Management of faecal incontinence and constipation in adults with central neurological diseases.

BACKGROUND: People with neurological disease have a much higher risk of both faecal incontinence and constipation than the general population. There is often a fine line between the two conditions, with any management intended to ameliorate one risking precipitating the other. Bowel problems are observed to be the cause of much anxiety and may reduce quality of life in these people. Current bowel management is largely empirical with a limited research base. OBJECTIVES: To determine the effects of management strategies for faecal incontinence and constipation in people with neurological diseases affecting the central nervous system. SEARCH STRATEGY: We searched the Cochrane Incontinence Group Specialised Trials Register (searched 26 January 2005), the Cochrane Central Register of Controlled Trials (Issue 2, 2005), MEDLINE (January 1966 to May 2005), EMBASE (January 1998 to May 2005) and all reference lists of relevant articles. SELECTION CRITERIA: All randomised or quasi-randomised trials evaluating any types of conservative or surgical measure for the management of faecal incontinence and constipation in people with neurological diseases were selected. Specific therapies for the treatment of neurological diseases that indirectly affect bowel dysfunction were also considered. DATA COLLECTION AND ANALYSIS: Two reviewers assessed the methodological quality of eligible trials and two reviewers independently extracted data from included trials using a range of pre-specified outcome measures. MAIN RESULTS: Ten trials were identified by the search strategy, most were small and of poor quality. Oral medications for constipation were the subject of four trials. Cisapride does not seem to have clinically useful effects in people with spinal cord injuries (three trials). Psyllium was associated with increased stool frequency in people with Parkinson's disease but did not alter colonic transit time (one trial). Prucalopride, an enterokinetic did not demonstrate obvious benefits in this patient group (one study). Some rectal preparations to initiate defaecation produced faster results than others (one trial). Different time schedules for administration of rectal medication may produce different bowel responses (one trial). Mechanical evacuation may be more effective than oral or rectal medication (one trial). There appears to be a benefit to patients in one-off educational interventions from nurses. The clinical significance of any of these results is difficult to interpret. AUTHORS' CONCLUSIONS: There is still remarkably little research on this common and, to patients, very significant condition. It is not possible to draw any recommendation for bowel care in people with neurological diseases from the trials included in this review. Bowel management for these people must remain empirical until well-designed controlled trials with adequate numbers and clinically relevant outcome measures become available.

Incidence and management of pulmonary embolism following spinal surgery occurring while under chemical thromboprophylaxis.

Patients undergoing spinal surgery are at risk of developing thromboembolic complications even though lower incidences have been reported as compared to joint arthroplasty surgery. Deep vein thrombosis (DVT) has been studied extensively in the context of spinal surgery but symptomatic pulmonary embolism (PE) has engaged less attention. We prospectively followed a consecutive cohort of 270 patients undergoing spinal surgery at a single institution. From these patients, only 26 were simple discectomies, while the largest proportion (226) was fusions. All patients received both low molecular weight heparin (LMWH) initiated after surgery and compressive stockings. PE was diagnosed with spiral chest CT. Six patients developed symptomatic PE, five during their hospital stay. In three of the six patients the embolic event occurred during the first 3 postoperative days. They were managed by the temporary insertion of an inferior vena cava (IVC) filter thus allowing for a delay in full-dose anticoagulation until removal of the filter. None of the PE patients suffered any bleeding complication as a result of the introduction of full anticoagulation. Two patients suffered postoperative haematomas, without development of neurological symptoms or signs, requiring emergency evacuation. The overall incidence of PE was 2.2% rising to 2.5% after exclusion of microdiscectomy cases. The incidence of PE was highest in anterior or combined thoracolumbar/lumbar procedures (4.2%). There is a large variation in the reported incidence of PE in the spinal literature. Results from the only study found in the literature specifically monitoring PE suggest an incidence of PE as high as 2.5%. Our study shows a similar incidence despite the use of LMWH. In the absence of randomized controlled trials (RCT) it is uncertain if this type of prophylaxis lowers the incidence of PE. However, other studies show that the morbidity of LMWH is very low. Since PE can be a life-threatening complication, LMWH may be a worthwhile option to consider for prophylaxis. RCTs are necessary in assessing the efficacy of DVT and PE prophylaxis in spinal patients.

