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The \emph{MIDNA} application specific integrated circuit (ASIC) is a skipper-CCD readout chip fabricated in a 65 nm LP-CMOS process that is capable of working at cryogenic temperatures. The chip integrates four front-end channels that process the skipper-CCD signal and performs differential averaging using a dual slope integration (DSI) circuit. Each readout channel contains a pre-amplifier, a DC restorer, and a dual-slope integrator with chopping capability. The integrator chopping is a key system design element in order to mitigate the effect of low-frequency noise produced by the integrator itself, and it is not often required with standard CCDs. Each channel consumes 4.5 mW of power, occupies 0.156 mm${^2}$ area and has an input referred noise of 2.7${\mu\nu}_{rms}$. It is demonstrated experimentally to achieve sub-electron noise when coupled with a skipper-CCD by means of averaging samples of each pixel. Sub-electron noise is shown in three different acquisition approaches. The signal range is 6000 electrons. The readout system achieves 0.2${e^{-}}$ RMS by averaging 1000 samples with MIDNA both at room temperature and at 180 Kelvin.

Climate models can produce accurate representations of the most important modes of climate variability, but they cannot be expected to follow their observed time evolution. This makes direct comparison of simulated and observed variability difficult and creates uncertainty in estimates of forced change. We investigate the role of three modes of climate variability, the North Atlantic Oscillation, El Niño–Southern Oscillation and the Southern Annular Mode, as pacemakers of climate variability since 1781, evaluating where their evolution masks or enhances forced climate trends. We use particle filter data assimilation to constrain the observed variability in a global climate model without nudging, producing a near-free-running model simulation with the time evolution of these modes similar to those observed. Since the climate model also contains external forcings, these simulations, in combination with model experiments with identical forcing but no assimilation, can be used to compare the forced response to the effect of the three modes assimilated and evaluate the extent to which these are confounded with the forced response. The assimilated model is significantly closer than the “forcing only” simulations to annual temperature and precipitation observations over many regions, in particular the tropics, the North Atlantic and Europe. The results indicate where initialised simulations that track these modes could be expected to show additional skill. Assimilating the three modes cannot explain the large discrepancy previously found between observed and modelled variability in the southern extra-tropics but constraining the El Niño–Southern Oscillation reconciles simulated global cooling with that observed after volcanic eruptions.

Background: pertussis vaccination in pregnancy is recommended in many countries to provide protection to young infants. The best timing for this vaccination is uncertain. In the UK, vaccination is recommended between 16 weeks and 32 weeks of gestation. In this trial we aimed to investigate the equivalence of three time periods for pertussis vaccination in pregnancy.Methods: in this open-label, equivalence, randomised controlled trial to investigate equivalence of different time windows for pertussis vaccination in pregnancy, participants were randomly assigned (1:1:1 ratio) to receive a pertussis-containing vaccine (Boostrix-inactivated poliovirus vaccine) in one of three gestational age groups, comprising group 1 (≤23 weeks + 6 days), group 2 (24-27 weeks + 6 days), and group 3 (28-31 weeks + 6 days) using a computer-generated randomisation list. The primary outcome was concentration of pertussis-specific antibodies in the infant born at term at birth. Maternal blood sampling was done before and 2 weeks after vaccination and at delivery, together with a cord sample, and an infant sample was collected at least 4 weeks after primary vaccination. Reactogenicity was assessed for 7 days after vaccination. This trial was registered with ClinicalTrials.gov (NCT03908164).Findings: between May 7, 2019, and Feb 13, 2020, of 1010 women assessed for eligibility, 364 women were recruited and 351 received the intervention (120 in group 1, 119 in group 2, and 112 in group 3). Equivalence of time periods was demonstrated for anti-pertussis toxin and anti-pertactin IgG concentrations. The cord blood geometric mean concentrations of anti-filamentous haemagglutinin IgG were higher with increasing gestational age at vaccination, such that for infants in group 1 (≤23 weeks + 6 days), equivalence to group 3 (28-31 weeks + 6 days) was not shown. Reported rates of fever were similar between study groups.Interpretation: pertussis vaccination at three different time intervals in pregnancy resulted in equivalent concentrations of IgG antibodies in infants against two of the three pertussis antigens assessed. Overall, these findings support recommendations to vaccinate any time between 16 weeks and 32 weeks of gestation.Funding: the Thrasher Research Fund and the National Immunisation Schedule Evaluation Consortium through the National Institute for Health and Care Research policy research programme.

