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Objective: To explore the ability of polarisation-sensitive optical coherence tomography (PS-OCT) to rapidly identify subtle signs of tissue degeneration in the equine joint.Method: Polarisation-sensitive optical coherence tomography (PS-OCT) images were systematically acquired in four locations along the medial and lateral condyles of the third metacarpal bone in five dissected equine specimens. Intensity and retardation PS-OCT images, and anomalies observed therein, were then compared and validated with high resolution images of the tissue sections obtained using Differential Interference contrast (DIC) optical light microscopy.Results: The PS-OCT system was capable of imaging the entire equine osteochondral unit, and allowed delineation of the three structurally differentiated zones of the joint, that is, the articular cartilage matrix, zone of calcified cartilage and underlying subchondral bone. Importantly, PS-OCT imaging was able to detect underlying matrix and bone changes not visible without dissection and/or microscopy.Conclusion: PS-OCT has substantial potential to detect, non-invasively, sub-surface microstructural changes that are known to be associated with the early stages of joint tissue degeneration. [ABSTRACT FROM AUTHOR]

Purpose: This article reflects the report by the British Branch of the International League Against Epilepsy (ILAE) Working Group on services for adults with epilepsy and intellectual disability (ID). Its terms of reference was to explore the current status of aspects of the care of people with an ID and epilepsy.Methods: Survey content was developed from key themes identified by consensus of the working group. An electronic survey was distributed via email. The sample population was the membership of the ILAE UK, Royal College of Psychiatrists (RCPsych) Faculty of ID, Epilepsy Nurses Association (ESNA), and the Association of British Neurologists (ABN). Following a six week response period the data was then collated, anonymised and distributed to the working group in order that opinion statements could be gathered.Results: The time taken for individuals with both new-onset and established epilepsy to undergo routine investigation was commonly at least 1-3 months, far beyond recommendations made by NICE (CG20). A small minority of clinicians would not consider non-pharmacological interventions including epilepsy surgery, vagus nerve stimulation, and ketogenic diet for this population. Almost universally responders are actively involved in the assessment and management of key risk areas including risk of drowning, hospitalization, medication side effects, and sudden unexpected death in epilepsy (SUDEP).Conclusion: This investigation identifies key themes and recommendations relating to care delivery and meeting the complex needs of people with ID and epilepsy. Adults with ID and epilepsy appear to exist in a unique, but inadequate, segment of epilepsy care delivery. [ABSTRACT FROM AUTHOR]

Abstract: Recent advances in legislation have enabled nurses in the United Kingdom (UK) to become Nurse Independent and Supplementary Prescribers (NISP). The NISP can assess, diagnose and independently prescribe any licensed medicine within their area of competence. This change has meant the number of nurse prescribers in disease specific areas has increased. This study set out to assess the number of Epilepsy Specialist Nurses (ESNs) prescribing and the context in which they do so. A draft questionnaire was developed and piloted with 10 ESNs. Minor changes to improve data collection were made. In April 2009 all known ESNs were invited via letter to complete the questionnaire. One month later a follow up reminder was mailed to all ESNs to encourage participation. Data was analyzed using percentages and cross tabulation. Completed questionnaires were returned by 29 nurse prescribers. Twenty ESNs were working as independent nurse prescribers, 6 as supplementary nurse prescribers and 3 as both. Prescribing practice demonstrated that 21 (72%) signed prescriptions, 28 (97%) made recommendations to other prescribers, 14 (48%) prescribed or amended ward/in patient drug prescriptions and 10 (34%) used clinical management plans. The medications prescribed by ESNs included anti-epilepsy medication, folic acid, vitamin K, anti-depressants, steroids, rescue medication and the contraceptive pill. Most ESNs wrote a prescription for a new drug at least once a week whilst most nurses titrated medication daily. Nurse prescribers held higher academic qualifications and had worked in the field of epilepsy for years. Epilepsy specialist nurse prescribing enabled a holistic approach to patient care. This paper identified the need for ESNs to update annually and audit their prescribing practice. [Copyright &y& Elsevier]

