Search

Background: In recent times, clinical negligence claims against National Health Service hospitals have doubled, with 8% of claims being made due to "failure to warn/informed consent." This study aimed to assess the current compliance of the neurosurgical division within a large tertiary neuroscience center with the national legal framework and professional guidelines around the issue of surgical consent and to develop strategies to improve the consent process. Methods: Electronic patient records (EPR) were accessed to collect demographic data and information regarding the surgical procedures. Telephone questionnaires were carried out. Neurosurgical registrars were interviewed. The author met with the trust's Legal team, the neuropsychology lead, and the trust's consent lead. Results: Fifty-eight patients were included in the analysis. Of the respondents to the questionnaire, 98% felt that they were adequately informed during the consent process. When consenting patients, all registrars felt that they explained the reason for the procedure, detailed benefits, and major risks, including uncommon and rare risks. However, 50% admitted to not specifically discussing the postoperative recovery time or alternatives. Only 15% admitted to documenting on the EPR or through a letter to the patient's General Practitioner. Conclusion: Informed consent is a delicate moment of communication between a clinician and the patient. Regular training and good communication skills help staff to focus on the most relevant aspects of consent, which should be delivered in an appropriate environment and with family support. Audio-visual aids can support the process but do not replace good communication. [ABSTRACT FROM AUTHOR]

Management of grazing lands for the accumulation of soil carbon stocks ([C.sub.S]) has been proposed as an effective way to reduce net greenhouse gas emissions from agriculture. However, there are conflicting reports on the effects of grazing management on soil carbon. Most comparisons have involved some combination of no grazing, rotational grazing and set stocking. In the present study we compared two adjacent commercial grazing systems, distinguished on the basis of inputs and livestock productivity, located on New England basaltic landscapes experiencing a cool temperate climate. The high-intensity (H) system sustains an average stocking rate of 18 dry sheep equivalents (dse) [ha.sup.-1], with a turnoff rate of 9 dse [ha.sup.-1] [year.sup.-1], with high levels of investment in assets, management and fertiliser. The low-intensity (L) system, with less intensive management and half the fertiliser of the H system, sustains a stocking rate of 9 dse [ha.sup.-1], with a turnoff rate of 3 dse [ha.sup.-1] [year.sup.-1], which is slightly higher than the regional average. Pasture biomass production was inferred (back-calculated) from stocking rates and animal feed requirements using published data. From the H and L systems, seven paired landscapes from valley floor to upper hillslopes and plateaux were selected. The seventh included a forest reserve. One hundred and eighty-six undisturbed soil cores (0-0.5 m depth) were assessed for bulk density, total C and N, particulate C and a range of plant nutrients. There were few differences in [C.sub.S], soil pH and nutrient levels between H and L grazing systems. Average [C.sub.S] (0-0.3 m) in pasture soils was 103 Mg [ha.sup.-1], but was higher in the forest soil at 190 Mg [ha.sup.-1]. Regression of [C.sub.S] versus soil mass was a satisfactory method of dealing with the bias introduced by the higher soil bulk density in perennial pasture systems compared with the forest. The similarity of [C.sub.S] in H and L pasture soils was despite inferred net primary production being 1.9-3.6 Mg C [ha.sup.-1] [year.sup.-1] greater in H than L systems, implying higher rates of C turnover in the former. The global warming potential of the inferred annual emissions of C[H.sub.4] and [N.sub.2]O in the H and L systems was equivalent to approximately 19% and 13% of the cycling atmospheric-plant C[O.sub.2] carbon respectively. Additional keywords: grazing animal emissions, particulate soil carbon., Introduction Increasing soil carbon stocks ([C.sub.S]) via changes in management of agricultural land to both increase biomass production and introduce less exploitative practices is an attractive way to reduce net [...]

