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Medical error is a serious public health concern and undermines healthcare organizations' commitment to drive safe, high-quality patient care. Voluntary error reporting (VER) is one key solution to address this concern because it is through conducting root cause analysis that constructive retrospective learning can take place to improve future practice. Nurses form the largest health workforce and are key stakeholders contributing to the institutional error management culture. While the significance of VER and nurses' role in driving this initiative cannot be further emphasized, studies revealed that nurses failed to engage in VER due to less positive experiences towards VER. Nurses' negative attitude towards VER can be attributed to unsupportive organizational responses to their act of VER, underpinned by the endorsement of blame, shame, and punitive culture consistent with the human approach to error management. This induces fear of speaking up for error among nurses, creating a culture of silence. This paper examines and discusses current policies underpinning the error management system and identifies the contemporary factors that challenge these policies, followed by proposing recommendations to support these policies to drive nurses' commitment to VER and improve the overall error management system.

BackgroundStarting in 2010, the epidermal growth factor receptor (EGFR) kinase inhibitors erlotinib and gefitinib were introduced into routine use in Aotearoa New Zealand (NZ) for treating advanced lung cancer, but their impact in this setting is unknown. ObjectiveThe study described in this protocol aims to understand the effectiveness and safety of these new personalized lung cancer treatments and the contributions made by concomitant medicines and other factors to adverse outcomes in the general NZ patient population. A substudy aimed to validate national electronic health databases as the data source and the methods for determining patient eligibility and identifying outcomes and variables. MethodsThis study will include all NZ patients with advanced EGFR mutation–positive lung cancer who were first dispensed erlotinib or gefitinib before October 1, 2020, and followed until death or for at least 1 year. Routinely collected health administrative and clinical data will be collated from national electronic cancer registration, hospital discharge, mortality registration, and pharmaceutical dispensing databases by deterministic data linkage using National Health Index numbers. The primary effectiveness and safety outcomes will be time to treatment discontinuation and serious adverse events, respectively. The primary variable will be high-risk concomitant medicines use with erlotinib or gefitinib. For the validation substudy (n=100), data from clinical records were compared to those from national electronic health databases and analyzed by agreement analysis for categorical data and by paired 2-tailed t tests for numerical data. ResultsIn the validation substudy, national electronic health databases and clinical records agreed in determining patient eligibility and for identifying serious adverse events, high-risk concomitant medicines use, and other categorical data with overall agreement and κ statistic of >90% and >0.8000, respectively; for example, for the determination of patient eligibility, the comparison of proxy and standard eligibility criteria applied to national electronic health databases and clinical records, respectively, showed overall agreement and κ statistic of 96% and 0.8936, respectively. Dates for estimating time to treatment discontinuation and other numerical variables and outcomes showed small differences, mostly with nonsignificant P values and 95% CIs overlapping with zero difference; for example, for the dates of the first dispensing of erlotinib or gefitinib, national electronic health databases and clinical records differed on average by approximately 4 days with a nonsignificant P value of .33 and 95% CIs overlapping with zero difference. As of May 2024, the main study is ongoing. ConclusionsA protocol is presented for a national whole-of-patient-population retrospective cohort study designed to describe the safety and effectiveness of erlotinib and gefitinib during their first decade of routine use in NZ for treating EGFR mutation–positive lung cancer. The validation substudy demonstrated the feasibility and validity of using national electronic health databases and the methods for determining patient eligibility and identifying the study outcomes and variables proposed in the study protocol. Trial RegistrationAustralian New Zealand Clinical Trials Registry ACTRN12615000998549; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=368928 International Registered Report Identifier (IRRID)DERR1-10.2196/51381

Abstract Passive acoustic telemetry is widely used to study the movements of aquatic animals. However, a holistic, mechanistic modelling framework that permits the reconstruction of fine‐scale movements and emergent patterns of space use from detections at receivers remains lacking. Here, we introduce an integrative modelling framework that recapitulates the movement and detection processes that generate detections to reconstruct fine‐scale movements and patterns of space use. This framework is supported by a new family of algorithms designed for detection and depth observations and can be flexibly extended to incorporate other data types. Using simulation, we illustrate applications of our framework and evaluate algorithm utility and sensitivity in different settings. As a case study, we analyse movement data collected from the Critically Endangered flapper skate (Dipturus intermedius) in Scotland. We show that our methods can be used to reconstruct fine‐scale movement paths, patterns of space use and support habitat preference analyses. For reconstructing patterns of space use, simulations show that the methods are consistently more instructive than the most widely used alternative approach (the mean‐position algorithm), particularly in clustered receiver arrays. For flapper skate, the reconstruction of movements reveals responses to disturbance, fine‐scale spatial partitioning and patterns of space use with significant implications for marine management. We conclude that this framework represents a widely applicable methodological advance with applications to studies of pelagic, demersal and benthic species across multiple spatiotemporal scales.

Study Design Retrospective cohort study. Purpose: The primary objective of this study was to determine the incidence and risk factors for incidental durotomies during lumbar decompression surgeries. In addition, we aimed to determine the changes in patient-reported outcome measures (PROMs) based on incidental durotomy status. Overview of Literature There is limited literature investigating the affect of incidental durotomy on patient reported outcome measures. While the majority of research does not suggest differences in complications, readmission, or revision rates, many studies rely on public databases, and their sensitivity and specificity for identifying incidental durotomies is unknown. Methods: Patients undergoing lumbar decompression with or without fusion at a single tertiary care center were grouped based on the presence of a durotomy. Multivariate analysis was performed for length of stay (LOS), hospital readmissions, and changes in PROMs. To identify surgical risk factors for durotomy, 3:1 propensity matching was performed using stepwise logistic regression. The sensitivity and specificity of the International Classification of Disease, 10th revision (ICD-10) codes (G96.11 and G97.41) were also assessed. Results: Of the 3,684 consecutive patients who underwent lumbar decompressions, 533 (14.5%) had durotomies, and a complete set of PROMs (preoperative and 1-year postoperative) were available for 737 patients (20.0%). Incidental durotomy was an independent predictor of increased LOS but not hospital readmission or worse PROMs. The durotomy repair method was not associated with hospital readmission or LOS. However, repair with collagen graft and suture predicted reduced improvement in Visual Analog Scale back (β=2.56, p=0.004). Independent risk factors for incidental durotomies included revisions (odds ratio [OR], 1.73; p

