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The purpose of this article was to consider the need for guidelines and consistent criteria for support and enrichment of students facing the transition from secondary school to tertiary education, and some of the challenges involved. The article’s narrow context is language and accounting; the wider context is challenges faced by most students and educators in the above key phases. Through a brief review of initiatives at two prominent universities in South Africa and an analysis of 17 interviews with teachers, tutors and lecturers working with adolescents, the researchers have sought to identify several existing challenges. Data collected indicate that most stakeholders acknowledge the importance of support / enrichment. Many, though, are unsure of how to achieve the desired outcomes of programmes. This conflict seems to lie in a lack of focused guidelines. There seems to be a need for consistency: this will strengthen initiatives as the successes and failures of educators and policy makers will help to form a framework for work in the immediate future.

The levels of two key pathogens, Salmonella and Campylobacter, are assessed along with the indicator organism Escherichia coli in aerosols within and outside poultry sheds. The studies have shown that the public health risk from these organisms in poultry environments via the aerosol pathway is very minimal.

Background: Nonmelanoma skin cancer is the most common malignancy. Multiple therapies prevent recurrence but vary widely in cost. The most common therapies are local destruction, excision, and Mohs surgery (histologically guided tumor removal). Clinical variables that may affect treatment choices can be identified, but little is known about how clinicians choose among therapies.Objective: The objective of this study was to learn if variations exist in the treatment of nonmelanoma skin cancer in different practice settings.Research Design: Prospective cohort study.Subjects: Subjects consisted of consecutive patients with nonmelanoma skin cancer at a university-affiliated private dermatology practice and the dermatology clinic at the nearby affiliated Veterans Affairs (VA) medical center.Data: We studied data from medical records and patient surveys.Results: Overall, 1777 nonrecurrent nonmelanoma skin cancers were diagnosed in 1375 patients. Compared with the VA site, patients at the private site were younger, more likely to be female, and less likely to be poor, and their tumors were smaller and less likely to be on visible areas of the body. Treatments varied between the 2 sites (P <0.001). The proportions of tumors treated at the private and VA sites, respectively, were 23% and 19% for destruction, 25% and 48% for excision, and 37% and 25% for Mohs surgery. In multiple clinical subgroups, Mohs surgery was more likely to be performed at the private site than at the VA. Moreover, in multivariable models controlling for clinical features that may have affected treatment choice, tumors at the private site were more likely than tumors at the VA to be treated with Mohs surgery (odds ratio, 2.39; 95% confidence interval, 1.54-3.70).Conclusions: Care for nonmelanoma skin cancer varied at 2 academic practice sites that are near each other and that share some clinician staff. These findings raise questions not only about overuse or underuse of procedures at the 2 sites, but also about systematic differences in patient preferences and/or physician incentives in prepaid and fee-for-service settings. [ABSTRACT FROM AUTHOR]

Background: ERCP is a technically challenging procedure. Glyceryl Trinitrate [GTN] has been shown to reduce sphincter of Oddi pressure. Several randomized controlled trials have sought to assess the clinical effect of GTN in ERCP. The objective of this study is to assess in a meta-analysis the benefit of routine GTN use in ERCP in cannulation success and post-ERCP pancreatitis. Methods: A comprehensive literature search was conducted using online databases PubMed, Medline and Cochrane database of randomised controlled trials. Studies included had to be randomised controlled trials of GTN use as in ERCP. The outcomes of interest were cannulation success and/or rate of post-ERCP pancreatitis. Data Collection and Analysis: Seven Randomised Controlled Trials were identified. Data was analysed using Cochrane Collaboration Review Manager software. Each study was weighted in accordance with its size and event rate. Outcome of interest from each study and pooled results had Risk Ratio and 95% confidence intervals calculated. Results: A total of six studies and 1321 patients were analysed for effect on cannulation success. A pooled Risk Ratio of 0.66 [95% CI 0.43–1.01] represents a relative risk reduction of 34%, though not statistically significant. Four studies and a total of 854 patients were analysed for rate of post ERCP pancreatitis. A pooled Risk Ratio of 0.56 [95% CI 0.37–0.85] represents a significant relative risk reduction of 44%. Conclusions: GTN administration in ERCP reduces the rate of post ERCP pancreatitis and may have a small benefit in cannulation success. [ABSTRACT FROM AUTHOR]

