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Purpose Inguinal lymph nodes are a rare but recognised site of metastasis in rectal adenocarcinoma. No guideline or consensus exists for the management of such cases. This review aims to provide a contemporary and comprehensive analysis of the published literature to aid clinical decision-making. Methods Systematic searches were performed using the PubMed, Embase, MEDLINE and Scopus and Cochrane CENTRAL Library databases from inception till December 2022. All studies reporting on the presentation, prognosis or management of patients with inguinal lymph node metastases (ILNM) were included. Pooled proportion meta-analyses were completed when possible and descriptive synthesis was utilised for the remaining outcomes. The Joanna Briggs Institute tool for case series was used to assess the risk of bias. Results Nineteen studies were eligible for inclusion, encompassing 18 case series and one population-based study using national registry data. A total of 487 patients were included in the primary studies. The prevalence of ILNM in rectal cancer is 0.36%. ILNM are associated with very low rectal tumours with a mean distance from the anal verge of 1.1 cm (95% CI 0.92–1.27). Invasion of the dentate line was found in 76% of cases (95% CI 59–93). In patients with isolated inguinal lymph node metastases, modern chemoradiotherapy regimens in combination with surgical excision of inguinal nodes are associated with 5-year overall survival rates of 53–78%. Conclusion In specific subsets of patients with ILNM, curative-intent treatment regimens are feasible, with oncological outcomes akin to those demonstrated in locally advanced rectal cancers.

The Southern Hemisphere storm track is a key component of the Earth’s global circulation patterns, with a prominent role in the movement of heat and momentum across the mid-latitudes, and a controlling influence over the behaviour of synoptic eddies. Storm track characteristics are expected to change with anthropogenic forcings, leading to changes in regional weather patterns, and impacting communities through its influence on extreme events. We document projected storm track climatologies at the end of the 21st century under high- and low-emissions scenarios using the CMIP6 generation of models. We find previously described projections – the poleward migration of the storm track, and intensification of storm activity – persist in CMIP6. We explore projections of spatio-temporal variability of the Southern Annular Mode, and consequences for the storm track.

ERA5 reanalysis is used to examine extreme precipitation using a spatially dependent precipitation threshold applied within a cyclone compositing framework. This is used to account for regional variation in precipitation generating processes within Southern Hemisphere mid-latitude cyclones across the cyclone lifecycle. The spatial extent of extreme precipitation is limited to a smaller region around the cyclone centre compared to non-extreme precipitation, though extreme precipitation displays a good spatial correlation with non-extreme precipitation. Extreme precipitation occurs more often during the deepening phase of the cyclone before it reaches a maximum depth. Precipitation occurrence at the 90th and 98th percentiles reduces to 46% and 30% of the deepening value across the cyclone lifecycle, averaged over the composite. Precipitation fraction at the 90th and 98th percentile reduces to 80% and 60% of the deepening value. Our methodology provides a quantitative assessment of precipitation extremes both spatially and temporally, within a cyclone compositing framework.

Storm tracks are a key component of global atmospheric circulation. Their influence ranges from macro- to mesoscale dynamics, from large-scale movement of heat and momentum to extreme weather events. The scale of their impact makes understanding storm track dynamics critical to forecasting and climate projections. In this study, we assess CMIP6 historical experiment fidelity to observations of the Southern Hemisphere storm track. Specifically, storm track climatology, variability, and its interactions with low-frequency variability, with the aim of providing confidence for projections of future climate. We find CMIP6 models replicate results from the ERA-5 reanalysis with high fidelity in some regards; namely, capturing climatology of the 500hPa geopotential height field, the role of large-scale variability, and the baroclinic connection with high-frequency variability. However, models fail to capture the magnitude and variability of the storm track, particularly canonical zonal asymmetry. Our results indicate the importance of the storm track is underestimated in CMIP6.

