Derivation, validation, and comparison of a new prognostic scoring system for acute lower gastrointestinal bleeding

\ua9 2023 The Authors. DEN Open published by John Wiley & Sons Australia, Ltd on behalf of Japan Gastroenterological Endoscopy Society.Objectives: Lower gastrointestinal bleeding is a common presentation with little data concerning risk factors for adverse outcomes. The aim was to derive and validate a scoring system to stratify risk in lower gastrointestinal bleeding and compare it to the Oakland score. Methods: A total of 2385 consecutive patients (mean age 65 years, 1140 males) were used to derive the score using multivariate logistic regression modeling then internally and externally validated. The Oakland score was applied and area under receiver operating characteristic (AUROC) curves were calculated and compared. A score of <1 was compared with an Oakland score of <9 to assess 30-day rebleeding and mortality rates. Results: Rebleeding was associated with age, inpatient bleeding, syncope, malignancy, tachycardia, hypotension, lower hemoglobin and mortality with age, inpatient bleeding, liver/gastrointestinal disease, tachycardia, and hypotension. The area under the receiver operating characteristic curves was 0.742 for rebleeding and 0.802 for mortality. A score <1 was associated with rebleeding (0.0%–2.2%) and mortality (0%). The Oakland score had a significantly lower area under the receiver operating characteristic curve for rebleeding of 0.687 but not for mortality; 0.757. A score <1 was associated with a lower 30-day rebleeding risk compared to an Oakland score <9 (4/379 vs. 15/355, p = 0.009) but not mortality (0/365 vs. 1/355, p = 0.493). Conclusions: Our score predicts 30-day rebleeding and mortality rate with low scores associated with very low risk. The Aberdeen score is superior to the Oakland score for predicting rebleeding. Prospective evaluation of both scores is required

City of clones: Facsimiles and governance in Sao Paulo, Brazil

São Paulo is a megacity defined by formal and informal patterns of urbanization. Informally urbanized spaces are not absent of state intent, despite appearances. Grassroots-led social and spatial practices for survival, agency and self-governance contribute to the reproduction of urban political order in surprisingly unoriginal and routinely recognizable ways. This article argues that these unexceptional informal practices can be understood as ‘facsimiles’ of their formal institutional originals. Using the example of cloned cars the article shows that the facsimile and the original are the same in form and function. Facsimiles do not exist outside of political authority, but are a byproduct and a component of it. They are indistinguishable in their bureaucratic deployment, recognition and acceptance as part of social and spatial order. This is the author accepted manuscript. The final version is available from Sage via https://doi.org/10.1177/001139211665729

Seasonal Consumptive Demand and Prey Use by Stocked Saugeyes in Ohio Reservoirs

Community structure and species composition may be strongly influenced by predator-prey interactions resulting from and leading to episodes of population abundance or scarcity. We quantified diets of stocked saugeyes (female walleye Sander vitreus × male sauger S. canadensis) and estimated biomass of their primary prey, gizzard shad Dorosoma cepedianum, in three Ohio reservoirs at quarterly intervals during July 2002-July 2003 to determine whether saugeye consumptive demand could exceed the supply of available gizzard shad prey, resulting in a shift to alternative prey. We incorporated water temperature and saugeye diet composition, growth, and mortality into walleye bioenergetics models, which allowed us to compare estimated prey-specific consumption rates by saugeyes with gizzard shad standing stocks estimated with acoustics. Spring and summer were critical seasons. During spring, gizzard shad biomass was low, saugeye consumptive demand was low, and saugeyes consumed primarily alternative prey. During summer, when age-0 gizzard shad became available as prey, saugeyes consumed similar proportions of gizzard shad and alternative prey. Saugeye cumulative consumptive demand in summer was high and approached the gizzard shad standing stock. However, during fall and winter, gizzard shad supply was adequate to support high (fall) or declining (winter) saugeye consumptive demand. Across reservoirs and seasons, saugeyes consumed alternative prey to varying degrees, primarily sunfishes Lepomis spp., yellow perch Perca flavescens, logperch Percina caprodes, and minnows Pimephales spp. Seasonal asynchrony between saugeye consumptive demand and gizzard shad biomass during spring and summer indicated that a saugeye population with high survival, growth, and consumptive demand will opportunistically increase use of prey other than gizzard shad. The manner in which saugeye predation quantitatively influences these prey species could not be assessed. However, overexploitation of gizzard shad prey appears to be unlikely at current saugeye population sizes, particularly considering the opportunistic use of alternative prey and the high reproductive potential of gizzard shad.Funding for this research was provided by the Ohio Department of Natural Resources, Division of Wildlife; Federal Aid in Sport Fish Restoration Project F-69-P, Fish Management in Ohio; and the Department of Evolution, Ecology, and Organismal Biology at The Ohio State University

