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The use of drains, including suction drains in neurosurgery is individual preference-based, rather than scientific evidence-based. Furthermore, the use of suction drains has been associated with significant risks to patients, including sudden death. We present 2 cases of unfortunate sudden deaths following uneventful cranioplasty procedures, both of which were associated with the use of a suction drain. We also review the literature focusing on the benefits and risks in the use of suction drains, and discuss pathophysiological mechanisms underlying sudden death associated with their use. There is no substantial evidence to support the use of suction drains in neurosurgery. Furthermore, they have been associated with significant complications, including risk to life. Our experience and literature review suggest that the risk of sudden death is disproportionately higher following cranioplasty. We do not recommend the use of suction drains in cranial neurosurgery, and we strongly recommend against their use in cranioplasty procedures. [ABSTRACT FROM AUTHOR]

Cranioplasty remains an essential procedure following craniectomy but is associated with high morbidity. We investigated factors associated with outcomes following first alloplastic cranioplasty. A single-centre, retrospective cohort study of patients undergoing first alloplastic cranioplasty at a tertiary neuroscience centre (01 March 2010–01 September 2021). Patient demographics and craniectomy/cranioplasty details were extracted. Primary outcome was all-cause explantation. Secondary outcomes were explantation secondary to infection, surgical morbidity and mortality. Multivariable analysis was performed using Cox proportional hazards regression or binary logistic regression. Included were 287 patients with a mean age of 42.9 years [SD = 15.4] at time of cranioplasty. The most common indication for craniectomy was traumatic brain injury (32.1%, n = 92). Cranioplasty materials included titanium plate (23.3%, n = 67), hydroxyapatite (22.3%, n = 64), acrylic (20.6%, n = 59), titanium mesh (19.2%, n = 55), hand-moulded PMMA cement (9.1%, n = 26) and PEEK (5.6%, n = 16). Median follow-up time after cranioplasty was 86.5 months (IQR 44.6–111.3). All-cause explantation was 12.2% (n = 35). Eighty-three patients (28.9%) had surgical morbidity. In multivariable analysis, the risk of all-cause explantation and explantation due to infection was reduced with the use of both hydroxyapatite (HR 0.22 [95% CI 0.07–0.71], p =.011, HR 0.22 [95% CI 0.05–0.93], p =.040) and acrylic (HR 0.20 [95% CI 0.06–0.73], p =.015, HR 0.24 [95% CI 0.06–0.97], p =.045), respectively. In addition, risk of explantation due to infection was increased when time to cranioplasty was between three and six months (HR 6.38 [95% CI 1.35–30.19], p =.020). Mean age at cranioplasty (HR 1.47 [95% CI 1.03–2.11], p =.034), titanium mesh (HR 5.36 [95% CI 1.88–15.24], p =.002), and use of a drain (HR 3.37 [95% CI 1.51–7.51], p =.003) increased risk of mortality. Morbidity is high following cranioplasty, with over a tenth requiring explantation. Hydroxyapatite and acrylic were associated with reduced risk of all-cause explantation and explantation due to infection. Cranioplasty insertion at three to six months was associated with increased risk of explantation due to infection. [ABSTRACT FROM AUTHOR]

The coronavirus disease 2019 (COVID-19) pandemic due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has challenged health-care systems and physicians worldwide to attempt to provide the best care to their patients with an evolving understanding of this unique pathogen. This disease and its worldwide impact have sparked tremendous interest in the epidemiology, pathogenesis, and clinical consequences of COVID-19. This accumulating body of evidence has centered around case series and often empiric therapies as controlled trials are just getting underway. What is clear is that patients appear to be at higher risk for thrombotic disease states including acute coronary syndrome (ACS), venous thromboembolism (VTE) such as deep vein thrombosis (DVT) or pulmonary embolism (PE), or stroke. Patients with underlying cardiovascular disease are also at higher risk for morbidity and mortality if infected. These patients are commonly treated with anticoagulation and/or antiplatelet medications and less commonly thrombolysis during hospitalization, potentially with great benefit but the management of these medications can be difficult in potentially critically ill patients. In an effort to align practice patterns across a large health system (Jefferson Health 2,622 staffed inpatient beds and 319 intensive care unit (ICU) beds across 14 facilities), a task force was assembled to address the utilization of anti-thrombotic and anti-platelet therapy in COVID-19 positive or suspected patients. The task force incorporated experts in Cardiology, Vascular Medicine, Hematology, Vascular Surgery, Pharmacy, and Vascular Neurology. Current guidelines, consensus documents, and policy documents from specialty organizations were used to formulate health system recommendations. Our goal is to provide guidance to the utilization of antithrombotic and antiplatelet therapies in patients with known or suspected COVID-19. [ABSTRACT FROM AUTHOR]