Management of faecal incontinence and constipation in adults with central neurological diseases.

BACKGROUND: People with neurological disease have a much higher risk of both faecal incontinence and constipation than the general population. There is often a fine dividing line between the two conditions, with any management intended to ameliorate, one risking precipitating the other. Bowel problems are observed to be the cause of much anxiety and may reduce quality of life in these people. Current bowel management is largely empirical with a limited research base. OBJECTIVES: To determine the effects of management strategies for faecal incontinence and constipation in people with neurological diseases affecting the central nervous system. SEARCH STRATEGY: We searched the Cochrane Incontinence Group Trials Register, the Cochrane Controlled Trials Register, MEDLINE, EMBASE and all reference lists of relevant articles. Date of the most recent searches: May 2000. SELECTION CRITERIA: All randomised or quasi-randomised trials evaluating any types of conservative, or surgical measure for the management of faecal incontinence and constipation in people with neurological diseases were selected. Specific therapies for the treatment of neurological diseases that indirectly affect bowel dysfunction have also been considered. DATA COLLECTION AND ANALYSIS: All three reviewers assessed the methodological quality of eligible trials and two reviewers independently extracted data from included trials using a range of pre-specified outcome measures. MAIN RESULTS: Only seven trials were identified by the search strategy and all were small and of poor quality. Oral medications for constipation were the subject of four trials. Cisapride does not seem to have clinically useful effects in people with spinal cord injuries (two trials). Psyllium was associated with increased stool frequency in people with Parkinson's disease but not altered colonic transit time (one trial). Some rectal preparations to initiate defecation produced faster results than others (one trial). Different time schedules for administration of rectal medication may produce different bowel responses (one trial). Mechanical evacuation may be more effective than oral or rectal medication (one trial). The clinical significance of any of these results is difficult to interpret. REVIEWER'S CONCLUSIONS: It is not possible to draw any recommendation for bowel care in people with neurological diseases from the trials included in this review. Bowel management for these people must remain empirical until well-designed controlled trials with adequate numbers and clinically relevant outcome measures become available.

Incidence of uterine post abortion infection at Hospital de Clínicas de Porto Alegre. Is prophylactic antibiotic necessary?

OBJECTIVE: To identify the incidence of pelvic infection after miscarriage undergoing uterine evacuation in a tertiary hospital in southern Brazil and to compare with the international literature.METHODS: we reviewed electronic medical records of the Hospital de Clinicas de Porto Alegre of all patients who underwent uterine evacuation for miscarriage between August 2008 and January 2012 were reviewed. We included all patients submitted to uterine curettage due to abortion and who had outpatient visits for review after the procedure. We calculated emographic and laboratory data of the study population, number needed for treatment (NNT) and number needed to harm (NNH).RESULTS: of the 857 revised electronic medical records, 377 patients were subjected to uterine evacuation for miscarriage; 55 cases were lost to follow-up, leaving 322 cases that were classified as not infected abortion on admission. The majority of the population was white (79%); HIV prevalence and positive VDRL was 0.3% and 2%, respectively. By following these 322 cases for a minimum of seven days, it was found that the incidence of post-procedure infection was 1.8% (95% CI 0.8 to 4). The NNT and NNH calculated for 42 months were 63 and 39, respectively.CONCLUSION: The incidence of post-abortion infection between August 2008 to January 2012 was 1.8% (0.8 to 4).

Orderly book, Second Regiment of U.S. Dragoons, New York, 1812-1813

The Second U.S. Regiment of Light Dragoons was formed in January 1812. In March of 1814, it merged with the First U.S. Regiment of Light Dragoons to form the Regiment of Light Dragoons.