Antarctic margin and Southern Ocean surface freshening has been observed in recent decades and is projected to continue over the twenty-first century. Surface freshening due to precipitation and sea ice changes is represented in coupled climate models; however, Antarctic ice sheet/shelf meltwater contributions are not. Because Antarctic melting is projected to accelerate over the twenty-first century, this constitutes a fundamental shortcoming in present-day projections of high-latitude climate. Southern Ocean surface freshening has been shown to cause surface cooling by reducing both ocean convection and the entrainment of warm subsurface waters to the surface. Over the twenty-first century, Antarctic meltwater is expected to alter the pattern of projected surface warming as well as having other climatic effects. However, there remains considerable uncertainty in projected Antarctic meltwater amounts, and previous findings could be model dependent. Here, we use the ACCESS-ESM1.5 coupled model to investigate global climate responses to low and high Antarctic meltwater additions over the twenty-first century under a high-emissions climate scenario. Our high-meltwater simulations produce anomalous surface cooling, increased Antarctic sea ice, subsurface ocean warming, and hemispheric differences in precipitation. Our low-meltwater simulations suggest that the magnitude of surface temperature and Antarctic sea ice responses is strongly dependent on the applied meltwater amount. Taken together, these findings highlight the importance of constraining projections of Antarctic ice sheet/shelf melt to better project global surface climate changes over the twenty-first century. Significance Statement Antarctic ice sheets and shelves are melting, adding meltwater to the Southern Ocean and changing the ocean circulation. Antarctic meltwater stratifies the upper ocean, resulting in cooling of the surface Southern Ocean but warming at depth that could accelerate ice shelf melting. Coupled climate models used to project twenty-first-century climate do not represent ice sheets or shelves, neglecting important climate impacts. Here we conduct meltwater simulations with a coupled climate model and find that the magnitude of climate responses is strongly dependent on the applied meltwater amount. This highlights 1) the importance of constraining Antarctic meltwater projections to better project global climate over the twenty-first century and 2) that it is important that Antarctic meltwater be represented in future-generation coupled climate models.

Background: Iron deficiency anemia is common in patients with advanced chronic kidney disease (CKD). Ferric derisomaltose (FDI) enables iron repletion in a single dose, unlike other forms of iron for IV administration, which require multiple doses. Protocols are commonly used with other IV irons, but there are limited Canadian data for FDI, and no protocol exists. Objectives: To evaluate the efficacy and safety of FDI for patients with CKD and to ascertain information related to its use in Canadian provinces. Methods: This retrospective cohort study involved patients with non–dialysis-dependent CKD (NDD-CKD) and patients undergoing peritoneal dialysis (PD) who received FDI in a tertiary hospital in Nova Scotia between June 2020 and May 2021. Each patient was followed for a minimum of 6 months. The efficacy outcomes were the changes from baseline in hemoglobin, transferrin saturation (TSAT), and ferritin after the first dose of FDI and at 3 and 6 months. The safety outcomes were the frequency and types of adverse reactions to FDI. Electronic surveys were sent to 33 Canadian renal pharmacists to gather information about FDI use, dosing, administration, monitoring, funding, and safety in their respective organizations. Results: A total of 52 infusions were administered to 35 patients during the study period. The median times between doses 1 and 2 and between doses 2 and 3 were 19.1 and 6.6 weeks, respectively. The median change from baseline to first post-FDI follow-up blood work was significant for hemoglobin (9.0 g/L, p = 0.023), TSAT (11 percentage points, p

Background: Observational studies have demonstrated improved outcomes with the adjunctive use of balloon guide catheters (BGC) during endovascular thrombectomy (EVT) for anterior circulation acute ischaemic stroke (AIS). However, the lack of high-level evidence and global practice heterogeneity justifies a randomised controlled trial (RCT) to investigate the effect of transient proximal blood flow arrest on the procedural and clinical outcomes of patients with AIS following EVT. Hypothesis: Proximal blood flow arrest in the cervical internal carotid artery during EVT for proximal large vessel occlusion is superior to no flow arrest in achieving complete vessel recanalisation. Methods: ProFATE is an investigator-initiated, pragmatic, multicentre RCT with blinding of participants and outcome assessment. An estimated 124 participants with an anterior circulation AIS due to large vessel occlusion, an NIHSS of ⩾2, ASPECTS ⩾ 5 and eligible for EVT using a first-line combined technique (contact aspiration and stent retriever) or contact aspiration only will be randomised (1:1) to receive BGC balloon inflation or no inflation during EVT. Outcomes: The primary outcome is the proportion of patients achieving near-complete/complete vessel recanalisation (eTICI 2c-3) at the end of the EVT procedure. Secondary outcomes include the functional outcome (modified Rankin Scale at 90 days), new or distal vascular territory clot embolisation rate, near-complete/complete recanalisation after the first pass, symptomatic intracranial haemorrhage, procedure-related complications and death at 90 days. Discussion: This is the first RCT to investigate the effect of proximal blood flow arrest during EVT using a BGC on the procedural and clinical outcomes of patients with AIS due to large vessel occlusion.

