Comparison of Negative Pressure Wound Therapy with or without a Split-Thickness Skin Graft in the Surgical Management of Axillary Hidradenitis Suppurativa: A Retrospective Cohort Study

Introduction: Negative pressure wound therapy (NPWT) alone or with the addition of a split-thickness skin graft (STSG) are 2 reconstructive options available after surgical excision of axillary hidradenitis suppurativa (HS). The aim of this study was to retrospectively examine patients undergoing these treatments and to assess clinical and patient-related outcome measures. Methods: A single-centre, retrospective analysis was conducted, evaluating surgical excision of axillary HS, with STSG and NPWT, or NPWT alone. Data collected included No. of post-operative clinic visits, time to heal, size of wound, disease recurrence, follow-up time, Dermatology Life Quality Index (DLQI), the Generalised Anxiety Disorder Assessment (GAD-7), the Patient Health Questionnaire Depression Scale (PHQ-9), Pain Visual Analogue Scale (PAINVAS2), the Brief Illness Perception Questionnaire (BIPQ), and Dermatology Visual Analogue Scale (DERMVAS). Two-tailed t-test and Mann-Whitney Wilcoxon U-tests were used to assess for significant relationships. Results: One hundred five patients were included in the study, 44 who received NPWT alone, and 61 who received NPWT + STSG. There was no significant difference in follow-up time (P = .934) or No. of follow-up appointments between groups (P = .287). There was a significant difference in time to heal between groups, with STSG + NPWT observing a mean time of 2.77 months and NPWT alone observing a mean time of 4.40 months (P = .0006). There was no difference in patient-reported outcomes between the 2 groups. Conclusion: There is no difference in patient-reported outcomes with the addition of an STSG to NPWT after surgical excision of HS. Wide excision and use of NPWT alone is an effective procedure for the treatment of axillary HS.

Tinkering with care: Implementing extended-release buprenorphine depot treatment for opioid dependence

We examine how extended-release buprenorphine depot (BUP-XR) is put to use and made to work in implementation practices, attending to how care practices are challenged and adapted as a long-acting technology is introduced into service in opioid agonist treatment (OAT) in Australia. Our approach is informed by ideas in science and technology studies (STS) emphasising the irreducible entanglement of care practices and technology, and in particular the concept of 'tinkering' as a practice of adaptation. To make our analysis, we draw on qualitative interview accounts (n = 19) of service providers involved in BUP-XR implementation across five sites. Our analysis considers the disruptive novelty of BUP-XR. Tinkering to make a novel technology work in practice slows down the expectation of implementation in relation to transformative innovation, despite the promise of dramatic or rapid change. Tinkering allowed for more open relations, for new care practices that departed from the routine and familiar, opening potential for how BUP-XR could be put to use and made to work in its new situation, and as its situation evolved along-with its implementation. Flexibility and openness of altering relations was, however, at times, held in tension with inflexibility and closure. This analysis identifies a concern for what is made present and what is made absent in the altered care network affected by BUP-XR, with the multiple effects of supervised daily dosing practices thrown into relief as they become absented. Tinkering to implement BUP-XR locally connects with a broader assemblage of trial and movement in the constitution of treatment. The introduction of long-acting technologies prompts new questions about embedded implementation practices, including supervised dosing, urinalysis, the time and place of psychosocial support, and how other social aspects of care might be recalibrated in drug treatment.

Exploring long-term outcomes of a peer support programme for parents* of children with disability in Australia

Peer support groups can offer parents of children with disability, positive well-being outcomes. Peer support groups not only provide opportunities for connections with others with similar experiences but also provide resources and information, emotional support, a sense of belonging and may help reduce stress and isolation. Peer support groups are an established form of support existing within family centred practice. However, it is unclear whether peer support groups achieve the outcomes that they aim to deliver. Further, little is known about the longer-term outcomes for parents attending such groups. This study aimed to explore the medium- and long-term outcomes and experiences of parents who participated in a peer support programme (the Now and Next programme) for parents of children with disability. Well-being data were collected at three timepoints (Ts): prior to commencing the programme (T1), immediately after completion of the programme (T2) and 6-30 months after completion of the programme (T3). Results of the study showed empowerment and well-being improved from T1 to T2, with gains maintained at T3. Hope scores did not significantly change over time. Participants continued to set and achieve goals over time using resources from the programme. Improvements in parents' well-being and empowerment scores were maintained in the longer-term. Our study contributes to evidence confirming sustained long-term outcomes of peer support programmes and demonstrates that building parent capacity, empowerment and well-being has a lasting effect on the parents of children with disability.

