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Young adults presenting with lower abdominal pain are commonly diagnosed with inflammatory conditions arising from appendix, bowel, urinary tract, or female genital tract. Appendiceal intussusception is rarely considered as the primary diagnosis.2 The presentation of intussusception ranges from acute or chronic abdominal pain and rectal bleeding to an incidental radiological or intraoperative finding.2,3 Pain due to uncomplicated endometriosis-induced appendiceal intussusceptions might be cyclical but can also mimic acute appendicitis, caecal polyp, and malignancy.1,4 The inability to diagnose the condition preoperatively has resulted in overzealous surgical resection for suspected malignancy.4 The misdiagnosis of appendiceal intussusception for caecal polyps has also led to caecal perforation because of misguided attempts at endoscopic resection.5 Efforts should be made to reach a diagnosis preoperatively.

Gender, Masculinities and Lifelong Learning reflects on current debates and discourses around gender and education, in which some academics, practitioners and policy-makers have referred to a crisis of masculinity. This book explores questions such as: Are men under-represented in education? Are women outstripping men in terms of achievement? What evidence supports the view that men are becoming educationally disadvantaged? Drawing on research from a number of countries, including the UK, Australia, New Zealand and Canada, the contributors' discuss a range of issues which intersect with gender to impact on education, including structural factors such as class, ethnicity and age as well as colonisation and migration. The book provides evidence and argument to illuminate contemporary debates about the involvement of men and women in education, including: The impact of colonisation on the gendering of education and lifelong learning International surveys on men, women and educational participation Gender, masculinities and migrants' learning experiences Boys-only classes as a response to 'the problem of underachieving boys' Men's perspectives on learning to become parents Community learning, gender and public policy Older men's perspectives on (re-)entering post-compulsory education The book goes on to suggest the implications for practice, research and policy. Importantly, it critically addresses some of the taken-for-granted beliefs about men and their engagement in lifelong learning, presenting new evidence to demonstrate the complexity of gender and education today. With these complexities in mind, the authors provide a framework for developing further understanding of the issues involved with gender and lifelong learning. Gender, Mascu

BackgroundA reliable system for grading operative difficulty of laparoscopic cholecystectomy would standardise description of findings and reporting of outcomes. The aim of this study was to validate a difficulty grading system (Nassar scale), testing its applicability and consistency in two large prospective datasets.MethodsPatient and disease-related variables and 30-day outcomes were identified in two prospective cholecystectomy databases: the multi-centre prospective cohort of 8820 patients from the recent CholeS Study and the single-surgeon series containing 4089 patients. Operative data and patient outcomes were correlated with Nassar operative difficultly scale, using Kendall’s tau for dichotomous variables, or Jonckheere–Terpstra tests for continuous variables. A ROC curve analysis was performed, to quantify the predictive accuracy of the scale for each outcome, with continuous outcomes dichotomised, prior to analysis.ResultsA higher operative difficulty grade was consistently associated with worse outcomes for the patients in both the reference and CholeS cohorts. The median length of stay increased from 0 to 4 days, and the 30-day complication rate from 7.6 to 24.4% as the difficulty grade increased from 1 to 4/5 (both p < 0.001). In the CholeS cohort, a higher difficulty grade was found to be most strongly associated with conversion to open and 30-day mortality (AUROC = 0.903, 0.822, respectively). On multivariable analysis, the Nassar operative difficultly scale was found to be a significant independent predictor of operative duration, conversion to open surgery, 30-day complications and 30-day reintervention (all p < 0.001).ConclusionWe have shown that an operative difficulty scale can standardise the description of operative findings by multiple grades of surgeons to facilitate audit, training assessment and research. It provides a tool for reporting operative findings, disease severity and technical difficulty and can be utilised in future research to reliably compare outcomes according to case mix and intra-operative difficulty.

BackgroundThe ability to accurately predict operative duration has the potential to optimise theatre efficiency and utilisation, thus reducing costs and increasing staff and patient satisfaction. With laparoscopic cholecystectomy being one of the most commonly performed procedures worldwide, a tool to predict operative duration could be extremely beneficial to healthcare organisations.MethodsData collected from the CholeS study on patients undergoing cholecystectomy in UK and Irish hospitals between 04/2014 and 05/2014 were used to study operative duration. A multivariable binary logistic regression model was produced in order to identify significant independent predictors of long (> 90 min) operations. The resulting model was converted to a risk score, which was subsequently validated on second cohort of patients using ROC curves.ResultsAfter exclusions, data were available for 7227 patients in the derivation (CholeS) cohort. The median operative duration was 60 min (interquartile range 45–85), with 17.7% of operations lasting longer than 90 min. Ten factors were found to be significant independent predictors of operative durations > 90 min, including ASA, age, previous surgical admissions, BMI, gallbladder wall thickness and CBD diameter. A risk score was then produced from these factors, and applied to a cohort of 2405 patients from a tertiary centre for external validation. This returned an area under the ROC curve of 0.708 (SE = 0.013, p < 0.001), with the proportions of operations lasting > 90 min increasing more than eightfold from 5.1 to 41.8% in the extremes of the score.ConclusionThe scoring tool produced in this study was found to be significantly predictive of long operative durations on validation in an external cohort. As such, the tool may have the potential to enable organisations to better organise theatre lists and deliver greater efficiencies in care.

The list of the CholeS management group, Collaborators and Data Validators were omitted from the Acknowledgments.

Our vision is for young people who are confident, connected, actively involved, and lifelong learners.

The Presbyterian minister comments on the decision by the Presbyterian General Assembly to bar from leadership anyone who is engaged in sexual activity outside Christian marriage which includes anyone in a civil union. Source: National Library of New Zealand Te Puna Matauranga o Aotearoa, licensed by the Department of Internal Affairs for re-use under the Creative Commons Attribution 3.0 New Zealand Licence.

The results of experimental and theoretical research into multiple site fatigue damage (MSD) in the skin splices of pressurized fuselages are described. Firstly, a coupon-type specimen has been designed, which approximates on-aircraft conditions, and allows realistic MSD to be created and studied in a laboratory environment. Other coupon specimens used in industry and research cannot be used for MSD testing, because the net section stress increases untypically as the cracks progress, and because the specimens tend to fail before MSD has developed. The specimen concept described in this thesis overcomes these problems. Secondly, a cost-effective computer program for predicting MSD crack growth within a frame-bay has been developed. It applies Rooke's superposition and compounding technique in a new way, and agrees well with experimental MSD crack growth curves.

\"MAN BELONGS TO THE EARTH\" evolved out of a chain of events that began when the United States government people selected IMAX for their pavilion at Spokane because of the success that format had enjoyed at EXPO 70 in Osaka. The designer of the pavilion. Herb Rosenthal (who had also designed the IBM Pavilion at EXPO 70) had seen the IMAX presentation in Japan and wanted to have it in his pavilion at Spokane.