The empty pelvis syndrome: a core data set from the PelvEx collaborative

BACKGROUND

Empty pelvis syndrome (EPS) is a significant source of morbidity following pelvic exenteration (PE), but is undefined. EPS outcome reporting and descriptors of radicality of PE are inconsistent; therefore, the best approaches for prevention are unknown. To facilitate future research into EPS, the aim of this study is to define a measurable core outcome set, core descriptor set and written definition for EPS. Consensus on strategies to mitigate EPS was also explored.

METHOD

Three-stage consensus methodology was used: longlisting with systematic review, healthcare professional event, patient engagement, and Delphi-piloting; shortlisting with two rounds of modified Delphi; and a confirmatory stage using a modified nominal group technique. This included a selection of measurement instruments, and iterative generation of a written EPS definition.

RESULTS

One hundred and three and 119 participants took part in the modified Delphi and consensus meetings, respectively. This encompassed international patient and healthcare professional representation with multidisciplinary input. Seventy statements were longlisted, seven core outcomes (bowel obstruction, enteroperineal fistula, chronic perineal sinus, infected pelvic collection, bowel obstruction, morbidity from reconstruction, re-intervention, and quality of life), and four core descriptors (magnitude of surgery, radiotherapy-induced damage, methods of reconstruction, and changes in volume of pelvic dead space) reached consensus-where applicable, measurement of these outcomes and descriptors was defined. A written definition for EPS was agreed.

CONCLUSIONS

EPS is an area of unmet research and clinical need. This study provides an agreed definition and core data set for EPS to facilitate further research.

Intracranial arachnoid cyst in pregnancy: case report, literature review and evaluation of neuraxial anaesthesia risk

Choosing the type of intrapartum anaesthesia for pregnant women with intracranial arachnoid cysts can be challenging due to a lack of research. We report the intrapartum anaesthetic management of a 25-year-old woman with a known 10 cm arachnoid cyst. By means of a literature review and discussion of safety surrounding neuraxial techniques, this report will help to inform obstetric anaesthesia practice. Overall, in the absence of raised intracranial pressure, neuraxial analgesia and anaesthesia during the intrapartum period appears to be a safe option.

Fluorescence lifetime Hong-Ou-Mandel sensing

Fluorescence Lifetime Imaging Microscopy in the time domain is typically performed by recording the arrival time of photons either by using electronic time tagging or a gated detector. As such the temporal resolution is limited by the performance of the electronics to 100's of picoseconds. Here, we demonstrate a fluorescence lifetime measurement technique based on photon-bunching statistics with a resolution that is only dependent on the duration of the reference photon or laser pulse, which can readily reach the 1-0.1 picosecond timescale. A range of fluorescent dyes having lifetimes spanning from 1.6 to 7 picoseconds have been here measured with only ~1 s measurement duration. We corroborate the effectiveness of the technique by measuring the Newtonian viscosity of glycerol/water mixtures by means of a molecular rotor having over an order of magnitude variability in lifetime, thus introducing a new method for contact-free nanorheology. Accessing fluorescence lifetime information at such high temporal resolution opens a doorway for a wide range of fluorescent markers to be adopted for studying yet unexplored fast biological processes, as well as fundamental interactions such as lifetime shortening in resonant plasmonic devices.

Provision of smoking cessation support for patients following a diagnosis of cancer in Ireland

There is growing evidence that smoking cessation (SC) improves outcomes following diagnosis of cancer. Notwithstanding adverse outcomes, a significant number of those diagnosed with cancer continue to smoke. Our objective was to document the SC services provided for patients with cancer by specialist adult cancer hospitals across Ireland, a country with a stated tobacco endgame goal. A cross-sectional survey based on recent national clinical guidelines was used to determine SC care delivery across eight adult cancer specialist hospitals, and one specialist radiotherapy centre. Qualtrics was used. The response rate was 88.9% with data reported from seven cancer hospitals and one specialist radiotherapy centre, all indicating they had some SC related provision (100%). Stop smoking medications were provided to cancer inpatients in two hospitals, at outpatients and attending day ward services in one hospital. Smokers with cancer were referred automatically to the SC service in two hospitals at diagnosis. While stop smoking medications were available 24 h a day in five hospitals, most did not stock all three (Nicotine Replacement Therapy, Bupropion, Varenicline). One hospital advised they had data on uptake of SC services for smokers with cancer but were unable to provide detail. There is considerable variation in SC information and services provided to cancer patients across adult cancer specialist centres in Ireland, reflecting the suboptimal practice of smoking cessation for patients with cancer found in the limited international audits. Such audits are essential to demonstrate service gaps and provide a baseline for service improvement.