Effectiveness of peer support programmes for improving well-being and quality of life in parents/carers of children with disability or chronic illness: A systematic review

AIM

This systematic review synthesized quantitative evidence from the past decade of the effectiveness of peer support programmes in improving the well-being and/or quality of life (QoL) for parents/carers of children with disability/chronic illnesses.

BACKGROUND

For children with disability or chronic illness, parents/carers are critical in enabling or limiting their child's development. The parent's/carer's ability to provide the necessary responsive and structured care is impacted by several factors, including their own personality, skills, resources and well-being. Peer support programmes often aim to build parent/carer and/or family capabilities. Although studies and reviews have found positive benefits arising from such programmes, the impact of such programmes, specifically on well-being and QoL, is unknown RESULTS: Quantitative studies published between 2011 and 2020 that examined the impact of programmes with a significant peer support component on parental/carer well-being, QoL and/or distress were identified from four databases and were searched and yielded 3605 articles, with 13 articles meeting the inclusion criteria. The results suggested that peer support is effective for reducing distress and improving the well-being and QoL among parents of children with disabilities; however, the evidence is limited by a high risk of bias in the included studies.

CONCLUSIONS

Although existing evidence suggests that programmes for parents/carers with a significant peer support component are beneficial for well-being and QoL, rigorous methodologies are needed in the future to gain a better understanding of the benefits of such programmes.

Role of relativistic laser intensity on isochoric heating of metal wire targets

In a recent experimental campaign, we used laser-accelerated relativistic hot electrons to ensure heating of thin titanium wire targets up to a warm dense matter (WDM) state [EPL114, 45002 (2016)10.1209/0295-5075/114/45002]. The WDM temperature profiles along several hundred microns of the wire were inferred by using spatially resolved X-ray emission spectroscopy looking at the Ti K_α characteristic lines. A maximum temperature of ∼30 eV was reached. Our study extends this work by discussing the influence of the laser parameters on temperature profiles and the optimisation of WDM wire-based generation. The depth of wire heating may reach several hundreds of microns and it is proven to be strictly dependent on the laser intensity. At the same time, it is quantitatively demonstrated that the maximum WDM temperature doesn't appear to be sensitive to the laser intensity and mainly depends on the deposited laser energy considering ranges of 6×10¹⁸-6×10²⁰ W/cm² and 50-200 J.

Prospects for high gain inertial fusion energy: an introduction to the first special edition

A European consortium of 15 laboratories across nine nations have worked together under the EUROFusion Enabling Research grants for the past decade with three principle objectives. These are: (a) investigating obstacles to ignition on megaJoule-class laser facilities; (b) investigating novel alternative approaches to ignition, including basic studies for fast ignition (both electron and ion-driven), auxiliary heating, shock ignition etc.; and (c) developing technologies that will be required in the future for a fusion reactor. The Hooke discussion meeting in March 2020 provided an opportunity to reflect on the progress made in inertial confinement fusion research world-wide to date. This first edition of two special issues seeks to identify paths forward to achieve high fusion energy gain. This article is part of a discussion meeting issue 'Prospects for high gain inertial fusion energy (part 1)'.

Effect of plastic coating on the density of plasma formed in Si foil targets irradiated by ultra-high-contrast relativistic laser pulses

The formation of high energy density matter occurs in inertial confinement fusion, astrophysical, and geophysical systems. In this context, it is important to couple as much energy as possible into a target while maintaining high density. A recent experimental campaign, using buried layer (or "sandwich" type) targets and the ultrahigh laser contrast Vulcan petawatt laser facility, resulted in 500 Mbar pressures in solid density plasmas (which corresponds to about 4.6×10^{7}J/cm^{3} energy density). The densities and temperatures of the generated plasma were measured based on the analysis of x-ray spectral line profiles and relative intensities.

HPA-axis hormone modulation of stress response circuitry activity in women with remitted major depression

Decades of clinical and basic research indicate significant links between altered hypothalamic-pituitary-adrenal (HPA)-axis hormone dynamics and major depressive disorder (MDD). Recent neuroimaging studies of MDD highlight abnormalities in stress response circuitry regions which play a role in the regulation of the HPA-axes. However, there is a dearth of research examining these systems in parallel, especially as related to potential trait characteristics. The current study addresses this gap by investigating neural responses to a mild visual stress challenge with real-time assessment of adrenal hormones in women with MDD in remission and controls. Fifteen women with recurrent MDD in remission (rMDD) and 15 healthy control women were scanned on a 3T Siemens MR scanner while viewing neutral and negative (stress-evoking) stimuli. Blood samples were obtained before, during, and after scanning for the measurement of HPA-axis hormone levels. Compared to controls, rMDD women demonstrated higher anxiety ratings, increased cortisol levels, and hyperactivation in the amygdala and hippocampus, p<0.05, family-wise error (FWE)-corrected in response to the stress challenge. Among rMDD women, amygdala activation was negatively related to cortisol changes and positively associated with the duration of remission. Findings presented here provide evidence for differential effects of altered HPA-axis hormone dynamics on hyperactivity in stress response circuitry regions elicited by a well-validated stress paradigm in women with recurrent MDD in remission.