‘Sons of athelings given to the earth’: Infant Mortality within Anglo-Saxon Mortuary Geography

FOR 20 OR MORE YEARS early Anglo-Saxon archaeologists have believed children are underrepresented in the cemetery evidence. They conclude that excavation misses small bones, that previous attitudes to reporting overlook the very young, or that infants and children were buried elsewhere. This is all well and good, but we must be careful of oversimplifying compound social and cultural responses to childhood and infant mortality. Previous approaches have offered methodological quandaries in the face of this under-representation. However, proportionally more infants were placed in large cemeteries and sometimes in specific zones. This trend is statistically significant and is therefore unlikely to result entirely from preservation or excavation problems. Early medieval cemeteries were part of regional mortuary geographies and provided places to stage events that promoted social cohesion across kinship systems extending over tribal territories. This paper argues that patterns in early Anglo-Saxon infant burial were the result of female mobility. Many women probably travelled locally to marry in a union which reinforced existing social networks. For an expectant mother, however, the safest place to give birth was with experience women in her maternal home. Infant identities were affected by personal and legal association with their mother’s parental kindred, so when an infant died in childbirth or months and years later, it was their mother’s identity which dictated burial location. As a result, cemeteries central to tribal identities became places to bury the sons and daughters of a regional tribal aristocracy

Improvements in sperm motility following low or high intensity dietary interventions in men with obesity

Introduction: Obesity increases risks of male infertility, but bariatric surgery does not improve semen quality. Recent uncontrolled studies suggest that a low-energy diet (LED) improves semen quality. Further evaluation within a randomized, controlled setting is warranted. Methods: Men with obesity (18-60 years) with normal sperm concentration (normal count) (n = 24) or oligozoospermia (n = 43) were randomized 1:1 to either 800 kcal/day LED for 16 weeks or control, brief dietary intervention (BDI) with 16 weeks’ observation. Semen parameters were compared at baseline and 16 weeks. Results: Mean age of men with normal count was 39.4 ± 6.4 in BDI and 40.2 ± 9.6 years in the LED group. Mean age of men with oligozoospermia was 39.5 ± 7.5 in BDI and 37.7 ± 6.6 years in the LED group. LED caused more weight loss than BDI in men with normal count (14.4 vs 6.3 kg; P < .001) and men with oligozoospermia (17.6 vs 1.8 kg; P < .001). Compared with baseline, in men with normal count total motility (TM) increased 48 ± 17% to 60 ± 10% (P < .05) after LED, and 52 ± 8% to 61 ± 6% (P < .0001) after BDI; progressive motility (PM) increased 41 ± 16% to 53 ± 10% (P < .05) after LED, and 45 ± 8% to 54 ± 65% (P < .001) after BDI. In men with oligozoospermia compared with baseline, TM increased 35% [26] to 52% [16] (P < .05) after LED, and 43% [28] to 50% [23] (P = .0587) after BDI; PM increased 29% [23] to 46% [18] (P < .05) after LED, and 33% [25] to 44% [25] (P < .05) after BDI. No differences in postintervention TM or PM were observed between LED and BDI groups in men with normal count or oligozoospermia. Conclusion: LED or BDI may be sufficient to improve sperm motility in men with obesity. The effects of paternal dietary intervention on fertility outcomes requires investigation

