Nutrition in the paediatric surgical patient

Nutritional care of surgical infants and children is of major importance. This is for several reasons: (i) body stores are often smaller and more precarious; (ii) infants and children not only require energy for maintenance, but also for growth; and (iii) as in adults, recovery from surgery is faster in those patients who are adequately nourished. Survival of infants with congenital anomalies dramatically improved following the introduction of parenteral nutrition. However, infection and cholestasis remain problematic for parenterally fed infants and children

Öffentliche Unterstützung für Demokratie und Autokratie in Russland

Putin genießt innerhalb der russischen Bevölkerung immer noch hohe Zustimmungswerte. Diese werden oftmals als öffentliche Akzeptanz gegenüber dem autoritären Kurs, der während Putins ersten beiden Amtszeiten als Präsident und seiner Zeit als Premierminister eingeschlagen wurde, interpretiert. Die Ergebnisse einiger Meinungsumfragen scheinen dieses Bild zu bestätigen. Allerdings könnte es auch sein, dass diese Befunde verzerrt sind und weniger Unterstützung für Demokratie anzeigen, als es tatsächlich der Fall ist. Die Herausforderung besteht nämlich darin, Zustimmung zu Demokratie in einem Land zu messen, in dem es gar keinen demokratischen Institutionen gibt. In Gesellschaften, die sich entweder auf dem Weg hin zu Demokratie oder weg von ihr bewegen, ist oft unklar, was »Demokratie« tatsächlich bedeutet. Institutionen und Praktiken, die das Label »Demokratie« tragen, handeln oft nicht so, wie es allgemeinen demokratischen Normen entsprechen würde. Interpretiert man die erwähnten Umfrageergebnisse unter diesem Gesichtspunkt, dann lassen sich Hinweise auf ein höheres Maß an passiver Unterstützung für Demokratie in Russland finden, als für gewöhnlich angenommen. Hingegen sind nur wenige bereit, sich aktiv politisch zu engagieren

А порядка в ней нет

Russian-language edition: One common explanation for the failure of democracy to take root in Russia more quickly and more thoroughly than it has points to inherited cultural values that predispose Russian citizens to favor an autocratic type of governance. Ellen Carnaghan takes aim at this cultural-determinist thesis in her study of Russian attitudes, based on intensive interviews with more than sixty citizens from all walks of life and a variety of political orientations. What she finds is that, rather than being influenced by an antidemocratic and anticapitalist ideology, these ordinary citizens view the economic and political system in Russia today very critically because it simply does not function well for them in meeting their everyday needs. They long for order not because they eschew democracy and free markets in any fundamental way, but because they experience them currently as chaotic and unpredictable, leading to constant frustration. As a result, there is reason to be optimistic about further progress in democratization: it depends on improving the functioning of existing institutions, not transforming deep-rooted cultural norms. In the Conclusion, Carnaghan applies her argument to elucidating the reasons why Russians have responded favorably to what Westerners see as moves in an antidemocratic direction by Vladimir Putin’s government

Investigation of the Pathophysiology and In-Utero Treatment of Gastroschisis-Related Intestinal Dysfunction

