Faecal Haemoglobin Estimated by Faecal Immunochemical Tests—An Indicator of Systemic Inflammation with Real Clinical Potential

Multimorbidity is the major cause of ill-health and premature death in developed countries. The ability to identify individuals at risk of developing chronic disease, particularly multimorbidity, reliably, and simply, and to identify undiagnosed disorders, is vital to reducing the global burden of disease. This narrative review, the first of recent studies, demonstrates that raised faecal haemoglobin concentration (f-Hb) is associated with increased all-cause and cause-specific mortality and with longer-term conditions including diabetes, hypertension, cardiovascular disease, and psoriasis, and with probable intake of particulate matter. We and others have hypothesized that elevated f-Hb (measured using a faecal immunochemical test) has considerable potential to identify individuals at risk of, or who already have, early stage, undiagnosed chronic disease. If f-Hb does prove to be an effective biomarker for chronic disease and multimorbidity, individuals with detectable f-Hb, but without an obvious source of gastrointestinal blood loss, could benefit from further assessment and early intervention. To test this hypothesis rigorously, longitudinal data-linkage methodology is required linking colorectal cancer screening data, and data on patients presenting with lower gastrointestinal symptoms, with routinely collected health information.

Knowledge from the Outside

Knowledge may be examined from the third-person perspective, as psychologists and sociologists do, or it may be examined from the first-person perspective, as each of us does when we reflect on what we ought to believe. This chapter takes the third-person perspective. One obvious source of knowledge is perception, and some general features of how our perceptual systems are able to pick up information about the world around us are highlighted. The role of the study of visual illusions in this research is an important focus of the chapter. Our ability to draw out the consequences of things we know by way of inference is another important source of knowledge, and some general features of how inference achieves its successes are discussed. Structural similarities between the ways in which perception works and the ways in which inference works are highlighted.

Ordovician and Mississippian stratigraphy in southwestern Missouri, USA

ABSTRACT A succession of Ordovician and Mississippian carbonates, separated unconformably, is exposed across the southern flank of the Ozark Dome in southwest Missouri. Deposits of both periods exemplify typical facies of the Midwestern United States: carbonate tidal-flat assemblages for the Early Ordovician and carbonate shelf environments for the Early–Middle Mississippian. The basic stratigraphic sequence of these deposits has been known for over a century, but interesting features remain to be addressed. Thin discontinuous sandstones are present within the Early Ordovician Cotter Dolomite, but the informal Swan Creek sandstone member seems anomalous. This sandstone can exceed 5 m in thickness and is fairly continuous across southwest Missouri. Most Ordovician sandstones in Missouri mark major transgressions above regional unconformities, but not the Swan Creek, and there is no obvious source of the sand. Therefore, we hypothesize that the Swan Creek represents reworked eolian dunes blown across the broad peritidal environment. Clastic sandstone dikes, apparently sourced from the Swan Creek, cut across beds of Cotter Dolomite near faults. We propose that these dikes are evidence of local faulting and seismicity during the Early Ordovician. Early and Middle Mississippian limestones comprise a sequence of shelf deposits, although mud mounds and other facies changes near the Missouri-Arkansas line mark the edge of the Mississippian shelf and the transition to a ramp setting. Early Mississippian carbonate deposition was interrupted by a short and localized influx of siliciclastic sediment comprising the Northview Formation. The Northview has additional characteristics consistent with a river-dominated deltaic deposit, which we suggest as its origin. If correct, this hypothesis implies that the history of tectonic features in the Midwest is more complicated than yet known. Finally, facies changes within and between the local Mississippian formations may record an early crustal response to the impending Ouachita orogeny farther to the south.

Combining genotypic and phenotypic variation in a geospatial framework to identify sources of mussels in northern New Zealand

The New Zealand green-lipped mussel aquaculture industry is largely dependent on the supply of young mussels that wash up on Ninety Mile Beach (so-called Kaitaia spat), which are collected and trucked to aquaculture farms. The locations of source populations of Kaitaia spat are unknown and this lack of knowledge represents a major problem because spat supply may be irregular. We combined genotypic (microsatellite) and phenotypic (shell geochemistry) data in a geospatial framework to determine if this new approach can help identify source populations of mussels collected from two spat-collecting and four non-spat-collecting sites further south. Genetic analyses resolved differentiated clusters (mostly three clusters), but no obvious source populations. Shell geochemistry analyses resolved six differentiated clusters, as did the combined genotypic and phenotypic data. Analyses revealed high levels of spatial and temporal variability in the geochemistry signal. Whilst we have not been able to identify the source site(s) of Kaitaia spat our analyses indicate that geospatial testing using combined genotypic and phenotypic data is a powerful approach. Next steps should employ analyses of single nucleotide polymorphism markers with shell geochemistry and in conjunction with high resolution physical oceanographic modelling to resolve the longstanding question of the origin of Kaitaia spat.