Folate and choline are methyl donor nutrients that may play a role in fetal brain development. Animal studies have reported that prenatal folate and choline supplementation are associated with better cognitive outcomes in offspring and that these nutrients may interact and affect brain development. Human studies that have investigated associations between maternal prenatal folate or choline levels and neurodevelopmental outcomes have reported contradictory findings and no human studies have examined the potential interactive effect of folate and choline on children’s neurodevelopment. During the second trimester of pregnancy, maternal red blood cell folate was measured from blood samples and choline intake was estimated using a 24-h dietary recall in 309 women in the APrON cohort. At 3–5 years of age, their children’s neurodevelopment was assessed using the Wechsler Preschool and Primary Scales of Intelligence – Fourth EditionCND, NEPSY-II language and memory subtests, four behavioral executive function tasks, and the Movement Assessment Battery for Children – Second Edition. Adjusted regressions revealed no associations between maternal folate and choline levels during pregnancy and most of the child outcomes. On the Dimensional Change Card Sort, an executive function task, there was an interaction effect; at high levels of choline intake (i.e., 1 SD above the mean; 223.03 mg/day), higher maternal folate status was associated with decreased odds of receiving a passing score (β = −0.44; 95%CI −0.81, −0.06). In conclusion, maternal folate status and choline intake during the second trimester of pregnancy were not associated with children’s intelligence, language, memory, or motor outcomes at 3–4 years of age; however, their interaction may have an influence children’s executive functions.

With the increasing use of novel semiconductor technologies such as SiC and GaN in inverter-fed electrical machines, the switching losses of the power electronics can be reduced. However, this leads to steeper voltage gradients, resulting in a strongly nonlinear transient potential distribution along the winding of the electrical machine. As a result, the insulation system – especially the turn-to-turn insulation – is subjected to additional voltage stress. To carry out targeted dimensioning of the insulation system, it is necessary to calculate the transient potential distribution in advance. In the design of a hairpin winding, it is possible to influence the transient potential differences by employing a method called “shifting” within the winding scheme and thus to reduce the maximum potential differences that occur. On this basis, a targeted design of winding plans with hairpins can be achieved. Here, both the transient potential differences between the conductors within a slot of the stator core and the potential differences between the conductors of different phases in the end winding region of the machine are considered. Furthermore, the voltage differences between the conductors and the stator core are determined and compared for different variants. In this way, it is possible to reduce the amount of material used in the insulation system. Finally, an advantageous winding layout plan based on reduced potential differences is compared with a reference plan.

Objective Whether psychosocial adversity during pregnancy impacts fetal health outcomes at birth remains underexplored. This is a critical issue given significant social disadvantage and psychosocial stress faced by pregnant women worldwide. Study design Measures of social disadvantage and psychological factors, and medical/reproductive and nutritional health status in pregnant women were obtained at each trimester. Using Structural Equation Modeling (SEM), we investigated the relationship of forms of adversity to each other and to infant gestational age, and birthweight. Results Among 399 singletons, Social Disadvantage significantly predicted gestational age (p = 0.003), and residual birthweight (p = 0.006). There was a 0.4 week decrease in gestational age and a 3% decrease in birthweight for each standard deviation increase in Social Disadvantage. Conclusion Significant negative effects of social adversity on the developing fetus were found. Notably, these effects emerged despite good prenatal care and after accounting for maternal age and medical reproductive risk factors.

As low as reasonably achievable principles (ALARA) should be applied during all X-ray examinations. In some institutions, an acute abdomen series includes both erect and supine radiography. The purpose of the study was to evaluate the effect of an erect position on absorbed dose to internal abdominal organs when compared with the supine position.A prospective study was undertaken where 81 patients were imaged in both supine and erect positions. The PCXMC Monte Carlo software was used to estimate individual organ doses using dose area product (DAP). Absorbed doses were calculated for the large intestines, active bone marrow, liver, lungs, small intestine, stomach, gallbladder, breasts, uterus, ovaries, urinary bladder, kidneys, testicles, and prostate.The results showed a significant increase of absorbed dose by 1.4% when moving from a supine to an erect position. The testes were found to be the organs most affected by the erect position and then the urinary bladder.According to the study's findings, using the erect position during abdominal radiography increases the radiation dose for all of the selected organs compared to using a supine position. Therefore, it is advised that the use of erect abdomen radiography be restricted to certain circumstances.

