Diverticular disease

© 2019 Colonic diverticula are formed by mucosal outpouching from the colonic wall. Their presence increases with increasing age with most, in Caucasian, being situated in the left colon. The aetiology of these outpouchings is not fully understood but dietary, lifestyle and genetic factors have all been implicated. Most patients with diverticula are asymptomatic (diverticulosis); however, approximately 20% develop symptoms such as intermittent abdominal pain and change in bowel habit and are said to have symptomatic diverticular disease. Acute diverticulitis is characterized by acute inflammation within these pockets, with associated constitutional symptoms. Other complications include perforation, abscess, fistulae, strictures and bleeding, albeit in relatively few patients. Stratifying patients using high-quality CT is important as it allows a more tailored approach to treatment. Managing chronic symptoms in symptomatic diverticulosis requires identifying those with long-standing irritable bowel syndrome, who might respond differently, from those with symptoms after acute diverticulitis. A high-fibre diet, cyclical antibiotics and anti-inflammatory treatments have been proposed, but no treatments have yet been shown to benefit unselected patients with symptomatic diverticular disease. Planned surgical resection in symptomatic patients must be undertaken on a case by case basis

Variation in the magnitude of a predator's effect from small to large islands

Should the effect of predation be stronger on small islands or on very large islands and mainlands? To make this question precise, we ask here whether the presence/absence of a particular type of predator has greater effects on given types of organisms lower down in the food web, the larger or the smaller the island. To obtain an answer, we used four studies from the same general system, subtropical islands of the Bahamas; here diurnal lizards are the predator, the direct effects are on web spiders (total density, species richness, composite diversity, dominance) and the indirect effects are on herbivory (percent leaf damage) and in part on aerial arthropods (numbers in sticky traps). In two studies, lizards were removed experimentally from enclosures on a very large island; the experiment was performed twice. In a third study, entirely unmanipulated medium-tolarge islands with and without lizards were compared. In a fourth study, lizards were introduced to a set of small-to-medium islands, while two other sets, one naturally with lizards and the other naturally without lizards, served both as controls and as another comparison. Effect magnitude is measured as the ratio of the larger to smaller of the treatment means. An overwhelming tendency exists for lizards to affect spider density, species richness and composite diversity more, the smaller the island; dominance shows little difference. Herbivory is also affected on average more on small islands, but the variation in effect magnitude with island area is less. Aerial arthropods are also affected more on average on small islands, but unlike the other variables the direction of the effect can be negative or positive, and the effect is often very weak. Thus the mainly direct effects of lizards vary more in magnitude than do the mainly indirect effects of lizards. We propose two explanations for effect magnitude to be greater, the smaller the island. First, greater isolation allows less reimmigration of prey on islands, leading to a greater effect magnitude. Second, fewer kinds of predators occur, the smaller the island, implying a greater effect of removing anyone kind.L'efecte de la depredació, hauria d'esser més gran a les illes petites o a les illes molt grans i als continents? Per precisar aquesta questió, al present treball ens demanam si la presència/absència d'un tipus particular de depredador te efectes més grans sobre determinats tipus d'organismes situats més abaix a la xarxa tròfica com mes gran 0 com més petita és l'illa. Per obtenir-ne una resposta, empram quatre estudis dins el mateix sistema general, les illes subtropicals de les Bahamas; les sargantanes diurnes hi són els depredadors, els efectes directes fan damunt les aranyes de tela (densitat total, riquesa d'espècies, diversitat composta, dorninància) i els efectes indirectes són sobre l'herbivoria (percentatge de fulles afectades) i en part sobre els artropodes aeris (nombres a les trampes d'aferrament). A dos estudis, les sargantanes foren substretes experimentalment de tancats a una illa molt gran; l'experiment es va fer dues vegades. A un tercer estudi, varen esser comparades illes mitjanes a grans, sense cap manipulació, amb i sense sargantanes. A un quart estudi, varen esser introduïdes sargantanes a un conjunt d'illes petites a mitjanes, mentre que altres dos conjunts d'illots, un naturalment amb sargantanes i l'altre naturalment sense sargantanes, varen servir com a controls i com a una altra comparació. La magnitud de l'efecte es va mesurar com a la relació entre la major i la menor de les mitjanes del tractament. Es dona una tendència aclaparadora en el sentit que com més petita és l'illa més afecten les sargantanes la densitat d'aranyes, la riquesa d'espècies i la diversitat composta; la dominància d'especies mostra poca diferència. L'herbivoria també està afectada més de mitjana a les illes més petites, però la variació en la magnitud de l'efecte amb l'àrea insular és poca. Eis artropodes aeris també estan afectats més en promig a les illes petites, però, a diferència de les altres variables, la direcció de l'efecte pot esser positiva o negativa, i l'efecte és sovint molt feble. Per això, els efectes principalment directes de les sargantanes varien més en magnitud que els efectes principalment indirectes de les sargantanes. Proposam dues explicacions per al fet que com més petita és l'illa més gran és la magnitud de l'efecte. Primera, un aïllament més gran permet menys reimmigració de les preses, conduïnt a una major magnitud de l'efecte. Segona, a com més petita és l'illa, menys tipus de depredadors hi ha, cosa que implica un efecte més gran quan se'n substreu un qualsevol