Study Design Retrospective cohort study. Purpose: To compare radiographic outcomes between unilateral and bilateral cage placement in transforaminal lumbar interbody fusions (TLIF) and to determine if the rate of fusion at the 1-year postoperative point was different in patients who received bilateral versus unilateral cages. Overview of Literature There is no clear evidence to dictate whether bilateral or unilateral cages promote superior radiographic or surgical outcomes in TLIF. Methods: Patients >18 years old who underwent primary one- or two-level TLIFs at our institution were identified and propensity-matched in a 3:1 fashion (unilateral:bilateral). Patient demographics, surgical characteristics, and radiographic outcomes, including vertebral endplate obliquity, segmental lordosis, subsidence, and fusion status, were compared between groups. Results: Of the 184 patients included, 46 received bilateral cages. Bilateral cage placement was associated with greater subsidence (1.06±1.25 mm vs. 0.59±1.16 mm, p=0.028) and enhanced restoration of segmental lordosis (5.74°±14.1° vs. −1.57°±10.9°, p=0.002) at the 1-year postoperative point, while unilateral cage placement was associated with an increased correction of endplate obliquity (−2.02°±4.42° vs. 0.24°±2.81°, p

Study Design Retrospective cohort study. Purpose To determine if polyetheretherketone (PEEK) or titanium alloy cages increase the rate of pseudarthrosis development or revision surgery rate compared with structural allograft following anterior cervical discectomy and fusion (ACDF) and identify if the cage type results in differences in patient-reported outcome measures (PROMs) versus structural allograft. Overview of Literature PEEK and titanium alloy cages have become popular options for ACDF intervertebral spacers. However, while data is beginning to emerge on how cage types affect arthrodesis rates, the effect of their composition on PROMs is less clear. Methods All patients aged >18 years who underwent primary one- to four-level ACDF at a single institution were retrospectively identified. Propensity matching was performed to compare patients’ PEEK or titanium alloy cages with structural allograft. Multivariate logistic regression analysis was performed to measure the effect of interbody spacer composition on the likelihood of pseudarthrosis development. Results Of the 502 patients who received structural allograft and had 1-year postoperative dynamic radiographs, 96 patients were propensity matched to 32 patients who received a PEEK cage, and 162 patients were propensity matched to 54 patients who received a titanium alloy cage. Multivariate logistic regression analysis identified that PEEK cage implants (odds ratio [OR], 3.34; p=0.007) predicted pseudarthrosis development compared with structural allograft implantation. Titanium alloy cage (OR, 1.64; p=0.156) implantation was not predictive of pseudarthrosis. One-year postoperative PROMs were not significantly different between patients who received PEEK or titanium alloy cages and those who received structural allograft (all p>0.05). Conclusions Compared with structural allograft, receiving a PEEK cage increased the risk of pseudarthrosis development following ACDF, whereas receiving a titanium alloy cage had no significant effect on pseudarthrosis development. One-year postoperative patient-reported outcomes were similar between patients who received structural allograft, PEEK, and titanium alloy interbody spacers.

Phase behavior, density, viscosity, conductivity, pH, and surface tension were measured, and FTIR was performed for a series of mixtures of sugar (glucose, fructose, xylose, and sucrose), water, and choline chloride (ChCl) at specific molar ratios. These mixtures, called sugar-based natural deep eutectic solvents (NADESs), were investigated as a function of temperature. Contact angle measurements indicated that NADES exhibited slightly lower wettability but higher surface tension than water. Temperature was found to greatly impact density, viscosity, and conductivity. The optimum water molar ratio for lower viscosity was found at ratios higher than those reported in the literature, indicating that the NADES investigated may have industrial process applications.

Background: In locally-advanced breast cancers (LABC), the previous primary goal of neoadjuvant systemic therapy was to improve resectability and achieve better margins. Currently, it can also provide important prognostic information based on actual response to therapy. Achieving pathologic complete response (pCR) after neoadjuvant therapy is targeted because it is associated with favorable disease-free survival (DFS) and overall survival (OS). The purpose of this study is to report the 5-year disease-free survival rate and overall survival rate among patients with LABC treated with neoadjuvant treatment followed by surgery. Methods: All patients with histologically diagnosed locally advanced breast cancer, who completed neoadjuvant therapy and surgery at St. Luke’s Medical Center from January 2007 to December 2017 where included. Response to neoadjuvant therapy were categorized using post-surgical pathologic reports. Survival curves were generated by the Kaplan-Meier method and compared using the log-rank test. Results: The cohort included 231 women, most were diagnosed with stage III disease (n=151). Pathologic complete response to neoadjuvant treatment had a significantly greater 5-year disease-free survival at 73.17% compared to those with residual disease after neoadjuvant treatment at 51.25% (Log-rank test p=0.0107). The locoregional recurrence-free survival and distant metastasis-free survival were 83.20% and 62.0% at 5 years, respectively. No deaths were recorded at 5 years for patients who achieved pathologic complete response after neoadjuvant chemotherapy. Conclusion: Pathologic complete response has better outcomes in terms of disease-free survival compared to those who did not achieve complete pathologic response after neoadjuvant therapy. Disease-free survival among patients who achieved pathologic complete response does not significantly differ among the different molecular phenotypes. The overall survival of the patients in this cohort does not differ in terms of phenotypic subtypes and mortality is seen among patients with disease progression.

Abstract A promising alternative to comprehensively performing genomics experiments is to, instead, perform a subset of experiments and use computational methods to impute the remainder. However, identifying the best imputation methods and what measures meaningfully evaluate performance are open questions. We address these questions by comprehensively analyzing 23 methods from the ENCODE Imputation Challenge. We find that imputation evaluations are challenging and confounded by distributional shifts from differences in data collection and processing over time, the amount of available data, and redundancy among performance measures. Our analyses suggest simple steps for overcoming these issues and promising directions for more robust research.

Study Design Single-center retrospective cohort. Purpose To compare surgical outcomes of patients based on lumbar drain variables relating to output and duration. Overview of Literature The use of drains following lumbar spine surgery, specifically with respect to hospital readmission, postoperative hematoma, postoperative anemia, and surgical site infections, has been controversial. Methods Patients aged ≥18 years who underwent lumbar fusion with a postoperative drain between 2017 and 2020 were included and grouped based on hospital readmission status, last 8-hour drain output (

Study Design Retrospective cohort. Purpose To determine (1) the effects of serotonin reuptake inhibitors in pseudarthrosis rates after anterior cervical decompression and fusion (ACDF) and (2) to identify patient-reported outcome measures in patients taking serotonin reuptake inhibitors. Overview of Literature Recent literature suggests that selective serotonin reuptake inhibitors (SSRIs) may inhibit fracture healing via downregulation of osteoblast differentiation. Spinal fusion supplementation with osteoblast-rich substances enhances spinal fusion, thus SSRIs may be detrimental. Methods Patients with 1-year postoperative dynamic cervical spine radiographs following ACDF were grouped into serotonin reuptake inhibitor prescriptions (SSRI, serotonin-norepinephrine reuptake inhibitor [SNRI], or tricyclic antidepressant [TCA]) and no prescription (atypical antidepressant or no antidepressant). Pseudarthrosis was defined as ≥1 mm interspinous process motion on dynamic radiographs. Logistic regression models were controlled for confounding to analyze pseudarthrosis rates. Alpha was set at p-values of

