Multiracial Representations of Self, Otherness, and ‘Disalienation’ on The Middle Passage: C1770-1810

Scholarships & Prizes Office. University of Sydne

Probioticaprofylaxe bij voorspeld ernstige acute pancreatitis : een gerandomiseerde, dubbelblinde, placebogecontroleerde trial

OBJECTIVE: To evaluate whether enteral prophylaxis with probiotics in patients with predicted severe acute pancreatitis prevents infectious complications. DESIGN: Multicentre, randomised, double-blind, placebo-controlled trial. METHOD: A total of 296 patients with predicted severe acute pancreatitis (APACHE II score > or = 8, Imrie score > or = 3 or C-reactive protein concentration > 150 mg/l) were included and randomised to one of two groups. Within 72 hours after symptom onset, patients received a multispecies preparation of probiotics or placebo given twice daily via a jejunal catheter for 28 days. The primary endpoint was the occurrence of one of the following infections during admission and go-day follow-up: infected pancreatic necrosis, bacteraemia, pneumonia, urosepsis or infected ascites. Secondary endpoints were mortality and adverse reactions. The study registration number is ISRCTN38327949. RESULTS: Treatment groups were similar at baseline with regard to patient characteristics and disease severity. Infections occurred in 30% of patients in the probiotics group (46 of 152 patients) and 28% of those in the placebo group (41 of 144 patients; relative risk (RR): 1.1; 95% CI: 0.8-1.5). The mortality rate was 16% in the probiotics group (24 of 152 patients) and 6% (9 of 144 patients) in the placebo group (RR: 2.5; 95% CI: 1.2-5.3). In the probiotics group, 9 patients developed bowel ischaemia (of whom 8 patients died), compared with none in the placebo group (p = 0.004). CONCLUSION: In patients with predicted severe acute pancreatitis, use of this combination of probiotic strains did not reduce the risk of infections. Probiotic prophylaxis was associated with a more than two-fold increase in mortality and should therefore not be administered in this category of patients.

Inspiring Womanhood: A re-interpretation of The Dawn

This thesis explores the diversity of content and ideas found in Louisa Lawson’s The Dawn, Australia’s first successful magazine ‘by women and for women’, showing that every element of the journal promoted a womanhood ideal for Australian women. Though remembered for the challenging arguments it made for women’s rights, most of the journal was taken up by beauty tips, household hints, recipes, women’s stories, health ideas, fashion articles and the like. This thesis examines such elements, noting how they served to help readers progress towards its womanhood ideal. It highlights the way that The Dawn’s discourse on women’s right was integrated into this ideal. It also analyses some of the key themes and ideas central to the ideal constructed in The Dawn, such as motherhood, beauty, and success in work and study

Guest-Dependence on Spin Crossover and Thermal Expansion in Nanoporous Coordination Framework Materials

Coordination framework materials have attracted much interest in modern chemistry due to the plethora of properties that they may possess. The frameworks described in this thesis demonstrate the properties of spin crossover, anomalous thermal expansion, and nanoporosity, which enables guest-dependent studies into the material behaviour. The first frameworks described are the [Fe(bpac)M(CN)4]•x(bpac){guest} (M = Ni, Pd, Pt; bpac = 1,4-bis(4′-pyridyl)acetylene) family. The properties of the alcohol-solvated [Fe(bpac)Pd(CN)4]•x(bpac) (x = 0.4, 0.5) frameworks were studied, and the major guest influence on the resulting spin crossover behaviour was determined to be due to an internal pressure effect produced by the kinetic volume and compressibility of the guest. By obtaining a variety of EtOH adsorption isotherms and isobars, a Temperature-Pressure phase diagram of SCO was produced for the [Fe(bpac)Pd(CN)4]•0.4(bpac){EtOH} material. In addition to these frameworks, the behaviour of the [Fe(bpac)(Au(CN)2)2)]•{guest} framework material was also investigated. This framework demonstrated unprecedented multifunctional behaviour, with a synergistic interplay between the spin crossover, lattice structure and host–guest properties. The framework lattice was exceptionally flexible, and displayed a facile ‘scissor-type’ motion of the {Fe(Au(CN)2)2} (4,4) grids. Due to the extreme conformational flexibility of the {Fe(Au(CN)2)2} (4,4)-grids of this material, the [Fe(bpac)(Au(CN)2)2)]•{EtOH} sample displayed colossal uniaxial thermal expansion behaviour. Below the spin transition, the a parameter displayed a maximum thermal expansion coefficient of −1070 × 10−6 K−1, which is an order of magnitude greater than any yet reported for this quantity. Guest-dependent studies on this framework demonstrate the strong effect of guest properties on the conformation of the framework lattice and the spin transition behaviour