This study describes the development and use of bacteriophage cocktails to control Campylobacter in broiler chickens, in a commercial setting, in Queensland Australia, following the birds from farm to the processing plant. The components of the bacteriophage cocktails were selected to be effective against the maximum number of Campylobacter jejuni and Campylobacter coli isolates encountered on SE Queensland farms. Farms were identified that had suitable Campylobacter target populations and phage were undetectable 1 week prior to the intended treatment. Cocktails of phages were administered at 47 days of age. Groups of study birds were slaughtered the following day, on-farm, at the end of flock transport to the plant, and at processing (approximately 28 h post-treatment). On Farm A, the phage treatment significantly reduced Campylobacter levels in the ceca at the farm in the range of 1-3 log 10 CFU/g ( p = 0.007), compared to mock treated controls. However, individual birds sampled on farm (1/10) or following transport (2/10) exhibited high cecal Campylobacter counts with low phage titers, suggesting that treatment periods > 24 h may be required to ensure phage replication for effective biocontrol in vivo . At the time of the trial the control birds in Farm B were phage positive despite having been negative one week earlier. There was no significant difference in the cecal Campylobacter counts between the treatment and control groups following treatment but a fall of 1.7 log 10 CFU/g was observed from that determined from birds collected the previous week ( p = 0.0004). Campylobacter isolates from both farms retained sensitivity to the treatment phages. These trials demonstrated bacteriophages sourced from Queensland farms have the potential to reduce intestinal Campylobacter levels in market ready broiler chickens., (Copyright © 2020 The State of Queensland (through the Department Agriculture and Fisheries).)

Introduction: There is a known association between Clostridium Septicum, mycotic aneurysm and colon neoplasm., Case Presentation: We report the case of a 90 year old female admitted with abdominal pain to the general surgery unit. Admission CT scan demonstrated a thick walled caecum and pericaecal inflammation suspicious for a perforated carcinoma. This was subsequently confirmed at colonoscopy with biopsy demonstrating a poorly differentiated adenocarcinoma. A laparoscopic right hemicolectomy was completed the following week after perioperative workup and intravenous antibiotic therapy. On the 9th postoperative day, fever and rising inflammatory markers prompted repeat abdominal CT scan which demonstrated a mycotic aneurysm of the upper abdominal aorta. After discussion with the vascular surgery and infectious diseases team, along the patient and family, the decision was made to palliate. The patient died at home from presumed spontaneous rupture two weeks after discharge., Discussion: Mycotic aneurysm in colonic malignancy is a rare and often lethal complication. C. Septicum is causative in over 70% of cases with concomitant colonic malignancy., Conclusion: Mycotic aneurysm should be considered in any deteriorating patient with concomitant colonic malignancy., (Copyright © 2018 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: Physical inactivity is significantly associated with more frequent hospitalizations and increased mortality in COPD even after adjusting for disease severity. While practice guidelines recommend regular physical activity for all patients with COPD, health systems are challenged in operationalizing an effective and sustainable approach to assist patients in being physically active., Methods: A pragmatic randomized controlled trial design was used to determine the effectiveness of a 12-month home and community-based physical activity coaching intervention (Walk On!) compared to standard care for 1650 patients at high risk for COPD exacerbations from a large integrated health care system. Eligible patients with a COPD-related hospitalization, emergency department visit, or observational stay in the previous 12months were automatically identified from the electronic medical records (EMR) system and randomized to treatment arms. The Walk On! intervention included collaborative monitoring of step counts, semi-automated step goal recommendations, individualized reinforcement from a physical activity coach, and peer/family support., Results: The primary composite outcome included all-cause hospitalizations, emergency department visits, observational stays, and death in the 12months following randomization. Secondary outcomes included COPD-related utilization, cardio-metabolic markers, physical activity, symptoms, and health-related quality of life. With the exception of patient reported outcomes, all utilization and clinical variables were automatically captured from the EMR., Conclusions: If successful, findings from this multi-stakeholder driven trial of a generalizable and scalable physical activity intervention, carefully designed with sufficient flexibility, intensity, and support for a large ethnically diverse sample could re-define the standard of care to effectively address physical inactivity in COPD., (Copyright © 2015 Elsevier Inc. All rights reserved.)

