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Background Significant numbers of individuals struggle to return to work following acute coronavirus disease 2019 (COVID-19). The UK Military developed an integrated medical and occupational pathway (Defence COVID-19 Recovery Service, DCRS) to ensure safe return to work for those with initially severe disease or persistent COVID-19 sequalae. Medical deployment status (MDS) is used to determine ability to perform job role without restriction ('fully deployable', FD) or with limitations ('medically downgraded', MDG). Aims To identify which variables differ between those who are FD and MDG 6 months after acute COVID-19. Within the downgraded cohort, a secondary aim is to understand which early factors are associated with persistent downgrading at 12 and 18 months. Methods Individuals undergoing DCRS had comprehensive clinical assessment. Following this, their electronic medical records were reviewed and MDS extracted at 6, 12 and 18 months. Fifty-seven predictors taken from DCRS were analysed. Associations were sought between initial and prolonged MDG. Results Three hundred and twenty-five participants were screened, with 222 included in the initial analysis. Those who were initially downgraded were more likely to have post-acute shortness of breath (SoB), fatigue and exercise intolerance (objective and subjective), cognitive impairment and report mental health symptoms. The presence of fatigue and SoB, cognitive impairment and mental health symptoms was associated with MDG at 12 months, and the latter two, at 18 months. There were also modest associations between cardiopulmonary function and sustained downgrading. Conclusions Understanding the factors that are associated with initial and sustained inability to return to work allows individualized, targeted interventions to be utilized. [ABSTRACT FROM AUTHOR]

Notes that stage models of learning to spell have not been helpful to teachers in teaching spelling. Describes a three year project, based in three inner London primary schools. Shows that although there is a developmental dimension to learning to spell, children nevertheless draw on several sources of knowledge from the outset. (RS)

The angiotensin-converting-enzyme (ACE)-inhibitory activities of a bovine sodium caseinate fermentate generated using the proteolytic capabilities of the porcine small intestinal isolate Lactobacillus animals DPC6134 are examined. ACE-inhibitory activity of 85.51 percent and 50 percent inhibitory concentration of 0.8mg protein/ml were observed in the crude 10-kDa Lactobacillus animalis DPC6134.

Objective: Robot-assisted surgery is a recognised treatment for pelvic-organ prolapse. Many of the surgical subgroup outcomes for apical prolapse are reported together, leading to a paucity of homogenous data.Design: Prospective observational cohort study (NCT01598467, clinicaltrials.gov) assessing outcomes for homogeneous subgroups of robot-assisted apical prolapse surgery.Setting: Two European tertiary referral hospitals.Population: Consecutive patients undergoing robot-assisted sacrocolpopexy (RASC) and supracervical hysterectomy with sacrocervicopexy (RSHS).Methods: Anatomical cure (simplified Pelvic Organ Prolapse Quantification, sPOPQ, stage 1), subjective cure (symptoms of bulge), and quality of life (Pelvic Floor Impact Questionnaire, PFIQ-7).Main Outcome Measures: Primary outcome: anatomical and subjective cure.Secondary Outcomes: surgical safety and intraoperative variables.Results: A total of 305 patients were included (RASC n = 188; RSHS n = 117). Twelve months follow-up was available for 144 (RASC 76.6%) and 109 (RSHS 93.2%) women. Anatomical success of the apical compartment occurred for 91% (RASC) and in 99% (RSHS) of the women. In all compartments, the success percentages were 67 and 65%, respectively. Most recurrences were in the anterior compartment [15.7% RASC (symptomatic 12.1%); 22.9% RSHS (symptomatic 4.8%)]. Symptoms of bulge improved from 97.4 to 17.4% (P < 0.0005). PFIQ-7 scores improved from 76.7 ± 62.3 to 13.5 ± 31.1 (P < 0.0005). The duration of surgery increased significantly for RSHS [183.1 ± 38.2 versus 145.3 ± 29.8 (P < 0.0005)]. Intraoperative complications and conversion rates were low (RASC, 5.3 and 4.3%; RSHS, 0.0 and 0.0%). Four severe postoperative complications occurred after RASC (2.1%) and one occurred after RSHS (1.6%).Conclusions: This is the largest reported prospective cohort study on robot-assisted apical prolapse surgery. Both procedures are safe, with durable results.Tweetable Abstract: European bi-centre trial concludes that robot-assisted surgery is a viable approach to managing apical prolapse. [ABSTRACT FROM AUTHOR]