C-reactive protein is superior to white blood cell count for early detection of complications after pancreatoduodenectomy: a retrospective multicenter cohort study

Background: Early detection of major complications after pancreatoduodenectomy could improve patient management and decrease the “failure-to-rescue” rate. In this retrospective cohort study, we aimed to compare the value of C-reactive protein (CRP) and white blood cell count (WBC) in the early detection of complications after pancreatoduodenectomy. Methods: We assessed pancreatoduodenectomies between January 2012 and December 2017. Major complications were defined as grade III or higher according to the Clavien-Dindo classification. Postoperative pancreatic fistula (POPF) was a secondary endpoint. ROC-curve and logistic regression analysis were performed for CRP and WBC. Results were validated in an external cohort. Results: In the development cohort (n = 285), 103 (36.1%) patients experienced a major complication. CRP was superior to WBC in detecting major complications on postoperative day (POD) 3 (AUC:0.74 vs. 0.54, P < 0.001) and POD 5 (AUC:0.77 vs. 0.68, P = 0.031), however not on POD 7 (AUC:0.77 vs. 0.76, P = 0.773). These results were confirmed in multivariable analysis and in the validation cohort (n = 202). CRP was also superior to WBC in detecting POPF on POD 3 (AUC: 0.78 vs. 0.54, P < 0.001) and POD 5 (AUC: 0.83 vs. 0.71, P < 0.001). Conclusion: CRP appears to be superior to WBC in the early detection of major complications and POPF after pancreatoduodenectomy

Recurrence of idiopathic acute pancreatitis after cholecystectomy: systematic review and meta-analysis

Background: Occult biliary disease has been suggested as a frequent underlying cause of idiopathic acute pancreatitis (IAP). Cholecystectomy has been proposed as a strategy to prevent recurrent IAP. The aim of this systematic review was to determine the efficacy of cholecystectomy in reducing the risk of recurrent IAP. Methods: PubMed, Embase and Cochrane Library databases were searched systematically for studies including patients with IAP treated by cholecystectomy, with data on recurrence of pancreatitis. Studies published before 1980 or including chronic pancreatitis and case reports were excluded. The primary outcome was recurrence rate. Quality was assessed using the Newcastle–Ottawa Scale. Meta-analyses were undertaken to calculate risk ratios using a random-effects model with the inverse-variance method. Results: Overall, ten studies were included, of which nine were used in pooled analyses. The study population consisted of 524 patients with 126 cholecystectomies. Of these 524 patients, 154 (29·4 (95 per cent c.i. 25·5 to 33·3) per cent) had recurrent disease. The recurrence rate was significantly lower after cholecystectomy than after conservative management (14 of 126 (11·1 per cent) versus 140 of 398 (35·2 per cent); risk ratio 0·44, 95 per cent c.i. 0·27 to 0·71). Even in patients in whom IAP was diagnosed after more extensive diagnostic testing, including endoscopic ultrasonography or magnetic resonance cholangiopancreatography, the recurrence rate appeared to be lower after cholecystectomy (4 of 36 (11 per cent) versus 42 of 108 (38·9 per cent); risk ratio 0·41, 0·16 to 1·07). Conclusion: Cholecystectomy after an episode of IAP reduces the risk of recurrent pancreatitis. This implies that current diagnostics are insufficient to exclude a biliary cause

Establishing and Coordinating a Nationwide Multidisciplinary Study Group: Lessons Learned by the Dutch Pancreatic Cancer Group

Surgical oncolog