The impact of cropping on the hydrology and fertility of Vertosols in the northern Darling Basin (average annual rainfall >550 mm) has received much attention, together with the constraints placed on crop growth by naturally occurring subsoil salt stocks. These factors have not been quantified in the drier (450--550 mm), marginal cropping areas to the west. With widespread adoption of zero tillage technology and the potential for large increases in the capture and storage of rainfall in good seasons, mobilisation of salt could be exacerbated should crop water use be constrained by salt toxicity and/or nutrient deficiency. We investigated the size of salt stocks, historic deep drainage, and nutrient depletion under continuous cropping in the Grey and Brown Vertosols of the Walgett and Coonamble districts of north-western NSW. Soils collected from seven paired sites (cropped v. control native vegetation) showed chloride concentrations >500mg/kg within 0-1.2 m, high exchangeable sodium percentage (~30%) at depth and deficiency in phosphorus, manganese and zinc. Soil total nitrogen decreased from an average stock of 4.9 t/ha at a rate of 0.008 t/ha.year under cropping within 0--0.1 m and soil carbon stocks decreased from 39 t/ha by 0.20 t/ha.year within 0-0.5 m.. Despite low rainfall, high evaporation and the large water-holding capacity of the cracking clays, there were significant downward shifts in chloride concentrations under cropping. Estimates of deep drainage under continuous cropping using chloride mass balance, chloride-front displacement and crop water-balance modelling with the Agricultural Production Systems Simulator (APSIM) generally agreed (range 0.1--2% of average annual rainfall). Simulations suggested that deep drainage may be increased 5-10-fold under zero-tillage winter cropping due to enhanced capture of rainfall by zero tillage compared with traditional practices. The associated flushing of salt from the root-zone together with correction of nutrient deficiency would enhance crop water use and productivity. Current methods indicate little storage in the subsoil for future deep drainage and that hydraulic conductivity is very low. Hence, the long-term effects of any increase in drainage rates, due to changes in cropping practices and/ or climate, on the potential for salinisation of groundwater or transient water logging of the surface, are equivocal., Introduction The alluvial cracking clay soils (Vertosols) of the northern reaches of the Darling Basin, eastern Australia, produce ~7 million tonnes (Mt) of wheat, coarse grains and pulses, and ~0.3 [...]

Indonesia's banking sector was devastated by the crisis that began in October 1997. Of the largest banks--the seven original state banks and the ten largest formerly private banks--none managed to [...]

This paper describes and analyses Indonesia's frustrating experience with chronic inflation, and demonstrates that the cause of continuing moderately high inflation is excessive growth of base money. It examines the central bank's current target growth rates for narrow and broad money and bank lending, and argues instead in favour of a single target rate for base money as the key to bringing inflation under control.

Abstract Background Jacobsen syndrome is a rare contiguous gene disorder that results from a terminal deletion of the long arm of chromosome 11. It is typically characterized by intellectual disability, a variety of physical anomalies and a distinctive facial appearance. The 11q deletion has traditionally been identified by routine chromosome analysis. Array-based comparative genomic hybridization (array-CGH) has offered new opportunities to identify and refine chromosomal abnormalities in regions known to be associated with clinical syndromes. Results Using the 1 Mb BAC array (Spectral Genomics), we screened 70 chromosomally normal children with idiopathic intellectual disability (ID) and congenital abnormalities, and identified five cases with submicroscopic abnormalities believed to contribute to their phenotypes. Here, we provide detailed molecular cytogenetic descriptions and clinical presentation of two unrelated subjects with de novo submicroscopic deletions within chromosome bands 11q24-25. In subject 1 the chromosome rearrangement consisted of a 6.18 Mb deletion (from 128.25–134.43 Mb) and an adjacent 5.04 Mb duplication (from 123.15–128.19 Mb), while in subject 2, a 4.74 Mb interstitial deletion was found (from 124.29–129.03 Mb). Higher resolution array analysis (385 K Nimblegen) was used to refine all breakpoints. Deletions of the 11q24-25 region are known to be associated with Jacobsen syndrome (JBS: OMIM 147791). However, neither of the subjects had the typical features of JBS (trigonocephaly, platelet disorder, heart abnormalities). Both subjects had ID, dysmorphic features and additional phenotypic abnormalities: subject 1 had a kidney abnormality, bilateral preauricular pits, pectus excavatum, mild to moderate conductive hearing loss and behavioral concerns; subject 2 had macrocephaly, an abnormal MRI with delayed myelination, fifth finger shortening and squaring of all fingertips, and sensorineural hearing loss. Conclusion Two individuals with ID who did not have the typical clinical features of Jacobsen syndrome were found to have deletions within the JBS region at 11q24-25. Their rearrangements facilitate the refinement of the JBS critical region and suggest that a) deletion of at least 3 of the 4 platelet function critical genes (ETS-1, FLI-1 and NFRKB and JAM3) is necessary for thrombocytopenia; b) one of the critical regions for heart abnormalities (conotruncal heart defects) may lie within 129.03 – 130.6 Mb; c) deletions of KCNJ1 and ADAMTS15 may contribute to the renal anomalies in Jacobsen Syndrome; d) the critical region for MRI abnormalities involves a region from 124.6 – 129.03 Mb. Our results reiterate the benefits of array-CGH for description of new phenotype/genotype associations and refinement of previously established ones.