Study Design A retrospective cohort study. Purpose To determine whether the 11-item modified frailty index (mFI) is associated with readmission rates, complication rates, revision rates, or differences in patient-reported outcome measures (PROMs) for patients undergoing posterior cervical decompression and fusion (PCDF). Overview of Literature mFI incorporates preexisting medical comorbidities and dependency status to determine physiological reserve. Based on previous literature, it may be used as a predictive tool for identifying postoperative clinical and surgical outcomes. Methods Patients undergoing elective PCDF at our urban academic medical center from 2014 to 2020 were included. Patients were categorized by mFI scores (0–0.08, 0.09–0.17, 0.18–0.26, and ≥0.27). Univariate statistics compared demographics, comorbidities, and clinical/surgical outcomes. Multiple linear regression analysis evaluated the magnitude of improvement in PROMs at 1 year. Results A total of 165 patients were included and grouped by mFI scores: 0 (n=36), 0.09 (n=62), 0.18 (n=42), and ≥0.27 (n=30). The severe frailty group (mFI ≥0.27) was significantly more likely to be diabetic (p

Social media have the potential to provide timely information about emergency situations and sudden events. However, finding relevant information among the millions of posts being added every day can be difficult, and in current approaches developing an automatic data analysis project requires time and technical skills. This work presents a new approach for the analysis of social media posts, based on configurable automatic classification combined with Citizen Science methodologies. The process is facilitated by a set of flexible, automatic and open-source data processing tools called the Citizen Science Solution Kit. The kit provides a comprehensive set of tools that can be used and personalized in different situations, particularly during natural emergencies, starting from images and text contained in the posts. The tools can be employed by citizen scientists for filtering, classifying, and geolocating the content with a human-in-the-loop approach to support the data analyst, including feedback and suggestions on how to configure the automated tools, and techniques to gather inputs from citizens. Using flooding scenario as a guiding example, this paper illustrates the structure and functioning of the different tools proposed to support citizens scientists in their projects, and a methodological approach to their use. The process is then validated by discussing three case studies based on the Albania earthquake of 2019, the Covid-19 pandemic, and the Thailand floods of 2021. The results suggest that a flexible approach to tools composition and configuration can support a timely setup of an analysis project by citizen scientists, especially in case of emergencies in unexpected locations.

This study was grounded on the established Community of Inquiry (CoI) Framework to assess the behavior of students during the synchronous classes and its association with the Basic Science Process Skills (BSPS). The participants of the study were twenty-eight students from the seventh grade class of a public elementary school in the Philippines. The quantitative data were collected from the survey questionnaires while the pre-test and post-test were measured using a rating scale instrument facilitated via Google forms. Pearson-r was used to find the correlation among the variables while the T-test for the differences between variables. The results divided the CoI into three presences. The teaching presence, social presence, and cognitive presence with an acceptable mean, implies a good sense of community among the learners. Furthermore, few students’ basic science process skills were advanced and proficient, while most were still approaching proficiency and developing levels. The constructs of the CoI Framework were associated with the basic science process skills for classifying. Similarly, there is a significant difference between the pre-test and post-test scores of the respondents in classifying and measuring. The results suggest that continuous exposure of the students to CoI during synchronous classes improves their ability to self-study during asynchronous classes.

Background: Globally, the COVID-19 pandemic has challenged the overall healthcare system. Healthcare workers are an essential workforce during a pandemic as they have been involved in treating patients with COVID-19. They have been exposed to detrimental effects such as high infection and death rates, chronic stress, and fear of uncertainty. Their adaptability in providing care and maintaining psychological equilibrium under unprecedented crises like COVID-19 is poorly understood. Objectives: This study aimed to explore the lived experiences and resilience of hospital pharmacists in the Philippines during the COVID-19 pandemic. Methods: A qualitative study was conducted among hospital pharmacists in Metro Manila, Philippines. In-depth interviews were conducted virtually using a semi-structured topic guide. Interview transcripts were transcribed verbatim and analyzed using interpretative phenomenological analysis. Results: The two themes that emerged from the data were challenges during the COVID-19 pandemic and the resilience of hospital pharmacists. Under challenges, it was subdivided into workplace and personal challenges. As for resilience, it was composed of positive coping mechanisms and positive outlooks of hospital pharmacists. Conclusions: Hospital pharmacists faced many challenges and learned to adapt to the continued impact of the pandemic. Hospitals are encouraged to implement measures to prepare for future public health crises and provide resources for both physical and mental health meant for hospital pharmacists.

Abstract Developments in animal electronic tagging and tracking have transformed the field of movement ecology, but interest is also growing in the contributions of tagged animals to oceanography. Animal-borne sensors can address data gaps, improve ocean model skill and support model validation, but previous studies in this area have focused almost exclusively on satellite-telemetered seabirds and seals. Here, for the first time, we develop the use of benthic species as animal oceanographers by combining archival (depth and temperature) data from animal-borne tags, passive acoustic telemetry and citizen-science mark-recapture records from 2016–17 for the Critically Endangered flapper skate (Dipturus intermedius) in Scotland. By comparing temperature observations to predictions from the West Scotland Coastal Ocean Modelling System, we quantify model skill and empirically validate an independent model update. The results from bottom-temperature and temperature-depth profile validation (5,324 observations) fill a key data gap in Scotland. For predictions in 2016, we identified a consistent warm bias (mean = 0.53 °C) but a subsequent model update reduced bias by an estimated 109% and improved model skill. This study uniquely demonstrates the use of benthic animal-borne sensors and citizen-science data for ocean model validation, broadening the range of animal oceanographers in aquatic environments.

Animal-Visitor Interactions (AVIs) have become commonplace in zoological institutions and facilities globally. However, most AVI research focuses on the effects of visitors on the welfare of animals, with considerably fewer studies examining the visitor experience itself. Furthermore, robust evaluations of the efficacy of zoo education programs and engagements for increasing visitor awareness of conservation issues, and for fostering long-term pro-conservation behavior changes in them, are under-researched. This paper reviews the current literature that pertains to the effects of zoo visitation and AVIs on visitor perceptions, beliefs, and attitudes. We briefly note some of the known effects that zoo visitors have on zoo animals, then explore the effects that factors such as enclosure design, animal visibility and behaviors, and AVIs can have on visitors’ overall experience whilst attending the zoo. We suggest that future research needs to more closely examine the relationships and interactions between zoo visitors and zoo animals; why some zoo visitors over others repeat visitation; what the differences in beliefs and attitudes may be between “zoo visitors” and “non-zoo visitors” (i.e., other general public); and to make a concerted effort to understand: (1) what visitors do after they leave the zoo, and (2) whether visitors adopt long-term pro-conservation behaviors into their daily lives. We further suggest that future research needs to start investigating indirect measures related to the visitor experience, such as: (a) individual conservation support outside of the zoo; (b) internet activity; (c) changes in sustainable purchasing practices related to knowledge gains; (d) financial investment in sustainable or ethical companies after knowledge gains; (e) and the longitudinal effects of zoo visits.