This article explores how the presence of competing logics in craft higher education (HE) influences educational provision and student experience. Findings are presented from four craft HE case studies across England, including analysis of degree programme specifications and module curricula and interviews with educators, current students and recent graduates conducted in 2018. The article presents how these logics influence employability-focused teaching in craft curricula and how this impacts time, space and facilities allocated to physical craft work. Key tensions identified include perceptions and measurement of graduate “success”, the impact on skill development and studio space and (dis)engagement with professional development training. The article concludes with reflection on how this relates to the perceived value of arts degrees, but argues that the responsibility to “prepare” students for craft careers cannot lie solely with HE providers.

School nurses frequently interact with school-age children and their parents/guardians regarding vaccinations. As a trusted source of information, the school nurse is in a unique position to share vaccine information with parents/guardians and school-age children that may dispel myths and, consequently, improve vaccination rates. Nevertheless, some parents/guardians are still reluctant to vaccinate their school-age children against Human Papilloma Virus (HPV) for a variety of reasons. Common barriers to HPV vaccination include a lack of understanding of the vaccine’s purpose, concerns regarding the vaccine’s safety, and insufficient recommendation from healthcare workers. However, school nurses have many duties in addition to ensuring vaccine compliance. School nurses may have difficulty remaining up-to-date on evidence-based answers to parents’/guardians’ questions about HPV vaccine. Therefore, the purpose of this article is to provide school nurses with a quick reference question and answer guide to parents’/guardians’ common HPV-related vaccination questions.

Traumatic brain injury (TBI) can lead to neurocognitive decline, in part due to phosphorylated tau (p-tau). Whether p-tau accumulation worsens in the setting of polytrauma remains unknown. Propranolol has shown clinical benefit in head injuries; however, the underlying mechanism is also unknown. We hypothesize that hemorrhagic shock would worsen p-tau accumulation but that propranolol would improve functional outcomes on behavioral studies.A murine polytrauma model was developed to examine the accumulation of p-tau and whether it can be mitigated by early administration of propranolol. TBI was induced using a weight-drop model and hemorrhagic shock was achieved via controlled hemorrhage for 1 h. Mice were given intraperitoneal propranolol 4 mg/kg or saline control. The animals underwent behavioral testing at 30 d postinjury and were sacrificed for cerebral histological analysis. These studies were completed in male and female mice.TBI alone led to increased p-tau generation compared to sham on both immunohistochemistry and immunofluorescence (P 0.05). The addition of hemorrhage led to greater accumulation of p-tau in the hippocampus (P 0.007). In male mice, p-tau accumulation decreased with propranolol administration for both polytrauma and TBI alone (P 0.0001). Male mice treated with propranolol also outperformed saline-control mice on the hippocampal-dependent behavioral assessment (P = 0.0013). These results were not replicated in female mice; the addition of hemorrhage did not increase p-tau accumulation and propranolol did not demonstrate a therapeutic effect.Polytrauma including TBI generates high levels of hippocampal p-tau, but propranolol may help prevent this accumulation to improve both neuropathological and functional outcomes in males.

