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Introduction: Gastrointestinal recovery describes the restoration of normal bowel function in patients with bowel disease. This may be prolonged in two common clinical settings: postoperative ileus and small bowel obstruction. Improving gastrointestinal recovery is a research priority but researchers are limited by variation in outcome reporting across clinical studies. This protocol describes the development of core outcome sets for gastrointestinal recovery in the contexts of postoperative ileus and small bowel obstruction. Method: An international Steering Group consisting of patient and clinician representatives has been established. As overlap between clinical contexts is anticipated, both outcome sets will be co‐developed and may be combined to form a common output with disease‐specific domains. The development process will comprise three phases, including definition of outcomes relevant to postoperative ileus and small bowel obstruction from systematic literature reviews and nominal‐group stakeholder discussions; online‐facilitated Delphi surveys via international networks; and a consensus meeting to ratify the final output. A nested study will explore if the development of overlapping outcome sets can be rationalized. Dissemination and implementation: The final output will be registered with the Core Outcome Measures in Effectiveness Trials initiative. A multi‐faceted, quality improvement campaign for the reporting of gastrointestinal recovery in clinical studies will be launched, targeting international professional and patient groups, charitable organizations and editorial committees. Success will be explored via an updated systematic review of outcomes 5 years after registration of the core outcome set. [ABSTRACT FROM AUTHOR]

Aim In order to develop its education agenda, the Association of Coloproctology of Great Britain and Ireland ( ACPGBI) sought the opinion of its members on current coloproctology training needs. The aims of this study were to canvass multidisciplinary needs and explore the perceived gaps and barriers to meeting them. Method A learner-needs analysis was performed between July 2015 and October 2016. A bespoke electronic survey was sent to 1453 colorectal healthcare professionals [ ACPGBI membership (1173), colorectal nurse specialists and allied health professionals ( NAHPs) (261) and regional chapter-leads (19)] seeking their needs, experiences and barriers to training across the coloproctology disciplines. Results In all, 390 responses were received [26.8% overall; 180 consultants/trainees (15%); 196 NAHPs (75%); 14 (74%) chapter-leads]. Lack of funding and difficulties in obtaining study leave were the most frequently reported barriers to course and conference attendance. Transanal total mesorectal excision and laparoscopic training were the top educational needs for consultants and trainees respectively. 79% of NAHP respondents reported education gaps on a broad range of clinical and non-clinical topics. NAHPs lacked information on relevant training opportunities and 27% felt available courses were insufficient to meet their educational needs. Wide heterogeneity in ACPGBI chapter composition and activity was reported. All groups felt the ACPGBI should increase the number of courses offered with coloproctology knowledge updates commonly requested. Conclusion A series of training needs across the coloproctology disciplines have been identified. These will underpin the development of the educational agenda for the ACPGBI. [ABSTRACT FROM AUTHOR]

Title. Bodily change following faecal stoma formation: qualitative interpretive synthesis.Aim. This paper is a report of a literature review conducted to answer the question 'How has the experience of bodily change following stoma formation been explored and interpreted through existing qualitative research?'.Background. A faecal stoma alters the function, appearance and sensation of the body. Quantitative research highlights the importance of bodily change following stoma formation but is limited in being able to explore what this experience means to ostomists. Qualitative research can identify ways in which ostomists experience their changed body but a conceptual framework of their experience drawn from qualitative findings which can inform patient-centred care has not yet been identified.Method. The Amed, ASSIA, CINAHL, Embase, Medline and Psycinfo databases were searched from inception to April 2009 using predefined inclusion criteria. Of 144 papers identified, 11 were selected for review. An interpretive review methodology for qualitative research synthesis was employed. Findings. Three broad themes of bodily experience following stoma formation were identified: loss of embodied wholeness, awareness of a disrupted lived body and disrupted bodily confidence. These highlight the impact of the experience of living with a stoma on the embodied self and the ostomist's embodiment within their lifeworld.Conclusion. A loss of embodied wholeness which underpins the experience of stoma formation can be represented through awareness of the disrupted lived body and impact on the lifeworld. Findings suggest the need for further research to identify a comprehensive conceptualization of bodily change, which can more closely match healthcare service to individual patient need. [ABSTRACT FROM AUTHOR]

