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The lobbying strategies of the food industry, which seek to undermine the development of regulatory measures intended to improve public health, are increasingly well documented and associated with slow progress in addressing diet-related diseases at national, regional and global levels. These strategies include the creation and dissemination of biased research findings in order to skew evidence in the favour of the industry, and to cast doubt about the harms stemming from its products and practices. Front-of-pack nutrition labelling (FoPNL) provides fertile ground for industry opposition, which we discuss in this commentary.

Abstract Legg-Calvé-Perthes disease is juvenile idiopathic osteonecrosis of the femoral head (ONFH) that has no effective clinical treatment. Previously, local injection of bone morphogenetic protein-2 (BMP2) for ONFH treatment showed a heterogeneous bone repair and a high incidence of heterotopic ossification (HO) due to the BMP2 leakage. Here, we developed a BMP2-hydrogel treatment via a transphyseal bone wash and subsequential injection of BMP2-loaded hydrogel. In vitro studies showed that a hydrogel of gelatin-heparin-tyramine retained the BMP2 for four weeks. The injection of the hydrogel can efficiently prevent leakage. With the bone wash, the injected hydrogel had a broad distribution in the head. In vivo studies on pigs revealed that the BMP2-hydrogel treatment produced a homogeneous bone regeneration without HO. It preserved the subchondral contour and restored the subchondral endochondral ossification, although it increased growth plate fusions. In summary, the study demonstrated a promising BMP2-hydrogel treatment for ONFH treatment, especially for teenagers.

Data annotation in NLP is a costly and time-consuming task, traditionally handled by human experts who require extensive training to enhance the task-related background knowledge. Besides, labeling social media texts is particularly challenging due to their brevity, informality, creativity, and varying human perceptions regarding the sociocultural context of the world. With the emergence of GPT models and their proficiency in various NLP tasks, this study aims to establish a performance baseline for GPT-4 as a social media text annotator. To achieve this, we employ our own dataset of tweets, expertly labeled for stance detection with full inter-rater agreement among three annotators. We experiment with three techniques: Zero-shot, Few-shot, and Zero-shot with Chain-of-Thoughts to create prompts for the labeling task. We utilize four training sets constructed with different label sets, including human labels, to fine-tune transformer-based large language models and various combinations of traditional machine learning models with embeddings for stance classification. Finally, all fine-tuned models undergo evaluation using a common testing set with human-generated labels. We use the results from models trained on human labels as the benchmark to assess GPT-4's potential as an annotator across the three prompting techniques. Based on the experimental findings, GPT-4 achieves comparable results through the Few-shot and Zero-shot Chain-of-Thoughts prompting methods. However, none of these labeling techniques surpass the top three models fine-tuned on human labels. Moreover, we introduce the Zero-shot Chain-of-Thoughts as an effective strategy for aspect-based social media text labeling, which performs better than the standard Zero-shot and yields results similar to the high-performing yet expensive Few-shot approach.

Purpose of reviewTo provide a detailed overview of the assessment of COVID-19-related olfactory dysfunction and its association with psychological, neuropsychiatric, and cognitive symptoms.Recent findingsCOVID-19-related olfactory dysfunction can have a detrimental impact to the quality of life of patients. Prior to the COVID-19 pandemic, olfactory and taste disorders were a common but under-rated, under-researched and under-treated sensory loss. The pandemic has exacerbated the current unmet need for accessing good healthcare for patients living with olfactory disorders and other symptoms secondary to COVID-19. This review thus explores the associations that COVID-19 has with psychological, neuropsychiatric, and cognitive symptoms, and provide a framework and rationale for the assessment of patients presenting with COVID-19 olfactory dysfunction.SummaryAcute COVID-19 infection and long COVID is not solely a disease of the respiratory and vascular systems. These two conditions have strong associations with psychological, neuropsychiatric, and cognitive symptoms. A systematic approach with history taking and examination particularly with nasal endoscopy can determine the impact that this has on the patient. Specific olfactory disorder questionnaires can demonstrate the impact on quality of life, while psychophysical testing can objectively assess and monitor olfaction over time. The role of cross-sectional imaging is not yet described for COVID-19-related olfactory dysfunction. Management options are limited to conservative adjunctive measures, with some medical therapies described.

BackgroundOver the past years, homelessness has become a substantial issue around the globe. The largest social services organization in Thunder Bay, Ontario, Canada, has observed that a majority of the people experiencing homelessness in the city were from outside of the city or province. Thus, to improve programming and resource allocation for people experiencing homelessness in the city, including shelter use, it was important to investigate the trends associated with homelessness and migration. ObjectiveThis study aimed to address 3 research questions related to homelessness and migration in Thunder Bay: What factors predict whether a person who migrated to the city and is experiencing homelessness stays or leaves shelters? If an individual stays, how long are they likely to stay? What factors predict stay duration? MethodsWe collected the required data from 2 sources: a survey conducted with people experiencing homelessness at 3 homeless shelters in Thunder Bay and the database of a homeless information management system. The records of 110 migrants were used for the analysis. Two feature selection techniques were used to address the first and third research questions, and 8 machine learning models were used to address the second research question. In addition, data augmentation was performed to improve the size of the data set and to resolve the class imbalance problem. The area under the receiver operating characteristic curve value and cross-validation accuracy were used to measure the models’ performances while avoiding possible model overfitting. ResultsFactors predicting an individual’s stay duration included home or previous district, highest educational qualification, recent receipt of mental health support, migrating to visit family or friends, and finding employment upon arrival. For research question 2, among the classification models developed for predicting the stay duration of migrants, the random forest and gradient boosting tree models presented better results with area under the receiver operating characteristic curve values of 0.91 and 0.93, respectively. Finally, home district, band membership, status card, previous district, and recent support for drug and/or alcohol use were recognized as the factors predicting stay duration. ConclusionsApplying machine learning enables researchers to make predictions related to migrants’ homelessness and investigate how various factors become determinants of the predictions. We hope that the findings of this study will aid future policy making and resource allocation to better serve people experiencing homelessness. However, further improvements in the data set size and interpretation of the identified factors in decision-making are required.

