Search

Limited research into professional rugby union players’ experiences of seeking formal support for their mental health exists, despite comparable rates of mental health issues among elite rugby players with the general population. This qualitative study explored professional players’ actual experiences of accessing Rugby Players Ireland’s mental well-being service, via separate focus group discussions with professional players (n = 5) and player development managers (n = 4) who refer players into the service. An inductive reflexive thematic analysis identified three themes detailing players’ (a) journey to disclosure of their mental health difficulties, (b) their expectations and engagement with the well-being service, and (c) participants’ reflections on mental health experiences in a high-performance environment. Embedding mental health as a key component of player development in high-performance environments, improving mental health literacy, normalizing mental health experiences, and encouraging help-seeking would help promote player well-being and support holistic development alongside sporting performance.

Publisher Copyright: © 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license Background: The trade-off between comparative effectiveness and reproductive morbidity of different treatment methods for cervical intraepithelial neoplasia (CIN) remains unclear. We aimed to determine the risks of treatment failure and preterm birth associated with various treatment techniques. Methods: In this systematic review and network meta-analysis, we searched MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials database for randomised and non-randomised studies reporting on oncological or reproductive outcomes after CIN treatments from database inception until March 9, 2022, without language restrictions. We included studies of women with CIN, glandular intraepithelial neoplasia, or stage IA1 cervical cancer treated with excision (cold knife conisation [CKC], laser conisation, and large loop excision of the transformation zone [LLETZ]) or ablation (radical diathermy, laser ablation, cold coagulation, and cryotherapy). We excluded women treated with hysterectomy. The primary outcomes were any treatment failure (defined as any abnormal histology or cytology) and preterm birth (

Significance Clearance of surgical margins in early cervical cancer prevents the need for adjuvant chemoradiation and associated morbidity and allows fertility preservation. Clearance of disease is also crucial in the surgical management of local recurrence of cervical tumors with exenterative surgery. In this study intelligent knife technology was able to discriminate healthy from abnormal lesions on the cervix with high accuracy, highlighting the potential to improve intraoperative management of women treated surgically for cervical cancer and, as a result, patient outcomes. While pilot experiments in vivo are encouraging, accuracy remains to be validated in larger patient cohorts. Future studies could also explore whether this technology could be used for management of cervical preinvasive disease., Clearance of surgical margins in cervical cancer prevents the need for adjuvant chemoradiation and allows fertility preservation. In this study, we determined the capacity of the rapid evaporative ionization mass spectrometry (REIMS), also known as intelligent knife (iKnife), to discriminate between healthy, preinvasive, and invasive cervical tissue. Cervical tissue samples were collected from women with healthy, human papilloma virus (HPV) ± cervical intraepithelial neoplasia (CIN), or cervical cancer. A handheld diathermy device generated surgical aerosol, which was transferred into a mass spectrometer for subsequent chemical analysis. Combination of principal component and linear discriminant analysis and least absolute shrinkage and selection operator was employed to study the spectral differences between groups. Significance of discriminatory m/z features was tested using univariate statistics and tandem MS performed to elucidate the structure of the significant peaks allowing separation of the two classes. We analyzed 87 samples (normal = 16, HPV ± CIN = 50, cancer = 21 patients). The iKnife discriminated with 100% accuracy normal (100%) vs. HPV ± CIN (100%) vs. cancer (100%) when compared to histology as the gold standard. When comparing normal vs. cancer samples, the accuracy was 100% with a sensitivity of 100% (95% CI 83.9 to 100) and specificity 100% (79.4 to 100). Univariate analysis revealed significant MS peaks in the cancer-to-normal separation belonging to various classes of complex lipids. The iKnife discriminates healthy from premalignant and invasive cervical lesions with high accuracy and can improve oncological outcomes and fertility preservation of women treated surgically for cervical cancer. Larger in vivo research cohorts are required to validate these findings.

Virtual reality is a growing platform for live entertainment, offering the feeling of embodiment and immersion that is central to storytelling for both audience and performers. Find out how several different artists are bringing the magic of theater to digital playhouses around the world.