Abstract: Agricultural systems in Canada are extensive in area, but not monitored or managed intensively. We developed informatics methods to better anticipate the severity, timing and geography of emerging pest risks to crops. The target insects, grasshoppers (Orthoptera: Acrididae), present special challenges in North America, as well as in China, because they occur as a complex of many species, only some of which represent significant risk to crops. We developed a Geographic Information System of insect and weather data in support of environmentally sustainable control methods. GIS-based maps of the outputs of simple weather-driven models of insect stage were provided to growers through a website containing current conditions. We combined delivery of this information with on-line training and non-technical tools for insect identification and selection of management actions. Color images for over 60 grasshopper species that assist recognition of pest versus non-pest species were provided on-line, with additional details provided in printed booklets (3500 copies were distributed free of charge). We also developed an iPhone application that provides similar information and assistance in recognizing species. We invited growers to attend on-line webinars (75 attendees) and in-person workshops (413 participants) for instruction on using the photographs and identification tips. A post-workshop survey completed by all the attendees indicated that most of the attendees (91%) scout their fields to check for the presence of grasshoppers, and that a majority of the farmers (90%) monitor or check their fields themselves, indicating that individual access to information is a valuable feature. Only 18 of the farmers at the workshops indicated that they had previously used species identification to determine pest risk status. [ABSTRACT FROM AUTHOR]

Aim: To establish the current practice for management of radiologically placed percutaneous drains for abdominal sepsis in the UK and prospectively study the management of radiologically placed drains at our institution. Method: A questionnaire on the management of radiologically placed drains was sent to all radiology departments on a Royal College of Radiologists database. We prospectively followed all drains placed by our radiology department for drainage of abdominal collections, over a 7-month period. Results: A total of 210 questionnaires were sent for the national survey, of these 117 were returned (55.7%). The majority of departments (70.5%) reported that after drain insertion the clinical team took over daily management. Just over 5% of departments either formally managed the drain or obtained final outcome data. From October 2003 to April 2004 we followed 63 consecutive drains placed in 45 patients, for abdominal sepsis. Thirty-nine drains (61.9%) were curative and 17 (26.9%) drains failed. Three drains (4.8%) were placed for palliation, and four drains (6.4%) were placed in order to temporise prior to surgery. Forty-three (68.3%) drains had a successful primary outcome: success after secondary percutaneous abscess drainage (PAD) improved to 46 (73.0%) drains. Two (3%) major complications occurred. Conclusions: The current approach in the UK to management of radiologically placed drains differs significantly from that practised in the USA. The most common type of support offered by radiology departments in the UK is of informal advice and follow-up, with the clinical team managing the patient's drain. Observations in our hospital highlighted problems relating to drain management that may impact on the success of PAD. We suggest that more formal radiological support after PAD would improve communication and potentially improve outcomes. [ABSTRACT FROM AUTHOR]

Immune dysregulation, polyendocrinopathy, enteropathy, X-linked (IPEX) syndrome is the prototypical primary immune regulatory disorder caused by mutations in the forkhead box protein 3 (FOXP3) gene, a critical transcription factor required for regulatory T cells (Tregs). Patients typically present with severe early onset autoimmune manifestations that can be fatal within the first year of life. Currently, the only cure for IPEX is allogeneic hematopoietic stem cell transplant (HSCT), but this comes with risk of complications and the survival probability at 15 years is 73.2% (F. Barzaghi et al 2018). Moreover, a suitable donor is not always available. As a monogenic immune disease with limited treatment options, IPEX is an ideal candidate for a gene therapy approach whereby patient hematopoietic stem cells are gene edited and reinfused for autologous transplant. We developed a CRISPR/Cas9 approach combined with AAV delivery of a donor template to restore FOXP3 expression at the endogenous locus, permitting regulated expression of wild-type FOXP3 irrespective of downstream mutations. We were able to edit CD4+ effector T cells (Teff) and Tregs, showing that they maintain characteristic phenotypic markers and are functional in vitro. IPEX patient Tregs edited with the construct had partial restoration of both FOXP3 expression and functional suppression upon co-culture with responder T cells. Gene edited cord blood hematopoietic stem and progenitor Cells (HSPCs) are capable of long-term engraftment in humanized mice and differentiate into multiple hematopoietic subsets (CD13, CD19, CD56, CD3) and partially reconstitute Tregs (CD4+CD25+FOXP3+). These results demonstrate the feasibility of using gene edited HSPCs and hold promise for autologous transplant in genetic autoimmune diseases such as IPEX syndrome. [ABSTRACT FROM AUTHOR]

In June 2020, observations of anthropogenic radionuclides in Estonia, Finland, and Sweden that were not related to any acknowledged environmental release led to a comprehensive investigation on the source and cause of the unusual emissions. Several of the observed radionuclides were on the list of Comprehensive Nuclear-Test-Ban Treaty (CTBT) relevant radionuclides as an indicator of a potential nuclear test, and warranted detailed investigation. While analysis of aerosol samples coupled with Atmospheric Transport and Dispersion Modelling (ATDM) is a standard approach for environmental particulate releases, several new techniques were employed to better characterize the samples that allowed for useful inferences to be made. These inferences were crucial in forming the ultimate hypothesis for determining the facility type and location of the release. • Unattributed anthropogenic radionuclides observed in the Baltic region in 2020. • Coincident spectroscopy and sample characterization help identify source facility. • Combination of tools allows characterizes release to aid with CTBT verification. [ABSTRACT FROM AUTHOR]