Grand challenges in entomology: Priorities for action in the coming decades

Entomology is key to understanding terrestrial and freshwater ecosystems at a time of unprecedented anthropogenic environmental change and offers substantial untapped potential to benefit humanity in a variety of ways, from improving agricultural practices to managing vector-borne diseases and inspiring technological advances.We identified high priority challenges for entomology using an inclusive, open, and democratic four-stage prioritisation approach, conducted among the membership and affiliates (hereafter 'members') of the UK-based Royal Entomological Society (RES).A list of 710 challenges was gathered from 189 RES members. Thematic analysis was used to group suggestions, followed by an online vote to determine initial priorities, which were subsequently ranked during an online workshop involving 37 participants.The outcome was a set of 61 priority challenges within four groupings of related themes: (i) 'Fundamental Research' (themes: Taxonomy, 'Blue Skies' [defined as research ideas without immediate practical application], Methods and Techniques); (ii) 'Anthropogenic Impacts and Conservation' (themes: Anthropogenic Impacts, Conservation Options); (iii) 'Uses, Ecosystem Services and Disservices' (themes: Ecosystem Benefits, Technology and Resources [use of insects as a resource, or as inspiration], Pests); (iv) 'Collaboration, Engagement and Training' (themes: Knowledge Access, Training and Collaboration, Societal Engagement).Priority challenges encompass research questions, funding objectives, new technologies, and priorities for outreach and engagement. Examples include training taxonomists, establishing a global network of insect monitoring sites, understanding the extent of insect declines, exploring roles of cultivated insects in food supply chains, and connecting professional with amateur entomologists. Responses to different challenges could be led by amateur and professional entomologists, at all career stages.Overall, the challenges provide a diverse array of options to inspire and initiate entomological activities and reveal the potential of entomology to contribute to addressing global challenges related to human health and well-being, and environmental change.

Outcomes of complex colorectal polyps managed by multi-disciplinary team strategies-a multi-centre observational study

PURPOSE

Team management strategies for complex colorectal polyps are recommended by professional guidelines. Multi-disciplinary meetings are used across the UK with limited information regarding their impact. The aim of this multi-centre observational study was to assess procedures and outcomes of patients managed using these approaches.

METHOD

This was a retrospective, observational study of patients managed by six UK sites. Information was collected regarding procedures and outcomes including length of stay, adverse events, readmissions and cancers.

RESULTS

Two thousand one hundred ninety-two complex polyps in 2109 patients were analysed with increasing referrals annually. Most presented symptomatically and the mean polyp size was 32.1 mm. Primary interventions included endoscopic therapy (75.6%), conservative management (8.3%), colonic resection (8.1%), trans-anal surgery (6.8%) or combined procedures (1.1%). The number of primary colonic resections decreased over the study period without a reciprocal increase in secondary procedures or recurrence. Secondary procedures were required in 7.8%. The median length of stay for endoscopic procedures was 0 days with 77.5% completed as day cases. Median length of stay was 5 days for colonic resections. Overall adverse event and 30-day readmission rates were 9.0% and 3.3% respectively. Malignancy was identified in 8.8%. Benign polyp recurrence occurred in 13.1% with a median follow up of 30.4 months. Screening detected lesions were more likely to undergo bowel resection. Colonic resection was associated with longer stays, higher adverse events and more cancers on final histology.

CONCLUSION

Multi-disciplinary team management of complex polyps is safe and effective. Standardisation of organisation and quality monitoring is needed to continue positive effects on outcomes and services.

Minimum standards of pelvic exenterative practice: PelvEx Collaborative guideline

This document outlines the important aspects of caring for patients who have been diagnosed with advanced pelvic cancer. It is primarily aimed at those who are establishing a service that adequately caters to this patient group. The relevant literature has been summarized and an attempt made to simplify the approach to management of these complex cases.

Smoking cessation for cancer patients through the lens of cancer specialists: challenges & solutions

Background

The benefits of smoking cessation (SC) for cancer patients are widely recognised. However, there has been a limited emphasis on SC in this context and it continues to be a challenge for cancer patients. As part of a larger feasibility study aiming to develop a structured SC pathway for cancer patients in Ireland, this qualitative study explored the SC practices, experiences and opinions of oncology healthcare professionals (HCPs).

