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Globally, 5–30% of children have eczema which could be partly attributable to skin cleansing routines. Evidence-based international guidance on this topic is lacking and dated national UK guidelines may not reflect best practices. We conducted a mixed method, UK-wide (England, Scotland, Northern Ireland and Wales) cross-sectional survey to investigate parental cleansing of their newborn's skin; 973 responses were suitable for inclusion. Sixty percent (60%) of participants delayed the first cleansing after birth for 48 h and 79.4% of participants cleansed their newborn's nappy area with each change. Participants from Scotland were more likely to cleanse their newborn within the first 48 h (X22 = 29.3, p

Research has demonstrated the positive effects self-rostering can have on employees’ work-life balance by allowing staff to select shifts that fit in with personal commitments. The midwifery team at Oxford Brookes University introduced self-rostering for placement shifts in an attempt to support students and practice colleagues, and enable students to continue practising during the pandemic. The roll-out of the initiative has been successful despite initial challenges. A ward manager appreciated the resulting reduction in her workload and observed students’ increased placement satisfaction. Two students described how they have benefitted from the autonomy and improved work-life balance that self-rostering provides.

Supplementary Table S1. Description of ELF levels in the most frequent jobs in low (

Background Exposure to high doses of ionizing radiation is among the few well-established brain tumour risk factors. We used data from the Interphone study to evaluate the effects of exposure to low-dose radiation from diagnostic radiological examinations on glioma, meningioma and acoustic neuroma risk. Methods Brain tumour cases (2644 gliomas, 2236 meningiomas, 1083 neuromas) diagnosed in 2000–02 were identified through hospitals in 13 countries, and 6068 controls (population-based controls in most centres) were included in the analysis. Participation across all centres was 64% for glioma cases, 78% for meningioma cases, 82% for acoustic neuroma cases and 53% for controls. Information on previous diagnostic radiological examinations was obtained by interviews, including the frequency, timing and indication for the examinations. Typical brain doses per type of examination were estimated based on the literature. Examinations within the 5 years before the index date were excluded from the dose estimation. Adjusted odds ratios were estimated using conditional logistic regression. Results No materially or consistently increased odds ratios for glioma, meningioma or acoustic neuroma were found for any specific type of examination, including computed tomography of the head and cerebral angiography. The only indication of an elevated risk was an increasing trend in risk of meningioma with the number of isotope scans, but no such trends for other examinations were observed. No gradient was found in risk with estimated brain dose. Age at exposure did not substantially modify the findings. Sensitivity analyses gave results consistent with the main analysis. Conclusions There was no consistent evidence for increased risks of brain tumours with X-ray examinations, although error from selection and recall bias cannot be completely excluded. A cautious interpretation is warranted for the observed association between isotope scans and meningioma.

Hidradenitis suppurativa (HS) is a chronic, inflammatory skin disease characterized by the formation of recurrent abscesses in apocrine-bearing areas. In advanced stages, chronic inflammation leads to sinus tract formation and cicatrization.

Conserving critical wildlife habitat at a regional scale can be challenging, especially when the region hosts a range of land uses, jurisdictions, and competing interests. Abundant opportunities exist for cooperation when vested conservation entities find common ground to use their unique strengths in a cooperative effort to protect and restore wetlands for wildlife and people. We present the Montezuma Wetlands Complex (MWC) Land Protection Partnership as a case study of regional conservation collaboration aimed at identifying areas in greatest need of wetland protection and restoration to support wetland wildlife and provide wildlife-based recreation. The MWC is among the most important wetland complexes in the Atlantic flyway of eastern North America for migratory birds because it provides critical migratory stopover habitat for millions of birds and regionally unique habitats for breeding birds and resident wildlife, including numerous endangered and threatened (E&T) species. This case study demonstrates how state, federal, and nonprofit entities with differing goals and objectives can partner to protect and restore critical wetland habitat for wildlife. Partners optimized efforts by developing an online survey that included physical, land cover, biological, and people/use attributes which were ranked by each partner to determine common priorities and applied these into a spatial mapping, decision-support tool. Within attribute categories, land protection (physical), emergent marshes (land use), E&T (biological), and recreational areas (people/use) were highest ranked by partners. The decision-support tool provided an objective method of ranking parcels of land for public outreach efforts by the partners to protect and restore wetland wildlife habitat.

