Developing a national colorectal educational agenda: a survey of the Association of Coloproctology of Great Britain and Ireland

AIM

In order to develop its education agenda, the Association of Coloproctology of Great Britain and Ireland (ACPGBI) sought the opinion of its members on current coloproctology training needs. The aims of this study were to canvass multidisciplinary needs and explore the perceived gaps and barriers to meeting them.

METHOD

A learner-needs analysis was performed between July 2015 and October 2016. A bespoke electronic survey was sent to 1453 colorectal healthcare professionals [ACPGBI membership (1173), colorectal nurse specialists and allied health professionals (NAHPs) (261) and regional chapter-leads (19)] seeking their needs, experiences and barriers to training across the coloproctology disciplines.

RESULTS

In all, 390 responses were received [26.8% overall; 180 consultants/trainees (15%); 196 NAHPs (75%); 14 (74%) chapter-leads]. Lack of funding and difficulties in obtaining study leave were the most frequently reported barriers to course and conference attendance. Transanal total mesorectal excision and laparoscopic training were the top educational needs for consultants and trainees respectively. 79% of NAHP respondents reported education gaps on a broad range of clinical and non-clinical topics. NAHPs lacked information on relevant training opportunities and 27% felt available courses were insufficient to meet their educational needs. Wide heterogeneity in ACPGBI chapter composition and activity was reported. All groups felt the ACPGBI should increase the number of courses offered with coloproctology knowledge updates commonly requested.

CONCLUSION

A series of training needs across the coloproctology disciplines have been identified. These will underpin the development of the educational agenda for the ACPGBI.

Environmental Toxins Found Historically in the Polycythemia Vera Cluster Area and their Potential for Inducing DNA Damage

In 2006, the Agency for Toxic Substances and Disease Registry received a request to determine whether a cluster of polycythemia vera patients existed in a northeast Pennsylvania community. A significant cluster of PV cases was identified at the nexus of three counties near several hazardous waste sites. The current study evaluated the potential for a select number of environmental contaminants previously detected in the cluster area to induce DNA damage using in vitro assays with hematopoietic stem-cell derived progenitor cells.

CD34+ cells were isolated from normal cord blood samples and were cultured for 48–72 hours to generate erythroid progenitor cells. Eighteen compounds were chosen for the assay; arsenic trioxide, benzo(a)pyrene, benzene, methylene chloride, 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD), trichloroethylene, potassium chloride, ethylbenzene, benzo[k]fluoranthene, styrene, cadmium chloride, hydroquinone, 1,1,1-trichloroethane, sodium cyanide, manganese chloride, chromium oxide, lead oxide, and sodium arsenite. Genotoxicity of the compounds was determined using the comet assay, and toxicity determined via the cell viability assay.

Using the comet assay, 16 compounds at 10 nM concentration, induced a significant amount of DNA damage compared to the control. When evaluating whether a dose-dependent relationship was present, seventeen of the eighteen compounds led to greater DNA damage with increasing exposure concentrations. 2,3,7,8-TCDD was particularly potent, inducing DNA damage in virtually all cells at 1 μM. In conclusion, most of the toxins evaluated using the comet assay showed potential to induce DNA damage in hematopoietic cells, and the genotoxic effects were dose-dependent.

Crystal plasticity as an indicator of the viscous-brittle transition in magmas

Understanding the flow of multi-phase (melt, crystals and bubbles) magmas is of great importance for interpreting eruption dynamics. Here we report the first observation of crystal plasticity, identified using electron backscatter diffraction, in plagioclase in andesite dome lavas from Volcán de Colima, Mexico. The same lavas, deformed experimentally at volcanic conduit temperature and load conditions, exhibit a further, systematic plastic response in the crystalline fraction, observable as a lattice misorientation. At higher stress, and higher crystal fraction, the amount of strain accommodated by crystal plasticity is larger. Crystal plastic distortion is highest in the intact segments of broken crystals, which have exceeded their plastic limit. We infer that crystal plasticity precludes failure and can punctuate the viscous-brittle transition in crystal-bearing magmas at certain shallow magmatic conditions. Since crystal plasticity varies systematically with imposed conditions, this raises the possibility that it may be used as a strain marker in well-constrained systems.

Use of a modified Delphi approach to develop research priorities for the association of coloproctology of Great Britain and Ireland

AIM

The modified Delphi approach is an established method for reaching a consensus opinion among a group of experts in a particular field. We have used this technique to survey the entire membership of the Association of Coloproctology of Great Britain and Ireland (ACPGBI) to reach a consensus on prioritizing clinical research questions in colorectal disease.

