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Background: The rapid development of less invasive and traumatic medical procedures has resulted in a mixture of terms used to describe them, without any agreed definition for each. This is confusing to both medical professionals and patients and can lead to unrealistic patient expectations. The aim of this article is to show the current confused nomenclature and to suggest a new, simple classification based on access and invasiveness (AI) that can be applied to any medical procedure. Methods: We performed an online search for definitions for ‘non-invasive’, ‘non-surgical’, ‘minimally invasive’, ‘minimal access’, ‘pinhole’ and ‘keyhole’. We then searched peer-reviewed medical papers(PRMPs) and patient facing websites (PFWs) for the following index procedures, to see which of the original 6 terms were used to describe them: transvaginal ultrasound, sclerotherapy for leg veins, botulinum toxin injections, dermal fillers, endovenous thermal ablation and laparoscopic gall bladder removal. Results: We found a wide variety of definitions for each of the initial terms. In both PRMPs and PFWs, there were a variety of terms used for each index procedure (i.e.: transvaginal ultrasound, injections of sclerotherapy, botulinum toxin or dermal fillers being both ‘non-invasive’ and ‘minimally invasive’) showing confusion in the classification of procedures. We suggested the ‘AI classification’ based on access (A - none, B - natural orifice or C - penetrating an epithelial surface) and invasiveness (1 - none, 2 - surface damage, 3 ‑ needle = <21G, 4 ‑ cannula >21G but not a surgical trocar, 5 ‑ surgical trocars or small incisions and 6 - incisions). Conclusion: The current confusion of terms used for procedures that are less invasive than the open surgical alternatives leads to confusion and possible false patient expectations. We have proposed an AI classification that can be applied easily to any procedure, giving a uniform classification for medical professionals and patients to understand. [ABSTRACT FROM AUTHOR]

We investigated how projected changes in land cover and climate affected simulated nitrate (NO3−) and organic nitrogen discharge for two watersheds within the Neuse River Basin, North Carolina, USA, for years 2010-2070. We applied the Soil and Water Assessment Tool watershed model to predict nitrogen discharge using (1) atmospheric carbon dioxide (CO2) concentrations predicted by the Intergovernmental Panel on Climate Change, (2) land cover change predicted by the Integrated Climate and Land Use Change project and (3) precipitation and temperature simulated by two statistically downscaled and bias-corrected Global Circulation Models. We determined the sensitivity of simulated nitrogen discharge to separate changes in each treatment [(1) CO2, (2) land cover and (3) precipitation and temperature (PT)] by comparing each treatment to a reference condition. Results showed that nitrogen discharges were most sensitive to changes in PT over the 60-year simulation. Nitrogen discharges had similar sensitivities to the CO2 and land cover treatments, which were only one-tenth the influence of the PT treatment. Under the CO2 treatment, nitrogen discharges increased with increasing ambient CO2. NO3− discharge decreased with increased urbanization; however, organic nitrogen had a varied response. Under the PT treatment, there was high spatial variability in nitrogen discharges. In a single year, certain sub-basins showed an 80% increase in nitrogen discharge relative to reference, while others showed a 400% decrease. With nitrogen discharge showing high sensitivity to PT change, we suggest that more emphasis should be placed on investigating impacts of PT on nutrient transport in the Neuse River Basin. Published 2015. This article is a U.S. Government work and is in the public domain in the USA [ABSTRACT FROM AUTHOR]

The status of heavy metal buildup in commercial and non-commercial ponds of Nile tilapia (Oreochromis niloticus) and its effect on fish health was evaluated. Pond water and tilapia meat were examined for Pb, As, cadmium Cd and Cu using flame atomic absorption spectrometry; and Hg through manual cold-vapor atomic absorption spectrometry. Standard methods in hematology were applied to estimate red and white blood cell function of fish in relation to heavy metal accumulation. The results revealed significantly higher Cu content in pond water of a commercial farm compared to the Cu content of water from a non-commercial farm, while similar levels of Hg and Pb were recorded. Tilapia meat from commercial ponds had significantly higher Pb and lower levels of Cu compared to meat from a non-commercial farm. Similar levels of Hg were observed in tilapia meat obtained from farms while tilapia meat from non-commercial ponds had significantly higher Cu. Neither As nor Cd were detected in the farms. Hematological evaluation revealed comparable counts of total red blood cell. Red blood cell indices such as hematocrit and mean corpuscular volume were significantly higher in tilapia from the commercial ponds. The amount of hemoglobin per red blood cell was similar in tilapia from the farms while mean corpuscular hemoglobin concentration was significantly higher in tilapia from the non-commercial farm. Total white blood cell and eosinophil counts of tilapia were similar in the farms. Tilapia from the commercial ponds had significantly high neutrophil and monocyte counts while tilapia from the non-commercial ponds had significantly high lymphocyte counts. The hematological evaluation indicate relationship of cellular components of fish blood and heavy metal accretion from the aquatic environment by Nile tilapia. [ABSTRACT FROM AUTHOR]

Objective: Surgery for paediatric cancer presents many stresses on patients and families. The authors aimed to understand the long‐term impact of childhood cancer surgery on survivors and parents. Methods: The study recruited participants from 11 Australia/New Zealand hospitals for telephone interviews. The authors used descriptive statistics to analyse participants' quantitative distress ratings and conducted thematic analysis of shared surgical experiences and needs. Results: Of 32 participants (n = 17 survivors, n = 15 parents), survivors' mean age at surgery was 6.9 (SD = 5.17) and parents' children were 2.1 years old (SD = 1.41) at time of surgery. Survivors had surgery on average 15.2 years ago (SD = 6.72) and parents' children 11.5 years ago (SD = 3.94). Parents and survivors rated surgery as highly distressing. Pre‐operatively, survivors recalled experiencing fear and pain mainly associated with pre‐operative procedures. Post‐operatively, survivors reported immobility and some lasting behavioural disturbances. Parents described pre‐ and intra‐operative anxiety and stress and some lasting post‐operative psychological disturbances. Experiences appeared to improve with clear/consistent communication from hospital staff, proximity to hospital, and with support for parents and children post‐operatively. Conclusions: Surgical treatment for childhood cancer can have a lasting impact for survivors and parents. Better information provision may improve families' surgical experience whilst reducing anxiety, distress and physical discomfort. [ABSTRACT FROM AUTHOR]