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The duodenum lies in front of the right kidney and renal vessels, the right psoas muscle, the inferior vena cava, and the aorta (Figure 26.1).
The duodenum is approximately 25 cm in length. It is the most fixed part of the small intestine and has no mesentery. It is anatomically divided into four parts:
The superior or first portion is intraperitoneal along the anterior half of its circumference. Superiorly, the first portion is attached to the hepatoduodenal ligament. The posterior wall is associated with the gastroduodenal artery, common bile duct, and the portal vein.
The descending or second portion shares a medial border with the head of the pancreas. It is bordered posteriorly by the medial surface of the right kidney, the right renal vessels, and the inferior vena cava. The hepatic flexure and transverse colon cross anteriorly. The common bile duct and main pancreatic duct drain into the medial wall of the descending duodenum.
The transverse or third portion is also entirely retroperitoneal. Posteriorly, it is bordered by the inferior vena cava and the aorta. The superior mesenteric vessels cross in front of this portion of the duodenum.
The ascending or fourth portion of the duodenum is approximately 2.5 cm in length and is primarily retroperitoneal, except for the most distal segment. It crosses anterior to and ascends to the left of the aorta to join the jejunum at the ligament of Treitz.
The common bile duct courses laterally within the hepatodudenal ligament and lies posterior to the first portion of the duodenum and pancreatic head, becoming partially invested within the parenchyma of the pancreatic head. The main pancreatic duct then joins the common bile duct to drain into the ampulla of Vater within the second portion of the duodenum. The ampulla of Vater is located approximately 7 cm from the pylorus. The accessory pancreatic duct drains approximately 2 cm proximal to the ampulla of Vater.
The vascular supply to the duodenum is intimately associated with the head of the pancreas. The head of the pancreas and the second portion of the duodenum derive their blood supply from the anterior and posterior pancreaticoduodenal arcades (Figure 26.2). These arcades lie on the surface of the pancreas near the duodenal C loop. Attempts to separate these two organs at this location usually results in ischemia of the duodenum.
Objectives: Caregivers of youth with heavy prenatal alcohol exposure report impaired communication, which can significantly impact quality of life. Using data collected as part of the Collaborative Initiative on Fetal Alcohol Spectrum Disorders (CIFASD), we examined whether cognitive variables predict communication ability of youth with histories of heavy prenatal alcohol exposure. Methods: Subjects (ages 10–16 years) comprised two groups: adolescents with heavy prenatal alcohol exposure (AE) and non-exposed controls (CON). Selected measures of executive function (NEPSY, Delis-Kaplan Executive Function System), working memory (CANTAB), and language were tested in the child, while parents completed communication ratings (Vineland Adaptive Behavior Scales – Second Edition). Separate multiple regression analyses determined which cognitive domains predicted communication ability. A final, global model of communication comprised the three cognitive models. Results: Spatial Working Memory and Inhibition significantly contributed to communication ability across groups. Twenty Questions performance related to communication ability in the CON group only while Word Generation performance related to communication ability in the AE group only. Effects remained significant in the global model, with the exception of Spatial Working Memory. Conclusions: Both groups displayed a relation between communication and Spatial Working Memory and Inhibition. Stronger communication ability related to stronger verbal fluency in the AE group and Twenty Questions performance in the CON group. These findings suggest that alcohol-exposed adolescents may rely more heavily on learned verbal storage or fluency for daily communication while non-exposed adolescents may rely more heavily on abstract thinking and verbal efficiency. Interventions aimed at aspects of executive function may be most effective at improving communication ability of these individuals. (JINS, 2018, 24, 1026–1037)
The purpose of the study is to describe changes in mental health among women following an oil spill and to examine their association with the Deepwater Horizon oil spill (DHOS).
The Women and Their Children’s Health study followed 2038 women in Louisiana after the DHOS. Subjects were interviewed in 2012-2014 and 2014-2016. Oil spill exposure was characterized using survey items about economic and physical exposures. Outcomes were depressive symptoms and mental distress.
After adjustment for relevant demographics, depressive symptoms increased over 2 time points following the DHOS, whereas symptoms of mental distress decreased. For every year increase in time since the DHOS, the rate ratio for depressive symptoms increased by a factor of 1.08. In contrast, the rate ratio for mental distress decreased by a factor of 0.97. In addition, initial associations between economic and physical exposure to the DHOS persisted up to 6 years after the spill; women who were more highly exposed experienced higher levels of depressive symptoms (rate ratios ranged from 1.08 to 1.11) and mental distress (rate ratios from 1.05 to 1.11) at each time point than women who were less exposed.