Summary Introduction: A link between regular paracetamol intake and asthma in adults has recently been postulated. Detoxification of paracetamol may deplete stores of glutathione, which is one of the major antioxidants present in the lung. A reduced source of glutathione in the lung may lead to increased oxidative damage to the epithelium and hence increased frequency and severity of asthma attacks in susceptible individuals. Aim of study: This study aimed to determine whether regular intake of maximum therapeutic doses of paracetamol reduced serum antioxidant capacity in healthy volunteers. Methods: Fifteen young healthy volunteers (nine men, six women, mean age 21·3 years, range 19–32) took maximum therapeutic doses of paracetamol (1 g four times a day) for 14 days. On days 0 and 14 blood samples were taken at baseline and hourly for a period of 4 h following ingestion of 1 g paracetamol. Single venous blood samples were collected 1 h after ingestion of 1 g paracetamol on days 4, 7 and 10. Blood samples were analysed for serum paracetamol concentration and total antioxidant capacity. Results: Mean total antioxidant capacity was significantly reduced over the 3-h post-dosing on both days 0 and 14 (P < 0·01). The results from days 4, 7 and 10 showed a trend towards reduced antioxidant activity over time. On day 14 values were consistently lower compared with the corresponding times on day 0 (P < 0·01 at 0, 1, 3 and 4 h, P < 0·05 at 2 h). Conclusions: Chronic ingestion of maximum therapeutic doses of paracetamol depletes serum antioxidant capacity in healthy volunteers in as few as 14 days, possibly by a reduction in glutathione. This may have implications for analgesic use in asthmatic individuals. Further studies are now required to assess the impact of paracetamol on antioxidant defences in the lung. [ABSTRACT FROM AUTHOR]

Straddle carriers represent a critical resource in the handling of containers within a container terminal. It is essential that they are deployed in an as efficient manner as possible. The research presented in this paper is motivated by the need to critically evaluate job assignment rules for straddle carriers that operate in a multiple straddle environment. This is achieved by developing a discrete event simulation model using industrial simulation software to model a container terminal located in Melbourne, Australia. The model accounts for variables such as the number of straddle carriers needed, the speed of straddle carriers, the arrival rate of trucks, and the job assignment rule. A principal finding of the study is that increasing the number of straddles in the present set-up from 6 to 7 has a negligible effect on daily throughput. However, an increase in the number of straddles to 7 is expected to have a profound effect on reducing the average waiting time of trucks within the terminal from over 16 minutes to under 9 minutes, a decrease of 46.5%. However, a further increase in the number of straddles results in no further increase in daily throughput. It was observed that the throughput of the terminal is very sensitive to the speeds at which straddles travel. The management of the terminal has proposed a new heuristic job assignment rule for straddles, because the present rule does not assign the jobs to straddles closest to the truck requesting to load or unload a container. As a result a new heuristic job assignment rule was tested. The simulation results revealed that both the old and new rules performed equally well using performance indicators such as average container flow time, daily throughput, average waiting time of jobs, number of jobs in the queue, and straddle utilisation. Therefore, the new rule will not improve these performance measures if implemented [ABSTRACT FROM AUTHOR]

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Hypophosphatasia is an inherited disorder characterized by defective mineralization of the skeletal and dental structures of the body and deficient liver/bone/kidney alkaline phosphatase (L/B/K ALP) activity. There has been a tremendous advance in our knowledge of this condition over the last decade due to the advent of highly specific DNA probes and novel microanalytic techniques. The purpose of this paper is threefold: to review the dental aspects of current literature about this rare condition; to present a case (and family study) that was diagnosed in a 5-yr-old boy from 0.14 microliters of gingival crevicular fluid, using a new ultrasensitive chemiluminescent assay for the enzyme alkaline phosphatase; and to provide strong evidence for an autosomal dominant mode of inheritance. [ABSTRACT FROM AUTHOR]

The search for markers of periodontal disease activity and progression has accelerated over the last decade, in an effort to replace existing subjective clinical measures of periodontal health status Research is being aimed at establishing more objective and quantitative methodology, capable of rapid diagnosis prior to the appearance of clinical signs of destruction disease. Such tests need to he sensitive enough to evaluate individual periodontal sites in health as well as disease states. We report the development of a new chemiluminescent assay for the enzyme alkaline phosphatase, that is capable of quantifying the enzyme in sub-microliter volumes of gingival crevicular fluid and serum. The technique will measure alkaline phosphatase (ALP) whilst immobilised on paper strips, without the need for an elution stage. It is simple. versatile and amenable to chair-side use. We discuss in detail the assay procedure and have examined levels of ALP in 11 adult volunteers with clinically healthy periodontal tissues. The mean ALP concentration was 2135 IU/L for GCF and 183 IU/L for serum, a 12-fold difference. There also appeared to be an "oral pattern" of enzyme distribution in healthy periodontal sites, with levels being higher in the anterior region of the mouth and highest in the lower anterior region. [ABSTRACT FROM AUTHOR]

The questionnaire responses of 559 agoraphobic subjects were analysed to see whether there was a shared hierarchical pattern of fear and avoidance. The items were divided on the basis of a principal component analysis into 13 loading on an Agoraphobia factor and eight on a Claustrophobia factor. When analysed with Guttman Scaling Analysis valid cumulative scales were found for each factor. These scales were replicated in three independent cohorts of subjects and met the most stringent scaling requirements. The scales produced three valid scores of severity for each individual, the first describing exactly which Agoraphobic items the subject avoids, the second describing Agoraphobic items feared and the third Claustrophobic items avoided. Since it is possible to deduce the current pattern of fear and avoidance from the scores, they can be used to summarize the clinical state of an individual client or for making precise descriptive comparisons between agoraphobics . The scales also indicate that agoraphobics do not develop their own unique set of difficulties from the possible pool of problems, but acquire an ordered set of difficulties, the order being shared by other agoraphobics .