Background Vaginal microbiota (VMB) composition is altered in women with cervical intra-epithelial neoplasia (CIN) compared to healthy controls and is associated with disease progression. However, the impact of CIN excision on the VMB and innate immunity is not known. This observational study aims to explore the impact of CIN excision on the VMB, antimicrobial peptides (AMP) and proinflammatory cytokines. Methods We sampled 103 non-pregnant, premenopausal women at the time of excisional treatment for CIN and at their 6-month follow-up visit. A further 39 untreated controls with normal cytology were also sampled. We used metataxonomics to group vaginal swab samples into community state types (CSTs) and ELISA to quantify cytokine and AMP levels in matched vaginal secretions. Analyses were performed to compare the bacterial composition and immune analyte levels before and after CIN excision and in healthy controls. Results Women with CIN had significantly higher rates of Lactobacillus species depletion pre-treatment compared to healthy controls (CST IV 21/103, 20% vs 1/39, 3%, p = 0.0081). Excision did not change the VMB composition, with CST IV remaining significantly more prevalent after excision compared to untreated, healthy controls (CST IV 19/103, 20% vs 1/39, 3%, p = 0.0142). Prevotella bivia and Sneathia amnii were significantly higher in samples before treatment compared to untreated controls, and Prevotella bivia remained significantly higher amongst the treated, with less Lactobacillus crispatus compared to untreated controls. IL-1β and IL-8 remained significantly elevated pre- (p < 0.0001 and p = 0.0014, respectively) and post-treatment (p < 0.0001 and p = 0.0035, respectively) compared to untreated controls. Levels of human beta-defensin-1 and secretory leukocyte protease inhibitor were both significantly reduced following CIN excision (p < 0.0001); however, their levels remained lower than controls post-treatment. Conclusions Women with CIN have an increased prevalence of Lactobacillus sp. depletion, high-diversity VMB composition, and higher levels of proinflammatory cytokines and AMPs compared to normal controls. Surgical excision of the disease reduces levels of vaginal AMPs but does not alter VMB composition or cytokine levels. These findings suggest that women with CIN have an inherent predisposition to a high-diversity proinflammatory environment that is not corrected by disease excision. The failure to re-establish a Lactobacillus-enriched CST may explain why women remain at high risk of pre-invasive and invasive disease recurrence.

Background: Human papillomavirus (HPV) testing from clinician-collected cervical and self-collected cervico-vaginal samples is more sensitive for detecting CIN2+/CIN3+ than cytology-based screening, stimulating interest in HPV testing from urine. The objective was to determine the performance of the Trovagene HPV test for the detection of CIN2+ from urine and PreservCyt cervical samples. Methods: Women referred for colposcopy at St Mary's Hospital (London, United Kingdom), following abnormal cytology, were recruited to this diagnostic accuracy study by convenience sampling (September 2011 to April 2013). A total of 501 paired urine and cervical samples were collected. Primary outcomes were sensitivity for CIN2+/CIN3+ and specificity for Results: Trovagene HPV test sensitivity and specificity from PreservCyt were similar to well-established tests [sensitivity for CIN3+ (n = 145) 96.3% (95% confidence interval (CI), 89.6–99.2); CIN2+ (n = 81) 94.5% (95% CI, 89.4–97.6); specificity for Conclusions: Trovagene HPV test's performance on PreservCyt cervical samples was comparable with established HPV tests. Sensitivity in urine, although slightly lower, may nevertheless be adequate for self-sampling. This referral population's higher HPV positivity rate affects specificity, warranting further studies in a screening population. Impact: This may prove useful for women not attending for cervical screening. Cancer Epidemiol Biomarkers Prev; 26(7); 1053–9. ©2017 AACR.

