Access to nutrition services and information after active cancer treatment: a mixed methods study

PURPOSE

Evidence-based guidelines for cancer strongly support nutrition and dietetic services for people with cancer and carers in order to improve patient-centred and health service outcomes. Access to nutrition services and information after completing active cancer treatment is relatively unknown in Australia. This study aimed to determine the availability, accessibility, barriers, and preferences to nutrition services and information after cancer treatment in Australia.

METHODS

Utilising mixed methods, people with cancer and carers completed a cross-sectional survey, and a sub-group of participants completed a semi-structured interview. The survey evaluated the availability of nutrition services, nutrition information searched, barriers, and preferences for nutrition information. Semi-structured interviews explored participant experience with nutrition services and information.

RESULTS

The 149 participants (including 10 carers) were predominately male and with a diagnosis of prostate cancer (63%). Overall, 23% of participants received nutrition information from a dietitian after cancer treatment. Participants (78%) indicated that accessing a nutrition specialist is the main barrier to receiving nutrition care after treatment. Most searched nutrition information on the internet (55%) and found the information easy to understand (89%), but conflicting (52%). Thematic analysis of interviews in fourteen cancer patients revealed three key themes pertaining to (1) preferred referral and timing of nutrition services, (2) lack of confidence in publicly available nutrition information, and (3) streamlining nutrition services for greater access.

CONCLUSION

Access to a dietitian and evidence-based information after cancer treatment is limited for people with cancer and carers in Australia, despite the high interest and need for ongoing nutrition care.

IMPLICATIONS FOR CANCER SURVIVORS

Models of care evaluating the provision of appropriate nutrition care and information provision after cancer treatment are needed to address this unmet survivorship need.

977 Breaking Out of Tradition: Designing Escape Rooms as Novel Simulation

Aim

The emerging field of gamification, the addition of game play elements to non-game settings, is widely used in business and is increasingly being used in education. Successful methods have included live leader boards and a web-based game solving a protein folding conundrum.

Method

We designed an escape room (ER), incorporating gaming elements, focussing on communication in a surgical environment. A cross over study was delivered to 4th year medical students, comparing traditional simulation. The ER included logic puzzles, hidden clues, padlocked boxes, and surgical skills appropriate to their level. Self-reported engagement and teamwork were recorded, as was observed teamwork and communication skills.

Results

Self-reported engagement was very high for the students compared to more traditional simulation, including better understanding of effective communication strategies. The ER group were less likely to self-identify learning points but structured debrief mitigated this difference.

Conclusions

Gamification techniques can be integrated with good engagement and educational outcomes and should be considered as an adjunct to existing simulation strategy.

971 Gamification of Education; Can Playable Education Result in Better Learning Outcomes?

Aim

Combining traditional simulation (TS) and the emerging field of gamification, to create medical Escape Rooms (ERS) has been used in Nursing to good results but is yet to be widely adopted in medical education. We conducted a pilot study to create ERS for undergraduates to assess their educational value.

Method

Existing Simulation themes of sepsis, post-operative bleeding, trauma, burns and communication in the theatre environment were developed into Escape Rooms by a multidisciplinary team. A cross over study for 4th year students was carried out. Questionnaires were used to evaluate the experience, learning assessed by pre and post quiz and observational tools for teamwork, communication and leadership were utilised.

Results

Qualitative data demonstrated overall good feedback on enjoyment an engagement. Quantitative data collected as pre- and post-exposure learning demonstrated equivocal benefit. Self-assessed teamwork showed equal in all domains and improved in contribution of knowledge and maintaining team focus on the ER group.

Conclusions

Participants find ER enjoyable have similar educational benefits of traditional simulation with the benefits on enhancing non-technical skills amongst a novice group. Escape rooms may be useful as an adjunct to TS particularly at developing non-technical skills.

Current Insights in Nutrition Assessment and Intervention for Malnutrition or Muscle Loss in People with Lung Cancer: A Narrative Review

Up to 70% of people with lung cancer may be affected by cancer-related malnutrition or muscle loss, depending on treatment modality and disease stage. This narrative review explores recent studies on malnutrition and muscle loss as well as nutritional and multimodal interventions to treat these conditions in the context of the changing treatment landscape in lung cancer. Various types of interventions, including individualized counseling, protein and other specific nutrient supplementation, as well as multimodal interventions to treat malnutrition and muscle loss, have been investigated. Overall, individualized dietary counseling, increasing protein intake, and supplementation with omega-3 (n-3) fatty acids appear to be beneficial for some, albeit varying, patient outcomes. Multimodal interventions, generally including a nutrition and exercise component, show promising results; however, the impact on patient outcomes is mixed. A key finding of this review is a lack of large, randomized trials to guide nutrition intervention specifically in people with lung cancer. Despite the high prevalence of malnutrition and muscle loss in people with lung cancer and the known adverse outcomes, current evidence for nutrition intervention is limited. A targeted effort is required to improve the quality of evidence for nutrition intervention in this population to provide support for clinicians to deliver effective nutrition care.