Orderly book, Second Regiment of U.S. Dragoons, New York, 1812-1813

An orderly book of the Second Regiment of U.S. Dragoons, New York, dated August 14, 1812-July 29, 1813. The book contains orders pertaining to day-to-day military matters, such as punishments for disobedience, court-martial proceedings, camp rules and regulations, and guidelines for interacting with civilians in the vicinity of the camp. The Regiment was stationed at various locations in upstate New York and Canada, including Greenbush, Albany, Sackets Harbor, Utica, Geneva, Fort Niagara and Fort George. General Henry Dearborn originally commanded the Regiment at Greenbush. Names noted in this book include:E. Beebe, Deputy Adjt. General; William King, Capt. 15th; John Chandler, General ;W. Gamewood, Major ;James Burns, Colonel;John Woodford, Major; Andrew McDowell, Capt.; Abm. Gustis, Major; C.W. Hunter, Brigade Major; Selden, Captain; Holland, Captain; Harris, Captain; Clarkson, Lieutenant; Johnson, Lieutenant; Robert Craig, Adjt.; R.G. Hith, A.A. General. Also included with the orderly book are a monthly return form, a contract for medical services, and a bonus pay voucher for Thomas Blunt. The monthly return form is partially completed and dated January 1813 at Greenbush, New York. It is signed by Captain Jonas Holland. The contract is dated May 20, 1812, between John Dodge, physician and surgeon, and Jonas Holland. The contract describes the services required of the physician and the salary to be paid. The bonus pay voucher is dated April 25, 1813, for $8.00 paid to Thomas Blunt by Captain Jonas Holland for 'enlisting into the army of the United States for five years'.

Agent Based Simulation of Street Robbery

Routine activity theory introduced by Cohen& Felson in 1979 states that criminal acts are caused due to the presenceof criminals, vic-timsand the absence of guardians in time and place. As the number of collision of these elements in place and time increases, criminal acts will also increase even if the number of criminals or civilians remains the same within the vicinity of a city. Street robbery is a typical example of routine ac-tivity theory and the occurrence of which can be predicted using routine activity theory. Agent-based models allow simulation of diversity among individuals. Therefore agent based simulation of street robbery can be used to visualize how chronological aspects of human activity influence the incidence of street robbery.The conceptual model identifies three classes of people-criminals, civilians and police with certain activity areas for each. Police exist only as agents of formal guardianship. Criminals with a tendency for crime will be in the search for their victims. Civilians without criminal tendencycan be either victims or guardians. In addition to criminal tendency, each civilian in the model has a unique set of characteristicslike wealth, employment status, ability for guardianship etc. These agents are subjected to random walk through a street environment guided by a Q –learning module and the possible outcomes are analyzed

Agent Based Evacuation Simulation Using Leader-Follower Model

Agent based simulation is a widely developing area in artificial intelligence.The simulation studies are extensively used in different areas of disaster management. This work deals with the study of an agent based evacuation simulation which is being done to handle the various evacuation behaviors.Various emergent behaviors of agents are addressed here. Dynamic grouping behaviors of agents are studied. Collision detection and obstacle avoidances are also incorporated in this approach.Evacuation is studied with single exits and multiple exits and efficiency is measured in terms of evacuation rate, collision rate etc.Net logo is the tool used which helps in the efficient modeling of scenarios in evacuation

Identifying and recording every casualty of armed conflict

This article discusses the international legal obligation to identify and record every casualty of armed conflict that finds its basis in the treaties and customs of international humanitarian law and international human rights law. The article applies the various facets of the legal obligation to the armed conflicts in Iraq and Sri Lanka and argues that the parties in these conflicts failed in their international legal responsibility to civilians.

State practice, customary humanitarian law and civilian casualties of armed conflict

The article examines the customary international law credentials of the humanitarian law rules proposed by the International Committee of the Red Cross (ICR) in 2005. It relies on the BIICL/Chatham House analysis as a ‘constructive comment’ on the methodology of the ICRC study and the rules formed as a result of that methodology with respect to the dead and missing as an aid to determination of their customary law status. It shows that most of the rules studied have a customary international lawpedigree which conforms to the conclusions formed on the rules generally in the Wilmshurst and Breau study. However, the rules with respect to return of personal effects, recording location of graves and notification of relatives of access to gravesites do not seem to have even on a majoritarian/deductive approach enough volume of state practice to establish them as customary with respect to civilians.

