How to deal with an open abdomen?

Appropriate open abdomen treatment is one of the key elements in the management of patients who require decompressive laparotomy or in whom the abdomen is left open prophylactically. Apart from fluid control and protection from external injury, fluid evacuation and facilitation of early closure are now the goals of open abdomen treatment. Abdominal negative pressure therapy has emerged as the most appropriate method to reach these goals. Especially when combined with strategies that allow progressive approximation of the fascial edges, high closure rates can be obtained. Intra-abdominal pressure measurement can be used to guide the surgical strategy and continued attention to intra-abdominal hypertension is necessary. This paper reviews recent advances as well as identifying the remaining challenges in patients requiring open abdomen treatment. The new classification system of the open abdomen is an important tool to use when comparing the efficacy of different strategies, as well as different systems of temporary abdominal closure

Biotechnological conversion of methane to methanol: evaluation of progress and potential

Sources of methane are numerous, and vary greatly in their use and sustainable credentials. A Jekyll and Hyde character, it is a valuable energy source present as geological deposits of natural gas, however it is also potent greenhouse gas, released during many waste management processes. Gas-to-liquid technologies are being investigated as a means to exploit and monetise non-traditional and unutilised methane sources. The product identified as having the greatest potential is methanol due to it being a robust, commercially mature conversion process from methane and its beneficial fuel characteristics. Commercial methane to methanol conversion requires high temperatures and pressures, in an energy intensive and costly process. In contrast methanotrophic bacteria perform the desired transformation under ambient conditions, using methane monooxygenase (MMO) enzymes. Despite the great potential of these bacteria a number of biotechnical difficulties are hindering progress towards an industrially suitable process. We have identified five major challenges that exist as barriers to a viable conversion process that, to our knowledge, have not previously been examined as distinct process challenges. Although biotechnological applications of methanotrophic bacteria have been reviewed in part, no review has comprehensively covered progress and challenges for a methane to methanol process from an industrial perspective. All published examples to date of methanotroph catalysed conversion of methane to methanol are collated, and standardised to allow direct comparison. The focus will be on conversion of methane to methanol by whole-cell, wild type, methanotroph cultures, and the potential for their application in an industrially relevant process. A recent shift in the research community focus from a mainly biological angle to an overall engineering approach, offers potential to exploit methanotrophs in an industrially relevant biotechnological gas-to-liquid process. Current innovations and future opportunities are discussed

Abdominal compliance: A bench-to-bedside review

Abdominal compliance is an important determinant and predictor of available workspace during laparoscopic surgery. Furthermore, critically ill patients with a reduced abdominal compliance are at an increased risk of developing intra-abdominal hypertension and abdominal compartment syndrome both of which are associated with high morbidity and mortality. Despite of this, abdominal compliance is a concept, which has been neglected in the past. Abdominal compliance is defined as a measure of the ease of abdominal expansion, expressed as a change in intra-abdominal volume per change in intra-abdominal pressure: abdominal compliance = delta intra-abdominal volume / delta intra-abdominal pressure. AC is a dynamic variable, dependent on base-line IAV and IAP as well as reshaping and stretching capacity. Whereas abdominal compliance itself can only rarely be measured, it always needs to be considered an important component of intra-abdominal pressure. Patients with decreased abdominal compliance are prone to fulminant development of abdominal compartment syndrome when concomitant risk factors for intra-abdominal hypertension are present. This review aims to clarify the pressure-volume relationship within the abdominal cavity. It highlights how different conditions and pathologies can affect abdominal compliance and which management strategies could be applied to avoid serious consequences of decreased abdominal compliance. We have pooled all available human data to calculate abdominal compliance values in patients acutely and chronically exposed to intra-abdominal hypertension and demonstrated an exponential abdominal pressure-volume relationship. Most importantly, patients with high level of intra-abdominal pressure have a reduced abdominal compliance. In these patients, only small reduction in intra-abdominal volume can significantly increase abdominal compliance and reduce intra-abdominal pressures. A greater knowledge on abdominal compliance may help in selecting a better surgical approach as well as reducing complications related to intra-abdominal hypertension

