For me or not for me? - that is the question : a study of mature students' decision making and higher education

The views expressed in this report are the authors ' and do not necessarily reflect those of the Department for Education an

Worsening of cerebral hyperemia by the administration of terlipressin in acute liver failure with severe hepatic encephalopathy

There is increasing evidence that terlipressin is useful in patients with cirrhosis and hepatorenal syndrome, but there are no data of its use in patients with acute liver failure (ALF) in whom hepatorenal syndrome is common. Although terlipressin produces systemic vasoconstriction, it produces cerebral vasodilatation and may increase cerebral blood flow (CBF). Increased CBF contributes to intracranial hypertension in patients with ALF. The aim of this study was to evaluate the safety of terlipressin in patients with ALF with respect to cerebral haemodynamics. Six successive patients with ALF were electively ventilated for grade IV hepatic encephalopathy. Patients were monitored invasively and CBF was measured (Kety- Schmidt technique). Measurements were made before, at 1, 3 hour and 5 hours after intravenous (single bolus) administration of terlipressin (0.005 mg/kg) )intravenously (single bolus), median 0.25mg (range 0.2-0.3). There was no significant change in heart rate, mean arterial pressure or cardiac output. CBF and jugular venous oxygen saturation both increased significantly at 1 hour (p<0.0=0.016) respectively. Intracranial pressure increased significantly at 21 hours (p<0=.0.031), returning back to baseline values at 42 hours. This study shows that administration of terlipressin, at a dose that did not alter systemic haemodynamicshemodynamics, resulted in worsening of cerebral hyperemia and intracranial hypertension in patients with ALF and severe hepatic encephalopathy. These data suggest the need to exercise extreme caution in the use of terlipressin in these patients in view of its potentially deleterious consequences on cerebral haemodynamics

Guidelines for the management of the foot health problems associated with rheumatoid arthritis

Background. Rheumatoid arthritis (RA) as a chronic systemic disease, commonly affects the feet, impacting negatively on patients' quality of life. Specialist podiatrists have a prime role to play in the assessment and management of foot and ankle problems within this patient group. However, it has been identified that in many areas there is no specialist podiatry service, with many patients being managed by non‐specialist podiatrists. Therefore, the North West Clinical Effectiveness Group for the Foot in Rheumatic Diseases (NWCEG) identified the need to develop ‘practitioner facing’ guidelines for the management of specific foot health problems associated with RA. Methods. Members of a guideline development group from the NWCEG each reviewed the evidence for specific aspects of the assessment and management of foot problems. Where evidence was lacking, ‘expert opinion’ was obtained from the members of the NWCEG and added as a consensus on current and best practice. An iterative approach was employed, with the results being reviewed and revised by all members of the group and external reviewers before the final guideline document was produced. Results. The management of specific foot problems (callus, nail pathology, ulceration) and the use of specific interventions (foot orthoses, footwear, patient education, steroid injection therapy) are detailed and standards in relation to each are provided. A diagrammatic screening pathway is presented, with the aim of guiding nonspecialist podiatrists through the complexity of assessing and managing those patients with problems requiring input from a specialist podiatrist and other members of the rheumatology multidisciplinary team. Conclusion. This pragmatic approach ensured that the guidelines were relevant and applicable to current practice as ‘best practice’, based on the available evidence from the literature and consensus expert opinion. These guidelines provide both specialist and non‐specialist podiatrists with the essential and ‘gold standard’ aspects of managing people with RA‐related foot problems

Improved Landau Gauge Fixing and Discretisation Errors

Lattice discretisation errors in the Landau gauge condition are examined. An improved gauge fixing algorithm in which order a^2 errors are removed is presented. Order a^2 improvement of the gauge fixing condition displays the secondary benefit of reducing the size of higher-order errors. These results emphasise the importance of implementing an improved gauge fixing condition.Comment: LATTICE99 (Improvement and Renormalization), 3 pages, 1 figur

Evaluating the Cephalonia method of library induction

This is a PDF version of an article published in SCONUL Focus© 2007. SCONUL Focus is available online at http://www.sconul.ac.uk/publications/newsletterThis article discusses the results of a survey carried out at the University of Chester library into student feedback of the Cephalonia method of library induction

Ostracods from freshwater and brackish environments of the Carboniferous of the Midland Valley of Scotland : the early colonization of terrestrial water bodies