Objective: This integrative review aimed to examine and understand nurses’ experiences of voluntary error reporting (VER) and elucidate factors underlying their decision to engage in VER. Method: This is an integrative review based on Whittemore & Knafl five-stage framework. A systematic search guided by the PRISMA 2020 approach was performed on four electronic databases: CINAHL, Medline (PubMed), Scopus, and Embase. Peer-reviewed articles published in the English language from January 2010 to December 2020 were retrieved and screened for relevancy. Results: Totally 31 papers were included in this review following the quality appraisal. A constant comparative approach was used to synthesize findings of eligible studies to report nurses' experiences of VER represented by three major themes: nurses' beliefs, behavior, and sentiments towards VER; nurses' perceived enabling factors of VER and nurses' perceived inhibiting factors of VER. Findings of this review revealed that nurses’ experiences of VER were less than ideal. Firstly, these negative experiences were accounted for by the interplays of factors that influenced their attitudes, perceptions, emotions, and practices. Additionally, their negative experiences were underpinned by a spectrum of system, administrative and organizational factors that focuses on attributing the error to human failure characterized by an unsupportive, blaming, and punitive approach to error management. Conclusion: Findings of this review add to the body of knowledge to inform on the areas of focus to guide nursing management perspectives to strengthen institutional efforts to improve nurses' recognition, reception, and contribution towards VER. It is recommended that nursing leaders prioritize and invest in strategies to enhance existing institutional error management approaches to establish a just and open patient safety culture that would promote positivity in nurses’ overall experiences towards VER.

Abstract Background Cervical cancer is the leading cancer among Ugandan women, contributing to 40 % of all cancer cases recorded in the cancer registry. Having identified the substantial impact of cervical cancer among Ugandan women, the Ministry of Health in 2010 launched a Strategic Plan for Cervical Cancer prevention and control. This study was conducted to determine if health workers working in rural health centres (HCs) III and IV in Northern Uganda provide cervical cancer screening services as recommended in the Strategic Plan. Methods A cross-sectional survey using a structured questionnaire was conducted among nurses, midwives and clinical officers working in rural HC III and IV in Northern Uganda. Data were entered in Epidata 3.1 and analysed using Stata 16 statistical software. Univariate, bivariate, and multivariate analyses were performed. Any factor with p-value ≤ 0.05 was considered a significant predictor of outcome. Results We surveyed 286 health workers. Fifty-one (18 %) health workers were screening women for cervical cancer. Fifty-eight (21 %) health workers have guideline for cervical cancer screening in their HCs, 93 (33 %) participants were trained to screen women for cervical cancer. Two hundred sixty-two (92 %) participants provided HPV vaccination. Two hundred forty-six (87 %) participants were conducting health education about cervical cancer in their HCs. Factors associated with screening women for cervical cancer include: being a staff member from HCs III (AOR = 0.30, 95 % CI 0.13–0.68, p = 0.00), being staff of HCs that have organization to support cervical cancer screening services (AOR = 4.38, 95 % CI 1.99–9.63, p-=0.00), being a health worker who had been trained to screen for cervical cancer (AOR = 2.21, 95 % CI 1.00–4.90, p = 0.05) and staff from HCs that has guideline for cervical cancer screening (AOR = 2.89, 95 % CI 1.22–6.86, p = 0.02). Conclusions This study shows an overall structural problem related to the delivery of cervical cancer screening services in HC III and IV in Northern Uganda which the Strategic Plan has not addressed. These structural problems need urgent attention if the Uganda government and other sub-Saharan African (SSA) countries are to achieve the World Health Organization (WHO) 90–70–90 targets by 2030 to be on track for cervical cancer elimination.

Petreus et al. describe a platform combining 3D tumour-on-chip technology and pump driven microfluidics to study drug effects at physiological exposures preclinically. They test colorectal cancer spheroids with combinations of two drugs and show that it can successfully predict efficacy in vivo, thereby providing a valuable tool for drug response and pharmacodynamic assessment and reducing the need for animal studies.

A large fraction of ice sheet discharge enters the ocean subsurface from underneath large floating ice-tongues. Here the authors show that associated nutrient export may be governed by shelf circulation and, especially for Fe, particle-dissolved phase exchanges, which is largely independent from freshwater Fe content.

Summary: Background: Cancer of the nasopharynx has remarkable geographic and ethnic variation in incidence and outcomes globally. Recent advances in diagnostic and therapeutic technologies provide new opportunities for early detection and improved outcomes. This study aimed to determine the incidence, demographics, outcomes and time trends of cancer of the nasopharynx in Aotearoa New Zealand over the last 25 years. Methods: In a population-based, national registry cohort study of notifications of malignant neoplasms of the nasopharynx made to the New Zealand Cancer Registry between 1994 and 2018, age-specific and age-standardised incidence rates and survival outcomes were evaluated. Findings: 577 registrations of nasopharyngeal cancer from between 1994 and 2018 were analysed; median age at diagnosis 54 years; 72.4% male; 37.4% Asian, 24.3% New Zealand European, 25.3% Pacific peoples, 13.0% Māori. Age-standardised annual incidence remained low (

Abstract Background Cervical cancer is a leading cancer and cause of premature death among women in Uganda aged 15 to 44 years. To address the increasing burden of cervical cancer in Uganda, the Ministry of Health has adopted several strategies which include public education and advocacy. This study aims to assess knowledge, attitudes, and practice of cervical cancer prevention among health workers employed in rural health centres (HCs) III and IV in the Acholi sub-region of Northern Uganda. Methods We conducted a cross-sectional survey of nurses, midwives, and clinical officers between February and April 2019 using self-administered questionnaire. We sampled fifty-four HCs III and eight HCs IV. In Uganda, HCs are structured from HC I to HC IV and the health care package provided increases with increasing level of the HC. We used Epidata version 3.1 to create database and analysis was performed using Stata 16. Descriptive and logistic regression analyses were performed. Factors with p-values ≤ 0.05 were considered as predictors of outcome. Results There were 286 participants who completed the questionnaire: Majority (188, 66%) were females. Nurses were 153 (54%). 141 (75%) female participants self-reported to have been screened for cervical cancer. 171 (60%) participants had adequate knowledge of cervical cancer. 187 (66%) participants had positive attitudes. Participants who indicated not to have ever received training on cervical cancer screening were less likely to have adequate knowledge (AOR = 0.39, 95% CI 0.21–0.71). Participants who indicated not to have ever been trained on cervical cancer screening were less likely to have positive attitudes (AOR = 0.52, 95% CI 0.28–0.97). Conclusion Health workers from rural HCs in Uganda play crucial role in cervical cancer prevention as they can reach a wider community. Their significance in the prevention of cervical cancer points to the need for Uganda and other sub-Sahara Africa (SSA) countries to establish training to improve their knowledge, attitudes, and practical skills on cervical cancer screening. Furthermore, Uganda government should develop and disseminate guidelines for cervical cancer prevention to rural health workers to promote standardised cervical cancer prevention activities.