Introduction/Background The innate immune system is a key factor in the fate of an HPV infection and a proinflammatory environment has been shown to facilitate HPV persistence and cervical carcinogenesis. Antimicrobial peptides (AMPs) have innate antibacterial and antiviral properties, as well as a role in tissue remodelling but have not been studied in cervical intraepithelial neoplasia (CIN). Bacterial vaginosis is known to be associated with HPV infection and CIN, therefore the vaginal microbiota (VMB) may also influence the innate immune response and subsequent disease state. We aimed to investigate changes in VMB composition and expression of Human Beta Defensin-1 (hBD-1), Secretory Leucocyte Protease Inhibitor (SLPI) and inflammatory cytokines according to disease status. Methodology Population: Non-pregnant, premenopausal women attending the colposcopy clinic in London, UK with cytological ± histological disease classification. Analysis: Vaginal swab samples were used for 16s rRNA bacterial sequencing to assess VMB composition and for enzyme-linked immunosorbent assay (ELISA) to determine hBD-1, SLPI, IL-1b and IL-8 levels. Results A total of 232 women were included and classified into three groups; 34 normal, 81 low-grade CIN, and 117 high-grade CIN. Lower levels of Lactobacillus spp. with increased bacterial species diversity, were seen with increasing disease severity. A bacterial vaginosis-like VMB was observed twice as frequently in women with high-grade disease (28%) compared to controls (14%). Higher levels of pro-inflammatory cytokines; IL-1b and IL-8 and AMPs; hBD-1 and SLPI increase with increasing disease severity. Conclusion Lactobacillus spp. are thought to protect the female reproductive tract from pathogens, including viruses and the lower levels observed with increasing disease severity, along with higher levels of pro-inflammatory cytokines may play a role in disease outcomes. AMPs are known to be overexpressed in several cancers, and therefore higher levels may have a deleterious effect due their ability to facilitate tissue remodeling that is required for carcinogenesis. Disclosure Nothing to disclose.

Background: The impact of lesion focality and centricity in relation to patient outcome and disease recurrence of vulvar intraepithelial neoplasia (VIN) is an understudied area of research, especially in immunocompromised women. The prevalence and incidence of VIN have increased steadily since the 1980s because of the co-existence of human papillomavirus (HPV) and human immunodeficiency virus (HIV). In this study, we retrospectively examined the records of VIN patients to determine the effect of lesion focality and centricity with respect to the interval to disease recurrence. Materials and Methods: All women diagnosed with VIN and managed between January 2002 and December 2011 were included (n = 90) and followed up until December 2017. Symptoms at the time of presentation, including HIV positivity (n = 75), were collated, including the influences of multifocality and multicentricity on time to disease recurrence. Results: Multicentricity caused a more rapid recurrence of disease than unicentricity (p = 0.006), whereas multifocality increased the risk of recurrence more than unifocality (p < 0.0001). Viral load in the HIV+ patients was not associated with time to disease recurrence, but the reduced number of CD4+ lymphocytes present in HIV+ patients was. Treatment modalities had no effect on disease recurrence. Conclusion: Both focality and centricity have effects on interval to recurrence and final patient outcome, with multifocal disease having a poorer prognosis. Centricity and focality should be recorded at the time of diagnosis and act as a warning for disease recurrence. HIV+ VIN patients with multifocal disease and/or known immunosuppression (low CD4+ lymphocyte counts) should be regarded as “high-risk” patients and treated accordingly.

Career pathways in high performance sport include a number of emotionally resonant transitions. Sport systems must be able to effectively support the athlete’s endeavors to negotiate such challenges. This study investigated qualitatively the experiences of Olympic athletes who took part in a three-tier, post-games career transition support program. The aim of the program was to increase athletes’ coping resources to successful negotiate the post-Olympic period. Ten athletes who participated in the program were recruited to participate in semi structured individual interviews. Directed content analysis was employed to identify key themes in the data. Athletes perceived two components of the program as particularly helpful, the normalization of the emotional and psychological challenge of the post Games period and the use of problem focused coping to redirect athlete focus to the future. The findings from this study provide a preliminary framework for the planning of future post-Games career transition support programs.

In this study, we describe diet and lifestyle practices of professional jockeys. Participants completed a 59-item nutrition, lifestyle, and health questionnaire (n = 21) and a 7-day estimated food diary (n = 18). Acute weight loss strategies included the use of saunas (86%), exercising to induce sweating (81%), and restricted energy intake (71%). Of the smokers (38%), 56% used smoking to control weight. Most (86%) jockeys reported attaining a 2-kg weight loss for racing (if required) 24-48 h before or on the designated race-day. Mean daily energy intake (1803 ± 564 kcal) was low and appeared to provide an insufficient availability of energy for sustainment of usual daily and metabolic processes. Carbohydrate intake (3.7 ± 1.3 g · kg⁻¹) was below recommendations for athletes. A substantial proportion of jockeys failed to meet the estimated average requirement and lower threshold intake for a number of micronutrients. Jockeys consumed well below (0-2) the recommended five daily servings of fruit and vegetables set by the World Health Organization. Pressures of the jockey lifestyle and rigid weight limits appear to encourage unhealthy weight management practices in this group and may risk long term-health.