Paranasal sinus mucocoeles can be secondary to chronic rhinosinusitis and can result in intra-orbital and intra-cranial complications requiring surgical management. The natural history of conservatively managed mucocoeles is not well established. We aimed to quantify the proportion of radiologically identified paranasal sinus mucocoeles resulting in complications over 10 years. We retrospectively reviewed anonymised data on radiologically diagnosed mucocoeles between 2011 and 2021 at two UK hospitals. We collected data on age at presentation, extent of sinus involvement, management and complications. We identified 60 patients with mucocoeles, of which 35 (58%) were incidental findings from radiological investigations. The mean age was 58 years. Fifteen patients (25%) were managed surgically and one presented with recurrence following surgery. Overall, six patients (10%) had an intra-orbital extension of their mucocoele and three (5%) had an intra-cranial extension. There was no difference in the rates of intra-cranial extension between conservative and surgical cases but surgical cases included a higher rate of intra-orbital extensions (27% vs. 4%, p = 0.01). The proportion of patients requiring surgical intervention in this study is low. Incidental and asymptomatic mucocoeles have a relatively benign disease course and selected uncomplicated cases can be considered for conservative management with serial scanning at 12 months.

Olfactory dysfunction affects approximately 20% of the population globally, with incidence increasing over the age of 60. The pathophysiology is complex, not yet fully understood, and depends on many factors, including the underlying cause. Despite this, the present literature on olfaction is limited due to significant heterogeneity in methodological approaches. This has resulted in limited effective treatments available for olfactory dysfunction. Medications for olfactory dysfunction can be administered locally (directly to the olfactory epithelium) or systemically (orally or intravenously). Currently, there are various methods for local drug delivery to the olfactory epithelium (nasal drops, nasal sprays, atomisers, pressured meter-dosed inhalers, rinses, and exhalation delivery systems). The aims of this review are to summarise the different methods of drug delivery to the olfactory cleft, evaluate the current literature to assess which method is the most effective in delivering drugs to the olfactory epithelium, and review the medications currently available to treat olfactory dysfunction topically. Going forward, further research is required to better establish effective methods of drug delivery to the olfactory epithelium to treat smell disorders.

This paper discusses a doctoral level epistemology course in social work, the course design and the arts-based methods used to help students conceptualize and transform their ideas around epistemology, research, and practice. The paper also includes students' first hand accounts of their art-making experiences in the class, their learning process and epistemological reasoning. The students provide narratives illustrating their struggles and evolution in their epistemological positioning and how the teaching methods and art-making helped them in their learning process. The paper ends summarizing a typology of "artful values" infused in the course and uses the students' experiences to capture epistemological education as an evolving artful process.

The aim is to understand the patient experience of living with chronic rhinosinusitis with nasal polyposis (CRSwNP), clinician interactions and how symptoms, smell and taste disturbance are managed. An anonymized, online survey was distributed through a UK charity, Fifth Sense, a UK otolaryngology clinic and online support groups to capture qualitative and quantitative data. Data were collected from 1st December 2022 to 1st February 2023. A total of 124 individuals participated. The majority were female (66%) and in the age range of 41–70 years; 74.2% of participants were from the UK with the rest from North America, Europe and Asia. A total of 107 participants declared they had CRSwNP. Rhinologists and general otolaryngology clinicians scored the highest for patient satisfaction whilst general practitioners scored the lowest. Satisfaction with the management of smell and taste disturbance was lower amongst all clinicians compared to overall satisfaction. Ratings correlated with response to therapy and clinician interactions. Respondents reported hyposmia/anosmia to be the most debilitating symptom. Surgery and oral steroids were considered to be effective; however, the benefit lasted less than six months (62%). Hyposmia/anosmia is a key CRSwNP symptom that has limited treatment options and is frequently undervalued by clinicians. There is a need for more effective management options, education and patient support.

This study aimed to evaluate factors that may predispose patients to not adhere to prescribed medication after endoscopic sinus surgery (ESS) and to compare SNOT-22 scores at 0–12 months post-operatively between adherent and non-adherent patients. CRS patients who underwent ESS between 2012 and 2016 were recruited to this retrospective cohort study. Adherence was assessed through a questionnaire and review of medical notes. Ninety-four participants were included (61% male, mean age 60). Of those, 66% did not adhere to their prescribed post-operative CRS medication timing or dosage. The most common reason for non-adherence was improvement of symptoms (17%), followed by deterioration of symptoms (11%) and side effects (10%). Post-operative SNOT-22 scores were lowest for non-intentionally non-adherent (NINA) participants with a mean of 10.5 [95% CI: 7.47–13.5], compared to 25.0 for intentionally non-adherent (INA) [95% CI: 17.6–32.4] and 17.7 for adherent patients [95% CI: 13.7–21.7], p = 0.01. This study identifies that almost two-thirds of patients are not compliant with CRS medications after ESS. NINA participants reported lower post-operative SNOT-22 scores compared to INA and adherent participants. Future studies should focus on educating patients to continue with medications post-operatively despite an initial improvement in symptoms.

Sympathetic ophthalmia is a dreaded ocular condition resulting in bilateral panuveitis following penetrating injury in one eye or associated with surgeries and laser procedures. We describe a case of a 13-year-old girl who presented with blurring of vision in the right eye for the past 2 years following penetrating trauma in the left eye 9 years back. Histopathology of left enucleated phthisical eye showed diffuse stromal choroiditis with B-cell proliferation on immunohistochemistry, thus confirming chronicity of the disease.

