Recurrent pancreatitis after partial ileal bypass for hyperlipidaemia : a case report

CITATION: Du Toit, D. F., Knott-Craig, C. & Laker, L. 1985. Recurrent pancreatitis after partial ileal bypass for hyperlipidaemia : a case report. South African Medical Journal, 68:483-484.The original publication is available at http://www.samj.org.zaThe case of a 28-year-old man with alcohol-induced bouts of recurrent acute pancreatitis after a partial ileal bypass performed for hyperlipidaemia is presented. Serial computed tomography proved valuable for assessing the resolution of the pancreatic mass. Peripheral parenteral hyperalimentation for 6 weeks had a beneficial effect on the course of the pancreatitis and proved to be useful for nutritional support.Publisher’s versio

Coherent deflection pattern and associated temperature enhancements in the near-Sun solar wind

Measurements of transverse magnetic field and velocity components from Parker Solar Probe have revealed a coherent quasi-periodic pattern in the near-Sun solar wind. As well as being Alfv\'enic and arc-polarised, these deflections were characterised by a consistent orientation and an increased proton core temperature, which was greater parallel to the magnetic field. We show that switchbacks represent the largest deflections within this underlying structure, which is itself consistent with the expected outflow from interchange reconnection simulations. Additionally, the spatial scale of the deflections was estimated to be around $1$\,Mm on the Sun, comparable to the jetting activity observed at coronal bright points within the base of coronal plumes. Therefore, our results could represent the in situ signature of interchange reconnection from coronal bright points within plumes, complementing recent numerical and observational studies. We also found a consistent relationship between the proton core temperature and magnetic field angle across the Parker Solar Probe encounters and discussed how such a persistent signature could be more indicative of an in situ mechanism creating a local increase in temperature. In future, observations of minor ions, radio bursts and remote sensing images could help further establish the connection between reconnection events on the Sun and signatures in the solar wind

Molecular microscopy on graphene

The autonomous ordering and assembly of atoms and molecules on atomically well-defined surfaces combines ease of fabrication with exquisite control over the shape, composition and mesoscale organization of the surface structures formed. Once the mechanisms controlling the self-ordering phenomena are fully understood, the self-assembly and growth processes can be steered to create a wide range of nanostructures with exotic and desirable properties, synthesised from the bottom-up, on an industrial scale from metallic, semiconducting and molecular materials. The work of this thesis aims to address questions concerning molecular self-assembly on graphene. Firstly, techniques for fabricating graphene membranes for electron microscopy (EM) are outlined. The complete fabrication process is described, beginning with the growth of CVD graphene, followed by the transfer of graphene from chemical vapour deposition (CVD) foils to a transmission electron microscope (TEM) support, and finishing with the cleaning steps involved to produce pristene regions of graphene. Strategies to chemically functionalise graphene through covalent and non-covalent means are detailed, as well as methods to fabricate more specialised graphene TEM membranes consisting of stacked and sandwiched graphene layers. With the methods used to fabricate and modify graphene EM membranes described, attention is next focused on specific microscopy techniques developed in order to study organic materials that readily damage when exposed to the electron beam in an electron microscope. Strategies to mitigate the damage arising due to beam exposure are investigated for a range of different organic molecules, and the effects of using a range of detection devices are also studied. Next, the growth of two very similar overlayer systems on graphene are studied. Trimesic acid (TMA) and terephthalic acid (TPA) thin films are grown on both freestanding and CVD graphene substrates for a range of thicknesses, and the resulting structures are probed using a range of microscopy techniques. For TMA, van der Waals epitaxy results in two preferred orientations of the assembly structure that grows in a layer-by-layer Frank-van der Merwe fashion, up to a height of ≈ 20 nm. In stark contrast, TPA assembles into a 2D monolayer before rapidly transitioning to its bulk-like structure as further layers are deposited, following a layer-plus-island, or Stranski-Krastanov, growth mode. Continuing the investigations into the structure of self-assembling molecular films on graphene, a pair of porphyrin-based molecules of the octaethyl porphyrin (OEP) class are studied. A monolayer film of OEP molecules is deposited either side of a freestanding graphene membrane, and the resulting assembly structure is driven by a remote interaction across the graphene between the two OEP films. The remote interaction is shown to diminish on the length scale of two graphene layers. Finally, the structure and motion of individual metal nanoclusters (M-NCs) deposited on freestanding graphene is studied using high-resolution TEM. Computational routines involving cross-correlation techniques are developed in order to better study the dynamic behaviour of M-NCs in atomically-resolved time-series image sequences. The strategies developed provide a means for accurately studying more complex systems, structural changes, and chemical reactions at atomic-resolution and in real-time

