Overcoming behavioral obstacles to escaping poverty

This is the author accepted manuscriptInternational development policy is ripe for an overhaul. Behavioral science can help policymakers to spur changes in behaviors that are difficult to explain from a conventional economic perspective and impede economic development. We focus here on two well-documented, often-coinciding psychological phenomena that have particularly wide-ranging implications for development policy: present bias (favoring immediate rewards over long-term considerations) and limited attention. We present a number of general policy recommendations that are informed by insight into these phenomena and offer concrete examples of how the recommendations can be implemented to help low-income individuals improve their lives and reach their long-term goals

Porencephaly and psychosis: a case report and review of the literature

<p>Abstract</p> <p>Background</p> <p>Malformations of the cerebral cortex are often associated with developmental delay and psychoses. Porencephaly is a rare congenital disorder of central nervous system involving a cyst or a cavity filled with cerebrospinal fluid, in brain's parenchyma.</p> <p>Case presentation</p> <p>We present a 25 years old woman with her first psychotic episode. She also suffers from porencephaly in the frontotemporal lobes region. It is emphasized that the two consistently abnormal brain regions in schizophrenia research had significant damage in this patient since birth. There is a total of only five cases of schizencephaly or porencephaly associated with psychosis in the scientific literature. Their clinical characteristics as well as the imaging results are described.</p> <p>Conclusion</p> <p>It is unclear if porencephaly and psychosis concur by chance or are causally related. The area where the porencephalic cysts appear seems to be of relevance. This case highlights the need for further research.</p

Incisional hernia following colorectal cancer surgery according to suture technique: Hughes Abdominal Repair Randomized Trial (HART).

BACKGROUND: Incisional hernias cause morbidity and may require further surgery. HART (Hughes Abdominal Repair Trial) assessed the effect of an alternative suture method on the incidence of incisional hernia following colorectal cancer surgery. METHODS: A pragmatic multicentre single-blind RCT allocated patients undergoing midline incision for colorectal cancer to either Hughes closure (double far-near-near-far sutures of 1 nylon suture at 2-cm intervals along the fascia combined with conventional mass closure) or the surgeon's standard closure. The primary outcome was the incidence of incisional hernia at 1 year assessed by clinical examination. An intention-to-treat analysis was performed. RESULTS: Between August 2014 and February 2018, 802 patients were randomized to either Hughes closure (401) or the standard mass closure group (401). At 1 year after surgery, 672 patients (83.7 per cent) were included in the primary outcome analysis; 50 of 339 patients (14.8 per cent) in the Hughes group and 57 of 333 (17.1 per cent) in the standard closure group had incisional hernia (OR 0.84, 95 per cent c.i. 0.55 to 1.27; P = 0.402). At 2 years, 78 patients (28.7 per cent) in the Hughes repair group and 84 (31.8 per cent) in the standard closure group had incisional hernia (OR 0.86, 0.59 to 1.25; P = 0.429). Adverse events were similar in the two groups, apart from the rate of surgical-site infection, which was higher in the Hughes group (13.2 versus 7.7 per cent; OR 1.82, 1.14 to 2.91; P = 0.011). CONCLUSION: The incidence of incisional hernia after colorectal cancer surgery is high. There was no statistical difference in incidence between Hughes closure and mass closure at 1 or 2 years. REGISTRATION NUMBER: ISRCTN25616490 (http://www.controlled-trials.com)

Evaluation of appendicitis risk prediction models in adults with suspected appendicitis