Spectral enhancement in the double pulse regime of laser proton acceleration

The use of two separate ultraintense laser pulses in laser-proton acceleration was compared to the single pulse case employing the same total laser energy. A double pulse profile, with the temporal separation of the pulses varied between 0.75-2.5 ps, was shown to result in an increased maximum proton energy and an increase in conversion efficiency to fast protons by up to a factor of 3.3. Particle-in-cell simulations indicate the existence of a two stage acceleration process. The second phase, induced by the main pulse preferentially accelerates slower protons located deeper in the plasma, in contrast to conventional target normal sheath acceleration.

A dual-channel, curved-crystal spectrograph for petawatt laser, x-ray backlighter source studies

A dual-channel, curved-crystal spectrograph was designed to measure time-integrated x-ray spectra in the approximately 1.5 to 2 keV range (6.2-8.2 A wavelength) from small-mass, thin-foil targets irradiated by the VULCAN petawatt laser focused up to 4x10(20) W/cm(2). The spectrograph consists of two cylindrically curved potassium-acid-phthalate crystals bent in the meridional plane to increase the spectral range by a factor of approximately 10 compared to a flat crystal. The device acquires single-shot x-ray spectra with good signal-to-background ratios in the hard x-ray background environment of petawatt laser-plasma interactions. The peak spectral energies of the aluminum He(alpha) and Ly(alpha) resonance lines were approximately 1.8 and approximately 1.0 mJ/eV sr (approximately 0.4 and 0.25 J/A sr), respectively, for 220 J, 10 ps laser irradiation.

Proton radiography of a laser-driven implosion

Protons accelerated by a picosecond laser pulse have been used to radiograph a 500 microm diameter capsule, imploded with 300 J of laser light in 6 symmetrically incident beams of wavelength 1.054 microm and pulse length 1 ns. Point projection proton backlighting was used to characterize the density gradients at discrete times through the implosion. Asymmetries were diagnosed both during the early and stagnation stages of the implosion. Comparison with analytic scattering theory and simple Monte Carlo simulations were consistent with a 3+/-1 g/cm3 core with diameter 85+/-10 microm. Scaling simulations show that protons>50 MeV are required to diagnose asymmetry in ignition scale conditions.

The sandwich omental flap for abdominal wall defect reconstruction

We present a case of a large full thickness abdominal wall defect following excision of a huge basal cell carcinoma, uniquely reconstructed with a sandwich omental flap, vicryl/prolene (vypro II) mesh and split thickness skin graft.

Rapidly progressive T cell lymphoma presenting as acute renal failure: case report and review of the literature

We describe a case of peripheral T cell lymphoma that is remarkable for its fulminate course and selective targeting of both kidneys. The patient was a 6-year-old girl who was in her usual state of good health until the onset of abdominal pain and fever. She was treated for acute oliguric renal failure and visual disturbances. A renal biopsy was performed. Biopsy findings were interpreted as suggestive of a vasculitic process, and treatment was initiated for a presumptive diagnosis of Wegener's granulomatosis. The patient died 3 days following admission, and autopsy revealed extensive bilateral kidney infiltration by a peripheral T cell lymphoma. The remainder of the body was spared with the exception of mild infiltration of the pulmonary parenchyma and choroid plexus by neoplastic lymphocytes. The neoplastic nature of the disease was confirmed utilizing immunoperoxidase stains and T cell receptor gene rearrangement. Primary renal lymphoma and renal failure attributable to involvement by lymphoma are rare findings that should be considered when other more common causes of renal insufficiency have been excluded. The presenting clinical complaints are generally of short duration, nonspecific, and atypical. Most patients exhibit oliguria. Physical examination may reveal hepatosplenomegaly, lymphadenopathy, and flank and/or abdominal mass(es). Laboratory findings frequently include an elevated serum creatinine, blood urea nitrogen, lactate dehydrogenase, and a mild proteinuria. Electrolyte abnormalities are variably present. Possible radiographic findings include hypodense or hypoechoic renal lesions and diffuse bilateral renal enlargement. Although the prognosis is dismal, survival may be prolonged utilizing current treatment modalities, and rare patients may be "cured" of disease. The clinical presentation, radiological findings, and prognosis of patients with clinically evident renal involvement by non-Hodgkin's lymphoma are discussed.

