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Background: Anastomotic leaks are associated with significant risk of morbidity, mortality and treatment costs after oesophagectomy. The aim of this study was to evaluate international variation in unit-level clinical practice and resource availability for the prevention and management of anastomotic leak following oesophagectomy.Method: The Oesophago-Gastric Anastomosis Audit (OGAA) is an international research collaboration focussed on improving the care and outcomes of patients undergoing oesophagectomy. Any unit performing oesophagectomy worldwide can register to participate in OGAA studies. An online unit survey was developed and disseminated to lead surgeons at each unit registered to participate in OGAA. High-income country (HIC) and low/middle-income country (LMIC) were defined according to the World Bank whilst unit volume were defined as < 20 versus 20-59 versus ≥60 cases/year in the unit.Results: Responses were received from 141 units, a 77% (141/182) response rate. Median annual oesophagectomy caseload was reported to be 26 (inter-quartile range 12-50). Only 48% (68/141) and 22% (31/141) of units had an Enhanced Recovery After Surgery (ERAS) program and ERAS nurse, respectively. HIC units had significantly higher rates of stapled anastomosis compared to LMIC units (66 vs 31%, p = 0.005). Routine post-operative contrast-swallow anastomotic assessment was performed in 52% (73/141) units. Stent placement and interventional radiology drainage for anastomotic leak management were more commonly available in HICs than LMICs (99 vs 59%, p < 0.001 and 99 vs 83%, p < 0.001).Conclusions: This international survey highlighted variation in surgical technique and management of anastomotic leak based on case volume and country income level. Further research is needed to understand the impact of this variation on patient outcomes.

Over the past decade, Lyman-alpha and metal line absorption observations have established the ubiquity of a gas-rich circumgalactic medium (CGM) around star-forming galaxies at z~0.2 potentially tracing half of the missing baryonic mass within galaxy halos. Unfortunately, these observations only provide a statistical measure of the gas in the CGM and do not constrain the spatial distribution and kinematics of the gas. Furthermore, we have limited sensitivity to Lyman-alpha at z~0 with existing instruments. As such, we remain ignorant of how this gas may flow from the CGM onto the disks of galaxies where it can fuel ongoing star-formation in the present day. Fortunately, 21-cm HI observations with radio telescopes can map HI emission providing both spatial and kinematic information for the CGM in galaxies at z=0. Observations with phased array feeds, radio cameras, on single-dish telescopes yield unmatched surface brightness sensitivity and survey speed. These observations can complete the census of HI in the CGM below N(HI), Science white paper for the Astro2020 Decadal Survey, 9 pages, 2 figures

Recent detections of a significant interstellar medium (ISM) in many post-starburst galaxies challenges their traditional classification as dust- and gas-poor merger remnants, rapidly transitioning to quiescence. We have conducted a multi-wavelength survey of 33 E+A post-starbursts selected from SDSS, including Spitzer, Herschel, and ALMA. We find compact, warm dust reservoirs with high polycyclic aromatic hydrocarbon (PAH) abundances. Their infrared spectral properties are unique, with dominant PAH emission, very weak nebular lines, and deep [C II] deficits - the aging burst populations provide an unusual "high-soft" radiation field that seemingly dominates the post-starbursts' ISM energetics. We also find unusually strong H2 rotational emission, among the brightest, relative to infrared luminosity, of any known galaxy - indicating a highly turbulent ISM. High-resolution ALMA CO(2-1) follow-up observations reveal that the molecular gas in these post-starbursts is exceptionally dense - rivaling the gas found in ULIRGs - and is concentrated in turbulent, rotating nuclear reservoirs. Coupled with modest SFRs from a range of infrared tracers, the post-starbursts' high gas densities indicate highly inefficient star formation - they lie more than an order of magnitude below the Kennicutt-Schmidt star-forming relation. These results paint a coherent picture of systems in which star formation was, indeed, rapidly truncated, but in which the ISM was not completely expelled. High-density nuclear reservoirs of molecular fuel remain but are supported against collapse by some form of continual turbulent heating.