In psychotic disorders, motivation and pleasure (MAP) deficits are associated with decreased social affiliation and functional impairment. We leveraged a transdiagnostic sample enriched for psychosis and a multi-method approach to test the hypothesis that MAP deficits undermine the benefits of social affiliation. Participants completed the Social Affiliation Enhancement Task (SAET) to cultivate affiliation with an experimental partner. While the SAET increased affiliation and mood, individuals with greater MAP deficits derived smaller emotional benefits from the partners indexed by subjective report and objective facial behavior. Following the SAET, we used the Handholding fMRI paradigm—combining a threat-anticipation manipulation with varying degrees of affiliative contact—to determine whether MAP deficits undermine the social regulation of distress. Individuals with greater MAP deficits showed diminished neural ‘benefits’—reduced dampening of threat-elicited activation from affiliative contact in key frontoparietal nodes of the Dorsal Attention Network. In short, MAP symptoms disrupt the emotional and neuroregulatory benefits of social affiliation.

Purpose: The aim of this study was to establish preliminary reference values for the Visual Analysis of Swallowing Efficiency and Safety (VASES) – a standardized rating methodology used to evaluate swallowing safety and efficiency for flexible endoscopic evaluations of swallowing (FEES). Method: FEES were completed in non-dysphagic, community-dwelling adults using a standardized protocol of 15 swallowing trials which varied by bolus size, consistency, contrast agent, and swallowing instructions. FEES were blindly analyzed using VASES. Primary outcome measures included bolus location at swallow onset, Penetration-Aspiration Scale (PAS) scores, and percentage-based residue ratings for six anatomic landmarks. Secondary outcome measures included sip size, bite size, and number of swallows.Results: Thirty-nine healthy adults completed the study, yielding an analysis of 584 swallows. Swallows were initiated with the bolus in the pharynx for 41.8% of trials. PAS 1 was the most common score, accounting for 75.3% of trials, followed by PAS 3, which accounted for 18.8% of trials. When residue was present (>0%), the amount was relatively small across all anatomic landmarks, with median residue ratings of 2.0% (oropharynx), 1.5% (hypopharynx), 3.0% (epiglottis), 3.0% (laryngeal vestibule), and 3.5% (vocal folds). Five events of aspiration were observed, which were characterized by subglottic residue ratings of 1%, 3%, 10%, 24%, and 90%. The average sip size of self-selected volume cup sips of water was 19.8 mL and the average bite size of a 3.0-gram saltine cracker was 1.33 grams. Seventy-eight percent of the trials in this study protocol (except 90 mL trials) were completed in a single swallow.Discussions: The results from this study provide preliminary reference values for VASES in healthy adults across a range of bolus volumes, consistencies, colorants, and swallowing instructions. These normative data provide useful insight into typical swallowing function during FEES with a standardized rating methodology. An open dataset is provided to aide in the diagnosis of normal and abnormal swallowing function in clinical and research practices (https://osf.io/4anzm/).

ERA5 reanalysis output is compared to WindSat measurements over cyclones at Southern Hemisphere mid- to high-latitudes. WindSat provides an independent measure of how well ERA5 represents cyclones, as WindSat is not assimilated into ERA5. We implement a tracking scheme to identify cyclone centres and tracks, before using cyclone composites to match concurrent data in ERA5 and WindSat. We find that both ERA5 and WindSat show comparable spatial structures for low level wind speed, total column water vapour, cloud liquid water and precipitation. Compared to WindSat, ERA5 underestimates total column water vapour by up to 5\% and cloud liquid water by up to 40\%. ERA5 underestimates precipitation in the warm sector by up to 15\%, but overestimates in the cold sector by up to 60\%. Similar biases in ERA5 are seen when comparing to AMSR-E data, even though AMSR-E radiances are assimilated into ERA5. Comparing ERA5 and WindSat across the cyclone lifecycle, a strong correlation is seen across the cyclone as it deepens and reaches peak intensity, before slightly declining as the cyclone decays. In the cold sector ERA5 shows underestimation of cloud liquid water, yet overestimates precipitation at all lifecycle stages. However, in the warm sector precipitation is underestimated. This potentially suggests the presence of biases within the ERA5 parameterisations of cloud and precipitation causing a disconnect between the two. Despite this, ERA5 shows strong correlation with WindSat and determines cyclone structure well across the cyclone lifecycle, showing its value for use in cyclone compositing analysis.