Optical interferometry-based array of seafloor environmental sensors using a transoceanic submarine cable

Optical fiber-based sensing technology can drastically improve Earth observations by enabling the use of existing submarine communication cables as seafloor sensors. Previous interferometric and polarization-based techniques demonstrated environmental sensing over cable lengths up to 10,500 kilometers. However, measurements were limited to the integrated changes over the entire length of the cable. We demonstrate the detection of earthquakes and ocean signals on individual spans between repeaters of a 5860-kilometer-long transatlantic cable rather than the whole cable. By applying this technique to the existing undersea communication cables, which have a repeater-to-repeater span length of 45 to 90 kilometers, the largely unmonitored ocean floor could be instrumented with thousands of permanent real-time environmental sensors without changes to the underwater infrastructure.

453 Introduction of A Novel Online Learning Platform Increases Junior Doctors Confidence Prior To Starting Trauma & Orthopaedic On-Calls

Aim

Trauma and Orthopaedic (T&O) junior doctors are expected to manage on-calls involving a high volume of patients presenting with a wide variety of complex conditions. Despite this, many junior doctors feel poorly prepared at the start of their placements with individual hospitals providing variable levels of induction. We therefore aimed to provide a free ‘Introduction to T&O on-calls’ course for junior doctors.

Method

The online platform ‘Zoom’ was used to provide 13 interactive lectures by T&O trainees and consultants over a single day in July 2020. In total, 280 UK junior doctors attended with 91.1% completing feedback. Pre- and post-course questionnaires were used to establish improved knowledge.

Results

Only 7.4% of participants either had or were aware of a local trust induction covering T&O on-calls. The course had an overall satisfaction rating of 90%, with participants showing a 15.3% improvement in on-call knowledge from pre-course to post-course (p<0.05). Prior to the course only 35% of participants felt prepared to perform an on-call which increased to 77% after the course. Almost all participants (90%) agreed that similar courses in other surgical specialties (General surgery (79%), Urology (60%), Vascular surgery (60%), ENT 55%)) which are commonly cross covered by junior doctors would be hugely beneficial.

Conclusions

Our principal focus moving forward is to establish a formal national induction programme for T&O junior doctors that is recognised by the relevant T&O organisations. This will instil confidence in the junior doctors whilst achieving patient safety and excellence during busy T&O on-calls.

762 Online surgical teaching during COVID-19: how best to engage the audience?

Aim

COVID-19 has dramatically altered how surgical teaching is provided; face-to-face teaching has been superseded by online teaching to limit viral transmission. Online teaching can lack engagement and therefore audience learning. The aim of this study was to determine which online teaching strategies best engage medical students.

Method

The ‘6th International Surgical Finals revision course’ took place on Zoom in December 2020 with 11 lectures provided by 11 different junior doctors using different lecturing techniques. It was attended by 208 final year medical students from across Europe. Post-course questionnaires were completed by 204 attendees (98.1%). All lectures were recorded and reviewed to identify engagement strategies.

Results

95% of attendees preferred the live talks, with 75.8% agreeing they ran more smoothly. There was a very strong correlation between engagement and overall lecture rating (correlation coefficient 0.94). There was also a strong correlation between the number of questions asked by the lecturer and engagement (correlation coefficient 0.55). Lecturers presenting with live video next to their slides were significantly more engaging (91% vs 83%; p<0.001). The use of webinar chat to allow participants to answer questions was significantly more engaging (91.5% vs 87.7%; p < 0.05). Using the Q&A function during the talk was not significantly more engaging (p>0.05).

Conclusions

Online surgical teaching has many benefits over face-to-face surgical teaching and is therefore likely to continue even after COVID-19 is forgotten. Engagement can be increased by using live talks with video stream alongside the slides with questions and the ability to answer also crucial to engagement.

627 Trauma & Orthopaedic National Selection – What Is Really Going Through the Mind of Applicants?

Aim

Obtaining a training number in Trauma & Orthopaedics (T&O) remains highly competitive. This study aims to provide an insight into applicant’s perceptions and preparation for the T&O national selection interview.