Abstract Background To evaluate the short- and mid-term effect of a specially tailored resistance and balance training provided in addition to usual cardiac rehabilitation (CR) care program in older patients after valve surgery/intervention. Methods Single-center (inpatient CR clinic in Lithuania) randomized controlled trial. Two hundred fifty-two patients were assessed for eligibility on the first day of admittance to CR early after (14.5 ± 5.9 days) valve surgery/intervention between January 2018 and November 2019. Participants were coded centrally in accordance with randomization 1:1 using a computerized list. Control group (CG) patients were provided with usual care phase-II-CR inpatient multidisciplinary CR program, while intervention group (IG) patients received additional resistance and balance training (3 d/wk). Patients participated in a 3-month follow-up. Main outcome measures were functional capacity (6 min walk test (6MWT, meters), cardiopulmonary exercise testing), physical performance (Short Physical Performance Battery (SPPB, score) and 5-m walk test (5MWT, meters/second)), strength (one repetition maximum test for leg press), physical frailty (SPPB, 5MWT). Results One hundred sixteen patients (76.1 ± 6.7 years, 50% male) who fulfilled the study inclusion criteria were randomized to IG (n = 60) or CG (n = 56) and participated in CR (18.6 ± 2.7 days). As a result, 6MWT (IG 247 ± 94.1 vs. 348 ± 100.1, CG 232 ± 102.8 vs. 333 ± 120.7), SPPB (IG 8.31 ± 2.21 vs. 9.51 ± 2.24, CG 7.95 ± 2.01 vs. 9.08 ± 2.35), 5MWT (IG 0.847 ± 0.31 vs. 0.965 ± 0.3, CG 0.765 ± 0.24 vs 0.879 ± 0.29) all other outcome variables and physical frailty level improved significantly (p

Abstract Background Uganda has one of the highest burdens of cervical cancer globally. In 2010 the Ugandan Ministry of Health launched the Strategic Plan for Cervical Cancer Prevention and Control with the hope of developing cervical cancer policy in Uganda. This study explored the beliefs of senior key informants in Uganda about cervical cancer prevention, the control programme, and the relevance of cervical cancer policy. Methods We conducted 15 key informant interviews with participants from six organisations across Northern and Central Uganda. Participants were drawn from district local government health departments, St. Mary’s Hospital Lacor, Uganda Nurses and Midwifery Council, non-governmental organisations (NGOs) and Ministry of Health in Kampala, Uganda. The interview recordings were transcribed and analysed using thematic analysis. Results Seven themes emerged relating to the cervical cancer prevention and control programmes in Uganda: (1) policy frameworks for cervical cancer, (2) operationalising cervical cancer prevention and control, (3) financial allocation and alignment, (4) human resources and capability, (5) essential supplies and vaccines, (6) administrative data and resource distribution, and (7) cervical cancer services. Conclusions The key informants perceive that the lack of a cervical cancer policy in Uganda is hindering cervical cancer prevention and control programmes. Therefore, the Ministry of Health and stakeholders need to work together in coming up with an effective policy framework that will accelerate efforts towards cervical cancer prevention and control in Uganda.

Abstract Background Targeted treatment with Epidermal Growth Factor Receptor (EGFR) tyrosine kinase inhibitors (TKIs) is superior to systemic chemotherapy in non-small cell lung cancer (NSCLC) patients with EGFR gene mutations. Detection of EGFR mutations is a challenge in many patients due to the lack of suitable tumour specimens for molecular testing or for other reasons. EGFR mutations are more common in female, Asian and never smoking NSCLC patients. Methods Patients were from a population-based retrospective cohort of 3556 patients diagnosed with non-squamous non-small cell lung cancer in northern New Zealand between 1 Feb 2010 and 31 July 2017. A total of 1694 patients were tested for EGFR mutations, of which information on 1665 patients was available for model development and validation. A multivariable logistic regression model was developed based on 1176 tested patients, and validated in 489 tested patients. Among 1862 patients not tested for EGFR mutations, 129 patients were treated with EGFR-TKIs. Their EGFR mutation probabilities were calculated using the model, and their duration of benefit and overall survival from the start of EGFR-TKI were compared among the three predicted probability groups: 0.6. Results The model has three predictors: sex, ethnicity and smoking status, and is presented as a nomogram to calculate EGFR mutation probabilities. The model performed well in the validation group (AUC = 0.75). The probability cut-point of 0.2 corresponds 68% sensitivity and 78% specificity. The model predictions were related to outcome in a group of TKI-treated patients with no biopsy testing available (n = 129); in subgroups with predicted probabilities of 0.6, median overall survival times from starting EGFR-TKI were 4.0, 5.5 and 18.3 months (p = 0.02); and median times remaining on EGFR-TKI treatment were 2.0, 4.2, and 14.0 months, respectively (p

Abstract Background Diabetic retinopathy screening (DRS) leads to the earlier detection of retinopathy and treatment that can prevent or delay the development of diabetes-related blindness. However, uptake continues to be sub-optimal in many countries, including Ireland. Routine management of type 2 diabetes largely takes place in primary care. As such, there may be an opportunity in primary care to introduce interventions to improve DRS uptake. However, few studies test the feasibility of interventions to enhance DRS uptake in this context. Our aim is to investigate the feasibility of an implementation intervention (IDEAs (Improving Diabetes Eye screening Attendance)) delivered in general practice to improve the uptake of the national DRS programme, RetinaScreen. Methods The IDEAs study is a cluster randomised pilot trial with an embedded process evaluation and economic evaluation. Following stratification by practice size, eight general practices (clusters) will be randomly allocated to intervention (n = 4) or wait-list control groups (n = 4). The intervention will be delivered for 6 months, after which, it will be administered to wait-list control practices. The intervention is multi-faceted and comprises provider-level components (training, audit and feedback, health care professional prompt, reimbursement) and patient-level components (GP-endorsed reminder with information leaflet delivered opportunistically face-to-face, and systematically by phone and letter). Patient inclusion criteria are type 1 or type 2 diabetes and DRS programme non-attendance. A multi-method approach will be used to determine screening uptake, evaluate the trial and study procedures and examine the acceptability and feasibility of the intervention from staff and patient perspectives. Quantitative and qualitative data will be collected on intervention uptake and delivery, research processes and outcomes. Data will be collected at the practice, health professional and patient level. A partial economic evaluation will be conducted to estimate the cost of delivering the implementation intervention in general practice. Formal continuation criteria will be used to determine whether IDEAs should progress to a definitive trial. Discussion Findings will determine whether IDEAsis feasible and acceptable and will be used to refine the intervention and study procedures. A definitive trial will determine whether IDEAs is a cost-effective intervention to improve DRS uptake and reduce diabetes-related blindness. Trial registration ClinicalTrials.gov NCT03901898 . Registered 3rd April 2019,