Rapidly progressive T cell lymphoma presenting as acute renal failure: case report and review of the literature

We describe a case of peripheral T cell lymphoma that is remarkable for its fulminate course and selective targeting of both kidneys. The patient was a 6-year-old girl who was in her usual state of good health until the onset of abdominal pain and fever. She was treated for acute oliguric renal failure and visual disturbances. A renal biopsy was performed. Biopsy findings were interpreted as suggestive of a vasculitic process, and treatment was initiated for a presumptive diagnosis of Wegener's granulomatosis. The patient died 3 days following admission, and autopsy revealed extensive bilateral kidney infiltration by a peripheral T cell lymphoma. The remainder of the body was spared with the exception of mild infiltration of the pulmonary parenchyma and choroid plexus by neoplastic lymphocytes. The neoplastic nature of the disease was confirmed utilizing immunoperoxidase stains and T cell receptor gene rearrangement. Primary renal lymphoma and renal failure attributable to involvement by lymphoma are rare findings that should be considered when other more common causes of renal insufficiency have been excluded. The presenting clinical complaints are generally of short duration, nonspecific, and atypical. Most patients exhibit oliguria. Physical examination may reveal hepatosplenomegaly, lymphadenopathy, and flank and/or abdominal mass(es). Laboratory findings frequently include an elevated serum creatinine, blood urea nitrogen, lactate dehydrogenase, and a mild proteinuria. Electrolyte abnormalities are variably present. Possible radiographic findings include hypodense or hypoechoic renal lesions and diffuse bilateral renal enlargement. Although the prognosis is dismal, survival may be prolonged utilizing current treatment modalities, and rare patients may be "cured" of disease. The clinical presentation, radiological findings, and prognosis of patients with clinically evident renal involvement by non-Hodgkin's lymphoma are discussed.

Seroepidemiology of the group-A streptococcal carriage state in a private pediatric practice

During a 24-month period, throat-swab cultures were obtained on 1,362 well children who were 3 months to 14 years of age. The overall incidence of positive cultures for group-A beta-hemolytic Streptococcus was 3.3%; in those children older than 1 year, it was 4.4%. The largest incidence of positive cultures occurred in the 5- to 7-year-old (8.3%) and 8- to 10-year-old (4.5%) age groups. No positive cultures were obtained from 339 infants younger than 1 year of age. There was no relation between positive cultures and the month of the year. There were no significant differences between the age, sex, presence of tonsils, previous group-A streptococcal infections, or the presence in a daycare center or school of children with positive cultures compared with those children with negative cultures. Follow-ups were obtained on 29 of 45 children with positive throat cultures; all of the children were asymptomatic and had normal results of physical examinations. Group-A streptococci of the same serotype as the original isolate were isolated from 19 of these children. Three to four days after a ten-day course of erythromycin estolate, five of 19 children again had positive cultures. Twenty-six of the 29 children had a total of 43 siblings residing in the home. Serotypically identical group-A streptococci were isolated from five siblings (11%). Only one of 29 patients from whom paired serum samples were obtained showed a fourfold rise or fall in the Streptozyme titers.

Erythromycin therapy for group A streptococcal pharyngitis. Results of a comparative study of the estolate and ethylsuccinate formulations

One hundred two children with group A streptococcal pharyngitis were treated on a randomized basis with either 15 mg/kg of erythromycin estolate or 25 mg/kg of erythromycin ethylsuccinate given twice daily for ten days. Twelve patients, including 11 erythromycin ethylsuccinate-treated patients and one erythromycin estolate-treated patient, were dropped from the study at the request of their parents because of abdominal cramping and/or nausea and vomiting that occurred 15 to 45 minutes after ingestion of drug. Eighteen other patients (12 treated with erythromycin ethylsuccinate and six treated with erythromycin estolate) had similar gastrointestinal (GI) tract symptoms that resolved or abated. Excluding patients with reinfections with new streptococcal serotypes and those with resistant strains, the bacteriologic failure rates were 4.3% and 17.5%, and the total failure rates were 6.4% and 35.3% with erythromycin estolate therapy and with erythromycin ethylsuccinate therapy, respectively. The high rate of GI tract intolerance associated with the erythromycin ethylsuccinate appears to be dose related.