Methods

Semi-structured interviews were conducted with 18 HCPs from lung, breast, cervical, head and neck and general oncology, across 4 specialist adult cancer hospitals in Ireland. Interview transcripts were analysed using thematic analysis.

Results

Four key themes emerged:

(1) Frequently ask and advise but infrequently assist: most HCPs ask about smoking and many advise about available supports, but few refer patients to SC services. Where offered, referrals were to hospital SC services and/or nicotine replacement therapy was prescribed; no HCP prescribed varenicline or bupropion. Barriers included lack of time, ill-defined referral pathways and lack of knowledge.

(2) Increased willingness but differing ability to quit: most patients were interested in quitting post diagnosis and had varying support needs, linked to cancer stage, social circumstances and stress levels.

(3) Need for an integrated or parallel service: all HCPs suggested that a structured and defined referral pathway will facilitate SC.

(4) Motivational counselling and pharmacotherapy combination: many HCPs suggested face to face as the best mode of intervention initially, with regular follow ups and ongoing support virtually, started pre-treatment, with an empathetic and empowering approach with provision of both motivational counselling and SC pharmacotherapy.

Conclusions

Smoking post cancer diagnosis has serious implications for cancer treatment and prognosis but is frequently overlooked. These findings will inform the design of a SC pathway for cancer patients.

Key messages

• Despite increased willingness to quit, there is inadequate and inconsistent SC support provision for cancer patients.

• Tailored SC support should be an integral part of comprehensive cancer care.

An All-Dielectric Metasurface Polarimeter

The polarization state of light is a key parameter in many imaging systems. For example, it can image mechanical stress and other physical properties that are not seen with conventional imaging and can also play a central role in quantum sensing. However, polarization is more difficult to image, and polarimetry typically involves several independent measurements with moving parts in the measurement device. Metasurfaces with interleaved designs have demonstrated sensitivity to either linear or circular/elliptical polarization states. Here, we present an all-dielectric meta-polarimeter for direct measurement of any arbitrary polarization state from a single-unit-cell design. By engineering a completely asymmetric design, we obtained a metasurface that can excite eigenmodes of the nanoresonators, thus displaying a unique diffraction pattern for not only any linear polarization state but all elliptical polarization states (and handedness) as well. The unique diffraction patterns are quantified into Stokes parameters with a resolution of 5° and with a polarization state fidelity of up to 99 ± 1%. This holds promise for applications in polarization imaging and quantum state tomography.

Two-photon interference LiDAR imaging

Optical Coherence Tomography (OCT) is a key 3D imaging technology that provides micron scale depth resolution for bio-imaging. This resolution substantially surpasses what it typically achieved in Light Detection and Ranging (LiDAR) which is often limited to the millimetre scale due to the impulse response of the detection electronics. However, the lack of coherence in LiDAR scenes, arising from mechanical motion for example, make OCT practically infeasible. Here we present a quantum interference inspired approach to LiDAR which achieves OCT depth resolutions without the need for high levels of stability. We demonstrate depth imaging capabilities with an effective impulse response of 70 μm, thereby allowing ranging and multiple reflections to be discerned with much higher resolution than conventional LiDAR approaches. This enhanced resolution opens up avenues for LiDAR in 3D facial recognition, and small feature detection/tracking as well as enhancing the capabilities of more complex time-of-flight methods such as imaging through obscurants and non-line-of-sight imaging.

Self-administration of Psilocybin in the Setting of Treatment-resistant Depression

BACKGROUND

Patients diagnosed with major depressive disorder (MDD) who fail to respond to two or more antidepressants are often considered to have treatment-resistant depression (TRD). Many of the current options for TRD have significant side effect profiles, are expensive, and are difficult to access. There has been a revival of psychedelic research in recent years that shows promising results in the treatment of TRD.

CASE PRESENTATION

Here, the case of a 43-year-old man with TRD is presented. TRD symptoms were greatly interfering with his life. He underwent psychological testing, lab work, adequate trials of numerous medications, transcranial magnetic stimulation (TMS), and electroconvulsive therapy, all without adequate relief of his symptoms. The patient began self-administering a microdosing regimen of psilocybin and experienced significant improvement of MDD symptoms, as characterized by Hamilton Depression Rating Scale (HDRS).