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Background: Cystic Fibrosis (CF) is an autosomal recessive disease that affects the function of a number of organs, principally the lungs, but also the gastrointestinal tract. The manifestations of cystic fibrosis transmembrane conductance regulator (CFTR) dysfunction in the gastrointestinal tract, as well as frequent antibiotic exposure, undoubtedly disrupts the gut microbiota. To analyse the effects of CF and its management on the microbiome, we compared the gut microbiota of 43 individuals with CF during a period of stability, to that of 69 non-CF controls using 454-pyrosequencing of the 16S rRNA gene. The impact of clinical parameters, including antibiotic therapy, on the results was also assessed. Results: The CF-associated microbiome had reduced microbial diversity, an increase in and a reduction in Firmicutes Bacteroidetes compared to the non-CF controls. While the greatest number of differences in taxonomic abundances of the intestinal microbiota was observed between individuals with CF and the healthy controls, gut microbiota differences were also reported between people with CF when grouped by clinical parameters including % predicted FEV1 (measure of lung dysfunction) and the number of intravenous (IV) antibiotic courses in the previous 12 months. Notably, CF individuals presenting with severe lung dysfunction (% predicted FEV1 ≤ 40%) had significantly (< 0.05) reduced gut microbiota diversity relative to those presenting with mild or moderate dysfunction. A significant negative correlation (-0.383, Simpson's Diversity Index) was also observed between the number of IV antibiotic courses and gut microbiota diversity. Conclusions: This is one of the largest single-centre studies on gut microbiota in stable adults with CF and demonstrates the significantly altered gut microbiota, including reduced microbial diversity seen in CF patients compared to healthy controls. The data show the impact that CF and it's management have on gut microbiota, presenting the opportunity to develop CF specific probiotics to minimise microbiota alterations. [ABSTRACT FROM AUTHOR]

Background: Little is known regarding the effect of bariatric surgery on urinary incontinence. Methods: Between September 2008 and November 2014, 240 female patients underwent bariatric surgery. Results: The prevalence of urinary incontinence preoperatively was 45 % (108). Eighty-two (76 %) completed urinary function questionnaires pre-operatively and post-operatively. Fifty-seven (70 %) underwent laparoscopic gastric bypass, twenty-four (29 %) underwent sleeve gastrectomy and one underwent a banding procedure. Thirty-one (38 %) reported leaking on sneezing or coughing-stress urinary incontinence (SUI). Thirteen (16 %) complained of leaking before reaching the toilet-overactive bladder syndrome (OAB). The remaining thirty-eight (46 %) reported mixed symptoms. The mean pre-operative weight and BMI were 133 (18) kg and 50 (SD = 6.2) kg/m respectively. The mean post-operative BMI drop was 16 (SD = 5.2) kg/m. Preoperatively, 61 (75 %) reported moderate to very severe urinary incontinence compared to 30 (37 %) post-operatively ( χ = 3.24.67, p = 0.050). Twenty-seven (33 %) patients reported complete resolution of their urinary incontinence. Fifty-one (62 %) patients required incontinence pads on a daily basis pre-operatively, compared to 35 (43 %) post-operatively ( χ = 22.211.6, p = 0.00). The mean International Consultation on Incontinence Questionnaire- Urinary Incontinence short form (ICIQ-UI SF) score was 9.3 (SD = 4.4) pre-operatively compared to 4.9 (SD = 5.3) post-operatively ( t = 7.2, p = 0.000). The improvement score post-operatively was 8 (SD = 3). A significant difference in the ICIQ-UI SF was identified between OAB and SUI groups when adjusting for age, number of children, type of delivery and pre-op BMI ( t = 1.98, p = 0.05). Conclusion: Bariatric surgery results in a clinically significant improvement in urinary incontinence. However, this is not proportional to pre-operative BMI, weight loss, age, parity and mode of delivery. [ABSTRACT FROM AUTHOR]

Objectives:The relevance of spatial composition in the microbial changes associated with UC is unclear. We coupled luminal brush samples, mucosal biopsies and laser capture microdissection with deep sequencing of the gut microbiota to develop an integrated spatial assessment of the microbial community in controls and UC. Design: A total of 98 samples were sequenced to a mean depth of 31 642 reads from nine individuals, four control volunteers undergoing routine colonoscopy and five patients undergoing surgical colectomy for medically-refractory UC. Samples were retrieved at four colorectal locations, incorporating the luminal microbiota, mucus gel layer and whole mucosal biopsies. Results: Interpersonal variability accounted for approximately half of the total variance. Surprisingly, within individuals, asymmetric Eigenvector map analysis demonstrated differentiation between the luminal and mucus gel microbiota, in both controls and UC, with no differentiation between colorectal regions. At a taxonomic level, differentiation was evident between both cohorts, as well as between the luminal and mucosal compartments, with a small group of taxa uniquely discriminating the luminal and mucosal microbiota in colitis. There was no correlation between regional inflammation and a breakdown in this spatial differentiation or bacterial diversity. Conclusions: Our study demonstrates a conserved spatial structure to the colonic microbiota, differentiating the luminal and mucosal communities, within the context of marked interpersonal variability. While elements of this structure overlap between UC and control volunteers, there are differences between the two groups, both in terms of the overall taxonomic composition and how spatial structure is ascribable to distinct taxa. [ABSTRACT FROM AUTHOR]