Hepatic angiomyolipomas (HAMLs) are rare mesenchymal neoplasms, which have highly variable imaging appearances, often leading to misdiagnosis. They belong to the family of perivascular epithelioid cell neoplasms (PEComas). HAMLs have a wide spectrum of imaging appearances due to variable amounts of smooth muscle cells, adipose tissue, and blood vessels in their makeup. Although typically sporadic, they are also associated with tuberous sclerosis. Sporadic lesions tend to be solitary whilst patients with tuberous sclerosis often have multiple HAMLs invariably accompanied by renal AMLs. Having been originally considered benign hamartomas, increasing reports of complications, including malignant behaviour, has also resulted in uncertainty in regard to their optimal management. Typically described imaging characteristics are of a hypervascular fat-containing lesion with prominent intratumoural vessels and an early draining vein; however HAMLs commonly demonstrate a paucity of fat or wash-out on contrast-enhanced imaging, and not all HAML lesions are hypervascular. HAMLs can therefore easily be misdiagnosed as other hepatic lesions, in particular hepatocellular carcinoma. This review describes the imaging characteristics of HAMLs, illustrating the wide variety of potential appearances across ultrasound, contrast-enhanced ultrasound, computed tomography, and magnetic resonance imaging, and highlights the challenges and potential errors that can be made. This review will aid radiologists in avoiding potentially major pitfalls when faced with this rare but important liver pathology. [ABSTRACT FROM AUTHOR]

Centrifugal-flow left ventricular assist devices (CF-LVADs) have improved morbidity and mortality for LVAD recipients. Hospital readmissions, however, remain common and affect quality of life and survival. We sought to identify factors associated with readmissions on LVAD support. Patients receiving a CF-LVAD between February 2011 and March 2021 were prospectively evaluated. Hospital readmissions were dichotomized into HF/LVAD-related or non-HF/LVAD-related. Multivariable logistic regression models augmented using the least absolute shrinkage and selection operator method for variable selection were used to estimate associations between ≥1 HF/LVAD-related readmissions and clinical variables. Our study cohort included 201 patients. Seventy percent (140/201) were readmitted for HF/LVAD-related reasons and accounted for 74% (489/657) of total readmissions. The main reasons for HF or LVAD-related readmission were major bleeding, major infection, heart failure exacerbation, and neurological dysfunction. Using pre-LVAD variables we built a multivariable model of HF/LVAD-related readmission. The variables associated with readmission were age, previous cardiac surgery, inotrope dependency, percutaneous LVAD/VA-ECMO support, duration of LVAD support, LVAD type, serum sodium and aspartate aminotransferase, and LV ejection fraction (Table). The area under the ROC curve (AUC) was 0.825. The inclusion of intra- and post-operative variables did not significantly increase accuracy (AUC=0.831) (Table). We created models accurately identifying patients with a high likelihood of readmissions after LVAD implant. Most variables associated with readmission can be identified pre-operatively. Our findings can guide the implementation of therapeutic strategies to mitigate readmission risk and further improve outcomes. [ABSTRACT FROM AUTHOR]

Type 2 diabetes mellitus (DM) and poor glycemic control portend a higher risk for cardiovascular morbidity and mortality. We sought to assess their impact on left ventricular assist device (LVAD)-mediated cardiac recovery in chronic advanced heart failure (HF). Consecutive patients (N=477) receiving a durable continuous-flow LVAD were prospectively evaluated. After excluding patients with acute HF etiologies or inadequate follow-up after LVAD (<3 months), 396 patients were stratified based on pre-LVAD DM status into non-diabetics (n=121; no history of DM and HbA1c <5.7) and diabetics/prediabetics (n=275; history of DM or HbA1c ≥5.7). Diabetics/prediabetics were further divided into 3 groups: prediabetics, n=106; well-controlled DM (HbA1c <7%), n=90; or not well-controlled DM, n=79. The absolute left ventricular ejection fraction (LVEF) change (ΔLVEF = LVEF post-LVAD - LVEF pre-LVAD) within one year on LVAD support was compared between groups with linear regression. DM is frequently associated with ischemic cardiomyopathy (ICM), so patients were stratified a priori into ICM and non-ICM (NICM). Compared to non-diabetics, diabetics/prediabetics were older, more likely male, with a higher BMI, and more commonly had an ICM, remote history of hypertension, and a longer HF symptoms duration. The Figure depicts the ΔLVEF between the study groups stratified into ICM or NICM. After adjusting for age, sex, BMI, HF symptoms duration, and history of hypertension, patients with well-controlled DM responded more favorably compared to patients with poor glycemic control. Overall, NICM patients responded more favorably than ICM patients. DM appears to negatively affect functional cardiac improvement on LVAD support and effective glycemic control seems to be beneficial in enhancing the favorable myocardial functional response. Further research is warranted to investigate the underlying mechanisms driving the differential responses. [ABSTRACT FROM AUTHOR]