A better understanding of recovery patterns following an oil spill can help direct critical mental health response efforts. (Disaster Med Public Health Preparedness. 2019;13:183–190)
RELIGIOUS, GENDERED, AND CULTURAL CONFLICTS abound in Ali and Nino and can be understood through the lens of honor, a foundational phenomenon in nearly every culture. Honor consistently plays a central role in defining the conflict between Ali, an Azerbaijani Muslim youth, and his Christian Georgian future wife, Nino. Their Romeo-and- Juliet love story explores the tensions inherent in these pairings. Honor is part of the conflict not just between two families, but also between complex, ever-changing pairings: male and female, public and private, Muslim and Christian, East and West. The conflicts about honor and shame in Ali and Nino offer a peek at the fluid boundaries between religion, culture, and politics.
Between the Oriental and European norms concerning female and male honor, the story of the two lovers unfolds across European and Middle-Eastern stages, where Muslim Ali must defend his own honor in his Middle-Eastern culture, as well as Christian Nino's honor in both Middle Eastern and Western settings. The honor structures that Ali and Nino encounter are flexible and—despite the apparent differences between East and West, masculine and feminine—do in fact complement one another or overlap at times. Ali and Nino plays with honor systems that at first sight appear contradictory, mostly by focusing on the Azerbaijani (Muslim, Oriental) honor system, but with instances where Western honor (Christian, Occidental) is thematized as well, demonstrating that honor codes in Azerbaijan mirror the country's political and geographical situation. Parallel to the political situation, the individual female body possesses a certain geography; it can be placed within a larger social constellation and be “mapped” within a certain geography in the novel and can be placed within a larger constellation. We see this in both Nino's relations with other men and the tensions between the country Azerbaijan (easily thought of as feminine) and other, larger forces that claim the country (and its riches) as their own.
Eastern Communitarianism vs. Western Political Liberalism
Ali and Nino offers Western readers a glimpse of Eastern culture. Kurban Said wrote a text positioned between cultures, and we must keep in mind that he is interested in how social and cultural systems interact with each other. Ali's culture and honor codes are perceived within a communitarian system, in which a communitarian identity dominates all others.
Toxoplasma gondii, a zoonotic parasite of global importance, infects all endothermic vertebrates, with extensive health implications. The prevalence of this parasite is seldom monitored in wildlife. Here, a semi-aquatic species, the Eurasian otter (Lutra lutra) was used as a model to assess the potential effect of climate, land cover and biotic factors on T. gondii seroprevalence in British wildlife. The Sabin–Feldman cytoplasm-modifying dye test identified T. gondii antibodies in 25·5% of blood samples from otters found dead, mainly as road kill, in England and Wales, between 2004 and 2010. Otters in the east of England were more likely to be infected with T. gondii than those in western regions. Land cover and temperature are key determinants of T. gondii infection risk, with more infection in arable areas and lower infection where temperatures are higher. The probability of T. gondii infection increased with host age, reflecting cumulative exposure with time, but there was no association between T. gondii seroprevalence and cause of host death.
In a preface to the first of the six volumes of domestic tours he published between 1798 and 1800 as The British Tourists; or Traveller's Pocket Companion, WilBritain's home territories comparatively little known:
It was long a reflection on the natiliam Fordyce Mavor began with a dry comment on the fact that the status and popularity of the Grand Tour had left onal taste and judgment, that our people of fashion knew something, from ocular demonstration, of the general appearance of every country in Europe, except their own.
This was a commonly held view in the period, but for a Scottish Whig like Mavor, the point was that the outstanding features of modern Britain were all on show in the home tour. ‘[I] n whatever light we regard the British Islands;’ he observed:
whether as the cradle of liberty, the mother of arts and sciences, the nurse of manufactures, the mistress of the sea; or whether we contemplate their genial soil, their mild climate, their various natural and artificial curiosities, we shall find no equal extent of territory, on the face of the globe, of more importance, or containing more attractions […]. (v– vi)
The project Mavor was introducing was his selection of the domestic tours published in the last third of the eighteenth century, which, at least on his terms, displayed the genre at its best. This work was, he stated, oriented towards patriotism and benevolence, framed in terms of ‘utility and propriety’ as a contribution to ‘to the public good’ (viii). The excerpted, collected tours were intended to detail British improvement and advancement – subjects that Mavor, who was from a modest background, was keen should circulate to the widest possible audience. Modern tours were, he noted, the preserve of the wealthy due to their cost, but he optimistically imagined The British Tourists as a way of putting them ‘within the reach of every class of his fellow subjects’ (ix). In tandem with the levelling sentiment of this comment, the project was one of enlightenment and education, and Mavor used metaphors of illumination to say more about the public benefit of collecting and abridging tours.
