Search

Ochronotic pigmentation of connective tissue is the central pathological process in the rare metabolic disease alkaptonuria (AKU). Tissue pigmentation in AKU occurs due to unmetabolised homogentisic acid (HGA) in the circulation, caused by an enzyme deficiency in the liver. Ochronotic pigmentation, derived from HGA, has previously been reported and described in large joints obtained from arthroplasty surgeries, which typically have advanced disease. Many tissues that are affected by ochronosis are not accessible for study during life, including tissues subjected to early and mid‐stage disease. Here, the opportunity arose to anatomically examine a 60‐year‐old AKU female body donor, allowing the investigation of previously understudied tissue, including those undergoing early‐stage pathological changes. Dissection of fresh‐frozen tissue was carried out and harvested tissues were fixed and examined histologically using H&E and Schmorl's stains to aid identification of ochronotic pigment. This work focusses on osteochondral tissues including extra‐skeletal cartilage, viscera and eyes. Gross and histological images demonstrating pigmentation in the cartilage and perichondrium of the ear ossicles, tympanic membrane and the pubic symphysis fibrocartilaginous disc are described for the first time here. We also show the first examination of the temporomandibular joint, which macroscopically appeared unpigmented, with histological analysis of the fibrocartilaginous disc showing no pigmentation. Pigmentation of non‐articular hyaline cartilage was observed in the respiratory tract, in both the hyaline cartilage and perichondrium, confirming previous findings. Within smaller joints, pigmentation of chondrons and the surrounding territorial matrix was observed, but was confined to calcified articular cartilage, and was not generally found in the hyaline articular cartilage. Dark pigmentation of the perichondrium adjacent to the articular surface was observed in numerous small joints. The calcified bone matrix was not pigmented but ochronosis was identified in a small fraction of trabecular osteocytes in the capitate and radius, with substantially more pigmented osteocytes observed in bone of the ear ossicles. Viscera examined were unpigmented. This anatomical examination of tissues from an AKU individual highlights that most osteochondral tissues are susceptible to HGA‐derived pigmentation, including the ear ossicles which are the smallest bones in the body. Within joints, calcified cartilage and perichondrium appear to be the earliest affected tissues, but why this is the case is not understood. Furthermore, why the TMJ disc was unaffected by pigmentation is intriguing. The heterogenous appearance of pigmentation both within and between different tissues indicates that factors other than tissue type (i.e. cartilage, perichondrium) and matrix composition (i.e. collagen‐rich, calcified) may affect the process of ochronosis, such as oxygen tension, loading patterns and tissue turnover. The effect of nitisinone treatment on the ochronotic disease state is considered, in this case 7 years of treatment, however comparisons could not be made to other cases due to inter‐individual variability. [ABSTRACT FROM AUTHOR]

The editorial discusses patient and public perspectives on acute type A aortic dissection, highlighting issues in initial management and the urgent need for quality improvement. Patients face preventable harm due to misdiagnosis, delays in treatment, and inadequate monitoring during transfers. The Aortic Dissection Charitable Trust works towards improving care and implementing NHS England's toolkit for acute aortic dissection. The editorial emphasizes the importance of communication, teamwork, and system design in diagnosing and treating this life-threatening condition. [Extracted from the article]

A 5‐year‐8‐month‐old, female, neutered Cavalier King Charles Spaniel presented with a 7‐day history of melena, intermittent haematemesis, mild lethargy and normal appetite. Following hospitalisation and supportive treatment with intravenous fluid therapy and medications, the clinical signs improved. On abdominal ultrasound, a proximal duodenal mass was seen. Gastrointestinal endoscopy identified an intraluminal duodenal mass lesion and endoscopic biopsies were obtained. Cytology from ultrasound‐guided fine‐needle aspirates and histology from endoscopic biopsies were suggestive of an epithelial duodenal polyp. Surgical resection via duodenotomy was performed, and the dog was discharged the following day with complete resolution of the clinical signs. The histological diagnosis was compatible with a hyperplastic polyp, not previously reported in this location. Little is known in terms of clinical signs, diagnostic options and prognosis following resection. In a follow‐up consult and abdominal ultrasound 351 days later, there was no polyp regrowth or recurrence of clinical signs. [ABSTRACT FROM AUTHOR]

Forensic case samples collected in sexual assaults typically contain DNA from multiple sources, which complicates short‐tandem repeat (STR) profiling. These samples are typically sent to a laboratory to separate the DNA from sperm and non‐sperm sources prior to analysis. Here, the automation and miniaturization of these steps using digital microfluidics (DMF) is reported, which may eventually enable processing sexual assault samples outside of the laboratory, at the point of need. When applied to vaginal swab samples collected up to 12 h post‐coitus (PC), the new method identifies single‐source (male) STR profiles. When applied to samples collected 24–72 h PC, the method identifies mixed STR profiles, suggesting room for improvement and/or potential for data deconvolution. In sum, an automated, miniaturized sample pre‐processing method for separating the DNA contained in sexual assault samples is demonstrated. This type of automated processing using DMF, especially when combined with Rapid DNA Analysis, has the potential to be used for processing of sexual assault samples in hospitals, police offices, and other locations outside of the laboratory. [ABSTRACT FROM AUTHOR]

Objectives Design/Method Results Conclusions The objective of this paper was to examine the predictors of breastfeeding exclusivity at two time‐points (6 and 26 weeks postpartum) using a dyadic mother–father extended model of the theory of planned behaviour.A sample of 1139 first‐time Australian mother–father dyads completed measures of each of the Theory of Planned Behaviour variables (intention, attitudes, subjective norms, and perceived behavioural control) and additional psychosocial and behavioural predictors of breastfeeding, including problems with breastfeeding, psychological distress, childcare stress, partner support, and the frequency and time of first public breastfeed. Confirmatory factor analyses were used to determine the factor structures of the latent constructs to be included in the structural model. Structural equation modelling was used to model pathways between variables.Breastfeeding exclusivity at 6 weeks was significantly predicted by breastfeeding self‐efficacy at 6 weeks, intention to exclusively breastfeed, and frequency of public breastfeeding over the month prior, whereas childcare stress, partner support, time of first public breastfeed, and fathers' variables (attitudes and subjective norms) had little influence. Self‐efficacy mediated the relationship between mothers' attitudes, psychological distress, and breastfeeding problems with breastfeeding exclusivity at 6 weeks. Breastfeeding exclusivity at 26 weeks was significantly predicted by mothers' attitudes, self‐efficacy, breastfeeding exclusivity at 6 weeks, and frequency of public breastfeeding in the month prior.The results highlight the importance of breastfeeding self‐efficacy and confidence to breastfeed in public as crucial constructs in promoting long‐term exclusive breastfeeding and provides support for an extended theory of planned behaviour model in predicting breastfeeding outcomes. [ABSTRACT FROM AUTHOR]

