Pancreatic Mass with an Unusual Pathology: A Case Report

Intra-abdominal abscesses formation in patients with no preceding symptoms is rare. Infection of the pancreas occurs in 5–9% of patients with acute pancreatitis, more commonly as a complication of necrotising or severe pancreatitis. We have reported a case of a 64-year-old almost entirely asymptomatic man who underwent a Whipple's procedure following extensive investigation of a pancreatic mass. The pathology and histology showed no evidence of malignancy, and instead a true pancreatic abscess, centred around an impacted cholesterol calculus in the distal CBD. Of suspicious pancreatic masses that are resected, chronic choledocholithiasis is the aetiology in less than 5% of nonmalignant or “false positives.” This report describes such a case

The development of a measure of social care outcome for older people. Funded/commissioned by: Department of Health

An essential element of identifying Best Value and monitoring cost-effective care is to be able to identify the outcomes of care. In the field of health services, use of utility-based health related quality of life measures has become widespread, indeed even required. If, in the new era of partnerships, social care outcomes are to be valued and included we need to develop measures that reflect utility or welfare gain from social care interventions. This paper reports on a study, commissioned as part of the Department of Health’s Outcomes of Social Care for Adults Initiative, that developed an instrument and associated utility indexes that provide a tool for evaluating social care interventions in both a research and service setting. Discrete choice conjoint analysis used to derive utility weights provided us with new insights into the relative importance of the core domains of social care to older people. Whilst discrete choice conjoint analysis is being increasingly used in health economics, this is the first study that has attempted to use it to derive a measure of outcome

Delayed Presentation of Isolated Complete Pancreatic Transection as a Result of Sport-Related Blunt Trauma to the Abdomen

Introduction: Blunt abdominal trauma is a rare but well-recognized cause of pancreatic transection. A delayed presentation of pancreatic fracture following sport-related blunt trauma with the coexisting diagnostic pitfalls is presented. Case Report: A 17-year-old rugby player was referred to our specialist unit after having been diagnosed with traumatic pancreatic transection, having presented 24 h after a sporting injury. Despite haemodynamic stability, at laparotomy he was found to have a diffuse mesenteric hematoma involving the large and small bowel mesentery, extending down to the sigmoid colon from the splenic flexure, and a large retroperitoneal hematoma arising from the pancreas. The pancreas was completely severed with the superior border of the distal segment remaining attached to the splenic vein that was intact. A distal pancreatectomy with spleen preservation and evacuation of the retroperitoneal hematoma was performed. Discussion/Conclusion: Blunt pancreatic trauma is a serious condition. Diagnosis and treatment may often be delayed, which in turn may drastically increase morbidity and mortality. Diagnostic difficulties apply to both paraclinical and radiological diagnostic methods. A high index of suspicion should be maintained in such cases, with a multi-modality diagnostic approach and prompt surgical intervention as required

Recreating the Feel of the Human Chest in a CPR Manikin via Programmable Pneumatic Damping

It is well known that the human chest exhibits a strong force displacement hysteresis during CPR, a stark contrast to the non hysteretic behavior of standard spring manikins. We hypothesize that individuals with experience performing CPR on humans would perceive a manikin with damping as more realistic and better for training. By analyzing data collected from chest compressions on real patients, we created a dynamic model that accounts for this hysteresis with a linear spring and a one-way variable damper, and we built a new high-fidelity manikin to enact the desired force displacement relationship. A linkage attached to the chest plate converts vertical compression motions to the horizontal displacement of a set of pneumatic dashpot pistons, sending a volume of air into and out of the manikin through a programmable valve. Position and pressure sensors allow a microcontroller to adjust the valve orifice so that the provided damping force closely follows the desired damping force throughout the compression cycle. Eight experienced CPR practitioners tested both the new manikin and an identical looking standard manikin; the manikin with damping received significantly higher ratings for haptic realism and perceived utility as a training tool

Spatial scaling properties of coral reef benthic communities

The spatial structure of ecological communities on tropical coral reefs across seascapes and geographies have historically been poorly understood. Here we addressed this for the first time using spatially expansive and thematically resolved benthic community data collected around five uninhabited central Pacific oceanic islands, spanning 6° latitude and 17° longitude. Using towed-diver digital image surveys over ~140 linear km of shallow (8–20 m depth) tropical reef, we highlight the autocorrelated nature of coral reef seascapes. Benthic functional groups and hard coral morphologies displayed significant spatial clustering (positive autocorrelation) up to kilometre-scales around all islands, in some instances dominating entire sections of coastline. The scale and strength of these autocorrelation patterns showed differences across geographies, but patterns were more similar between islands in closer proximity and of a similar size. For example, crustose coralline algae (CCA) were clustered up to scales of 0.3 km at neighbouring Howland and Baker Islands and macroalgae were spatially clustered at scales up to ~3 km at both neighbouring Kingman Reef and Palmyra Atoll. Of all the functional groups, macroalgae had the highest levels of spatial clustering across geographies at the finest resolution of our data (100 m). There were several cases where the upper scale at which benthic community members showed evidence of spatial clustering correlated highly with the upper scales at which concurrent gradients in physical environmental drivers were spatially clustered. These correlations were stronger for surface wave energy than subsurface temperature (regardless of benthic group) and turf algae and CCA had the closest alignments in scale with wave energy across functional groups and geographies. Our findings suggest such physical drivers not only limit or promote the abundance of various benthic competitors on coral reefs, but also play a key role in governing their spatial scaling properties across seascapes

Association of open-angle glaucoma loci with incident glaucoma in the Blue Mountains Eye Study.