DISCUSSION

In recent years, multiple randomized, controlled trials (RCTs) have shown the benefit of psilocybin in the treatment of varying types of depression. One trial evaluated psilocybin and escitalopram as treatments for depression, and psilocybin was found to be superior.

CONCLUSION

This case suggests the possible benefit of psilocybin in the setting of TRD, as outlined in recent research. Additional research is needed to confirm these observations.

Light detection and ranging with entangled photons

Single-photon light detection and ranging (LiDAR) is a key technology for depth imaging through complex environments. Despite recent advances, an open challenge is the ability to isolate the LiDAR signal from other spurious sources including background light and jamming signals. Here we show that a time-resolved coincidence scheme can address these challenges by exploiting spatio-temporal correlations between entangled photon pairs. We demonstrate that a photon-pair-based LiDAR can distill desired depth information in the presence of both synchronous and asynchronous spurious signals without prior knowledge of the scene and the target object. This result enables the development of robust and secure quantum LiDAR systems and paves the way to time-resolved quantum imaging applications.

'Pretty in Pink' and 'Girl Power': An analysis of the targeting and representation of women in alcohol brand marketing on Facebook and Instagram

BACKGROUND

Alcohol marketing helps shape how gender roles and relations are understood, and the gendered nature of drinking learned. In recent years, changes in how women are presented and addressed in marketing, including alcohol marketing, have been observed. This reflects the shifting social, political and regulatory context, in which increased attention has been given to gender inequality and the damaging impact of gender stereotypes. Research is yet to explore the gendered nature of alcohol marketing within this contemporary context.

METHODS

A quantitative content and qualitative thematic analysis of alcohol marketing posts (N = 2600) by 20 alcohol brands on Facebook and Instagram pages over an 18 month period (1st January 2019-30th June 2020) was conducted. Marketing strategies were identified, and the way in which posts targeted, represented and engaged women analysed.

FINDINGS

New (e.g. 'influencer' collaborations) and established (e.g. competitions) strategies were being used to target both women and men. Drinking was presented as a feminine practice and as an important component of 'doing' a combination of traditional, post-feminist and feminist femininities. Women were assigned a range of gender roles that acknowledged their individual pleasures and achievements, and traditional gender roles and stereotypes were both reinforced and rejected to promote alcohol use. An important move away from sexualising and demeaning women to the appropriation of feminist and equality messages was observed, which may appeal to a wider range of women, including those embracing feminist identities.

CONCLUSION

Alcohol brand marketing encourages alcohol use to women through both perpetuating and challenging gender stereotypes. Claims by brands of a commitment to equality are at odds with the harms related to alcohol consumption that contribute to the widening of health and social inequalities. It is important that future work on women's drinking and alcohol marketing is situated within the shifting social-political climate in which traditional, post-feminist and new fourth wave feminist rhetoric and femininities co-exist.

Has the national fall in smoking rate in Ireland been replicated in cancer patients? a 5-year report

Background

Population smoking rates are falling in Ireland, however many cancer patients continue smoking post diagnosis, despite its association with poorer treatment and clinical outcomes. As part of a feasibility study of smoking cessation for cancer patients in Ireland, a review of smoking rates in cancer patients was undertaken.

Methods

The Hospital Inpatient Enquiry system (HIPE), a national database which collects administrative, demographic & clinical data on discharges from public hospitals in Ireland, provided data (2014-2018) on smoking status of adult discharges with a cancer diagnosis (overall, breast, lung, cervical and head & neck (H&N). Smoking trends were compared with Healthy Ireland data (2015-2018), from a national survey for adults on health & wellbeing.

Results

During 2014-18, current smoking rose for all cancers (10.5%-11.4%), cervical cancer (11%-19.8%) and initially (2014-2016) for H&N (3%-12.7%) and lung (24.7%-27.2%), which dropped to 7.6% and 24% respectively in 2018; breast was stable at 6 ± 0.6%. Rates are lower than the general population (23%-20%). During 2014-17, past smoking rates demonstrated an upward trend among all cancers and specific cancers, with the highest prevalence among lung (30.3-39%) and lowest among breast (7.3-11%); comparative general population data was 23-28%. Current smoking rates for all cancers were highest among 50-59-year-olds (14-16%), which contrasts with the general population (24-35 years at 32-28%). Current and past smoking rates for all cancers were consistently higher among males, similar to the general population.