Prolapsed submucosal pyomyoma postpartum, a rare complication of fibroids

Background Pyomyoma is an unusual fibroid that usually develops during the puerperal or postmenopausal period. If not promptly diagnosed and treated, it can become life threatening. Although various conservative and surgical therapies have been discussed in the literature for this condition, there are very few reports related to the management of prolapsed pedunculated submucosal myoma. Case presentation In this case report, an intramural fibroid transformed into a pedunculated submucosal pyomyoma, which prolapsed into the vagina after a miscarriage and caused life-threatening toxic shock. Apart from prompt antibiotic treatment, a transabdominal myomectomy rather than hysterectomy was performed due to the very large diameter of the pyomyoma. As a result, fertility was preserved, and the patient conceived naturally and delivered a healthy baby two years later. Discussion and conclusions It is important to maintain strong clinical suspicion for pregnant or postpartum women with a triad of pain, sepsis without an obvious source and a known diagnosis of leiomyoma. Timely recognition and prompt surgical treatment with antibiotics are necessary and could conserve the uterus for future fertility.

Stream Flow

Changes in stream discharge after earthquakes are among the most interesting hydrologic responses because they are visible at Earth’s surface and can be dramatic. Here we focus on changes that persist for extended periods but have no obvious source. Such increases have been documented for a long time but their origins are still under debate. We first review some general characteristics of streamflow responses to earthquakes; we then discuss several mechanisms that have been proposed to explain these responses and the source of the extra water. The different hypotheses imply different crustal processes and different water–rock interactions during the earthquake cycle. In most instances, these hypotheses are under-constrained. We suggest that multiple mechanisms may be activated by an earthquake.

The Producer’s Liability in Negligence

Although the provisions of Pt I of the Consumer Protection Act 1987 imposing strict liability for damage caused by defective products are the primary source of tortious liability in the area covered by this work, they are by no means the sole such source. This is principally because of the limitations which have been placed on the scope of the Act. These affect such issues as the persons who are potentially subject to liability, the types of damage or loss covered, and in particular the exclusion of damage to commercial property, the incidence of limitation periods, and the fact that the Act does not apply to products which the defendant supplied before it came into force on 1 March 1988. Moreover, even where the Act is potentially applicable it will often be considered prudent to pursue alternative sources of liability, notably those which arise under the general law of negligence. Certainly, this has been the experience of the position in the United States. Nonetheless, in reading the text which follows it should be remembered that nowadays the Act is the most obvious source of liability in most cases in which it is claimed that a defective product has caused death, personal injury, or damage to what may be broadly termed consumer property.

Early empirical antimicrobial therapy does not prevent sepsis development in critically ill surgical patients with suspected nosocomial infection: a retrospective analysis

Background: Early administration of antibiotics to septic shock patients decreases in-hospital mortality, but there is a lack of studies evaluating the role of early empirical antibiotics in surgical patients with suspected nosocomial infection without sepsis. Methods: Retrospective cohort of adult patients admitted to a surgical Intensive Care Unit in a tertiary hospital. We defined early empirical antibiotic group by the initiation of antibiotic therapy within 24h after infection’s suspicion, and conservative group by antibiotic therapy initiation 24 hours after infection’s suspicion or not prescribed within 14 days. The primary outcome was a composite of death, septic shock or sepsis within 14 days from the clinical suspicion of infection. Regression models were used to identify associations between factors and the primary outcome. Results: From 2007 patients admitted to intensive care unit, 341 surgical patients (71% trauma patients) with suspected nosocomial infection without sepsis and with no obvious source of infection were included in the cohort. Age, gender, traumatic brain injury, admission type (trauma vs. non-trauma), SAPS 3, SOFA, vasopressor use or rate of mechanical ventilation did not differ between early empirical antibiotic and conservative groups. In the conservative group, 57% of patients received antibiotics within 14 days. The composite primary outcome occurred in 41% of patients in the conservative group and 56% in the early empirical antimicrobial group, (p=0.007). The 14-day incidence of septic shock or mortality was similar in both groups. Multivariate analysis showed early antimicrobial therapy (OR 1.83 [95% CI 1.16-2.88] , p = 0.008), non-trauma admission (OR 2.32 [1.40-3.90], p = 0.001) and mechanical ventilation (OR 2.09 [1.31-3.35], p = 0.002) were associated with the primary outcome. Exploratory analysis including only patients with positive cultures also did not find any benefit of early empiric antibiotic therapy (OR 1.39 [0.78-2.49], p = 0.26) Conclusions: Early empiric antibiotic therapy does not decrease the incidence of sepsis, septic shock or death within 14 days in critically ill stable surgical patients with suspected infection but with no obvious source.