Method

162 junior doctors applying to T&O national selection in 2021 were sent questionnaires using SurveyMonkey in December 2020. Applicants were identified from those attending the annual OrthoRevision ‘ST3 Core Knowledge Interview Course’. In total, 74 junior doctors (45.7%) covering all 16 surgical training regions in the UK completed feedback.

Results

There were wide variations in how much applicants would spend on preparation for the interview (e.g., books, revision websites, courses): 45.9% spend £100 - £500; 21.6% spend £500-£1,000; and 6.8% spend >£1,000. Most start preparation 3 months prior to the interview (42.5%) with the preferred method being practice with colleagues (49.3%). Almost all candidates (80.2%) use the ‘OrthoInterview’ question bank. Free mock interview courses were only available to 27% with candidates strongly in favour (78%) of the study budget covering preparatory courses in addition to study leave being granted to attend these courses (86%). At the first attempt at obtaining a training number, 69.9% were selective about where they would accept a job; in subsequent years candidates would be more willing to accept a job in any deanery (40.3%).

Conclusions

For the first time, we present the perceptions of applicants to T&O national training in the UK. Many candidates dedicate a large amount of time and money to the process and are initially more selective about where they apply.

460 Remote Orthopaedic Clinics during COVID-19: Lessons for a Sustainable Future

Aim

The COVID-19 pandemic has led to a focus on non-face to face (NF2F) orthopaedic clinics. Our aim was to establish whether NF2F clinics were sustainable according to the ‘Triple Bottom Line’ framework by taking account of the impact on patients, the planet and financial cost.

Method

This retrospective cohort study was carried out at a large DGH with 261 patients identified as having undergone F2F or NF2F orthopaedic consultations (April 2020). These patients were contacted by telephone to establish their experience, mode of transport and preference for future consultations. Data was also collected relating to environmental and financial costs to the patient and trust.

Results

Final analysis included 180 patients (69%): 42% had a F2F consultation and 58% a NF2F consultation. There was no significant difference between each group in terms of convenience, ease of communication, subjective patient safety, or overall satisfaction rating (p>0.05). 80% of NF2F patients would be happy with virtual consultations in future. Mean journey distance was 18.6 miles leading to a reduction in total carbon emissions of 563.9kg CO2e (66%), equating to 2106 miles in a medium sized car. The hospital visit carbon cost (heating, lighting, and waste generation) was reduced by 3,967kg CO2e (58%). The financial cost (petrol and parking) was also reduced by an average of £8.96 per person.

Conclusions

NF2F consultations are aligned to the NHS ‘Long Term Plan’. They (i) deliver high patient satisfaction with equivalent outcomes to F2F consultations; (ii) have reduced carbon emissions from transportation and hospital running; and (iii) are cheaper.

Real-time monitoring of volume flow, mass flow and shredder power consumption in mixed solid waste processing

Real-time material flow monitoring is not yet implemented in mixed solid waste processing, but it is important for an efficient quality assured production and the development of the smart waste factory. The present paper shows results of practical investigation of the Real-Time Material Flow Monitoring in a large-scale Solid Recovered Fuel (SRF) production plant and a semi large-scale processing line (Technical line 4.0) using mixed solid waste. The investigations aimed to research the fundamentals for generating mass flow data from volume flow data and volume and mass flow data from shredder power consumption. It could be shown that a mass determination from volume flow data with the help of density determinations can be practically realized in a good approximation (deviation < 1%) to the gravimetrically determined mass in an SRF production plant. With R² = 0.47, the power consumption of a shredder in the SRF plant shows a low to medium correlation to the corresponding volume flow. In the 31 tests with the Technical Line 4.0, both, the mass flow and the volume flow could be measured in real-time. Combining these data results in the temporal density curve and shows strong fluctuations for shredded commercial waste. Comparing the mean bulk densities for each test with those from the density determinations of taken samples shows a robust correlation (R² = 0.82). Analyzes of the material composition of the shredded mixed solid waste show strong correlations to bulk density for the proportions of the fractions rest (positive correlation) and plastics (negative correlation).

Awake tracheal intubation with the ProVu™ video stylet: a case series

Management of the difficult airway is integral to peri-operative practice. The development of devices to simplify airway handling are changing our approach to tracheal intubation. We report a case series of three patients who underwent awake tracheal intubation with the ProVu™ video stylet (Flexicare Medical Ltd, Mountain Ash, UK). All three patients had predicted difficult airways, including: limited mouth opening secondary to radiotherapy; previous exenteration, hemi-maxillectomy and scapular free flap formation; and cervical fixation. Awake tracheal intubation was performed successfully in all three cases, with no complications reported. This is the first reported case series of the ProVu™ video stylet as an awake tracheal intubation device. The benefits and limitations of this video stylet are discussed.