Conclusions

HIPE data is limited by duplicate episodes of care, and it is recognised that smoking documentation may be an underestimate. However, it is useful to analyse trends, as these limitations should be stable over the 5-year study period. Rates remain high; our further research will document barriers and facilitators to smoking cessation among cancer patients.

Key messages

Smoking rates in cancer patients are high despite proven benefits of smoking cessation. Supportive smoking cessation services as part of routine cancer care are indicated.

1431 Stoma Intubation, Isolation and Negative Pressure Wound Therapy for Complex Stoma-Associated Wounds: New Technique and Case Series

Background

The use of negative pressure wound therapy (NPWT) in colorectal surgery has been demonstrated for treating perineal defects, enterocutaneous fistula and stoma dehiscence. Here we describe a technique for closure of complex stoma-associated wounds using a novel commercial intubation device alongside NPWT to protect the surrounding wound from the stoma effluent. The device has previously described for use with enterocutaneous fistula. We present two cases that have been successfully treated with this technique.

Technique and Cases

The first case is of 88-year-old women with a retracted loop ileostomy and the second a 48 year-old male with a retracted end colostomy. Both patients underwent significant emergency peristomal debridement and in both cases the commercial device was deployed to intubate the stoma. VAC foam and standard adhesive dressings were used to form a quality seal and the pressure set to 125mmHg. In both cases near complete healing was achieved to the point that standard stoma bags and management could be used.

Conclusions

This is the first description of the use of an isolation device in complex stoma associated wounds. We have found the Fistula Funnel to be highly effective in this context.

A descriptive retrospective study on mortality and involuntary culling in beef and dairy cattle production systems of Western Australia (1981-2018)

Identifying and quantifying the relative frequency of involuntary losses is an essential first step in developing fit-for-purpose herd health programmes. The objective of this study was to provide an estimate of the relative frequency of reasons for mortality among south-west Western Australian beef and dairy cattle, based on necropsy findings from a university-based veterinary pathology referral centre over 38 years. A total of 904 cattle were submitted for postmortem examination throughout the study period. Gastrointestinal, cardiopulmonary and reproductive conditions were the most common causes of mortality in cattle submitted for necropsy at Murdoch University for the period 1981-2018. In dairy cattle, the common problems were gastrointestinal (bloat, abomasal displacements) 18% (59/320), cardiovascular (traumatic reticulo-pericarditis) 9% (30/320) and respiratory conditions (pneumonia) 8% (27/320). In beef cattle, the most common conditions were gastrointestinal (bloat, rumen acidosis) 11% (39/358), reproductive (metritis) 11% (38/358), cardiovascular (traumatic reticulo-pericarditis) 7% (25/358), respiratory (pneumonia) 7% (24/358), lameness (fractures) 6%, (21/358) and hepatobiliary conditions (blue-green algae poisoning, hepatotoxicity) 6% (21/358). Selection bias and missing data were potential confounders in this study. Although necropsy investigations provide useful information on animal mortalities and avenues for future herd health programmes, there is a need to standardise data capture methods and disease definition criteria, and conduct more detailed recording of data both at the farm level and at necropsy diagnostic centres.

3D Imaging from Multipath Temporal Echoes

Echo location is a broad approach to imaging and sensing that includes both manmade RADAR, LIDAR, SONAR, and also animal navigation. However, full 3D information based on echo location requires some form of scanning of the scene in order to provide the spatial location of the echo origin-points. Without this spatial information, imaging objects in three-dimensional (3D) is a very challenging task as the inverse retrieval problem is strongly ill-posed. Here, we show that the temporal information encoded in the return echoes that are reflected multiple times within a scene is sufficient to faithfully render an image in 3D. Numerical modeling and an information theoretic perspective prove the concept and provide insight into the role of the multipath information. We experimentally demonstrate the concept by using both radio frequency and acoustic waves for imaging individuals moving in a closed environment.

Super-resolution time-resolved imaging using computational sensor fusion

Imaging across both the full transverse spatial and temporal dimensions of a scene with high precision in all three coordinates is key to applications ranging from LIDAR to fluorescence lifetime imaging. However, compromises that sacrifice, for example, spatial resolution at the expense of temporal resolution are often required, in particular when the full 3-dimensional data cube is required in short acquisition times. We introduce a sensor fusion approach that combines data having low-spatial resolution but high temporal precision gathered with a single-photon-avalanche-diode (SPAD) array with data that has high spatial but no temporal resolution, such as that acquired with a standard CMOS camera. Our method, based on blurring the image on the SPAD array and computational sensor fusion, reconstructs time-resolved images at significantly higher spatial resolution than the SPAD input, upsampling numerical data by a factor \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$12 \times 12$$\end{document}12×12, and demonstrating up to \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$4 \times 4$$\end{document}4×4 upsampling of experimental data. We demonstrate the technique for both LIDAR applications and FLIM of fluorescent cancer cells. This technique paves the way to high spatial resolution SPAD imaging or, equivalently, FLIM imaging with conventional microscopes at frame rates accelerated by more than an order of magnitude.

