Aim: To compare characteristics of recreational vs. medical growers in a sample of small-scale cannabis cultivators from 12 countries.
Methods: Six thousand eight hundred ninety six respondents who ...took part in an online survey were divided into three groups as: those who reported growing for recreational use, those cultivating for medical purposes who also reported use of other illegal drugs, and those who reported cultivation for medical use and didn't use other illegal substances. The groups were compared using multinomial logistic regression.
Findings: In comparison to recreational growers, the two groups of medical growers included more females, consumed cannabis more frequently, and were more likely to cite health-related motivations for growing. The medical growers without other illicit drug use shared some of the same features with the medical growers with illicit drug use, but in comparison to both other groups, they were older, used less alcohol and tobacco, and were less likely to be involved in illicit activities other than drug crimes.
Conclusions: Findings suggest that claims of medical use are not simply an attempt to justify personal cannabis consumption, but do at least partly reflect a genuine belief in medical benefit. However, those growing cannabis for medical reasons form a heterogeneous group of people.
The elemental diet (ED) is a formula to support nutritional status without increasing chylous burden. This study evaluates the efficacy of early ED feeding after pancreatoduodenectomy (PD).
A ...prospective phase II study of consecutive patients who underwent PD with early ED feeding was conducted. Patient backgrounds, surgical outcomes, and ED feeding tolerability were compared with a historical cohort of 74 PD patients with early enteral feeding of a low residue diet (LRD).
The ED group comprised 104 patients. No patient in the ED group discontinued enteral feeding because of chylous ascites (CAs), whereas 17.6% of the LRD group experienced refractory CAs that disrupted further enteral feeding. The CAs rate was significantly decreased in the ED group compared with the LRD group (3.9% and 48.7%, respectively; P < 0.001). There was no significant difference in the incidence of major complications (ED: 17.3%, LRD: 18.9%; P = 0.844). Postoperative prognostic nutritional index was similar between the 2 groups ( P = 0.764). In multivariate analysis, enteral feeding formula, and sex were independent risk factors for CAs (LRD: P < 0.001, odds ratio, 22.87; female: P = 0.019, odds ratio, 2.78).
An ED reduces postoperative CAs of patients undergoing PD in the setting of early enteral feeding.
Background
A serious complication after pancreatoduodenectomy (PD) is postoperative pancreatic fistula (POPF). The aim of this study was to analyse the incidence and predictive factors for POPF by ...using a large nationwide cohort.
Methods
Data from the Swedish National Registry for Pancreatic and Periampullary Cancer for all patients undergoing a PD from 2010 until 30th June 2018 were collected. The material was analysed in two groups, no POPF and clinically relevant (grade B and C) POPF.
Results
A total of 2503 patients underwent PD, of which 245 (10%) developed POPF. Patients with POPF had significantly more overall complications (Clavien Dindo ≥3a, 75% vs. 21%,
p
< 0.001) and longer hospital stay (median 23 16–35 vs. 11 8–15,
p
< 0.001) than patients without POPF. The risk of POPF was higher with increased BMI (OR 1.08,
p
< 0.001). Preoperative presence of diabetes (OR 0.52,
p
= 0.012) and preoperative biliary drainage (OR 0.34,
p
< 0.001) reduced the risk of POPF. Reconstruction with pancreaticojejunostomy caused a more than two folded increase in POPF compared with pancreaticogastrostomy (OR 2.41,
p
< 0.001). Weight gain ≥2 kg on postoperative day 1 was also a risk factor (OR 1.76,
p
< 0.001).
Conclusion
A high BMI, a pancreaticojejunostomy and postoperative weight gain were risk factors for developing POPF. Diabetes or preoperative biliary drainage was protective.
The elevated demands of the new knowledge economy pose particular challenges to rural and northern regions in Canada, long acknowledged by policymakers to suffer from acute human capital deficits. ...Rural residents obtain lower levels of education than their urban counterparts and those that do obtain post-secondary training often migrate to urban regions offering abundant employment opportunities and higher wages. Despite an emerging consensus around over skill deficits across rural regions, Canadian researchers have yet to systematically explore contemporary rural-urban differences in human capital using refined measures of literacy and numeracy skills. We ameliorate this deficiency by mapping rural-urban disparities in skills across the working age population (16–65) using Statistics Canada's 2012 Longitudinal International Study of Adults (LISA). Our results indicate that residents from smaller population centers and rural areas within Canada show significantly lower skills proficiencies. These differences across location of residence shrink considerably when controlling for education level, underscoring the need to enhance post-secondary access in rural areas.