Background Daratumumab is a human CD38-directed monoclonal antibody indicated for the treatment of relapsed and refractory multiple myeloma (MM). Methods A multicenter, open-label treatment protocol provided early access to daratumumab for patients who had progressive MM after they received ≥3 prior lines of therapy that included a proteasome inhibitor and an immunomodulatory agent or if they were refractory to both a proteasome inhibitor and an immunomodulatory agent. Patients received daratumumab 16 mg/kg weekly for 8 weeks, every other week for 16 weeks, and monthly until they developed disease progression, unacceptable toxicity, or 60 days after the drug gained US approval. Treatment-emergent grade ≥3 adverse events (AEs), serious AEs, and AEs of special interest were collected. Results Three hundred forty-eight patients were enrolled at 39 US sites between June and December 2015. Patients received study therapy for a median of 1.9 months (range, 0.03-6.0 months). Fifty-two percent of patients transitioned to commercially-available daratumumab and 37% discontinued because of progressive disease. Grade ≥3 AEs occurred in 50% of patients, including thrombocytopenia (15%) and anemia (14%). Serious AEs occurred in 35% of patients (12% were drug-related), including infections (11%). Infusion reactions occurred in 56%, 2%, and 2% of patients during the first, second, and all subsequent infusions, respectively; respiratory symptoms (cough, dyspnea, throat irritation, nasal congestion) were common. The infusion reaction rate for the first infusion was 38% in 50 patients at 2 sites who received montelukast as premedication for their first infusion and 59% in patients who did not receive montelukast. Conclusions The current findings are consistent with previously reported trials and confirm the safety profile of daratumumab in heavily pretreated US patients who have relapsed or refractory MM. Cancer 2018;124:000-000.

Une surveillance en santé publique en temps opportun est nécessaire pour comprendre les tendances associées à la consommation d’opioïdes et à ses méfaits connexes. Cet article met en correspondance les données sur la délivrance d’opioïdes recueillies par le Nova Scotia Prescription Monitoring Program et les données sur les décès compilées par le Service de médecin légiste de la Nouvelle-Écosse. La surveillance simultanée des tendances au moyen de ces sources de données est essentielle pour détecter les effets sur la population (qu’ils soient intentionnels ou non) des interventions liées à la prescription d’opioïdes.

Timely public health surveillance is required to understand trends in opioid use and harms. Here, opioid dispensing data from the Nova Scotia Prescription Monitoring Program are presented alongside fatality data from the Nova Scotia Medical Examiner Service. Concurrent monitoring of trends in these data sources is essential to detect population-level effects (whether intended or unintended) of interventions related to opioid prescribing.Une surveillance en santé publique en temps opportun est nécessaire pour comprendre les tendances associées à la consommation d’opioïdes et à ses méfaits connexes. Cet article met en correspondance les données sur la délivrance d’opioïdes recueillies par le Nova Scotia Prescription Monitoring Program et les données sur les décès compilées par le Service de médecin légiste de la Nouvelle-Écosse. La surveillance simultanée des tendances au moyen de ces sources de données est essentielle pour détecter les effets sur la population (qu’ils soient intentionnels ou non) des interventions liées à la prescription d’opioïdes.

4530 Background: FGFRa appear in approximately 15% of cases of mUC. Data on whether FGFRa in mUC have a prognostic impact or predictive benefit for particular treatments have been limited by small sample sizes. The objective of this study was to evaluate the association between tumor FGFRa and clinical outcomes of patients with advanced UC or mUC regardless of therapy type and status. Methods: A convenience sample of oncologists and urologists across the United States provided patient level data on 400 patients with stage IIIb or IV UC via a standardized questionnaire over a 1-month period (August 17, 2020 – September 20, 2020). Study design enriched for FGFRa by requiring physicians to provide ≥1 FGFRa patient record. The questionnaire included physician characteristics, patient demographic information, FGFR status, therapy given, response, and clinical and radiographic measures of progression. Patient records were eligible for inclusion if they were identified and treated during July 1, 2017, to June 30, 2019. Cox proportional hazards models were used to estimate adjusted risk of disease progression by FGFR status. Results: A total of 104 physicians (58.7% medical oncologists, 31.7% hematologic oncologists, and 9.6% urologic oncologists) contributed 414 patient records Overall, 73.9% of the patients were male and the average age was 64.5 years (SD ±10.6). Median follow-up was 15 months. Of the 414 patients, 218 (52.7%) had FGFRa and 196 (47.3%) had FGFR wild-type ( FGFRwt) mUC . Of the 218 patients with FGFRa, 47.2% were treated with front-line chemo, 27.5% with a programmed death-ligand 1 inhibitor (PD-L1), 11.5% with chemo + PD-L1, and 13.8% with other treatments. Of the 196 FGFRwt patients, 63.2% were treated with front-line chemo, 21.9% with PD-L1, 12.2% with chemo + PD-L1, and 2.6% with other treatments. There was no difference in response or progression status for those receiving front-line chemo (HR, 1.15; 95% CI, 0.86-1.55). Among 97 patients (55 FGFRa and 42 FGFRwt) who received PD-L1 alone as front-line therapy, those who had FGFRa had an adjusted risk of progression 2 times higher than their FGFRwt counterparts (HR, 2.12; 95% CI, 1.13-4.00). Conclusions: Patients with FGFRa mUC progressed earlier than FGFRwt patients treated with front-line PDL-1 inhibitors; however, there was no difference in progression in patients treated with chemo based upon FGFR status. This real-world study using a survey design efficiently generated a relatively large FGFRa dataset, mitigating a core limitation of other studies assessing the patient population with FGFRa. Further work is warranted to validate these results and determine the optimal strategy for treating the patient with FGFRa mUC. Gene expression profiling of FGFRa mUC samples from clinical trials will help determine the potential impact of subtype or other features that may associate with benefit from therapy.