METHOD

Three rounds of surveys were conducted using a web-based tool. In the first, the ACPGBI membership was invited to submit research questions. In Rounds 2 and 3 they were asked to score questions on priority. A steering group analysed the results of each round to identify those questions ranked as being of highest priority.

RESULTS

Five hundred and two questions were submitted in Round 1. Following two rounds of voting and analysis, a list of 25 priority questions was produced, including 15 cancer-related and 10 noncancer-related questions.

CONCLUSION

It is anticipated that these results will: (i) set the research agenda over the next few years for the study of colorectal disease in the United Kingdom, (ii) promote development and (iii) define funding of new research and prioritize areas of unmet clinical need where the potential clinical impact is greatest.

Determining the rp-process flow through 56Ni: resonances in 57Cu(p,γ)58Zn identified with GRETINA

An approach is presented to experimentally constrain previously unreachable (p, γ) reaction rates on nuclei far from stability in the astrophysical rp process. Energies of all critical resonances in the (57)Cu(p,γ)(58)Zn reaction are deduced by populating states in (58)Zn with a (d, n) reaction in inverse kinematics at 75 MeV/u, and detecting γ-ray-recoil coincidences with the state-of-the-art γ-ray tracking array GRETINA and the S800 spectrograph at the National Superconducting Cyclotron Laboratory. The results reduce the uncertainty in the (57)Cu(p,γ) reaction rate by several orders of magnitude. The effective lifetime of (56)Ni, an important waiting point in the rp process in x-ray bursts, can now be determined entirely from experimentally constrained reaction rates.

Attosecond pulse shaping around a Cooper minimum

High harmonic generation (HHG) is used to measure the spectral phase of the recombination dipole matrix element (RDM) in argon over a broad frequency range that includes the 3p Cooper minimum (CM). The measured RDM phase agrees well with predictions based on the scattering phases and amplitudes of the interfering s- and d-channel contributions to the complementary photoionization process. The reconstructed attosecond bursts that underlie the HHG process show that the derivative of the RDM spectral phase, the group delay, does not have a straightforward interpretation as an emission time, in contrast to the usual attochirp group delay. Instead, the rapid RDM phase variation caused by the CM reshapes the attosecond bursts.

Responsivity to criminogenic need in forensic intellectual disability services

BACKGROUND

Research has shown for some time that addressing criminogenic need is one of the crucial aspects of reducing reoffending in all types of offenders. Criminogenic need such as anger or inappropriate sexual interest is considered to be crucial in the commission of the offence. The aim of the present study is to investigate the extent to which forensic services address the needs of those accepted into services.

METHOD

This study reviews the treatment for 197 offenders with intellectual disability accepted into a range of services. Participants' case files were examined to ascertain the extent to which need was addressed through recognised therapies. A standard pro forma was used on which we had established good reliability across four research assistants.

RESULTS

The most frequently referred problems were violence and sexual offending. Specialist forensic intellectual disability community services were significantly more likely to provide treatment specifically designed to address index behaviours when compared to generic community services and secure services.

CONCLUSIONS

Various possible explanations of these findings are explored including staffing levels, diagnosed mental illness, expertise of staff and clarity of purpose in services.

Spontaneous reversal of the developmental aging of normal human cells following transcriptional reprogramming

AIM

To determine whether transcriptional reprogramming is capable of reversing the developmental aging of normal human somatic cells to an embryonic state.

MATERIALS & METHODS

An isogenic system was utilized to facilitate an accurate assessment of the reprogramming of telomere restriction fragment (TRF) length of aged differentiated cells to that of the human embryonic stem (hES) cell line from which they were originally derived. An hES-derived mortal clonal cell strain EN13 was reprogrammed by SOX2, OCT4 and KLF4. The six resulting induced pluripotent stem (iPS) cell lines were surveyed for telomere length, telomerase activity and telomere-related gene expression. In addition, we measured all these parameters in widely-used hES and iPS cell lines and compared the results to those obtained in the six new isogenic iPS cell lines.