The article discusses the role of anaesthesia associates in the UK and their scope of practice. The findings from the National Audit Project of the Royal College of Anaesthetists show that anaesthesia associates have a wide range of responsibilities, including inducing anaesthesia without direct supervision, leading a cardiac arrest, and providing anaesthesia for high-risk patients and major surgeries. However, these responsibilities go beyond the agreed scope of practice for anaesthesia associates. The article explores the implications of these findings for future healthcare delivery and discusses the concerns and opinions of doctors regarding the role of anaesthesia associates. It also highlights the need for clear identification of roles, titles, and qualifications to ensure patient safety and transparency. The article suggests that collaboration between anaesthetists and anaesthesia associates is crucial for the successful implementation of these roles. It also mentions the international perspective on non-physician anaesthetists and the importance of learning from other countries' experiences. The article concludes by emphasizing the need for regulation and the importance of addressing the concerns of doctors and patients in order to ensure safe and effective healthcare delivery. [Extracted from the article]

Improving composite cathode function is key to the success of the solid‐state battery. Maximizing attainable cathode capacity and retention requires integrating suitable polymeric binders that retain a sufficiently high ionic conductivity and long‐term chemo‐mechanical stability of the cathode active material‐solid‐electrolyte‐carbon mixture. Herein, we report block copolymer networks composed of lithium borate polycarbonates and poly(ethylene oxide) that improved the capacity (200 mAh g−1 at 1.75 mA cm−2) and capacity retention (94 % over 300 cycles) of all‐solid‐state composite cathodes with nickel‐rich LiNi0.8Co0.1Mn0.1O2 cathode active material, Li6PS5Cl solid electrolyte, and carbon. Tetrahedral B(OR)2(OH)2− anions immobilized on the polycarbonate segments provide hydrogen‐bonding chain crosslinking and selective Li‐counterion conductivity, parameterized by Li‐ion transference numbers close to unity (tLi+~0.94). With 90 wt % polycarbonate content and a flexible low glass transition temperature backbone, the single‐ion conductors achieved high Li‐ion conductivities of 0.2 mS cm−1 at 30 °C. The work should inform future binder design for improving the processability of cathode composites towards commercializing solid‐state batteries, and allow use in other cell configurations, such as lithium‐sulphur cathode designs. [ABSTRACT FROM AUTHOR]

Background: Pneumothorax can cause distressing breathlessness, however the effect of the accumulated air in the pleural space and its association with diaphragmatic function and symptoms of breathlessness is not well understood. Bendopnoea is an evolving clinical symptom that has been demonstrated as clinically useful in some heart and lung conditions. Whether bendopnoea is present in patients with pneumothorax, and its potential clinical usefulness has not yet been investigated. The PASE study is a pilot study to explore the incidence and clinical relevance of bendopnoea in patients with pneumothorax and may provide better understanding of pneumothorax related dyspnoea. Methods: PASE is a prospective study. Eligible patients are assessed at baseline (pre air drainage/lung reinflation) and in patients whose pneumothorax resolves once the lung has re‐expanded (post conservative management or air drainage procedure). Outcome measures include the incidence of bendopnoea, correlation of the associated symptoms (pain and breathlessness) to the severity of bendopnoea and the size of pneumothorax; and correlation with clinical outcome (i.e., response to air drainage/lung reinflation). The study will recruit 50 participants. Discussion: This is the first study to explore bendopnoea in patients with pneumothorax. The presence and significance of bendopnoea in relation to clinical and physiological parameters in patients with pneumothorax requires investigation. The findings of this study may further current understanding of dyspnoea related pneumothorax. Trial Registration: Name of the registry: Australia New Zealand Clinical Trial Registry Trial registration number: ACTRN12623001109695p. URL of the trial registry record for this trial: https://anzctr.org.au/Trial/Registration/TrialReview.aspx?id=386631&isReview=true Date of registration: Registered on 24 October 2023. Funding of the trial: This study has not received grant support. The study is sponsored by the Institute for Respiratory Health, a not‐for‐profit organisation. Name and contact information for the trial sponsor: Mr Bi Lam; Finance manager. Level 2, 6 Verdun Street, Nedlands, WA 6009. Role of sponsor: The funder is not involved in the planning of the study, gathering, analysing, and interpreting the data, or in preparing the manuscript. Protocol version: 1. [ABSTRACT FROM AUTHOR]

Summary: Cultivated spinach (Spinacia oleracea) is a dioecious species. We report high‐quality genome sequences for its two closest wild relatives, Spinacia turkestanica and Spinacia tetrandra, which are also dioecious, and are used to study the genetics of spinach domestication.Using a combination of genomic approaches, we assembled genomes of both these species and analyzed them in comparison with the previously assembled S. oleracea genome.These species diverged c. 6.3 million years ago (Ma), while cultivated spinach split from S. turkestanica 0.8 Ma. In all three species, all six chromosomes include very large gene‐poor, repeat‐rich regions, which, in S. oleracea, are pericentromeric regions with very low recombination rates in both male and female genetic maps. We describe population genomic evidence that the similar regions in the wild species also recombine rarely. We characterized 282 structural variants (SVs) that have been selected during domestication. These regions include genes associated with leaf margin type and flowering time. We also describe evidence that the downy mildew resistance loci of cultivated spinach are derived from introgression from both wild spinach species.Collectively, this study reveals the genome architecture of spinach assemblies and highlights the importance of SVs during the domestication of cultivated spinach. [ABSTRACT FROM AUTHOR]