Efficient derivation of significant results from mechanical processing experiments with mixed solid waste: Coarse-shredding of commercial waste

Deriving significant experiment-based conclusions on mechanical processing of mixed solid waste is challenging: the input material cannot be downscaled in a way that enables drawing transferable conclusions from lab-scale experiments. Hence experiments need to be conducted in industry-scale, using real waste. Besides the enormous resulting experimental efforts and costs, which economically limit the number of experimental runs, identifying and quantifying significant effects is complicated by the distortion of the data introduced by the waste's variability. The distortion is particularly high for cases where sampling is necessary and in experiments where material cannot be re-used from one run to the next. In the latter case, inter-experimental differences of the waste add to the distortion of the data. In this work, a systematic approach for deriving representative and significant results at the minimum possible effort is described and evaluated, based on the method of Design of Experiments. It is applied to a 32 runs D-optimal industry-scale coarse-shredding experiment with mixed commercial solid waste, based on a reduced cubic design model, examining the influence of the gap width, shaft rotation speed, and cutting tool geometry on the throughput behavior and energy demand. The resulting models are highly significant (model p-values < 0.0001), proving the ability to extract reliable information from industry-scale waste processing experiments. Concerning commercial waste shredding, the models provide new insights into process behavior, for example, the quadratic dependence of the mass flow on the shaft rotation speed, with the highest hourly mass flows at 84% of the maximum shaft rotation speed.

Real time material flow monitoring in mechanical waste processing and the relevance of fluctuations

To achieve the goals of the circular economy, significant improvements in non-hazardous solid waste processing/treatment must be made. Large deficits in the digitalization of mechanical waste treatment plants (smart waste factory) offer great potential for improvement. Real-time material flow monitoring is carried out in very few plants, thus wasting considerable potential for improving plant performance. This article describes results from the authors' own practical analyses using sensor-based technologies for monitoring material flows, an on-site investigation in a large waste treatment plant and also in a pilot-scale plant (Technical Line 4.0) using mixed commercial waste (MCW) from Austria. The obtained data shows that the quantitative monitoring of volume and mass flow (via laser triangulation as well as near-infrared (NIR) based monitoring) and material composition (NIR sensor) is possible. The observed fluctuations were categorised in short-, mid- and long-term fluctuations and were led back to their causes, i.e. discontinuous feeding process, material and machine-specific characteristics. Using the quotient of the 90% (Q90) and 10% (Q10) quantiles of time-resolved volume-flow data for the assessment of fluctuations, for the considered time-intervals, resulted in Q90 / Q10 ratios between 3.39 and 4.58. If short-term fluctuations (within the observed time-intervals) are related to the 29.6 s moving average, deviations between 1.8% and 6.8% result. To verify the relevance of such fluctuations, sensor-based sorting (SBS) experiments were conducted, revealing a reduced product purity of 6% due to short-term fluctuations in the feed of the SBS-Machine using light packaging waste (LPW).

Clocks, Viruses, and Immunity: Lessons for the COVID-19 Pandemic

Circadian rhythms are evolutionarily conserved anticipatory systems that allow the host to prepare and respond to threats in its environment. This article summarizes a European Biological Rhythms Society (EBRS) workshop held in July 2020 to review current knowledge of the interplay between the circadian clock and viral infections to inform therapeutic strategies against SARS-CoV-2 and COVID-19. A large body of work supports the role of the circadian clock in regulating various aspects of viral replication, host responses, and associated pathogenesis. We review the evidence describing the multifaceted role of the circadian clock, spanning host susceptibility, antiviral mechanisms, and host resilience. Finally, we define the most pressing research questions and how our knowledge of chronobiology can inform key translational research priorities.

Influence of pre-screening on down-stream processing for the production of plastic enriched fractions for recycling from mixed commercial and municipal waste

The use of plastic waste as resource gains more and more attention. In this context, material recycling is especially focused on packaging plastics. Further waste streams that contain a significant amount of plastics are mixed commercial and municipal solid waste. To assess the potential of plastics for recycling and energy recovery from these material streams large-scale experiments were conducted. The potential of mechanical pre-processing with the aim of generating a 3D-plastics pre-concentrate was assessed. The focus of these investigations was put on the relevance of the screening stage and its influence on down-stream material processing via ballistic separation and sensor-based sorting. Results demonstrate not only that the screening of both waste streams leads to enrichment of plastics in coarse particle size ranges (especially >80 mm) and transfer of contaminants, organics and minerals to fine fractions (especially <10 mm), but also that sensor-based sorting performance can be significantly enhanced due to cleaning effects on plastics, induced by the material circulation and the resulting interparticle friction in a drum screen. On the downside, the material rotation in a drum screen leads to tail-formation that can create plant down-time through clogging as well as material losses and impairment of pre-concentrates.

