Geometric-phase interference in a Mn12 single-molecule magnet with fourfold rotational symmetry.

We study the magnetic relaxation rate Γ of the single-molecule magnet Mn(12)-tBuAc as a function of the magnetic field component H(T) transverse to the molecule's easy axis. When the spin is near a magnetic quantum tunneling resonance, we find that Γ increases abruptly at certain values of H(T). These increases are observed just beyond values of H(T) at which a geometric-phase interference effect suppresses tunneling between two excited energy levels. The effect is washed out by rotating H(T) away from the spin's hard axis, thereby suppressing the interference effect. Detailed numerical calculations of Γ using the known spin Hamiltonian accurately reproduce the observed behavior. These results are the first experimental evidence for geometric-phase interference in a single-molecule magnet with true fourfold symmetry.

Reading a preoperative CT scan to guide complex abdominal wall reconstructive surgery.

Computed tomography (CT) scanning is the imaging modality of choice when planning the overall management and operative approach to complex abdominal wall hernias. Despite its availability and well-recognised benefits there are no guidelines or recommendations regarding how best to read or report such scans for this application. In this paper we aim to outline an approach to interpreting preoperative CT scans in abdominal wall reconstruction (AWR). This approach breaks up the interpretive process into 4 steps-concentrating on the hernia or hernias, any complicating features of the hernia(s), the surrounding soft tissues and the abdominopelvic cavity as a whole-and was developed as a distillation of the authors' collective experience. We describe the key features that should be looked for at each of the four steps and the rationale for their inclusion.

Separating the components of an abdominal wall fellowship.

Complex abdominal wall reconstruction is an emerging subspecialty yet, despite the abundance of abdominal wall hernias requiring treatment and the increasing complexity of this type of surgery, there are few opportunities for surgeons to gain subspecialist training in this field. In this paper we discuss the need for focused training in complex abdominal wall reconstruction, outline some of the problems that may be hindering the availability of such opportunities and propose potential solutions to these issues.

Physical activity recommendations pre and post abdominal wall reconstruction: a scoping review of the evidence.

PURPOSE: There are no universally agreed guidelines regarding which types of physical activity are safe and/or recommended in the perioperative period for patients undergoing ventral hernia repair or abdominal wall reconstruction (AWR). This study is intended to identify and summarise the literature on this topic. METHODS: Database searches of PubMed, CINAHL, Allied & Complementary medicine database, PEDro and Web of Science were performed followed by a snowballing search using two papers identified by the database search and four hand-selected papers of the authors' choosing. Inclusion-cohort studies, randomized controlled trials, prospective or retrospective. Studies concerning complex incisional hernia repairs and AWRs including a "prehabilitation" and/or "rehabilitation" program targeting the abdominal wall muscles in which the interventions were of a physical exercise nature. RoB2 and Robins-I were used to assess risk of bias. Prospero CRD42021236745. No external funding. Data from the included studies were extracted using a table based on the Cochrane Consumers and Communication Review Group's data extraction template. RESULTS: The database search yielded 5423 records. After screening two titles were selected for inclusion in our study. The snowballing search identified 49 records. After screening one title was selected for inclusion in our study. Three total papers were included-two randomised studies and one cohort study (combined 423 patients). All three studies subjected their patients to varying types of physical activity preoperatively, one study also prescribed these activities postoperatively. The outcomes differed between the studies therefore meta-analysis was impossible-two studies measured hernia recurrence, one measured peak torque. All three studies showed improved outcomes in their study groups compared to controls however significant methodological flaws and confounding factors existed in all three studies. No adverse events were reported. CONCLUSIONS: The literature supporting the advice given to patients regarding recommended physical activity levels in the perioperative period for AWR patients is sparse. Further research is urgently required on this subject.

Standards of practice in UK emergency departments before, during and after conscious sedation.

BACKGROUND: The agents used for conscious sedation are well known to have potentially serious complications. It is recommended that patients receiving them should be objectively monitored until it is deemed safe. An audit of our departmental practices led us to conduct a national questionnaire to determine how we compared with other units in the UK. METHODS: All 211 UK emergency departments (EDs) seeing >40,000 patients/year were contacted and asked to take part in a telephone questionnaire. Interviewees were asked questions regarding which agents were used within their department, the types and duration of monitoring, whether or not patients were fasted, what consent was recorded, the number of staff present and who they were, and what follow-up arrangements were used. RESULTS: 183 departments (87%) completed the questionnaire. Opiates (77%) and benzodiazepines (97%) were the most commonly used agents. Heart rate/blood pressure monitoring (95%), ECG (86%) and pulse oximetry (97%) were used in the majority of cases. Other monitoring modalities, particularly neurological, were either used or documented infrequently. 112 departments (61%) monitored their patients for a set time (4-360 min; mean 97 min). The remainder were monitored until the patient scored a certain Glasgow Coma Score or was subjectively deemed fit. Only 24 departments (13%) ensured that their patients were fasted. 62 departments (34%) did not formally record either written or verbal consent. 80 departments (44%) had 2 members of staff present; the remainder had a minimum of 3. All departments had at least 1 ED doctor and nurse. 174 departments (95%) used fracture clinic follow-up. For conscious sedation, 51 departments (28%) had set proformas and 54 departments (30%) had set policies. CONCLUSION: Certain practices were applied in most departments but none were universal, with most being subject to wide variation. The local results reflected this, suggesting that a variation may exist both within and between individual units.

Nonspecific enhancement of host defenses against infection: experimental evidence of a new order of efficacy and safety.

Enhancement of nonspecific host defenses against bacterial challenge has been a long-standing goal often thwarted by variable efficacy, inconsistent bioassay, and paradoxic immunosuppression. Muramyl dipeptide provides enhanced survival after intravenous challenge with less than 8 x 10(3) Klebsiella, as well as improved local control of infection at sites of intramuscular bacterial injection, with and without a surgical foreign body. No depression of host response was seen over wide ranges of doses and intervals. Muramyl dipeptide provides a new order of efficacy and safety and warrants continued careful assessment.

The Latino Health Advocacy Program: a collaborative lay health advisor approach.

There have been numerous calls in the literature for health educators to develop programs to improve access to and utilization of health and human services by traditionally underserved communities, including Latinos. While the literature suggests several principles that can guide the development of these programs, it is important to address the needs, and build on the strengths, of the specific community of interest. It is, therefore, important to use collaborative approaches in which community members take an active role in the initiation, design, implementation, and evaluation of program activities. Lay health advisor programs are particularly well suited to this approach as they are designed to build on the strength of already existing community relationships to improve community health. This article describes a collaborative, culturally appropriate, holistic, and ecological lay health advisor program--the Latino Health Advocacy Program. Lessons learned and implications for future program development are discussed.

Preoperatively determinable factors predictive of diabetes mellitus remission following Roux-en-Y gastric bypass: a review of the literature.

It is well established that weight loss in general and bariatric surgery in particular can improve glycaemic control in diabetics. Current NICE guidelines recommend that those patients with type 2 diabetes mellitus and a BMI of 35 kg/m(2) or more should be considered for bariatric surgery in order to optimise their glycaemic control and minimise their risk of long-term complications. The commonest bariatric procedure in the UK is the Roux-en-Y gastric bypass that has been shown to result in long-standing type 2 diabetes resolution in 83 % of patients. Since such surgery carries a small but significant risk of mortality, as well as posing considerable lifestyle implications for the patient, numerous studies have been performed with a view to identifying which patients and which procedures are most likely to result in these desired benefits. This paper summarises the existing literature on this topic.