Summary: In the Vetrix clade of Salix, a genus of woody flowering plants, sex determination involves chromosome 15, but an XY system has changed to a ZW system. We studied the detailed genetic changes involved.We used genome sequencing, with chromosome conformation capture (Hi‐C) and PacBio HiFi reads to assemble chromosome level gap‐free X and Y of Salix arbutifolia, and distinguished the haplotypes in the 15X‐ and 15Y‐linked regions, to study the evolutionary history of the sex‐linked regions (SLRs).Our sequencing revealed heteromorphism of the X and Y haplotypes of the SLR, with the X‐linked region being considerably larger than the corresponding Y region, mainly due to accumulated repetitive sequences and gene duplications.The phylogenies of single‐copy orthogroups within the SLRs indicate that S. arbutifolia and Salix purpurea share an ancestral SLR within a repeat‐rich region near the chromosome 15 centromere. During the change in heterogamety, the X‐linked region changed to a W‐linked one, while the Z was derived from the Y. [ABSTRACT FROM AUTHOR]

This article highlights the significance of pilot studies in research and offers guidance on how to design, conduct, and report them. Pilot studies serve as preliminary investigations that help identify potential issues in future trials. However, it is important to note that many studies labeled as pilot studies are actually different types of studies. Pilot studies can evaluate various aspects of a future study, such as recruitment rates, data optimization, and treatment safety. They also provide an opportunity to refine study methods before conducting larger trials. Nonetheless, it is important to acknowledge the limitations of pilot studies and interpret their findings cautiously. The article also provides reporting guidelines specifically for non-randomized pilot studies. These guidelines cover different aspects of pilot studies, including randomization methods, analytical methods, participant flow, recruitment, baseline data, outcomes, and interpretation. The document also emphasizes the importance of assessing the quality of pilot studies and planning for the conversion of a pilot study into a full hypothesis-testing trial. The authors stress the need for rigorous methodology and clear progression criteria in pilot studies to ensure informative and publishable results. [Extracted from the article]

Multiple sclerosis (MS) is a complex neurological and autoimmune disease with an established genetic component. Families with multiple cases of MS are rare but do occur. We hypothesised that multicase families may have a heightened polygenic risk for MS. In this work, we have determined whether polygenic risk for MS is enriched in multicase families in comparison to a case-control cohort. Using the findings from the largest MS genome-wide association study, we calculated a weighted polygenic risk score (wPRS) for MS. We applied this wPRS to study a population-based MS case-control cohort (3,252 people with MS and 5,725 controls) and three multicase MS families (9 individuals with MS, 10 unaffected family members). For both the population-based cohort and the three families, 167 of the 233 known genome-wide significant MS-associated variants were identified and used to calculate the wPRS. Within the population-based cohort, the wPRS was significantly higher in MS cases than controls (P = 2.2x 10-16). The wPRS of familial MS cases was not significantly different to population-based MS cases (P > 0.05). Both affected and unaffected MS family members had higher wPRS than population controls. MS families have a higher polygenic risk for MS, but this did not differ to the polygenic risk of population-based MS cases. Only one family carried the established HLA-DRB1 15:01 MS risk allele, which was present in both affected and unaffected family members. Across families, unaffected family members had an elevated polygenic risk in comparison to population controls indicating that a higher polygenic risk does not fully explain the clustering of MS in families. [ABSTRACT FROM AUTHOR]

Background: Getting a diagnosis of dementia does not equate to equitable access to care. People with dementia and unpaid carers face many barriers to care, which can vary within, and across, different countries and cultures. With little evidence across different countries, the aim of this scoping exercise was to identify the different and similar types of inequalities in dementia across Europe, and provide recommendations for addressing these. Methods: We conducted a brief online survey with INTERDEM and INTERDEM Academy members across Europe, and with members of Alzheimer Europe's European Working Group of People with Dementia and Carers in February and March 2023. Members were asked about whether inequalities in dementia care existed within their country; if yes, to highlight three key inequalities. Responses on barriers were coded into groups, and frequencies of inequalities were calculated. Highlighted inequalities were discussed and prioritised at face‐to‐face and virtual consensus meetings in England, Ireland, Italy, and Poland, involving people with dementia, unpaid carers, health and social care providers, and non‐profit organisations. Results: Forty‐nine academics, PhD students, people with dementia and unpaid carers from 10 countries (Belgium, Denmark, Germany, Greece, Ireland, Italy, Poland, Malta, Netherlands, UK) completed the survey. The most frequently identified inequalities focused on unawareness and lack of information, higher level system issues (i.e. lack of communication among care professionals), lack of service suitability, and stigma. Other barriers included workforce training and knowledge, financial costs, culture and language, lack of single‐point‐of‐contact person, age, and living location/postcode lottery. There was general consensus among people living dementia and care providers of unawareness as a key barrier in different European countries, with varied priorities in Ireland depending on geographical location. Conclusions: These findings provide a first insight on dementia inequalities across Europe, generate cross‐country learnings on how to address these inequalities in dementia, and can underpin further solution‐focused research that informs policy and key decision makers to implement changes. Key points: There are numerous similar barriers to accessing dementia care across different European countries.Some of the key challenges to equitable dementia care are lack of workforce knowledge, lack of information, stigma, financial barriers, and lack of communication among care professionals.Cultural challenges, postcode lottery, and service suitability were also raised as key barriers to dementia care. [ABSTRACT FROM AUTHOR]

