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Background Truncus arteriosus (TA) or persistent arterial trunk describes the presence of a solitary arterial trunk arising from the base of the heart, supported by a common ventriculoarterial junction. The trunk gives rise to the coronary arteries, systemic arteries, and at least one pulmonary artery. Truncus arteriosus is a rare congenital cardiac disease, and even rarer is the absence of ventricular septal defect. Case summary We report a case of a 2-day-old infant who presented with cyanosis and a cardiac murmur. He was diagnosed with TA with intact ventricular septum (IVS), as well as crossed pulmonary arteries which was identified on pre-operative imaging. We describe the surgical management and short-term follow-up. Discussion Our clinical case demonstrates a unique diagnosis and management of TA with IVS identified by pre-operative imaging with good surgical outcome.

Rationale, Aims and Objectives\ud Emergency hospital readmissions within 30 days of discharge from hospital are considered a marker for the quality of hospital care, patient experience, the discharge process and integration with community services. This paper describes the frequency and variations in cause of emergency readmissions at 30 and 90 days following discharge after acute stroke from two stroke units.\ud \ud Methods\ud Retrospective data collection of Hospital Episodes Statistics (HES) and Sentinel Stroke National Audit Programme (SSNAP) of consecutive acute stroke hospital discharges over 24 months from 2017 to 2019 from two specialist stroke units in England. HES data were used to calculate the Charlson comorbidity index (CCI). Covariates were analysed for their association with readmission rate, including: age; gender; CCI; length of stay for first stroke admission; living alone; discharge to a care home; discharge receiving stroke specialist early supported discharge (ESD) rehabilitation and stroke severity as determined by National Institute for Health Stroke Scale on stroke admission.\ud \ud Results\ud From 2017 to 2019 there were 1999 live discharges with a primary diagnosis of stroke. Both hospitals had a trend of increasing readmission rates with increasing stroke severity and comorbidity. Longer length of stroke admission, especially for patients with increasing stroke severity, and patients receiving ESD rehabilitation after discharge reduced 90-day readmissions. This association was stronger at 90 days than at 30 days. Different readmission event rates were found at 30 and 90 days and when events were compared between the two hospitals.\ud \ud Conclusion\ud Understanding differences in readmission event rates between hospitals at 30 and 90 days can support local planning of patient needs in the first weeks after stroke discharge and to investigate ways for hospital to reduce the impact of readmission. It is recommended that stroke services use both 30 and 90-day readmissions to inform service evaluation and improvement.

Caring for a child, particularly one with a rare disease, presents a challenging set of stressors that can impact entire family networks. Given this shared impact, caregivers can engage in communal coping to address the caregiving process, defined as the perception of caregiving as shared and collaborative behaviors to address it. In this study, we examined one common measure of communal coping-first person plural pronouns or "we-talk"-in caregivers of either (a) children with rare or undiagnosed diseases or (b) typically developing children. We sought to examine how we-talk is linked to (a) caregiver health and well-being and (b) social network involvement in caregiving. Caregivers (

The Wildlife Health Bridge was established in 2009 with the aim of improving the expertise and knowledge base of wildlife health professionals in biodiverse low- and middle-income countries. The Wildlife Health Bridge centres around partnerships among educational institutions: the Zoological Society of London, the Royal Veterinary College, the University of Edinburgh’s Royal (Dick) School of Veterinary Studies, the Wildlife Institute of India, and the University of Melbourne Veterinary School. The Wildlife Health Bridge provides quality education in wildlife health, ecosystem health, and wildlife biology, facilitates the interchange of students between collaborating countries for research studies and provides a global graduate network of wildlife health professionals. In addition to established Masters’ level wildlife health training programmes run by the partner organisations, the Wildlife Health Bridge has developed a collaborative field-based course, Interventions in Wild Animal Health, provided annually in India since 2016, which has trained 138 veterinarians to date, enhancing local and international capacity in managing emerging wildlife health issues and building global professional linkages. The Wildlife Health Bridge’s Wild Animal Alumni network facilitates networking and exchange between Wildlife Health Bridge institutions and graduates, with over 701 members from 67 countries, half of which are biodiverse low- and middle-income countries. Collaboration between educational institutions has enabled new ideas and ongoing developments in the delivery of materials and learning outcomes. The Wildlife Health Bridge is building global capacity in trained wildlife health professionals, through educational programmes and a synergised network, with the aim of impacting conservation practice to benefit human, domestic animal and wildlife health.

Cancers occur across species. Understanding what is consistent and varies across species can provide new insights into cancer initiation and evolution, with significant implications for advancing human healthcare, animal welfare, and wildlife conservation. We built the pan-species cancer digital pathology atlas (PANCAD) and conducted the first pan-species study of computational comparative pathology using a supervised convolutional neural network algorithm trained on human samples. The artificial intelligence algorithm achieves high accuracy in measuring immune response through single-cell classification for two transmissible cancers (canine transmissible venereal tumour, 0.94; Tasmanian devil facial tumour disease, 0.88). Furthermore, in 18 other vertebrate species (mammalia=11, reptilia=4, aves=2, and amphibia=1), accuracy (0.57-0.94) was influenced by cell morphological similarity preserved across different taxonomic groups, tumour sites, and variations in the immune compartment. A new metric, named morphospace overlap, was developed to guide veterinary pathologists towards rational deployment of this technology on new samples. This study provides the foundation and guidelines for transferring artificial intelligence technologies to veterinary pathology based on a new understanding of morphological conservation, which could vastly accelerate new developments in veterinary medicine and comparative oncology.