Background Appendicitis is the most common general surgical emergency worldwide, but its diagnosis remains challenging. The aim of this study was to determine whether existing risk prediction models can reliably identify patients presenting to hospital in the UK with acute right iliac fossa (RIF) pain who are at low risk of appendicitis. Methods A systematic search was completed to identify all existing appendicitis risk prediction models. Models were validated using UK data from an international prospective cohort study that captured consecutive patients aged 16–45 years presenting to hospital with acute RIF in March to June 2017. The main outcome was best achievable model specificity (proportion of patients who did not have appendicitis correctly classified as low risk) whilst maintaining a failure rate below 5 per cent (proportion of patients identified as low risk who actually had appendicitis). Results Some 5345 patients across 154 UK hospitals were identified, of which two‐thirds (3613 of 5345, 67·6 per cent) were women. Women were more than twice as likely to undergo surgery with removal of a histologically normal appendix (272 of 964, 28·2 per cent) than men (120 of 993, 12·1 per cent) (relative risk 2·33, 95 per cent c.i. 1·92 to 2·84; P < 0·001). Of 15 validated risk prediction models, the Adult Appendicitis Score performed best (cut‐off score 8 or less, specificity 63·1 per cent, failure rate 3·7 per cent). The Appendicitis Inflammatory Response Score performed best for men (cut‐off score 2 or less, specificity 24·7 per cent, failure rate 2·4 per cent). Conclusion Women in the UK had a disproportionate risk of admission without surgical intervention and had high rates of normal appendicectomy. Risk prediction models to support shared decision‐making by identifying adults in the UK at low risk of appendicitis were identified

An Advanced Rough Surface Continuum-Based Contact and Sliding Model in the Presence of Molecularly Thin Lubricant

A model of molecularly thin lubricant layer behavior for rough, sliding contact is presented in this work as a function of lubricant layer morphology. Building on previous work by the authors where the lubricant layer was assumed to be uniform in thickness and morphology, lubricant contributions to contact are presently treated at the asperity level and the effects of lubricant bonding ratio and coverage are accounted for. Effective stiffnesses for lubricated asperities are used to calculate the bearing and shear forces, while variable surface energy is modeled at the asperity level and used within an improved continuum adhesive formulation. Contributions from asperities in lubricant and solid contact for partial coverage are determined within the context of a statistical mechanics model. The proposed model can be used to study the mixed nanolubrication regime expected during light contact or ‘‘surfing’’ recording in magnetic storage, where sustained nanolubricant contact would partially deplete mobile molecules from the contact interface.

Solitary axillary lymph nodal metastasis from primary ovarian cancer: An unusual presentation

Background: The most common sites of visceral metastases in ovarian cancer are the liver and lungs, whereas the most frequent sites of lymph nodal involvement are abdominal, para-aortic, mediastinal, and pelvic nodes. Peripheral isolated lymph node metastasis is extremely rare. Case Report: This case represents an ovarian cancer with large metastasis to the right axillary mass. A 79-year-old female presented with a palpable and visibly enlarged mass. A neck lymph nodal mass was found on the CT scan with biopsy showing metastatic carcinoma with morphology and immunophenotype of ovarian primary tumor. Conclusions: Axillary metastasis secondary to ovarian carcinoma is an infrequent clinical entity

Vulvar melanoma presenting as postmenopausal bleeding: A case report

Primary melanomas of the vulva are extremely rare, creating obstacles in the differential diagnosis of other epithelial and non-epithelial malignancies. Due to their rarity, there are only approximately 250 cases reported in the current literature. Vulvar melanomas tend to relapse locally, as well as develop locoregional and distant metastasis through lymph node and haematic dissemination. The authors describe a case of an 84-year-old Caucasian female patient, presenting with postmenopausal bleeding, consistent with primary vulvar melanoma cause, which was successfully diagnosed and treated accordingly

Solitary axillary lymph nodal metastasis from primary ovarian cancer: An unusual presentation

Background: The most common sites of visceral metastases in ovarian cancer are the liver and lungs, whereas the most frequent sites of lymph nodal involvement are abdominal, para-aortic, mediastinal, and pelvic nodes. Peripheral isolated lymph node metastasis is extremely rare. Case Report: This case represents an ovarian cancer with large metastasis to the right axillary mass. A 79-year-old female presented with a palpable and visibly enlarged mass. A neck lymph nodal mass was found on the CT scan with biopsy showing metastatic carcinoma with morphology and immunophenotype of ovarian primary tumor. Conclusions: Axillary metastasis secondary to ovarian carcinoma is an infrequent clinical entity