Background: Peritonitis remains a significant cause of peritoneal dialysis (PD)-associated morbidity, and technique failure. Non-tuberculous mycobacteria (NTM), commonly found in the environment (soil and water sources), are a rare cause of PD peritonitis, particularly important to consider in culture negative peritonitis. Methods: Cases were identified via a search of the local microbiology laboratory database system between 01/01/2011 and 01/01/2020 at the Queen Elizabeth Hospital Birmingham, UK. Cases were identified by isolation of a Mycobacterium sp. other than Mycobacterium tuberculosis complex either from a PD exit site culture or from PD peritoneal fluid culture. We identified nine cases of peritonitis and one of isolated exit site infection (ESI). Results: Clinical presentation was similar to peritonitis caused by usual bacterial pathogens. Of the peritonitis cases, three were due to M. chelonae, three M. fortuitum, two M. abscessus and one M. chimera. The ESI was caused by M. fortuitum. The peritoneal fluid microscopy showed a neutrophil predominance. In 80 % of the cases in our cohort, the microorganism was identified from the culture of the first peritoneal dialysis (PD) fluid sample, however the time to identification from culture ranged from 2 to 27 days. All mycobacteria were grown from standard culture media, except for M. chimera which required a specialist mycobacterial liquid culture system. All cases of peritonitis underwent PD catheter removal with conversion to haemodialysis. Treatment length and antibiotic combinations varied significantly, with some cases being successfully treated with courses as short as 4 weeks. Significant antibiotic related side effects including hearing loss and QTc prolongation were noted. Conclusion: We would recommend extending standard microbiological cultures of culture negative peritonitis to 2 weeks and employing mycobacterial culture media incubated for 6–10 weeks as would be standard for mycobacterial investigations, prior to exclusion of NTM as a causative organism of peritonitis.

ObjectiveThis study analyses the 2020 survey and reviews the 2009, 2014 surveys to ascertain which Behçet's symptoms, personal and family status, patients' lifestyle, and work-related outcomes impacted on Health-Related Quality of Life (HRQoL).MethodsFour hundred and fifty-nine Behçet's patients submitted an online survey/questionnaire. Patients provided information on socio-demographic characteristics, disease duration, historical and current symptoms, systemic and topical medication, health related lifestyle, work-related outcomes regarding employment status and claiming benefits and Quality of Life (QoL) measured by EQ-5D index.ResultsFour hundred and nineteen patients met the inclusion criteria, and 371 who had full data (Males: Females: Others = 84:285:2, mean–age = 41.1 ± 23.3:38 ± 13.2:40 ± 5). The main symptoms associated with patients seeking medical care were mouth ulcers 30% and genital ulcers 23%, joint 14%, and eye problems 9%. The EQ-5D index for 2009, 2014, 2020 was (mean ± SD); 0.47 ± 0.38, 0.42 ± 0.37, 0.34 ± 0.40, respectively, p < 0.05. 2020 patients had the worst values of the five domains compared to 2014 and 2009. Interestingly, mobility value was the same over the 10 years of monitoring patients. Behçet's syndrome (BS) symptoms that had significant negative impact on QoL were; 2009 (arthropathy, neurological problems, pathergy reaction, and stomach/bowel symptoms), 2014 (arthropathy, headache, neurological problems, pathergy reaction, and skin lesions), 2020 (arthropathy, neurological problems, and stomach/bowel symptoms). The 2014 and 2020 surveys reported the QoL is significantly better in patients on immunosuppressant, who did sport, continued in employment and not receiving benefits.ConclusionJoints and neurological symptoms are the main symptoms which had negative impact on BS patients over the 10 years, sociodemographic (gender, age, marital, and education status), lifestyle (medication, cannabis, drinking wine, and regular exercise), employment status (employee and no career change), and accessing benefits (never claim benefit) had significant influence on patients' HRQoL.

The loss of electron flux of the outer radiation belt has been widely studied in terms of the mechanism that brings in these losses. There are a few studies which have attempted to explain the interplanetary conditions that favor the depletions. As the Sun is the prime cause of any change happening in the magnetosphere, it is important to look at the solar drivers that bring in such changes. In this study, we attempt to understand the effect of solar structures and substructures on the loss of radiation belt high-energy electrons during intense geomagnetic storms. The superposed epoch analysis is used to observe any peculiar changes in GOES electron flux data during the storms that are associated with solar structures such as CME and CIR, ICME substructures such as the magnetic cloud, magnetic cloud with sheath, ejecta, ejecta with sheath, and only sheath. The long-term data also give an opportunity to compare the flux decrease during solar cycles 23 and 24. It has been observed that 1) CIR-associated storms cause a comparatively higher flux decrease than CME-associated storms, 2) sheath-related storms bring out a higher flux decrease, and 3) there is no significant change in flux for the storms of both the solar cycles. The flux decrease in intense storms at the geostationary orbit is essentially triggered by the “Dst effect.” Apart from this, the minimum IMF Bz and northward IMF Bz before turning southward add to the flux decrease. These results hold true for the electron depletions occurring only during intense geomagnetic storms and may alter otherwise.

