Procedure for prolapsed haemorrhoids vs excisional haemorrhoidectomy: A systematic review and meta-analysis

Background. The procedure for prolapse and haemorrhoids (PPH) was introduced to address the postoperative pain following excisional haemorrhoidectomy (EH). Objective. To assess the efficacy of both procedures to treat haemorrhoids. Data sources. Literature review using MEDLINE. Articles addressing PPH and EH were included. Study selection. RCTs comparing EH and PPH with ≥20 patients. Data extraction. Primary endpoints were pain, operative time, hospital stay, satisfaction with procedure and time to return to normal activity. Secondary endpoints such as recurrence and complications were collated for descriptive analysis. A metaanalysis was performed using the random effects model on studies reporting ‘mean' and SD or SEM. Data synthesis. PPH was associated with less postoperative pain, less operative time, shorter hospital stay and earlier return to normal activities compared with EH. There appears to be no significant difference in satisfaction with the procedure. There was no difference between the two procedures in terms of complications. There were more recurrences after PPH. Conclusion. Compared with EH, PPH is associated with less postoperative pain, reduced operative time and hospital stay and earlier return to normal activity, and a trend towards improved patient satisfaction. The rate of recurrence appears higher with PPH. South African Medical Journal Vol. 99 (1) 2009: pp. 43-5

Differential regulation of RNF8-mediated Lys48- and Lys63-based poly-ubiquitylation

Pairing of a given E3 ubiquitin ligase with different E2s allows synthesis of ubiquitin conjugates of different topologies. While this phenomenon contributes to functional diversity, it remains largely unknown how a single E3 ubiquitin ligase recognizes multiple E2s, and whether identical structural requirements determine their respective interactions. The E3 ubiquitin ligase RNF8 that plays a critically important role in transducing DNA damage signals, interacts with E2s UBCH8 and UBC13, and catalyzes both K48- and K63-linked ubiquitin chains. Interestingly, we report here that a single-point mutation (I405A) on the RNF8 polypeptide uncouples its ability in catalyzing K48- and K63-linked ubiquitin chain formation. Accordingly, while RNF8 interacted with E2s UBCH8 and UBC13, its I405A mutation selectively disrupted its functional interaction with UBCH8, and impaired K48-based poly-ubiquitylation reactions. In contrast, RNF8 I405A preserved its interaction with UBC13, synthesized K63-linked ubiquitin chains, and assembled BRCA1 and 53BP1 at sites of DNA breaks. Together, our data suggest that RNF8 regulates K48- and K63-linked poly-ubiquitylation via differential RING-dependent interactions with its E2s UBCH8 and UBC13, respectively.published_or_final_versio

Pore network analysis of Brae Formation sandstone, North Sea

In this work, we apply digital rock physics (DRP) to characterize the pore networks of the Brae Formation sandstones from two different wells in the Miller field area (North Sea, UK). Using X-ray micro-CT scans, we calculate the porosity and permeability and generate pore network models to assess pore shape characteristics. The porous samples are marked by macroporosities ranging from 4.9% to 15.2% with the effective porosities varying from 0 to 14.8%. The samples also contained some microporosity hosted in secondary and accessory mineral phases, varying between 2.6% and 10.7%. Pore network model results for total porosity indicate that the samples have median pore and throat radii ranging from 5.5 μm to 16.8 μm and 6.4 μm–12.9 μm, respectively. The throat length of all samples has a median value ranging between 36.3 μm and 82.4 μm. The ratio between effective porosity and total porosity (φ∗) varies with total porosity (φ) following the exponential relation φ∗ = 0.98 − e− (φ− 0.032)/0.028. Pore network connectivity is established at a porosity of 3% and full communication is achieved at porosities exceeding 10%. Permeability was found to vary with total porosity with an exponent of 3.67. Based on these observations and the results from our models, the connectivity of the pore network has important implications for predicting reservoir performance during large scale subsurface projects such as hydrocarbon production and CO2 storage

Immediate Memory and Electrophysiologic Effects of Prefrontal Cortex Transcranial Direct Current Stimulation on Neurotypical Individuals and Individuals with Chronic Traumatic Brain Injury: A Pilot Study.

PURPOSE/AIM: Memory impairment post-TBI is common, frequently persistent, and functionally debilitating. The purposes of this pilot study were to assess and to compare immediate behavioral auditory working memory and electrophysiologic effects of three different, randomized, conditions of left dorsolateral prefrontal cortex (LDLPFC) transcranial direct current stimulation (tDCS) applied to four neurotypical adults and four adults with chronic traumatic brain injury (TBI). MATERIALS/METHODS: Pre- and post- anodal, cathodal, and sham tDCS auditory memory performance, auditory event-related potentials (P300 amplitude and latency) and power of alpha and theta EEG bands were measured across individuals in each group. RESULTS: Post-anodal tDCS only, the neurotypical and TBI groups both demonstrated significantly improved immediate auditory memory function. Also post-anodal tDCS, the TBI group demonstrated significantly increased P300 amplitude versus post-sham tDCS. The neurotypical group demonstrated no pre- post tDCS electrophysiologic changes across conditions. CONCLUSIONS: These findings are consistent with findings of other studies of immediate tDCS effects on other types of memory in neurotypical individuals and in individuals with Parkinson's disease, Alzheimer's disease, and stroke and suggest that individuals with memory impairments second to chronic TBI may benefit from LDLPFC anodal tDCS. Pairing tDCS with traditional behavioral memory interventions may facilitate TBI rehabilitation outcomes and warrants continued investigation

