(1RS,2SR,7RS,8RS)-N-Benzoyltricyclo[6.2.2.0²,⁷]dodeca-9,11-diene-1,10-dicarboximide

The title 1,4-photoadduct, C₂₁H₁₉NO₃, was formed on irradiation of N-benzoylphthalimide in dichloromethane containing cyclohexene. The bond lengths and angles are generally within the normal ranges. A notable feature of the molecule is the presence within it of four contiguous chiral centres

4',5',6',7'-Tetrachlorospiro[cyclohex-2-ene-1,2'-indan]-1',3'-dione

The title compound, C₁₄H₈Cl₄O₂, has been isolated following irradiation of a dichloromethane solution of N-acetyltetrachlorophthalimide and cyclohexene. The structure refinement is slightly compromised by the disorder over two positions of equal occupancy of a methylene groupβ to the spiro C atom

Benzylammonium 2,4-bis(dicyanomethylene)-2,3-dihydroisoindolide

The cation and anion of the title salt, C⁷H₁₀N⁺.C₁₄H₄N₅-, are both bisected by a crystallographic mirror plane. Extensive hydrogen bonding, with the R₆⁶(28) graph-set motif, connects the ions into layers

Risk of cancer following primary total hip replacement or primary resurfacing arthroplasty of the hip : A retrospective cohort study in Scotland

Acknowledgements: We are grateful to Lee Barnsdale, Doug Clark, and Richard Dobbie for advice and assistance with data preparation before analysis, and to the three anonymous referees for their helpful comments and suggestions.Peer reviewedPublisher PD

Largeness and SQ-universality of cyclically presented groups

Largeness, SQ-universality, and the existence of free subgroups of rank 2 are measures of the complexity of a finitely presented group. We obtain conditions under which a cyclically presented group possesses one or more of these properties. We apply our results to a class of groups introduced by Prishchepov which contains, amongst others, the various generalizations of Fibonacci groups introduced by Campbell and Robertson

Development of a Pain Management Protocol for a Paediatric Ward in the Gambia, West Africa

Despite recent advances in our understanding of paediatric pain and its management, pain continues to be undertreated globally, particularly in children and in low income countries. This article describes the development of a paediatric analgesia and sedation protocol, tailored to the specific setting of the Medical Research Council (MRC) paediatric ward in the Gambia, West Africa. An iterative process was used throughout development, with inputs from the medical literature, local providers, and pain experts, incorporated to ensure a safe, effective, and locally appropriate protocol. We demonstrate that evidence-based published guidelines, can and should be adapted to allow for optimal pain management given the resources and capabilities of specific health care settings. It is hoped that the process and protocol described here, will not only help to improve care on the MRC ward, but serve as an example to others working toward improving pain management in similar health care settings

Association of Secondhand Smoke Exposure with Pediatric Invasive Bacterial Disease and Bacterial Carriage: A Systematic Review and Meta-analysis

Background: A number of epidemiologic studies have observed an association between secondhand smoke (SHS) exposure and pediatric invasive bacterial disease (IBD) but the evidence has not been systematically reviewed. We carried out a systematic review and meta-analysis of SHS exposure and two outcomes, IBD and pharyngeal carriage of bacteria, for Neisseria meningitidis (N. meningitidis), Haemophilus influenzae type B (Hib), and Streptococcus pneumoniae (S. pneumoniae). Methods and Findings: Two independent reviewers searched Medline, EMBASE, and selected other databases, and screened articles for inclusion and exclusion criteria. We identified 30 case-control studies on SHS and IBD, and 12 crosssectional studies on SHS and bacterial carriage. Weighted summary odd ratios (ORs) were calculated for each outcome and for studies with specific design and quality characteristics. Tests for heterogeneity and publication bias were performed. Compared with those unexposed to SHS, summary OR for SHS exposure was 2.02 (95% confidence interval [CI] 1.52–2.69) for invasive meningococcal disease, 1.21 (95% CI 0.69–2.14) for invasive pneumococcal disease, and 1.22 (95% CI 0.93–1.62) for invasive Hib disease. For pharyngeal carriage, summary OR was 1.68 (95% CI, 1.19–2.36) for N. meningitidis, 1.66 (95% CI 1.33–2.07) for S. pneumoniae, and 0.96 (95% CI 0.48–1.95) for Hib. The association between SHS exposure and invasive meningococcal and Hib diseases was consistent regardless of outcome definitions, age groups, study designs, and publication year. The effect estimates were larger in studies among children younger than 6 years of age for all three IBDs, and in studies with the more rigorous laboratory-confirmed diagnosis for invasive meningococcal disease (summary OR 3.24; 95% CI 1.72–6.13). Conclusions: When considered together with evidence from direct smoking and biological mechanisms, our systematic review and meta-analysis indicates that SHS exposure may be associated with invasive meningococcal disease. The epidemiologic evidence is currently insufficient to show an association between SHS and invasive Hib disease or pneumococcal disease. Because the burden of IBD is highest in developing countries where SHS is increasing, there is a need for high-quality studies to confirm these results, and for interventions to reduce exposure of children to SHS