Background: Current interventions to support medication adherence in people with type 2 diabetes are generally resource-intensive and ineffective. Brief messages, such as those delivered via short message service (SMS) systems, are increasingly used in digital health interventions to support adherence because they can be delivered on a wide scale and at low cost. The content of SMS text messages is a crucial intervention feature for promoting behavior change, but it is often unclear what the rationale is for chosen wording or any underlying mechanisms targeted for behavioral change. There is little guidance for developing and optimizing brief message content for use in mobile device–delivered interventions. Objective: This review aimed to (1) identify theoretical constructs (ie, the targets that interventions aim to change) and behavioral strategies (ie, features of intervention content) found to be associated with medication adherence in patients with type 2 diabetes and (2) map these onto a standard taxonomy for behavior change techniques (BCTs, that is, active ingredients of interventions used to promote behavioral change, to produce an evidence-based set of approaches that have shown promise of improving adherence in previous studies and which could be further tested in digital health interventions. Methods: A rapid systematic review of existing relevant systematic reviews was conducted. MEDLINE and PsycINFO databases were searched from inception to April 10, 2017. Inclusion criteria were (1) systematic reviews of quantitative data if the studies reviewed identified predictors of or correlates with medication adherence or evaluated medication adherence–enhancing interventions and included adult participants taking medication to manage a chronic physical health condition, and (2) systematic reviews of qualitative studies of experiences of medication adherence for adult participants with type 2 diabetes. Data were extracted on review characteristics and BCTs, theoretical constructs, or behavioral strategies associated with improved adherence. Constructs and strategies were mapped onto the BCT version 1 taxonomy. Results: A total of 1701 references were identified; 25 systematic reviews (19 quantitative reviews, 3 qualitative reviews, and 3 mixed-method reviews) were included. Moreover, 20 theoretical constructs (eg, self-efficacy) and 19 behavioral strategies (eg, habit analysis) were identified in the included reviews. In total, 46 BCTs were identified as being related to medication adherence in type 2 diabetes (eg, habit formation, prompts or cues, and information about health consequences). Conclusions: We identified 46 promising BCTs related to medication adherence in type 2 diabetes on which the content of brief messages delivered through mobile devices to improve adherence could be based. By using explicit systematic review methods and linking our findings to a standardized taxonomy of BCTs, we have described a novel approach for the development of digital message content. Future brief message interventions that aim to support medication adherence could incorporate the identified BCTs.

Yvonne Kiera Bartlett,1 Nikki Newhouse,2 Hannah A Long,1 Andrew J Farmer,2 David P French1 1Manchester Centre for Health Psychology, School of Health Sciences, University of Manchester, Manchester, UK; 2Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UKCorrespondence: Yvonne Kiera BartlettManchester Centre for Health Psychology, School of Health Sciences, University of Manchester, Coupland 1 Building, Oxford Road, Manchester M13 9PL, UKTel +44 161 306 5436Fax +44 161 275 2588Email kiera.bartlett@manchester.ac.ukBackground: Many people with type 2 diabetes do not take their treatment as prescribed. Brief messages to support medication use could reach large numbers of people at a very low cost per person, but current interventions using brief messages rarely adequately describe the content of the messages, nor base these messages on explicit behavior change principles. This study reports the views of people with type 2 diabetes concerning the acceptability of 1) a messaging system and 2) proposed messages based on behavior change techniques (BCTs) and beliefs and concerns around taking medication.Methods: The proposed system and brief messages were discussed in focus groups of people with type 2 diabetes recruited through general practices in England. Transcripts were analyzed thematically.Participants: Twenty-three participants took part in one of five focus group discussions. All participants were over 18 years, were taking tablet medication for their diabetes, and had access to a mobile phone. Key exclusion criteria were recent hospitalization for hyper- or hypoglycemia or diagnosis with a terminal illness.Results: Four themes were identified as relating to the acceptability of the messaging system: “opportunities and limitations of technology”, “us and them (who is the system for?)”, “responsibility for adherence”, and “diabetes management beyond medication”. Participants recognized the benefit of using technology. Those with high confidence in their ability to adhere were keen to make a distinction between themselves and those who did not adhere; participants were more comfortable taking responsibility for medication than diet and exercise. Acceptability of the messages hinged on avoiding “preaching to the converted”.Conclusions: These findings show that brief messaging could be acceptable to the target population for a range of diabetes-related behaviors but highlight the need for such a system to be perceived as personally relevant. Acceptable messages would need to maintain novelty for the target population.Keywords: diabetes, mHealth, health psychology, behavior change, qualitative, focus groups