This article is available under the terms of the Creative Commons Attribution License (CC BY). http://creativecommons.org/licenses/by/3.0/ You may distribute and copy the article, create extracts, abstracts, and other revised versions, adaptations or derivative works of or from an article (such as a translation), to include in a collective work (such as an anthology), to text or data mine the article, including for commercial purposes without permission from Elsevier. The original work must always be appropriately credited.PURPOSE: To determine if open-angle glaucoma (OAG)-associated single nucleotide polymorphisms (SNPs) are associated with incident glaucoma and if such genetic information is useful in OAG risk prediction. DESIGN: Case-control from within a population-based longitudinal study. METHODS: study population: Individuals aged over 49 years of age living in the Blue Mountains region west of Sydney and enrolled in the Blue Mountains Eye Study. observation: Cases for this sub-study (n = 67) developed incident OAG between baseline and 10-year visits, in either eye, while controls (n = 1919) had no evidence for OAG at any visit. All participants had an ocular examination and DNA genotyped for reported OAG risk SNPs. main outcome measure: Incident OAG. RESULTS: Two loci also known to be associated with cup-to-disc ratio as well as OAG (9p21 near CDKN2B-AS1 and SIX1/SIX6) were both significantly associated with incident OAG in the Blue Mountains Eye Study cohort (P = .006 and P = .004, respectively). The TMCO1 locus was nominally associated (P = .012), while the CAV1/CAV2 and 8q22 loci were not associated. Multivariate logistic regression and neural network analysis both indicated that the genetic risk factors contributed positively to the predictive models incorporating traditional risk factors. CONCLUSIONS: This study shows that previously reported genetic variations related to OAG and cup-to-disc ratio are associated with the onset of OAG and thus may become useful in risk prediction algorithms designed to target early treatment to those most at risk of developing glaucoma

Report of the Scientific Council Meeting 01 -15 June 2017

Council met at the Sobey Building, Saint Mary’s University, Halifax, NS, Canada, during 01 – 15 June 2017, to consider the various matters in its Agenda. Representatives attended from Canada, Denmark (in respect of Faroe Islands and Greenland), the European Union (France, Germany (via WebEx), Portugal, Spain, the United Kingdom and the European Commission), Japan, the Russian Federation and the United States of America. Observers from the Ecology Action Centre and Dalhousie University were also present. The Executive Secretary, Scientific Council Coordinator and other members of the Secretariat were in attendance. The Executive Committee met prior to the opening session of the Council to discuss the provisional agenda and plan of work. The Council was called to order at 1000 hours on 01 June 2017. The provisional agenda was adopted with modification. The Scientific Council Coordinator was appointed the rapporteur. The Council was informed that the meeting was quorate and authorization had been received by the Executive Secretary for proxy votes from the European Union, Denmark (in respect of Faroe Islands and Greenland), Iceland, Japan, Republic of Korea, and Norway. The opening session was adjourned at 1200 hours on 01 June 2017. Several sessions were held throughout the course of the meeting to deal with specific items on the agenda. The Council considered adopted the STACFEN report on 8 June 2017, and the STACPUB, STACFIS and STACREC reports on 15 June 2017. The concluding session was called to order at 0830 hours on 15 June 2017. The Council considered and adopted the report the Scientific Council Report of this meeting of 01 -15 June 2017. The Chair received approval to leave the report in draft form for about two weeks to allow for minor editing and proof-reading on the usual strict understanding there would be no substantive changes. The meeting was adjourned at 1430 hours on 15 June 2017. The Reports of the Standing Committees as adopted by the Council are appended as follows: Appendix I - Report of the Standing Committee on Fisheries Environment (STACFEN), Appendix II - Report of Standing Committee on Publications (STACPUB), Appendix III - Report of Standing Committee on Research Coordination (STACREC), and Appendix IV - Report of Standing Committee on Fisheries Science (STACFIS). The Agenda, List of Research (SCR) and Summary (SCS) Documents, and List of Representatives, Advisers and Experts, are given in Appendix V-VII. The Council’s considerations on the Standing Committee Reports, and other matters addressed by the Council follow in Sections II-XV

The role of teamwork and non-technical skills for improving emergency surgical outcomes: an international perspective

The assurance of patient safety in emergency general surgery remains challenging due to the patients' high-risk underlying conditions and the wide variability in emergency surgical care provided around the globe. The authors of this article convened as an expert panel on patient safety in surgery at the 8(th) International Conference of the World Society of Emergency Surgery (WSES) in Edinburgh, Scotland, on September 7-10, 2021. This review article represents the proceedings from the expert panel discussions at the WSES congress and was designed to provide an international perspective on optimizing teamwork and non-technical skills in emergency general surgery