The dynamics of Abell 2634

We have amassed a large sample of velocity data for the cluster of galaxies Abell 2634 which contains the wide-angle tail (WAT) radio source 3C 465. Robust indicators of location and scale and their confidence intervals are used to determine if the cD galaxy, containing the WAT, has a significant peculiar motion. We find a cD peculiar radial velocity of 219 plus or minus 98 km s(exp -1). Further dynamical analyses, including substructure and normality tests, suggest that A 2634 is an unrelaxed cluster whose radio source structure may be bent by the turbulent gas of a recent cluster-subcluster merger

Admission Decision-Making in Hospital Emergency Departments: the Role of the Accompanying Person

In resource-stretched emergency departments, people accompanying patients play key roles in patients' care. This article presents analysis of the ways health professionals and accompanying persons talked about admission decisions and caring roles. The authors used ethnographic case study design involving participant observation and semi-structured interviews with 13 patients, 17 accompanying persons and 26 healthcare professionals in four National Health Service hospitals in south-west England. Focused analysis of interactional data revealed that professionals’ standardization of the patient-carer relationship contrasted with accompanying persons' varied connections with patients. Accompanying persons could directly or obliquely express willingness, ambivalence and resistance to supporting patients’ care. The drive to avoid admissions can lead health professionals to deploy conversational skills to enlist accompanying persons for discharge care without exploring the meanings of their particular relations with patients. Taking a relationship-centered approach could improve attention to accompanying persons as co-producers of healthcare and participants in decision-making

How Group-Based Interventions Can Improve Services for People with Severe Obesity

This is the final version. Available on open access from Springer via the DOI in this recordPurpose of Review Rising demand for specialised “Tier 3” weight management services in England is exceeding capacity, leading many services to offer group-based care programmes. This review considers the organisation of current provision, exploring how group programmes may enhance services and how these could be scaled up for wider implementation. Recent Findings Existing group-based programmes mainly focus on providing patients with information and education about their condition. Evidence suggests that groups themselves offer therapeutic benefits beyond this, by underpinning patients’ engagement with programme materials and contributing to wider health and well-being. To maximise these benefits, there is a need to attend to the group processes that emerge in treatment groups which, left unchecked, may limit or even adversely impact programme outcomes. Summary Group-based interventions may be of benefit to patients in Tier 3 specialist weight management services, although their format is complex and reliant on facilitators’ expertise.National Institute for Health Research (NIHR

An international assessment of the adoption of enhanced recovery after surgery (ERAS (R)) principles across colorectal units in 2019-2020

Aim The Enhanced Recovery After Surgery (ERAS (R)) Society guidelines aim to standardize perioperative care in colorectal surgery via 25 principles. We aimed to assess the variation in uptake of these principles across an international network of colorectal units. Method An online survey was circulated amongst European Society of Coloproctology members in 2019-2020. For each ERAS principle, respondents were asked to score how frequently the principle was implemented in their hospital, from 1 ('rarely') to 4 ('always'). Respondents were also asked to recall whether practice had changed since 2017. Subgroup analyses based on hospital characteristics were conducted. Results Of hospitals approached, 58% responded to the survey (195/335), with 296 individual responses (multiple responses were received from some hospitals). The majority were European (163/195, 83.6%). Overall, respondents indicated they 'most often' or 'always' adhered to most individual ERAS principles (18/25, 72%). Variability in the uptake of principles was reported, with universal uptake of some principles (e.g., prophylactic antibiotics; early mobilization) and inconsistency from 'rarely' to 'always' in others (e.g., no nasogastric intubation; no preoperative fasting and carbohydrate drinks). In alignment with 2018 ERAS guideline updates, adherence to principles for prehabilitation, managing anaemia and postoperative nutrition appears to have increased since 2017. Conclusions Uptake of ERAS principles varied across hospitals, and not all 25 principles were equally adhered to. Whilst some principles exhibited a high level of acceptance, others had a wide variability in uptake indicative of controversy or barriers to uptake. Further research into specific principles is required to improve ERAS implementation