In 2015 and 2016, atmospheric transport modeling challenges were conducted in the context of the Comprehensive Nuclear-Test-Ban Treaty (CTBT) verification, however, with a more limited scope with respect to emission inventories, simulation period and number of relevant samples (i.e., those above the Minimum Detectable Concentration (MDC)) involved. Therefore, a more comprehensive atmospheric transport modeling challenge was organized in 2019. Stack release data of Xe-133 were provided by the Institut National des Radioéléments/IRE (Belgium) and the Canadian Nuclear Laboratories/CNL (Canada) and accounted for in the simulations over a three (mandatory) or six (optional) months period. Best estimate emissions of additional facilities (radiopharmaceutical production and nuclear research facilities, commercial reactors or relevant research reactors) of the Northern Hemisphere were included as well. Model results were compared with observed atmospheric activity concentrations at four International Monitoring System (IMS) stations located in Europe and North America with overall considerable influence of IRE and/or CNL emissions for evaluation of the participants' runs. Participants were prompted to work with controlled and harmonized model set-ups to make runs more comparable, but also to increase diversity. It was found that using the stack emissions of IRE and CNL with daily resolution does not lead to better results than disaggregating annual emissions of these two facilities taken from the literature if an overall score for all stations covering all valid observed samples is considered. A moderate benefit of roughly 10% is visible in statistical scores for samples influenced by IRE and/or CNL to at least 50% and there can be considerable benefit for individual samples. Effects of transport errors, not properly characterized remaining emitters and long IMS sampling times (12–24 h) undoubtedly are in contrast to and reduce the benefit of high-quality IRE and CNL stack data. Complementary best estimates for remaining emitters push the scores up by 18% compared to just considering IRE and CNL emissions alone. Despite the efforts undertaken the full multi-model ensemble built is highly redundant. An ensemble based on a few arbitrary runs is sufficient to model the Xe-133 background at the stations investigated. The effective ensemble size is below five. An optimized ensemble at each station has on average slightly higher skill compared to the full ensemble. However, the improvement (maximum of 20% and minimum of 3% in RMSE) in skill is likely being too small for being exploited for an independent period. • The civil Xe-133 background was modeled including all known emitters. • Daily stack emissions from just two main emitters have only moderate added value. • The background dominated by a single main emitter can be successfully modeled. • Remaining emissions may be small, but their sum can be a decisive factor. • The multi-model ensemble is highly redundant despite countermeasures taken. [ABSTRACT FROM AUTHOR]

Although significant reverse cardiac remodeling is required for an LVAD-supported patient to be considered for device weaning, multiple factors including patient willingness, physician expertise, and center experience influence this complex decision. Existing predictive models defining cardiac recovery as device removal might underestimate reverse remodeling rates and lack accuracy in identifying patients prone to improve cardiac structure and function. We sought to develop a predictive tool to identify patients with such potential, independent of the decision to deactivate a durable, surgically deployed device. Chronic HF patients (N=703) requiring continuous-flow LVADs were evaluated. After excluding patients with acute HF and/or <3 months post-LVAD follow up, 3 US programs contributed 390 patients (derivation cohort), while 5 US programs formed the validation cohort (n=245). We defined responders as patients with an LVEF ≥40% and LVEDD ≤6.0 cm within a year on LVAD support. Multivariable logistic regression on the derivation set yielded a predictive model, which was externally tested; a predictive score was developed. Overall, 18.5% of the patients were responders. Compared to the validation, patients in the derivation cohort were more likely white (83 vs 69%; p<0.001), with ischemic HF (42 vs 33%; p=0.04), and longer HF duration (88 vs 66 months; p<0.001). Multivariable predictors of responders and the derived scoring system are shown in the Figure (c-statistic 0.74 [95% CI: 0.66-0.83] and 0.71 [95% CI: 0.59-0.77] in the derivation and validation set). We propose a novel score to predict significant cardiac improvement on LVAD support achieving good discriminative performance in distinct, heterogeneous, contemporary cohorts. This tool can be useful in selecting patients to implement diagnostic and therapeutic protocols to promote reverse remodeling and myocardial recovery. [ABSTRACT FROM AUTHOR]