Background: A randomised trial to ascertain whether women who do not attend for cervical screening are more likely to respond to the opportunity to collect a self-sample for human papillomavirus (HPV) testing, or to a further invitation to attend for cervical screening. Methods: The study was carried out in a Primary Care Trust (PCT) in London between June 2009 and December 2009. In total, 3000 women were randomly selected from persistent non-responders (i.e., who had not responded to at least two invitations to attend for screening). The women were randomised on a 1 : 1 basis to either receive an HPV self-sampling kit or a further invitation to attend for cervical cytology. The main outcome measures were (1) percentage of women attending for cervical cytology compared with those returning a self-sample HPV test or attending for cytology subsequent to receiving the kit and (2) percentage of those testing positive for HPV who attended further investigation. Results: The total response in the self-sampling group for screening was 10.2%. Of the 1500 women in the control group sent a further invitation for cervical screening, 4.5% attended for cytology screening. This difference is highly statistically significant (P

Persistent infection with oncogenic Human Papillomavirus (HPV) is necessary for cervical carcinogenesis. Although evidence suggests that the vaginal microbiome plays a functional role in the persistence or regression of HPV infections, this has yet to be described in women with cervical intra-epithelial neoplasia (CIN). We hypothesised that increasing microbiome diversity is associated with increasing CIN severity. llumina MiSeq sequencing of 16S rRNA gene amplicons was used to characterise the vaginal microbiota of women with low-grade squamous intra-epithelial lesions (LSIL; n = 52), high-grade (HSIL; n = 92), invasive cervical cancer (ICC; n = 5) and healthy controls (n = 20). Hierarchical clustering analysis revealed an increased prevalence of microbiomes characterised by high-diversity and low levels of Lactobacillus spp. (community state type-CST IV) with increasing disease severity, irrespective of HPV status (Normal = 2/20,10%; LSIL = 11/52,21%; HSIL = 25/92,27%; ICC = 2/5,40%). Increasing disease severity was associated with decreasing relative abundance of Lactobacillus spp. The vaginal microbiome in HSIL was characterised by higher levels of Sneathia sanguinegens (P

This study investigated the factors perceived by 191 international athletes to have either facilitated or inhibited their development and success. Using Carlson’s (1993) framework as a reference point, the athlete’s ‘microsystem’ (i.e., supportive roles, activities and interpersonal relationships) was the site of the strongest positive factors in the eyes of these elite performers. These microsystem factors included family, friends and coaches. Consistent with Carlson’s ecological perspective, the personal attributes of the athletes were perceived to be central to maximizing their talent and responding to their environment and circumstances. A key implication of these findings is that if success is to be achieved, athletes require strong personal motivation and a supportive microsystem, particularly in the early and middle stages of development. As the athlete progresses, the need for wider, system-based support becomes apparent so that the sporting, financial and personal challenges associated w...

Background: Several new assays have been developed for high-risk HPV testing of cervical samples; we compare six HPV tests in a screening population. Methods: Residual material from liquid-based PreservCyt samples was assayed. Four tests (Hybrid Capture 2, Cobas, Abbott and Becton-Dickinson (BD)) measured HPV DNA while two used RNA (APTIMA and NorChip). Results: Positivity rates ranged from 13.4 to 16.3% for the DNA-based tests with a significantly lower positivity rate for the Abbott assay. The Gen-Probe APTIMA assay was positive in 10.3% of women, which was significantly lower than all the DNA tests; the NorChip PreTect HPV-Proofer test was much lower at 5.2%. 40 CIN2+ cases were identified, of which 19 were CIN3+. All CIN3+ cases were HPV positive by all tests except for one, which was negative by the Abbott assay and five which were negative by the NorChip test. Conclusion: All HPV tests except NorChip showed high sensitivity for high-grade lesions positive by cytology, suggesting co-testing is unnecessary when using HPV tests. Positivity rates in cytology-negative specimens were similar for the DNA-based tests, but lower for the APTIMA test suggesting this maintains the high sensitivity of DNA tests, but with better specificity.