•Residents from smaller population centers and rural areas within Canada show significantly lower skills proficiencies.•Rural residents show significantly lower literacy as well as numeracy proficiencies compared to urban counterparts.•Skills differences across population centers are largely explained by differences in formal education levels.
Background Pancreatic fistula (PF) is the most common significant complication after pancreaticoduodenectomy. Invagination and duct-to-mucosa anastomoses are anastomotic techniques that are commonly ...performed after pancreaticoduodenectomy. There are conflicting data on invagination vs duct-to-mucosa anastomoses about which is superior for minimizing the risk of PF. In addition, all previous studies involved multiple operating surgeons and failed to control for variation in surgeon expertise. Study Design This was a randomized controlled study comparing the outcomes of PD between patients who underwent invagination vs those who had duct-to-mucosa anastomoses. All 132 patients were operated on between October 2012 and March 2015 by a single surgeon experienced in both procedures. Pancreatic fistula was the main end point. Results Overall and clinically relevant rates of PF rate were 29.5% and 10.6%, respectively. Overall PF rates in the patients treated with invagination vs duct-to-mucosa anastomoses were 30.9% vs 28.5% (p = 0.729), respectively and the corresponding clinically relevant PF rates were 17.6% vs 3.1%, respectively (p = 0.004). Although the overall complication rates were similar in the 2 groups, severe complications were significantly more frequent in the patients treated with invagination (p = 0.013). Duct-to-mucosa anastomosis was also associated with shorter postoperative hospital stay (13 vs 15 days; p = 0.021). There was one perioperative death. Independent variables for the risk of PF were the diameter of the pancreatic duct (greater risk with smaller diameter), the underlying pathology, and male sex. Conclusions Both methods yield similar overall rates for PF, but the rate of clinically relevant PF is lower in patients treated with duct-to-mucosa anastomosis. Additional single-surgeon studies or multi-institution randomized trials controlling for comparable expertise in both procedures should be conducted to confirm these results.
Asia-Pacific is one of the most densely populated regions of the world and is experiencing rapid economic changes and urbanization. Environmental pollution is a significant problem associated with ...the rapid modernization of many cities in South Asia. It is not surprising that the prevalences of asthma and allergies are increasing rapidly, although the underlying reasons remain largely unknown. Many studies from this region have documented the changing prevalence of allergic diseases in various parts of the world. However, the methodologies used were neither standardized nor validated, making the results difficult to evaluate. The International Study of Asthma and Allergies in Childhood (ISAAC) has provided a global epidemiology map of asthma and allergic diseases, as well as the trend of changes in the prevalence of these diseases. Allergic sensitization is extremely common in many Asian communities. However, the prevalence of allergic diseases remains relatively rare. The rapid urbanization in the region, which increases environmental pollution and can affect the rural environment, will likely increase the prevalence of asthma and allergies in Asia.
Study abroad is a potentially valuable experience in today's global economy. With proper preparation it can be transformational. It can open you to the appreciation of other cultures; develop the ...transferable intercultural skills for interacting with people from different backgrounds; and deepen your self-awareness about your values and expectations. It can build confidence as you learn to navigate unfamiliar situations, and help you deal with the ambiguities of life.Study abroad also develops knowledge and insights about our interconnected world that will serve you well whether you choose a career in business, non-profits, education, or government. A recent study by IES Abroad found that many employers value the intercultural skills and personal development that students gain from their travel. Students who had studied abroad reported higher starting salaries and were more likely to have landed a job within six months of graduation than the national average. This book is written for you, as a student who is learning about the world first-hand, and probably traveling abroad for the first time. It addresses the challenges of adapting thinking and behavior as you travel in an unfamiliar environment, of making the most of the opportunities, and of meeting and interacting with the locals.This book is designed to help you prepare for your study abroad experience so you can get the most from it, and gain critical intercultural skills while crossing cultures. It offers strategies for learning about and exploring cultural differences and similarities of the country you will visit; and advice about how to actively observe and participate in the life of the locality in which you will find yourself. Each chapter illustrates key concepts through the personal accounts of students who have "been there, done that." This book aims to help you with your own personal journey, and to make your study abroad experience as meaningful, rewarding, and insightful as possible.
