On the Road to Recovery psychological therapy versus treatment as usual for forensic mental health patients:Study protocol for a randomized controlled feasibility trial

Abstract Background On the Road to Recovery (OTRTR) is a brief low intensity group psychological therapy that aims to improve patients’ insight into their mental disorder and develop adaptive coping skills to help manage distress. OTRTR is currently delivered in forensic mental health services in Scotland. However, to date, this therapy has not been evaluated as to its effectiveness or safety for forensic patients. Methods This is a parallel-group feasibility randomized controlled trial with single-blind assessments comparing OTRTR therapy to treatment as usual (TAU) for forensic mental health patients. Fifty participants will be recruited from high, medium, and low secure forensic mental health services in Scotland. Participants will receive OTRTR for approximately 12 weeks or continue treatment as usual for 12 weeks. The trial’s primary aims relate to testing the acceptability and feasibility of key trial procedures that would be necessary for a definitive RCT of OTRTR. The secondary aims include estimating therapeutic effect sizes on clinical outcomes including insight and coping skills. The study design also features an adverse event monitoring plan to estimate the safety of OTRTR for participants, as well as use of intensive longitudinal methods to identify “key ingredients” to the OTRTR therapy protocol. Discussion This study will inform the design and sample size for a future full-scale randomized controlled trial (RCT), which will be conducted to determine the effectiveness of the On the Road to Recovery intervention in improving forensic mental health patients’ clinical insight and coping skills. Trial registration ISRCTN Registry, ISRCTN75126867 registered 27 July 201

Acute small bowel obstruction secondary to intestinal endometriosis, an elusive condition: a case report

<p>Abstract</p> <p>Background</p> <p>Endometriosis is a benign condition affecting females of reproductive age. Although intestinal endometriosis is common it is rare for the condition to manifest as an acute bowel obstruction secondary to ileocaecal and appendicular endometriosis. This case is important to report as it highlights the diagnostic difficulty this particular condition presents to an emergency surgeon.</p> <p>Case presentation</p> <p>We present the case of a 33 year old female of Asian origin who presented with symptoms and signs of an acute small bowel obstruction. A right hemicolectomy for suspected malignancy was performed with an ileocolic anastomosis. Histological examination demonstrated extensive endometriosis of the appendix and ileocaecal junction.</p> <p>Conclusion</p> <p>Enteric endometriosis should be considered as a differential diagnosis when assessing females of reproductive age with acute small bowel obstruction. A high index of suspicion is required to arrive at a diagnosis of this elusive condition.</p

An elective combined caesarean section and small bowel GIST resection during the third trimester of pregnancy: Report of a case

AbstractINTRODUCTIONGastro-Intestinal Stromal Tumours (GISTs) are rare with an estimated incidence of only 11–15 per million. In pregnancy, GISTs are an extremely rare occurrence and are thus complex to manage from an ethical, surgical and oncological perspective.PRESENTATION OF CASEWe present the first reported case in the literature of a successful combined lower segment caesarean section (LSCS) and a tumour resection in a 31-year-old pregnant patient presenting with a small bowel GIST.DISCUSSIONWe compare and contrast our case with other reported cases of GIST resection in pregnancy and discuss the challenges faced by both patients and clinicians.CONCLUSIONOur case demonstrates that a combined LSCS and GIST resection is feasible. In addition, our case highlights the importance of both the multidisciplinary setting and the consideration of patients’ wishes in the successful management of this complex group of patients

A robust data-driven macro-socioeconomic-energy model

In a resource-constrained world with growing population and demand for energy, goods, and services with commensurate environmental impacts, we need to understand how these trends relate to aspects of economic activity. We present a computational model that links energy demand through to final economic consumption, illustrated by application to UK data. Our model fits within a whole-economy framework which harmonises multiple national accounting procedures. Our model minimises both the number of exogenous aspects and tuning factors by using historical data to calibrate relationships. We divide economic activity into a number of distinct but interdependent outputs that are non-substitutable in the short-term. The dynamic aspects assume that supply follows demand, but are constrained in the short-term by physical infrastructure. At the same time, capital formation grows the physical infrastructure. Our model regenerates historical data dynamically as a basis for projecting forward scenarios to discuss pathways to a lower carbon future

A rare case of small bowel volvulus after jenjunoileal bariatric bypass requiring emergency surgery: a case report

<p>Abstract</p> <p>Introduction</p> <p>Bariatric surgery is on the increase throughout the world. Jejunoileal bypass bariatric procedures have fallen out of favor in western surgical centers due to the high rate of associated complications. They are, however, performed routinely in other centers and as a consequence of health tourism, management of complications related to these procedures may still be encountered.</p> <p>Case presentation</p> <p>We describe a rare case of small bowel obstruction in a 45-year-old British Caucasian woman, secondary to a volvulus of the jejunoileal anastomosis following bariatric bypass surgery. The pre-operative diagnosis was confirmed by radiology. We describe a successful surgical technique for this rare complication.</p> <p>Conclusions</p> <p>Bariatric surgery may be complicated by bowel obstruction. Early imaging is vital for diagnosis and effective management. The use of our surgical technique provides a simple and effective approach for the successful management of this bariatric complication.</p

Energy, Aesthetics and Knowledge in Complex Economic Systems

It is argued that the fact that economic systems are dissipative structures must be taken fully into account in economics if we are to understand the nature of the economic-ecological interface and how to deal with emergent environmental problems, such as global warming. Such problems are a product of economic growth, which is widely accepted to be the outcome of the acquisition and application of knowledge. Drawing upon disparate literatures within and outside economics, it is argued that economic growth should be more properly viewed as the outcome of a co-evolutionary process that involves the autocatalytic interaction of new knowledge and access of increasing amounts of free energy to do increasingly specialized forms of work. The conventional view is that energy is just a factor of production used increasingly as new knowledge is employed. The possibility of reverse causation is considered here. Specifically, the relevance of the ‘energy hypothesis,’ associated with Eric Schneider and his collaborators, is assessed. This hypothesis states that all dissipative structures have, as their primary objective, the reduction of accessible free energy gradients. It is concluded that such a hypothesis cannot be rejected in the context of economic behaviour and that this opens up an important research agenda for economists. It is argued that such research has to be interdisciplinary because our economic behaviour is driven by aspirational goals which are aesthetic constructions in the mind and strongly connected to our emotions. In this regard, recent neuropsychological literature, arguing that certain emotional dispositions are necessary before we can employ our cognitive capabilities effectively, is important to digest. Thus, the possibility exists that it is in the emotional domain of the mind that the energy hypothesis is operative. Aesthetic constructions are, thus, connecting agents in the knowledge-energy co-evolutionary process. Some of the macroeconomic evidence concerning the relationship between free energy use and economic growth is considered and it is found that the energy hypothesis cannot be rejected in the economic domain. However, considerably more research needs to be undertaken before any firm conclusions can be drawn