Temporary balloon catheter occlusion for control of haemorrhage following penetrating axillary artery injury

Penetrating injuries of the axillary artery are uncommon. Their repair can be difficult in the presence of torrential haemorrhage, which obscures the surgical field. We describe the use of interventional radiology for temporary control of bleeding to facilitate surgical repair in a case of penetrating axillary artery injury

Strong resonant tunneling, level repulsion and spectral type for one-dimensional adiabatic quasi-periodic Schr\"{o}dinger operators

In this paper, we consider one dimensional adiabatic quasi-periodic Schr\"{o}dinger operators in the regime of strong resonant tunneling. We show the emergence of a level repulsion phenomenon which is seen to be very naturally related to the local spectral type of the operator: the more singular the spectrum, the weaker the repulsion

The role of hyperbaric oxygen therapy in ischaemic diabetic lower extremity ulcers: A double-blind randomised-controlled trial

AbstractObjective: ischaemic lower-extremity ulcers in the diabetic population are a source of major concern because of the associated high risk of limb-threatening complications. The aim of this study was to evaluate the role of hyperbaric oxygen in the management of these ulcers. Method: eighteen diabetic patients with ischaemic, non-healing lower-extremity ulcers were recruited in a double-blind study. Patients were randomly assigned either to receive 100% oxygen (treatment group) or air (control group), at 2.4 atmospheres of absolute pressure for 90 min daily (total of 30 treatments). Results: healing with complete epithelialisation was achieved in five out of eight ulcers in the treatment group compared to one out of eight ulcers in the control group. The median decrease of the wound areas in the treatment group was 100% and in the control group was 52% (p = 0.027). Cost-effectiveness analysis has shown that despite the extra cost involved in using hyperbaric oxygen, there was a potential saving in the total cost of treatment for each patient during the study. Conclusion: hyperbaric oxygen enhanced the healing of ischaemic, non-healing diabetic leg ulcers and may be used as a valuable adjunct to conventional therapy when reconstructive surgery is not possible.Eur J Vasc Endovasc Surg 25, 513-518 (2003

Sun exposure behaviour, seasonal vitamin D deficiency, and relationship to bone health in adolescents

YesContext: Vitamin D is essential for bone health in adolescence, where there is rapid bone mineral content accrual. As cutaneous sun-exposure provides vitamin D, there is no recommended oral intake for UK adolescents. Objective: Assess seasonal vitamin D status and its contributors in white Caucasian adolescents, and examine bone health in those found deficient. Design: Prospective cohort study. Setting: Six schools in Greater Manchester, UK. Participants: 131 adolescents, 12–15 years. Intervention(s): Seasonal assessment of circulating 25-hydroxyvitamin D (25OHD), personal sunexposure and dietary vitamin D. Adolescents deficient (25OHD <10 ng/mL/25 nmol/L) in ≥one season underwent dual-energy X-ray absorptiometry (lumbar spine, femoral neck), with bone mineral apparent density (BMAD) correction for size, and peripheral quantitative computed tomography (distal radius) for volumetric (v)BMD. Main Outcome Measure: Serum 25OHD; BMD. Results: Mean 25OHD was highest in September: 24.1 (SD 6.9) ng/mL and lowest in January: 15.5 (5.9) ng/mL. Over the year, 16% were deficient in ≥one season and 79% insufficient (25OHD <20 ng/mL/50 nmol/L) including 28% in September. Dietary vitamin D was low year-round while personal sun-exposure was seasonal and predominantly across the school week. Holidays accounted for 17% variation in peak 25OHD (p<0.001). Nineteen adolescents underwent bone assessment, which showed low femoral neck BMAD versus matched reference data (p=0.0002), 3 with Z≤ -2.0 distal radius trabecular vBMD. Conclusions: Sun-exposure levels failed to provide adequate vitamin D, ~one-quarter adolescents insufficient even at summer-peak. Seasonal vitamin D deficiency was prevalent and those affected had low BMD. Recommendations on vitamin D acquisition are indicated in this age-group.The Bupa Foundation (Grant number TBF-M10-017)