Inclusive early childhood education : an analysis of 32 European examples

This report is part of the three-year Inclusive Early Childhood Education (IECE) project run by the European Agency for Special Needs and Inclusive Education (the Agency) from 2015 to 2017. The project aims to identify, analyse and subsequently promote the main characteristics of quality inclusive pre-primary education for all children from three years of age to the start of primary education. This report presents the results of a qualitative analysis of 32 descriptions of examples of IECE provisions across Europe. The descriptions were submitted to the project in August 2015. The findings represent European practitioners’ perceptions of and practices for IECE. An inductive thematic data analysis method was used, in that themes or issues were initially derived from reading the descriptions. This inductive process was, however, also intertwined with relevant theory, particularly the Agency’s ‘ultimate vision for inclusive education systems’ that: ... ensure that all learners of any age are provided with meaningful, high‐quality educational opportunities in their local community, alongside their friends and peers(European Agency, 2015, p. 1). In total, 25 subthemes were identified. These were organised into a new Ecosystem Model of Inclusive Early Childhood Education, which is also presented in a comprehensive diagram (Figure 1). Two major perspectives previously used in describing the quality of ECE settings inspired this new model. These are the Outcome-Process-Structure model and the Ecological Systems model. The subthemes were subsequently grouped into five main themes: • Theme 1: The first main and central theme is ‘Child belongingness, engagement and learning’, often generally understood as active participation. This participation is regarded as both the main outcome and process of IECE. • Theme 2: Five major processesinvolving the child’s direct experience in the IECE setting enable this central outcome and process. These processes are: − Positive interaction with adults and peers − Involvement in play and other daily activities − A child-centred approach − Personalised assessment for learning − Accommodations, adaptations and support. • Theme 3: These processes are in turn supported by structural factors, consisting of the physical, social, cultural and educational environment. These factors may operate at different ecological levels. Some operate within the ECE setting and include: − A warm welcome for every child and family − Family involvement within the ECE setting. − A holistic curriculum designed for all children’s needs − An environment designed for all children − Staff who are appropriately qualified for IECE − A culturally-responsive social and physical environment − Inclusive leadership committed to respect and engagement for all individuals − Collaboration and shared responsibility among all stakeholders. • Theme 4: Inclusive processes experienced by the child are also influenced by more distant structural factors in the community surrounding the ECE setting. These include: − Collaboration between the ECE setting and the children’s families − Relevant in-service training for ECE staff − Wider community commitment and support for serving all children − Inter-disciplinary and inter-agency co-operation of services from outside the ECE setting that serve the children in the pre-school − Organising smooth transitions between home and the ECE setting. • Theme 5: Finally, the analysis found a number of structural factors operating at the macro-system level. These factors were not in direct contact with the ECE setting. However, they still influenced inclusive processes in the setting. They are: − A rights-based approach to ECE − Provision of mainstream ECE access for all − Setting up regional/national standards for a holistic IECE curriculum − Availability of initial education for teachers and other staff for IECE − Good governance and funding systems for IECE − Procedures for regular monitoring and evaluation. This overview of the ecosystem of outcomes, processes and structures for IECE is presented in the Results chapter. Five evidence-based chapters, dedicated to each of the five main themes, follow this. Each chapter presents a brief description of each of the outcome, process or structural factors within each main theme. These are accompanied by one to five quotations from each of the 32 example descriptions. The quotations illustrate and provide concrete evidence of what constitutes quality outcomes, processes and structures that are prevalent across Europe. The quotations were chosen both to reflect the different types of IECE concepts and practices, and to reflect the variety of countries and cultures where they occur. They are intended to stimulate inclusive developments in research, policy and practice in Europe and internationally. Finally, the Conclusion highlights the added value that this analysis contributes to IECE research, policy and practice. Four new insights are addressed: 1. The development of the new Ecosystem Model of IECE, inspired by two previous major models, should clarify the understanding of the issues related to quality ECE. 2. The analysis shows how, within an inclusive perspective, IECE’s primary goal is best conceived as that of ensuring quality outcomes for all children in terms of participation. This is described here as belongingness, engagement and learning. 3. The analysis shines a new light on the major processes in which children are directly involved and which mostinfluence each child’s participation and learning. These need to be a major focus of any intervention to improve ECE quality. 4. The analysis clarifies the structural factors needed to support the development of more inclusive ECE settings. It also shows how these factors are related to local and national policies and practices. Situating the structures at the ECE setting, community and regional/national levels isimportant in levering them to bring about the changes needed to enable each child to participate and learn.peer-reviewe

The interplay between the surface and bottom water environment within the Benguela Upwelling System over the last 70 ka

