National prospective cohort study of the burden of acute small bowel obstruction

BackgroundSmall bowel obstruction is a common surgical emergency, and is associated with high levels of morbidity and mortality across the world. The literature provides little information on the conservatively managed group. The aim of this study was to describe the burden of small bowel obstruction in the UK.MethodsThis prospective cohort study was conducted in 131 acute hospitals in the UK between January and April 2017, delivered by trainee research collaboratives. Adult patients with a diagnosis of mechanical small bowel obstruction were included. The primary outcome was in-hospital mortality. Secondary outcomes included complications, unplanned intensive care admission and readmission within 30 days of discharge. Practice measures, including use of radiological investigations, water soluble contrast, operative and nutritional interventions, were collected.ResultsOf 2341 patients identified, 693 (29·6 per cent) underwent immediate surgery (within 24 h of admission), 500 (21·4 per cent) had delayed surgery after initial conservative management, and 1148 (49·0 per cent) were managed non-operatively. The mortality rate was 6·6 per cent (6·4 per cent for non-operative management, 6·8 per cent for immediate surgery, 6·8 per cent for delayed surgery; P = 0·911). The major complication rate was 14·4 per cent overall, affecting 19·0 per cent in the immediate surgery, 23·6 per cent in the delayed surgery and 7·7 per cent in the non-operative management groups (P < 0·001). Cox regression found hernia or malignant aetiology and malnutrition to be associated with higher rates of death. Malignant aetiology, operative intervention, acute kidney injury and malnutrition were associated with increased risk of major complication.ConclusionSmall bowel obstruction represents a significant healthcare burden. Patient-level factors such as timing of surgery, acute kidney injury and nutritional status are factors that might be modified to improve outcomes

Expanding Disease Definitions in Guidelines and Expert Panel Ties to Industry:A Cross-sectional Study of Common Conditions in the United States

BACKGROUND: Financial ties between health professionals and industry may unduly influence professional judgments and some researchers have suggested that widening disease definitions may be one driver of over-diagnosis, bringing potentially unnecessary labeling and harm. We aimed to identify guidelines in which disease definitions were changed, to assess whether any proposed changes would increase the numbers of individuals considered to have the disease, whether potential harms of expanding disease definitions were investigated, and the extent of members' industry ties. METHODS AND FINDINGS: We undertook a cross-sectional study of the most recent publication between 2000 and 2013 from national and international guideline panels making decisions about definitions or diagnostic criteria for common conditions in the United States. We assessed whether proposed changes widened or narrowed disease definitions, rationales offered, mention of potential harms of those changes, and the nature and extent of disclosed ties between members and pharmaceutical or device companies. Of 16 publications on 14 common conditions, ten proposed changes widening and one narrowing definitions. For five, impact was unclear. Widening fell into three categories: creating “pre-disease”; lowering diagnostic thresholds; and proposing earlier or different diagnostic methods. Rationales included standardising diagnostic criteria and new evidence about risks for people previously considered to not have the disease. No publication included rigorous assessment of potential harms of proposed changes. Among 14 panels with disclosures, the average proportion of members with industry ties was 75%. Twelve were chaired by people with ties. For members with ties, the median number of companies to which they had ties was seven. Companies with ties to the highest proportions of members were active in the relevant therapeutic area. Limitations arise from reliance on only disclosed ties, and exclusion of conditions too broad to enable analysis of single panel publications. CONCLUSIONS: For the common conditions studied, a majority of panels proposed changes to disease definitions that increased the number of individuals considered to have the disease, none reported rigorous assessment of potential harms of that widening, and most had a majority of members disclosing financial ties to pharmaceutical companies. Please see later in the article for the Editors' Summar

Early childhood Child and Adolescent Needs and Strengths (CANS): Indiana multi-system comprehensive Glossary, v 2.2

The early childhood or Birth to Five CANS assessment tool is developmentally appropriate for infants, toddlers and preschoolers. Similar to the Comprehensive Child and Adolescent Needs and Strengths (CANS, Lyons, 2009) 5 to 17 tool, the early childhood version considers basic life dimensions or domains (social/emotional needs, risk factors, risk behaviors, daily life functioning, child strengths, acculturation and caregiver strengths and needs).Funded by the Indiana Family and Social Service Administration, Division of Mental Health and Addiction through a contract with Indiana University for Training and Consultative Services to support the meaningful use of the Child and Adolescent Needs and Strengths (CANS) and Adult Needs and Strengths Assessment (ANSA) tools

