Bioabsorbable mesh use in midline abdominal wall prophylaxis and repair achieving fascial closure:a cross-sectional review of stage of innovation

Background: Achieving stable closure of complex or contaminated abdominal wall incisions remains challenging. This study aimed to characterise the stage of innovation for bioabsorbable mesh devices used during both midline closure prophylaxis and complex abdominal wall reconstruction and to evaluate the quality of current evidence.Methods: A systematic review of published and ongoing studies was performed until 31st December 2019. Inclusion criteria were studies where bioabsorbable mesh was used to support fascial closure either prophylactically after midline laparotomy or for repair of incisional hernia with midline incision. Exclusion criteria were: (1) study design was a systematic review, meta-analysis, letter, review, comment, or conference abstract; (2) included less than p patients; (3) only evaluated biological, synthetic or composite meshes. The primary outcome measure was the IDEAL framework stage of innovation. The key secondary outcome measure was the risk of bias in non-randomised studies of interventions (ROBINS-I) criteria for study quality.Results: Twelve studies including 1287 patients were included. Three studies considered mesh prophylaxis and nine studies considered hernia repair. There were only two published studies of IDEAL 2B. The remainder was IDEAL 2A studies. The quality of the evidence was categorised as having a risk of bias of a moderate, serious or critical level in nine of the twelve included studies using the ROBINS-I tool.Conclusion: The evidence base for bioabsorbable mesh is limited. Better reporting and quality control of surgical techniques are needed. Although new trial results over the next decade will improve the evidence base, more trials in emergency and contaminated settings are required to establish the limits of indication

Cosmological Simulations with Scale-Free Initial Conditions I: Adiabatic Hydrodynamics

We analyze hierarchical structure formation based on scale-free initial conditions in an Einstein-de Sitter universe, including a baryonic component. We present three independent, smoothed particle hydrodynamics (SPH) simulations, performed with two different SPH codes (TreeSPH and P3MSPH) at two resolutions. Each simulation is based upon identical initial conditions, which consist of Gaussian distributed initial density fluctuations that have an n=-1 power spectrum. The baryonic material is modeled as an ideal gas subject only to shock heating and adiabatic heating and cooling. The evolution is expected to be self-similar in time, and under certain restrictions we identify the expected scalings for many properties of the distribution of collapsed objects in all three realizations. The distributions of dark matter masses, baryon masses, and mass and emission weighted temperatures scale quite reliably. However, the density estimates in the central regions of these structures are determined by the degree of numerical resolution. As a result, mean gas densities and luminosities obey the expected scalings only when calculated within a limited dynamic range in density contrast. The temperatures and luminosities of the groups show tight correlations with the baryon masses, which can be well-represented by power-laws. The Press-Schechter (PS) approximation predicts the distribution of group dark matter and baryon masses fairly well, though it tends to overestimate the baryon masses. Combining the PS mass distribution with the measured relations for T(M) and L(M) predicts the temperature and luminosity distributions reasonably, though there are some discrepancies at high temperatures/luminosities. The three simulations agree well for the properties of groups that are resolved by 32 or more particles.Comment: 40 pages, 16 embedded postscript figures, uses AASTEX 4.0 style. Minor wording changes, to appear in ApJ. Abridged abstrac

Why do patients develop severe pressure ulcers? a retrospective case study.

Objectives: This study focuses on the ways in which the organisational context can influence the development of severe pressure ulcers. Severe pressure ulcers are important indicators of failures in the organisation and delivery of treatment and care. We have a good understanding of patients’ risk factors, but a poor understanding of the role played by the organisational context in their development. Setting: The study was undertaken in six sites in Yorkshire, England. The settings were sampled in order to maximise diversity, and included patients’ own homes, acute hospital medical and surgical wards, a community hospital and a nursing home during a period of respite care. Participants: Data were collected about eight individuals who developed severe pressure ulcers, using a retrospective case study design. The data sources included interviews with individuals with severe pressure ulcers, and with staff who had treated and cared for them, and clinical notes. Results: 4 accounts indicated that specific actions by clinicians contributed to the development of severe pressure ulcers. Seven of the 8 accounts indicated that they developed in organisational contexts where (1) clinicians failed to listen and respond to the patients’ or carers’ observations about their risks or the quality of their treatment and care, (2) clinicians failed to recognise and respond to clear signs that a patient had a pressure ulcer or was at risk of developing one and (3) services were not effectively coordinated. Conclusions: Patient accounts could only be partially explained in terms of specific events or sequences of events. The findings support the conclusion that there was general acceptance of suboptimal clinical practices in 7 of the 8 contexts where patients developed severe pressure ulcers

'You likes your way, we got our own way': Gypsy and Travellers' views on infant feeding and health professional support