The aim of this prospective cohort study was to investigate perioperative and postoperative outcomes for bitches that were neutered at different times in relation to puberty (rather than age). Three hundred and six Labrador and Golden Retriever crossbreed bitches were neutered before (prepubertal neuter [PPN], n = 155) or after puberty (Control, n = 151) by experienced veterinarians at one of four veterinary practices (VP1-4). Data were gathered from veterinarians at the time of neutering and from bitch caregivers for the 14-day period after neutering using purpose-designed questionnaires. PPN bitches had shorter surgery durations than Control bitches (OR = 0.877, 91% CI = 0.800 to 0.961, P = 0.015). Longer surgery durations were reported for bitches that had intraoperative complications (OR = 1.620, 91% CI = 1.397 to 1.879, P 0.001). Shorter surgery durations were reported for VP1 compared to all other veterinary practices (OR = 1.189 to 1.534, P 0.001). There was no difference in the number of PPN or Control bitches that had perioperative complications (PPN: 3.9%, n = 6; Control: 7.7%, n = 11) and no bitch had more than one perioperative complication reported. For the 14-day postoperative period, fewer PPN (1.3%, n = 2) compared to Control bitches (8.9%, n = 13) had wound discharge (Chi-square = 11.151, D.F = 1, P = 0.001) or showed inappetence (PPN: 2.9%, n = 4; Control: 17.3%, n = 19, Chi-square = 14.884, D.F. = 1, P 0.001). There was no difference in the number of PPN and Control bitches that had redness or swelling of the wound (52 PPN, 48 Control), showed attention to the wound (6 PPN, 6 Control), required veterinary attention (25 PPN, 23 Control), or that showed any other unusual behaviours: discomfort (27 PPN, 16 Control), uncharacteristic irritability (2 PPN, 4 Control), or uncharacteristic licking or chewing of parts of the body (15 PPN, 6 Control). Bitches neutered at VP2-4 were more likely to have wound redness or swelling reported than those neutered at VP1 (OR = 3.109 to 4.076, P = 0.003). Future studies should consider the impact of veterinary practice on results. These results for peri and postoperative complications could suggest that prepubertal ovariohysterectomy may be a suitable option for neutering bitches. However, it is recommended that they be interpreted together with evidence relating to the impacts on other factors including behaviour and longer-term health in order to make fully informed decisions.

Innovation, and the creative thinking that provides the basis for innovation, is of great value for organizations. In this article we describe what is needed for people to think creatively, noting that creative thinking is a complex, albeit voluntary, activity involving performance on certain types of problems. The ways leaders influence peoples’ willingness to engage in, and ability to solve, creative problems are then described. Leaders of creative efforts must not only motivate creative work but also actively contribute to creative problem-solving both by engaging followers in creative problem-solving and by establishing the conditions that allow creative problem-solving at the individual, team, and firm levels. The implications of these observations for leader assessment and leader development are discussed.

BACKGROUND: In high TB burden countries, access to drug susceptibility testing is a major bottleneck. Targeted next-generation sequencing (tNGS) is a promising technology for rapid resistance detection. This study assessed the role of tNGS for the diagnosis of drug-resistant TB (DR-TB).METHODS: A total of 161 samples from bacteriologically confirmed TB cases were subjected to tNGS using the Deeplex® Myc-TB kit and sequenced using the MiSeq platform. These samples were also processed for conventional phenotypic DST (pDST) using 13 drugs on Mycobacteria Growth Indicator Tube and line-probe assays (MTBDRplus and MTBDRsl).RESULTS: There were 146 DR-TB and 15 drug-susceptible TB (DS-TB) samples. About 70% of patients with DR-TB had no previous TB treatment history. Overall, 88.2% had rifampicin-resistant/multidrug-resistant TB (RR/MDR-TB), 58.5% pre-extensively drug-resistant TB (pre-XDR-TB) and 9.2% had XDR-TB as defined by the WHO (2020). Around 8% (n = 13) of samples were non-culturable; however, identified 8 were resistant to first and second-line drugs using tNGS. Resistance frequency was similar across methods, with discordance in drugs less reliable using pDST or with limited mutational representation within databases. Sensitivities were aligned with literature reports for most drugs. We observed 10% heteroresistance, while 75% of strains were of Lineages 2 and 3.CONCLUSIONS: Programme data supported tNGS in the diagnosis of DR-TB for early treatment using individualised regimens.

This article addresses issues of gender inequality in the UK’s contemporary art sector. It combines quantitative data on shifts in gender representation from over a hundred commercial contemporary art galleries in London in 2016, 2019 and 2022 with qualitative interviews with leading gallery directors. The research seeks to uncover structural inequalities in the commercial art sector which continue to create obstacles for female artists. In particular, we highlight the impact of the myth of meritocracy and an insistence on “quality” (particularly in relation to masculine ideology around ‘genius’); the continuing relationship between art history and the contemporary art market; the impact of parenting on the careers of female artists; and, the commercial sector’s influence on the public and not-for-profit arena in light of dwindling government financial support of public institutions. Our key findings underline that the commercial sector is increasingly necessary for career success, and that biases against women in the commercial art world inhibit opportunities for women artists and the number of women being represented by commercial galleries. Our data, collected over a period of six years, shows a mere 1% annual improvement, to just 34% in 2022.