From 7 to 8 December 2016, a forensic summit was held at the AFP facilities in Canberra under the theme of ‘Towards 2030’. The aim of that summit was to critically evaluate, through plenary presentations and five discussion forums, how the forensic science capability of Australia and New Zealand is placed to respond to a dynamic and complex future. One of the discussion forums met under the theme Core Capability and Capacity. The group was tasked with addressing questions such as: what is forensic science and what are our main objectives? What are our core capabilities? Are they changing or likely to change towards 2030? This article presents a high level summary of the discussion held around the strategic issue of capability and capacity. It concludes with statements representing the outcomes of the working group discussions. From these statements, recommendations will be developed to influence future work by the forensic science community of Australia and New Zealand. [ABSTRACT FROM AUTHOR]

Asynchronous computer mediated communication (CMC) would seem to be an ideal medium for supporting development in student argumentation. This paper investigates this assumption through two studies. The first study compared asynchronous CMC with face-to-face discussions. The transactional and strategic level of the argumentation (i.e. measures of argumentation quality) observed in face-to-face discussions was higher than that observed in CMC discussions; however, this difference was not reflected in the students' subsequent level of argumentation. The second study compared a CMC discussion consisting of students from the same degree programme with those from different degree programmes. Students from the same degree programme participated more in the discussion than students from different degree programmes, but the structural quality of the argumentation was higher for students from different degree programmes. The implications of these findings for the methods used to assess the quality of argumentation are discussed. [ABSTRACT FROM AUTHOR]

Arthritic pain is a common and disabling problem for many older adults. There is widespread evidence that despite its prevalance and debilitating effects on the physical, emotional and cognitive status of older adults, arthritic pain remains under-treated in those age 65 and older. This condition significantly and negatively impacts older adult' quality of life and is a critical problem that requires the attention of gerontological social work. This chapter provides a brief summary of arthritic pain in older adults. It also discusses the treatment efficacy of cognitive-behavioral therapy and psycho-educational programs for older adults with this type of pain. [ABSTRACT FROM AUTHOR]

The author argues that trends in library literature mask the inherently patriarchal aspects of reference services. Through the critical educational theories of Paulo Freire and others, it is suggested here that there is a need to transform reference services in order to better serve the needs of today's users and that innovative technologies provide an opportunity to do so. [ABSTRACT FROM AUTHOR]

Hospice social workers make distinct contributions to the care of terminally ill persons and their loved ones. This study contributes to social work's professional knowledge base by examining methods by which hospice social workers are evaluated by their supervisors as well as their clients. This article reports on a survey of 109 hospices' evaluative methods for social workers. Implications for patient care and hospice operations are discussed. [ABSTRACT FROM AUTHOR]

Organotin compounds have been implicated as reproductive toxicants and endocrine disruptors primarily through studies in aquatic organisms, with little information available in mammals. Among the organotins, aryltins have been less studied than alkyltins. Extensive data is available on mammalian developmental and reproductive toxicity of one aryltin compound, triphenyltin (TPT), from toxicity studies conducted in connection with the registration of triphenyltin hydroxide (TPTH) as a pesticide and supporting publications from the open literature. Indications of adverse functional and morphological effects on the reproductive tract of rats were reported in a dose range of 1.4–20 mg/kg/d. Gonadal histopathology (both ovaries and testes) and infertility were affected at the higher doses, while reproductive-tract cancer, smaller litter sizes, and reproductive organ weights were affected at the lower end of the dose range. In vitro studies indicate that TPT can directly activate androgen receptor-mediated transcription and inhibit enzymes that are involved in steroid hormone metabolism. These data suggest that the aryltin TPT can be active as a reproductive toxicant in mammals and may be a human endocrine disruptor. [ABSTRACT FROM AUTHOR]

The process by which elders with disabilities are forced to relocate from their homes to congregate living facilities is of critical societal importance. This article is a descriptive exploration of the lived experiences of forty-one persons aged 60 and over that made such a transition. This research assists social workers to better understand this vulnerable population. The social work profession serves the most vulnerable members of our society. The personal, professional, and policy implications that stem from research such as this enables the profession to carry out its stated commitments to our society's elderly cohort. [ABSTRACT FROM AUTHOR]

During the period 1992 - 1996, the then Foyle Community Unit of Management of the Western Health and Social Services Board undertook three large scale investigations into organised child sexual abuse. This paper will focus upon the third and what transpired to be the largest and most complex of their investigations. This particular investigation took over one year to complete and involved 52 families and 102 children. The authors hope that this paper will provide a sense of what it was like to be involved in such an investigation from the perspective of management and will explore the lessons learned and reflect upon the issues that are central to an effective management response. [ABSTRACT FROM PUBLISHER]