Internal Friction and Vulnerability of Mixed Alkali Glasses

Based on a hopping model we show how the mixed alkali effect in glasses can be understood if only a small fraction c_V ofthe available sites for the mobile ions is vacant. In particular, we reproduce the peculiar behavior of the internal friction and the steep fall (''vulnerability'') of the mobility of the majority ion upon small replacements by the minority ion. The single and mixed alkali internal friction peaks are caused by ion-vacancy and ion-ion exchange processes. If c_V is small, they can become comparable in height even at small mixing ratios. The large vulnerability is explained by a trapping of vacancies induced by the minority ions. Reasonable choices of model parameters yield typical behaviors found in experiments.Comment: 4 pages, 4 figure

Gender inequalities and academic journal publishing: The view from the Journal of American Studies

This is the author accepted manuscript. The final version is available from Cambridge University Press via the DOI in this recordThis virtual special issue is the outcome of a project entitled Women and JAS, which was launched by the coeditors of the Journal of American Studies in October 2019 to document the involvement of women in the journal's day-to-day business from its inception in 1956 as the Bulletin of the British Association for American Studies. The project arises out of – and will hopefully contribute to – larger conversations about the progression of women scholars in academia. While the UK and US higher-education contexts (the contexts most pertinent to this discussion) differ, there are notable similarities in terms of the relationship between gender and career advancement. Both witness attrition of women from academia as they progress from undergraduate studies to PhD and beyond; both see disproportionate numbers of women scholars employed in precarious, part-time and/or teaching-only roles; both see a very low proportion of women in senior professorial roles; fewer women in both locations apply for (and are, therefore, awarded) major grants. In the UK, specifically, recent conversations around gender inequality in higher education have revolved around issues (and initiatives) such as the gender pay gap, Athena SWAN, sexual harassment and the effects of nondisclosure agreements (NDAs), caring responsibilities and affective labour

The uncertainty principle and classical amplitudes

We study the variance in the measurement of observables during scattering events, as computed using amplitudes. The classical regime, characterised by negligible uncertainty, emerges as a consequence of an infinite set of relationships among multileg, multiloop amplitudes in a momentum-transfer expansion. We discuss two non-trivial examples in detail: the six-point tree and the five-point one-loop amplitudes in scalar QED. We interpret these relationships in terms of a coherent exponentiation of radiative effects in the classical limit which generalises the eikonal formula, and show how to recover the impulse, including radiation reaction, from this generalised eikonal. Finally, we incorporate the physics of spin into our framework

Optical properties of high quality Cu2ZnSnSe4 thin films

Cu2ZnSnSe4 thin films, fabricated on bare or molybdenum coated glass substrates by magnetron sputtering and selenisation, were studied by a range of techniques. Photoluminescence spectra reveal an excitonic peak and two phonon replicas of a donor-acceptor pair (DAP) recombination. Its acceptor and donor ionisation energies are 27 and 7 meV, respectively. This demonstrates that high-quality Cu2ZnSnSe4 thin films can be fabricated. An experimental value for the longitudinal optical phonon energy of 28 meV was estimated. The band gap energy of 1.01 eV at room temperature was determined using optical absorption spectr

Frequency Dependent Rheology of Vesicular Rhyolite

Frequency dependent rheology of magmas may result from the presence of inclusions (bubbles, crystals) in the melt and/or from viscoelastic behavior of the melt itself. With the addition of deformable inclusions to a melt possessing viscoelastic properties one might expect changes in the relaxation spectrum of the shear stresses of the material (e.g., broadening of the relaxation spectrum) resulting from the viscously deformable geometry of the second phase. We have begun to investigate the effect of bubbles on the frequency dependent rheology of rhyolite melt. The present study deals with the rheology of bubble-free and vesicular rhyolite melts containing spherical voids of 10 and 30 vol %. We used a sinusoidal torsion deformation device. Vesicular rhyolite melts were generated by the melting (at 1 bar) of an Armenian obsidian (Dry Fountain, Erevan, Armenia) and Little Glass Mountain obsidian (California). The real and imaginary parts of shear viscosity and shear modulus have been determined in a frequency range of 0.005–10 Hz and temperature range of 600°–900°C. The relaxed shear viscosities of samples obtained at low frequencies and high temperatures compare well with data previously obtained by parallel plate viscometry. The relaxed shear viscosity of vesicular rhyolites decreases progressively with increasing bubble content. The relaxation spectrum for rhyolite melt without bubbles has an asymmetric form and fits an extended exponent relaxation. The presence of deformable bubbles results in an imaginary component of the shear modulus that becomes more symmetrical and extends into the low-frequency/high-temperature range. The internal friction Q −1 is unaffected in the high-frequency/low-temperature range by the presence of bubbles and depends on the bubble content in the high-temperature/low-frequency range. The present work, in combination with the previous study of Stein and Spera (1992), illustrates that magma viscosity can either increase or decrease with bubble content, depending upon the rate of style of strain during magmatic flow