This study examined the reliability of auditory-perceptual assessments of cough amongst a group of novice clinicians before and after a standardized training protocol. Authors include: James Curtis, James Borders, Avery Dakin, and Michelle Troche.

Additional file 1: Table S1. Missing data. Table S2. ROTEM analysis for patients in the VHA group at admission. Table S3. Blood products and coagulation factors cost before and after matching in euros

Supplementary Material 2

Supplementary Material 1

Objectives To examine whether trauma and orthopaedic surgeons could visually assess the anteversion and inclination of a total hip replacement acetabular component from standard anteroposterior radiograph and anteversion on a standard lateral radiograph with accuracy or reproducibility. Main outcome measurement: The main outcome was accuracy of visual estimations of angles. The secondary outcome was whether these estimations were reproducible though intra-observer variability. Results Mean angles of anteversion on the anteroposterior, inclination on the anteroposterior and anteversion on the lateral on formal measurements were 15.2°, 45.4° and 19.9°; and the visual estimates were 17.5°, 45.9° and 18.2°, respectively. When comparing the visual estimates of surgeons and formal measurements, the results ranged from very poor to very good. Intra-observer reproducibility was moderate for all angles. The difference between the consultants and speciality registrars was not significant. Conclusion This study illustrated that not all orthopaedic surgeons were able to visually estimate angles well. Although some of our participants were very accurate, there were some who statistically were very poor. This level of inaccuracy can lead to inconsistency and we strongly suggested specialist software is used to assess acetabular cup position on postoperative plane radiographs rather than relying on ‘visual estimations’.

This study presents a 1:25,000 geomorphological map of the northern sector of Ulu Peninsula, James Ross Island, Antarctic Peninsula. The map covers an area of c. 250 km(2), and documents the landforms and surficial sediments of one of the largest ice-free areas in Antarctica, based on remote sensing and field-based mapping. The large-scale landscape features are determined by the underlying Cretaceous sedimentary and Neogene volcanic geology, which has been sculpted by overlying ice masses during glacial periods. Paraglacial and periglacial features are superimposed upon remnant glacial features, reflecting the post-glacial evolution of the landscape. The study area can be broadly separated into three geomorphological sectors, according to the dominant contemporary Earth-surface processes; specifically, a glacierised southern sector, a paraglacial-dominated eastern sector, and a periglacial-dominated central/northern sector. This map provides a basis for further interdisciplinary research, and insight into the potential future landscape evolution of other parts of the Antarctic Peninsula as the climate warms.

Army Officers face increased moral pressure in modern warfare, where character judgement and ethical judgement are vital. This article reports the results of a study of 242 junior British Army offi...

On 9 August 1870, the Elementary Education Act of 1870 received Royal Assent. 2020 has proven to be a most unhappy anniversary, the 150th, or sesquicentenary, during which the education system buil...

Emergency colonic surgery carries a high mortality rate. In the UK, strategies to improve outcomes in emergency general surgery recommend a consultant surgeon to be physically present during all operations involving a patient with a predicted mortality > 5%. To test the assertion of the consultant surgeon’s presence in theatre as a determinate of improved outcome, we assessed patients following an emergency colonic resection and the effect of operator seniority. A retrospective analysis was undertaken for all patients undergoing an emergency colonic resection during a 4-year period between 2013 and 2017. Patient’s pre-operative risk was assessed using P-POSSUM score and ASA grade. Outcomes assessed were post-operative morbidity (recorded using Clavien–Dindo classification), 30 day/inpatient mortality and length of stay (LOS). Outcomes were then compared between consultant and trainee led cases using univariate logistic regression techniques with results presented in terms of odds ratios (95% confidence intervals). A p value of 0.05 is used to determine statistical significance. A total of 130 patients were identified over the 4-year study period. 65% had their operation performed by a consultant and 35% by a trainee. Pre-operative P-POSSUM scores were the same between the groups (9.4% [5.0–25.2] vs 9.4% [4.9–28.6] p 0.75). There was no significant difference in post-operative complication rates between consultant and trainee led cases for minor (OR 1.58 [0.76–3.20] p 0.27) or major complications (OR 1.08 [0.50–2.31] p 0.84). Overall post-operative mortality was 14% with a trend for higher mortality rates in consultant led cases (15% vs 9%) albeit not statistically significant (p 0.57). Despite similar complication rates, trainee led operations were associated with slightly longer LOS at 19 (IQR 12–38) vs 15 (IQR 9–23) days (p 0.56). Emergency colonic surgery remains associated with a high level of morbidity and mortality. However, consultant presence at the operating table does not appear to be the sole determinant of outcome following an emergency colonic resection.

