Attitudes of surgeons to the use of postoperative markers of the systemic inflammatory response following elective surgery

Background: Cancer is responsible for 7.6 million deaths worldwide and surgery is the primary modality of a curative outcome. Postoperative care is of considerable importance and it is against this backdrop that a questionnaire based study assessing the attitudes of surgeons to monitoring postoperative systemic inflammation was carried out. Method: A Web based survey including 10 questions on the “attitudes of surgeons to the use of postoperative markers of the systemic inflammatory response following elective surgery” was distributed via email. Two cohorts were approached to participate in the survey. Cohort 1 consisted of 1092 surgeons on the “Association of Coloproctology of Great Britain and Ireland (ACPGBI)” membership list. Cohort 2 consisted of 270 surgeons who had published in this field in the past as identified by two recent reviews. A reminder email was sent out 21 days after the initial email in both cases and the survey was closed after 42 days in both cases. Result: In total 29 surgeons (2.7%) from cohort 1 and 40 surgeons (14.8%) from cohort 2 responded to the survey. The majority of responders were from Europe (77%), were colorectal specialists (64%) and were consultants (84%) and worked in teaching hospitals (54%) and used minimally invasive techniques (87%). The majority of responders measured CRP routinely in the post-operative period (85%) and used CRP to guide their decision making (91%) and believed that CRP monitoring should be incorporated into postoperative guidelines (81%). Conclusion: Although there was a limited response the majority of surgeons surveyed measure the systemic inflammatory response following elective surgery and use CRP measurements together with clinical findings to guide postoperative care. The present results provide a baseline against which future surveys can be compared

How and why systemic inflammation worsens quality of life in patients with advanced cancer

Introduction: The presence of an innate host systemic inflammatory response has been reported to be a negative prognostic factor in a wide group of solid tumour types in both the operable and advanced setting, both local and distant. In addition, this host systemic inflammatory response is associated with both clinician reported patient performance status and self-reported measures of quality of life in patients with cancer. Areas covered: A variety of mechanisms are thought to underlie this, including the influence of the host immune response on physical symptoms such as pain and fatigue, its effect on organ systems associated with physical ability and well being such as skeletal muscle, and bone marrow. Furthermore, this innate inflammatory response is thought to have a direct negative impact on mood through its action on the central nervous system. Expert commentary: It is clear that the host systemic inflammatory response represents a target for intervention in terms of both improving quality of life and prognosis in patients with advanced cancer. Based on this paradigm, future research should focus both on pathways which might be targeted by novel agents, but also on whether existing anti-inflammatory drugs might be of benefit

Therapeutic activism : Men of Hope Refugee Association Uganda breaking the silence over male rape in conflict-related sexual violence

Men’s experiences as victims of sexual and gender-based violence remain little recognised in research, policy or practice. Mainstream narratives generally continue to depict men as perpetrators of violence and women as victims. Yet, having been linked to forced migration in contexts of armed conflict, sexual violence against men is slowly becoming recognised as far more widespread than was previously thought. Responding to this, the Institute of Development Studies approached the Refugee Law Project and Men of Hope Refugee Association Uganda in order to jointly design and carry out a study on collective action among male survivors of conflict-related sexual violence. This report explores one central question addressed by the study: ‘despite the odds stacked against them, what makes it possible for male survivors of conflict-related sexual violence to organise and become activists, challenging discriminatory social and gender norms?’ The study finds that, despite pervasive discrimination, groups of male survivors have been able to develop resilience and mutual support through collective action. Further, the study finds that third-party service providers and non-governmental organisations can play an important support role in reinforcing the resilience and capacity of male survivors to organise collectively. The report addresses the overarching question through three main sub-questions: 1. How can looking at male survivors of sexual violence help us understand the complexity of men’s relationship to sexual and gender-based violence? 2. How and why do groups of male survivors of conflict-related sexual violence respond to their experiences of violence, oppression, stigmatisation and marginalisation, including as refugees? 3. How does the individual agency of male survivors of sexual violence living as refugees interact with collective action to respond to the experience of violence and marginalisation

Global quantum Hall phase diagram from visibility diagrams

We propose a construction of a global phase diagram for the quantum Hall effect. This global phase diagram is based on our previous constructions of visibility diagrams in the context of the Quantum Hall Effect. The topology of the phase diagram we obtain is in good agreement with experimental observations (when the spin effect can be neglected). This phase diagram does not show floating.Comment: LaTeX2e, 9 pages, 5 eps figure

Polarised infrared emission from X-ray binary jets

Near-infrared (NIR) and optical polarimetric observations of a selection of X-ray binaries are presented. The targets were observed using the Very Large Telescope and the United Kingdom Infrared Telescope. We detect a significant level (3 sigma) of linear polarisation in four sources. The polarisation is found to be intrinsic (at the > 3 sigma level) in two sources; GRO J1655-40 (~ 4-7% in H and Ks-bands during an outburst) and Sco X-1 (~ 0.1-0.9% in H and K), which is stronger at lower frequencies. This is likely to be the signature of optically thin synchrotron emission from the collimated jets in these systems, whose presence indicates a partially-ordered magnetic field is present at the inner regions of the jets. In Sco X-1 the intrinsic polarisation is variable (and sometimes absent) in the H and K-bands. In the J-band (i.e. at higher frequencies) the polarisation is not significantly variable and is consistent with an interstellar origin. The optical light from GX 339-4 is also polarised, but at a level and position angle consistent with scattering by interstellar dust. The other polarised source is SS 433, which has a low level (0.5-0.8%) of J-band polarisation, likely due to local scattering. The NIR counterparts of GRO J0422+32, XTE J1118+480, 4U 0614+09 and Aql X-1 (which were all in or near quiescence) have a linear polarisation level of < 16% (3 sigma upper limit, some are < 6%). We discuss how such observations may be used to constrain the ordering of the magnetic field close to the base of the jet in such systems.Comment: Accepted to be published in MNRAS; 13 pages, 6 figure

