•Rectal washouts with primary pull-through (PT) is the preferred management for Hirschsprung's disease.•Colostomies are classically preferred in three-stage PT.•Nearly 50% of our cohort required a ...stoma before PT.•22% required a stoma post-PT and were more likely to need a long-term stoma.
To review the role of stomas in the initial and long-term management of Hirschsprung disease (HD).
Patients treated for HD at our institution between January 2004 and August 2021 were identified. Data were collected regarding: demographics, indication/bowel location/type of stomas performed and outcomes, pull-through (PT) procedure, and follow-up duration.
Ninety-five patients (78 male) were identified including one early unrelated death. Forty-four of 94 (47%) required a stoma before PT procedure. Of these 44, 38 (86%) had ileostomies and the remaining six (14%) colostomies; one ileostomy remains long-term. The commonest indication for initial stomas was washout failure (41%).
Ninety-one patients had undergone primary PT or secondary PT with stoma closure at the time of the study.
A further new stoma was required after primary PT or three-stage management in 20/91 (22%). The commonest indications were constipation/soiling (25%) and anastomotic leak (20%). Seven out of 20 (35%) were performed within 30 days of a previous procedure and all were closed; three patients required further long-term stomas. Thirteen (65%) required a stoma >30 days, nine remain long-term. Surgical revision of stomas was required in 14/56 (25%) – prolapse and retraction being the commonest indications. Overall, 56/94 (60%) patients required stomas (pre- and/or post-PT) to manage their condition and 13/94 (14%) have a long-term stoma in place. Mean follow-up was 7.8 years (0.5 - 17.6).
Stomas remain an integral part of HD management both initially (47%) and long-term (14%); they carry a considerable associated morbidity. Ileostomy is preferred for initial management.
Level III
Repeat missing child reports in Wales Hutchings, Emma; Browne, Kevin D.; Chou, Shihning ...
Child abuse & neglect,
February 2019, 2019-02-00, 20190201, Letnik:
88
Journal Article
Recenzirano
Odprti dostop
There were approximately 306,000 reports of missing persons in the UK from 2012 to 2013, 64% involved children. Repeat missing incidents account for approximately 38% of reported missing incidences. ...Within their research Biehal et al. (2003) identified that 70% of missing children had voluntarily left their home and the majority of these were considered to have 'run away'. Research suggests that there is heavy demand on public services in responding to children that are regularly reported missing.
The purpose of this study was to explore data recorded in respect of children reported missing as a result of running away. The main objective of this study was to develop a set of risk factors to predict repeat missing incidences using a logistic regression method.
This study explored the characteristics of 523 children who were reported missing to Gwent (Wales) Police as a result of running away.
Using data collected by the Gwent Missing Children's Team in Wales, over a one-year period, this study compared two groups of children: 275 (53%) who were reported missing once ('low risk') and 248 (47%) who were reported more than once ('high risk').
Results indicated that five significant risk factors identified by logistic regression could distinguish outcome in 73% of cases. The five risk factors were; looked after children, substance use, suspected sexual exploitation, known to Youth Offending Services and a history of abuse/neglect.
These risk factors could potentially be used in Gwent to guide intervention strategies, with those children identified as 'high risk' of repeat missing incidents requiring more comprehensive intervention and support.
The overarching aim of this thesis is to further understanding and knowledge of risk factors relevant to children who runaway. More specifically to; identify risk factors most relevant to children ...running away; establish whether risk factors can be used to distinguish between those children reported missing once versus those reported on multiple occasions; and evaluate assessment methods currently being used with this group. The systematic review explores risk factors associated with children who runaway. Successful identification of risk factors can be used to inform risk assessment which in turn inform intervention strategies. Through an electronic search 573 references were identified since 2002. However, only 15 references were included in the final review once inclusion and exclusion criteria were applied. Through this review it was identified that runaways are a heterogeneous group. Risk factors most consistently identified to be associated with running away spanned multiple levels including; gender, socioeconomic status, family structure, history of abuse/neglect, substance use and school attachment/engagement. Implications for intervention are discussed. The empirical study utilised data collected by the Gwent Missing Children’s Team collected over a one year period (N= 523) to explore risk factors associated with repeat missing reports. The aim of this study was to develop a model that could be utilised in practice to identify those most at risk of repeat missing incidences in order to direct resources effectively. Through logistic regression analyses it was found that five risk factors can be used to distinguish between those children reported missing once (low risk, N= 275) versus those reported missing on multiple occasions (high risk, N= 248). This provided a simple summation checklist that can correctly classify 70.4% of missing cases. This checklist can be used to inform resource allocation with those children identified as high risk warranting more comprehensive intervention and support. The case study presented the assessment and intervention of an adolescent reported missing to Gwent Police. The aim of this study was to provide an in-depth analysis of a missing child case making links to relevant psychological theory and highlighting implications on practice. This case study demonstrated the cross over between running away and sexual exploitation and highlighted the importance in providing specialist intervention services in order to reduce risk of harm through repeat running away. Finally, a critique of a risk assessment tool widely used in Wales with runaways who are suspected to be at risk of sexual exploitation is presented. Within this critique it was found that the Sexual Exploitation Risk Assessment Framework (SERAF) combines consistency in approach with ease and efficiency of identification and intervention for children at risk of, or abused through, sexual exploitation. However, the tool requires empirical validation and reliability analyses before it can be considered a scientific assessment of risk. Overall, this thesis provides evidence for the use of risk factors in identifying children who are likely to be reported missing or runaway. It suggests that this group is heterogeneous and that risk factors relevant to predicting running away span multiple levels. This suggests that intervention should be holistic and target identified risk factors. Risk assessments currently utilised in respect of this group require validation. Further research to inform such risk assessments is also recommended.