Enrollments in international education programs are projected to grow exponentially as students, parents, and university personnel seek to prepare future leaders who can live and work effectively in ...a global environment. What do we know about the outcomes of such programs, and how can educators become more intentional about designing, and assessing, the impact of such courses? How can we help students achieve the intercultural growth and transformation that they may envision as they set forth on their international sojourn?International education provides opportunities for students to grow personally, and to learn in a rich and intense educational environment. The outcomes of such opportunities emphasize not only traditional academic competence, but also changes in motivations, attitudes, self-identity, and values. It is these latter, co-academic, concepts that are the focus of this book. Its goal is to give solid substance to the growth and transformation approach to study abroad. It defines the central concept of intercultural competence, sets it within the framework of transformative learning theory, and offers ideas and strategies for facilitating its development. In doing so, it goes far beyond traditional emphases on the achievement of such formal skills as foreign language acquisition or specific knowledge of course content in national literatures, arts, or history. This book provides study abroad educators with a theoretical framework and examples of practice to craft more meaningful activities that will make a long-term difference in the quality of student experiences, and set the stage for transformative change. If we plan to send a million students a year to study abroad within the decade, we need approaches to maximize student growth outcomes in an efficient and effective way. It is also relevant for anyone engaged in courses in adult education, college student services, comparative and international education, international business, intercultural rel
Front-of-pack (FOP) nutrition labelling is a globally recommended strategy to encourage healthier food choices. We evaluated the effect of FOP labels on the perceived healthfulness of a sweetened ...fruit drink in an international sample of adult consumers.
Six-arm randomised controlled experiment to examine the impact of FOP labels (no label control, Guideline Daily Amounts (GDA), Multiple Traffic Lights, the Health Star Ratings (HSR), Health Warning Labels, and 'High-in' Warning Labels (HIWL)) on the perceived healthfulness of the drink. Linear regression models by country examined healthfulness perceptions on FOP nutrition labels, testing for interactions by demographic characteristics.
Online survey in 2018 among participants from Australia, Canada, Mexico, United Kingdom (UK) and United States.
Adults (≥18 years, n 22 140).
Compared with control, HIWL had the greatest impact in lowering perceived healthfulness (β from -0·62 to -1·71) across all countries. The HIWL and the HSR had a similar effect in Australia. Other labels were effective in decreasing the perceived healthfulness of the drink within some countries only, but to a lower extent. The GDA did not reduce perceived healthfulness in most countries. In the UK, the effect of HIWL differed by age group, with greater impact among older participants (> 40 years). There were no other variations across key demographic characteristics.
HIWL, which communicates clear, non-quantitative messages about high levels of nutrients of concern, demonstrated the greatest efficacy to decrease the perceived healthfulness of a sweetened fruit drink across countries. This effect was similar across demographic characteristics.
Background
Delayed gastric emptying (DGE) is a common complication after pancreatoduodenectomy (PD). DGE causes prolonged hospital stay and a decrease in quality of life. This study analyzes ...predictive factors for development of DGE after PD, also in the absence of surgical complications.
Method
Data from the Swedish National Pancreatic Cancer Registry for patients undergoing standard and pylorus preserving open PD from January 2010 until June 30, 2018, were collected. Data were analyzed in two groups, no DGE and DGE. A subgroup of patients with DGE but without surgical complications was compared to patients without DGE or any other surgical complication.
Results
In total, 2503 patients were included, of which 470 (19%) had DGE. In the DGE group, 238 had other coexisting surgical complications and 232 had not. Postoperative pancreatic fistula (OR = 4.22,
p
< 0.001), surgical infection (OR = 1.44,
p
= 0.013), heart disease (OR = 1.32,
p
= 0.023) and medical complications (OR = 1.35,
p
= 0.025) increased the risk for DGE. A standard PD compared with pylorus preserving resection (OR = 1.69,
p
= 0.001) and a reconstruction with a pancreaticojejunostomy compared with a pancreaticogastrostomy (OR = 1.83,
p
< 0.001) increased the risk. For patients without surgical complications, a standard PD and reconstruction with pancreaticojejunostomy still increased the risk for DGE.
Conclusion
DGE is more common after standard PD compared to pylorus preserving PD and after reconstruction with PJ compared to PG in this national cohort, both in the presence of other surgical complications as well as in the absence of other complications.
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