The NASA/IPAC Teacher Archive Research Program (NITARP) partners small groups of educators with a research astronomer for a year-long authentic research project. This program aligns well with the characteristics of high-quality professional development (PD) programs and has worked with a total of 103 educators since 2005. In this paper, surveys were explored that were obtained from 74 different educators, at up to four waypoints during the course of 13 months, incorporating data from the class of 2010 through the class of 2017. This paper investigates how participating teachers describe their motivations for participating in NITARP as evidenced in these feedback forms. Analysis of self-reported data allows a mapping onto a continuum ranging from more inward-focused to more outward-focused; there is a shift from more inward-focused responses to more outward-focused responses. This insight into teacher motivations has implications for how the educators might be supported during their year with the program. This work provides a new way of parameterizing why educators participate in PD programs that require a considerable investment of time. NITARP, since it has many qualities of successful PD, serves as a model for similar PD programs in other STEM subjects. Likewise, the analysis method might also be useful to similarly evaluate other PD programs., Accepted by PRPER for the Focused Collection on Astronomy Education Research

NITARP, the NASA/IPAC Teacher Archive Research Program, partners small groups of predominantly high school educators with research astronomers for a year-long research project. This paper presents a summary of how NITARP works and the lessons learned over the last 13 years. The program lasts a calendar year, January to January, and involves three ~week-long trips: to the American Astronomical Society (AAS) winter meeting, to Caltech in the summer (with students), and back to a winter AAS meeting (with students) to present their results. Because NITARP has been running since 2009, and its predecessor ran from 2005-2008, there have been many lessons learned over the last 13 years that have informed the development of the program. The most critical is that scientists must see their work with the educators on their team as a partnership of equals who have specialized in different professions. NITARP teams appear to function most efficiently with approximately 5 people: a mentor astronomer, a mentor teacher (who has been through the program before), and 3 new educators. Educators are asked to step into the role of learner and develop their question-asking skills as they work to develop an understanding of a subject in which they will not have command of all the information and processes needed. Critical to the success of each team is the development of communication skills and fluid plan of action to keep the lines of communication open. This program has allowed more than 100 educators to present more than 60 total science posters at the AAS., Comment: Accepted by refereed conference proceedings for RTSRE 2017

The aim of the study was to evaluate the relationship between bacterial vaginosis (BV) and relapse of cervical intraepithelial neoplasia grade 2 or more (CIN2+) after Loop electrosurgical excision procedure (LEEP).One hundred four patients who underwent LEEP for CIN2+ were followed up every six months for three years. Fifty-three were negative for BV and fifty-one were positive. Each clinical control included Pap test, colposcopy, Amsel criteria test, HPV-DNA, and HPV-mRNA test.Patients' age, presence of BV, positivity to HPV-DNA and HPV-mRNA tests were analyzed. The average age of patients was 42.5 ± 8.92 years (median: 42.5; range from 27 to 58 years). The minimum follow-up was 6 months and maximum 36 months (average: 22.8 ± 4.53; median: 24). The 10% of the patients with HPV-mRNA test negative had relapsed, compared to 45% of patients with HPV-mRNA test positive. Among the 53 patients without BV the 20% had relapsed compared with 23% of 51 patients with diagnosis of BV.There is no evidence for higher percentage of relapse in patients with BV, submitted to excisional procedure for CIN2+ associated to HPV-m-RNA test positivity. There is only a correlation among BV and relapse of CIN2+ lesions after LEEP.