Disorders which impact the whole brain, such as epilepsy, depression and schizophrenia, have a severe impact on people's lives. Pharmaceutical therapies act on a systemic level and can result in ...numerous unpleasant side effects. Targeted clinical treatments, like epilepsy surgery, have variable success rates. Alternative targeted therapies such as transcranial direct current stimulation (tDCS) have shown promise for treating brain disorders. tDCS involves applying small electric felds to the brain with minimal reported side effects. However, tDCS is hampered by variability in efficacy, which has prevented widespread clinical adoption. In this thesis I implement computational models that can take patient-specifc data to predict treatment efficacy. In chapter 3 I show an implementation of a model of tDCS at the level of brain tissue. Current finite element models (FEMs) can provide patient-specific predictions of current ow, but they cannot predict the functional impact on neural activity. I develop a model that takes a FEM electric field as an input and predicts its effect on neural tissue. I validate this model with comparison to published experimental data. In chapter 4 I apply the model to predict the impact of electric fields on tissue exhibiting beta oscillations. Beta oscillations are linked to a number of disorders, including movement disorders (Basha et al., 2014; Little and Brown, 2014) and epilepsy (Koelewijn et al., 2015; Hamandi et al., 2011). The model is additionally extended to have multiple regions. I show that stimulation effects can spread to, and accumulate in, untargeted regions. Finally, in chapter 5 I move to a whole brain model using patient derived connectivity. This model provides a framework for personalising surgery procedures based on patient connectivity data. The models I present provide frameworks for computational approaches to improve clinical practice. By using computer modelling patient-specific approaches become tractable. I hope that this work will facilitate patient-specific treatment planning, leading to improvement in clinical treatment for a range of neurological disorders.
The overarching aim of this thesis is to further understanding and knowledge of risk factors relevant to children who runaway. More specifically to; identify risk factors most relevant to children ...running away; establish whether risk factors can be used to distinguish between those children reported missing once versus those reported on multiple occasions; and evaluate assessment methods currently being used with this group. The systematic review explores risk factors associated with children who runaway. Successful identification of risk factors can be used to inform risk assessment which in turn inform intervention strategies. Through an electronic search 573 references were identified since 2002. However, only 15 references were included in the final review once inclusion and exclusion criteria were applied. Through this review it was identified that runaways are a heterogeneous group. Risk factors most consistently identified to be associated with running away spanned multiple levels including; gender, socioeconomic status, family structure, history of abuse/neglect, substance use and school attachment/engagement. Implications for intervention are discussed. The empirical study utilised data collected by the Gwent Missing Children’s Team collected over a one year period (N= 523) to explore risk factors associated with repeat missing reports. The aim of this study was to develop a model that could be utilised in practice to identify those most at risk of repeat missing incidences in order to direct resources effectively. Through logistic regression analyses it was found that five risk factors can be used to distinguish between those children reported missing once (low risk, N= 275) versus those reported missing on multiple occasions (high risk, N= 248). This provided a simple summation checklist that can correctly classify 70.4% of missing cases. This checklist can be used to inform resource allocation with those children identified as high risk warranting more comprehensive intervention and support. The case study presented the assessment and intervention of an adolescent reported missing to Gwent Police. The aim of this study was to provide an in-depth analysis of a missing child case making links to relevant psychological theory and highlighting implications on practice. This case study demonstrated the cross over between running away and sexual exploitation and highlighted the importance in providing specialist intervention services in order to reduce risk of harm through repeat running away. Finally, a critique of a risk assessment tool widely used in Wales with runaways who are suspected to be at risk of sexual exploitation is presented. Within this critique it was found that the Sexual Exploitation Risk Assessment Framework (SERAF) combines consistency in approach with ease and efficiency of identification and intervention for children at risk of, or abused through, sexual exploitation. However, the tool requires empirical validation and reliability analyses before it can be considered a scientific assessment of risk. Overall, this thesis provides evidence for the use of risk factors in identifying children who are likely to be reported missing or runaway. It suggests that this group is heterogeneous and that risk factors relevant to predicting running away span multiple levels. This suggests that intervention should be holistic and target identified risk factors. Risk assessments currently utilised in respect of this group require validation. Further research to inform such risk assessments is also recommended.
