Consensus exercise identifying priorities for research in the field of general surgery of childhood in the UK.

BACKGROUND: The evidence base underlying clinical practice in children's general surgery is poor and high-quality collaborative clinical research is required to address current treatment uncertainties. The aim of this study was, through a consensus process, to identify research priorities for clinical research in this field amongst surgeons who treat children. METHODS: Questions were invited in a scoping survey amongst general surgeons and specialist paediatric surgeons. These were refined by the study team and subsequently prioritized in a two-stage modified Delphi process. RESULTS: In the scoping survey, a total of 226 questions covering a broad scope of children's elective and emergency general surgery were submitted by 76 different clinicians. These were refined to 71 research questions for prioritization. A total of 168 clinicians took part in stage one of the prioritization process, and 157 in stage two. A 'top 10' list of priority research questions was generated for both elective and emergency general surgery of childhood. These cover a range of conditions and concepts, including inguinal hernia, undescended testis, appendicitis, abdominal trauma and enhanced recovery pathways. CONCLUSION: Through consensus amongst surgeons who treat children, 10 priority research questions for each of the elective and emergency fields have been identified. These should provide a basis for the development of high-quality multicentre research projects to address these questions, and ultimately improve outcomes for children requiring surgical care.

Mapping the lateral extent of human cadaver decomposition with soil chemistry.

Soil below decomposing cadavers may have a different lateral spatial extent depending upon whether scavengers have access to the human cadaver or not. We examined the lateral spatial extent of decomposition products to a depth of 7cm of soils beneath two decomposing corpses, one in which the subject was autopsied, unclothed and placed under a wire cage to restrict scavenger access and one in which the subject was not autopsied, unclothed and exposed to scavengers. The two bodies had accumulated degree days (ADD) of 5799 and 5469 and post mortem interval (PMI) of 288 and 248d, respectively. The spatial extent for dissolved organic carbon (DOC) and organic nitrogen (DON) for both bodies was large but similar suggesting some movement off site for both compounds. Mean DOC was 1087±727 and 1484±1236µgg(-1) dry soil under the two corpses relative to 150±68µgg(-1) in upslope control soils. Sulfate tended to have 'hot spots' of lower values relative to the control soils indicative of anaerobic respiration. pH was lower and electrical conductivity was higher in the soil under both decomposing cadavers relative to control soils. Some of the nutrients examined downslope of the human remains were significantly higher than control soils upslope suggesting movement of decomposition products off-site which could be an important factor when using human remains detector dogs.

Effects of aerobic exercise training on cognitive function and cortical vascularity in monkeys.

This study examined whether regular exercise training, at a level that would be recommended for middle-aged people interested in improving fitness could lead to improved cognitive performance and increased blood flow to the brain in another primate species. Adult female cynomolgus monkeys were trained to run on treadmills for 1 h a day, 5 days a week, for a 5 month period (n=16; 1.9+/-0.4 miles/day). A sedentary control group sat daily on immobile treadmills (n=8). Half of the runners had an additional sedentary period for 3 months at the end of the exercise period (n=8). In all groups, half of the monkeys were middle-aged (10-12 years old) and half were more mature (15-17 years old). Starting the fifth week of exercise training, monkeys underwent cognitive testing using the Wisconsin General Testing Apparatus (WGTA). Regardless of age, the exercising group learned to use the WGTA significantly faster (4.6+/-3.4 days) compared to controls (8.3+/-4.8 days; P=0.05). At the end of 5 months of running monkeys showed increased fitness, and the vascular volume fraction in the motor cortex in mature adult running monkeys was increased significantly compared to controls (P=0.029). However, increased vascular volume did not remain apparent after a 3-month sedentary period. These findings indicate that the level of exercise associated with improved fitness in middle-aged humans is sufficient to increase both the rate of learning and blood flow to the cerebral cortex, at least during the period of regular exercise.