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Pancreatic necrosis is among the most frequently encountered local complications of acute pancreatitis and associates with severe disease. Infected pancreatic necrosis further enhances the risk for morbidity and mortality. Pancreatic fluid collections that result from pancreatic necrosis evolve from acute necrotic collections to walled off necrosis and are defined by their distinct characteristics on cross sectional imaging. A variety of interventions spanning multiple disciplines are available for the drainage and debridement of pancreatic necrosis. Prospective, randomized trials have identified management strategies that incorporate minimally invasive interventions as having the best outcomes for patients with symptomatic pancreatic necrosis. The scientific literature has confidently positioned endoscopic drainage and necrosectomy among the most effective interventions for patients with symptomatic walled off necrosis. Innovations such as the use of metallic stents, chemical debridement and multiple modalities for drainage of pancreatic necrosis show promise in improving outcomes for patients managed with endoscopic interventions.

Abstract Background Strengthening the coordination, continuity and intersectoral cooperation for cancer patients’ during cancer treatment is being underlined by international guidelines and research. General practitioners have assumed a growing role in the cancer patient disease trajectory because of their roles as coordinators and the consistent health provider. However, general practitioners are challenged in providing support for cancer patients both during treatment and in the survivorship phase. General practitioners reported barriers are lack of timely and relevant communication from the oncologist and limited knowledge to guidelines, as well as lack of trust from patients. Therefore, the current study will examine whether a shared video-based consultation between the cancer patient, general practitioner and oncologist can ease general’ challenges and thereby enhance the patient-centeredness for the cancer patients and their perception of intersectoral cooperation and continuity. Methods The study is designed as a pragmatic randomised controlled trial for patients starting chemotherapy at the Department of Oncology, Lillebaelt Hospital, Denmark who are listed with a general practitioner in the Region of Southern Denmark. We intend to include 278 adults diagnosed with colorectal, breast, lung, gynecologic or prostate cancer. The intervention group will receive the “Partnership intervention” which consists of one or more video-consultations between the cancer patient, general practitioner and oncologist. The consultations are estimated to last between 10 and 20 min. The specific aims of the consultation are, summary of the patient trajectory, sharing of knowledge regarding comorbidity, psychosocial resources and needs, physical well-being, medicine, anxiety and depression symptoms, spouses, workability and late complication and side-effects to the cancer treatment. Discussion Video-based consultation that brings the cancer patient, the general practitioner and the oncologist together in the early phase of treatment may facilitate a sense of partnership that is powerful enough to improve the patient’s perception of intersectoral cooperation, continuity of cancer care and health-related quality of life. Trial registration ClincialTrials.gov Identifier: NCT02716168. Date of registration: 03.03.2016.

Purpose As part of the process evaluation, this study aimed to explore experiences, attitudes and perspectives of the oncological department on sharing patient consultations with GPs using video.Methods Four semistructured interviews with five oncologists and four nurse specialists were conducted in February 2020. We focused on the informants’ experiences and reflections on the potential of future implementation of the concept ‘inviting the GP for a shared consultation by video’. The analyses were based on an inductive, open-minded, hermeneutic phenomenological approach.Results A total of six overall themes were identified: structuring consultation and communication, perceptions of GP involvement in cancer care, stressors, making a difference, alternative ways of cross-sector communication and needs for redesigning the model. The concept made sense and was deemed useful, but solving the many technical and organisational problems is pivotal. Case-specific tasks and relational issues were targeted by pragmatically rethinking protocol expectations and the usual way of communication and structuring patient encounters. Case selection was discussed as one way of maturing the concept.Conclusion This Danish study adds new insight into understanding different aspects of the process, causal mechanisms as well as the potential of future implementation of video-based tripartite encounters. Beyond solving the technical problems, case selection and organisational issues are important. Acknowledging the disruption of the usual workflow, the introduction of new phases of the usual encounter and the variety of patient–GP relationships to be embraced may help to better understand and comply with barriers and facilitators of communication and sharing.Trial registration number NCT02716168.