The Case of Weapons of Mass Destruction at the Outset of the Iraq War

My thesis looks into the events leading up to the 2003 U.S. invasion of Iraq. In particular I investigate the intelligence regarding the presence of weapons of mass destruction in Iraq and how that intelligence was interpreted by the Bush administration. Furthermore, I look at how the case for war was presented by the Bush administration to the rest of the world and whether or not the administration’s reasoning was justified. In conclusion I assess the underlying motive for the war in Iraq and whether or not it was in the best interest of the United States of America

Calcium-dependent regulation of the cell cycle via a novel MAPK–NF-κB pathway in Swiss 3T3 cells

Nuclear factor kappa B (NF-κB) has been implicated in the regulation of cell proliferation and transformation. We investigated the role of the serum-induced intracellular calcium increase in the NF-κB–dependent cell cycle progression in Swiss 3T3 fibroblasts. Noninvasive photoactivation of a calcium chelator (Diazo-2) was used to specifically disrupt the transient rise in calcium induced by serum stimulation of starved Swiss 3T3 cells. The serum-induced intracellular calcium peak was essential for subsequent NF-κB activation (measured by real-time imaging of the dynamic p65 and IκBα fluorescent fusion proteins), cyclin D1 (CD1) promoter-directed transcription (measured by real-time luminescence imaging of CD1 promoter-directed firefly luciferase activity), and progression to cell division. We further showed that the serum-induced mitogen-activated protein kinase (MAPK) phosphorylation is calcium dependent. Inhibition of the MAPK- but not the PtdIns3K-dependent pathway inhibited NF-κB signaling, and further, CD1 transcription and cell cycle progression. These data suggest that a serum-dependent calcium signal regulates the cell cycle via a MAPK–NF-κB pathway in Swiss 3T3 cells

Research Evaluating Staff Training Online for Resilience (RESTORE): Protocol for a single-arm feasibility study of an online acceptance and commitment therapy intervention to improve staff wellbeing in palliative care settings

Background Palliative care workers commonly experience workplace stress and distress. General stressors include unmanageable workloads and staff shortages. Stressors specific to palliative care include regular exposure to death, loss and grief. The COVID pandemic exacerbated exhaustion and burnout across the healthcare system, including for those providing palliative care. Evidence based psychological support interventions, tailored to the needs and context of palliative care workers, are needed. Acceptance and Commitment Therapy (ACT) is an established form of cognitive behavioural therapy which uses behavioural psychology, values, acceptance, and mindfulness techniques to improve mental health and wellbeing. ACT is effective in improving workplace wellbeing in many occupational settings. Our study examines the acceptability and feasibility of an online ACT-based intervention to improve mental health and wellbeing in staff caring for people with an advanced progressive illness. Methods A single-arm feasibility trial. We will seek to recruit 30 participants to take part in an 8- week online ACT-based intervention, consisting of three synchronous facilitated group sessions and five asynchronous self-directed learning modules. We will use convergent mixed methods to evaluate the feasibility of the intervention. Quantitative feasibility outcomes will include participant recruitment and retention rates, alongside completion rates of measures assessing stress, quality of life, wellbeing, and psychological flexibility. Focus groups and interviews will explore participant perspectives on the intervention. We will run a stakeholder workshop to further refine the intervention and identify outcomes for use in a future evaluation. We will describe participant perspectives on intervention acceptability, format, content, and perceived impact alongside rates of intervention recruitment, retention, and outcome measure completion. Conclusion We will show whether a brief, online ACT intervention is acceptable to, and feasible for palliative care workers. Findings will be used to further refine the intervention and provide essential information on outcome assessment prior to a full-scale evaluation