Aim Kawasaki disease (KD) is one of the most common causes of acquired cardiac disease in children in high-income countries. The incidence of coronary artery disease (CAD), despite treatment with intravenous immunoglobulin, ranges from 5 to 20%. Determining risk factors for CAD may assist with management and reduce long-term complications. Methods Retrospective data were collected for all patients presenting to the Women's and Children's Hospital with a discharge diagnosis of KD over a 10.5-year period, from 2007 to 2018. Results A total of 141 patients were included in the review; 101 patients fulfilled complete criteria for KD; 25 incomplete criteria and 15 did not meet criteria but were treated for KD. CAD was present in 27.7% of all patients, ranging from ectasia to giant aneurysms based on Z-scores and echocardiogram descriptions. Medium to large aneurysms accounted for 8.5% of all patients with suspected KD. Patients with CAD were more likely to: fulfil incomplete criteria (odds ratio (OR) 4.3, 95% confidence interval (CI) 1.7-10.8, P = 0.0027), be less than 12 months of age (OR 11.38, 95% CI 2.94-44.11, P = 0.0001), have CRP > 100 (OR 2.8, 95% CI 1.31-6.02, P = 0.0068) and have a delay in treatment (average day of illness prior to treatment 8.89 vs. 6.78 (OR 1.19, 95% CI 1.05-1.35, P = 0.0055)). Patients with a Kobayashi score ≥4 had a higher rate of re-treatment with intravenous immunoglobulin (OR 3.16, 95% CI 1.27-7.83, P = 0.013). Conclusion Our data are consistent with previously reported risk factors, and high rates of CAD despite standard treatment.

After laying their eggs and refilling the egg chamber, sea turtles scatter sand extensively around the nest site. This is presumed to camouflage the nest, or optimize local conditions for egg development, but a consensus on its function is lacking. We quantified activity and mapped the movements of hawksbill (

After laying their eggs and refilling the egg chamber, sea turtles scatter sand extensively around the nest site. This is presumed to camouflage the nest, or optimize local conditions for egg development, but a consensus on its function is lacking. We quantified activity and mapped the movements of hawksbill ( Eretmochelys imbricata ) and leatherback ( Dermochelys coriacea ) turtles during sand-scattering. For leatherbacks, we also recorded activity at each sand-scattering position. For hawksbills, we recorded breathing rates during nesting as an indicator of metabolic investment and compared with published values for leatherbacks. Temporal and inferred metabolic investment in sand-scattering was substantial for both species. Neither species remained near the nest while sand-scattering, instead moving to several other positions to scatter sand, changing direction each time, progressively displacing themselves from the nest site. Movement patterns were highly diverse between individuals, but activity at each sand-scattering position changed little between completion of egg chamber refilling and return to the sea. Our findings are inconsistent with sand-scattering being to directly camouflage the nest, or primarily for modifying the nest-proximal environment. Instead, they are consistent with the construction of a series of dispersed decoy nests that may reduce the discovery of nests by predators.

This multifactorial study used a newly developed ventral videography technique to investigate the feeding behavior of 18-mo-old juvenile greenlip abalone (21.1 g, 55.6 mm), and hybrid abalone (23.4 g, 57.6 mm) fed either a formulated commercial diet or live Ulva sp. at 18°C and 22°C. Feeding behavior was scored in terms of the following activities: quiescence, alertness, moving, feeding, distance traveled, velocity, and homing. There was a significant effect of diet type and temperature on feeding behavior of abalone. Both types of abalone were more active and exhibited the highest velocity when fed the formulated diet at 22°C. Greenlip abalone spent a larger proportion of time feeding on Ulva sp. than on the formulated diet, regardless of the water temperature. In contrast, no significant difference was observed in the proportion of time feeding between diet types for hybrid abalone. Both types of abalone rapidly located and consumed Ulva sp. when feed was introduced into the aquaria at 1600 h (...

John Gavin Craig graduated from Queen’s University Belfast in 1970 and spent the next three years working there in hospital medicine, when the Troubles were at their height. He returned to his home county of Yorkshire and worked as a hospital registrar in Leeds, where his gained his membership of the Royal College of Physicians. He went on to join his father, John G Craig, and Robert Murdoch in their practice …

In this study, we investigated the role of age in three categories of 168 sex offenders, including 53 rapists, 62 pedophiles, and 53 sadists. On the basis of the match between requisites of completing each type of sexual offense, we hypothesized that rapists would be less represented in the older age group, whereas pedophilic and sexually sadistic offenders would show a more muted decline with age. This hypothesis was supported by the data, clearly a showing smaller number of rapists in the over 40 group relative to the number of pedophiles and sadists (p = 0.0009.) Further examination of the files eliminated the alternate explanation ascribing this pattern to lack of opportunity in older rapists because of incarceration. These results suggest that age over 40 may mitigate incidence of recidivism in rapists, but not in pedophiles or sexual sadists. Approximately one third of the sexual sadists had committed either first- or second-degree murder, whereas none of the nonsadistic rapists or pedophiles had these crimes on their records. The data further justify categorization of sex offenders into nonsadistic rapist, sadistic rapist, and pedophilic offenders in future research to enhance precision in delineating demographic characteristics and putative causal explanations for sexual offending.