Background Persistent infection with oncogenic human papillomavirus (HPV) is necessary for the development of cervical cancer. Although evidence indicates that the vaginal microbiome can have a functional role in the persistence or regression of HPV infections, this possibility has yet to be described in women with cervical intraepithelial neoplasia (CIN). We aimed to test the hypothesis that increasing microbiome diversity is associated with increasing CIN severity. Methods Vaginal swabs were collected, and vaginal microbiome characterised by 16S rRNA gene sequencing (MiSeq, Illumina, San Diego, CA, USA). Women were categorised according to disease severity (invasive cervical cancer [ICC], high-grade squamous intraepithelial lesions [HSIL], low-grade squamous intraepithelial lesions [LSIL], and healthy controls) and HPV status and genotype. Multivariate modelling of sequence data was used to examine bacterial species classification data, and correlated to disease severity and HPV status and genotype. Findings Hierarchical clustering analysis of bacterial species data revealed an association between increased disease severity and increased prevalence of microbiomes characterised by high-diversity and low levels of Lactobacillus spp (community state type CST IV), irrespective of HPV status (2 [10%] of 20 controls, 11 [21%] of 52 LSIL, 25 [27%]of 92 HSIL, ICC 2 [40%] of 5 ICC). Increasing disease severity was associated with decreasing relative abundance of Lactobacillus spp. The vaginal microbiome in women with HSIL was characterised by higher relative abundance of Sneathia sanguinegens (p Anaerococcus tetradius (p Peptostreptococcus anaerobius (p L jensenii (p Interpretation We show that women with CIN have a more diverse Lactobacillus -depleted vaginal microbiome, compared with healthy women. This finding supports previous reports indicating that a dysbiotic microbiome could be involved in HPV persistence. The vaginal microbiome can have a role in carcinogenesis and warrants further investigation. Future therapeutic strategies might allow modulation of the vaginal microbiome towards a vaginal community structure that promotes HPV clearance. Funding Imperial College Healthcare Charity, British Society for Colposcopy and Cervical Pathology.

High-risk human papillomavirus (HPV) DNA/RNA testing provides higher sensitivity but lower specificity than cytology for the identification of high-grade cervical intraepithelial neoplasia (CIN). Several new HPV tests are now available for this purpose, and a direct comparison of their properties is needed. Seven tests were evaluated with samples in liquid PreservCyt transport medium from 1,099 women referred for colposcopy: the Hybrid Capture 2 (Qiagen), Cobas (Roche), PreTect HPV-Proofer (NorChip), Aptima HPV (Gen-Probe), and Abbott RealTi m e assays, the BD HPV test, and CINtec p16 INK4a cytology (mtm laboratories) immunocytochemistry. Sensitivity, specificity, and positive predictive value (PPV) were based on the worst histology found on either the biopsy or the treatment specimen after central review. Three hundred fifty-nine women (32.7%) had CIN grade 2+ (CIN2+), with 224 (20.4%) having CIN3+. For detection of CIN2+, Hybrid Capture 2 had 96.3% sensitivity, 19.5% specificity, and 37.4% PPV. Cobas had 95.2% sensitivity, 24.0% specificity, and 37.6% PPV. The BD HPV test had 95.0% sensitivity, 24.2% specificity, and 37.8% PPV. Abbott RealTi m e had 93.3% sensitivity, 27.3% specificity, and 38.2% PPV. Aptima had 95.3% sensitivity, 28.8% specificity, and 39.3% PPV. PreTect HPV-Proofer had 74.1% sensitivity, 70.8% specificity, and 55.4% PPV. CINtec p16 INK4a cytology had 85.7% sensitivity, 54.7% specificity, and 49.1% PPV. Cytology of a specimen taken at colposcopy (mild dyskaryosis or worse) had 88.9% sensitivity, 58.1% specificity, and 50.7% PPV. Our study confirms that, in a referral setting, HPV testing by a number of different tests provides high sensitivity for high-grade disease. Further work is needed to confirm these findings in a routine screening setting.