Summary: The principles of environmentally sustainable healthcare as applied to anaesthesia and peri‐operative care are well documented. Associated recommendations focus on generic principles that can be applied to all areas of practice. These include reducing the use of inhalational anaesthetic agents and carbon dioxide equivalent emissions of modern peri‐operative care. However, four areas of practice have specific patient, surgical and anaesthetic factors that present barriers to the implementation of some of these principles, namely: neuroanaesthesia; obstetric; paediatric; and cardiac anaesthesia. This narrative review describes these factors and synthesises the available evidence to highlight areas of sustainable practice clinicians can address today, as well as posing several unanswered questions for the future. In neuroanaesthesia, improvements can be made by undertaking awake surgery, moving towards more reusables and embracing telemedicine in quaternary services. Obstetric anaesthesia continues to present questions regarding how services can move away from nitrous oxide use or limit its release to the environment. The focus for paediatric anaesthesia is addressing the barriers to total intravenous and regional anaesthesia. For cardiac anaesthesia, a significant emphasis is determining how to focus the substantial resources required on those who will benefit from cardiac interventions, rather than universal implementation. Whilst the landscape of evidence‐based sustainable practice is evolving, there remains an urgent need for further original evidence in healthcare sustainability targeting these four clinical areas. [ABSTRACT FROM AUTHOR]

Africa's population is expected to triple by 2050, owing to rapid urbanisation and overall demographic trends. The combined pressures of urbanisation and climate change impact the ecosystem and the services it provides. As a result, additional dangers such as increased flooding, and environmental disruption have risen. Therefore, devising adaptive solutions to mitigate flood risk impacts while also building community resilience is needed. Evidence suggests that Nature‐based Solutions (NbS) can potentially alleviate floods and mitigate climate change impacts while also delivering other societal benefits. Despite rising NbS popularity following its recognition in the last decade, studies on its recognition in Africa remain limited. For this reason, this paper reviewed NbS studies conducted in East Africa (EA) to evaluate opportunities and barriers surrounding NbS adoption in EA. Academic literature published from January 2012 to May 2022 was reviewed using a comprehensive search of the SCOPUS database. Results show 14 papers have been published during the period, with the majority being post‐2020. In addition, the majority of the articles focused on cities and peri‐urban settlements, while public awareness, clear guidelines on performance monitoring, stakeholder inclusion, and diverse demonstration projects were highlighted as potential success factors for the adoption of NbS in EA. [ABSTRACT FROM AUTHOR]

Objectives: The objective was to report and compare the complications and recurrence rates of urethral prolapse in dogs when treated with urethropexy, resection and anastomosis or a combined surgical technique. Study design: Retrospective study. Materials and Methods: A total of 86 dogs were identified from the medical records of 10 veterinary referral hospitals from February 2012 and October 2022. Dogs were included if they underwent surgery for a urethral prolapse at first presentation. Complications were classified as minor or major based on the necessity of further surgical intervention. Complications leading to death were also considered major complications. Results: Seventy‐nine dogs were included, urethropexy (n=44), resection and anastomosis (n=27) and a combined surgical technique (n=8). Minor complications were identified in 41 of 79 dogs (51.9%): urethropexy 19 of 44 (43.2%), resection and anastomosis 18 of 27 (66.6%) and a combined surgical technique four of eight (50%). Major complications occurred in 23 dogs (29.1%), of which 21 were recurrence (26.6%). Recurrence occurred in 17 of 44 dogs following a urethropexy (38.6%), three of 27 dogs following resection and anastomosis (11.1%) and one of eight dogs treated with a combined surgical technique (12.5%). Recurrence of a urethral prolapse was significantly more likely following urethropexy in comparison to resection and anastomosis. Clinical Significance: Resection and anastomosis was associated with a lower recurrence rate in comparison to urethropexy for the surgical treatment of urethral prolapse. Based on these results, we concluded that resection and anastomosis may be preferable to urethropexy for treatment of urethral prolapse at first presentation. Urethropexy, and resection and anastomosis combined surgical technique was associated with low recurrence rate; however, further studies will be needed to clarify if it provides any benefit over resection and anastomosis. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this study is to retrospectively report complication and infection rates associated with the use of Penrose drains in a large population of dogs; and to compare complication and infection rates of dogs hospitalised for maintenance of their Penrose drains with those that were discharged home with their drains in place. Materials and Methods: We performed a retrospective search of medical records from 2014 to 2022 for dogs that had a Penrose drain placed into a wound in one institution. Our population was sub‐divided into dogs discharged home with a drain in place; dogs discharged only after drain removal; and dogs recovered part of the time in hospital and part at home (with the drain in situ). Postoperative complications were graded using the Clavien‐Dindo scale. Results: Two hundred and eight dogs were included. The overall complication rate was 40.9% (85/208), with most complications considered minor. The overall infection rate was 16.9% (35/207). Dogs discharged home with the drain in situ <24 hours after surgery (n=136) had similar complication (39.0%) and infection (16.2%) rates to dogs kept hospitalised for drain care (n=50, 42.9%, 18.4%) and dogs kept hospitalised for >24 hours but discharged with the drain in situ (n=18, 50.0%, 22.2%). Clinical Significance: Our study results show no significant influence on the complication or infection rates between dogs that were hospitalised for drain care and those discharged home with drains in situ within 24 hours of surgery. [ABSTRACT FROM AUTHOR]

Objectives: To describe the clinical presentation, diagnostic findings, surgical treatment and outcome of dogs diagnosed with parotid duct ectasia. Materials and Methods: Medical records of dogs diagnosed with parotid duct ectasia between 2010 and 2023 at six small animal referral hospitals were retrospectively reviewed. Outcome was assessed by contacting the owners or referring veterinarians. Results: Fourteen dogs were included. Lateral facial swelling was the most common clinical presentation. CT revealed a tortuous cavitary tubular fluid‐filled structure consistent with a dilated parotid duct in all dogs. Surgical treatment included marsupialisation of the parotid duct papilla, surgical exploration of the duct alone, parotid duct marsupialisation with surgical exploration of the duct, parotidectomy or en‐bloc parotid duct resection. The aetiology of parotid duct ectasia was not established in 13 of 14 dogs. In one case, a foreign body was retrieved from the duct. No recurrence of clinical signs was noted during the follow‐up period (range 21 to 2900 days). Clinical Significance: Parotid duct ectasia should be considered for dogs with a lateralised fluctuant non‐painful tubular facial swelling. Surgical management was associated with a favourable prognosis without evidence of recurrence in all cases reported in the case series. [ABSTRACT FROM AUTHOR]

