Ischemic Gastropathy: An Unusual Cause of Abdominal Pain and Gastric Ulcers

Chronic mesenteric ischemia classically presents as “intestinal angina” with generalized postprandial abdominal pain lasting up to 3 hours. Over time, these episodes can become much more intense and ultimately lead to sitophobia with significant weight loss. Symptoms are not specific and often mistakenly attributed to other gastrointestinal etiologies such as peptic ulcer disease. Gastric ulcerations as a direct result of mesenteric ischemia have been reported but are relatively rare because of the rich collateral blood supply to the stomach. Therefore, a diagnosis of ischemic gastropathy is seldom entertained in patients presenting with abdominal pain and gastriculcers.     

Sutural growth restriction and modern human facial evolution: an experimental study in a pig model

Facial size reduction and facial retraction are key features that distinguish modern humans from archaic Homo. In order to more fully understand the emergence of modern human craniofacial form, it is necessary to understand the underlying evolutionary basis for these defining characteristics. Although it is well established that the cranial base exerts considerable influence on the evolutionary and ontogenetic development of facial form, less emphasis has been placed on developmental factors intrinsic to the facial skeleton proper. The present analysis was designed to assess anteroposterior facial reduction in a pig model and to examine the potential role that this dynamic has played in the evolution of modern human facial form. Ten female sibship cohorts, each consisting of three individuals, were allocated to one of three groups. In the experimental group (n = 10), microplates were affixed bilaterally across the zygomaticomaxillary and frontonasomaxillary sutures at 2 months of age. The sham group (n = 10) received only screw implantation and the controls (n = 10) underwent no surgery. Following 4 months of post‐surgical growth, we assessed variation in facial form using linear measurements and principal components analysis of Procrustes scaled landmarks. There were no differences between the control and sham groups; however, the experimental group exhibited a highly significant reduction in facial projection and overall size. These changes were associated with significant differences in the infraorbital region of the experimental group including the presence of an infraorbital depression and an inferiorly and coronally oriented infraorbital plane in contrast to a flat, superiorly and sagittally infraorbital plane in the control and sham groups. These altered configurations are markedly similar to important additional facial features that differentiate modern humans from archaic Homo, and suggest that facial length restriction via rigid plate fixation is a potentially useful model to assess the developmental factors that underlie changing patterns in craniofacial form associated with the emergence of modern humans.     

Recanting of life-time inhalant use: how big a problem and what to make of it

Aims   To establish the prevalence of recanting of life-time inhalant use, identify correlates of recanting to gain insight to its causes and develop a method for distinguishing recanters who truly are versus are not life-time users of inhalants.
Design and setting   Longitudinal survey data from students in 62 South Dakota middle schools who were participating in a field trial to evaluate a school-based drug prevention program.
Measurements   At grades 7–8, participants reported on their life-time inhalant use, other drug use and drug-related beliefs, attitudes and behaviors.
Findings   Forty-nine per cent of students who reported life-time inhalant use at grade 7 recanted their reports a year later. Comparison of students who recanted inhalant use with those who did or did not report inhalant use consistently on drug-related beliefs, attitudes and behaviors at grades 7 and 8 suggested that, whereas some inhalant use recanting reflects denial of past behavior, some reflects erroneous initial reporting. Based on a latent mixture model fitted to the multivariate distribution of grade 7 and grade 8 responses of recanters and consistent reporters, we calculated the probability that each recanter was, in fact, a life-time inhalant user. An estimated 67% of the recanters in our sample appear to be life-time inhalant users who admitted use in grade 7 and then denied that use at grade 8; 33% appear to be students who reported use incorrectly at grade 7 and then corrected that error at grade 8.
Conclusions   Inhalant use recanting is a significant problem that, if not handled carefully, is likely to have a considerable impact on our understanding of the etiology of inhalant use and efforts to prevent it.     

Nurse education: factors associated with attrition

Title.  Nurse education: factors associated with attrition.
Aim.  This paper is a report of a study to identify the factors having an impact on student completion rates in a preregistration programme.
Background.  Nursing student attrition is an international issue causing concern in many parts of the developed world including Australia, the United States and Europe. In the United Kingdom, nursing student attrition has become a major issue, despite having one of the lowest general university dropout rates in the developed world.
Method.  A retrospective cohort study was conducted in 2007 using routinely-collected demographic and completion data on four cohorts of nursing students (1259 in total) studying at a large English university.
Findings.  Students who were older on entry were more likely to complete the programme than younger students, and those who had only the minimum educational qualifications on entry were less likely to complete than those with higher-level qualifications. There was some evidence of increased risk of resigning from the course in students taking the child branch, and increased risk of discontinuation (involuntary removal) from the course in both male and black/minority ethnic students. There was also some evidence that the healthcare organization responsible for a student's placement could influence completion rates.
Conclusion.  To improve attrition rates on preregistration nursing programmes, higher education institutions should actively target recruitment at mature candidates; increase the level of qualification required to gain entry; examine course structures for flexibility and provide multi-level student support.