While there is evidence that discrimination against LGBTQ + people can cause homelessness, or worsen experiences, in this paper we consider law, policy and practice to tackle homelessness among LGBTQ + people. Contrasting the different legal systems across the UK nations of England, Scotland and Wales, we firstly consider how law, as structured around the norm of the heterosexual nuclear family, can be designed to discriminate against LGBTQ + people. Turning to practice within organisations tackling homelessness, we then present evidence on how support can be explicitly, or inadvertently, discriminatory while trying to be well-intentioned. Evidence from an organisation that has embedded LGBTQ + inclusion into its services offers a best practice alternative. We conclude, using utopia as a method, by suggesting that a full respect for LGBTQ + lives in homelessness law and policy should ‘queer’ it, making it more inclusive and producing better outcomes for all people experiencing homelessness.

BACKGROUND: Nurses often carry out swallow screening when patients are admitted to hospital following a stroke, some receive further training to conduct more comprehensive tests. Little is known about how they perceive their role. The aim of this study was to understand the experiences of Dysphagia Trained Nurses (DTNs) in acute stroke who conduct the comprehensive tests. METHODS: Nine DTNs were recruited from one UK hospital. They were identified by maximum variation and convenience sampling ensuring a broad demographic. Semi-structured interviews were carried out during usual shift patterns, in a quiet room on the acute stroke unit by a research and clinical SLT. Thematic analysis was conducted by two researchers and a summary of themes was verified by the participants. RESULTS: Four main themes were identified relating to the role, screening tool, training and pathway. The role was highly regarded, bringing professional benefits such as job satisfaction and career development. Nurses also identified that it was an essential role in acute stroke for the health and wellbeing of patients. The tool was easy to use but needed adaptations at times and the pathway was difficult to adhere to during busy periods when the use of the test with certain patients was questioned. Training and support was deemed crucial for the role and confidence developed with experience. CONCLUSIONS: Dysphagia Trained Nurses who conduct comprehensive dysphagia screening tests in acute stroke value the role. Further research is needed to quantify the impact that the nurses have on patient outcomes and stroke pathways.

Creative intermediaries are increasingly recognised for their role in facilitating the growth and development of creative entrepreneurs and creative and cultural industries. There is also a growing interest in the role of creative and cultural industries in developing economies, for economic development but also cultural engagement and social change. In this article, we bring a Global South perspective to the study of creative intermediaries in the craft sector by exploring how they engage with makers and markets for craft products in Cape Town, South Africa and beyond. Using qualitative interviews with key players from four intermediary organisations working at the community level through to luxury export, we present their different business models and approaches to supporting the development of the craft sector and makers. We reflect on the role they play in addressing inequalities, especially in opportunities to access craft careers and develop sustainable livelihoods for disadvantaged communities. We also consider some of the key challenges these intermediaries face in relation to policy, infrastructure, finance and global competition. The article argues for the value of adopting an ecological perspective in studying the role of craft intermediaries to recognise their role in addressing inequalities in accessing craft careers and the importance of support for makers at different stages in their professional development.

There is growing interest in creative graduate skillsets, but so far there has been limited investigation of the specific skills and resource requirements of early-career crafts graduates. Drawing on qualitative interviews and quantitative rankings of skills and resources conducted with 25 graduates from four higher education providers in England, this article examines the role and relative priority of different skills and resources in establishing a professional practice. It is identified that the skills and resources key to professional practice are highly interrelated, and proposed that the diverse requirements for professional practice should be understood as an amalgam rather than isolated components, with the acquisition of skills and resources seen as accumulative. The potential for a lack of key resources to exacerbate inequalities in who can enter and work in the craft economy is discussed and recommendations made for initiatives that could help to address an unequal distribution of resources.

To assess the safety of foregoing invasive monitoring in a select group of patients undergoing awake craniotomy for supratentorial tumor resection.Awake craniotomies were performed for tumor resection without invasive blood pressure monitoring when there was no preexisting cardiopulmonary indication as determined by the attending anesthesiologist according to institutional protocol. Noninvasive monitoring was performed every 3-5 minutes intraoperatively and then every 15 minutes in the recovery room for 4 hours before transfer to the ward.At a single tertiary care hospital, 74 consecutive awake surgeries were performed with noninvasive blood pressure monitoring. Among patients, 39 (52.7%) were male, 42 (83.8%) had infiltrative primary brain tumors, 2 (2.7%) had a history of coronary artery disease, 6 (8.1%) were diabetics, 10 (29.7%) were smokers, and 22 (29.7%) were on antihypertensive medications preoperatively. American Society of Anesthesiologists classification was I in 1.4% of patients, II in 36.4%, III in 60.8%, and IV in 1.4%. Intraoperative vasoactive medications were administered in 21 (28.4%) patients; 8 (38%) of these were on antihypertensive agents preoperatively. Vasodilators were administered in 13 (61.9%) patients, vasopressors were given in 6 (28.6%) patients, and both vasodilators and vasopressors were given in 2 (9.5%) patients. One patient experienced a lenticulostriate artery stroke intraoperatively, and 1 patient experienced atrial fibrillation 1 week postoperatively. There were no other perioperative anesthetic, hemorrhagic, renal, or cardiopulmonary complications.Intraoperative physiologic control and surgical site complication avoidance do not warrant routine invasive blood pressure monitoring during awake craniotomy for tumor resection.

