An unusual case of pancreatic fistula.

We report an unusual case of a pancreatic fistula communicating with an appendicectomy wound. This occurred following an episode of acute haemorrhagic pancreatitis. The patient was initially admitted with signs and symptoms indicating appendicitis and went to theatre for an open appendicectomy. However, this did not resolve his symptoms and a laparotomy was performed the next day revealing haemorrhagic pancreatitis. He endured a stormy post-operative course, the cause of which was found to be an external pancreatic fistula with discharge of amylase-rich fluid from the Lanz incision. A trial of conservative management failed despite multiple percutaneous drainage procedures and treatment with broad-spectrum antibiotics. After a second opinion was sought, it was decided to fit a roux loop anastomosis between the head of the pancreas and the duodenum to divert the fistulous fluid. This procedure was a success and the patient remains well 2 years later

A review of the electrical properties of semiconductor nanowires: Insights gained from terahertz conductivity spectroscopy

Accurately measuring and controlling the electrical properties of semiconductor nanowires is of paramount importance in the development of novel nanowire-based devices. In light of this, terahertz (THz) conductivity spectroscopy has emerged as an ideal non-contact technique for probing nanowire electrical conductivity and is showing tremendous value in the targeted development of nanowire devices. THz spectroscopic measurements of nanowires enable charge carrier lifetimes, mobilities, dopant concentrations and surface recombination velocities to be measured with high accuracy and high throughput in a contact-free fashion. This review spans seminal and recent studies of the electronic properties of nanowires using THz spectroscopy. A didactic description of THz time-domain spectroscopy, optical pump–THz probe spectroscopy, and their application to nanowires is included. We review a variety of technologically important nanowire materials, including GaAs, InAs, InP, GaN and InN nanowires, Si and Ge nanowires, ZnO nanowires, nanowire heterostructures, doped nanowires and modulation-doped nanowires. Finally, we discuss how THz measurements are guiding the development of nanowire-based devices, with the example of single-nanowire photoconductive THz receivers.The authors gratefully acknowledge EPSRC (UK) for research funding. H J Joyce gratefully acknowledges the Royal Commission for the Exhibition of 1851 for her research fellowship.This is the final version of the article. It first appeared from IOP via https://doi.org/10.1088/0268-1242/31/10/10300

A review of the methodological features of systematic reviews in maternal medicine

Background In maternal medicine, research evidence is scattered making it difficult to access information for clinical decision making. Systematic reviews of good methodological quality are essential to provide valid inferences and to produce usable evidence summaries to guide management. This review assesses the methodological features of existing systematic reviews in maternal medicine, comparing Cochrane and non-Cochrane reviews in maternal medicine. Methods Medline, Embase, Database of Reviews of Effectiveness (DARE) and Cochrane Database of Systematic Reviews (CDSR) were searched for relevant reviews published between 2001 and 2006. We selected those reviews in which a minimum of two databases were searched and the primary outcome was related to the maternal condition. The selected reviews were assessed for information on framing of question, literature search and methods of review. Results Out of 2846 citations, 68 reviews were selected. Among these, 39 (57%) were Cochrane reviews. Most of the reviews (50/68, 74%) evaluated therapeutic interventions. Overall, 54/68 (79%) addressed a focussed question. Although 64/68 (94%) reviews had a detailed search description, only 17/68 (25%) searched without language restriction. 32/68 (47%) attempted to include unpublished data and 11/68 (16%) assessed for the risk of missing studies quantitatively. The reviews had deficiencies in the assessment of validity of studies and exploration for heterogeneity. When compared to Cochrane reviews, other reviews were significantly inferior in specifying questions (OR 20.3, 95% CI 1.1–381.3, p = 0.04), framing focussed questions (OR 30.9, 95% CI 3.7- 256.2, p = 0.001), use of unpublished data (OR 5.6, 95% CI 1.9–16.4, p = 0.002), assessment for heterogeneity (OR 38.1, 95%CI 2.1, 688.2, p = 0.01) and use of meta-analyses (OR 3.7, 95% CI 1.3–10.8, p = 0.02). Conclusion This study identifies areas which have a strong influence on maternal morbidity and mortality but lack good quality systematic reviews. Overall quality of the existing systematic reviews was variable. Cochrane reviews were of better quality as compared to other reviews. There is a need for good quality systematic reviews to inform practice in maternal medicine