The incidence of abnormal cervical cytology in pregnancy is similar to that reported for non-pregnant women. Furthermore, 1% of pregnant women annually screened for cervical cancer will be diagnosed with cervical intraepithelial neoplasia (CIN) of various degrees. For this reason, Pap smear should be performed in the first trimester of pregnancy. The persistence of HR-HPV infection is related to the development of CIN. However, the relationship between CIN and HR-HPV infection during pregnancy and postpartum can hardly be found. The aim of this work was to assess the proper management of abnormal cytology during and after pregnancy evaluating regression rate, persistence rate and risk of progression and the predictive role of HPV molecular tests.Patients with abnormal cervical cytology were followed-up using colposcopy and colposcopy-directed biopsies every 12 weeks. Molecular tests were performed at the moment of the cytological diagnosis. Patients not treated in pregnancy were re-evaluated with cytology, colposcopy, biopsies, HPV-DNA test and HPV-mRNA test for a final diagnosis 8 weeks postpartum. Women with a persistent CIN 2-3 lesion at this follow-up check, underwent an excisional procedure by LEEP and then re-evaluated every 6 months for a year.HPV-DNA test showed a sensitivity of 90.5% and a negative predictive value of 96.4%. Specificity and positive predictive values were 67.9% and 43.2%, respectively. For HPV-mRNA test, a sensitivity of 76.2% and a NPV of 93.9% were found; specificity and PPV were 98.7% and 94.1% respectively.An observational management based on the use of molecular test and particularly HPV-mRNA test for its higher specificity, is a reasonable possibility in the follow-up of CIN2/3 lesions during pregnancy.

Bovine respiratory disease (BRD) is the primary cause of morbidity and mortality in cattle during the feeding period. Management of BRD cases relies on the observation of cattle behavioral changes by caregivers. This paper describes the use of multiple antemortem diagnostic technologies in combination to improve outcomes in the clinical management of BRD., American Association of Bovine Practitioners Proceedings of the Annual Conference, 2015

Follicular cysts are an important disorder affecting 5 to 30% of dairy cows that leads to abnormal estrous cycle behavior and economic losses due to infertility. The underlying causes of follicular cysts are not fully understood, and responses to therapeutic strategies have been inconsistent. Therefore, veterinarians face challenges in treating cystic ovarian follicles in dairy cattle. The objective of this study was to evaluate the role of the pro-inflammatory mediator IL-1-beta (IL1B) and select metabolites found in blood and follicular fluid from 2 groups of cows., American Association of Bovine Practitioners Proceedings of the Annual Conference, 2015

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Background An ageing population has service planners concerned about future levels of disease which are age dependent. Predictions of mortality for colorectal, lung and breast cancers, which account for 30% of cancer cases and 40% of cancers deaths, were calculated for 2010 and 2015, based on trends in death rates and the predicted change in the demography of the Northern Ireland population. Methods The US National Cancer Institute's “Joinpoint” program was used to check for structural breaks in the time series of cancer death rates from 1984 to 2004. The prediction models applied to the data allowed variations in trends across age groups to be taken into account. A linear model was used for increasing or constant trends and a log linear model was used where the trend was decreasing. The models assume the number of deaths in each stratum, defined by age-sex and time-period, is Poisson distributed, with the average value determined by a log or linear function. Results Recent trends in rates of cancers studied were downwards except for female lung. Predictions include decreased colorectal cancer deaths in females and lung cancer deaths in males. In females, lung cancer deaths are predicted to more than double by the year 2015 (473 deaths), based on the 1984 level. Colorectal death rates in males are predicted to drop, but the number of deaths will increase by more than 10%, due to demographic change. Numbers of breast cancer deaths are likely to rise slightly, despite falling age standardised death rates, due to an ageing population. Conclusions This work has provided estimates of early future trends, useful to service planners, and highlights the need for tobacco control, to reduce numbers of lung cancer deaths in females. The recently announced control of environmental tobacco legislation is one welcome development which should reduce lung cancer mortality in Northern Ireland.

Several studies have suggested a possible role for HPV in the pathogenesis of the breast cancer. We investigated the presence of the HPV DNA in breast cancers and non malignant disease breast tissues by the use of a standard HPV detection method (INNO-Lipa HPV), in order to detect HPV DNA in metastatic nodes, to investigate a possible cervical HPV co-infection, and to evaluate the E6/E7 mRNA expression in HPV DNA positive breast cancer tissues. The rate of HPV infection was significantly higher in the cancer group than in controls (9/31 vs. 0/12, p = 0.04). One out of eight metastatic axillary nodes was positive for HPV infection; 2/3 of the positive HPV breast cancer patients were co-infected at the cervical site. The role of the virus in breast oncogenesis is still unclear, since our analysis failed in demonstrating the expression of viral E6 and E7 in positive HPV positive breast tumor tissues.