Supplemental Digital Content is available in the text., Objectives: To compare outcomes of children receiving noninvasive ventilation with those receiving invasive ventilation as first-line mode of mechanical ventilation following unplanned intensive care admission. Design: Propensity score-matched cohort study analyzing data prospectively collected by the Pediatric Intensive Care Audit Network over 8 years (2007–2014). Setting: Thirty-one PICUs in the United Kingdom and Ireland; twenty-one of whom submitted Pediatric Critical Care Minimum Dataset data for the entire study period. Patients: Children consecutively admitted to study PICUs. Planned admissions following surgery, unplanned admissions from other hospitals, those on chronic ventilation, and those who did not receive mechanical ventilation on the day of PICU admission were excluded. Interventions: Use of noninvasive ventilation, rather than invasive ventilation, as the first-line mode of mechanical ventilation. Measurements and Main Results: PICU mortality, length of ventilation, length of PICU stay, and ventilator-free days at day 28. During the study period, there were 151,128 PICU admissions. A total of 15,144 admissions (10%) were eligible for analysis once predefined exclusion criteria were applied: 4,804 (31.7%) received “noninvasive ventilation first,” whereas 10,221 (67.5%) received “invasive ventilation first”; 119 (0.8%) admissions could not be classified. Admitting PICU site explained 6.5% of the variation in first-line mechanical ventilation group (95% CI, 2.0–19.0%). In propensity score-matched analyses, receiving noninvasive ventilation first was associated with a significant reduction in mortality by 3.1% (95% CI, 1.7–4.6%), length of ventilation by 1.6 days (95% CI, 1.0–2.3), and length of PICU stay by 2.1 days (95% CI, 1.3–3.0), as well as an increase in ventilator-free days at day 28 by 3.7 days (95% CI, 3.1–4.3). Conclusions: Use of noninvasive ventilation as first-line mode of mechanical ventilation in critically ill children admitted to PICU in an unplanned fashion may be associated with significant clinical benefits. Further high-quality evidence regarding optimal patient selection and timing of initiation of noninvasive ventilation could lead to less variability in clinical care between institutions and improved patient outcomes.

Purpose of review Missions to the Moon or more distant planets are planned in the next future, and will push back the limits of our experience in providing medical support in remote environments. Medical preparedness is ongoing, and involves planning for emergency surgical interventions and anaesthetic procedures. This review will summarize what principles of ambulatory anaesthesia on Earth could benefit the environment of a space mission with its unique constraints. Recent findings Ambulatory anaesthesia relies on several principles such as improved patient pathway, correct patient selection, optimized procedural strategies to hasten recovery and active prevention of postoperative complications. Severe limitations in the equipment available and the skills of the crew members represent the key factors to be taken into account when designing the on-board medical system for future interplanetary space missions. Summary The application of some of the key principles of ambulatory anaesthesia, as well as recent advances in anaesthetic techniques and better understanding of human adaptation to the space environment might allow nonanaesthesiologist physicians to perform common anaesthetic procedures, whilst maximizing crew safety and minimizing the impact of medical events on the mission.

Large nasal septal perforations have higher extrusion rates with pre-fabricated septal obturators. A prospective cohort study was conducted including patients with septal perforation who underwent custom-made septal buttons and quality-of-life outcomes were measured. The mean total SNOT-22 score improved after insertion of the prosthesis with highest change in perforation specific symptoms (crusting, bleeding, whistling). Accurate sizing and successful closure with 3-D printing technology for obturation of large septal perforations have resulted in improvement in quality of life scores and perforation specific symptoms. Long-term retention rates of the prosthesis and temporal changes in quality of life indices will require further evaluation.

INTRODUCTION: The impact of patient gender in germinomas and medulloblastomas is a well-documented factor influencing incidence and outcome of these tumours, which may be due to differential susceptibility to tumourogenesis and treatment response between the genders. The role of gender phenotype in other paediatric CNS tumours is not as distinct. METHODS: The Surveillance Epidemiology and End Result (SEER) registry (covering 28% of US patients) between 2000–11 was used to collect age-adjusted incidence and overall survival (OS) rates for common paediatric (