P-P24 Optimising post-operative nutrition in patients undergoing pancreaticoduodenectomy

Background A considerable number of patients undergoing pancreaticoduodenectomy require supplemental nutrition in the postoperative period. However, there remains no national consensus on the optimal postoperative supplemental feeding modality. Furthermore, at our institution a variation in practice exists when considering post-operative entera (via the naso-jejunal (NJ)) or parenteral nutrition (PN). This study aimed to evaluate the utility of post-operative enteral or parenteral nutrition at our centre and to explore risk factors predisposing patients to post-operative nutritional deficits requiring supplementation. Methods We retrospectively analysed the electronic case records of all patients undergoing a pancreaticoduodenectomy between November 2019 and November 2020 at our HPB specialist centre. Key patient demographic data and post-operative nutritional requirements with route, length and indication for supplemental feeding as well as biochemical markers, length of stay (LoS) and complications were collected and analysed. Data were analysed via intention to treat analysis. Results 48 patients underwent a pancreaticoduodenectomy, of which 26 had an NJ tube inserted intra-operatively. 16 (33%) patients required supplemental feeding, via NJ route in 7 and PN in 9. 2 patients were intolerant to NJ feeds and progressed to PN. NJ fed patients had shorter LoS (12(10-42) vs. 28(14-63) days)(p = 0.09) compared to PN feeding. PN-related line infection or thrombosis in 4 (36%) patients. Supplemental feeding met daily kcal requirements in 13 (81%) patients, but PN was associated with greater weight loss (-5%) than NJ feeding (-3%). Significantly increasing the risk of needing supplemental nutrition: advanced age(p = 0.04), ASA≥2(p = 0.04) and anastomotic leak(p = 0.02). Conclusions In this group of patients, NJ feeding was largely well-tolerated and the majority of patients met their required daily kcal via this route. Due to the increased incidence of complications associated with PN, NJ feeding should be considered as the 1st line option for post-operative nutritional supplementation, with intra-operative insertion of an NJ tube considered for higher-risk patients.

Crack 2.0

The 1984 Sentencing Reform Act charged the U.S. Sentencing Commission with developing sentencing guidelines that advanced the purposes of sentencing under 18 U.S.C. § 3553(a). After the Supreme Court cases Booker, Kimbrough, Gall, and Spears, it is now well established—at least with federal drug trafficking offenses—that the Commission did not fulfill that directive. The magnitude of that failure (coupled with some of Congress’s own misguided decisions) has previously been highlighted by the evolution of federal crack sentencing policies, the Fair Sentencing Act, the related line of Supreme Court cases, and more recently the First Step Act. Congress’s compromise correction of over twenty years (essentially a generation) of a failed war on crack did nothing to further correct similar defects with federal drug sentencing policies for other controlled substances—particularly with respect to methamphetamine. Given the resurgence of methamphetamine trafficking, use, and prosecutions, this paper will analyze post-1988 federal methamphetamine sentencing policy to illustrate how the drug-type, quantity, and purity model for punishing drug trafficking offenses still produces unwarranted sentencing disparities between similar controlled substances or different forms of the same controlled substances—and in the end plainly fails to effectively deter the targeted criminal conduct or advance the purposes of federal sentencing under 18 U.S.C. § 3553(a).

Rejecting Constituent Power

This chapter examines two related traditions of thought that reject the existence of an extra-legal constituent power or deprive it of one of its main features. The first of these traditions, the doctrine of the historical or internal constitution, presented a direct challenge to the theory of constituent power. In Spain, the main exponent of this doctrine during the 19th century was Gaspar Melchor de Jovellanos, who held that rather than the result of an act of will, constitutions emerged through long historical processes and could not be simply created and recreated. The second (and related) line of attack against the concept of constituent power during the 19th century came from the French and Spanish doctrinaires. The doctrinaires rejected the idea that the people (or any other individual or group) had a right to create new constitutional orders. For them, sovereign authority belonged to reason itself, not to the monarch or the community. The chapter examines the practical implications of these ideas by exploring the debates that took place during the adoption of the Spanish Constitution of 1845.

Resilience

A consistent finding from research on animal models of depression and PTSD is that some animals are highly susceptible to the effects of stressful stimulation, while others show few obvious effects. A relatively new of line of research on resilience has emerged and has directed attention to those animals that are resistant to the effects of chronic or traumatic stressors. By tracking animals that are resistant to the behavioral effects of these stressful paradigms, one can then explore the molecular underpinnings of resilience in the brains of these same animals. Using chronic social defeat stress, some investigators have focused their attention on the ventral tegmental area, nucleus accumbens, and the prefrontal cortex. Other systems that have been studied include signaling molecules of the immune system and communication pathways between the immune system and the brain. A related line of research has addressed the possibility that prior exposure to stressors may inoculate animals to the deleterious effects of later stressor exposure.

A new Spirodela polyrhiza genome and proteome reveal a conserved chromosomal structure with high abundances of proteins favoring energy production

Duckweeds are a monophyletic group of rapidly reproducing aquatic monocots in the Lemnaceae family. Spirodela polyrhiza, the Greater Duckweed, has the largest body plan yet the smallest genome size in the family (1C = 150 Mb). Given their clonal, exponentially fast reproduction, a key question is whether genome structure is conserved across the species in the absence of meiotic recombination. We generated a highly contiguous, chromosome-scale assembly of Spirodela polyrhiza line Sp7498 using Oxford Nanopore plus Hi-C scaffolding (Sp7498_HiC) which is highly syntenic with a related line (Sp9509). Both the Sp7498_HiC and Sp9509 genome assemblies reveal large chromosomal misorientations in a recent PacBio assembly of Sp7498, highlighting the necessity of orthogonal long-range scaffolding techniques like Hi-C and BioNano optical mapping. Shotgun proteomics of Sp7498 verified the expression of ∼2,250 proteins and revealed a high abundance of proteins involved in photosynthesis and carbohydrate metabolism among other functions. In addition, a strong increase in chloroplast proteins was observed that correlated to chloroplast density. This Sp7498_HiC genome was generated cheaply and quickly with a single Oxford Nanopore MinION flow cell and one Hi-C library in a classroom setting. Combining these data with a mass spectrometry-generated proteome illustrates the utility of duckweed as a model for genomics- and proteomics-based education.