The Mississippian Strathclyde Group of the Midland Valley of Scotland yields some of the earliest non-marine ostracods. The succession records shallow marine, deltaic, estuarine, lagoonal, lacustrine, fluvial and swamp environments representing a series of staging-posts between fully marine and limnetic settings. Macrofossils and ostracods are assigned to marine, marginal marine, brackish and freshwater environments based on their faunal assemblage patterns. Key brackish to freshwater ostracods are Geisina arcuata, Paraparchites circularis n. sp., Shemonaella ornata n. sp. and Silenites sp. A, associated with the bivalves Anthraconaia, Carbonicola, Cardiopteridium, Curvirimula, Naiadites, the microconchid ‘Spirorbis’, Spinicaudata and fish. Many Platycopina and Paraparchiticopina ostracods are interpreted as euryhaline, which corresponds with their occurrence in marine to coastal plain water bodies, and supports the ‘estuary effect’ hypothesis of non-marine colonization. The success of non-marine colonization by ostracods was dependent on the intrinsic adaptations of ostracod species to lower salinities, such as new reproductive strategies and the timing of extrinsic mechanisms to drive non-marine colonization, such as sea-level change. The genus Carbonita is the oldest and most common freshwater ostracod, and went on to dominate freshwater environments in the Late Palaeozoic

CATASTROPHIC FLANK COLLAPSE ON TA’U ISLAND AND SUBSEQUENT TSUNAMI: HAS THIS OCCURRED DURING THE LAST 170 YEARS?

Ta’u, the easternmost inhabited island in the Samoan Islands archipelago, exhibits a series of down-faulted benches on its southern flank, believed to be the remnant of ~30 km3 catastrophic collapse. A historical map of Ta’u charted in 1839 during the United States Exploring Expedition, which did not show the benches, suggests that the event occurred less than 170 years ago. A collapse event of this magnitude would have generated a locally devastating tsunami, with possible impacts experienced at the regional level. However, no written or oral records of such an event exist. A number of key questions thus emerge, and formed the basis for this study. Did this event actually happen within the last 170 years, and if so, how and why could it have gone unnoticed? Or, is the event much older than the impression obtained from the literature? The catastrophic flank collapse was modeled using 100 m contour-resolution bathymetry data of the Ta’u region, coupled with rational assumptions made on the geometry of the failed mass. This enabled numerical landslide- tsunami simulation in the Cornell Multigrid Coupled Tsunami Model (COMCOT). The results indicate that if an event of this magnitude occurred in the last 170 years, it could not have gone unnoticed by local inhabitants. It thus seems likely that the initial survey conducted during the Exploring Expedition was inaccurate. Nevertheless, the well-preserved nature of the benches indicates collapse relatively recently and raises the possibility of future collapse

Primary succession on a seasonal tropical rocky shore: The relative roles of spatial heterogeneity and herbivory

Hong Kong is within the tropics and has a seasonal climate. In winter, shores support patches of ephemeral macroalgae and areas of seemingly bare rock close to crevices where molluscan herbivores are abundant. Using a factorial design of herbivore exclusions in areas far and close to crevices, the development of algal assemblages was monitored in mid-shore, cleared areas, in winter. To estimate the role of herbivore mucus deposition, half the treatments received a mucus application. Algal development was estimated from macroalgal and biofilm development and chlorophyll a levels. In all areas, biofilms (diatoms, unicellular cyanobacteria) developed rapidly in herbivore exclusions followed by ephemeral macroalgae (Enteromorpha spp. and Porphyra suborbiculata). In herbivore access treatments, however, the algal assemblage was influenced by treatment location; few macroalgae developed in areas close to crevices, and the rock was dominated by cyanobacteria. A negative relationship between macroalgae and biofilms suggested that ephemeral algae were competitively dominant. In areas distant from herbivore refuges, ephemeral macroalgae did develop, illustrating that the effectiveness of molluscan herbivores was limited to 50 to 100 cm from these refuges. The absence of large herbivorous fish, and the sparse numbers of herbivorous crabs at this site, means that algae can achieve a spatial escape from consumption, and where this occurs competition between producers is important in assemblage development. Mucus appeared to play a limited role, only sometimes stimulating initial stages of unicellular cyanobacteria and macroalgae. With the onset of summer, macroalgae died back, and rock space became available for colonization. Unicellular cyanobacteria developed rapidly but were replaced in all treatments by the encrusting macroalga, Hapalospongidion gelatinosum, which dominated treatments until the end of the experiment. On seasonal, tropical shores processes influencing community structure can, therefore, be temporally variable and their relative importance, even at the same shore level, can change with season.published_or_final_versio