BACKGROUND: Gastroschisis is a paraumbilical abdominal wall defect through which the bowel herniates. The bowel is in direct contact with the amniotic fluid. At birth the bowel is often thickened and shortened. The main gastroschisis-related morbidity is that of intestinal dysmotility but the mechanism(s) underlying this are poorly understood and no treatment advances have occurred since the advent of parenteral nutrition. Human studies have shown that the third trimester amniotic fluid of gastroschisis pregnancies is proinflammatory. In addition, in animal models of gastroschisis and human pathological gut tissue interstitial cells of Cajal (ICC – pacemaker cells of the gut) have been found to be decreased in number and immature within gastroschisis bowel. HYPOTHESES: Gastroschisis-related intestinal dysfunction (GRID) is secondary to deficient, immature bowel wall ICC. AIMS: My primary aim in this thesis was to investigate the development of ICC in gastroschisis utilising genetic animal models and human pathological gut tissue. Additionally, I aimed to determine the overall morphology of gastroschisis bowel wall, the impact of inflammatory modulation on bowel wall development and the impact of clinical antenatal interventions on infant outcomes. METHODS: Quantitative analysis of bowel wall ICC, enteric neurons and architecture were performed utilising genetic animal gastroschisis models and human pathological tissue. Modulation of in-utero inflammation was performed through in-utero injections of IL-8 (pro-inflammatory protein) in a genetic animal gastroschisis model. Finally, retrospective clinical data on gastroschisis were collected from three paediatric surgical centres to determine whether early delivery or administration of maternal antenatal corticosteroids could improve infant morbidity. RESULTS: Phenotypic analysis of the Scribble knockout mouse model revealed the expressed abdominal wall defect (AWD) to be that of exomphalos rather than gastroschisis. Additionally, phenotypic analysis of the aortic carboxypeptidase-like protein (ACLP) knockout mouse showed the AWD was not characteristic of gastroschisis as the externalised bowel was free floating within exocoelomic fluid and not the amniotic fluid. Bowel wall ICC were architecturally normal but reduced in number in AWD fetuses compared to controls. In-utero injection of IL-8 further reduced ICC numbers. In contrast, analysis of human pathological gut tissue showed no difference in the number or architecture of bowel wall ICC between gastroschisis and control tissue. However, the gastroschisis bowel wall was significantly thicker than that of controls with evidence of smooth muscle hyperplasia and deficiency of α-smooth muscle actin within the longitudinal muscle layer. The clinical retrospective data showed that early delivery of gastroschisis fetuses did not improve bowel function and was associated with prolonged time to full enteral feeds and length of hospital stay. Additionally, there was no evidence that administration of maternal antenatal corticosteroids improved time to full enteral feeds or length of hospital stay in gastroschisis infants. CONCLUSION: Phenotypic analysis of abdominal wall defects in murine models is challenging. However, accurate delineation of the defect anatomy is essential to ensure appropriate result reporting and data analysis. The presented data suggests the ICC may be less important as the cause of GRID than originally expected. However, another potential cause for GRID is bowel wall thickening comprising of smooth muscle hyperplasia and possible bowel myopathy for which there are several hypothesised triggers. Additionally, the data presented in this thesis do not support early delivery of gastroschisis fetuses or the administration of maternal antenatal corticosteroids as methods to improve gastroschisis infant outcomes. The results of this thesis have generated some important findings and have highlighted a number of novel hypotheses for the trigger of GRID. Further research on the basis of these findings within an appropriate animal model and through prospective non-invasive human studies are required in order to develop a targeted antenatal therapy to improve gastroschisis infant bowel function and clinical outcomes

A critical evaluation of predictive models for rooted soil strength with application to predicting the seismic deformation of rooted slopes

This paper presents a comparative study of three different classes of model for estimating the reinforcing effect of plant roots in soil, namely (i) fibre pull-out model, (ii) fibre break models (including Wu and Waldron’s Model (WWM) and the Fibre Bundle Model (FBM)) and (iii) beam bending or p-y models (specifically Beam on a Non-linear Winkler-Foundation (BNWF) models). Firstly, the prediction model of root reinforcement based on pull-out being the dominant mechanism for different potential slip plane depths was proposed. The resulting root reinforcement calculated were then compared with those derived from the other two types of models. The estimated rooted soil strength distributions were then incorporated within a fully dynamic, plane-strain continuum finite element model to assess the consequences of the selection of rooted soil strength model on the global seismic stability of a vegetated slope (assessed via accumulated slip during earthquake shaking). For the particular case considered in this paper (no roots were observed to have broken after shearing), root cohesion predicted by the pull-out model is much closer to that the BNWF model, but is largely over-predicted by the family of fibre break models. In terms of the effects on the stability of vegetated slopes, there exists a threshold value beyond which the position of the critical slip plane would bypass the rooted zones, rather than passing through them. Further increase of root cohesion beyond this value has minimal effect on the global slope behaviour. This implies that significantly over-predicted root cohesion from fibre break models when used to model roots with non-negligible bending stiffness may still provide a reasonable prediction of overall behaviour, so long as the critical failure mechanism is already bypassing the root-reinforced zones. © 2019, The Author(s)