Background: Shared care models present an opportunity for patients to receive the benefits of specialist care combined with the continuity of care provided by a GP. Aim: To test the effects on GP-perceived involvement in cancer care and their satisfaction with this cross-sectoral information after bringing the patient, GP, and oncologist together in a shared video consultation. Design & setting: GPs from the Region of Southern Denmark evaluated a randomised controlled trial testing shared video consultations. Method: This study describes secondary outcomes based on a 4 months' follow-up survey from GPs participating in The Partnership Project (PSP). Patient perception of coordination of care at 7 months' follow-up was the primary outcome of the PSP. A tripartite video consultation was conducted during cancer treatment to share tasks and roles between health professionals with the patient. Results: The study included 281 patients, and 105 unique GPs returned 124 questionnaires. Video consultations were accomplished in 68% of scheduled cases. The study found an increased odds ratio (OR) of 3.03 for GP satisfaction with the distribution of tasks and roles, and they experienced more involvement in the cancer patients' trajectory. The study found an increased OR of 6.95 for the GP perception of more direct contact and dialogue with the Department of Oncology. There was a decreased OR of 0.88 for the GP to be engaged in handling anxiety and psychological concerns. Conclusion: The study showed that involving the GP in one shared consultation increased the odds of the GP being satisfied with the distribution of tasks and roles, and feeling more involved in the cancer patient’s trajectory. However, recruitment and response rates from GPs were limiting factors.

Background: Guidelines have proposed that GPs should have a central role as coordinators of care and support patients with cancer during all stages of treatment, follow-up, and rehabilitation. Multidisciplinary video consultation involving the patient with cancer, the oncologist, and the GP may help to define roles and tasks, and this resulting clarity may enable greater support for patients with cancer. Aim: To explore the consultation structure, content, and task clarification when a GP and an oncologist are attending a video consultation with a patient with cancer. Design & setting: A qualitative study took place in the Region of Southern Denmark to investigate multidisciplinary video consultations, based on thematic analysis. Method: Recordings of 12 video consultations were analysed using the framework method. A combined deductive and inductive approach was undertaken. The deductive themes were selected based on a consultation guide given to the doctors before the consultations. Results: The study identified 15 themes, which were grouped into the following three categories: the implications of sharing a consultation; consultation structure; and health concerns. Conclusion: Multidisciplinary video-based consultations with a patient and two health professionals succeeded in having a patient-centred communication style. In clarifying tasks between the GP and oncologist to support the patient, work-related issues and professional support for psychosocial challenges were always a task for the GP. Dissemination of this first-line evidence may improve acceptability among medical specialists and help assist GPs in supporting patients with cancer. However, focus on the involvement of relatives should be emphasised.

While several studies have investigated mouse ultrasonic vocalizations (USVs) emitted by isolated pups or by males in mating contexts, studies of behavioral contexts other than mating and vocalization categories other than USVs have been limited. By improving our understanding of the vocalizations emitted by mice across behavioral contexts, we will better understand the natural vocal behavior of mice and better interpret vocalizations from mouse models of disease. Hypothesizing that mouse vocal behavior would differ depending on behavioral context, we recorded vocalizations from male CBA/CaJ mice across three behavioral contexts including mating, isolation, and restraint. We found that brief restraint elevated blood corticosterone levels of mice, indicating increased stress relative to isolation. Further, after three days of brief restraint, mice displayed behavioral changes indicative of stress. These persisted for at least two days after restraint. Contextual differences in mouse vocal behavior were striking and robust across animals. Thus, while USVs were the most common vocalization type across contexts, the spectrotemporal features of USVs were context-dependent. Compared to the mating context, vocalizations during isolation and restraint displayed a broader frequency range, with a greater emphasis on frequencies below 50 kHz. These contexts also included more non-USV vocal categories and different vocal patterns. We identified a new Mid-Frequency Vocalization, a tonal vocalization with fundamental frequencies below 18 kHz, which was almost exclusively emitted by mice undergoing restraint stress. These differences combine to form vocal behavior that is grossly different among behavioral contexts and may reflect the level of anxiety in these contexts.