Catch-and-release angling is widespread, but the impacts of this practice for captured individuals are understudied, especially among elasmobranchs. Studies on sub-lethal behavioural impacts are particularly sparse, despite their importance for the interpretation of biologging data and for assessments of species’ tolerance to capture. In this study, the behavioural responses of flapper skate (Dipturus intermedius) to catch-and-release angling were described for the first time, using archival observations (depth and temperature) for 21 tag deployment/retrieval events and five recreational angling events that occurred during tagged individuals’ time at liberty from charter vessels off the west coast of Scotland in 2016–17. During capture (8–50 minutes), the changes in depth and temperature experienced by individuals typically exceeded natural variability. Post-release, behavioural change was apparent from visual inspection, regression and functional data analysis of the time series. Immediately following release, movements into deeper water and short periods of low vertical activity (usually 1–2 hours in duration) were common. However, overall average vertical activity was typically around 38% higher in the 12 hours following release than in undisturbed activity. A small number of individuals (n = 3, 14%) exhibited irregular post-release behaviour in the form of rapid, transient re-ascents towards the surface following release. Collectively, the evidence for limited, short-term behavioural changes suggests that flapper skate behaviour is relatively resilient to catch-and-release angling from charter vessels, but irregular post-release behaviour in 14% of individuals is sufficiently notable to indicate that further research is required on the impacts of this practice. This study clearly demonstrates the value of biologging data and behavioural analyses for examining the impacts of disturbance and separating ‘disturbed’ and ‘undisturbed’ behaviours in studies of animal movement.

The use of mineral-based cutting fluids in machining has the drawback of affecting the environment and industries are under pressures to reduce its use in favor of cleaner productions. In this regard, the vegetal-based cutting fluids can be a superior alternative, provided they improve the technical outcomes. In the milling process, dry cutting is commonly performed, however, the application of cutting fluids using the minimum quantity of lubricant (MQL) method has proven advantageous when compared with dry machining. Furthermore, in the midst of the availability of several cutting fluids in the market, the testing of their individual performance can ascertain their potential and effectiveness for a particular application. This study examined the performances of two vegetable-based and one mineral-based oils applied by the MQL method, followed by their comparison with dry cutting amid end milling of AISI 1045 steel with TiAlN-coated cemented carbide inserts. The cutting temperature, machining forces, power consumption, workpiece surface roughness, tool life, and tool wear mechanisms were chosen as the output parameters. The experiments were conducted using two cutting speeds (150 and 200 m/min) and feed rates (0.07 and 0.14 mm/tooth), and constant axial (1 mm) and radial depths of the cut (25 mm). The temperature was measured using a K-type thermocouple soldered to the part and an infrared camera. The power was monitored with a Fluke 435 energy analyzer, and the machining force components with a Kistler dynamometer. The worn inserts were inspected under a scanning electron microscope (SEM) to analyze the tool wear mechanism. The MQL-assisted application of the cutting fluids notably lowered the cutting temperature and increased the tools’ lives. However, the cutting fluids did not reflect any significant effect on the machining force, power consumption, or surface roughness. Among all the analyzed cutting conditions, the abrasive wear mechanism dominated, damaging the cutting edges, flank, and rake surfaces of the cutting tools. In addition, adhesive and diffusion wear mechanisms were also observed.

Abstract Background In Latin America, where Plasmodium vivax malaria is more prevalent, it is known that this species plays an important role in the sustainability of transmission, and can have an impact on morbidity in terms of anaemia, nutritional status, and cognitive development in children. Methods The present study aimed to assess the impact of malaria infection on cognition of children in a peri-urban community in the Brazilian Amazon with moderate endemicity by applying Home Inventory and WPPSI-IV. A non-concurrent cohort study was designed and the cognitive, haematological, and nutritional profiles of the children were assessed. Children with documented malaria history were identified from official reported data. Results A total of 219 children aged between 2 and 7 years were enrolled. Although 205 (95%) children had normal birth weight, 177 (81%) were malnourished, and 35 (16%) had anaemia. Among the 100 (46%) children who experienced at least one episode of malaria, 89 (89%) children demonstrated low level of cognitive development. The findings showed that Plasmodium vivax malaria was an independent risk factor for low cognitive development. Conclusions In addition to the known economic impact of malaria in the Amazon region, the study highlights the deleterious effects P. vivax malaria has on the socio-cultural development of the population.

Seasonal and ontogenetic variations in depth use by benthic species are often concomitant with changes in their spatial distribution. This has implications for the efficacy of spatial conservation measures such as marine protected areas (MPAs). The critically endangered flapper skate (Dipturus intermedius) is the designation feature of an MPA in Scotland. This species is generally associated with deeper waters >100 m; however, little is known about its seasonal or ontogenetic variation in habitat use. This study used archival depth data from 25 immature and mature flapper skate tagged in the MPA over multiple years. Time series ranged from 3 to 772 (mean = 246) days. Generalised additive mixed models and highest density intervals were used to identify home (95%) and core (50%) highest density depth regions (HDDRs) to quantify depth use in relation to time of year and body size. Skate used a total depth range of 1–312 m, but home HDDRs typically occurred between 20 and 225 m. Core HDDRs displayed significant seasonal and ontogenetic variations. Summer core HDDRs (100–150 m) suggest high occupancy of the deep trenches in the region by skate of most size classes. There was an inverse relationship between body size and depth use and a seasonal trend of skate moving into shallow water over winter months. These results suggest that flapper skate are not solely associated with deep water, as skate, especially large females, are frequently found in shallow waters (25–75 m). The current management, which protects the entire depth range, is appropriate for the protection of flapper skate through much of its life history. This research demonstrates why collecting data across seasonal scales and multiple ontogenetic stages is needed to assess the effectiveness of spatial management.