Carbapenemase gene <i>bla</i>_OXA-48 detected at six freshwater sites in Northern Ireland discharging onto identified bathing locations

Faecal contamination of surface waters has the potential to spread not only pathogenic organisms but also antimicrobial resistant organisms. During the bathing season of 2021, weekly water samples, from six selected coastal bathing locations (n = 93) and their freshwater tributaries (n = 93), in Northern Ireland (UK), were examined for concentrations of faecal indicator bacteria Escherichia coli and intestinal enterococci. Microbial source tracking involved detection of genetic markers from the genus Bacteroides using PCR assays for the general AllBac marker, the human HF8 marker and the ruminant BacR marker for the detection of human, and ruminant sources of faecal contamination. The presence of beta-lactamase genes blaOXA-48, blaKPC, and blaNDM-1 was determined using PCR assays for the investigation of antimicrobial resistance genes that are responsible for lack of efficacy in major broad-spectrum antibiotics. The beta-lactamase gene blaOXA-48 was found in freshwater tributary samples at all six locations. blaOXA-48 was detected in 83% of samples that tested positive for the human marker and 69% of samples that tested positive for the ruminant marker over all six locations. This study suggests a risk of human exposure to antimicrobial resistant bacteria where bathing waters receive at least episodically substantial transfers from such tributaries

End of organised atheism. The genealogy of the law on freedom of conscience and its conceptual effects in Russia

In the current climate of the perceived alliance between the Russian Orthodox Church and the state, atheist activists in Moscow share a sense of juridical marginality that they seek to mitigate through claims to equal rights between believers and atheists under the Russian law on freedom of conscience. In their demands for their constitutional rights, including the right to political critique, atheist activists come across as figures of dissent at risk of the state's persecution. Their experiences constitute a remarkable (and unexamined in anthropology) reversal of political and ideological primacy of state-sponsored atheism during the Soviet days. To illuminate the legal context of the atheists’ current predicament, the article traces an alternative genealogy of the Russian law on freedom of conscience from the inception of the Soviet state through the law's post-Soviet reforms. The article shows that the legal reforms have paved the way for practical changes to the privileged legal status of organized atheism and brought about implicit conceptual effects that sideline the Soviet meaning of freedom of conscience as freedom from religion and obscure historical references to conscience as an atheist tenet of Soviet ethics

Haemostatics in surgery and our experience in the enucleoresection of renal cell carcinoma

<p>Abstract</p> <p>Background</p> <p>30 patients, with T1 renal cell carcinomas (RCC) who underwent open enucleoresection of the tumour, were randomized to the use of a topical haemostatic agent (Floseal) or to an infrared-sapphire coagulator (ISC), to compare their efficacy in achieving haemostasis. Methods: Successful intra-operative haemostasis, intra- and post-operative bleeding, operative time, hospital discharge were evaluated.</p> <p>Results</p> <p>Statistically higher rates of successful haemostasis and shorter time-to-haemostasis (8,1 vs 12,9 min) were observed in the FloSeal group (p < 0.001 both). Patients operative time was not different between Group 1 vs 2 (58.7 ± 12 vs 62.4 ± 15; p > 0.05). The average blood loss during surgery was less (60 +/- 25.5 mL) for the FloSeal group than for the ISC group (85 +/- 40.5 mL) (p < 0.05). Postoperative blood loss was 25 +/- 5 mL and 40 +/- 45 mL for Floseal and ISC respectively, (p < 0.05). Length of the postoperative hospital discharge was 2.5 +/- 1.2 days for FloSeal group and 3.5 +/- 1.3 for the Group 2 (p < 0.05). No major immediate or delayed complications were observed in either Groups.</p> <p>Conclusions</p> <p>The use of Floseal and ISC offer a safe and efficacy haemostasis in the enucleoresection of RCC. Moreover, our results show a less intra-operative and post-operative blood loss as well as a shorter time to haemostasis of Floseal in respect to ISC.</p