Immediate versus postponed intervention for infected necrotizing pancreatitis

BACKGROUND Infected necrotizing pancreatitis is a potentially lethal disease that is treated with the use of a step-up approach, with catheter drainage often delayed until the infected necrosis is encapsulated. Whether outcomes could be improved by earlier catheter drainage is unknown. METHODS We conducted a multicenter, randomized superiority trial involving patients with infected necrotizing pancreatitis, in which we compared immediate drainage within 24 hours after randomization once infected necrosis was diagnosed with drainage that was postponed until the stage of walled-off necrosis was reached. The primary end point was the score on the Comprehensive Complication Index, which incorporates all complications over the course of 6 months of follow-up. RESULTS A total of 104 patients were randomly assigned to immediate drainage (55 patients) or postponed drainage (49 patients). The mean score on the Comprehensive Complication Index (scores range from 0 to 100, with higher scores indicating more severe complications) was 57 in the immediate-drainage group and 58 in the postponed-drainage group (mean difference, −1; 95% confidence interval [CI], −12 to 10; P=0.90). Mortality was 13% in the immediate-drainage group and 10% in the postponed-drainage group (relative risk, 1.25; 95% CI, 0.42 to 3.68). The mean number of interventions (catheter drainage and necrosectomy) was 4.4 in the immediate-drainage group and 2.6 in the postponed-drainage group (mean difference, 1.8; 95% CI, 0.6 to 3.0). In the postponed-drainage group, 19 patients (39%) were treated conservatively with antibiotics and did not require drainage; 17 of these patients survived. The incidence of adverse events was similar in the two groups. CONCLUSIONS This trial did not show the superiority of immediate drainage over postponed drainage with regard to complications in patients with infected necrotizing pancreatitis. Patients randomly assigned to the postponed-drainage strategy received fewer invasive interventions

The effects of siblings on the migration of women in two rural areas of Belgium and the Netherlands, 1829-1940

This study explores the extent to which the presence and activities of siblings shaped the chances of women migrating to rural and urban areas in two rural areas of Belgium and the Netherlands during the second half of the nineteenth and first decades of the twentieth century. Shared-frailty Cox proportional hazard analyses of longitudinal data from historical population registers show that siblings exerted an additive impact on women's migration, independently of temporal and household characteristics. Just how siblings influenced women's migration depended on regional modes of production and on employment opportunities. In the Zeeland region, sisters channelled each other into service positions. In the Pays de Herve, where men and women found industrial work in the Walloon cities, women were as much influenced by their brothers' activities. Evidence is found for two mechanisms explaining the effects of siblings: micro-economic notions of joint-household decision-making and social capital theory

Fullness of life as minimal unit: Science, technology, engineering, and mathematics (STEM) learning across the life span.

Challenged by a National Science Foundation–funded conference, 2020 Vision: The Next Generation of STEM Learning Research, in which participants were asked to recognize science, technology, engineering, and mathematics (STEM) learning as lifelong, life-wide, and life-deep, we draw upon 20 years of research across the lifespan to propose a new way of thinking about and investigating the topic. We propose Fullness of Life (or Total Life) as the minimal unit of analysis that allows people generally and researchers specifically to make sense of cognition. This move reverses traditional perspectives: Rather than understanding life from the position of STEM activities, we understand STEM learning from the perspective of life taken as a whole. We propose three attendant concepts that do not focus on stable knowledge content but on (a) the ability to mobilize and augment knowledge (knowledgeability), (b) the necessity to develop the disposition of the débrouillard/e and bricoleur, and (c) the necessity to conceive knowledgeability as collective property, outcome of collective praxis. We conclude by commenting on five dimensions suggested as need requirements for implementing a 2020 vision for STEM learning research

Cultural diversity in science education through Novelization: Against the Epicization of science and cultural centralization.

Science educators are confronted with the challenge to accommodate in their classes an increasing cultural and linguistic diversity that results from globalization. Challenged by the call to work towards valuing and keeping this diversity in the face of the canonical nature of school science discourse, we propose a new way of thinking about and investigating these problems. Drawing on the work of Mikhail Bakhtin, we articulate epicization and novelization as concepts that allow us to understand, respectively, the processes of (a) centralizing and homogenizing culture and language and (b) pluralizing culture and language. We present and analyze three examples that exhibit how existing mundane science education practices tend, by means of epicization, towards a unitary language and to cultural centralization. We then propose novelization as a way for thinking the opening up of science education by interacting with and incorporating alternative forms of knowing that arise from cultural diversit

Global patterns in students' views of science and interest in science

International studies have shown that interest in science and technology among primary and secondary school students in Western European countries is low and seems to be decreasing. In many countries outside Europe, and especially in developing countries, interest in science and technology remains strong. As part of the large-scale European Union funded ‘Science Education for Diversity’ project, a questionnaire probing potential reasons for this difference was completed by students in the UK, Netherlands, Turkey, Lebanon, India and Malaysia. This questionnaire sought information about favourite courses, extracurricular activities and views on the nature of science. Over 9,000 students aged mainly between 10 and 14 years completed the questionnaire. Results revealed that students in countries outside Western Europe showed a greater interest in school science, in careers related to science and in extracurricular activities related to science than did Western European students. Non-European students were also more likely to hold an empiricist view of the nature of science and to believe that science can solve many problems faced by the world. Multilevel analysis revealed a strong correlation between interest in science and having such a view of the Nature of Science