Ediacaran metazoan reveals lophotrochozoan affinity and deepens root of Cambrian Explosion

Through exceptional preservation, we establish a phylogenetic connection between Ediacaran and Cambrian metazoans. We describe the first three-dimensional, pyritized soft tissue in Namacalathus from the Ediacaran Nama Group, Namibia, which follows the underlying form of a stalked, cup-shaped, calcitic skeleton, with six radially arranged lobes projecting into an apical opening and lateral lumens. A thick body wall and probable J-shaped gut are present within the cup, and the middle layer of the often-spinose skeleton and skeletal pores are selectively pyritized, supporting an organic-rich composition and tripartite construction with possible sensory punctae. These features suggest a total group lophotrochozoan affinity. These morphological data support molecular phylogenies and demonstrates that the origin of modern lophotrochozoan phyla, and their ability to biomineralize, had deep roots in the Ediacaran.

Perioperative intravenous contrast administration and the incidence of acute kidney injury after major gastrointestinal surgery: prospective, multicentre cohort study

BACKGROUND

This study aimed to determine the impact of preoperative exposure to intravenous contrast for CT and the risk of developing postoperative acute kidney injury (AKI) in patients undergoing major gastrointestinal surgery.

METHODS

This prospective, multicentre cohort study included adults undergoing gastrointestinal resection, stoma reversal or liver resection. Both elective and emergency procedures were included. Preoperative exposure to intravenous contrast was defined as exposure to contrast administered for the purposes of CT up to 7 days before surgery. The primary endpoint was the rate of AKI within 7 days. Propensity score-matched models were adjusted for patient, disease and operative variables. In a sensitivity analysis, a propensity score-matched model explored the association between preoperative exposure to contrast and AKI in the first 48 h after surgery.

RESULTS

A total of 5378 patients were included across 173 centres. Overall, 1249 patients (23·2 per cent) received intravenous contrast. The overall rate of AKI within 7 days of surgery was 13·4 per cent (718 of 5378). In the propensity score-matched model, preoperative exposure to contrast was not associated with AKI within 7 days (odds ratio (OR) 0·95, 95 per cent c.i. 0·73 to 1·21; P = 0·669). The sensitivity analysis showed no association between preoperative contrast administration and AKI within 48 h after operation (OR 1·09, 0·84 to 1·41; P = 0·498).

CONCLUSION

There was no association between preoperative intravenous contrast administered for CT up to 7 days before surgery and postoperative AKI. Risk of contrast-induced nephropathy should not be used as a reason to avoid contrast-enhanced CT.

0077 Objective Sleep and Neural Response to Thermal Pain Testing Following Cognitive Behavioral Treatment in Patients with Comorbid Insomnia and Fibromyalgia: A Pilot Study

Introduction

Fibromyalgia (FM) is characterized by high rates of insomnia and abnormal central pain processing/heightened response to stimuli (i.e., central sensitization). This study examines whether cognitive behavioral treatments (CBTs) that target insomnia and pain improve central pain processing [indicated by decreased response to quantitative sensory testing (QST) using thermal stimuli] in patients with fibromyalgia and insomnia.

Methods

Before and after CBT-I, CBT-P or waitlist, adults (N=32, Mage=55.9, SD=12.2) with FM and insomnia completed QST during fMRI (Phillips Achieva 3T scanner), 14-daily pain ratings [least(0)-most(100) intense pain imaginable] and 1-night in-home polysomnography (AURA/Grass Technologies). Imaging data were processed using Brain Voyager (Brain Innovation/Netherlands). Random effects ANCOVA identified regions with significant group (3-CBT-I, CBT-P, waitlist) by time (baseline, post-treatment) interactions in brain hemodynamic response to QST. Linear regressions (using residualized change scores) were conducted for each significant region to examine how pain and sleep changes (%Stages 1–3 NREM, %REM) were related to brain response changes.

Results

Eleven regions exhibited significant interactions (ps&lt.00; large effects; right hemisphere: inferior frontal, superior temporal, mid-occipital, and cingulate gyri, lentiform nucleus; left hemisphere: angular, superior temporal, mid-frontal, inferior occipital, mid-temporal, and inferior frontal gyri). CBT-I decreased brain response to QST in 8 regions and CBT-P in 3 regions (CBT-I effects&gtCBT-P). Waitlist increased response in 6 regions. Pain ratings, %Stage 2 and %REM sleep were not significant for any region and were dropped from the models. Increased %Stage 1 and/or %Stage 3 predicted decreased brain response to QST in 8 of the 11 regions (ps&lt.01), accounting for 19–45% of the variance.