Catheter-associated urinary tract infections (CAUTIs) are among the most common hospital-acquired infections (HAIs). Reducing CAUTI rates has become a major focus of attention due to increasing public health concerns and reimbursement implications.
To implement and describe a multifaceted intervention to decrease CAUTIs in our ICUs with an emphasis on indications for obtaining a urine culture.
A project team composed of all critical care disciplines was assembled to address an institutional goal of decreasing CAUTIs. Interventions implemented between year 1 and year 2 included protocols recommended by the Centers for Disease Control and Prevention for placement, maintenance, and removal of catheters. Leaders from all critical care disciplines agreed to align routine culturing practice with American College of Critical Care Medicine (ACCCM) and Infectious Disease Society of America (IDSA) guidelines for evaluating a fever in a critically ill patient. Surveillance data for CAUTI and hospital-acquired bloodstream infection (HABSI) were recorded prospectively according to National Healthcare Safety Network (NHSN) protocols. Device utilization ratios (DURs), rates of CAUTI, HABSI, and urine cultures were calculated and compared.
The CAUTI rate decreased from 3.0 per 1,000 catheter days in 2013 to 1.9 in 2014. The DUR was 0.7 in 2013 and 0.68 in 2014. The HABSI rates per 1,000 patient days decreased from 2.8 in 2013 to 2.4 in 2014.
Effectively reducing ICU CAUTI rates requires a multifaceted and collaborative approach; stewardship of culturing was a key and safe component of our successful reduction efforts.
Numerous studies have investigated human resources as a source of sustained competitive advantage, indicating that the high-performance work systems created by certain human resource development and human resource management practices lead to greater firm performance. Though the mechanism by which this link exists remains a ‘black box,’ substantial evidence shows organizations benefit by adopting the human resource development and human resource management practices that lead to high-performance work systems. We discuss two divergent perspectives, institutional theory and resource-based view, and their impact on high-performance work systems. We argue that organizations adhering to tenets of institutional theory experience isomorphism in certain human resource development and human resource management practices, whereas resource-based view attributes create ways that firms differentiate their practices. We posit that to be competitive firms must balance the push–pull effect of institutional pressure with that of resource-based view differentiation.
The refractory nature of BaTiO3 leads to limited densification and grain growth for films processed at low temperatures and a modest nonlinear dielectric response due to a marked sensitivity to physical scale and material quality. Adding liquid-forming sintering aids, common in bulk ceramics, to thin films enhances mass transport, leading to enhanced grain growth at lower temperatures. This work explores the effectiveness of a sputtered CuO buffer layer with BaO–B2O3 (BBO) fluxes to engineer the microstructure of BaTiO3 films. Grain size and homogeneity increase in the presence of even a ∼1 nm CuO layer. In general, grain size increases from 75 to 370 nm with an addition of 2.2% BBO and 8 nm CuO. Room temperature capacitance in fluxed films increases by a factor of 5 over pure films, and ferroelectric phase transitions are clearly observable in dielectric measurements. CuO–BBO proves effective on (0001) Al2O3 and (100) MgO substrates, although all microstructures are notably finer for the latter.
The histories of chronicles composed in England during the fourteenth and fifteenth centuries and onwards, with a focus on texts belonging to or engaging with the Prose Brut tradition, are thefocus of this volume. The contributors examine the composition, dissemination and reception of historical texts written in Anglo-Norman, Latin and English, including the Prose Brut chronicle (c. 1300 and later), Castleford's Chronicle (c. 1327), and Nicholas Trevet's Les Cronicles (c. 1334), looking at questions of the processes of writing, rewriting, printing and editing history. They cross traditional boundaries of subject and period, taking multi-disciplinary approaches to their studies in order to underscore the (shifting) historical, social and political contexts inwhich medieval English chronicles were used and read from the fourteenth century through to the present day. As such, the volume honours the pioneering work of the late Professor Lister M. Matheson, whose research in this area demonstrated that a full understanding of medieval historical literature demands attention to both the content of the works in question and to the material circumstances of producing those works.
Jaclyn Rajsic is a Lecturer in Medieval Literature in the School of English and Drama at Queen Mary University of London; Erik Kooper taught Old and Middle English at Utrecht University; until his retirement in 2007; Dominique Hoche is an Associate Professor at West Liberty University in West Virginia.
Contributors: Elizabeth J. Bryan, Caroline D. Eckhardt, A.S.G. Edwards, Dan Embree, Alexander L. Kaufman, Edward Donald Kennedy, Erik Kooper, Julia Marvin, William Marx, Krista A. Murchison, Heather Pagan, Jaclyn Rajsic, Christine M. Rose, NeilWeijer