Penetrating or stricturing diseases are the major determinants of time to first and repeat resection surgery in Crohn's disease

BACKGROUND About 80% of patients with Crohn's disease (CD) require bowel resection and up to 65% will undergo a second resection within 10 years. This study reports clinical risk factors for resection surgery (RS) and repeat RS. METHODS Retrospective cohort study, using data from patients included in the Swiss Inflammatory Bowel Disease Cohort. Cox regression analyses were performed to estimate rates of initial and repeated RS. RESULTS Out of 1,138 CD cohort patients, 417 (36.6%) had already undergone RS at the time of inclusion. Kaplan-Meier curves showed that the probability of being free of RS was 65% after 10 years, 42% after 20 years, and 23% after 40 years. Perianal involvement (PA) did not modify this probability to a significant extent. The main adjusted risk factors for RS were smoking at diagnosis (hazard ratio (HR) = 1.33; p = 0.006), stricturing with vs. without PA (HR = 4.91 vs. 4.11; p < 0.001) or penetrating disease with vs. without PA (HR = 3.53 vs. 4.58; p < 0.001). The risk factor for repeat RS was penetrating disease with vs. without PA (HR = 3.17 vs. 2.24; p < 0.05). CONCLUSION The risk of RS was confirmed to be very high for CD in our cohort. Smoking status at diagnosis, but mostly penetrating and stricturing diseases increase the risk of RS.

Search for long-lived stopped R-hadrons decaying out-of-time with pp collisions using the ATLAS detector

An updated search is performed for gluino, top squark, or bottom squark R-hadrons that have come to rest within the ATLAS calorimeter, and decay at some later time to hadronic jets and a neutralino, using 5.0 and 22.9 fb(-1) of pp collisions at 7 and 8 TeV, respectively. Candidate decay events are triggered in selected empty bunch crossings of the LHC in order to remove pp collision backgrounds. Selections based on jet shape and muon system activity are applied to discriminate signal events from cosmic ray and beam-halo muon backgrounds. In the absence of an excess of events, improved limits are set on gluino, stop, and sbottom masses for different decays, lifetimes, and neutralino masses. With a neutralino of mass 100 GeV, the analysis excludes gluinos with mass below 832 GeV (with an expected lower limit of 731 GeV), for a gluino lifetime between 10 mu s and 1000 s in the generic R-hadron model with equal branching ratios for decays to q (q) over bar(chi) over tilde (0) and g (chi) over tilde (0). Under the same assumptions for the neutralino mass and squark lifetime, top squarks and bottom squarks in the Regge R-hadron model are excluded with masses below 379 and 344 GeV, respectively.

The New Cockney: New Ethnicities and Adolescent Speech in the Traditional East End of London

The New Cockney provides a sociolinguistic account of speech variation among adolescents in the 'traditional' East End of London. The study takes account of the social and economic upheaval in the area since the 1950s, primarily concentrating on factors such as the immigration of the Bangladeshi community and its effect on the Cockney dialect. By paying attention to the particular, this book contributes to a better understanding of the more general concerns of linguistic variation. With a focus on the interaction and social practices of a group of adolescents attending a youth centre, the study highlights some of the possible mechanisms for language change.

Risk factors for potentially avoidable readmissions due to end-of-life care issues

BACKGROUND Repeated hospitalizations are frequent toward the end of life, where each admission should be an opportunity to initiate advance-care planning to high-risk patients. OBJECTIVE To identify the risk factors for having a 30-day potentially avoidable readmission due to end-of-life care issues among all medical patients. DESIGN Nested case-control study. SETTING/PATIENTS All 10,275 consecutive discharges from any medical service of an academic tertiary medical center in Boston, Massachusetts between July 1, 2009 and June 30, 2010. MEASUREMENTS A random sample of all the potentially avoidable 30-day readmissions was independently reviewed by 9 trained physicians to identify the ones due to end-of-life issues. RESULTS Among 534, 30-day potentially avoidable readmission cases reviewed, 80 (15%) were due to an end-of-life care issue. In multivariable analysis, the following risk factors were significantly associated with a 30-day potentially avoidable readmission due to end-of-life care issues: number of admissions in the previous 12 months (odds ratio [OR]: 1.10 per admission, 95% confidence interval [CI]: 1.02-1.20), neoplasm (OR: 5.60, 95% CI: 2.85-10.98), opiate medications at discharge (OR: 2.29, 95% CI: 1.29-4.07), Elixhauser comorbidity index (OR: 1.16 per 5-point increase, 95% CI: 1.10-1.22). The discrimination of the model (C statistic) was 0.85. CONCLUSIONS In a medical population, we identified 4 main risk factors that were significantly associated with 30-day potentially avoidable readmission due to end-of-life care issues, producing a model with very good to excellent discrimination. Patients with these risk factors might benefit from palliative care consultation prior to discharge in order to improve end-of-life care and possibly reduce unnecessary rehospitalizations.