Conclusion

Compared to CBT-P, CBT-I prompted greater improvement in abnormal pain processing in patients with fibromyalgia and insomnia. Increased NREM sleep may underlie these pain processing improvements following treatment. Future research examining the potential role of NREM sleep in central sensitization and pain processing is warranted.

Support

National Institute of Arthritis and Musculoskeletal and Skin Diseases (R01AR055160 and R01AR005160-S1; McCrae, PI). Data collected as part of clinical trial NCT02001077 Sleep and Pain Interventions (SPIN) at the University of Florida (McCrae, PI).

Regional nutrient decrease drove redox stabilisation and metazoan diversification in the late Ediacaran Nama Group, Namibia

The late Ediacaran witnessed an increase in metazoan diversity and ecological complexity, marking the inception of the Cambrian Explosion. To constrain the drivers of this diversification, we combine redox and nutrient data for two shelf transects, with an inventory of biotic diversity and distribution from the Nama Group, Namibia (~550 to ~538 Million years ago; Ma). Unstable marine redox conditions characterised all water depths in inner to outer ramp settings from ~550 to 547 Ma, when the first skeletal metazoans appeared. However, a marked deepening of the redoxcline and a reduced frequency of anoxic incursions onto the inner to mid-ramp is recorded from ~547 Ma onwards, with full ventilation of the outer ramp by ~542 Ma. Phosphorus speciation data show that, whilst anoxic ferruginous conditions were initially conducive to the drawdown of bioavailable phosphorus, they also permitted a limited degree of phosphorus recycling back to the water column. A long-term decrease in nutrient delivery from continental weathering, coupled with a possible decrease in upwelling, led to the gradual ventilation of the Nama Group basins. This, in turn, further decreased anoxic recycling of bioavailable phosphorus to the water column, promoting the development of stable oxic conditions and the radiation of new mobile taxa.

A gut reaction to exercise

Alterations in gut microbiome composition and function predict those who respond favorably to exercise in metabolic control.

Keeping nanoparticles within the joint

Manganese dioxide nanoparticles target chondrocytes, protecting cartilage tissue from inflammation-induced oxidative damage.

Alternative rhythms in schizophrenia

A distinct set of rhythmically expressed genes related to mitochondrial function is identified in the brains of patients with schizophrenia.

Digitalisation and intelligent robotics in value chain of circular economy oriented waste management - A review

The general aim of circular economy is the most efficient and comprehensive use of resources. In order to achieve this goal, new approaches of Industry 4.0 are being developed and implemented in the field of waste management. The innovative K-project: Recycling and Recovery of Waste 4.0 - "ReWaste4.0" deals with topics such as digitalisation and the use of robotic technologies in waste management. Here, a summary of the already published results in these areas, which were divided into the four focused topics, is given: Collection and Logistics, Machines and waste treatment plants, Business models and Data Tools. Presented are systems and methods already used in waste management, as well as technologies that have already been successfully applied in other industrial sectors and will also be relevant in the waste management sector for the future. The focus is set on systems that could be used in waste treatment plants or machines in the future in order to make treatment of waste more efficient. In particular, systems which carry out the sorting of (mixed) waste via robotic technologies are of interest. Furthermore "smart bins" with sensors for material detection or level measurement, methods for digital image analysis and new business models have already been developed. The technologies are often based on large amounts of data that can contribute to increase the efficiency within plants. In addition, the results of an online market survey of companies from the waste management industry on the subject of waste management 4.0 or "digital readiness" are summarized.

Sussing out sensitivity to light: How evening light impacts individuals’ circadian systems

Interindividual differences in sensitivity to evening light may present a new component of circadian disruption.

Mathematical modelling of contact dermatitis from nickel and chromium

Dermal exposure to metal allergens can lead to irritant and allergic contact dermatitis (ACD). In this paper we present a mathematical model of the absorption of metal ions, hexavalent chromium and nickel, into the viable epidermis and compare the localised irritant and T-lymphocyte (T-cell) mediated immune responses. The model accounts for the spatial-temporal variation of skin health, extra and intracellular allergen concentrations, innate immune cells, T-cells, cytokine signalling and lymph node activity up to about 6 days after contact with these metals; repair processes associated with withdrawal of exposure to both metals is not considered in the current model, being assumed secondary during the initial phases of exposure. Simulations of the resulting system of PDEs are studied in one-dimension, i.e. across skin depth, and three-dimensional scenarios with the aim of comparing the responses to the two ions in the cases of first contact (no T-cells initially present) and second contact (T-cells initially present). The results show that on continuous contact, chromium ions elicit stronger skin inflammation, but for nickel, subsequent re-exposure stimulates stronger responses due to an accumulation of cytotoxic T-cell mediated responses which characterise ACD. Furthermore, the surface area of contact to these metals has little effect on the speed of response, whilst sensitivity is predicted to increase with the thickness of skin. The modelling approach is generic and should be applicable to describe contact dermatitis from a wide range of allergens.