Civilian casualties and nuclear weapons: the application of the rule of distinction

This chapter considers the possible use in armed conflict of low-yield (also known as tactical) nuclear weapons. The Legality of the Threat or Use of Nuclear Weapons Advisory Opinion maintained that it is a cardinal principle that a State must never make civilians an object of attack and must consequently never use weapons that are incapable of distinguishing between civilian and military targets. As international humanitarian law applies equally to any use of nuclear weapons, it is argued that there is no use of nuclear weapons that could spare civilian casualties particularly if you view the long-term health and environmental effects of the use of such weaponry.

Voices of Occupiers/Liberators: The BBC's Radio Propaganda in Italy between 1942 and 1945

The ambiguity of the role played by British propaganda in Italy during the Second World War is clearly reflected in the phenomenon of Radio London. While Radio London raised the morale of the Italian civilians living under the Fascist regime and provided them with alternative information on the conflict, the microphones of the BBC were also used by the British government to address a country they were planning to occupy. In this article, I will analyse the occupation/liberation operations that were run at the BBC Italian Service from two separate angles. On the one hand, the analysis of the programmes broadcast between the months preceding the Allies’ landing in Sicily and the actual occupation shows how the Allies built their image as liberators and guarantors of better living conditions. On the other, the analysis of the relationships between the Foreign Office and the anti-Fascist exiles reveals that the Italian BBC broadcasters were not always allowed to freely express their political opinion or to dispose of their own lives.

Civilian casualties – do we really care? The failure of the revolution in military affairs of non-lethal weapons in the U.S., Russia and Israel

Causing civilian casualties during military operations has become a much politicised topic in international relations since the Second World War. Since the last decade of the 20th century, different scholars and political analysts have claimed that human life is valued more and more among the general international community. This argument has led many researchers to assume that democratic culture and traditions, modern ethical and moral issues have created a desire for a world without war or, at least, a demand that contemporary armed conflicts, if unavoidable, at least have to be far less lethal forcing the military to seek new technologies that can minimise civilian casualties and collateral damage. Non-Lethal Weapons (NLW) – weapons that are intended to minimise civilian casualties and collateral damage – are based on the technology that, during the 1990s, was expected to revolutionise the conduct of warfare making it significantly less deadly. The rapid rise of interest in NLW, ignited by the American military twenty five years ago, sparked off an entirely new military, as well as an academic, discourse concerning their potential contribution to military success on the 21st century battlefields. It seems, however, that except for this debate, very little has been done within the military forces themselves. This research suggests that the roots of this situation are much deeper than the simple professional misconduct of the military establishment, or the poor political behaviour of political leaders, who had sent them to fight. Following the story of NLW in the U.S., Russia and Israel this research focuses on the political and cultural aspects that have been supposed to force the military organisations of these countries to adopt new technologies and operational and organisational concepts regarding NLW in an attempt to minimise enemy civilian casualties during their military operations. This research finds that while American, Russian and Israeli national characters are, undoubtedly, products of the unique historical experience of each one of these nations, all of three pay very little regard to foreigners’ lives. Moreover, while it is generally argued that the international political pressure is a crucial factor that leads to the significant reduction of harmed civilians and destroyed civilian infrastructure, the findings of this research suggest that the American, Russian and Israeli governments are well prepared and politically equipped to fend off international criticism. As the analyses of the American, Russian and Israeli cases reveal, the political-military leaderships of these countries have very little external or domestic reasons to minimise enemy civilian casualties through fundamental-revolutionary change in their conduct of war. In other words, this research finds that employment of NLW have failed because the political leadership asks the militaries to reduce the enemy civilian casualties to a politically acceptable level, rather than to the technologically possible minimum; as in the socio-cultural-political context of each country, support for the former appears to be significantly higher than for the latter.