±0.03ftday(-1), 0.1 pore volumes were injected over the course of each image acquisition, a four-fold reduction when compared to a fully-sampled RARE acquisition. Finally, the 3D CS-RARE technique has been used to image the drainage of dodecane into the water-saturated rock in which the dynamics of the coalescence of discrete clusters of the non-wetting phase are clearly observed. The enhancement in the temporal resolution that has been achieved using the CS-RARE approach enables dynamic transport processes pertinent to laboratory core floods to be investigated in 3D on a time-scale and with a spatial resolution that, until now, has not been possible.Royal Dutch Shell plc; Engineering and Physical Sciences Research Council (EP/K039318/1, EP/M00483X/1)This is the final version of the article. It first appeared from Elsevier via http://dx.doi.org/10.1016/j.jmr.2016.07.01

Evolution of Novel Signal Traits in the Absence of Female Preferences in Neoconocephalus Katydids (Orthoptera, Tettigoniidae)

Background Significance: Communication signals that function to bring together the sexes are important for maintaining reproductive isolation in many taxa. Changes in male calls are often attributed to sexual selection, in which female preferences initiate signal divergence. Natural selection can also influence signal traits if calls attract predators or parasitoids, or if calling is energetically costly. Neutral evolution is often neglected in the context of acoustic communication. Methodology/Principal Findings: We describe a signal trait that appears to have evolved in the absence of either sexual or natural selection. In the katydid genus Neoconocephalus, calls with a derived pattern in which pulses are grouped into pairs have evolved five times independently. We have previously shown that in three of these species, females require the double pulse pattern for call recognition, and hence the recognition system of the females is also in a derived state. Here we describe the remaining two species and find that although males produce the derived call pattern, females use the ancestral recognition mechanism in which no pulse pattern is required. Females respond equally well to the single and double pulse calls, indicating that the derived trait is selectively neutral in the context of mate recognition. Conclusions/Significance: These results suggest that 1) neutral changes in signal traits could be important in the diversification of communication systems, and 2) males rather than females may be responsible for initiating signa