Targeting senescence within the Alzheimer’s plaque

Amyloid β drives senescence of oligodendrocyte progenitor cells, presenting a potential therapeutic target.

Minimal methylation classifier (MIMIC): A novel method for derivation and rapid diagnostic detection of disease-associated DNA methylation signatures

Rapid and reliable detection of disease-associated DNA methylation patterns has major potential to advance molecular diagnostics and underpin research investigations. We describe the development and validation of minimal methylation classifier (MIMIC), combining CpG signature design from genome-wide datasets, multiplex-PCR and detection by single-base extension and MALDI-TOF mass spectrometry, in a novel method to assess multi-locus DNA methylation profiles within routine clinically-applicable assays. We illustrate the application of MIMIC to successfully identify the methylation-dependent diagnostic molecular subgroups of medulloblastoma (the most common malignant childhood brain tumour), using scant/low-quality samples remaining from the most recently completed pan-European medulloblastoma clinical trial, refractory to analysis by conventional genome-wide DNA methylation analysis. Using this approach, we identify critical DNA methylation patterns from previously inaccessible cohorts, and reveal novel survival differences between the medulloblastoma disease subgroups with significant potential for clinical exploitation.

Intraspecific variation in an Ediacaran skeletal metazoan: Namacalathus from the Nama Group, Namibia

Namacalathus hermanastes is one of the oldest known skeletal metazoans, found in carbonate settings of the terminal Ediacaran (~550-541 million years ago [Ma]). The palaeoecology of this widespread, goblet-shaped, benthic organism is poorly constrained yet critical for understanding the dynamics of the earliest metazoan communities. Analysis of in situ assemblages from the Nama Group, Namibia (~548-541 Ma), shows that Namacalathus exhibited size variation in response to differing water depths, hydrodynamic conditions and substrate types. In low-energy, inner ramp environments, Namacalathus attains the largest average sizes but grew in transient, loosely aggregating, monospecific aggregations attached to microbial mats. In high-energy mid-ramp reefs, Namacalathus spatially segregated into different palaeoecological habitats with distinct size distributions. In outer ramp environments, individuals were small and formed patchy, dense, monospecific aggregations attached to thin microbial mats. Asexual budding is common in all settings. We infer that variations in size distribution in Namacalathus reflect differences in habitat heterogeneity and stability, including the longevity of mechanically stable substrates and oxic conditions. In the Nama Group, long-lived skeletal metazoan communities developed within topographically heterogeneous mid-ramp reefs, which provided diverse mechanically stable microbial substrates in persistently oxic waters, while inner and outer ramp communities were often ephemeral, developing during fleeting episodes of either oxia and/or substrate stability. We conclude that Namacalathus, which forms a component of these communities in the Nama Group, was a generalist that adapted to various palaeoecological habitats within a heterogeneous ecosystem landscape where favourable conditions persisted, and was also able to opportunistically colonise transiently hospitable environments. These early skeletal metazoans colonised previously unoccupied substrates in thrombolitic reefs and other microbial carbonate settings, and while they experienced relatively low levels of interspecific competition, they were nonetheless adapted to the diverse environments and highly dynamic redox conditions present in the terminal Ediacaran.

The influence of solution environment on the nucleation kinetics and crystallisability of para-aminobenzoic acid

The influence of solvent on the solution thermodynamics, nucleation-kinetics and crystal growth of alpha para-aminobenzoic acid (PABA) crystallising from supersaturated solutions, is examined through analysis of the metastable zone width.