Patients with rheumatoid arthritis (RA) have an increased risk of select cancers, including lymphoma and lung cancer. Whether RA influences prostate cancer risk is uncertain. We aimed to determine the risk of prostate cancer in patients with RA compared to patients without RA in the Veterans Health Administration (VA).We performed a matched (up to 1:5) cohort study of male patients with and without RA in the VA from 2000 to 2018. RA status, as well as covariates, were obtained from national VA databases. Prostate cancer was identified through linked VA cancer databases and the National Death Index. Multivariable Cox models compared prostate cancer risk between patients with RA and patients without RA, including models that accounted for retention in the VA system.We included 56,514 veterans with RA and 227,284 veterans without RA. During 2,337,104 patient-years of follow-up, 6,550 prostate cancers occurred. Prostate cancer incidence (per 1,000 patient-years) was 3.50 (95% confidence interval [95% CI] 3.32-3.69) in patients with RA and 2.66 (95% CI 2.58-2.73) in patients without RA. After accounting for confounders and censoring for attrition of VA health care, RA was modestly associated with a higher prostate cancer risk (adjusted HR [HRRA was associated with a modestly increased risk of prostate cancer, but not prostate cancer mortality, after accounting for relevant confounders and several potential sources of bias. However, even minimal unmeasured confounding could explain these findings.

To assess whether circulating levels of adiponectin, leptin, and fibroblast growth factor 21 (FGF-21) are associated with incident cardiovascular disease (CVD) in rheumatoid arthritis (RA).Adipokines were measured using banked enrollment serum from patients with RA and dichotomized above/below the median value. Incident CVD events (coronary artery disease [CAD], stroke, heart failure [HF] hospitalization, venous thromboembolism, CVD-related deaths) were identified using administrative data and the National Death Index. Covariates were derived from medical record, biorepository, and registry databases. Multivariable Cox models were generated to quantify associations between adipokine concentrations and CVD incidence. Five-year incidence rates were predicted.Among 2,598 participants, 639 (25%) had at least 1 CVD event over 19,585 patient-years of follow-up. High adiponectin levels were independently associated with HF hospitalization (hazard ratio [HR] 1.39 [95% confidence interval (95% CI) 1.07-1.79], P = 0.01) and CVD-related death (HR 1.49 [95% CI 1.16-1.92], P = 0.002) but not with other CVD events. High leptin was independently associated with CVD-related death (HR 1.44 [95% CI 1.05-1.97], P = 0.02). High FGF-21 levels were independently associated with lower rates of CAD (HR 0.75 [95% CI 0.58-0.97], P = 0.03). In subgroup analyses, associations between high adiponectin and leptin levels with CVD-related death were driven by strong associations in nonobese patients.Adipokines are associated with HF hospitalization and CVD-related death in patients with RA, with stronger associations in nonobese participants. These findings suggest that adipokines effectively predict clinically important outcomes in RA perhaps through an association with body composition and metabolic health. Further study is needed to determine whether adipokine measures might augment existing tools to identify RA patients at increased risk of CVD.

To compare all-cause and cause-specific mortality risk between patients with gout and patients without gout in the Veteran's Health Administration (VHA).We performed a matched cohort study, identifying patients with gout in the VHA from January 1999 to September 2015 based on the presence of ≥2 International Classification of Diseases, Ninth Revision codes for gout (274.X). Gout patients were matched up to 1:10 on birth year, sex, and year of VHA enrollment with patients without gout and followed until death or end of study (December 2017). Cause of death was obtained from the National Death Index. Associations of gout with all-cause and cause-specific mortality were examined using multivariable Cox regression.Gout (n = 559,243) and matched non-gout controls (n = 5,428,760) had a mean age of 67 years and were 99% male. There were 246,291 deaths over 4,250,371 patient-years in gout patients and 2,000,000 deaths over 40,441,353 patient-years of follow-up in controls. After matching, gout patients had an increased risk of death (hazard ratio [HR] 1.09 [95% confidence interval (95% CI) 1.08-1.09]), which was no longer present after adjusting for comorbidities (HR 0.98 [95% CI 0.97-0.98]). The strongest association of gout with cause-specific mortality was observed with genitourinary conditions (HR 1.50 [95% CI 1.47-1.54]). Gout patients were at lower risk of death related to neurologic (e.g., Alzheimer's disease and Parkinson's disease) (HR 0.63 [95% CI 0.62-0.65]) and mental health (HR 0.66 [95% CI 0.65-0.68]) conditions.A higher risk of death among gout patients in the VHA was related to comorbidity burden. While deaths attributable to neurologic and mental health conditions were less frequent among gout patients, genitourinary conditions were the most overrepresented causes of death.