Rational design, synthesis and testing of novel tricyclic topoisomerase inhibitors for the treatment of bacterial infections part 2

Building on our previously-reported novel tricyclic topoisomerase inhibitors (NTTIs), we disclose the discovery of REDX07965, which has an MIC90 of 0.5 μg mL-1 against Staphylococcus aureus, favourable in vitro pharmacokinetic properties, selectivity versus human topoisomerase II and an acceptable toxicity profile. The results herein validate a rational design approach to address the urgent unmet medical need for novel antibiotics.

Simultaneous pelvic exenteration and liver resection for primary rectal cancer with synchronous liver metastases: results from the PelvEx Collaborative

AIM

At presentation, 15-20% of patients with rectal cancer already have synchronous liver metastases. The aim of this study was to determine the surgical and survival outcomes in patients with advanced rectal cancer who underwent combined pelvic exenteration and liver (oligometastatic) resection.

METHOD

Data from 20 international institutions that performed simultaneous pelvic exenteration and liver resection between 2007 and 2017 were accumulated. Primarily, we examined perioperative outcomes, morbidity and mortality. We also assessed the impact that margin status had on survival.

RESULTS

Of 128 patients, 72 (56.2%) were men with a median age of 60 years [interquartile range (IQR) 15 years]. The median size of the liver oligometastatic deposits was 2 cm (IQR 1.8 cm). The median duration of surgery was 406 min (IQR 240 min), with a median blood loss of 1090 ml (IQR 2010 ml). A negative resection margin (R0 resection) was achieved in 73.5% of pelvic exenterations and 66.4% of liver resections. The 30-day mortality rate was 1.6%, and 32% of patients had a major postoperative complication. The 5-year overall survival for patients in whom an R0 resection of both primary and metastatic disease was achieved was 54.6% compared with 20% for those with an R1/R2 resection (P = 0.006).

CONCLUSION

Simultaneous pelvic exenteration and liver resection is feasible, with acceptable morbidity and mortality. Simultaneous resection should only be performed where an R0 resection of both pelvic and hepatic disease is anticipated.

Role of late photons in diffuse optical imaging

The ability to image through turbid media, such as organic tissues, is a highly attractive prospect for biological and medical imaging. This is challenging, however, due to the highly scattering properties of tissues which scramble the image information. The earliest photons that arrive at the detector are often associated with ballistic transmission, whilst the later photons are associated with complex paths due to multiple independent scattering events and are therefore typically considered to be detrimental to the final image formation process. In this work, we report on the importance of these highly diffuse, "late" photons for computational time-of-flight diffuse optical imaging. In thick scattering materials, >80 transport mean free paths, we provide evidence that including late photons in the inverse retrieval enhances the image reconstruction quality. We also show that the late photons alone have sufficient information to retrieve images of a similar quality to early photon gated data. This result emphasises the importance in the strongly diffusive regime of fully time-resolved imaging techniques.

Learning from calorie posting/traffic light systems introduction in a University hospital canteen

Key messages

Introduction of traffic light system and calorie posting needs evaluation. Females appear more likely to avail of traffic light systems and calorie posting in relation to food choices.

Optimizing Diabetes Self-management Using the Novel Skills, Confidence, and Preparedness Index (SCPI)

OBJECTIVE

The Skills, Confidence, and Preparedness Index (SCPI) is an electronic tool designed to assess three dimensions (knowledge, confidence, and preparedness) in a clinically relevant measure with immediate feedback to guide the individualization of patient education. This study sought to assess the validity and reliability of the final SCPI generation, its relevance to glycemia, and its responsiveness to patient education.

RESEARCH DESIGN AND METHODS

In Part 1, patients with type 1 and type 2 diabetes were recruited from specialist clinics over a 6-month period and completed the 23-item SCPI using a tablet. In Part 2, participants also underwent a diabetes self-management education (DSME) program. Baseline SCPI score was used to guide the DSME, and SCPI and glycemia were assessed at completion.