Assédio Moral em análise: o status quo dos estudos na Administração

Os estudos quanto ao assédio moral no ambiente de trabalho são recentes no Brasil, pois datam de menos de 20 anos. Porém, embora recentes, vários autores vêm contribuindo de forma sistêmica para desvendar esse fenômeno quanto às causas e, principalmente, seus efeitos. Dessa forma, faz-se necessário analisar os estudos nacionais quanto às características das contribuições publicadas no meio científico, sobretudo, das ciências administrativas e áreas afins. O objetivo do presente artigo é elaborar um panorama geral da produção científica sobre assédio moral no âmbito nacional, tendo como delimitação da fonte de pesquisa os periódicos científicos nacionais. Para nortear o trabalho, de maneira sistêmica, os métodos foram balizados pelos princípios contidos nas leis que delimitam a análise bibliométrica. A ancoragem nas leis que formam a estrutura do rigor metodológico bibliométrico serviu para destacar aspectos intrínsecos da literatura nacional encontrada em revistas científicas. Os resultados mostram que ao considerar a mais importante base de indexação nacional, a Spell, é possível encontrar 46 trabalhos publicados em 27 diferentes periódicos, que foram elaborados por 93 autores. Além do mais, a Universidade Federal de Santa Catarina tem se apresentado como a mais profícua instituição de pesquisa, e o periódico Cadernos EBAPE.BR o meio de maior divulgação, dentre outros resultados. Por fim, a partir dos resultados encontrados, é possível evidenciar que a temática do assédio moral tem sido uma evidente fonte de pesquisa na área das ciências administrativas e áreas afim. Studies on moral harassment in the work environment are recent in Brazil, since they date from less than 20 years. However, although recent, several authors have contributed systemically to unravel this phenomenon regarding the causes and, mainly, their effects. Thus, it is necessary to analyze the national studies regarding the characteristics of the contributions published in the scientific environment, above all, the administrative sciences and related areas. The objective of this article is to elaborate an overview of the scientific production in moral harassment, at the national level, having as delimitation of the research source the national scientific journals. To guide the work, in a systemic way, the methods were marked by the principles contained in the laws that delimit the bibliometric analysis. The anchoring in the laws that form the structure of bibliometric methodological rigor served to highlight intrinsic aspects of the national literature found in scientific journals. The results show that when considering the most important national index base, Spell, it is possible to find 46 papers published in 27 different journals, which were elaborated by 93 authors. In addition, the Federal University of Santa Catarina has presented itself as the most profitable research institution, and the journal Cadernos EBAPE.BR, the most widely publicized medium, among other results. Finally, from the results found, it is possible to show that the issue of bullying has been an obvious source of research in the area of administrative sciences and related areas.

Where to Next? Unsolved Questions

The first ten chapters of this book are a kind of snapshot that captures the current state of knowledge and proposes a scenario for life’s beginning that is based on the properties of RNA described by Harry Noller in the epigraph (Noller, 2012). Despite this progress, there are still enormous gaps in our understanding that remain to be filled. The purpose of this chapter is to make those gaps explicit for future investigators who might be attracted to the question of how life can begin. Because life is an interacting system of immense complexity, each component of which is essential to cellular function as a living system, the gaps have little in common. They can be presented as a set of questions related to sources and properties of organic compounds, mechanisms for capturing energy, polymerization and replication of nucleic acids, the origin of ribosomes, and the transmission of genetic information. For each question, I will discuss one or more papers that could provide clues to an answer and then add some ideas that might serve as guides to future research. A source of mononucleotides is a problem not just for the hypothesis being presented in this book but for any proposed pathway to the origin of life. Unlike amino acids, there is no obvious source of mononucleotides, for the following reasons: Three different molecular species must be present in an aqueous solution at concentrations sufficient for a reaction to occur. They must somehow, even in this mixture of organic solutes, form a specific ester bond between a phosphate and a ribose, then must form an N-glycoside bond between the ribose and a nucleobase (Fig. 11.1), and these reactions must occur spontaneously in a hydrothermal environment. Furthermore, it is not enough for one base to occur in the solution, all four (adenine, uracil, guanine, and cytosine) must be present.