Crystal orientation mapping and microindentation reveal anisotropy in Porites skeletons

Structures made by scleractinian corals support diverse ocean ecosystems. Despite the importance of coral skeletons and their predicted vulnerability to climate change, few studies have examined the mechanical and crystallographic properties of coral skeletons at the micro- and nano-scales. Here, we investigated the interplay of crystallographic and microarchitectural organization with mechanical anisotropy within Porites skeletons by measuring Young’s modulus and hardness along surfaces transverse and longitudinal to the primary coral growth direction. We observed micro-scale anisotropy, where the transverse surface had greater Young’s modulus and hardness by ∼ 6 GPa and 0.2 GPa, respectively. Electron backscatter diffraction (EBSD) revealed that this surface also had a higher percentage of crystals oriented with the a-axis between ± 30-60∘, relative to the longitudinal surface, and a broader grain size distribution. Within a region containing a sharp microscale gradient in Young’s modulus, nanoscale indentation mapping, energy dispersive spectroscopy (EDS), EBSD, and Raman crystallography were performed. A correlative trend showed higher Young’s modulus and hardness in regions with individual crystal bases (c-axis) facing upward, and in crystal fibers relative to centers of calcification. These relationships highlight the difference in mechanical properties between scales (i.e. crystals, crystal bundles, grains). Observations of crystal orientation and mechanical properties suggest that anisotropy is driven by microscale organization and crystal packing, rather than intrinsic crystal anisotropy. In comparison with previous observations of nanoscale isotropy in corals, our results illustrate the role of hierarchical architecture in coral skeletons and the influence of biotic and abiotic factors on mechanical properties at different scales

Expanding disease definitions in guidelines and expert panel ties to industry: A cross-sectional study of common conditions in the United States

Background: Financial ties between health professionals and industry may unduly influence professional judgments and some researchers have suggested that widening disease definitions may be one driver of over-diagnosis, bringing potentially unnecessary labeling and harm. We aimed to identify guidelines in which disease definitions were changed, to assess whether any proposed changes would increase the numbers of individuals considered to have the disease, whether potential harms of expanding disease definitions were investigated, and the extent of members' industry ties. Methods and Findings: We undertook a cross-sectional study of the most recent publication between 2000 and 2013 from national and international guideline panels making decisions about definitions or diagnostic criteria for common conditions in the United States. We assessed whether proposed changes widened or narrowed disease definitions, rationales offered, mention of potential harms of those changes, and the nature and extent of disclosed ties between members and pharmaceutical or device companies. Of 16 publications on 14 common conditions, ten proposed changes widening and one narrowing definitions. For five, impact was unclear. Widening fell into three categories: creating "pre-disease''; lowering diagnostic thresholds; and proposing earlier or different diagnostic methods. Rationales included standardising diagnostic criteria and new evidence about risks for people previously considered to not have the disease. No publication included rigorous assessment of potential harms of proposed changes. Among 14 panels with disclosures, the average proportion of members with industry ties was 75%. Twelve were chaired by people with ties. For members with ties, the median number of companies to which they had ties was seven. Companies with ties to the highest proportions of members were active in the relevant therapeutic area. Limitations arise from reliance on only disclosed ties, and exclusion of conditions too broad to enable analysis of single panel publications. Conclusions: For the common conditions studied, a majority of panels proposed changes to disease definitions that increased the number of individuals considered to have the disease, none reported rigorous assessment of potential harms of that widening, and most had a majority of members disclosing financial ties to pharmaceutical companies