Reports suggest that dogs have experienced more quality time with their owners and have exhibited less separation-related behaviour during COVID-19. This study aims to define and explore the changes in the social behaviour of adult dogs, identify any perceived short- and long-term effects and identify the implications that future events may have due to the implementation and withdrawal of COVID-19 restrictions. Owners of dogs aged between 3 and 6 years living in England were recruited for semi-structured interviews about their dogs’ social behaviours before, during and after lockdown. Interviews were transcribed and thematic analysis was used to identify key themes. Fifteen owners of eighteen dogs were interviewed in December 2021 to January 2022. All owners interviewed noticed a change in behaviour either during or following the COVID-19 lockdowns. Many owners found that fear-related and aggressive behaviours increased, particularly after lockdown restrictions had been lifted. There is a risk to human and animal safety if fear-related behaviours are not properly managed and there is a danger to dog welfare through relinquishment as owners struggle to cope with problematic behaviours. An increase in the duration of walks is comparable to other studies; however, this study found that many owners continued to walk their dogs more than restrictions allowed. Reliable information or behavioural support by qualified professionals may be needed to aid owners in mitigating the impacts of the COVID-19 pandemic. Behaviour modification plans or information could include positive techniques such as desensitisation and counterconditioning. More widely, owners should be prepared for any future behavioural changes due to unpredictable events which may alter the dog–owner dynamic. Results can be adapted to the increase in at-home working following the pandemic or other novel experiences and changes of routine such as retirement, job change or relocation. More awareness of the long-term implications of the COVID-19 pandemic is needed to prepare dog behaviour professionals for future owner concerns.

BackgroundNon-squamous non-small cell lung cancer (NSCLC) patients with Epidermal Growth Factor Receptor (EGFR) mutation benefit from targeted treatments. Previous studies reported EGFR mutation-positive proportions among tested non-squamous NSCLC patients. However, incidence rates and population risk of EGFR mutation-positive and EGFR mutation-negative non-squamous NSCLC have not been assessed. This study therefore aimed to estimate the population-based incidence rates of EGFR mutation-positive and EGFR mutation-negative non-squamous NSCLC in different population groups defined by sex, ethnic group and smoking status.MethodsThis study included data from all non-squamous NSCLC patients diagnosed in northern New Zealand between 1/02/2010 and 31/07/2017 (N = 3815), obtained from a population-based cancer registry. Age-specific incidence rates, WHO age-standardised rates (ASRs) and rates adjusted for incomplete testing were calculated for EGFR mutation-positive and EGFR mutation-negative diseases for the study cohort as a whole and subgroups of patients.ResultsAmong 3815 patients, 45% were tested for EGFR mutations; 22.5% of those tested were EGFR mutation-positive. The ASR of EGFR mutation-positive NSCLC was 5.05 (95%CI 4.71-5.39) per 100,000 person-years. ASRs for EGFR mutation-positive NSCLC were higher for females than males: standardised incidence ratio (SIR) 1.50 (1.31-1.73); higher for Pacifica, Asians and Māori compared with New Zealand Europeans: SIRs 3.47 (2.48-4.85), 3.35 (2.62-4.28), and 2.02 (1.43-2.87), respectively; and, only slightly increased in ever-smokers compared with never-smokers: SIR 1.25 (1.02-1.53). In contrast, the ASR of EGFR mutation-negative NSCLC was 17.39 (16.75-18.02) per 100,000 person-years, showing a strong association with smoking; was higher for men; highest for Māori, followed by Pacifica and then New Zealand Europeans, and lowest for Asians. When corrected for incomplete testing, SIRs by sex, ethnicity and smoking, for both diseases, remained similar to those based on tested patients.ConclusionThe population risk of EGFR mutation-positive NSCLC was significantly higher for Māori and Pacifica compared with New Zealand Europeans.

Abstract Background To describe the development of polypharmacy and its components in a British birth cohort in its seventh decade and to investigate socioeconomic and gender differences independent of disease burden. Methods Data from the MRC National Survey for Health and Development were analysed to determine the prevalence and composition of polypharmacy at age 69 and changes since ages 60 to 64. Multinomial regression was used to test associations between gender, education and occupational social class and total, cardiological and non-cardiological polypharmacy controlling for disease burden. Results At age 69, 22.8% of individuals were taking more than 5 medications. There was an increase in the use of 5 to 8 medications (+ 2.3%) and over 9 medications (+ 0.8%) between ages 60–64 and 69. The greatest increases were found for cardiovascular (+ 13.4%) and gastrointestinal medications (+ 7.3%). Men experienced greater cardiological polypharmacy, women greater non-cardiological polypharmacy. Higher levels of education were associated with lower polypharmacy independent of disease burden, with strongest effects seen for over five cardiological medications (RRR 0.3, 95% CI 0.2–0.5 p

Recent technological developments facilitate the collection of location data from fishing vessels at an increasing rate. The development of low-cost electronic systems allows tracking of small-scale fishing vessels, a sector of fishing fleets typically characterized by many, relatively small vessels. The imminent production of large spatial datasets for this previously data-poor sector creates a challenge in terms of data analysis. Several methods have been used to infer the spatial distribution of fishing activities from positional data. Here, we compare five approaches using either vessel speed, or speed and turning angle, to infer fishing activity in the Scottish inshore fleet. We assess the performance of each approach using observational records of true vessel activity. Although results are similar across methods, a trip-based Gaussian mixture model provides the best overall performance and highest computational efficiency for our use-case, allowing accurate estimation of the spatial distribution of active fishing (97% of true area captured). When vessel movement data can be validated, we recommend assessing the performance of different methods. These results illustrate the feasibility of designing a monitoring system to efficiently generate information on fishing grounds, fishing intensity, or monitoring of compliance to regulations at a nationwide scale in near-real-time.

BACKGROUND AND OBJECTIVE: Radiation therapy has increasingly been used in the management of pelvic malignancies. However, the use of radiation continues to pose a risk of a secondary malignancy to its recipients. This study investigates the risk of secondary malignancy development following radiation for primary pelvic malignancies. METHODS: A retrospective cohort review of the Surveillance, Epidemiology, and End Results database from 1975 to 2016 was performed. Primary pelvic malignancies were subdivided based on the receipt of radiation, and secondary malignancies were stratified as pelvic or nonpelvic to investigate the local effect of radiation. KEY FINDINGS AND LIMITATIONS: A total of 2 102 192 patients were analyzed (1 189 108 with prostate, 315 026 with bladder, 88 809 with cervical, 249 535 with uterine, and 259 714 with rectal/anal cancer). The incidence rate (defined as cases per 1000 person years) of any secondary malignancies (including but not limited to secondary pelvic malignancies) was higher in radiation patients than in nonradiation patients (incidence rate ratio [IRR] 1.04, confidence interval [CI] 1.03-1.05), with significantly greater rates noted in radiation patients with prostate (IRR 1.22, CI 1.21-1.24), uterine (IRR 1.34), and cervical (IRR 1.80, CI 1.72-1.88) cancer. While the overall incidence rate of any secondary pelvic malignancy was lower in radiation patients (IRR 0.79, CI 0.78-0.81), a greater incidence was still noted in the same cohorts including radiation patients with prostate (IRR 1.42, CI 1.39-1.45), uterine (IRR 1.15, CI 1.08-1.21), and cervical (IRR 1.72, CI 1.59-1.86) cancer. CONCLUSIONS AND CLINICAL IMPLICATIONS: Except for localized cervical cancer, when put in the context of median overall survival, the impact of radiation likely does not carry enough weight to change practice patterns. Radiation for pelvic malignancies increases the risk for several secondary malignancies, and more specifically, secondary pelvic malignancies, but with a relatively low absolute risk of secondary malignancies, the benefits of radiation warrant continued use for most pelvic malignancies. Practice changes should be considered for radiation utilization in malignancies with excellent cancer-specific survival such as cervical cancer. PATIENT SUMMARY: The use of radiation for the management of pelvic malignancies induces a risk of secondary malignancies to its recipients. However, the absolute risk being low, the benefits of radiation warrant its continued use, and a change in practice patterns is unlikely.