Improvement of the processes around the radiology workplace : avoidance of time delays

Radiologists have been confronted with multiple new challenges in recent years. While there has been a steady increase in the number of radiological examinations and imaging material per examination, examination protocols have become more complex and highly time-consuming whereas case-based remuneration is on the decline. The identification of inefficient components in examination processes and reporting is therefore essential. Where and why do time delays occur? How can they be avoided? The following article provides a brief overview and is designed to stimulate discussion.

Measuring Intensity of End of Life Care: A Systematic Review.

BACKGROUND Many studies have measured the intensity of end of life care. However, no summary of the measures used in the field is currently available. OBJECTIVES To summarise features, characteristics of use and reported validity of measures used for evaluating intensity of end of life care. METHODS This was a systematic review according to PRISMA guidelines. We performed a comprehensive literature search in Ovid Medline, Embase, The Cochrane Library of Systematic Reviews and reference lists published between 1990-2014. Two reviewers independently screened titles, abstracts, full texts and extracted data. Studies were eligible if they used a measure of end of life care intensity, defined as all quantifiable measures describing the type and intensity of medical care administered during the last year of life. RESULTS A total of 58 of 1590 potentially eligible studies met our inclusion criteria and were included. The most commonly reported measures were hospitalizations (n = 44), intensive care unit admissions (n = 39) and chemotherapy use (n = 27). Studies measured intensity of care in different timeframes ranging from 48 hours to 12 months. The majority of studies were conducted in cancer patients (n = 31). Only 4 studies included information on validation of the measures used. None evaluated construct validity, while 3 studies considered criterion and 1 study reported both content and criterion validity. CONCLUSIONS This review provides a synthesis to aid in choosing intensity of end of life care measures based on their previous use but simultaneously highlights the crucial need for more validation studies and consensus in the field.

Timing of retreat of the Reuss Glacier (Switzerland) at the end of the Last Glacial Maximum

We used cosmogenic 10Be and 36Cl to establish the timing of the onset of deglaciation after the Last Glacial Maximum of the Reuss Glacier, one of the piedmont lobes of the Alpine ice cap that reached the northern Alpine foreland in Switzerland. In this study, we sampled erratic boulders both at the frontal position in the foreland (Lenzburg and Wohlen, canton Aargau) and at the lateral Alpine border position (Seeboden moraine, Rigi, canton Schwyz). The minimum age for the beginning of retreat is 22.2 ± 1.0 ka at the frontal (terminal) position and 20.4 ± 1.0 ka at the lateral position. These ages are directly comparable with exposure ages from the other piedmont lobes in the northern Alpine foreland. Our data from the mountain called Rigi, do not support the hypothesis that boulders located external to the Seeboden moraine were deposited prior to the last glacial cycle. We present a first exposure age from an erratic boulder in a retreat position in the Alpine foreland. The Reuss Glacier was approximately 12 km behind the maximal extent no later than at 18.6 ± 0.9 ka.

Mobile Temporalities: Place, Ruination and the Dialectics of Time

In this chapter I explore the ambiguous, contradictory and often transient ways the past enters into our lives. I shed light on the interplay of mobility and temporality in the lifeworlds of two Somalis who left Mogadishu with the outbreak of the war in the 1990s. Looking into the ways they actively make sense of this crucial ‘memory-place’ (Ricoeur 2004), a place that that has been turned into a landscape of ruins and rubble, alternative understandings of memory and temporality will emerge. Instead of producing a continuum between here and there, and now and then, the stories and photographs discussed in this chapter form dialectical images – images that refuse to be woven into a coherent picture of the past. By emphasising the dialectical ways these two individuals make sense of Mogadishu’s past and presence, I am following Walter Benjamin’s cue to rethink deeply modern analytical categories such as history, memory and temporality by highlighting the brief, fragmented moments of their appearance in everyday life.

“Delendum est Imperium Ottomanorum“: War Crimes, Crimes against Humanity and the End of the Ottoman Empire

The Ottoman Empire’s status as a full member of the international community of civilized states, which was bound by the rules of international law, had been challenged again and again during the formative period of the international law in the late nineteenth and early twentieth century. When the First World War began, it was the first global military conflict, in which these rules of international law were put to the test. In the case of the Ottoman Empire quite a few questions were not yet settled, not least because the country was still bound by unequal treaties and because it had never ratified the renewed Hague Rules of Land Warfare of 1907, which it had only signed under reservations. Against this background the contribution will therefore focus on the debate amongst legal scholars on violations of the laws of war (and humanity) in regard to the Ottoman Empire during the First World War.