The Benguela Upwelling System (BUS), located between 30 and 20°S, is one of the fundamentalhigh-productivity systems of the world ocean. The BUS has previously been studied in terms of primaryproductivity and ecology over glacial-interglacial timescales; however, the response and coupling with thebenthic environment have received little attention. Here, for the ?rst time, we present a high-resolutionreconstruction of the BUS highlighting the link between surface and benthic productivity and their responseto climatic and oceanographic changes over the last 70 ka. The study is based on benthic foraminiferal faunalanalysis together with analyses of diatom assemblages, grain size of the terrigenous fraction, and stable Oand C isotopic and bulk biogenic components of core GeoB3606-1. We reveal signi?cant shifts in benthicforaminiferal assemblage composition. Tight coupling existed between the surface and bottom waterenvironment especially throughout marine isotope stages 4 and 3 (MIS4 and MIS3). Due to the high exportproduction, the site has essentially experienced continuous low oxygen conditions; however, there are timeperiods where the hypoxic conditions were even more notable. Two of these severe hypoxic periods wereduring parts of MIS4 and MIS3 where we ?nd an inverse relationship between diatom and benthicforaminifera accumulation, meaning that during times of extremely high phytodetritus export we notestrongly suppressed benthic productivity. We also stress the importance of food source for the benthosthroughout the record. Shifts in export productivity are attributed not only to upwelling intensity and?lament front position, but also, regional-global climatic and oceanographic changes had signi?cant impacton the BUS dynamics

A Bias-Aware EnKF Estimator for Aerodynamic Flows

Ensemble methods can integrate measurement data and CFD-based models to estimate the state of fluid systems in a robust and cost-efficient way. However, discretization errors can render numerical solutions a biased representation of reality. Left unaccounted for, biased forecast and observation models can lead to poor estimator performance. In this work, we propose a low-rank representation for the bias whose dynamics is represented by a colorednoise process. System state and bias parameters are simultaneously corrected on-line with the Ensemble Kalman Filter (EnKF) algorithm. The proposed methodology is demonstrated to achieve a 70% error reduction for the problem of estimating the state of the two-dimensional low-Re flow past a flat plate at high angle of attack using an ensemble of coarse-mesh simulations and pressure measurements at the surface of the body, compared to a bias-blind estimator. Strategies to determine the bias statistics and to deal with nonlinear observation functions in the context of ensemble methods are discussed

Population assessment of future trajectories in coronary heart disease mortality.

Background: Coronary heart disease (CHD) mortality rates have been decreasing in Iceland since the 1980s, largely reflecting improvements in cardiovascular risk factors. The purpose of this study was to predict future CHD mortality in Iceland based on potential risk factor trends. Methods and findings: The previously validated IMPACT model was used to predict changes in CHD mortality between 2010 and 2040 among the projected population of Iceland aged 25–74. Calculations were based on combining: i) data on population numbers and projections (Statistics Iceland), ii) population risk factor levels and projections (Refine Reykjavik study), and iii) effectiveness of specific risk factor reductions (published meta-analyses). Projections for three contrasting scenarios were compared: 1) If the historical risk factor trends of past 30 years were to continue, the declining death rates of past decades would level off, reflecting population ageing. 2) If recent trends in risk factors (past 5 years) continue, this would result in a death rate increasing from 49 to 70 per 100,000. This would reflect a recent plateau in previously falling cholesterol levels and recent rapid increases in obesity and diabetes prevalence. 3) Assuming that in 2040 the entire population enjoys optimal risk factor levels observed in low risk cohorts, this would prevent almost all premature CHD deaths before 2040. Conclusions: The potential increase in CHD deaths with recent trends in risk factor levels is alarming both for Iceland and probably for comparable Western populations. However, our results show considerable room for reducing CHD mortality. Achieving the best case scenario could eradicate premature CHD deaths by 2040. Public health policy interventions based on these predictions may provide a cost effective means of reducing CHD mortality in the future

Automated Phase Mapping with AgileFD and its Application to Light Absorber Discovery in the V-Mn-Nb Oxide System

Rapid construction of phase diagrams is a central tenet of combinatorial materials science with accelerated materials discovery efforts often hampered by challenges in interpreting combinatorial x-ray diffraction datasets, which we address by developing AgileFD, an artificial intelligence algorithm that enables rapid phase mapping from a combinatorial library of x-ray diffraction patterns. AgileFD models alloying-based peak shifting through a novel expansion of convolutional nonnegative matrix factorization, which not only improves the identification of constituent phases but also maps their concentration and lattice parameter as a function of composition. By incorporating Gibbs’ phase rule into the algorithm, physically meaningful phase maps are obtained with unsupervised operation, and more refined solutions are attained by injecting expert knowledge of the system. The algorithm is demonstrated through investigation of the V-Mn-Nb oxide system where decomposition of eight oxide phases, including two with substantial alloying, provides the first phase map for this pseudo-ternary system. This phase map enables interpretation of high-throughput band gap data, leading to the discovery of new solar light absorbers and the alloying-based tuning of the direct-allowed band-gap energy of MnV2O6. The open-source family of AgileFD algorithms can be implemented into a broad range of high throughput workflows to accelerate materials discovery