Background: Gypsies and Travellers are known to have poor health status and access to health services, even in comparison to other ethnic minority groups. People from this stigmatised ethnic group are rarely consulted about their health needs or health service provision. Optimal infant feeding in the first year of life has the potential to improve life long health. Objective: The aim of this study is to explore mothers and grandmothers' views on feeding in the first year of life, including the support provided by health professionals. Methods: Semi-structured interviews were conducted with a purposively selected sample of 22 mothers and grandmothers of English Gypsy, Irish Traveller and Romanian Roma ethnicity between November 2011 and February 2012 in a city in South-West England. Results Few women perceived themselves as requiring help from health professionals in infant feeding, as acceptable and accessible support was available from within their own communities. Roma mothers described a tradition of breastfeeding and appropriately timed weaning, while English Gypsies and Irish Travellers customarily practised less healthy infant feeding. When mothers requested support, health service provision was often found inadequate. Conclusion: Exploring the views of Gypsies and Travellers is important to gain insight into the provision of health services for this marginalised ethnic group. This study has implications for policy and the practice of health professionals, in indicating the customary feeding behaviours of some Gypsy and Travellers, and highlighting areas meriting culturally sensitive health promotion

Fossil Groups Origins: I. RX J105453.3+552102 a very massive and relaxed system at z~0.5

The most accepted scenario for the origin of fossil groups (FGs) is that they are galaxy associations in which the merging rate was fast and efficient. These systems have assembled half of their mass at early epoch of the Universe, subsequently growing by minor mergers. They could contain a fossil record of the galaxy structure formation. We have started a project in order to characterize a large sample of FGs. In this paper we present the analysis of the fossil system RX J105453.3+552102. Optical deep images were used for studying the properties of the brightest group galaxy and for computing the photometric luminosity function of the group. We have also performed a detail dynamical analysis of the system based on redshift data for 116 galaxies. This galaxy system is located at z=0.47, and shows a quite large line-of-sight velocity dispersion \sigma_{v}~1000 km/s. Assuming the dynamical equilibrium, we estimated a virial mass of M ~ 10^{15} h_{70} M_{\odot}. No evidence of substructure was found within 1.4 Mpc radius. We found a statistically significant departure from Gaussianity of the group members velocities in the most external regions of the group. This could indicate the presence of galaxies in radial orbits in the external region of the group. We also found that the photometrical luminosity function is bimodal, showing a lack of M_{r} ~ -19.5 galaxies. The brightest group galaxy shows low Sersic parameter (n~2) and a small peculiar velocity. Indeed, our accurate photometry shows that the difference between the brightest and the second brightest galaxies is 1.9 mag in the r-band, while the classical definition of FGs is based on a magnitude gap of 2. We conclude that this fossil system does not follow the empirical definition of FGs. Nevertheless, it is a massive, old and undisturbed galaxy system with little infall of L^{*} galaxies since its initial collapse.Comment: 17 pages, 14 figures, accepted for publication at A&

Does treating obesity stabilize chronic kidney disease?

BACKGROUND: Obesity is a growing health issue in the Western world. Obesity, as part of the metabolic syndrome adds to the morbidity and mortality. The incidence of diabetes and hypertension, two primary etiological factors for chronic renal failure, is significantly higher with obesity. We report a case with morbid obesity whose renal function was stabilized with aggressive management of his obesity. CASE REPORT: A 43-year old morbidly obese Caucasian male was referred for evaluation of his chronic renal failure. He had been hypertensive with well controlled blood pressure with a body mass index of 46 and a baseline serum creatinine of 4.3 mg/dl (estimated glomerular filtration rate of 16 ml/min). He had failed all conservative attempts at weight reduction and hence was referred for a gastric by-pass surgery. Following the bariatric surgery he had approximately 90 lbs. weight loss over 8-months and his serum creatinine stabilized to 4.0 mg/dl. CONCLUSION: Obesity appears to be an independent risk factor for renal failure. Targeting obesity is beneficial not only for better control of hypertension and diabetes, but also possibly helps stabilization of chronic kidney failure

Kinematic properties of early-type galaxy haloes using planetary nebulae

We present new planetary nebulae (PNe) positions, radial velocities, and magnitudes for 6 early-type galaxies obtained with the Planetary Nebulae Spectrograph, their two-dimensional velocity and velocity dispersion fields. We extend this study to include an additional 10 early-type galaxies with PNe radial velocity measurements available from the literature, to obtain a broader description of the outer-halo kinematics in early-type galaxies. These data extend the information derived from stellar kinematics to typically up to ~8 Re. The combination of photometry, stellar and PNe kinematics shows: i) good agreement between the PNe number density and the stellar surface brightness in the region where the two data sets overlap; ii) good agreement between PNe and stellar kinematics; iii) that the mean rms velocity profiles fall into two groups: with of the galaxies characterized by slowly decreasing profiles and the remainder having steeply falling profiles; iv) a larger variety of velocity dispersion profiles; v) that twists and misalignments in the velocity fields are more frequent at large radii, including some fast rotators; vi) that outer haloes are characterised by more complex radial profiles of the specific angular momentum-related lambda_R parameter than observed within 1Re; vii) that many objects are more rotationally dominated at large radii than in their central parts; and viii) that the halo kinematics are correlated with other galaxy properties, such as total luminosity, isophotal shape, total stellar mass, V/sigma, and alpha parameter, with a clear separation between fast and slow rotators.Comment: 36 pages, 21 figures, revised version for MNRA