Labour supply and skills demands in fashion retailing

If, as Adam Smith once famously suggested, Britain was a nation of shopkeepers then it is now a nation of shopworkers. Retail is now a significant part of the UK economy, accounting for £256 billion in sales and one-third of all consumer spending (Skillsmart, 2007). It is the largest private sector employer in the UK, employing 3m workers, or 1 in 10 of the working population. For future job creation in the UK economy retail is also similarly prominent and the sector is expected to create a further 250,000 jobs to 2014 (Skillsmart, 2007). The centrality of retail to economic success and job creation is apparent in other advanced economies. For example, within the US, retail sales is the occupation with the largest projected job growth in the period 2004-2014 (Gatta et al., 2009) and in Australia retail accounts for 1 in 6 workers (Buchanan et al., 2003). Within the UK these workers are employed in approximately 290,000 businesses, encompassing large and small organizations and also a number of sub-sectors. This variance suggests that retail should not be regarded as homogenous in its labour demands. Hart et al. (2007) note how skill requirements and the types of workers employed may differ across the sector. This chapter further opens up this point, providing an analysis of the labour supply and skills demands for the sub-sectors of clothing, footwear and leather goods, which are described by Skillsmart (2007: 48) as being 'significant categories in UK retailing'

Using geographically weighted regression to explore the spatially heterogeneous spread of bovine tuberculosis in England and Wales

An understanding of the factors that affect the spread of endemic bovine tuberculosis (bTB) is critical for the development of measures to stop and reverse this spread. Analyses of spatial data need to account for the inherent spatial heterogeneity within the data, or else spatial autocorrelation can lead to an overestimate of the significance of variables. This study used three methods of analysis—least-squares linear regression with a spatial autocorrelation term, geographically weighted regression (GWR) and boosted regression tree (BRT) analysis—to identify the factors that influence the spread of endemic bTB at a local level in England and Wales. The linear regression and GWR methods demonstrated the importance of accounting for spatial differences in risk factors for bTB, and showed some consistency in the identification of certain factors related to flooding, disease history and the presence of multiple genotypes of bTB. This is the first attempt to explore the factors associated with the spread of endemic bTB in England and Wales using GWR. This technique improves on least-squares linear regression approaches by identifying regional differences in the factors associated with bTB spread. However, interpretation of these complex regional differences is difficult and the approach does not lend itself to predictive models which are likely to be of more value to policy makers. Methods such as BRT may be more suited to such a task. Here we have demonstrated that GWR and BRT can produce comparable outputs

Effectiveness of a High School Alcohol Misuse Prevention Program

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/65153/1/j.1530-0277.1996.tb05253.x.pd

VALORACIÓN NUTRICIONAL EN LACTANTES DE ENTRE 8 A 12 MESES DE VIDA

<!-- /* Font Definitions */ @font-face {font-family:"Cambria Math"; panose-1:2 4 5 3 5 4 6 3 2 4; mso-font-charset:0; mso-generic-font-family:roman; mso-font-pitch:variable; mso-font-signature:-1610611985 1107304683 0 0 159 0;} /* Style Definitions */ p.MsoNormal, li.MsoNormal, div.MsoNormal {mso-style-unhide:no; mso-style-qformat:yes; mso-style-parent:""; margin:0cm; margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:12.0pt; mso-bidi-font-size:10.0pt; font-family:"Times New Roman","serif"; mso-fareast-font-family:"Times New Roman";} .MsoChpDefault {mso-style-type:export-only; mso-default-props:yes; font-size:10.0pt; mso-ansi-font-size:10.0pt; mso-bidi-font-size:10.0pt;} @page Section1 {size:612.0pt 792.0pt; margin:70.85pt 3.0cm 70.85pt 3.0cm; mso-header-margin:36.0pt; mso-footer-margin:36.0pt; mso-paper-source:0;} div.Section1 {page:Section1;} --> Objective: The aim of this study was to analyze the diet of infants that receive supplemental breast milk, by way of a two-week survey on nutrition consumption, completed by the parents of infants between 8 and 12 months of age from the province of Badajoz, Spain. Dial® software was used for the nutritional analysis and quantification.  Results: The analysis of the daily diet shows in this study that it is repetitive and equivalent in all infants during this age interval, which is made: at the beginning of the day for follow-on milk and infantile cereals, followed by vegetable baby food with meat, fruit baby food, and finally at the end of the day follow-on milk and cereals again. Indicating that energy intake was correct (1355 ± 252.93 kcal), highlighting that regarding macronutrients the protein percentage intake (44.40 ± 5.014 g/day) is high compared to the daily recommendations. In addition, it presents a repetitive and constant dietary pattern throughout all the participants. Conclusion: In our study population with supplementary feeding, the diet of these infants between 8 and 12 months of age is suited to the daily energy needs for that period of growth, as well as an inadequate daily ingestion on proteins. .Objetivo: En este trabajo se ha tratado de conocer profundamente la alimentación infantil con lactancia complementaria, a través de un cuestionario de consumo de alimentos de dos semanas de duración, el cual fue completado por los padres de lactantes de entre 8 y 12 meses, de la provincia de Badajoz. Para su análisis y cuantificación nutricional se manejó la aplicación informática Dial©.  Resultados: El análisis de la dieta diaria mostró en su estudio que es repetitiva y equivalente en todos los lactantes durante este intervalo de edad, la cual estaba constituida: al inicio del día por leches de continuación y cereales infantiles, continuando con potitos de verduras con carne, potitos de fruta y por último al final del día, de nuevo leches de continuación y cereales infantiles. Indicar que la ingesta energética era correcta (1355 ± 252,93 kcal), destacando que en lo que respecta a macronutrientes el porcentaje en proteínas se encontró elevado (44,40 ± 5,014 g) frente a las recomendaciones diarias. Además de presentar un patrón dietético repetitivo y constante en toda la población. Conclusión: En la población estudiada con lactancia complementaria, la dieta de estos lactantes entre 8 y 12 meses de vida se adecua a las necesidades energéticas diarias para dicho periodo de crecimiento, pero mantienen una inadecuada ingesta diaria de proteínas