In August 2021, the United States withdrew from Afghanistan after 20 years. The fall of the Afghan government to the Taliban resulted in the displacement of some Afghans. Canada committed to welcoming thousands of refugees. Research suggests that refugees tend to have higher rates of post-traumatic stress, and Afghan refugees, in particular, have among the highest rates. Another body of literature suggests that religious coping has positive effects. This paper presents qualitative data from interviews with 11 Afghan refugees who arrived in Ontario after August 2021 with the intent to combine these two findings. In so doing, we sought to understand how Afghan refugees described their experiences of displacement and the extent to which those experiences were traumatic, but also how they relied on Islam to cope with the traumatic effects of displacement. The interviews we conducted suggested that our participants experienced exposure to death, exposure to threat of death and/or injury, and described some of symptoms of the criteria for PTSD. The interviews also suggested that the participants coped using Islamic concepts, beliefs, and rituals. The qualitative data we present provide rich descriptions of the experiences of trauma in the face of displacement and religious coping.

Objectives To assess practice in the care of adults with suspected community-acquired bacterial meningitis in the UK and Ireland.Design Retrospective cohort study.Setting 64 UK and Irish hospitals.Participants 1471 adults with community-acquired meningitis of any aetiology in 2017.Results None of the audit standards, from the 2016 UK Joint Specialists Societies guideline on diagnosis and management of meningitis, were met in all cases. With respect to 20 of 30 assessed standards, clinical management provided for patients was in line with recommendations in less than 50% of cases. 45% of patients had blood cultures taken within an hour of admission, 0.5% had a lumbar puncture within 1 hour, 26% within 8 hours. 28% had bacterial molecular diagnostic tests on cerebrospinal fluid. Median time to first dose of antibiotics was 3.2 hours (IQR 1.3–9.2). 80% received empirical parenteral cephalosporins. 55% ≥60 years and 31% of immunocompromised patients received anti-Listeria antibiotics. 21% received steroids. Of the 1471 patients, 20% had confirmed bacterial meningitis. Among those with bacterial meningitis, pneumococcal aetiology, admission to intensive care and initial Glasgow Coma Scale Score less than 14 were associated with in-hospital mortality (adjusted OR (aOR) 2.08, 95% CI 0.96 to 4.48; aOR 4.28, 95% CI 1.81 to 10.1; aOR 2.90, 95% CI 1.26 to 6.71, respectively). Dexamethasone therapy was weakly associated with a reduction in mortality in both those with proven bacterial meningitis (aOR 0.57, 95% CI 0.28 to 1.17) and with pneumococcal meningitis (aOR 0.47, 95% CI 0.20 to 1.10).Conclusion This study demonstrates that clinical care for patients with meningitis in the UK is not in line with current evidence-based national guidelines. Diagnostics and therapeutics should be targeted for quality improvement strategies. Work should be done to improve the impact of guidelines, understand why they are not followed and, once published, ensure they translate into changed practice.

This work aimed to investigate the validity of wearable activity monitors (WAMs) as an objective tool to measure the return toward normal functional mobility following abdominal wall surgery. This was achieved by quantifying and comparing pre- and postoperative physical activity (PA). A multicenter, prospective, observational cohort study was designed. Patients undergoing abdominal wall surgery were assessed for eligibility and consent for study participation was obtained. Participants were asked to wear a WAM (AX3, Axivity) on the wrist of their dominant hand at least 48 hours pre-operatively, for up to 2 weeks postop, and again after 6 months postop for 48 hours. A cohort of 20 patients were recruited in this validation study with a mean age of 47.3 ± 13.0 years. Postoperation, the percentage median PA (±IQR) dropped to 32.6% (20.1), whereas on day 14, PA had reached 64.6% (22.7) of the preoperative value providing construct validity. Activity levels at >6 months postop increased by 16.4% on an average when compared to baseline preoperative PA (p = 0.046). This study demonstrates that WAMs are valid markers of postoperative recovery following abdominal wall surgery. This was achieved by quantifying the reduction in PA postoperation, which has not been previously shown. In addition, this study suggests that abdominal wall surgery may improve the patient's quality of life via increased functional mobility at 6 months postop. In the future, this technology could be used to identify the patient and surgical factors that are predictors of outcome following abdominal wall surgery. [ABSTRACT FROM AUTHOR]

Vascular anomalies are vascular lesions that are present from childhood. They are classified into tumours or malformations based on clinical and histological features. Benign infantile haemangiomas are the most common vascular tumour and have a predictable self-limiting course. Rarer vascular tumours exist, and some may cause platelet consumption. Management is usually conservative, with active treatment reserved for functional or cosmetic complications (ulceration, or obstruction and distortion of vital structures). Oral propranolol is useful for troublesome lesions. Vascular malformations are structural anomalies of vascular morphogenesis present at birth without cellular proliferation that, in general, grow with the patient. They are sub-classified by vessel type as 'low flow' (capillary, lymphatic and venous) and 'high flow' (arteriovenous) or lesions with a combination of vessel type. They become problematic under certain circumstances, usually puberty and also pregnancy. The most troublesome are extensive lesions, especially venous and arteriovenous. Their effects may be cosmetic, those of a space-occupying lesion, infection, bleeding, pain or coagulopathy. Venous lesions cause consumptive coagulopathy, sometimes with life-threatening risks. Treatment options include medication and symptom control with antibiotics, analgesia, control of menses, compression garments and intervention with laser (capillary type), sclerotherapy, embolization and/or surgical excision. Patients with complex lesions are best managed by a multidisciplinary team and all surgical sub-specialties may be involved. [ABSTRACT FROM AUTHOR]