Bioabsorbable mesh use in midline abdominal wall prophylaxis and repair achieving fascial closure:a cross-sectional review of stage of innovation

Background: Achieving stable closure of complex or contaminated abdominal wall incisions remains challenging. This study aimed to characterise the stage of innovation for bioabsorbable mesh devices used during both midline closure prophylaxis and complex abdominal wall reconstruction and to evaluate the quality of current evidence.Methods: A systematic review of published and ongoing studies was performed until 31st December 2019. Inclusion criteria were studies where bioabsorbable mesh was used to support fascial closure either prophylactically after midline laparotomy or for repair of incisional hernia with midline incision. Exclusion criteria were: (1) study design was a systematic review, meta-analysis, letter, review, comment, or conference abstract; (2) included less than p patients; (3) only evaluated biological, synthetic or composite meshes. The primary outcome measure was the IDEAL framework stage of innovation. The key secondary outcome measure was the risk of bias in non-randomised studies of interventions (ROBINS-I) criteria for study quality.Results: Twelve studies including 1287 patients were included. Three studies considered mesh prophylaxis and nine studies considered hernia repair. There were only two published studies of IDEAL 2B. The remainder was IDEAL 2A studies. The quality of the evidence was categorised as having a risk of bias of a moderate, serious or critical level in nine of the twelve included studies using the ROBINS-I tool.Conclusion: The evidence base for bioabsorbable mesh is limited. Better reporting and quality control of surgical techniques are needed. Although new trial results over the next decade will improve the evidence base, more trials in emergency and contaminated settings are required to establish the limits of indication

All Hands on Deck: A Team Approach to System Migration

Purpose: To determine if a team approach to a complex integrated library system (ILS) migration would result in a timely and successful outcome. Brief Description: Changing needs and an aging integrated library system server platform prompted Himmelfarb Health Sciences Library to migrate to a new ILS. After considering several options, Himmelfarb decided to join with the George Washington University\u27s Jacob Burns Law Library in their move to a hosted instance of Innovative Interface\u27s Sierra ILS and Encore OPAC. Though some separation of data and functionality could be achieved, there were several functions that would be shared between the two libraries\u27 systems. A successful transition would depend upon both libraries\u27: detailed knowledge of the system data determining essential functionality to preserve willingness to change and accommodate Because the Law Library\u27s Sierra migration was delayed until mid-December 2012 and Himmelfarb\u27s pre-paid server maintenance was ending in March 2013, the window to accomplish migration was a short 12 weeks, prompting the decision to team-manage the migration. Conclusion: Teams and organizational tools, including weekly meetings to discuss problems, ensured the timely completion of key assignments that were critical to meeting the Go Live date goal. The team approach allowed the work and decision-making to be distributed among a large percentage of the staff, creating a broader sense of ownership. Distribution of tasks allowed a high level of attention to detail necessary for an optimal outcome

Central K-band kinematics and line strength maps of NGC 1399

In this paper we present for the first time high spatial resolution K-band maps of the central kinematical and near-infrared spectral properties of the giant cD galaxy in the Fornax cluster, NGC 1399. We confirm the presence of a central velocity dispersion dip within radius < 0.2" seen in previous long-slit studies. Our velocity dispersion maps give evidence for a non-symmetric structure in this central area by showing three sigma peaks to the north-east, south-east and west of the galaxy centre. Additionally we measure near-IR line strength indices at unprecedented spatial resolution in NGC 1399. The most important features we observe in our 2-dimensional line strength maps are drops in Na I and CO(2-0) line strength in the nuclear region of the galaxy, coinciding spatially with the drop in sigma. The observed line strength and velocity dispersion changes suggest a scenario where the centre of NGC 1399 harbours a dynamically cold subsystem with a distinct stellar population.Comment: 9 pages, 5 figures, accepted for publication in A&