Looking inside the black box : a theory-based process evaluation alongside a randomised controlled trial of printed educational materials (the Ontario printed educational message, OPEM) to improve referral and prescribing practices in primary care in Ontario, Canada

Background: Randomised controlled trials of implementation strategies tell us whether (or not) an intervention results in changes in professional behaviour but little about the causal mechanisms that produce any change. Theory-based process evaluations collect data on theoretical constructs alongside randomised trials to explore possible causal mechanisms and effect modifiers. This is similar to measuring intermediate endpoints in clinical trials to further understand the biological basis of any observed effects (for example, measuring lipid profiles alongside trials of lipid lowering drugs where the primary endpoint could be reduction in vascular related deaths). This study protocol describes a theory-based process evaluation alongside the Ontario Printed Educational Message (OPEM) trial. We hypothesize that the OPEM interventions are most likely to operate through changes in physicians' behavioural intentions due to improved attitudes or subjective norms with little or no change in perceived behavioural control. We will test this hypothesis using a well-validated social cognition model, the theory of planned behaviour (TPB) that incorporates these constructs. Methods/design: We will develop theory-based surveys using standard methods based upon the TPB for the second and third replications, and survey a subsample of Ontario family physicians from each arm of the trial two months before and six months after the dissemination of the index edition of informed, the evidence based newsletter used for the interventions. In the third replication, our study will converge with the "TRY-ME" protocol (a second study conducted alongside the OPEM trial), in which the content of educational messages was constructed using both standard methods and methods informed by psychological theory. We will modify Dillman's total design method to maximise response rates. Preliminary analyses will initially assess the internal reliability of the measures and use regression to explore the relationships between predictor and dependent variable (intention to advise diabetic patients to have annual retinopathy screening and to prescribe thiazide diuretics for first line treatment of uncomplicated hypertension). We will then compare groups using methods appropriate for comparing independent samples to determine whether there have been changes in the predicted constructs (attitudes, subjective norms, or intentions) across the study groups as hypothesised, and will assess the convergence between the process evaluation results and the main trial results.The OPEM trial and OPEM process evaluation are funded by the Canadian Institute of Health Research (CIHR). The OPEM process evaluation study was developed as part of the CIHR funded interdisciplinary capacity enhancement team KT-ICEBeRG. Gaston Godin, Jeremy Grimshaw and France Légaré hold Canada Research Chairs. Louise Lemyre holds an R.S. McLaughlin Research Chair

Using the IUCN Red List to map threats to terrestrial vertebrates at global scale

The Anthropocene is characterized by unparalleled human impact on other species, potentially ushering in the sixth mass extinction. Yet mitigation efforts remain hampered by limited information on the spatial patterns and intensity of the threats driving global biodiversity loss. Here we use expert-derived information from the International Union for Conservation of Nature Red List on threats to 23,271 species, representing all terrestrial amphibians, birds and mammals, to generate global maps of the six major threats to these groups: agriculture, hunting and trapping, logging, pollution, invasive species, and climate change. Our results show that agriculture and logging are pervasive in the tropics and that hunting and trapping is the most geographically widespread threat to mammals and birds. Additionally, current representations of human pressure underestimate the overall pressure on biodiversity, due to the exclusion of threats such as hunting and climate change. Alarmingly, this is particularly the case in areas of the highest biodiversity importance

Pharmacist services for non-hospitalised patients (Review)

This is the peer reviewed version of the following article: de Barra M, Scott CL, Scott NW, Johnston M, de Bruin M, Nkansah N, Bond CM, Matheson CI, Rackow P, Williams AJ, Watson MC. Pharmacist services for non‐hospitalised patients. Cochrane Database of Systematic Reviews. 2018(9)., which has been published in final form at https://doi.org/10.1002/14651858.CD013102. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived Versions