RESULTS

We observed variable but relatively long TRF lengths in three widely studied hES cell lines (16.09-21.1 kb) but markedly shorter TRF lengths (6.4-12.6 kb) in five similarly widely studied iPS cell lines. Transcriptome analysis comparing these hES and iPS cell lines showed modest variation in a small subset of genes implicated in telomere length regulation. However, iPS cell lines consistently showed reduced levels of telomerase activity compared with hES cell lines. In order to verify these results in an isogenic background, we generated six iPS cell clones from the hES-derived cell line EN13. These iPS cell clones showed initial telomere lengths comparable to the parental EN13 cells, had telomerase activity, expressed embryonic stem cell markers and had a telomere-related transcriptome similar to hES cells. Subsequent culture of five out of six lines generally showed telomere shortening to lengths similar to that observed in the widely distributed iPS lines. However, the clone EH3, with relatively high levels of telomerase activity, progressively increased TRF length over 60 days of serial culture back to that of the parental hES cell line.

CONCLUSION

Prematurely aged (shortened) telomeres appears to be a common feature of iPS cells created by current pluripotency protocols. However, the spontaneous appearance of lines that express sufficient telomerase activity to extend telomere length may allow the reversal of developmental aging in human cells for use in regenerative medicine.

Rotational Skin Stretch Feedback: A Wearable Haptic Display for Motion

We present a wearable haptic feedback device that imparts rotational skin stretch to the hairy skin, along with the results of psychophysical tests to determine its resolution and accuracy for motion display. Tracking experiments with visual markers reveal the pattern of skin motion and strain imparted by the device, confirming subjective impressions that the design represents a trade-off between perception at low stimulus levels and comfort at maximum stimulus levels. In an isolated environment, users were able to discriminate between different rotational displacements of stretch within two to five degrees, depending on the reference stimulus. In a more realistic setting, subjects were able to use feedback from the device to control the positioning of a virtual object within six degrees or ±6.5 degrees of the total range of motion. When subjects were passive and exposed to arbitrary rotations of the device, the accuracy was poorer, although it improved with training. The results suggest that wearable skin stretch devices can be an effective means of providing feedback about a user's controlled joint or limb motions for motion training and similar applications.

The Lewisian Complex: insights into deep crustal evolution

The Lewisian Complex is an Archaean/Proterozoic craton fragment found in NW Scotland and throughout the Outer Hebrides. The 1907 memoir recognized, simply from field relationships and petrographic observation, key features of Lewisian evolution. The bulk of the Lewisian is an old, deformed complex consisting mainly of acid igneous rocks, with some basics, ultrabasics and metasediments. In the Central District of the mainland these are pyroxene bearing (now recognized as granulite facies). The Lewisian Complex was intruded by a suite of basic and ultrabasic dykes which show variable states of later deformation, the intensity of strain being correlated with the development of hornblende schist in the dykes and amphibolite facies assemblages in the country rocks. In the Northern and Southern Districts, this deformation is pervasive and the dykes become concordant hornblende schist sheets. The new foliation with transposed dykes and metasediment sheets is then folded around NW–SE axes. Today there is no single agreed model for the evolution of the complex but an outline is as follows. In the pre-dyke (Scourian) history, subduction led to melting of oceanic crust which provided vast volumes of tonalite-trondhjemite-granodiorite in the period 3100–2700 Ma. Ages show geographic variations but it is not proven whether that implies large displacements between pieces of crust or whether it represents intrusions into other intrusions. The subcontinental lithospheric mantle dates from c. 3000 Ma. K, U and other large ion lithophile elements are depleted in the Central District of the mainland; this is due to depletion in the downgoing oceanic slab which in turn is a result of dehydration prior to melting. Other areas are not depleted in such elements, so various tectonic settings were involved. Remnants of metabasic material in the Lewisian may be relics of oceanic crust. Granulite facies metamorphism with, in places, P>10 kb and T>1000 °C occurred a considerable time after intrusion so is not necessarily linked to igneous events. This ‘Badcallian’ episode affected mainly the Central District and a part of the southern Outer Hebrides; other areas show only amphibolite facies. Zircon dating indicates two high-grade events at 2500 and 2700 Ma. During the ‘Inverian’ episode a series of wide amphibolite-facies shear zones affected the granulite-facies Scourian gneiss prior to the intrusion of the Scourie dykes. The Scourie dykes were intruded from 2400–2000 Ma and are largely quartz tholeiites derived from enriched subcontinental lithospheric mantle; there are some picrites which yield the oldest ages but are also seen to crosscut basic dykes. The dykes trend NW–SE and are steep where not affected by later deformation except where they intrude along, and are controlled by, Inverian fabrics. Post-dyke (Laxfordian) history involves the development of calc-alkaline igneous rocks in the Outer Hebrides and mainland (c. 1900 Ma). Volcanics associated with sediments younger than 2000 Ma comprise an accretionary complex formed in a subduction setting; they are now intercalated between slabs of Archaean basement indicating that the complex was involved in collision with continental crust. Huge strains transposing dykes and country rocks affected almost all of the Outer Hebrides and the mainland except for the Central District. The NW–SE trending lineation indicates the collision direction; the metasediments on the mainland and the South Harris Igneous Complex may mark a folded suture between two continents. Metamorphism was amphibolite facies almost everywhere; in South Harris it was granulite facies at c. 1880 Ma. At 1750–1675 Ma, a distinct event, called late Laxfordian but much younger than earlier Laxfordian metamorphism and with a distinct tectonic setting, caused folding of the previous structures along NW–SE axes, migmatization and renewed amphibolite facies metamorphism.