Background and Objective: Indwelling pleural catheter (IPC) and indwelling peritoneal catheter (IPeC) have established roles in the management of malignant pleural and peritoneal effusions but catheter‐related infections remain a major concern. Topical mupirocin prophylaxis has been shown to reduce peritoneal dialysis catheter infections. This study aimed to assess the (i) compatibility of IPC with mupirocin and (ii) feasibility, tolerability and compliance of topical mupirocin prophylaxis in patients with an IPC or IPeC. Methods: (i) Three preparations of mupirocin were applied onto segments of IPC thrice weekly and examined with scanning electron microscope (SEM) at different time intervals. (ii) Consecutive patients fitted with IPC or IPeC were given topical mupirocin prophylaxis to apply to the catheter exit‐site following every drainage/dressing change (at least twice weekly) and followed up for 6 months. Results: (i) No detectable structural catheter damage was found with mupirocin applied for up to 6 months. (ii) Fifty indwelling catheters were inserted in 48 patients for malignant pleural (n = 41) and peritoneal (n = 9) effusions. Median follow‐up was 121 [median, IQR 19–181] days. All patients tolerated mupirocin well; one patient reported short‐term local tenderness. Compliance was excellent with 95.8% of the 989 scheduled doses delivered. Six patients developed catheter‐related pleural (n = 3), concurrent peritoneal/local (n = 1) and skin/tract (n = 2) infections from Streptococcus mitis (with Bacillus species or anaerobes), Staphylococcus aureus, Klebsiella pneumoniae and Pseudomonas aeruginosa. Conclusion: This first study of long‐term prevention of IPC‐ or IPeC‐related infections found topical mupirocin prophylaxis feasible and well tolerated. Its efficacy warrants future randomized studies. [ABSTRACT FROM AUTHOR]

Objective: Medicaid enrollees in rural and frontier areas face inadequate access to mental health services, but the extent to which access varies for different provider types is unknown. We assessed access to Medicaid‐participating prescribing and nonprescribing mental health clinicians, focusing on Oregon, which has a substantial rural population. Methods: Using 2018 Medicaid claims data, we identified enrollees aged 18‐64 with psychiatric diagnoses and specialty mental health providers who billed Medicaid at least once during the study period. We measured both 30‐ and 60‐minute drive time to a mental health provider, and a spatial access score derived from the enhanced 2‐step floating catchment area (E2SFCA) approach at the level of Zip Code Tabulation Areas (ZCTAs). Results were stratified for prescribers and nonprescribers, across urban, rural, and frontier areas. Results: Overall, a majority of ZCTAs (68.6%) had at least 1 mental health prescriber and nonprescriber within a 30‐minute drive. E2SFCA measures demonstrated that while frontier ZCTAs had the lowest access to prescribers (84.3% in the lowest quintile of access) compared to other regions, some frontier ZCTAs had relatively high access to nonprescribers (34.3% in the third and fourth quartiles of access). Conclusions: Some frontier areas with relatively poor access to Medicaid‐participating mental health prescribers demonstrated relatively high access to nonprescribers, suggesting reliance on nonprescribing clinicians for mental health care delivery amid rural workforce constraints. Efforts to monitor network adequacy should consider differential access to different provider types, and incorporate methods, such as E2SFCA, to better account for service demand and supply. [ABSTRACT FROM AUTHOR]

Identification of patients who will undergo futile surgery is complex, as some extreme-risk patients will ultimately survive and a smaller proportion will even be discharged home. Keywords: decision-making; laparotomy; peri-operative; risk EN decision-making laparotomy peri-operative risk 1431 1434 4 11/09/23 20231201 NES 231201 Whilst saying "yes" to more interventions for a high-risk patient who is unwell can be easy, drawing a line between benefit and harm for these interventions is not. This is because experienced clinicians still feel that some of these extreme-risk patients may benefit from surgery, and a small number of patients do indeed survive. A study by Chiu et al. examined the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database for patients undergoing laparotomies and identified 2% of patients as "extreme-risk", carrying a 30-day mortality rate of 71% [[14]]. [Extracted from the article]

Objectives: Breastfeeding has a number of benefits for both mothers and their infants. Research has examined the psychosocial influences on breastfeeding, yielding important findings in relation to particular constructs that play a significant role in this vital health behaviour. One such construct is subjective norms. However, there are mixed findings in relation to the role of subjective norms in breastfeeding behaviours. This may be due to the lack of consistent measure of subjective norms across studies. Further, the influence of fathers' subjective norms on breastfeeding continuation remains unclear due to a lack of measurement. Thus, the aim of the current study was to develop and assess a reliable and valid subjective norms scale specific to breastfeeding for use among both mothers and fathers. Design/Methods: Subjective norms items were developed by researchers in the domain and were tested among 949 couples. Results: Findings indicated that both subjective norms scales had excellent reliability, construct validity, and predictive validity. It was also found that both the mothers' and fathers' subjective norms scales tapped into two key structures: breastfeeding in general, and breastfeeding in public. Further, maternal subjective norms were predictive of breastfeeding behaviours but not paternal subjective norms. Conclusions: These findings indicate that the developed subjective norms scales are reliable and valid and capture key elements of breastfeeding subjective norms among both mothers and fathers. Use of this measure in future research can help better understand the role of both mothers' and fathers' subjective norms in influencing breastfeeding behaviours. [ABSTRACT FROM AUTHOR]