Human–animal interactions (HAIs) in zoos can be rewarding for both humans and animals, but can also be fraught with ethical and welfare perils. Contact with animals can be beneficial for all parties involved, and can indeed lead to pro-conservation and respect for nature behaviours being adopted by humans after so-called “profound experiences” of connecting or interacting with animals. Yet, human–animal interactions may also increase certain individuals’ desires for inappropriate wild-animal ‘pet’ ownership, and can convey a false sense of acceptability of exploiting animals for “cheap titillation”. Indeed, this has been reflected in a recent research review conducted on animal–visitor interactions in zoos from a number of different countries and global regions. These are unintended consequences that ”modern, ethical zoos” would try to minimise, or avoid completely where possible, though most zoos still offer close-contact experiences with their animals. Three ethical frameworks that may be beneficial for ethically run zoos to incorporate when considering human–animal interactions are: Compassionate Conservation, Conservation Welfare and Duty of Care. These three ethical frameworks are concerned with the welfare state and outcomes for individual animals, not just the population or species. Human–animal interactions in zoos may be acceptable in many circumstances and may be beneficial to both animal and human participants; however, they must be closely monitored through welfare tracking tools. The World Association of Zoos and Aquariums (WAZA) has published guidelines for human–animal interactions that are mandatory for member institutions to adhere to, although whether these guidelines are taken as mandatory or suggestions at individual institutions is unknown. Some suggestions for relevant extensions to the guidelines are suggested herein. Melding Duty of Care and the two Conservation ethical frameworks would be ideal for assessing the ethical acceptability of such interactions as they currently occur, and for considering how they should be modified to occur (or not) into the future in zoological settings.

This interview is a discussion with Ken Foster, eminent and groundbreaking sports law scholar, currently Associate Fellow at the Centre for Law and Popular Culture at the University of Westminster. Foster is asked to reflect on the development of sports law scholarship from the 1980s and his own specific experiences as the first academic to teach sport and law in the UK during the 1980s. In his reflections on the development of the field, notable in its early days for ‘lack of materials’, Foster highlights theimportance of theory, of sporting culture and custom and the still under-researched area of ‘private adjudication systems in sport’. It concludes that ‘sport specific or national tribunals’ still offers a wealth of opportunities to explore materials still ‘waiting to be researched’. This interview forms part of ESLJ’s special collection, ‘Ken Foster and the Development of Sports Law’ which includes a new (2019) article by Ken Foster, ‘Global Sports Law Revisited’ https://doi.org/10.16997/eslj.228.The following questions were sent to Ken Foster in April 2018 and a dialogue took place over the following months clarifying some of the points made. The questions were designed by the ESLJ team.

The concept of sentience, how it is characterised and which non-human animals possess it have long been of contention in academic and intellectual debates. Many have argued that there is no way to empirically know that animals have conscious experiences. Yet others argue that consciousness, awareness and sentience in non-human animals can be quite obvious, and can indeed be measured empirically. Most modern declarations of animal sentience from official organisations and governments now include all vertebrate animals as sentient beings, including reptiles and fish. Some declarations also include some invertebrate species. This conceptual, ethical and scientific review first focuses on conceptual components and definitions of consciousness, awareness and sentience. It then specifically discusses how cognitive, neurobiological, ethological and comparative psychological research in non-avian reptiles over the last century has evidenced many capacities that historically were denied to this class of animals. Non-avian reptiles do indeed possess all of the necessary capacities to be declared as sentient beings, at least in the small proportion of reptile species that have actually been empirically investigated so far. It is suggested that much innovative future research will continue to uncover evidence of capabilities linked to sentience within a wide range of species, including non-avian reptiles, fish and invertebrates.

Lin (2014) developed a framework of the method of the sample-moment-based density approximant, for estimating the probability density function of microdata based on noise multiplied data. Theoretically, it provides a promising method for data users in generating the synthetic data of the original data without accessing the original data; however, technical issues can cause problems implementing the method. In this paper, we describe a software package called MaskDensity14, written in the R language, that uses a computational approach to solve the technical issues and makes the method of the sample-moment-based density approximant feasible. MaskDensity14 has applications in many areas, such as sharing clinical trial data and survey data without releasing the original data. Keywords: Confidential data, Data masking, Multiplicative noise, Sample-moment-based density approximant

GROMACS is one of the most widely used open-source and free software codes in chemistry, used primarily for dynamical simulations of biomolecules. It provides a rich set of calculation types, preparation and analysis tools. Several advanced techniques for free-energy calculations are supported. In version 5, it reaches new performance heights, through several new and enhanced parallelization algorithms. These work on every level; SIMD registers inside cores, multithreading, heterogeneous CPU–GPU acceleration, state-of-the-art 3D domain decomposition, and ensemble-level parallelization through built-in replica exchange and the separate Copernicus framework. The latest best-in-class compressed trajectory storage format is supported. Keywords: Molecular dynamics, GPU, SIMD, Free energy

Renal cell carcinoma (RCC) is a common diagnosis, of which a notable portion of patients present with an extension into the venous circulation causing an inferior vena cava (IVC) tumor thrombus. Venous extension has significant implications for staging and subsequent treatment planning, with recommendations for more aggressive surgical removal, although associated surgical morbidity and mortality is relatively increased. The methods for surgical removal of RCC with IVC thrombus remain complex, particularly surrounding the use of robot-assisted surgery. Robot assistance for radical nephrectomy in this context is recently emerging. Thrombus level has important implications for surgical technique and prognosis. Other preoperative considerations may include location, laterality, size, and wall invasion. The urology literature on treatment of such tumors is largely limited to case series and institutional studies that describe the feasibility of various surgical options for these complex tumors. Further understanding of the outcomes and patient-specific risk factors would shed increased light on the optimal treatment for such cases. This narrative review provides a thorough overview on the previously reported use of robot-assisted nephrectomy in RCC with IVC thrombus to inform further studies which may optimize outcomes and guide shared decision-making.