The use of oral antibiotics and mechanical bowel preparation in elective colorectal resection for the reduction of surgical site infection.

Surgical site infection (SSI) is a major cause of morbidity following elective colorectal resection worldwide. Reduction in SSI rates can be achieved with the use of SSI reduction bundles. Debate about the role of mechanical bowel preparation and oral antibiotics (MOAB) in reducing SSI has persisted over decades with considerable variation in international practice. This article summarises the arguments for and against the routine use of MOAB in the elective setting, highlighting the areas of controversy and evidence gaps and provides pragmatic suggestions for colorectal practice.This topical debate paper was commissioned by the President and Executive of the Association of Coloproctology of Great Britain and Ireland. ACPGBI also funded the open access publication fee. The authors would like to thank Ms J Pipe for her comments from the patient perspective and Miss N Fearnhead for her support in developing this debate article

HER2 testing in breast cancer: Opportunities and challenges

Human epidermal growth factor receptor 2 (HER2) is overexpressed in 15-25% of breast cancers, usually as a result of HER2 gene amplification. Positive HER2 status is considered to be an adverse prognostic factor. Recognition of the role of HER2 in breast cancer growth has led to the development of anti-HER2 directed therapy, with the humanized monoclonal antibody trastuzumab (Herceptin (R)) having been approved for the therapy of HER2-positive metastatic breast cancer. Clinical studies have further suggested that HER2 status can provide important information regarding success or failure of certain hormonal therapies or chemotherapies. As a result of these developments, there has been increasing demand to perform HER2 testing on current and archived breast cancer specimens. This article reviews the molecular background of HER2 function, activation and inhibition as well as current opinions concerning its role in chemosensitivity and interaction with estrogen receptor biology. The different tissue-based assays used to detect HER2 amplification and overexpression are discussed with respect to their advantages and disadvantages, when to test (at initial diagnosis or pre-treatment), where to test (locally or centralized) and the need for quality assurance to ensure accurate and valid testing results

“Cycles upon cycles, stories upon stories” : contemporary audio media and podcast horror’s new frights

During the last ten years the ever-fertile horror and Gothic genres have birthed a new type of fright-fiction: podcast horror. Podcast horror is a narrative horror form based in audio media and the properties of sound. Despite association with oral ghost tales, radio drama, and movie and TV soundscapes, podcast horror remains academically overlooked. Podcasts offer fertile ground for the revitalization and evolution of such extant audio-horror traditions, yet they offer innovation too. Characterized by their pre-recorded nature, individualized listening times and formats, often “amateur” or non-corporate production, and isolation from an ongoing media stream more typical of radio or TV, podcasts potentialize the instigation of newer audio-horror methods and traits. Podcast horror shows vary greatly in form and content, from almost campfire-style oral tales, comprising listener-produced and performed content (Drabblecast; Tales to Terrify; NoSleep); to audio dramas reminiscent of radio’s Golden Era (Tales from Beyond the Pale; 19 Nocturne Boulevard); to dramas delivered in radio-broadcast style (Welcome to Night Vale; Ice Box Theatre); to, most recently, dramas, which are themselves acknowledging and exploratory of the podcast form (TANIS; The Black Tapes Podcast; Lime Town). Yet within this broad spectrum, sympathies and conventions arise which often not only explore and expand notions of Gothic sound, but which challenge broader existing horror and Gothic genre norms. This article thus demonstrates the extent to which podcast horror uses its audio form, technology and mediation to disrupt and evolve Gothic/horror fiction, not through a cumulative chronological formulation of podcast horror but through a maintained and alternately synthesized panorama of forms. Herein new aspects of generic narration, audience, narrative and aesthetic emerge. Exploring a broad spectrum of American and British horror podcasts, this article shows horror podcasting to utilize podcasting’s novel means of horror and Gothic distribution/consumption to create fresh, unique and potent horror forms. This article reveals plot details about some of the podcasts examined

Attenuation technique for measuring sediment displacement levels

A technique for obtaining accurate, high (spatial) resolution measurements of sediment redeposition levels is described. In certain regimes, the method may also be employed to provide measurements of sediment layer thickness as a function of time. The method uses a uniform light source placed beneath the layer, consisting of transparent particles, so that the intensity of light at a point on the surface of the layer can be related to the depth of particles at that point. A set of experiments, using the impact of a vortex ring with a glass ballotini particle layer as the resuspension mechanism, are described to test and illustrate the technique

External beam irradiation of myocardial carcinoid metastases: a case report

The heart is an exceedingly rare site of metastatic involvement in carcinoid tumors. Only nineteen cases have been described in the literature over the past 30 years. We report here on a patient who presented with progressive carcinoid syndrome despite surgical resection of her liver metastases. She was found to have cardiac metastases on inidium-111-pentetreotide scintigraphy and subsequently underwent external beam radiation to the heart resulting in symptomatic palliation of her syndrome and objective radiographic response. To our knowledge, this is the first reported case of metastatic cardiac carcinoid treated with external beam irradiation