A Covariant Approach To Ashtekar's Canonical Gravity

A Lorentz and general co-ordinate co-variant form of canonical gravity, using Ashtekar's variables, is investigated. A co-variant treatment due to Crnkovic and Witten is used, in which a point in phase space represents a solution of the equations of motion and a symplectic functional two form is constructed which is Lorentz and general co-ordinate invariant. The subtleties and difficulties due to the complex nature of Ashtekar's variables are addressed and resolved.Comment: 18 pages, Plain Te

Impact evaluation of different cash-based intervention modalities on child and maternal nutritional status in Sindh Province, Pakistan, at 6 mo and at 1 y: A cluster randomised controlled trial

BACKGROUND: Cash-based interventions (CBIs), offer an interesting opportunity to prevent increases in wasting in humanitarian aid settings. However, questions remain as to the impact of CBIs on nutritional status and, therefore, how to incorporate them into emergency programmes to maximise their success in terms of improved nutritional outcomes. This study evaluated the effects of three different CBI modalities on nutritional outcomes in children under 5 y of age at 6 mo and at 1 y. METHODS AND FINDINGS: We conducted a four-arm parallel longitudinal cluster randomised controlled trial in 114 villages in Dadu District, Pakistan. The study included poor and very poor households (n = 2,496) with one or more children aged 6–48 mo (n = 3,584) at baseline. All four arms had equal access to an Action Against Hunger–supported programme. The three intervention arms were as follows: standard cash (SC), a cash transfer of 1,500 Pakistani rupees (PKR) (approximately US$14; 1 PKR = US$0.009543); double cash (DC), a cash transfer of 3,000 PKR; or a fresh food voucher (FFV) of 1,500 PKR; the cash or voucher amount was given every month over six consecutive months. The control group (CG) received no specific cash-related interventions. The median total household income for the study sample was 8,075 PKR (approximately US$77) at baseline. We hypothesized that, compared to the CG in each case, FFVs would be more effective than SC, and that DC would be more effective than SC—both at 6 mo and at 1 y—for reducing the risk of child wasting. Primary outcomes of interest were prevalence of being wasted (weight-for-height z-score [WHZ] < −2) and mean WHZ at 6 mo and at 1 y. The odds of a child being wasted were significantly lower in the DC arm after 6 mo (odds ratio [OR] = 0.52; 95% CI 0.29, 0.92; p = 0.02) compared to the CG. Mean WHZ significantly improved in both the FFV and DC arms at 6 mo (FFV: z-score = 0.16; 95% CI 0.05, 0.26; p = 0.004; DC: z-score = 0.11; 95% CI 0.00, 0.21; p = 0.05) compared to the CG. Significant differences on the primary outcome were seen only at 6 mo. All three intervention groups showed similar significantly lower odds of being stunted (height-for-age z-score [HAZ] < −2) at 6 mo (DC: OR = 0.39; 95% CI 0.24, 0.64; p < 0.001; FFV: OR = 0.41; 95% CI 0.25, 0.67; p < 0.001; SC: OR = 0.36; 95% CI 0.22, 0.59; p < 0.001) and at 1 y (DC: OR = 0.53; 95% CI 0.35, 0.82; p = 0.004; FFV: OR = 0.48; 95% CI 0.31, 0.73; p = 0.001; SC: OR = 0.54; 95% CI 0.36, 0.81; p = 0.003) compared to the CG. Significant improvements in height-for-age outcomes were also seen for severe stunting (HAZ < −3) and mean HAZ. An unintended outcome was observed in the FFV arm: a negative intervention effect on mean haemoglobin (Hb) status (−2.6 g/l; 95% CI −4.5, −0.8; p = 0.005). Limitations of this study included the inability to mask participants or data collectors to the different interventions, the potentially restrictive nature of the FFVs, not being able to measure a threshold effect for the two different cash amounts or compare the different quantities of food consumed, and data collection challenges given the difficult environment in which this study was set. CONCLUSIONS: In this setting, the amount of cash given was important. The larger cash transfer had the greatest effect on wasting, but only at 6 mo. Impacts at both 6 mo and at 1 y were seen for height-based growth variables regardless of the intervention modality, indicating a trend toward nutrition resilience. Purchasing restrictions applied to food-based voucher transfers could have unintended effects, and their use needs to be carefully planned to avoid this

Derivation of the Semi-circle Law from the Law of Corresponding States

We show that, for the transition between any two quantum Hall states, the semi-circle law and the existence of a duality symmetry follow solely from the consistency of the law of corresponding states with the two-dimensional scaling flow. This puts these two effects on a sound theoretical footing, implying that both should hold exactly at zero temperature, independently of the details of the microscopic electron dynamics. This derivation also shows how the experimental evidence favours taking the two-dimensional flow seriously for the whole transition, and not just near the critical points.Comment: 4 pages, 1 figure, typeset in LaTeX (uses revtex