Introduction: Nomophobia, i.e., No mobile phone phobia, is the irrational fear of being out of mobile phone contact. Mostly youth get very anxious on not being able to use their smartphone. Thus, identification of the extent of the problem in this population might be helpful. Aims: The aims of this study were to find the presence of nomophobia and its severity among the medical students, postgraduate residents, and faculty and to assess the association with certain demographic factors, mobile phone use-related factors, and nomophobia among them. Settings and Design: This observational, cross-sectional study was conducted in a medical college and tertiary care hospital. Materials and Methods: An online survey was conducted by using Google Forms and utilizing validated No Mo Nomophobia- Questionnaires. A self-reported questionnaire inclusive of demographic data, information regarding smartphone use, and factors of nomophobia was administered. A total of 446 people participated in this survey. SPSS version 20 of the institute was used. Levene's test for equality of variances, independent t-test for equality of means, and analysis of variance were used for statistical analysis. P < 0.05 was considered statistically significant. Results: The mean NMP-Q score was found to be 79.08. The mean age of the study participants was 22.83 years (±4.68). Majority (62%) of the participants reported moderate level of nomophobia. Factors such as female gender, MBBS students, single relationship status, and age 50 applications in smartphone showed higher scores of nomophobia. Living arrangements, number of phones and SIM cards, and duration of cell phone use had no significant impact on nomophobia scores. Conclusion: A significant prevalence of nomophobia was noted among medical graduates, which highlights the need for early identification and intervention.

Background Many differences exist in postgraduate surgical training programmes worldwide. The aim of this study was to provide an overview of the training requirements in general surgery across 23 different countries. Methods A collaborator affiliated with each country collected data from the country's official training body website, where possible. The information collected included: management, teaching, academic and operative competencies, mandatory courses, years of postgraduate training (inclusive of intern years), working‐hours regulations, selection process into training and formal examination. Results Countries included were Australia, Belgium, Canada, Colombia, Denmark, Germany, Greece, Guatemala, India, Ireland, Italy, Kuwait, the Netherlands, New Zealand, Russia, Saudi Arabia, South Africa, South Korea, Sweden, Switzerland, UK, USA and Zambia. Frameworks for defining the outcomes of surgical training have been defined nationally in some countries, with some similarities to those in the UK and Ireland. However, some training programmes remain heterogeneous with regional variation, including those in many European countries. Some countries outline minimum operative case requirement (range 60–1600), mandatory courses, or operative, academic or management competencies. The length of postgraduate training ranges from 4 to 10 years. The maximum hours worked per week ranges from 38 to 88 h, but with no limit in some countries. Conclusion Countries have specific and often differing requirements of their medical profession. Equivalence in training is granted on political agreements, not healthcare need or competencies acquired during training.

Background: In India, millions of people are suffering from chronic kidney disease (CKD). Hemodialysis imposes a variety of physical and psychosocial stressors that challenge not only the patients but also the caregivers. Psychiatric illness in patients with end-stage renal disease (ESRD) has persistently intrigued health-care workers due to its effect on morbidity and health-care costs in ESRD. Objective: The objective of this study was to assess psychiatric morbidity among ESRD patients on hemodialysis. Materials and Methods: The study enrolled 170 patients with ESRD undergoing hemodialysis. Psychiatric morbidity was assessed using Mini International Neuropsychiatric Interview. Results and Discussion: Of the 170 patients studied, 70.6% were males and 29.4% were females. The mean age of the patients was 40.8 (SD = 14.8). Psychiatric morbidity was present in 42(24.7%) patients. The common diagnosis was major depressive episode (n = 37) followed by generalized anxiety disorder (n = 3), dysthymia (n = 1), and alcohol dependence syndrome (n = 1). No significant association was seen between gender and marital status in psychiatric morbidity. Duration of renal illness had a significant association with psychiatric illness (P < 0.0001). A similar duration of dialysis also had an association with psychiatric illness (P < 0.0001) with a majority of patients having psychiatric complaints within 6 months of onset of dialysis. The presence of nonrenal comorbidities also had a significant association with psychiatric illness (P < 0.005). Conclusion: This study has shown psychiatric illness among patients with ESRD on hemodialysis and its association with various factors such as duration of renal illness, duration of dialysis, and the presence of comorbidities.

Shyam Ajay Gokani,1,* Ekta Sharma,2,* Tanisha Sharma,3 Shyam Venkatesan Moudhgalya,3 Subothini Sara Selvendran,4 Nikhil Aggarwal5 1Research Department of Primary Care & Population Health, University College London (Royal Free Campus), London, UK; 2Academic Section of Vascular Surgery, Division of Surgery, Imperial College London, Charing Cross Hospital, London, UK; 3Department of Medicine, St George’s University of London, London, UK; 4Department of Medicine, Southampton University, Southampton, UK; 5Department of Medicine, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK*These authors contributed equally to this workCorrespondence: Shyam Ajay GokaniResearch Department of Primary Care and Population Health, University College London (Royal Free Campus), London, UKTel +44 20 7679 2000Fax +44 20 7472 6871Email shyamg@live.co.ukBackground: Critical appraisal is an important skill for clinicians of the future which medical students often have limited opportunities to develop. This study aimed to evaluate whether a national journal club session could improve medical students’ confidence with critical appraisal.Methods: 98 medical students attended a critical appraisal lecture and supervised journal article discussions. Junior doctor mentors supported students to submit discussion points as a letter-to-the-editor. An online cross-sectional survey was administered before and after the conference.Results: 74 students responded, reporting increased confidence with critically appraising research articles (median score 2 vs 4, p