Introduction: Differences in mesh composition may affect outcomes such as erosion, tissue integration and inflammation. The majority of commercially available meshes are type 1, manufactured from monofilament polypropylene with differing pore sizes and mechanical properties. Objective: To assess the local tolerance of four commercially available meshes in terms of mesh integration and host tissue response. Method: Using an animal model, mesh was implanted onto the abdominal sheath. Animals were sacrificed at 7, 30 and 90 days and data collected. Results: Strength of mesh-skin integration increased in all groups across the three time points. Polyform displayed highest strength of separation overall. VM PFR and Iprolite reached their maximum integration earliest. In regard to mesh abdominal wall integration Polyform had the greatest strength of separation, with Ultrapro displaying some weakening of integration at 30 and 90 days. Host tissue response was similar in all groups at each time point. Conclusion: Polyform and VM PFR have enhanced tissue integration when compared to Ultrapro. This decreased integration in Ultrapro may lead to increased mesh failure. The composition of mesh affects its integration and potentially its failure rate but not host tissue response. These observations in mesh characteristics may benefit the design of next generation meshes with a view to reducing failure rates and erosion. [ABSTRACT FROM AUTHOR]

Robotic surgery is associated with reduced hospital stay compared with open surgery. While the initial outlay is expensive, the increased number of patients amenable to this minimal access approach compared with conventional 'keyhole surgery' has the potential for financial savings. Our aim was to show the cost per surgery and the potential for savings with increased caseload and reduced hospital bed stay. A cost analysis was performed incorporating an audit of robotic surgery over the initial 3 years. This was performed using prospectively acquired data completed after each robotically assisted case. Depreciation and maintenance on the robot accounted for an outlay of €260,000/annum. Due to the learning curves and hospital constraints, in year 1, an average of 1.5 cases were performed per week at a cost of €5,980/case, this cost reduced to €4,250 over the next 2 years with an increase to 2.4 cases/week. We projected that if maximum usage of nine cases/week was achieved the cost would reduce to €2,523/case. In 2010, 36 % of all hysterectomies were performed robotically. The average length of stay for robot-assisted cases was two nights compared to six to eight nights for open hysterectomy. The robotic approach is associated with savings of approximately €201,933/year compared with a similar tertiary referral hospital in Ireland with no robot. Purchasing a robot is costly but associated with greater cost savings when reduced length of stay is accounted for. Furthermore, maximisation of robotic use further decreases the cost per case. [ABSTRACT FROM AUTHOR]

The da Vinci® Surgical System dominates robotic surgery, as the only robotic device to have FDA approval in gynaecology. The benefits of robot-assisted surgery include decreased length of stay, decreased blood loss and analgesic requirements. Ergonomic improvements allow the surgeon to operate with less risk of neck and back injury. Unfortunately the initial economic impact of purchasing and maintaining a robot are great but must be balanced with the potential savings from reduced length of stay and earlier return to normal activity. This review looks at the uses for the robot in both gynaecology and urogynaecology, assessing the efficacy of this modality compared to both straight stick (laparoscopy) and open procedures. We assess the benefits to both patient and surgeon from the available literature. Within the current economic environment we appraise the costs associated with the robot. [ABSTRACT FROM AUTHOR]

Aims: In this study, we compare seven different methods which have been designed or modified to extract total DNA from raw milk and raw milk cheese with a view to its subsequent use for the PCR of bacterial DNA. Materials and Results: Seven extraction methods were employed to extract total DNA from these foods, and their relative success with respect to the yield and purity of the DNA isolated, and its quality as a template for downstream PCR, was compared. Although all of the methods were successful with respect to the extraction of DNA naturally present in cheese, they varied in their relative ability to extract DNA from milk. However, when milk was spiked with a representative Gram-positive ( Listeria monocytogenes EGDe) or Gram-negative ( Salmonella enterica serovar Typhimurium LT2) bacterium, it was established that all methods successfully extracted DNA which was suitable for subsequent detection by PCR. Conclusions: Of the seven approaches, the PowerFood™ Microbial DNA Isolation kit (MoBio Laboratories Inc.) was found to most consistently extract highly concentrated and pure DNA with a view to its subsequent use for PCR-based amplification and also facilitated accurate detection by real-time quantitative PCR. Significance and Impact of the Study: Accurately assessing the bacterial composition of milk and cheese is of great importance to the dairy industry. Increasingly, DNA-based technologies are being employed to provide an accurate assessment of this microbiota. However, these approaches are dependent on our ability to extract DNA of sufficient yield and purity. This study compares a number of different options and highlights the relative success of these approaches. We also highlight the success of one method to extract DNA from different microbial populations as well as DNA which is suitable for real-time PCR of microbes of interest, a challenge often encountered by the food industry. [ABSTRACT FROM AUTHOR]