Extensive metazoan reefs from the Ediacaran Nama Group, Namibia: the rise of benthic suspension feeding

We describe new, ecologically complex reef types from the Ediacaran Nama Group, Namibia, dated at ~548 million years ago (Ma), where the earliest known skeletal metazoans, Cloudina riemkeae and Namacalathus, formed extensive reefs up to 20 m in height and width. C. riemkeae formed densely aggregating assemblages associated with microbialite and thrombolite, each from 30 to 100 mm high, which successively colonised former generations to create stacked laminar or columnar reef frameworks. C. riemkeae individuals show budding, multiple, radiating attachment sites and cementation between individuals. Isolated Namacalathus either intergrew with C. riemkeae or formed dense, monospecific aggregations succeeding C. riemkeae frameworks, providing a potential example of environmentally mediated ecological succession. Cloudina and Namacalathus also grow cryptically, either as pendent aggregations from laminar crypt ceilings in microbial framework reefs or as clusters associated with thrombolite attached to neptunian dyke walls. These reefs are notable for their size, exceeding that of the succeeding Lower Cambrian archaeocyath-microbial communities. The repeated colonisation shown by C. riemkeae of former assemblages implies philopatric larval aggregation to colonise limited favourable substrates. As such, not only were skeletal metazoans more important contributors to reef building in the Ediacaran, but there were also more variable reef types with more complex ecologies, than previously thought. Such an abundance of inferred suspension feeders with biomineralised skeletons indicates the efficient exploitation of new resources, more active carbon removal with a strengthened energy flow between planktic and benthic realms, and the rise of biological control over benthic carbonate production. These mark the prelude to the Cambrian Explosion and the modernisation of the global carbon cycle.

Diabetes in people with an intellectual disability: a systematic review of prevalence, incidence and impact

AIMS

To establish the prevalence and incidence of type 1 and type 2 diabetes in people with an intellectual and developmental disability and determine their impact on health and well-being and to appraise the evidence available to inform good practice in diabetes management for people with intellectual and developmental disabilities.

METHODS

We conducted separate searches of multiple databases (EMBASE, CINAHL, MEDLINE, PsycINFO, SCOPUS, Web of Science, PUBMED and Cochrane Library) to find relevant articles.

RESULTS

A total of 13 studies were identified: 13 addressed the prevalence of diabetes in people with intellectual and developmental disability, three addressed the impact of diabetes on their health and well-being and three addressed the management of diabetes. The prevalence of diabetes in people with intellectual and developmental disability remains uncertain, and the incidence of diabetes in this group of people is unknown. There is some evidence to support the assertion that people with intellectual and developmental disability might be at greater risk of diabetes than the general population. Overall, the quality of the evidence on which to base prevention and management strategies is variable.

CONCLUSIONS

There is a paucity of research focusing on the prevalence, incidence and impact of diabetes among people with intellectual and developmental disability. Further research is needed to inform policy and practice in this area and, in particular, work is needed to develop methodologies, evaluation tools, educational resources and diabetes care support services appropriate to the needs of people with intellectual and developmental disability.

Early animals. Ediacaran metazoan reefs from the Nama Group, Namibia

Reef-building in metazoans represents an important ecological innovation whereby individuals collectively enhance feeding efficiency and gain protection from competitors and predation. The appearance of metazoan reefs in the fossil record therefore indicates an adaptive response to complex ecological pressures. In the Nama Group, Namibia, we found evidence of reef-building by the earliest known skeletal metazoan, the globally distributed Cloudina, ~548 million years ago. These Cloudina reefs formed open frameworks without a microbial component but with mutual attachment and cementation between individuals. Orientated growth implies a passive suspension-feeding habit into nutrient-rich currents. The characteristics of Cloudina support the view that metazoan reef-building was promoted by the rise of substrate competitors and predators.

Emergency demand and repeat attendances by older patients

BACKGROUND

Population ageing is projected to impact on health services utilisation including Emergency Departments (ED), with older patients reportedly having a high rate of return visits. We describe and compare patterns in ED utilisation between older and younger adults, and quantify the proportion and rate of return visits.

METHODS

Population-based retrospective analysis of metropolitan Melbourne public hospital ED data, 1999/2000 to 2008/2009. Numbers of patients, presentations, re-presentations and rates per 1000 population were calculated, with comparison of older (aged ≥ 70 years) and younger (15-69 years) attendances.

RESULTS

Population growth in each age group was similar over the study period, yet ED presentations rose by 72% for older adults compared with a 59% increase for younger adults. Rates per 1000 population rose with increasing age. Of the population aged ≥ 70 years, 39% presented to ED compared with 17% of the population aged 15-69 years in 2008/2009. Twenty-seven per cent of the increase in older adult presentations was driven by a cohort who attended ≥ 4 times in 2008/2009. The number of older patients presenting ≥ 4 times doubled over the decade, contributing to 23% of all older presentations in 2008/2009. ED length of stay rose with increasing age; 69% of older adults remained in ED for ≥ 4 h compared with 39% of younger adults in 2008/2009. The number of older adult ED hospital admissions doubled over the decade.

CONCLUSIONS

Older patients are disproportionately represented among ED attendances. They also have an increasing propensity to re-present to ED, indicating a need to identify the clinical, social and health system-related risk factors for re-attendance by specific patients.