From Provider to Enabler of Care: Reconfiguring Local Authority Support for Older People and Carers in Leeds, 2008 to 2013

This article explores developments in the support available to older people and carers (i.e., caregivers) in the city of Leeds, United Kingdom, and examines provision changes during a period characterized by unprecedented resource constraint and new developments in national-local governance. Using documentary evidence, official statistics and findings from recent studies led by the author, the effects of these changes on service planning and delivery and the approach taken by local actors to mitigate their impact are highlighted. The statistical data show a marked decline in some types of services for older people during a five year period during which the city council took steps to mobilize citizens and develop new services and system improvements. The analysis focuses on theories of social quality as a framework for analysis of the complex picture of change related to service provision. It concludes that although citizen involvement and consultations exerted a positive influence in delivering support to some older people and carers, research over a longer timescale is needed to show if these changes are adequate to protect older people and carers from the effects of ongoing budgetary constraints

Energy Dependent Morphology in the PWN Candidate HESS J1825-137

Observations with H.E.S.S. revealed a new source of very high-energy (VHE) gamma-rays above 100 GeV - HESS J1825-137 - extending mainly to the south of the energetic pulsar PSRB1823-13. A detailed spectral and morphological analysis of HESS J1825-137 reveals for the first time in VHE gamma-ray astronomy a steepening of the energy spectrum with increasing distance from the pulsar. This behavior can be understood by invoking radiative cooling of the IC-Compton gamma-ray emitting electrons during their propagation. In this scenario the vastly different sizes between the VHE gamma-ray emitting region and the X-ray PWN associated with PSRB1823-13 can be naturally explained by different cooling timescales for the radiating electron populations. If this scenario is correct, HESS J1825-137 can serve as a prototype for a whole class of asymmetric PWN in which the X-rays are extended over a much smaller angular scales than the gamma-rays and can help understanding recent detections of X-ray PWN in systems such as HESS J1640-465 and HESS J1813-178. The future GLAST satellite will probe lower electron energies shedding further light on cooling and diffusion processes in this source

Multicenter experience from the UK and Ireland of use of lumen-apposing metal stent for transluminal drainage of pancreatic fluid collections

Background and study aims: Pancreatic fluid collection (PFC) is a common complication of pancreatitis for which endoscopic ultrasound-guided drainage is first-line treatment. A new single-device, lumen-apposing, covered self-expanding metal stent (LAMS) has been licensed for PFC drainage. We therefore present our multicenter experience with the LAMS for PFC drainage in a multicenter prospective case series to assess success and complication rates. Patients and methods: All adult patients from 11 tertiary centers who had LAMS placement for PFC from July 2015 to July 2016 were included. Data including indications, technical success, clinical success, collection resolution, stent removal, early and late adverse events (AEs), mortality and recurrence at 6 months were collected. Results: 116 patients, median age 52.5 years (range 16 – 80) and 67 % male, were treated with a single LAMS in each case. The indication was walled off necrosis (WON) in 70 and pseudocyst in 46. Median size of the PFC was 11 cm (5 – 21 cm) and the estimated median necrotic volume in WON was 30 % (5 % – 90 %). Stent insertion was technically successful in 115 (99.1 %) and clinically successful in 109 (94 %). Early serious AEs (SAEs): n = 7 sepsis, n = 1 stent blockage with food, n = 1 stent migration requiring laparotomy, n = 1 stent dislodgement and n = 1 bleeding requiring emboliZation. Late AEs: n = 1 buried stent and n = 1 esophageal fistula. Non-procedure-related deaths: n = 3 (2.5 %). Conclusion: This multicenter case series demonstrates that use of the new LAMS is feasible, effective and relatively safe in draining PFC with a technical success rate of 99 % and cumulative SAE rate of 11.2 %