There remains considerable debate over the active form of gold under operating conditions of a recently validated gold catalyst for acetylene hydrochlorination. We have performed an in situ x-ray ...absorption fine structure study of gold/carbon (Au/C) catalysts under acetylene hydrochlorination reaction conditions and show that highly active catalysts comprise single-site cationic Au entities whose activity correlates with the ratio of Au(I):Au(III) present. We demonstrate that these Au/C catalysts are supported analogs of single-site homogeneous Au catalysts and propose a mechanism, supported by computational modeling, based on a redox couple of Au(I)-Au(III) species.
Display omitted
•Pd/ZnO is a poor methanol synthesis catalyst showing RWGS.•Reduction produces PdZn alloy nanoparticles.•PdZn shows high selectivity to methanol.•Sol immobilisation produces smaller, ...more stable particles.
The direct hydrogenation of CO2 into methanol is crucial for providing a means of CO2 fixation and a way to store cleanly produced hydrogen in a more energy-dense and transportable form. Here we have prepared two series of Pd/ZnO catalysts, both by immobilisation of PVA-protected Pd colloids and by Pd impregnation of PdCl2 to investigate structure activity relationships for direct CO2 hydrogenation. Very different performances were found for the different preparation methods, and the Pd loading and pre-reduction of the catalysts were shown to be important factors for optimising methanol yield. The crucial factor for high methanol yield is the formation of a Pd–Zn alloy, either during the reaction itself, or better by high temperature pre-reduction. The formation of the alloy greatly reduces CO production by the reverse water gas shift reaction. The catalysts prepared by sol-immobilisation were relatively stable to thermal treatment. In contrast, the impregnated catalysts were much less thermally stable, due to the presence of remnant chloride on the surface of the catalyst, which was absent for the case of sol immobilisation preparation. The results illustrate the importance of controlling the PdZn particle size and its surface structure for the catalysts to achieve high methanol selectivity (60%, the rest being CO) and conversion (11%) at 250°C and 20bar. Selectivity for sol-immobilised catalysts decreases from 60% at 3nm average diameter, to 20% at 7nm.
The typical presentation of semantic dementia is associated with marked, left predominant anterior temporal lobe atrophy and with changes in language. About 30% of individuals, however, present with ...predominant right anterior temporal lobe atrophy, usually accompanied by behavioural changes and prosopagnosia. Here, we aimed to establish whether these initially distinct clinical presentations evolve into a similar syndrome at the neural and behavioural level. Thirty-one patients who presented with predominant anterior temporal lobe atrophy were included. Based on imaging, patients were categorized as either predominant left (n = 22) or right (n = 9) semantic dementia. Thirty-three Alzheimer's disease patients and 25 healthy controls were included for comparison. Participants completed the Addenbrooke's Cognitive Examination, a Face and Emotion Processing Battery and the Cambridge Behavioural Inventory, and underwent magnetic resonance imaging annually. Longitudinal neuroimaging analyses showed greater right temporal pole atrophy in left semantic dementia than Alzheimer's disease, whereas right semantic dementia showed greater orbitofrontal and left temporal lobe atrophy than Alzheimer's disease. Importantly, direct comparisons between semantic dementia groups revealed that over time, left semantic dementia showed progressive thinning in the right temporal pole, whereas right semantic dementia showed thinning in the orbitofrontal cortex and anterior cingulate. Behaviourally, longitudinal analyses revealed that general cognition declined in all patients. In contrast, patients with left and right semantic dementia showed greater emotion recognition decline than Alzheimer's disease. In addition, left semantic dementia showed greater motivation loss than Alzheimer's disease. Correlational analyses revealed that emotion recognition was associated with right temporal pole, right medial orbitofrontal and right fusiform integrity, while changes in motivation were associated with right temporal pole cortical thinning. While left and right semantic dementia show distinct profiles at presentation, both phenotypes develop deficits in emotion recognition and behaviour. These findings highlight the pervasive socio-emotional deficits in frontotemporal dementia, even in patients with an initial language presentation. These changes reflect right anterior temporal and orbitofrontal cortex degeneration, underscoring the role of these regions in social cognition and behaviour.
Several reproductive strategies have been identified as key factors that contribute to the establishment and dispersal of invasive species in new environments. These strategies include early ...maturity, high reproductive capacity and flexibility in timing of reproduction. It is therefore critical to investigate the reproductive biology of target exotic species to understand their potential for population increase and invasive spread, and to inform management control strategies. The European fanworm, Sabella spallanzanii (Gmelin 1791), has established invasive populations along the southern coast of Australia. Gamete development and reproductive periodicity of this worm were investigated in two populations in Gulf St Vincent in South Australia over a 1 year period (July 2012 to June 2013). Samples of worms were collected monthly and dissected for histological analysis. Most individuals reached reproductive maturity at 70 mm body length (thorax and abdomen). Individuals from both populations contained mature and developing gametes year-round and a distinct spawning season was not observed. This may indicate sustained spawning by the population over the year, which provides a constant supply of new recruits to the area. Body length and egg size of worms from these populations were smaller than conspecifics in its native range and other invasive locations. Reproduction and development of S. spallanzanii differs not only between native and invasive locations, but also within invasive locations. This study has shown that S. spallanzanii exhibits a higher phenotypic plasticity and reproductive flexibility than previously known.
PDF