Many Faculties of Education in the UK and elsewhere have ‘social justice’ written into their mission statements. But are they concerned by questions of social justice in education, or has the term ...

This thesis was scanned from the print manuscript for digital preservation and is copyright the author. Researchers can access this thesis by asking their local university, institution or public library to make a request on their behalf. Monash staff and postgraduate students can use the link in the References field.

Additional file 1. Supplementary material.

While the sustainability transitions literature has highlighted the importance of agency in technological change, there is still limited understanding of the role of transnational actors, such as development agencies, which tend to be key drivers of energy transitions in low-income countries. This paper aims to fill this gap by investigating the role of transnational actors in the development of off-grid solar PV regime in Uganda, from the early 1980s to 2017. Specifically, we develop a typology of transnational actors and examine their roles in mobilizing the flow of knowledge, capital and technology towards shaping the country's off-grid solar PV rural electrification regime. By discussing the pivotal role of foreign actors, their underlying motives and their shifting importance over time, the paper demonstrates empirically the highly transnational nature of regime development. In doing so, we contribute to the academic literature on actor-oriented determinants in sustainability transitions, as applied to low-income countries.

BackgroundUsers of prosthetic devices face the accumulation of potentially drug-resistant pathogenic bacteria on the skin/prosthesis interface. In this study, we took surface swabs of the skin/prosthesis interface of eleven disabled athletes to identify microorganisms present. In addition to determining their antimicrobial resistance profile, we assessed their sensitivity to Manuka honey and Garlic extract (allicin) MethodsEleven volunteers were directed to swab the skin at the skin/prosthesis interface. After initial isolation of microorganisms we employed the following general microbiological methods; Gram stain, Catalase test, Oxidase test, lactose fermenting capability, haemolytic capability, Staphaurex, mannitol fermenting capability, Streptex; API Staph, 20E, Candida, and BBL crystal identification system tests. Once identified, isolates were analysed for their sensitivity to penicillin, erythromycin. ampicillin, vancomycin, ceftazidime, ciprofloxacin, gentamicin and colistin-sulphate. Isolates were also analysed for their sensitivity to allicin (Garlic Extract (GE)) and Manuka honey (Medihoney™) (MH). ResultsEleven isolates were identified, Bacillus cereus, Staphylococcus haemolyticus, Staphylococcus aureus, Micrococcus luteus, Pseudomonas oryzihabitans, Micrococcus spp., Bacillus subtilis, Group D Streptococcus, Pantoea spp., Enterobacter cloacae and Bergyella zoohelcum. All Gram-positive organisms were resistant to 1.5 units of penicillin and 10 μg of ampicillin, and two Gram-negatives Pseudomonas oryzihabitans and Bergyella zoohelcum were resistant to 10 μg ceftazidime, whilst Bergyella zoohelcum, was also resistant to 10 μg of gentamicin. In comparison, all organisms were sensitive to Manuka honey and nine sensitive to Allicin. ConclusionsThis study highlights the prevalence of uncommon drug resistant microorganisms on the skin within a vulnerable population, highlighting the potential for MH or GE intervention.

As Earth’s climate heats up, glacier structures are being revealed in unprecedented detail, allowing glaciologists to understand how the behavior of glaciers has changed over centuries to millennia.