Considering a Holistic Focus of Attention as an Alternative to an External Focus

Empirical findings consistently suggest that an external focus of attention leads to superior performance when compared to an internal focus by encouraging more automatic processing. However, for certain skills (e.g., gymnastics routines) it can be challenging to identify a meaningful external focus cue. A related line of research suggests that focusing on the general feeling of a movement (i.e., holistic focus) may also be useful in avoiding conscious control of movements. The purpose of this study was to determine how an internal focus (INT), external focus (EXT), and holistic focus (HOL) impact the performance of a standing long jump. Participants (N = 27) completed two baseline jumps followed by two jumps in each focus condition. Jump distance was analyzed in a 6 (Order) × 4 (Focus) mixed ANOVA. Results indicated a significant main effect of focus (p < .001), with EXT and HOL resulting in farther jumps than INT and baseline conditions (p-values < .05). EXT and HOL did not differ significantly from each other, and INT did not differ significantly from baseline. The findings suggest that a holistic focus can be another effective means of avoiding conscious control of movement when an external focus is not practical or desired.

Trackless mourning: the mobilities of love and loss

In response to recent work in cultural geography on the spatial practices of mourning and remembrance, I draw upon my own research on the discourse of romantic love (in the field of literary and cultural theory) in order to theorise a connection between the memorial practices associated with the ‘life’ of a relationship and those pursued in retrospect. Through a focus on embodied mobility, I propose that there are implicit links between the way in which we create and store memories ( à propos Bergson), the way we protect and project them (the processes commonly associated with nostalgia) and the way we activate them in later years (memorialisation). A secondary – but related – line of argument concerns the distinction between public (and ‘spectacular’) and private (and ‘invisible’) memorial practices and the function of mobilities of various kinds within each. With reference to a small selection of autobiographical and literary texts, I reflect upon the way in which burials (in the Christian tradition) have, for centuries, been inscribed by spectacular hypermobility (for the deceased as well as the bereaved) and how, by contrast, our more private memorial practices are often invisible precisely because they exist only as micro-mobilities of some kind. For while mourning may involve visits to memorials in the landscape (as explored in the work of Avril Maddrell and others), it may equally take the form of walks (or drives) devoid of both destination and visible trace (what I refer to here as a ‘trackless mourning’) or express itself in the smallest of gestures that, unbeknown to the world, unite the deceased and the bereaved.

Devastating Monsoon: Water Induced Disaster Management Practices in Nepal

Nepal is prone to a variety of recurring natural disasters such as floods, landslides, snow avalanches, thunderstorms, drought, earth quake and epidemics. In particular, floods, landslides, hailstorms and drought are almost regular phenomena. This paper has focused mainly on water induced disaster (Monsoon) prepared through review of documents, consultation with related line agencies and field level interaction with affected communities. The paper also seeks to explore and document the major disasters and their impacts in Nepal. It discusses policy and program, institutional arrangement and activities related to the disaster management as well as identification of gaps in the policy and program. Nepal has attempted to manage the prevalence of these hazards and their associated disasters through both informal civic involvement and formal government instruments. A legal and policy environment to deal with disasters has existed in one or the other form in Nepal since 1982, and these have been reviewed. Study showed that disaster management activities only found initial response rather post disaster program. However, findings of the previous and present programs and activities on disaster management have not addressed effectively to the vulnerable people and to reduce the impact from disasters at the local level. It is suggested that disaster management policy and program should be integrated and mainstreamed in development agenda.

Antalya İli Tarıma Dayalı Sanayinin Yapısal Analizi

In the province of Antalya, agriculture and tourism sectors with their added value come into the prominence in this economic integration. Agro-industries accelerated from agriculture sector have taken their places in this integration. For this purpose, a survey was carried out with agricultural-based industrial enterprises operating in Antalya province. With the help of the data obtained from the questionnaires, an industrial transaction table was created. In this table, input-output coefficients matrix was reached and production multipliers on the sectors were calculated through the operations of the leontief matrix. In this study, agriculture-based industrial sectors were grouped and reduced to 9 sectors. According to the results obtained, the sector that provides the highest contribution in terms of production multipliers is vegetable production. This means that the total of the Leontif reverse matrix column of this sector is 3.26904, which means that the increase in production in the vegetable production sector will be 3.26904 times higher than the increase in production in the other nine sectors in response to a one-unit increase in production in the vegetable production sector. This sector is followed by the fruit and vegetable processing industry with 3.07305 coefficient vegetable oils and 2.736016. Sugary products industry 1.76583 coefficient was calculated. With these coefficients, it can be said that these sub-sectors have made significant contributions. In all of the studied sectors, if production is increased by one unit, there is another reproduction which gives rise to the production of the sector in the related line. Accordingly, the coefficient of bakery products sector is 2.660875 and is the highest. According to this figure, if the production of the other eight sectors examined increase one unit, it can be said that bakery products will be required to increase the input level of the industry to eight sectors by 2.66 times.