There is significant interest in the use of terbium radioisotopes for applications in cancer therapy and diagnosis. Of these, 161Tb, as a medium energy beta-emitter, is being investigated as a potential alternative to 177Lu. The relatively high proportion of conversion electron and Auger electron emissions per decay make 161Tb an attractive targeted therapeutic. As a product of nuclear fission, 161Tb is also of importance to nuclear forensics. The standard uncertainty of the current evaluated half-life of 6.89(2) d contributes significantly to the standard uncertainty of any decay corrected activity determination made. Furthermore, the accuracy of this evaluated half-life has been called into question by measurements reported in 2020 at the Institute of Radiation Physics (IRA), Switzerland, who reported a half-life of 6.953(2) d. In the current work, the half-life of the 161Tb ground state decay has been measured at three independent laboratories located in the United Kingdom and the United States of America for a total of six determinations using three independent measurement techniques; gamma-ray spectrometry, ionisation chamber measurement and liquid scintillation counting. The half-life determined for 161Tb of 6.9637(29) d confirms the observed 1% relative increase observed by IRA, though the reported half-lives in this work and at IRA are significantly different (ζ-score = 3.1). • Half-life of 161Tb measured by three independent radiometric techniques. • Six consistent half-life determinations made across NPL, AWE and PNNL. • New half-life of 6.9637(29) d supports recent observations of discrepancies in the historic literature. [ABSTRACT FROM AUTHOR]

Aims: To evaluate the variance in current UK clinical practice and clinical outcomes for direct percutaneous radiologically inserted gastrostomy (RIG). Materials and methods: A prospective UK multicentre survey of RIG performed between October 2008 and August 2010 was performed through the British Society of Gastrointestinal and Abdominal Radiology (BSGAR). Results: Data from 684 patients were provided by 45 radiologists working at 17 UK centres. Two hundred and sixty-three cases (40%) were performed with loop-retained catheters, and 346 (53%) with balloon-retained devices. Sixty percent of all patients experienced pain in the first 24 h, but settled in the majority thereafter. Early complications, defined as occurring in the first 24 h, included minor bleeding (1%), wound infection (3%), peritonism (2%), and tube misplacement (1%). Late complications, defined as occurring between day 2 and day 30 post-procedure, included mild pain (30%), persisting peritonism (2%), and 30 day mortality of 1% (5/665). Pre-procedural antibiotics or anti-methicillin-resistant Staphylococcus aureus (MRSA) prophylaxis did not affect the rate of wound infection, peritonitis, post-procedural pain, or mortality. Ninety-three percent of cases were performed using gastropexy. Gastropexy decreased post-procedural pain (p < 0.001), but gastropexy-related complications occurred in 5% of patients. However, post-procedure pain increased with the number of gastropexy sutures used (p < 0.001). The use of gastropexy did not affect the overall complication rate or mortality. Post-procedure pain increased significantly as tube size increased (p < 0.001). The use of balloon-retention feeding tubes was associated with more pain than the deployment of loop-retention devices (p < 0.001). Conclusion: RIG is a relatively safe procedure with a mortality of 1%, with or without gastropexy. Pain is the commonest complication. The use of gastropexy, fixation dressing or skin sutures, smaller tube sizes, and loop-retention catheters significantly reduced the incidence of pain. There was a gastropexy-related complication rate in 5% of patients. Neither pre-procedural antibiotics nor anti-MRSA prophylaxis affected the rate of wound infection. [Copyright &y& Elsevier]

Abstract: Using a nationally representative sample from the 2008 Paraguayan National Survey of Demography and Sexual and Reproductive Health, we examine the association between emotional, physical, and sexual intimate partner violence (IPV) and mental health among women aged 15–44 years who have ever been married or in a consensual union. The results from multivariate logistic regression models demonstrate that controlling for women’s socioeconomic and marital status and history of childhood abuse and their male partners’ unemployment and alcohol consumption, IPV is independently associated with an increased risk for common mental disorders (CMD) and suicidal ideation measured by the Self Reporting Questionnaire (SRQ-20). IPV variables substantially improve the explanatory power of the models, particularly for suicidal ideation. Emotional abuse, regardless of when it occurred, is associated with the greatest increased risk for CMD whereas recent physical abuse is associated with the greatest increased risk for suicidal ideation. These findings suggest that efforts to identify women with mental health problems, particularly suicidal ideation, should include screening for the types and history of IPV victimization. [ABSTRACT FROM AUTHOR]