Introduction: The detectability of low contrast detail (LCD) is a method used to assess image quality (IQ) in neonatal radiography; however, there is a lack of data on the relationship between LCD detectability and visual IQ. The study aims at investigating the relationship between the LCD detectability and visual IQ and pathology visibility (PV). Methods: Several acquisition parameters were employed to obtain a group of images from a neonatal Gammex chest phantom. Three observers applied relative visual grading analysis (VGA) for assessing the IQ and PV. A simulated pneumothorax visibility (PNV) and simulated hyaline membrane disease visibility (HMV) represented PV. Next, a CDRAD 2.0 phantom was radiographed utilising the same acquisition protocols, and several paired images were obtained. With the use of CDRAD analyser software, the detectability of LCD was assessed and expressed by an image quality figure inverse (IQFiinv) metric. The correlation between the IQFinv and each of IQ, PNV and HMV was examined. Results: The physical measure (IQFinv) and the visual assessment of IQ were shown to be strongly correlated (r = 0.95; p < 0.001). Using Pearson's correlation, the IQFinv, PNV, and HMV were found to be strongly correlated (r = 0.94; p < 0.001) and (r = 0.92; p < 0.001), correspondingly. Conclusion: Results of the study show that physical measures of LCD detectability utilising the CDRAD 2.0 phantom is strongly corelated with visual IQ and PV (PNV and HMV) and can be used to evaluate IQ when undertaking neonatal chest radiography (CXR). Implications for practice: This study establishes the feasibility of utilising the physical measure (IQFinv) and the CDRAD 2.0 phantom in routine quality assurance and neonatal CXR optimisation studies.

INTRODUCTION: The Radiography Research Ethics Standards for Europe (RRESFE) project aims to provide a cross-sectional snapshot of current research ethics systems, processes, and awareness of such, across Europe together with identifying the associated challenges, education, and training needs. \ud \ud METHODS: A cross-sectional online survey targeting radiography researchers in Europe was conducted. Data collection took place between April 26 and July 12, 2021, using a snowball sampling approach. Descriptive and analytical statistics were used to identify trends in research ethics frameworks across Europe. \ud \ud RESULTS: 285 responses were received across 33 European and 23 non-European countries. Most (n = 221; 95%) European respondents stated ethics approval is required before commencing research in their country. Requirements around research ethics approval and awareness of such requirements varied by European region (X2 (2, n = 129) = 7.234, p = 0.013) and were found to differ depending on the type of research participant and study design. Additionally, European respondents reported ethics approval is a national requirement more often than their non-European counterparts (X2 (1, n = 282) = 4.316, p = 0.049). Requirements for ethics approval were also associated with the undergraduate programme duration (2-year vs. 3-year vs. 3.5 year vs. 4-year vs. multiple programme durations; X2 (4, n = 231) = 10.075, p = 0.016) and availability of postgraduate training (postgraduate training available vs. postgraduate training not available; X2 (1, n = 231) = 15.448, p =

Transhepatic percutaneous cholangioscopy (PC) can be used for the diagnosis and treatment of biliary pathology. It allows for direct visualization of the biliary system to identify pathologic changes, perform biopsies, and treat biliary obstruction. The effectiveness and safety of PC in adults have been established. However, the data on the use of PC in pediatric patients are limited. In this case series, the outcomes in 4 pediatric patients (3 girls; mean age, 4 [range, 1-8] years) who underwent 6 PC procedures were examined. Three out of the 6 (50%) PC procedures were performed for diagnostic visualization of the biliary tree and/or small intestine, whereas the remaining 3 (50%) were performed for the treatment of biliary obstruction causing chronic cholestasis. The technical and procedural success rate was 100%, and no complications were encountered during or 30 days after the procedure. This study supports the feasibility and safety of PC in pediatric patients for the management of biliary pathology.