Programmable models of growth and mutation of cancer-cell populations

In this paper we propose a systematic approach to construct mathematical models describing populations of cancer-cells at different stages of disease development. The methodology we propose is based on stochastic Concurrent Constraint Programming, a flexible stochastic modelling language. The methodology is tested on (and partially motivated by) the study of prostate cancer. In particular, we prove how our method is suitable to systematically reconstruct different mathematical models of prostate cancer growth - together with interactions with different kinds of hormone therapy - at different levels of refinement.Comment: In Proceedings CompMod 2011, arXiv:1109.104

A Full PFPF Shell Model Study of a~=~48 Nuclei

Exact diagonalizations with a minimally modified realistic force lead to detailed agreement with measured level schemes and electromagnetic transitions in $^{48}$Ca, $^{48}$Sc, $^{48}$Ti, $^{48}$V, $^{48}$Cr and $^{48}$Mn. Gamow-Teller strength functions are systematically calculated and reproduce the data to within the standard quenching factor. Their fine structure indicates that fragmentation makes much strength unobservable. As a by-product, the calculations suggest a microscopic description of the onset of rotational motion. The spectroscopic quality of the results provides strong arguments in favour of the general validity of monopole corrected realistic forces, which is discussed.Comment: 30 pages, LaTeX with epsf.sty, 14 Postscript figures included and compressed using uufiles. Completely new version of previous preprint nucl-th/9307001. FTUAM-93/01, CRN/PT 93-3

Inequalities in health and community-oriented social work: lessons from Cuba?

Social justice is, as the World Health Organization Commission on Social Determinants of Health (WHO CSDH, 2008) reminds us, ‘a matter of life and death’. While the stark differences in mortality rates and life expectancy between rich and poor countries might be the most obvious example of this, it is also true that ‘Within countries, the differences in life chances are dramatic and are seen in all countries – even the richest’ (WHO CSDH, 2008: 26). As the Commission demonstrates, the roots of these inequities lie in social conditions, suggesting an important role for social work in this area. Unfortunately, the Commission says very little about the type of social work that might be appropriate: nevertheless, the report does provide fresh impetus to the debate about what social workers might contribute to tackling health inequalities. In this article, we suggest that a community-oriented approach to social work is required. In making a case for this, we review the progress of the government’s drive to reduce inequalities in England,1 arguing that this has, thus far, been largely unsuccessful because it has primarily been pursued through health-care services, while addressing the wider (social) determinants of health has been a secondary consideration. In contrast, we offer the example of Cuban community-oriented social work (COSW) which has helped maintain population health at a level that stands comparison with much wealthier nations, despite the hardships and inequalities which followed economic collapse in the 1990s. In many ways the Cuban situation is unusual, perhaps unique, so we are not arguing that Cuban social work methods can be readily transferred. Rather, we suggest that, in the neglected field of tackling health inequalities, social workers can learn from the general approach taken in Cuba. To establish the context of this discussion, we begin by defining key concepts: COSW itself, health inequalities and inequity, the health gap and the health gradient

Seasonal size variation in the predatory cladoceran Bythotrephes cederstroemii in Lake Michigan

1.  Dry weight, body length and spine length were measured for the exotic cladoceran Bythotrephes cederstroemii collected from offshore and inshore stations in southeastern Lake Michigan. Average dry weight of each developmental stage exhibited seasonal variation by a factor of more than 5. 2.  Mean dry weight of Bythotrephes was closely correlated with water temperature. Contrary to the inverse relationship between water temperature and body size frequently observed for other invertebrates, the dry weight of Bythotrephes increased at higher ambient temperatures. 3.  No significant correlation was observed between abundances of major zooplankton taxa and the dry weight of Bythotrephes . An indirect effect of temperature on prey consumption may cause seasonal variation in dry weight of Bythotrephes in Lake Michigan. 4.  Distances between adjacent pairs of barbs, added to the caudal spine with each moult, are significantly shorter in Bythotrephes which produce resting eggs. Less material investment in the exoskeleton of sexually reproducing females was observed in favour of growth and reproduction.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/74641/1/j.1365-2427.1994.tb00842.x.pd