HPV DNA testing is known to be much more sensitive than cytology, but less specific. A range of HPV and related tests in 858 women referred for colposcopy because of an abnormal smear were evaluated to compare the performances of these tests. This article compared the Abbott test to other tests which had been previously evaluated. This test was a real true test for 14 high-risk HPV types. The Abbott test was found to be highly sensitive for cervical intraepithelial neoplasia grade 3 or worse (CIN3+) (98.9%) with a specificity of 31.5%. These numbers were comparable with the Qiagen HC2 test, the Roche Linear Array and Amplicor tests, and the Gen-Probe APTIMA test. Differences between these tests appeared to be related mostly to the choice of cutoff level. An added feature of the Abbott test was the provision of type specific results for HPV 16 and 18. J. Med. Virol. 82: 1186–1191, 2010. © 2010 Wiley-Liss, Inc.

Background: The detection of high-risk human papillomavirus (HPV) DNA provides higher sensitivity but lower specificity than cytology for the identification of high-grade cervical intraepithelial neoplasia (CIN). This study compared the sensitivity and specificity of several adjunctive tests for the detection of high-grade CIN in a population referred to colposcopy because of abnormal cytology. Methods: 953 women participated in the study. Up to seven tests were carried out on a liquid PreservCyt sample: Hybrid Capture II (Digene), Amplicor (Roche), PreTect HPV-Proofer (NorChip), APTIMA HPV assay (Gen-Probe), Linear Array (Roche), Clinical-Arrays (Genomica), and CINtec p16INK4a Cytology (mtm Laboratories) immunocytochemistry. Sensitivity, specificity, and positive predictive value (PPV) were based on the worst histology seen on either the biopsy or the treatment specimen after central review. Results: 273 (28.6%) women had high-grade disease (CIN2+) on worst histology, with 193 (20.2%) having CIN3+. For the detection of CIN2+, Hybrid Capture II had a sensitivity of 99.6%, specificity of 28.4%, and PPV of 36.1%. Amplicor had a sensitivity of 98.9%, specificity of 21.7%, and PPV of 33.5%. PreTect HPV-Proofer had a sensitivity of 73.6%, specificity of 73.1%, and PPV of 52.0%. APTIMA had a sensitivity of 95.2%, specificity of 42.2%, and PPV of 39.9%. CINtec p16INK4a Cytology had a sensitivity of 83.0%, specificity of 68.7%, and PPV of 52.3%. Linear Array had a sensitivity of 98.2%, specificity of 32.8%, and PPV of 37.7%. Clinical-Arrays had a sensitivity of 80.9%, specificity of 37.1%, and PPV of 33.0%. (Cancer Epidemiol Biomarkers Prev 2008;17(11):3033–42)

A 43-year-old woman from Southern Africa presented with an eight-month history of a painless vulval ulcer. She did not have any relevant past medical or drug history. She had never had, or ever been offered an HIV antibody test despite being from an endemic region. On examination, there was an ulcer on her right labia and a painless right inguinal lymph node. Herpes simplex virus (HSV) type 2 culture was positive. The HIV antibody test was also positive. Other cultures and serology including syphilis were negative. A biopsy was suggestive of herpes simplex. The vulval ulcer resolved on oral aciclovir only. Atypical genital herpes has been described in HIV disease, although it is often painful. This case emphasises the importance of offering an HIV antibody test to patients presenting with atypical genital ulcers. Moreover, it reinforces the paradigm that 'any anogenital ulcer (painful or not) can be herpetic in origin'.

peer-reviewed Contextualised within physical activity policy (Schoppe, Bauman & Bull, 2004) this paper presents a critical review of current sport development pathway models, (including the pyramid concept, long-term athlete development and the development model of sport participation), acknowledging a number of issues that we should be cognizant of when working with models (Lyle, 2002). Along with a review of the existing situation in Ireland with regards to the governance of sport and patterns in sport (non)participation, the paper discusses the need for a broader and more encompassing framework that encourages lifelong involvement in sport and physical activity. The paper reviews the Irish lifelong involvement in sport and physical activity (LISPA) framework as a policy ‘for’ complementing both a performance-oriented and participation-oriented model and addressing the particular physical activity and sporting requirements within the Irish context. The LISPA framework has been adopted by the Irish Sports Council as the model to underpin all its work aimed at improving participation rates in sport in Ireland, although the Council have yet to identify how best to promote the LISPA framework. Suggestions on how to maximize the implementation and success of the framework are discussed.