Designing theoretically-informed implementation interventions

Clinical and health services research is continually producing new findings that may contribute to effective and efficient patient care. However, the transfer of research findings into practice is unpredictable and can be a slow and haphazard process. Ideally, the choice of implementation strategies would be based upon evidence from randomised controlled trials or systematic reviews of a given implementation strategy. Unfortunately, reviews of implementation strategies consistently report effectiveness some, but not all of the time; possible causes of this variation are seldom reported or measured by the investigators in the original studies. Thus, any attempts to extrapolate from study settings to the real world are hampered by a lack of understanding of the effects of key elements of individuals, interventions, and the settings in which they were trialled. The explicit use of theory offers a way of addressing these issues and has a number of advantages, such as providing: a generalisable framework within which to represent the dimensions that implementation studies address, a process by which to inform the development and delivery of interventions, a guide when evaluating, and a way to allow for an exploration of potential causal mechanisms. However, the use of theory in designing implementation interventions is methodologically challenging for a number of reasons, including choosing between theories and faithfully translating theoretical constructs into interventions. The explicit use of theory offers potential advantages in terms of facilitating a better understanding of the generalisability and replicability of implementation interventions. However, this is a relatively unexplored methodological area

On the Considerations of Using Near Real Time Data for Space Weather Hazard Forecasting

Space weather represents a severe threat to ground-based infrastructure, satellites and communications. Accurately forecasting when such threats are likely (e.g., when we may see large induced currents) will help to mitigate the societal and financial costs. In recent years computational models have been created that can forecast hazardous intervals, however they generally use post-processed “science” solar wind data from upstream of the Earth. In this work we investigate the quality and continuity of the data that are available in Near-Real-Time (NRT) from the Advanced Composition Explorer and Deep Space Climate Observatory (DSCOVR) spacecraft. In general, the data available in NRT corresponds well with post-processed data, however there are three main areas of concern: greater short-term variability in the NRT data, occasional anomalous values and frequent data gaps. Some space weather models are able to compensate for these issues if they are also present in the data used to fit (or train) the model, while others will require extra checks to be implemented in order to produce high quality forecasts. We find that the DSCOVR NRT data are generally more continuous, though they have been available for small fraction of a solar cycle and therefore DSCOVR has experienced a limited range of solar wind conditions. We find that short gaps are the most common, and are most frequently found in the plasma data. To maximize forecast availability we suggest the implementation of limited interpolation if possible, for example, for gaps of 5 min or less, which could increase the fraction of valid input data considerably

Unintended Consequences of Incentive Provision for Behaviour Change and Maintenance around Childbirth

Financial (positive or negative) and non-financial incentives or rewards are increasingly used in attempts to influence health behaviours. While unintended consequences of incentive provision are discussed in the literature, evidence syntheses did not identify any primary research with the aim of investigating unintended consequences of incentive interventions for lifestyle behaviour change. Our objective was to investigate perceived positive and negative unintended consequences of incentive provision for a shortlist of seven promising incentive strategies for smoking cessation in pregnancy and breastfeeding. A multi-disciplinary, mixed-methods approach included involving two service-user mother and baby groups from disadvantaged areas with experience of the target behaviours as study co-investigators. Systematic reviews informed the shortlist of incentive strategies. Qualitative semi-structured interviews and a web-based survey of health professionals asked open questions on positive and negative consequences of incentives. The participants from three UK regions were a diverse sample with and without direct experience of incentive interventions: 88 pregnant women/recent mothers/partners/family members; 53 service providers; 24 experts/decision makers and interactive discussions with 63 conference attendees. Maternity and early years health professionals (n = 497) including doctors, midwives, health visitors, public health and related staff participated in the survey. Qualitative analysis identified ethical, political, cultural, social and psychological implications of incentive delivery at population and individual levels. Four key themes emerged: how incentives can address or create inequalities; enhance or diminish intrinsic motivation and wellbeing; have a positive or negative effect on relationships with others within personal networks or health providers; and can impact on health systems and resources by raising awareness and directing service delivery, but may be detrimental to other health care areas. Financial incentives are controversial and generated emotive and oppositional responses. The planning, design and delivery of future incentive interventions should evaluate unexpected consequences to inform the evidence for effectiveness, cost-effectiveness and future implementation

Micrositing variability and mean flow scaling for marine turbulence in Ramsey Sound

We present turbulence results from two acoustic Doppler current profiler measurement campaigns carried out in Ramsey Sound at two locations within 50mof one another. The first measurements were taken in 2009 and the second in 2011; both include a complete spring–neap cycle. In this paper we characterise turbulence through turbulent kinetic energy (TKE) density and integral lengthscales and their relationships with one another and with mean flow parameters. We briefly describe the methods used to calculate these parameters. We find that a flood–ebb asymmetry is present in the data from both measurement campaigns, but although the flood tides are similar at both locations, the ebb tides are much more energetic in the 2011 data than the 2009 data. We suggest that this may be due to differences in seabed features between the two measurement locations. Dimensional analysis is employed to investigate how TKE scales with mean flow velocity; we find that the expected quadratic scaling is not well supported by the data at either measurement location. As a consequence, flows that have more energetic turbulence may instead appear to be less turbulent if judged by turbulence intensity. We investigate the correlation between lengthscales and TKE density and find that it is highly site-specific: it should not be assumed that for a given measurement location highly energetic turbulence is associated with larger flow structures or vice versa