Background: Following a measles outbreak in a vaccine-rejecting community between April and September 2011 in South-East England, local health agencies implemented a two-pronged measles-mumps-rubella (MMR) immunisation campaign from August to October offered at the local general practice where most cases were registered. The campaign included (a) accelerated vaccination of children earlier than scheduled (1st dose at 6-11 months, or 2nd dose at 18-39 months), (b) catch-up of those aged over 18 months who had had no MMR immunisations or were late for second MMR. We investigated the impact of the outbreak and campaign on the number of MMR doses given., Materials and Methods: In January 2012, we collected information on MMR vaccination for children registered at the practice aged 6 months-16 years on 1 August 2011, through the child health information system. We counted the number of MMR doses administered in 2011 and compared it to 2008-2010 data. We estimated the proportion vaccinated among the children eligible for the accelerated and catch-up campaign., Results: The local practice administered 257 MMR doses in 2011, a 114% increase on the average for 2008-2010. Among children eligible for earlier MMR vaccination 5/26 (19%) received a first dose, and 34/57 (60%) a second dose. Among children eligible for catch-up, 20/329 (6%) received their first MMR and 39/121 (32%) their second. Of 1538 children, the proportion completely unimmunised for MMR declined by 3 percentage-points after the outbreak., Discussion: Uptake of MMR vaccination significantly increased during the outbreak following the immunisation campaign. Those amenable to MMR vaccination seem to have benefited from the campaign more than those with no previous vaccinations. Future evaluations should address what made a few parents change their mind and have their children vaccinated for the first time during the outbreak., (Copyright © 2014 Elsevier Ltd. All rights reserved.)

Objective: To learn if treatment of recurrent nonmelanoma skin cancer (NMSC) varied in different practice settings., Design: Prospective cohort study of consecutive patients with recurrent NMSC., Setting: A university-based dermatology practice and the dermatology clinic at the affiliated Veterans Affairs Medical Center (VAMC). Conventional therapies for NMSC were available at both sites. Patients All 191 patients diagnosed as having recurrent NMSC in 1999 and 2000 were included in the study. Data were collected from medical record review and surveys mailed to patients. Main Outcome Measure Performance of Mohs micrographic surgery (Mohs)., Results: Patients at the VAMC were older, less educated, poorer, and had more comorbid illnesses, but their tumors were similar to those of patients at the university-based practice. Treatment choices differed at the 2 sites: the proportions of tumors treated in the VAMC and university sites were 60% and 14%, respectively, for excisional surgery; and 24% and 61%, respectively, for Mohs (P < .001). In multivariate analyses adjusting for patient, tumor, and physician features that may have affected treatment choice, tumors treated at the university-based site remained significantly more likely to be treated with Mohs (odds ratio, 8.68 [95% confidence interval, 3.66-20.55]; P < .001)., Conclusions: Substantial variation existed in the treatment of recurrent NMSC in different practice settings. This variation was not explained by measured clinical characteristics of the patients or the tumors.

Background: Evidence continues to accumulate that oxidative stress is etiologically important in the pathogenesis of age-related maculopathy (ARM) and that appropriate antioxidants of dietary origin may protect against this condition., Objective: Risk factors for ARM may be classed as established or putative. We report a study designed to investigate whether such risk factors are associated with a dietary lack of antioxidants relevant to retinal health., Design: Dietary, anthropometric, and sociodemographic details relating to 828 healthy Irish subjects aged 20-60 y were recorded in a cross-sectional fashion and analyzed for associations between risk factors for ARM and dietary intake of relevant nutrients., Results: Of the established risk factors for ARM, increasing age was associated with a relative lack of dietary zeaxanthin (P < 0.05) and tobacco use with a relative lack of dietary vitamin C (P < 0.05). Of the putative risk factors for ARM, alcohol consumption was associated with a relative lack of dietary alpha-linoleic acid (P < 0.05), and female sex was associated with a relative lack of dietary zinc (P < 0.05)., Conclusions: We showed that several variables related to risk for ARM are associated with a relative dietary lack of key nutrients. Our finding that age, the most important and universal risk factor for ARM, is associated with a relative lack of dietary zeaxanthin, is an important finding that warrants further investigation.