This paper is concerned with the scope for developing countries to benefit from the Internet in non‐synchronous ways that is, in cases where some delay is involved in the delivery of information, as compared with the real‐time alternative used in developed countries. The first part of the paper draws on insights from Becker and others, to argue that poor people in poor countries are wont to exchange (relatively abundant) time for reductions in the cost of Internet use. The second part of the paper then examines whether such time‐intensive products actually exist and to the extent they do, how the required degree of cost reductions are effected in practice. I conclude that time‐intensive Internet technology represents a highly promising opportunity for developing countries to close the digital divide, an opportunity that warrants serious academic scrutiny.

Methane seeps are among the most productive habitats along continental margins, as anaerobic methane-oxidizing euryarchaeaota and sulfur-metabolizing deltaproteobacteria form the biological base of a dynamic deep-sea ecosystem. The degree of methane seepage therefore represents one important variable in ecosystem dynamics, and the recent discovery of carbonate-hosted endolithic methanotrophy exposes another potentially discriminating factor: physical substrate type. Methanotrophic microbial communities have been detected within diverse seep-associated habitats, including unlithified sediments, protolithic carbonate nodules, and lithified carbonate slabs and chemoherms of distinct mineralogies. However, a systematic assessment of the diversity and community structure associated with these different habitats has been lacking. In this study, microbial aggregate analysis, microbial abundance quantification, mineralogical identification, and archaeal and bacterial 16S rRNA gene clone libraries were used to deconvolve the relationships between seepage activity, substrate type, and microbial community structure. We report prevalent methane-oxidizing archaeal lineages in both active and low-activity seep settings, and a strong community dependence on both seepage activity and substrate type. Statistical treatments of relative taxa abundances indicate that archaeal community structure is more dependent on the degree of methane seepage than physical substrate type; bacterial assemblages appear to be more strongly influenced by the type of colonization substrate than seepage activity. These findings provide a window into the determinants of community structure and function, improving our understanding of potential elemental cycling at seep sites.

This review describes mechanisms and circuitry underlying combination-sensitive response properties in the auditory brainstem and midbrain. Combination-sensitive neurons, performing a type of auditory spectro-temporal integration, respond to specific, properly timed combinations of spectral elements in vocal signals and other acoustic stimuli. While these neurons are known to occur in the auditory forebrain of many vertebrate species, the work described here establishes their origin in the auditory brainstem and midbrain. Focusing on the mustached bat, we review several major findings: 1) Combination-sensitive responses involve facilitatory interactions, inhibitory interactions, or both when activated by distinct spectral elements in complex sounds. 2) Combination-sensitive responses are created in distinct stages: inhibition arises mainly in lateral lemniscal nuclei of the auditory brainstem, while facilitation arises in the inferior colliculus (IC) of the midbrain. 3) Spectral integration underlying combination-sensitive responses requires a low frequency input tuned well below a neuron’s characteristic frequency (ChF). Low-ChF neurons in the auditory brainstem project to high-ChF regions in brainstem or IC to create combination sensitivity. 4) At their sites of origin, both facilitatory and inhibitory combination-sensitive interactions depend on glycinergic inputs and are eliminated by glycine receptor blockade. Surprisingly, facilitatory interactions in IC depend almost exclusively on glycinergic inputs and are largely independent of glutamatergic and GABAergic inputs. 5) The medial nucleus of the trapezoid body, the lateral lemniscal nuclei, and the IC play critical roles in creating combination-sensitive responses. We propose that these mechanisms, based on work in the mustached bat, apply to a broad range of mammals and other vertebrates that depend on temporally sensitive integration of information across the audible spectrum.

Turkey's strengths have long driven the U.S. to overlook transgressions. They may again get a pass as U.S. regional interests prevail. The U.S. has maintained a close relationship with Turkey [...]