Objectives The psychological impact of the COVID-19 pandemic on doctors is a significant concern. Due to the emergence of multiple pandemic waves, longitudinal data on the impact of COVID-19 are vital to ensure an adequate psychological care response. The primary aim was to assess the prevalence and degree of psychological distress and trauma in frontline doctors during the acceleration, peak and deceleration of the COVID-19 first wave. Personal and professional factors associated with psychological distress are also reported.Design A prospective online three-part longitudinal survey.Setting Acute hospitals in the UK and Ireland.Participants Frontline doctors working in emergency medicine, anaesthetics and intensive care medicine during the first wave of the COVID-19 pandemic in March 2020.Primary outcome measures Psychological distress and trauma measured using the General Health Questionnaire-12 and the Impact of Events-Revised.Results The initial acceleration survey distributed across networks generated a sample of 5440 doctors. Peak and deceleration response rates from the original sample were 71.6% (n=3896) and 56.6% (n=3079), respectively. Prevalence of psychological distress was 44.7% (n=1334) during the acceleration, 36.9% (n=1098) at peak and 31.5% (n=918) at the deceleration phase. The prevalence of trauma was 23.7% (n=647) at peak and 17.7% (n=484) at deceleration. The prevalence of probable post-traumatic stress disorder was 12.6% (n=343) at peak and 10.1% (n=276) at deceleration. Worry of family infection due to clinical work was the factor most strongly associated with both distress (R2=0.06) and trauma (R2=0.10).Conclusion Findings reflect a pattern of elevated distress at acceleration and peak, with some natural recovery. It is essential that policymakers seek to prevent future adverse effects through (a) provision of vital equipment to mitigate physical and psychological harm, (b) increased awareness and recognition of signs of psychological distress and (c) the development of clear pathways to effective psychological care.Trial registration number ISRCTN10666798.

Objective: The purpose of this study was to examine the effect of herbal formulation - Aayudh Advance on viral load as well as recovery duration in mild symptomatic patients diagnosed with Corona Virus Disease 2019 (COVID-19). It also aimed to study the effect of Herbal formulation – Aayudh Advance in terms of clinical improvement of various sign and symptoms in mild symptomatic COVID-19 patients. Method: Once the patient suffice the requirement of inclusion, exclusion criteria of the study than as per the method of ‘Covariate Adaptive Randomization’ technique, patient was assigned in either Aayudh Advance arm (Test arm) or Control Arm. Here standard of Care treatment was given to all patients of both the arms. Treatment was given for the period of 14 days or till patient turned COVID-19 negative, which ever was earlier. Clinical signs and symptoms viz. body temperature, SpO 2, Scoring of Cough & Scoring of Shortness of breath were recorded on all 5 Clinical visits along with biochemical testing like RT-PCR (with CT value of E gene and RDRP gene), serum ferritin, CRP and NLR observed on weekly Visit. Result: Total 74 patients were enrolled in the present study. Out of which 60 patients (30 patients in each group) have completed study as per the protocol, whereas 14 patients have voluntarily withdrawn from the study due to getting early discharge from the hospital. All patients in Aayudh Advance treatment group recovered (100%) after 14 days. This observed recovery was 15.38% more as compared to Standard of Care treatment alone. Further, there was statistically significant reduction (p

Abstract Throat aurora is a special discrete auroral form often observed at the ionospheric convection throat region near magnetic local noon. Some observational properties of throat aurora have been established, but the geomagnetic response is not yet explored. Using geomagnetic observations from a chain of stations in the Norwegian sector and auroral observations from an all‐sky imager and the DMSP satellites, for the first time, we identify geomagnetic responses associated with the occurrence of throat aurora. These variations are well explained by combining the models of flux transfer events and throat aurora. The estimated increase in ionospheric equivalent current confirms the association of throat aurora with ground observations. The results provide further evidence for throat aurora being associated with magnetopause reconnection. Based on the observational features, a new association of geomagnetic variations with throat aurora may be defined to reflect their occurrence at high latitudes near local noon.

Shyam Ajay Gokani,1 Karl O Elmqvist,1 Osman El-Koubani,1 Javier Ash,1 Sudeep K Biswas,1 Maxime Rigaudy2 1Faculty of Medicine, Imperial College London, London, UK; 2Hull York Medical School, University of York, York, UK Purpose: This study aimed to perform an economic evaluation of small bite sutures versus large bite sutures in the closure of midline laparotomies in the United Kingdom National Health Service (NHS).Methods: A cost-utility analysis was conducted using data from a systematic literature review. Large bite sutures placed 10 mm from the wound edge were compared to small bite sutures 3–6 mm from the wound edge. The analysis used a 3-year time horizon in order to take into account complications including incisional hernias and surgical site infections (SSIs). Cost and benefit data were considered from the perspective of the NHS. A two-way sensitivity analysis was conducted to assess the impact of a variation in the clinical effectiveness of small bite sutures.Results: The incremental cost-effectiveness ratio was calculated to be −£482.61 per quality-adjusted life year (QALY) using the proposed small bite suture technique, indicating a cost saving to the NHS. Sensitivity analysis demonstrated that small bites are a cost-neutral technique provided that the cost of using small bites is less than £98 per patient. Small bites cost less than £20,000/QALY when they reduce either the rate of SSIs by more than 15% or the rate of hernias by more than 3.4%.Conclusion: This study proposes that small bite sutures should become the mainstay suturing technique in the closure of midline laparotomies, replacing large bite sutures, which dominate current practice. The financial savings accompanied by the decrease in SSI rates and herniation warrant the use of this new technique. The sensitivity analysis demonstrates that findings hold true for a wide range of levels of clinical effectiveness for small bites. Keywords: suture technique, economic evaluation, surgical site infection, incisional hernia