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Objective: To determine whether self monitoring, alone or\ud with instruction in incorporating the results into self care,is more effective than usual care in improving glycaemic control in non-insulin treated patients with type 2 diabetes.\ud \ud Design: Three arm, open, parallel group randomised trial.\ud Setting 48 general practices in Oxfordshire and South\ud Yorkshire.\ud \ud Participants: 453 patients with non-insulin treated type 2\ud diabetes (mean age 65.7 years) for a median duration of\ud three years and a mean haemoglobin A1c level of 7.5%.\ud Interventions Standardised usual care with measurements of HbA1c every three months as the control group (n=152), blood glucose self monitoring with advice for patients to contact their doctor for interpretation of results, in addition to usual care (n=150), and blood glucose self monitoring with additional training of patients in interpretation and application of the results to\ud enhance motivation and maintain adherence to a healthy\ud lifestyle (n=151).\ud \ud Main outcome measure: HbA1c level measured at\ud 12 months.\ud \ud Results: At 12 months the differences in HbA1c level\ud between the three groups (adjusted for baseline HbA1c\ud level) were not statistically significant (P=0.12). The\ud difference in unadjusted mean change in HbA1c level from\ud baseline to 12 months between the control and less\ud intensive self monitoring groups was −0.14% (95%\ud confidence interval −0.35% to 0.07%) and between the\ud control and more intensive self monitoring groups was\ud −0.17% (−0.37% to 0.03%).\ud \ud Conclusions: Evidence is not convincing of an effect of self monitoring blood glucose, with or without instruction in incorporating findings into self care, in improving\ud glycaemic control compared with usual care in reasonably\ud well controlled non-insulin treated patients with type 2\ud diabetes.\ud \ud Trial registration Current Controlled Trials\ud ISRCTN47464659.

The Catalan-Larcombe-French sequence has been studied in several previous papers [P. J. Larcombe and D. R. French, Congr. Numerantium 143, 33-64 (2000; Zbl 0971.05001) and ibid. 148, 65-91 (2001; Zbl 0999.05003)]. The second of these papers derived a formula for the exponent of 2 in the prime factorization of these numbers. The present paper computes an easily derived asymptotic for that exponent; it does not discuss results concerning any other prime factors.

Gene amplification is a relatively frequent event in human malignant tumors and is believed to have an important function in neoplastic transformation and tumor progression. Our attention has been focused on the amplification and the expression of the int-2 gene for several reasons: (1) In the mouse mammary tumorigenesis int-2 is frequently activated by MMTV proviral integration. (2) The human homolog of int-2, located on chromosome 11q13, is frequently amplified in human primary tumors and is comprised in an amplification unit encompassing the hst gene, which is often coamplified; the amplification at the 11q13 locus in breast carcinomas correlates with a poor outcome of the disease. (3) int-2 and hst belong to the basic FGF gene family. All these observations raise the possibility that the human int-2 gene plays an active role in the neoplastic process, but this will prove to be true only if int-2 is expressed in human tumors. In the present study we used RNA:RNA in situ hybridization and Northern blot analysis to show that int-2 gene is expressed in a number of human carcinomas amplified at the same locus.

Previous studies have indicated that crown morphology and within-crown color variations, rather than between-crown color differences, are principal keys to the accurate aerial detection of Dutch elm disease (DED). Because within-crown color variations often tend to be very subtle on conventional infrared photographs, microdensitometry and subsequent digital enhancement were evaluated as potential means of improving detection accuracy. Vertical 70 mm color infrared photographs at scales of 1:6,000 and 1:12,000 were taken on several dates during 1979-80 over a St. Paul, Minnesota study area containing high incidence of DED. Scanning microdensitometer data from the photographs were processed using three enhancement techniques: color contrast stretch, two-band spectral ratioing, and multiple discriminant analysis. The numerically processed data were subsequently reconverted to image form using a high resolution color film recorder. Experienced interpreters analyzed both the original imagery and the enhanced products. The computer enhanced images dramatically increased the expression of subtle within-crown and between-crown color variations, but only nominally improved detection accuracy. Thus, the factor limiting detection from vertical photography appears to be the inconsistency, not the subtletly, in which DED is manifested as crown color variation.