Integrated groundwater management: An overview of concepts and challenges

Managing water is a grand challenge problem and has become one of humanity’s foremost priorities. Surface water resources are typically societally managed and relatively well understood; groundwater resources, however, are often hidden and more difficult to conceptualize. Replenishment rates of groundwater cannot match past and current rates of depletion in many parts of the world. In addition, declining quality of the remaining groundwater commonly cannot support all agricultural, industrial and urban demands and ecosystem functioning, especially in the developed world. In the developing world, it can fail to even meet essential human needs. The issue is: how do we manage this crucial resource in an acceptable way, one that considers the sustainability of the resource for future generations and the socioeconomic and environmental impacts? In many cases this means restoring aquifers of concern to some sustainable equilibrium over a negotiated period of time, and seeking opportunities for better managing groundwater conjunctively with surface water and other resource uses. However, there are many, often-interrelated, dimensions to managing groundwater effectively. Effective groundwater management is underpinned by sound science (biophysical and social) that actively engages the wider community and relevant stakeholders in the decision making process. Generally, an integrated approach will mean “thinking beyond the aquifer”, a view which considers the wider context of surface water links, catchment management and cross-sectoral issues with economics, energy, climate, agriculture and the environment. The aim of the book is to document for the first time the dimensions and requirements of sound integrated groundwater management (IGM). The primary focus is on groundwater management within its system, but integrates linkages beyond the aquifer. The book provides an encompassing synthesis for researchers, practitioners and water resource managers on the concepts and tools required for defensible IGM, including how IGM can be applied to achieve more sustainable socioeconomic and environmental outcomes, and key challenges of IGM. The book is divided into five parts: integration overview and problem settings; governance; socioeconomics; biophysical aspects; and modelling and decision support. However, IGM is integrated by definition, thus these divisions should be considered a convenience for presenting the topics rather than hard and fast demarcations of the topic area

Building social capital through breastfeeding peer support: Insights from an evaluation of a voluntary breastfeeding peer support service in North-West England

Background: Peer support is reported to be a key method to help build social capital in communities. To date there are no studies that describe how this can be achieved through a breastfeeding peer support service. In this paper we present findings from an evaluation of a voluntary model of breastfeeding peer support in North-West England to describe how the service was operationalized and embedded into the community. This study was undertaken from May, 2012 to May, 2013. Methods: Interviews (group or individual) were held with 87 participants: 24 breastfeeding women, 13 peer supporters and 50 health and community professionals. The data contained within 23 monthly monitoring reports (January, 2011 to February 2013) compiled by the voluntary peer support service were also extracted and analysed. Results: Thematic analysis was undertaken using social capital concepts as a theoretical lens. Key findings were identified to resonate with ’bonding’, ‘bridging’ and ‘linking’ forms of social capital. These insights illuminate how the peer support service facilitates ‘bonds’ with its members, and within and between women who access the service; how the service ‘bridges’ with individuals from different interests and backgrounds, and how ‘links’ were forged with those in authority to gain access and reach to women and to promote a breastfeeding culture. Some of the tensions highlighted within the social capital literature were also identified. Conclusions: Horizontal and vertical relationships forged between the peer support service and community members enabled peer support to be embedded into care pathways, helped to promote positive attitudes to breastfeeding and to disseminate knowledge and maximise reach for breastfeeding support across the community. Further effort to engage with those of different ethnic backgrounds and to resolve tensions between peer supporters and health professionals is warranted

Comparative study on the use of specific and heterologous microsatellite primers in the stingless bees Melipona rufiventris and M. mondury (Hymenoptera, Apidae)

Due to their high degree of polymorphism, microsatellites are considered useful tools for studying population genetics. Nevertheless, studies of genetic diversity in stingless bees by means of these primers have revealed a low level of polymorphism, possibly the consequence of the heterologous primers used, since in most cases these were not specifically designed for the species under consideration. Herein we compared the number of polymorphic loci and alleles per locus, as well as observed heterozygosity in Melipona rufiventris and M. mondury populations, using specific and heterologous primers. The use of specific primers placed in evidence the greater frequency of polymorphic loci and alleles per locus, besides an expressive increase in observed heterozygosity in M. rufiventris and M. mondury, thereby reinforcing the idea that populational studies should be undertaken by preferably using species-specific microsatellite primers

Formation of regulatory modules by local sequence duplication

Turnover of regulatory sequence and function is an important part of molecular evolution. But what are the modes of sequence evolution leading to rapid formation and loss of regulatory sites? Here, we show that a large fraction of neighboring transcription factor binding sites in the fly genome have formed from a common sequence origin by local duplications. This mode of evolution is found to produce regulatory information: duplications can seed new sites in the neighborhood of existing sites. Duplicate seeds evolve subsequently by point mutations, often towards binding a different factor than their ancestral neighbor sites. These results are based on a statistical analysis of 346 cis-regulatory modules in the Drosophila melanogaster genome, and a comparison set of intergenic regulatory sequence in Saccharomyces cerevisiae. In fly regulatory modules, pairs of binding sites show significantly enhanced sequence similarity up to distances of about 50 bp. We analyze these data in terms of an evolutionary model with two distinct modes of site formation: (i) evolution from independent sequence origin and (ii) divergent evolution following duplication of a common ancestor sequence. Our results suggest that pervasive formation of binding sites by local sequence duplications distinguishes the complex regulatory architecture of higher eukaryotes from the simpler architecture of unicellular organisms