Bright lights show the way

Evidence from education in England and around the world reveals that bigger is often better

Pragmatic randomized controlled trial of the Mind Management Skills for Life Programme as an intervention for occupational burnout in mental healthcare professionals

Background Occupational burnout is highly prevalent in the mental healthcare workforce and associated with poorer job satisfaction, performance and outcomes. Aims To evaluate the effects of the Mind Management Skills for Life Programme on burnout and wellbeing. Methods N = 173 mental health nurses were recruited from the English National Health Service during the acute phase of the COVID-19 crisis. Participants were allocated to an immediate intervention or a delayed intervention control group, using a stepped wedge randomized controlled trial design. Measures of burnout (OLBI) and wellbeing (WEMWBS) were completed at four time-points: [1] baseline; [2] after the first group finished the intervention; [3] after the second group finished the intervention; and [4] six-months follow-up. Results Between-group differences were compared at each time-point using ANCOVA adjusting for baseline severity. Statistically significant effects on burnout (d = 0.60) and wellbeing (d = −0.62) were found at time-point 2, favouring the intervention relative to waitlist control. No significant differences were found at subsequent time-points, indicating that both groups improved and maintained their gains after the intervention. Conclusions This intervention led to moderate improvements in burnout and wellbeing, despite the adverse circumstances of the COVID-19 pandemic at the time of the study

The side effects of service changes: exploring the longitudinal impact of participation in a randomised controlled trial (DOORWAYS) on staff perceptions of barriers to change

Background: Staff and service users have expressed concerns that service improvements in British mental health wards have been slow or transient. It is possible that certain changes are positive for some (e.g. service users), but negative for others (e.g. staff), which may affect implementation success. In this study, we explore whether a programme of change to improve the therapeutic milieu on mental health wards influenced staff perceptions of barriers to change, 12 months after implementation. Method: A cluster randomised controlled trial called DOORWAYS was conducted on eight British, inner-city acute mental health wards. Randomisation was achieved using a list randomly generated by a computer. A psychologist trained ward staff (mainly nurses) to deliver evidence-based groups and supported their initial implementation. The impact of these changes was measured over 12 months (when 4 wards were randomised), according to nurses’ perceptions of barriers to change (VOCALISE), using unstructured multivariate linear regression models. This innovative analysis method allows maximum use of data in randomised controlled trials with reduced sample sizes due to substantial drop out rates. The contextual influences of occupational status (staff) and of workplace setting (ward) were also considered. Results: Staff who participated in the intervention had significantly worse perceptions of barriers to change at follow up. The perceptions of staff in the control group did not change over time. In both groups (N = 120), direct care staff had more negative perceptions of barriers to change, and perceptions varied according to ward. Across time, direct care staff in the intervention group became more negative than those in the control group. Conclusion: Participation in this program of change, worsened staff perceptions of barriers to change. In addition, occupational status (being from the direct care group) had a negative effect on perceptions of barriers to change, an effect that continued across time and was worse in the intervention group. Those providing direct care should be offered extra support when changes are introduced and through the implementation process. More effort should be placed around reducing the perceived burden of innovation for staff in mental health wards