Background: Haemophagocytic lymphohistiocytosis (HLH) or macrophage activation syndrome (MAS) has a potentially high mortality rate. Anakinra, an interleukin‐1 receptor antagonist, is now recommended early in HLH/MAS, with intravenous (IV) use proposed in critically unwell patients. This systematic review establishes the literature relating to IV anakinra in secondary HLH/MAS (sHLH/MAS). Methods: We screened Embase, PubMed, and Medline, including all reports of IV anakinra for HLH or MAS. We extracted age, HLH/MAS trigger, continuous infusion or bolus dosing, and survival. Results: Twenty‐nine case reports/series identified 87 patients (median age 22 years, range 22 months to 84 years), all with sHLH. Amongst identifiable triggers, 43% were systemic infection, 33% rheumatological, 9% oncological. Children had predominantly a rheumatological trigger (48%), whilst adults were more commonly infection‐driven (50%). Overall, rheumatologically triggered disease showed greater survival (83.3%), particularly compared with oncological triggers (42.9%). Children had a greater survival, particularly under 10 years (83%, vs. adults, 63%). Conclusions: Despite IV anakinra recipients likely to be critically unwell, this cohort had similar disease triggers and survival compared to large historical cohorts, and enhances awareness of age and trigger‐specific survival patterns. IV anakinra had a wide therapeutic dosing range and tolerability, regardless of trigger, demonstrating substantial utility in severe sHLH/MAS. [ABSTRACT FROM AUTHOR]

Guidance for writing a narrative review paper for I Anaesthesia i is shown in Table 3. 3 Table Guidance for writing a narrative review for Anaesthesia. Keywords: evidence; narrative review; peri-operative; systematic review EN evidence narrative review peri-operative systematic review 1162 1166 5 08/07/23 20230901 NES 230901 Over recent years, there has been a marked increase in the number and types of reviews seen in the medical literature. Flaws of narrative reviews Critics will argue that narrative reviews are the lowest form of clinical evidence because they are entirely dependent on the knowledge, experience and communicative ability of the authors. [Extracted from the article]

Summary: It is essential that academic publishing complies with the highest standards in terms of ethics, research conduct and manuscript preparation. This protects the rights and welfare of research participants, ensures the integrity of study results and aids the communication and dissemination of novel findings into clinical practice. This position statement outlines the current policies and practices of the Editors of Anaesthesia and Anaesthesia Reports in relation to academic medical publishing. [ABSTRACT FROM AUTHOR]

Vulvar lichen planus (VLP) is a chronic inflammatory disease which adversely affects patients' quality of life. The pathogenesis of VLP is unknown although Th1 immune response has been implicated. We aimed to discover specific tissue‐based protein biomarkers in VLP compared to normal vulvar tissue (NVT), vulvar lichen sclerosus (VLS) and oral lichen planus (OLP). We used laser capture microdissection‐liquid chromatography‐ tandem mass spectrometry to assess protein expression in fixed lesional mucosal specimens from patients with VLP (n = 5). We then compared proteomic profiles against those of NVT (n = 4), VLS (n = 5), OLP (n = 6) and normal oral mucosa (n = 5), previously published by our group. IL16, PTPRC, PTPRCAP, TAP1 and ITGB2 and were significantly overexpressed in VLP compared to NVT. Ingenuity pathway analysis identified antigen presentation and integrin signalling pathways. Proteins overexpressed in both VLP versus NVT and OLP versus NOM included IL16, PTPRC, PTPRCAP, TAP1, HLA‐DPB1, HLA‐B and HLA‐DRA. This proteomic analysis revealed several overexpressed proteins in VLP that relate to Th1 autoimmunity, including IL16. Overlapping pathways, including those involving IFNγ and Th1 signalling, were observed between VLP, VLS, and OLP. [ABSTRACT FROM AUTHOR]

As part of I Anaesthesia i 's Reviewer Recommendations series, we will outline why visual representation of data is important, describe the different ways to visualise information and how best to do it, and list the common pitfalls to avoid. Keywords: communication; figures; graphics; research dissemination EN communication figures graphics research dissemination 1031 1035 5 07/06/23 20230801 NES 230801 Visual representation of data is an evolving field driven by advances in statistical programming [[1]] and graphical design, and the expansion of academic social media, creating an audience requiring concise yet impactful information. The most important aspect of data visualisation is function and that the data and overall messages are correctly represented and not lost within the style or design. If you feel it is worth investing in data visualisation software, then Adobe Creative Cloud (Adobe Inc., San Jose, CA, USA) offers a suite of programmes which can be used for different aspects of data visualisation. [Extracted from the article]

This article discusses the importance of addressing climate change in the context of peri-operative medicine and sustainable healthcare. It emphasizes the need for clinicians to take action and provides an up-to-date synthesis of science, data, and international expertise on sustainable healthcare. The article covers various topics, including the controversy surrounding volatile anaesthetic agents, the potential for innovation in volatile capture technology, reducing unwarranted variation in clinical practice, and applying sustainable practices to different anaesthetic subspecialties. The perspectives of atmospheric scientists, surgeons, and patients are also included. The article concludes by calling for personal, organizational, societal, and political efforts to tackle climate change and reduce emissions. [Extracted from the article]

Anaesthesia 2021; 76: 312 - 9. 12 Shelley BG, McCall PJ, Glass A, Orzechowska I, Klein AA, the Association of Cardiothoracic Anaesthesia and collaborators. An evaluation of the outcome metric "days alive and at home" in older patients after hip fracture surgery. This was achieved by implementation of a complete bundle of peri-operative care, rather than a strategy of screening in isolation.These data came at a time when there was focus on restarting elective surgery whilst keeping patients and staff safe. Keywords: bias; cohort; confounding; observational EN bias cohort confounding observational 521 525 5 03/15/23 20230401 NES 230401 Retrospective observational studies are non-randomised, non-interventional analyses of existing data relating to patients, care received and outcomes. [Extracted from the article]