Aaina Mittal,1 Shyam Gokani,1 Alexander Zargaran,2 Javier Ash,1 Georgina Kerry,3 Dara Rasasingam1 1Department of Medicine, Imperial College School of Medicine, Imperial College London, London, 2Department of Medicine, St. George’s, University of London, London, 3Department of Medicine, University of Birmingham Medical School, Birmingham, UK We read with great interest the article by Stuckey et al1 entitled “The role of smartphones in encouraging physical activity in adults” recently published in the International Journal of General Medicine. As the article identifies, “lack of physical activity is a global public health issue”,1 so finding ways of encouraging it is essential to better health outcomes worldwide. Bearing this in mind and recognising the article has set groundwork for prospective exploration in the areas it addresses, scope for future research in this area can be identified. Authors' replyMelanie I Stuckey,1 Shawn W Carter,2 Emily Knight3 1Research and Academics, Ontario Shores Centre for Mental Health Sciences, Whitby, ON, Canada, 2Eating Disorder Residential Program, Ontario Shores Centre for Mental Health Sciences, Whitby, ON, Canada, 3Faculty of Health Sciences, University of Western Ontario, London, ON, Canada Thank you for providing the opportunity to respond to the letter written by Mittal et al in response to our paper titled “The role of smartphones in encouraging physical activity in adults.”1 We generally agree with their comments, but add considerations for each of their three suggestions. View the original paper by Stuckey and colleagues.

To understand variation in the cost of autologous breast reconstruction in the UK, including identifying key areas of cost variability, differences between and within units and the impact of enhanced recovery protocols (ERAS). A micro-costing study was designed based on the responses to a national survey of clinical preferences completed by the majority of plastic surgeons and anaesthetists involved in the UK. Detailed costs were estimated from macro elements such as ward and theatre running costs, down to that of surgical meshes, anaesthetic drugs and flap monitoring devices. The largest variation in cost arose from postoperative location and length of stay, preoperative imaging and flap monitoring strategies. Plastic surgeon costs varied from £1282 to £3141, whereas anaesthetic costs were between £32 and £151 (not including salary). Estimated cost variation within units was up to £893 per case. Units with ERAS had significantly lower total costs than those without (p < 0.05). This study reveals significant cost variation in breast reconstruction in the UK based on clinician preferences. Many areas of practice driving this variation lack strong evidence of any clinical advantage. The total cost of a deep inferior epigastric perforator in the majority, if not all units, likely surpasses the national tariff for reimbursement, particularly when considering additional resource demand for immediate and bilateral breast reconstruction, as well as future symmetrisation procedures. Whilst units should look to streamline costs through ERAS, there should also be a realistic tariff that promotes excellent care. [ABSTRACT FROM AUTHOR]

Background: Chronic rhinosinusitis (CRS) is a heterogeneous condition characterized by differing inflammatory endotypes. The identification of suitable biomarkers could enable personalized approaches to treatment selection. Objective: This study aimed to identify and summarize clinical studies of biomarkers in adults with CRS in order to inform future research into CRS endotypes. Methods: We conducted systematic searches of MEDLINE and Web of Science from inception to January 30, 2022 and included all clinical studies of adult CRS patients and healthy controls measuring biomarkers using enzyme-linked immunosorbent assays or Luminex immunoassays. Outcomes included the name and tissue type of identified biomarkers and expression patterns within CRS phenotypes. Study quality was assessed using the National Institutes of Health quality assessment tool for observational cohort and cross-sectional studies. A narrative synthesis was performed. Results: We identified 78 relevant studies involving up to 9394 patients, predominantly with CRS with nasal polyposis. Studies identified 80 biomarkers from nasal tissue, 25 from nasal secretions, 14 from nasal lavage fluid, 24 from serum, and one from urine. The majority of biomarkers found to distinguish CRS phenotypes were identified in nasal tissue, especially in nasal polyps. Serum biomarkers were more commonly found to differentiate CRS from controls. The most frequently measured biomarker was IL-5, followed by IL-13 and IL-4. Serum IgE, IL-17, pentraxin-3 and nasal phospho-janus kinase 2, IL-5, IL-6, IL-17A, granulocyte-colony stimulating factor, and interferon gamma were identified as correlated with disease severity. Conclusion: We have identified numerous potential biomarkers to differentiate a range of CRS phenotypes. Future studies should focus on the prognostic role of nasal tissue biomarkers or expand on the more limited studies of nasal secretions and nasal lavage fluid. We registered this study in PROSPERO (CRD42022302787). [ABSTRACT FROM AUTHOR]

This brief paper outlines the various ways that Canadian Evangelical faith-based organisations in Southern Ontario effect “client transformation”. Data from qualitative interviews, focus groups, and surveys administered to clients and providers in faith-based organizations yielded two types of outcomes—spiritual and non-spiritual. Regarding the latter, I suggest two sub-types of non-spiritual outcomes: (a) socio-behavioural and (b) psycho-affective changes. I also suggest three major types of spiritual outcomes: (a) growing in Christianity, (b) warming to Christianity, and (c) accepting Christianity. I conclude with a discussion about implications and limitations of the study for the scholarship on faith-based organizations.

Shyam Ajay Gokani, 1 Ekta Sharma, 2 Tanisha Sharma, 3 Shyam Venkatesan Moudhgalya, 3 Subothini Sara Selvendran, 4 Nikhil Aggarwal 5 1Research Department of Primary Care & Population Health, University College London (Royal Free Campus), London, UK; 2Academic Section of Vascular Surgery, Division of Surgery, Imperial College London, Charing Cross Hospital, London, UK; 3Department of Medicine, St George’s University of London, London, UK; 4Department of Medicine, Southampton University, Southampton, UK; 5Department of Medicine, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UKCorrespondence: Shyam Ajay GokaniResearch Department of Primary Care and Population Health, University College London (Royal Free Campus), London, UKTel +44 20 7679 2000Fax +44 20 7472 6871Email shyamg@live.co.ukWe thank the authors for their considered comments and insightful questions. 1Ng and Yap mention that they would like more information on the training and experience of the tutors. All of the tutors involved in delivering critical appraisal small group lectures had attended a minimum of a one-week teaching skills course. Additionally, they were all academic foundation doctors. In London, this entails competitive selection to a research post after a rigorous interview involving critical appraisal of an abstract, and a proven interest in academic medicine. Approximately half of the additional tutors involved in mentoring were also academic foundation doctors, and most had undergone teaching skills courses as a compulsory part of their medical training.This is in response to the Letter to the Editor. Read the original article.

