We present an interesting and rare case of traumatic Gerbode ventricular septal defect and complete heart block. The multimodality images illustrate the diagnosis well. This case is an excellent demonstration of the diagnostic utility of multimodality imaging.

We investigate the synthesis of kesterite Cu2ZnSnS4 (CZTS) thin films using thermal evaporation from copper, zinc and tin pellets and post-annealing in a sulfur atmosphere. The effects of chemical composition were studied both on the absorber layer properties and on the final solar cell performance. It is confirmed that CZTS thin film chemical composition affects the carrier concentration profile, which then influences the solar cell properties. Solar cells using a CZTS thin film with composition ratio Cu/(Zn+Sn) = 0.87, and Zn/Sn = 1.24 exhibited an open-circuit voltage of 483 mV, a short-circuit current of 14.54 mA/cm2, a fill factor of 37.66 % and a conversion efficiency of 2.64 %. Only a small deviation from the optimal chemical composition can drop device performance to a lower level, which confirms that the CZTS solar cells with high conversion efficiency existed in a relatively narrow composition region.

Land use and the management of our natural resources such as soils and water offer great opportunities to sequester carbon and mitigate the effects of climate change. Actions on forestry, soil carbon and damaged peatlands each have the potential to reduce Scottish emissions in 2020 by hundreds of thousands of tonnes. Most actions to reduce emissions from land use have beneficial effects on other ecosystem services, so if we can cut emissions we can in many circumstances improve the environment. The cost of reducing emissions through land use change can be low in relation to other means of cutting emissions. The Scottish Land Use Strategy and the Ecosystem Approach it calls for, employing the concept of ecosystem services, offers a way of balancing environmental, social and economic demands on the land. Scotland's land, soils, forests and waters are all likely to be significantly altered by future climate change. Each of these components of the land-based environment offers opportunities for mitigation and adaptation to climate change. The emerging new imperatives for securing food, water and energy at a global level are equally important for Scotland, and interact with the need for environmental security and for dealing with climate change.

Current ultrasound techniques can accurately determine the chorionicity of twins, but not zygosity. We previously proposed that the zygosity of spontaneously conceived twins can be determined at early ultrasound, where 2 corpora lutea infers dizygosity, and 1 implies monozygosity. Here we did a case series, comparing zygosity predicted using this method with definitive DNA genotyping of twins after birth. We retrospectively identified 14 ultrasound reports of spontaneous twin pregnancies at 6(+0 days) to 13+6 weeks' gestation, where both ovaries were seen and the number of corpora lutea documented. We visited all twin pairs, obtained buccal smears, and determined zygosity by genotyping 9 independent microsatellite markers. All 8 cases where 2 corpora lutea were seen were dizygotic pregnancies. One further case where 3 corpora lutea were seen was also dizygotic. All 3 sets of monozygotic twins had 1 corpus luteum. There were 2 cases incorrectly assigned, where 1 corpus luteum was seen in dizygotic pregnancies. We conclude if 2 corpora lutea are seen at a first trimester ultrasound of spontaneously conceived dichorionic twins, they appear to be almost certainly dizygotic. However, if 1 corpus luteum is seen in dichorionic twins, zygosity cannot be determined with certainty since it is either monozygotic, or dizygotic where a second corpus luteum has been missed.

We present a patient with DiGeorge syndrome and an isolated right subclavian artery arising from the right pulmonary artery via a right-sided ductus arteriosus. The patient showed a subclavian and pulmonary steal with perfusion of the right arm and right lung via retrograde circulation in the right vertebral artery. The patient underwent successful surgical repair.

The prevalence of falls and associated injuries increases with age and dependency. The highest occurs among individuals living in long-term care institutions. Preventing falls results in reduced physical and psychological morbidity as well as having cost-saving implications. This review explores both uni- and multifactorial approaches to reducing fall rates and risk in individuals in long-term care, as well as highlighting the differences in this group from community-dwelling individuals.

Background. There is limited randomized controlled trial (RCT) evidence for compulsory community treatment. Other study methods may clarify their effectiveness. We reviewed RCT and non-RCT evidence for the effect of compulsory community treatment on hospital admissions, bed-days, compliance and out-patient contacts.

Method. A systematic review of RCTs, controlled before-and-after (CBA) studies, and interrupted time series (ITS) analyses. Meta-analysis of RCTs.

Results. Eight papers covering five studies (two RCTs and three CBAs) met inclusion criteria (total n=1108). There was no statistical difference in 12-month admission rates between subjects on involuntary out-patient treatment and controls. Survival analyses of time to admission were equivocal. All five studies reported decreases in the number of bed-days following involuntary out-patient treatment but this only reached statistical significance in one situation; patients receiving the intervention were less likely to have admissions of over 100 days. There was no difference in treatment adherence between the intervention and control groups in either RCT or two of the CBA studies. However, the third CBA study reported a statistically significant increase of nearly five visits in the mean number of overall contacts in the involuntary out-patient treatment group.

Conclusions. The evidence for involuntary out-patient treatment in reducing either admissions or bed-days is very limited. It therefore cannot be seen as a less restrictive alternative to admission. Other effects are uncertain. Evaluation of a wide range of outcomes should be included if this type of legislation is introduced.