Background: As healthcare is responsible for 7% of Australia's carbon emissions, it was recognised that a policy implemented at St George Hospital, Sydney, to reduce non‐urgent pathology testing to 2 days per week and, on other days only if essential, would also result in a reduction in carbon emissions. The aim of the study was to measure the impact of this intervention on pathology collections and associated carbon emissions and pathology costs. Aims: To measure the impact of an intervention to reduce unnecessary testing on pathology collections and associated carbon emissions and pathology costs. Methods: The difference in the number of pathology collections, carbon dioxide equivalents (CO2e) for five common blood tests and pathology cost per admission were compared between a 6‐month reference period and 6‐month intervention period. CO2e were estimated from published pathology CO2e impacts. Cost was derived from pathology billing records. Outcomes were modelled using multivariable negative binomial, generalised linear and logistic regression. Results: In total, 24 585 pathology collections in 5695 patients were identified. In adjusted analysis, the rate of collections was lower during the intervention period (rate ratio 0.90; 95% confidence interval (CI), 0.86–0.95; P < 0.001). This resulted in a reduction of 53 g CO2e (95% CI, 24–83 g; P < 0.001) and $22 (95% CI, $9–$34; P = 0.001) in pathology fees per admission. The intervention was estimated to have saved 132 kg CO2e (95% CI, 59–205 kg) and $53 573 (95% CI, 22 076–85 096). Conclusions: Reduction in unnecessary hospital pathology collections was associated with both carbon emission and cost savings. Pathology stewardship warrants further study as a potentially scalable, cost‐effective and incentivising pathway to lowering healthcare associated greenhouse gas emissions. [ABSTRACT FROM AUTHOR]

Oral lichen planus (OLP) confers an approximately 1% risk of transformation to oral squamous cell carcinoma (OSCC). Early identification of high‐risk OLP would be very helpful for optimal patient management. We aimed to discover specific tissue‐based protein biomarkers in patients with OLP who developed OSCC compared to those who did not. We used laser capture microdissection– and nanoLC–tandem mass spectrometry to assess protein expression in fixed lesional mucosal specimens in patients with indolent OLP (no OSCC after at least 5‐year follow‐up, n = 6), transforming OLP (non‐dysplastic epithelium with lichenoid inflammation marginal to OSCC, n = 6) or normal oral mucosa (NOM, n = 5). Transforming OLP protein profile was enriched for actin cytoskeleton, mitochondrial dysfunction and oxidative phosphorylation pathways. CA1, TNNT3, SYNM and MB were overexpressed, and FBLN1 was underexpressed in transforming OLP compared with indolent OLP. Integrin signalling and antigen presentation pathways were enriched in both indolent and transforming OLP compared with NOM. This proteomic study provides potential biomarkers, such as CA1 overexpression, for higher‐risk OLP. While further validation studies are needed, we propose that epithelial–mesenchymal transition may be involved in OLP carcinogenesis. [ABSTRACT FROM AUTHOR]

Introduction: Antimicrobial resistance is one of the biggest threats facing global humanity. In 2014, Public Health England (now the UK Health Security Agency) launched the Antibiotic Guardian (AG) campaign as a national health promotion initiative to increase public and health professionals' commitment to reducing the threat of antibiotic resistance (ABR). The aim of this research study was to gain a snapshot of public AG attitudes towards antibiotic use, the AG campaign and illness postpledge. Methodology: This research used an exploratory study design using thematic and framework analysis of semistructured, in‐depth interviews. A purposive convenience sampling strategy was used to recruit 10 participants; adults in the general population who had registered with and chosen an AG pledge via the AG online platform during November 2020 were eligible for inclusion. Interviews were conducted via Zoom. Results: Six main themes were identified: campaign awareness, motivators to pledge (uncertainty about the future of ABR, personal gratification, personal responsibility, moral obligation and COVID‐19), perceptions of personal responsibility (and patient perspectives of moral obligation in clinicians), the impact of the campaign and campaign promotion. Pledging appeared to solidify existing perceptions AGs held. Behavioural motivations for responsible antibiotic behaviours stemmed from perceptions of personal responsibility, moral obligation and concerns about ABR. AGs attributed responsibility to variable patterns in overprescribing. Perceptions towards COVID‐19, coinciding with the previously established study period, appeared mixed. AGs were keen to promote responsible perceptions in relation to antibiotics, resistance and the AG campaign. However, poor social acceptability of ABR concern was raised as a barrier to campaign promotion. Discussion: The AGs' longstanding commitment to antimicrobial resistance demonstrates the importance of a pre‐existing interest in the public's self‐reported judicious behaviours and decision to pledge to an ABR‐focused campaign. Presenting the local and global threat to human mortality and morbidity in a more relatable format in public messaging should be considered in future strategies promoting ABR awareness and shifts in public perceptions. More frequent messaging to existing AGs is further recommended to propagate positive behaviour change among a wider audience. Patient or Public Contribution: This study was based on interviews with adult members of the public who had pledged to be AGs via the website www.AntibioticGuardian.com. Interviews were based on the public's perceptions of the AG campaign, antibiotic use and ABR. [ABSTRACT FROM AUTHOR]

Purpose: Currently, there are no UK optometric guidelines regarding the pre and postoperative refractive management of patients undergoing cataract surgery. This study used a Delphi method to gain consensus on best practice. Methods: Eighteen recommendations targeted areas of concern/variability in advice that were highlighted in an earlier focus group study of refractive management for patients who had received cataract surgery. These covered three topics: preoperative target refraction discussions, postoperative refractive management and driving advice postoperatively. The recommendations were then developed using evidence from optometry and ophthalmology clinical expertise and the research literature. Eighteen recommendations underwent a process of agreement and modification using a Delphi study consisting of a panel of 22 highly experienced optometrists (N = 11, 25 years mean clinical experience) and ophthalmologists (N = 11, 17 years mean clinical experience) who rated and commented upon the importance and feasibility of each recommendation. The responses were considered by the research team and the recommendations modified and/or removed prior to a second Delphi round of responses to a modified series of recommendations. Consensus of opinion was defined as greater than 80% of panellists 'agreed' or 'strongly agreed' on the recommendation for both importance and feasibility. Results: Fourteen of the 18 recommendations reached consensus in the first round. A second round of the Delphi method saw 17 modified recommendations scored and commented upon by 20 clinicians. Fifteen recommendations reached consensus after two rounds of the Delphi method. Conclusions: Recommendations to guide the pre and postoperative refractive management of patients undergoing cataract surgery were agreed between highly experienced optometrists and ophthalmologists using a 2‐round Delphi method. Patients would benefit from consistent target refraction discussions, postoperative refractive management and driving advice, and recommendations were of particular benefit to less experienced optometrists. [ABSTRACT FROM AUTHOR]