Developing a core outcome set for future infertility research : An international consensus development study

STUDY QUESTION: Can a core outcome set to standardize outcome selection, collection and reporting across future infertility research be developed? SUMMARY ANSWER: A minimum data set, known as a core outcome set, has been developed for randomized controlled trials (RCTs) and systematic reviews evaluating potential treatments for infertility. WHAT IS KNOWN ALREADY: Complex issues, including a failure to consider the perspectives of people with fertility problems when selecting outcomes, variations in outcome definitions and the selective reporting of outcomes on the basis of statistical analysis, make the results of infertility research difficult to interpret. STUDY DESIGN, SIZE, DURATION: A three-round Delphi survey (372 participants from 41 countries) and consensus development workshop (30 participants from 27 countries). PARTICIPANTS/MATERIALS, SETTING, METHODS: Healthcare professionals, researchers and people with fertility problems were brought together in an open and transparent process using formal consensus science methods. MAIN RESULTS AND THE ROLE OF CHANCE: The core outcome set consists of: viable intrauterine pregnancy confirmed by ultrasound (accounting for singleton, twin and higher multiple pregnancy); pregnancy loss (accounting for ectopic pregnancy, miscarriage, stillbirth and termination of pregnancy); live birth; gestational age at delivery; birthweight; neonatal mortality; and major congenital anomaly. Time to pregnancy leading to live birth should be reported when applicable. LIMITATIONS, REASONS FOR CAUTION: We used consensus development methods which have inherent limitations, including the representativeness of the participant sample, Delphi survey attrition and an arbitrary consensus threshold. WIDER IMPLICATIONS OF THE FINDINGS: Embedding the core outcome set within RCTs and systematic reviews should ensure the comprehensive selection, collection and reporting of core outcomes. Research funding bodies, the Standard Protocol Items: Recommendations for Interventional Trials (SPIRIT) statement, and over 80 specialty journals, including the Cochrane Gynaecology and Fertility Group, Fertility and Sterility and Human Reproduction, have committed to implementing this core outcome set. STUDY FUNDING/COMPETING INTEREST(S): This research was funded by the Catalyst Fund, Royal Society of New Zealand, Auckland Medical Research Fund and Maurice and Phyllis Paykel Trust. The funder had no role in the design and conduct of the study, the collection, management, analysis or interpretation of data, or manuscript preparation. B.W.J.M. is supported by a National Health and Medical Research Council Practitioner Fellowship (GNT1082548). S.B. was supported by University of Auckland Foundation Seelye Travelling Fellowship. S.B. reports being the Editor-in-Chief of Human Reproduction Open and an editor of the Cochrane Gynaecology and Fertility group. J.L.H.E. reports being the Editor Emeritus of Human Reproduction. J.M.L.K. reports research sponsorship from Ferring and Theramex. R.S.L. reports consultancy fees from Abbvie, Bayer, Ferring, Fractyl, Insud Pharma and Kindex and research sponsorship from Guerbet and Hass Avocado Board. B.W.J.M. reports consultancy fees from Guerbet, iGenomix, Merck, Merck KGaA and ObsEva. C.N. reports being the Co Editor-in-Chief of Fertility and Sterility and Section Editor of the Journal of Urology, research sponsorship from Ferring, and retains a financial interest in NexHand. A.S. reports consultancy fees from Guerbet. E.H.Y.N. reports research sponsorship from Merck. N.L.V. reports consultancy and conference fees from Ferring, Merck and Merck Sharp and Dohme. The remaining authors declare no competing interests in relation to the work presented. All authors have completed the disclosure form