Welland Medical (United Kingdom)

To investigate wound healing after application of adjunctive topical haemoglobin spray in patients with chronic wounds. Consecutive patients with a diversity of chronic wounds (defined as <40% reduction in wound size within 4 weeks) were treated with standard wound care plus haemoglobin spray and evaluated over a 26-week period. Results were compared with a retrospective cohort of 50 consecutive patients treated with standard wound care alone. We evaluated 50 patients for a 26-week evaluation period, during which 45/50 patients (90%) treated with haemoglobin spray were completely healed compared with 19/50 retrospective control patients (38%) (p<0.001). Mean time to complete wound healing was 6.6 weeks (range: 3-22) in the haemoglobin spray group compared with 11.4 weeks (range: 3-25) in the control group (p=0.01). Cox proportional hazards analysis model adjusting for baseline wound size and months wound present also yielded significant treatment effects. Exudate, slough and pain levels were all reduced to a greater extent versus control group. Haemoglobin spray resulted in a higher number of healed wounds and a faster rate of healing, as well as a positive impact on other wound parameters. These results are in accordance with other published data and supports the adjunctive use of haemoglobin spray in patients with a wide variety of chronic wounds of all sizes and origins.

Agricultural drainage ditches are ubiquitous features in lowland agricultural landscapes, built primarily to facilitate land drainage, irrigate agricultural crops and alleviate flood risk. Most drainage ditches are considered artificial waterbodies and are not typically included in routine monitoring programmes, and as a result the faunal and floral communities they support are poorly quantified. This paper characterises the aquatic macroinvertebrate diversity (alpha, beta and gamma) of agricultural drainage ditches managed by an internal drainage board in Lincolnshire, UK. The drainage ditches support very diverse macroinvertebrate communities at both the site (alpha diversity) and landscape scale (gamma diversity) with the main arterial drainage ditches supporting greater numbers of taxa when compared to smaller side ditches. Examination of the between site community heterogeneity (beta diversity) indicated that differences among ditches were high spatially and temporally. The results illustrate that both main arterial and side ditches make a unique contribution to aquatic biodiversity of the agricultural landscape. Given the need to maintain drainage ditches to support agriculture and flood defence measures, we advocate the application of principles from ‘reconciliation ecology’ to inform the future management and conservation of drainage ditches.

The church of St Bartholomew the Great in West Smithfield is not generally thought of as a building of major importance, probably because the plan of its presbytery seems to suggest that it was a rather outmoded imitation of Norwich Cathedral. The first part of this paper examines the basis for such an assumption and offers an explanation for the similarities between the presbyteries of the two buildings. Affiliations between the two institutions are placed in the wider context of the aspirations of the London episcopate in the decades either side of II00. Smithfield emerges as an extraordinary building, highly untypical of contemporary Augustinian architecture. The twelfth-century foundation narrative of Smithfield implies that, while in building, the church struck onlookers as astonishingly innovative. Taken at face value, this is puzzling, since most of the elements of its design had been common architectural currency for a generation or more. This apparently paradoxical situation is explored in the second part of the paper and the basis for Smithfield's perceived modernity while under construction very tentatively reconstructed.

EDITOR—As a general practitioner, I believe that the guidance from the Driver and Vehicle Licensing Agency (DVLA) is unclear about when an elderly person should be advised or instructed to cease driving. Conditions commoner in elderly people, but not unique to them, such as decreased visual acuity and myocardial infarction, have clear guidelines on how they restrict the licence to drive, but there is insufficient advice about slowed reaction times, decreased spatial …

"Introduction to the Study of Military History for Canadian Students." Canadian Historical Review, 36(3), pp. 268–269

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