Dara Rasasingam,1 Georgina Kerry,2 Shyam Gokani,1 Alexander Zargaran,3 Javier Ash,1 Aaina Mittal1 1Department of Medicine, Imperial College School of Medicine, Imperial College London, London, 2Department of Medicine, University of Birmingham Medical School, Birmingham, 3Department of Medicine, St. George’s, University of London, London, UK Abstract: Medical education follows the clinical drive toward patient-centered care and, therefore, puts strong emphasis on the development of empathy by medical students. It has, however, been found that there is a decline in empathy throughout a student’s education. Students’ participation in role-play as the doctor has been proved to improve patient care in a clinical capacity. Here, it is proposed that patient role-play can enhance patient care holistically, by enhancing key communication skills and student’s empathy. Keywords: empathy, role-play, medical education

The devastating flood episode (16–17 June 2013) at Kedarnath (Uttrakhand, India), caused a huge loss of lives and loss of physical/material wealth. To understand this catastrophic event, rainfall/convective data and associated climate meteorological parameters are investigated. A low-pressure zone with very high cloud cover (60–90 %) and relative humidity (70–100 %), associated with low (< 4 m s−1) wind velocity, are observed over the Kedarnath region during 15–17 June. The cause of this disaster seems to be heavy and continuous rainfall, associated with snowmelt and the overflooding/collapse of Chorabari Lake, located upstream. Monsoon advancement was much faster than usual, due to the presence of the convectively active phase of the Madden–Julian oscillation.

Background: Preparation of highly standardized herbal products with respect to chemical composition and biological activity is considered to be a valuable approach in this field. SJT-DI-02 polyherbal formulation was successfully developed at our institute and filed for patent at Mumbai patent office. Objective: The present work was marker based standardization of patented, novel and efficacious polyherbal formulation namely SJT-DI-02 for the treatment of diabetes. The SJT-DI-02 was comprised of dried extracts of rhizomes of Acorus calamus, leaves of Aegle marmelose, fruits of Benincasa hispida, roots of Chlorophytum arendinaceum, seeds of Eugenia jambolana, leaves of Ocimum sanctum, pericarp of Punica granatum, seeds of Tamarindus indica. Selected plants were collected, dried and extracted with suitable solvents. The formulation was prepared by mixing different fractions of extracts. Materials and Methods: For successful and best standardization, first of all selection and procurement was carried out. Selection is done on the basis of therapeutic efficacy and amount of the marker present in the particular plant part. At the time of procurement side by side phytochemical screening and estimation of phytoconstituents was carried out. After completion of preliminary screening using characterized markers, we tried to develop best TLC systems using selected solvent composition. Finally well-developed TLC systems were applied in HPTLC. In the present study polyherbal formulation was standardized by using different four markers. TLC Densitometric methods were developed using HPTLC for the quantification of these marker compounds. Solvent systems were optimized to achieve best resolution of the marker compounds from other components of the sample extract. The identity of the bands in the sample extracts were confirmed by comparing the Rf and the absorption spectra by overlaying their UV absorption spectra with those of their respective standards. The purity of the bands due to marker compounds in the sample extracts were confirmed by overlaying the absorption spectra recorded at start, middle and end position of the band in the sample tracks. After conforming all these things fingerprints were developed for all three formulations which will be act as authentification and quality control tool. Results: % w/w of asarones is 3.61, % w/w of marmelosin is 4.60, % w/w of gallic acid is 10.80 and % w/w of lupeol is 4.13.The method was validated in terms of linearity, precision, repeatability, limit of detection, limit of quantification and accuracy. In well-developed mobile phase system linearity was found to be in the range of 0.983-0.995, % recovery was found to be in the range of 97.48-99.63, % RSD for intraday and interday was found to be 0.13- 0.70 and 0.32 -1.41 and LOD and LOQ was found to be in the range of 0.15- 0.61 and 0.45 -1.83 microgram per ml. Conclusion: Thus High performance thin layer chromatography (HPTLC) methods were developed and validated in terms of linearity, precision, repeatability, limit of detection, limit of quantification and accuracy. The methods were rapid, sensitive, reproducible and economical. It does not suffer any positive or negative interference due to common other component present in the formulation and would also serve as a tool for authentication of herbal products containing marmelosin, gallic acid, lupeol and asarones. Thus this work provides standardized and therapeutically active polyherbal formulations for the different ailments.

Objectives Generational changes in lifestyle expectations, working environments and the feminisation of the medical workforce have seen an increased demand in postgraduate less than full-time training (LTFT). Despite this, concerns remain regarding access to, and information about, flexible training for surgeons. This study aimed to assess the opinions and experiences of LTFT for surgical trainees.Design Prospective, questionnaire-based cross-sectional study.Setting/participants An electronic, self-administered questionnaire was distributed in the UK and Republic of Ireland through mailing lists via the Association of Surgeons in Training and British Orthopedic Trainee Association.Results Overall, 876 completed responses were received, representing all grades of trainee across all 10 surgical specialties. Median age was 33 years and 63.4% were female. Of those who had undertaken LTFT, 92.5% (148/160) were female. Most worked 60% of a full-time post (86/160, 53.8%). The reasons for either choosing or considering LTFT were childrearing (82.7%), caring for a dependent (12.6%) and sporting commitments (6.8%). Males were less likely to list childrearing than females (64.9% vs 87.6%; p