Keywords: Bayes; chance; evidence; statistics EN Bayes chance evidence statistics 119 124 6 12/09/22 20230101 NES 230101 A new drug has been developed which, if given immediately following return of spontaneous circulation to patients who have suffered an out-of-hospital cardiac arrest, may improve outcomes. Science before statistics The goal of most trials is to test causality and determine the probabilities of useful (or harmful) effects of interventions. GLO:1WP/01jan23:anae15800-fig-0001.jpg PHOTO (COLOR): 1 Flowchart showing the range of frequentist tests available to generate a p value, which is the probability of observing sample data at least as extreme as what you got, given the null hypothesis is true. However, such manipulations are mathematically and philosophically related to the statistics used to generate the p value, and they still only tell us about the probability of data. [Extracted from the article]

A 2‐year 8‐month‐old female dobermann presented for a recheck after previous crown reduction and vital pulp therapy. On cardiac auscultation, rapid and irregularly irregular heart rhythm and irregular and asynchronous pulses were detected. On electrocardiogram and transthoracic echocardiogram, findings were suggestive of constrictive pericarditis complicated with bi‐atrial enlargement and atrial fibrillation. Subtotal pericardiectomy was performed. The patient was premedicated with methadone (0.2 mg/kg intravenously), and anaesthesia was induced with midazolam (0.2 mg/kg intravenously) and propofol (60 mg), and maintained with isoflurane in oxygen. Constant‐rate infusions of fentanyl (0.1–0.2 µg/kg/min) and lidocaine (50 µg/kg/min) were administered. Dobutamine (1–5 µg/kg/min) helped to maintain mean arterial blood pressure above 65 mmHg. Fluid resuscitation and noradrenaline infusion (0.1 µg/kg/min) started after constriction was released to optimise preload. Haemodynamic support and ventricular rate control continued during the immediate postoperative period. Recovery from general anaesthesia was uneventful. [ABSTRACT FROM AUTHOR]

Vulvar lichen sclerosus (VLS) confers approximately 3% risk of malignant transformation to vulvar squamous cell carcinoma (VSCC). We used unbiased proteomic methods to identify differentially expressed proteins in tissue of patients with VLS who developed VSCC compared to those who did not. We used laser capture microdissection‐ and nanoLC‐tandem mass spectrometry to assess protein expression in individuals in normal vulvar tissue (NVT, n = 4), indolent VLS (no VSCC after at least 5 years follow‐up, n = 5) or transforming VSCC (preceding VSCC, n = 5). Interferon‐γ and antigen‐presenting pathways are overexpressed in indolent and transforming VLS compared to NVT. There was differential expression of malignancy‐related proteins in transforming VLS compared to indolent VLS (CAV1 overexpression, AKAP12 underexpression), particularly in the EIF2 translation pathway, which has been previously implicated in carcinogenesis. Results of this study provide additional molecular evidence supporting the concept that VLS is a risk factor for VSCC and highlights possible future biomarkers and/or therapeutic targets. [ABSTRACT FROM AUTHOR]

The guppy Y chromosome has been considered a model system for the evolution of suppressed recombination between sex chromosomes, and it has been proposed that complete sex‐linkage has evolved across about 3 Mb surrounding this fish's sex‐determining locus, followed by recombination suppression across a further 7 Mb of the 23 Mb XY pair, forming younger "evolutionary strata". Sequences of the guppy genome show that Y is very similar to the X chromosome. Knowing which parts of the Y are completely nonrecombining, and whether there is indeed a large completely nonrecombining region, are important for understanding its evolution. Here, we describe analyses of PoolSeq data in samples from within multiple natural populations from Trinidad, yielding new results that support previous evidence for occasional recombination between the guppy Y and X. We detected recent demographic changes, notably that downstream populations have higher synonymous site diversity than upstream ones and other expected signals of bottlenecks. We detected evidence of associations between sequence variants and the sex‐determining locus, rather than divergence under a complete lack of recombination. Although recombination is infrequent, it is frequent enough that associations with SNPs can suggest the region in which the sex‐determining locus must be located. Diversity is elevated across a physically large region of the sex chromosome, conforming to predictions for a genome region with infrequent recombination that carries one or more sexually antagonistic polymorphisms. However, no consistently male‐specific variants were found, supporting the suggestion that any completely sex‐linked region may be very small. [ABSTRACT FROM AUTHOR]

The article discusses the NAP7 series, which consists of 12 papers on peri-operative cardiac arrest. The papers went through peer review and were published over a two-year period. The series covers various topics such as obstetrics, anaphylaxis, airway management, and resuscitation decisions. The dissemination of the papers included open-access publishing, social media posts, author interviews, and podcasts. The article emphasizes the importance of reading the full papers and critiquing the methods used. It suggests that readers should start with the main results papers from November 2023 and explore papers related to their specific area of practice. [Extracted from the article]

We write to address recent claims by regarding the potentially important and underappreciated phenomena of "indirect selection," the observation that neutral regions may be affected by natural selection. We argue both that this phenomenon—generally known as genetic hitchhiking—is neither new nor poorly studied, and that the patterns described by the authors have multiple alternative explanations. [ABSTRACT FROM AUTHOR]

There is a need to prioritise equity, diversity and inclusion within anaesthesia and medicine as a whole. This position statement outlines the Anaesthesia Editors' current policies and practices aiming to achieve equity, represent the diversity of our specialty and actively include people engaged with this journal and beyond. We will define, promote and embed principles of equity, diversity and inclusion across all our work. We will monitor and report author and editor characteristics and ensure recruitment practices are transparent and adhere to our principles on equity, diversity and inclusion. We will attempt to remove systemic barriers restricting those from under-represented groups from progressing into leadership roles within anaesthesia. We will respond to threats and barriers to the principles and practices we set. With these principles and specific actions we undertake, we aim to be pro-active rather than reactive. We commit to embracing and embedding equity, diversity and inclusion in all our practices and regularly reviewing, improving and updating our policies and practices. [ABSTRACT FROM AUTHOR]