Attosecond synchronization of high-order harmonics from midinfrared drivers

The group delay dispersion, also known as the attochirp, of high-order harmonics generated in gases has been identified as the main intrinsic limitation to the duration of Fourier-synthesized attosecond pulses. Theory implies that the attochirp, which is inversely proportional to the laser wavelength, can be decreased at longer wavelength. Here we report the first measurement of the wavelength dependence of the attochirp using an all-optical, in situ method [N. Dudovich, Nature Phys. 2, 781 (2006)10.1038/nphys434]. We show that a 2 microm driving wavelength reduces the attochirp with respect to 0.8 microm at comparable intensities.

Defining distinct caregiver subpopulations by intensity of end-of-life care provided

Interventions designed to assist informal caregivers who serve individuals at or near the end of life have predominantly focused on caregiving spouses. Can we define other caregiver subpopulations--by intensity of care provided--so as to enable better a) identification of caregiver needs and b) targeting of support to caregivers? The Health Omnibus Survey, an annual face-to-face survey in South Australia, collects health-related data from a representative sample of 4400 households. Piloted questions included in the 2001-2005 Health Omnibus surveys addressed death of a loved one, caregiving provided, impact of caregiving and caregiver characteristics. Of 18,224 respondents, 5302 reported a loved one's death due to terminal illness in the previous 5 years. In all, 502 (10%) provided daily care [5-7 days/week], 619 (12%) provided intermittent care [2-4 days/week] and 425 (8%) provided rare care. Active (daily plus intermittent) caregivers, compared with non-active (rare) caregivers, were more often women (63% vs 50%; P < 0.0001). Daily caregivers were distinguishable from intermittent; daily caregivers were more often widowed (95% vs 7%; P < 0.0001) and >or=60 years (80% vs 64%; P < 0.0001); intermittent caregivers were more commonly children/parents (35%), other relatives (33%), or friends (26%; P < 0.0001) and were better educated, more active in paid work and wealthier. Financial burden, experience at time of death, ability to move on after the death and need for grief support also differed by intensity of caregiving. Caregiver subpopulations can be defined according to intensity of caregiving with distinct demographic features helping to distinguish them.

Effect of neoadjuvant chemotherapy on circumferential margin positivity and its impact on prognosis in patients with resectable oesophageal cancer

Background

The significance of circumferential resection margin (CRM) involvement in oesophageal cancer surgery is controversial. This study investigated the relationship between CRM involvement, locoregional recurrence and survival, after surgery alone or with neoadjuvant chemotherapy.

Methods

Patients operated on by one surgeon at a tertiary referral centre between October 1997 and May 2004 were identified from a prospective database.

Results

Some 242 patients underwent oesophagectomy; 91 had surgery alone, 142 had neoadjuvant chemotherapy and nine neoadjuvant chemoradiotherapy. Among patients with histologically confirmed T3 tumours, 26 (55 per cent) of 47 who underwent surgery alone had CRM involvement, compared with 27 (31 per cent) of 88 patients who completed two cycles of neoadjuvant chemotherapy (P = 0·005). Thirty-seven (42 per cent) of 89 patients with a negative CRM developed locoregional recurrence, compared with 33 (59 per cent) of 56 with a positive margin (P = 0·032); median survival was 28 and 12 months respectively (P &lt; 0·001). Cox multivariable regression analysis identified CRM involvement as an independent prognostic factor (P = 0·006).

Conclusion

A positive CRM is an independent predictor of overall survival after oesophageal cancer resection. There has been a significant decrease in CRM involvement with the introduction of neoadjuvant chemotherapy.