The role of robot-assisted surgery across gynaecology is evolving with increasing numbers of procedures being undertaken with varying degrees of complexity. While the risk of conversion is low at approximately 1 %, the reasons for conversion are variable. These range from technical issues with the robot, surgical complications such as haemorrhage and anaesthetics issues such as an inability to ventilate the patient adequately. While many conversions to open or laparoscopic approach are not due to life-threatening indications, it is important that the theatre staff are aware of the indication and can perform an emergency undocking as effectively, efficiently and safely as possible when the need arises. Unfortunately, there is a paucity of the literature available outlining such protocols. For this reason, we developed an emergency undocking protocol clearly outlining the role of each theatre staff member and the need for clear concise communication. [ABSTRACT FROM AUTHOR]

Maternal perception of decreased fetal movements (DFM) is associated with increased incidence of stillbirth and intrauterine growth restriction. We hypothesised that clinical assessment of women perceiving DFM may identify patients at highest risk of poor perinatal outcome. This was a retrospective study of 203 patients presenting to the obstetric triage service with DFM. Information on obstetric and past medical history, the current presentation with DFM and the outcome of pregnancy was collected. Using multivariate analysis, odds ratios (OR) and 95% confidence intervals (CI) were calculated for poor pregnancy outcome defined as stillbirth, small for gestational age or pre-term delivery. The rate of stillbirth was increased in women with DFM (OR 2.9). Some 26.6% of women perceiving DFM had a poor perinatal outcome. Women with relevant past obstetric history (OR 2.11), two or more presentations of DFM (OR 1.92), or who measured small-for-dates (OR 19.53) were at increased risk of poor pregnancy outcome. These preliminary data suggest that some features of clinical assessment can identify patients at increased risk of poor perinatal outcome after presentation with DFM. Such patients may be prioritised for detailed assessment of fetal growth and wellbeing. [ABSTRACT FROM AUTHOR]

Aims: To isolate and characterize peptides from bovine colostrum with antimicrobial activity. Methods and Results: Three peptides were purified from fresh colostrum by a range of chromatographic methods using antimicrobial activity against Escherichia coli DH5α to screen for the most active fractions. Two peptides, with antimicrobial activity, casecidin 17 and casecidin 15, were identical to sequences in the C-terminal of bovine β-casein (YQEPVLGPVRGPFPIIV and YQEPVLGPVRGPFPI) and had corresponding molecular masses of 1881·00 and 1669·06 Da, respectively. The third peptide was the known peptide isracidin which has a mass of 2763·80 Da and sequence of RPKHPIKHQGLPQEVLNENLLRF. Casecidin 17 and casecidin 15 had identical minimal inhibition concentrations (MICs) against E. coli DPC6053 of 0·4 mg ml−1. Structural modelling suggested amphiphilic structures having identical inhibitory and structural properties. The MIC value of isracidin against E. coli DPC6053 was 0·2 mg ml−1. Conclusions: This study shows the presence of three antimicrobial peptides in colostrum which may contribute to a bioprotective role to limit pathogen contamination. Furthermore, the discovery of casecidin 17 and 15 may provide the basis for novel antimicrobial peptide design. Significance and Impact of the Study: This is the first study to characterize peptides with antimicrobial activity present in fresh bovine colostrum. [ABSTRACT FROM AUTHOR]

Nonstructural carbohydrate (NSC) concentrations might reflect the strategies described in the leaf economic spectrum (LES) due to their dependence on photosynthesis and respiration. We examined if NSC concentrations correlate with leaf structure, chemistry, and physiology traits for 114 species from 19 sites and 5 biomes around the globe. Total leaf NSC concentrations varied greatly from 16 to 199 mg g -1 dry mass and were mostly independent of leaf gas exchange and the LES traits. By contrast, leaf NSC residence time was shorter in species with higher rates of photosynthesis, following the fast-slow strategies in the LES. An average leaf held an amount of NSCs that could sustain one night of leaf respiration and could be replenished in just a few hours of photosynthesis under saturating light, indicating that most daily carbon gain is exported. Our results suggest that NSC export is clearly linked to the economics of return on resource investment., (© 2024 The Author(s). New Phytologist © 2024 New Phytologist Foundation.)