RESULTS

In total, 423 patients met inclusion criteria and 405 had evaluable data. SCPI scores were found to have a high degree of validity, internal consistency, and test-retest reliability, with no floor or ceiling effects. Scoring was negatively correlated with HbA_1c (type 1 diabetes: r = -0.26, P = 0.001; type 2 diabetes: r = -0.20, P = 0.004). In 51 participants who underwent a DSME intervention (6.4 ± 0.6 visits over a mean ± SD 3.4 ± 0.8 months), mean HbA_1c improvement was 1.2 ± 0.2% (13.1 ± 2.2 mmol/mol, P < 0.0001). Total SCPI score and each subscore improved in parallel.

CONCLUSIONS

The SCPI tool is a quick and easy-to-use measurement of three domains: skills, confidence, and preparedness. The instant scoring and feedback and its relationship to glycemic control should improve the efficiency and quality of individualizing care in the diabetes clinic.

The mad leading the blind: Perceptions of the vaccine-refusal movement among Australians who support vaccination

BACKGROUND

Vaccine refusal is shaped by the social ecology in which it occurs. How people who refuse vaccines are communicated to and treated may affect the nature and strength of their negative vaccine beliefs, and their responsiveness to health promotion messages. Yet little is known about how people who refuse vaccines are perceived by the public. Our research examined perceptions among pro-vaccine Australians of the vaccine-refusal movement.

METHODS

Descriptions of the vaccine-refusal movement by 2666 pro-vaccine Australians were analysed using thematic discourse analysis. Descriptive themes were identified via inductive, iterative coding. Discourse analysis techniques were then used to interpret latent beliefs about the vaccine-refusal movement.

RESULTS

Participants had negative and stigmatising perceptions of the vaccine-refusal movement. They believed the movement is dangerous, misinformed, and comprised of charlatans and fools who are unintelligent, selfish, overly emotional, conspiratorial and scientifically illiterate. Discursive analysis showed that these perceptions were underpinned by beliefs that people would have to be defective in some way to believe anti-vaccine rhetoric. Furthermore, perceptions were underpinned by beliefs that the movement spreads not only disease, but also dangerous ideas that were seen to attack the social order, institutions, values and reason. Participants' intensely-negative views related to their inability to imagine why someone would refuse vaccines.

CONCLUSIONS

This research provides a focused, qualitative account of public perceptions of the vaccine-refusal movement. The findings are concerning: stigma towards vaccine-refusing people may adversely affect their wellbeing and entrench their negative vaccine beliefs. The research suggests that more compassionate, nuanced discussion of vaccine refusal in the public sphere is needed. It also supports the need to systematically examine public attitudes towards vaccine refusal as a determinant of vaccine confidence.

Time-of-Flight Imaging at 10 ps Resolution with an ICCD Camera

ICCD cameras can record low light events with extreme temporal resolution. Thus, they are used in a variety of bio-medical applications for single photon time of flight measurements and LIDAR measurements. In this paper, we present a method which allows improvement of the temporal resolution of ICCD cameras down to 10 ps (from the native 200 ps of our model), thus placing ICCD cameras at a better temporal resolution than SPAD cameras and in direct competition with streak cameras. The higher temporal resolution can serve for better tracking and visualization of the information carried in time-of-flight measurements.

Attosecond-resolution Hong-Ou-Mandel interferometry

When two indistinguishable photons are each incident on separate input ports of a beamsplitter, they "bunch" deterministically, exiting via the same port as a direct consequence of their bosonic nature. This two-photon interference effect has long-held the potential for application in precision measurement of time delays, such as those induced by transparent specimens with unknown thickness profiles. However, the technique has never achieved resolutions significantly better than the few-femtosecond (micrometer) scale other than in a common-path geometry that severely limits applications. We develop the precision of Hong-Ou-Mandel interferometry toward the ultimate limits dictated by statistical estimation theory, achieving few-attosecond (or nanometer path length) scale resolutions in a dual-arm geometry, thus providing access to length scales pertinent to cell biology and monoatomic layer two-dimensional materials.

Patient Texting in General Practice: Who, Why, Why Not? A National Survey of Text Messaging in Irish General Practice

Introduction The benefits of text messaging patients are well documented. The General Medical Council recently published guidance endorsing text messaging. The use of text messaging by GPs in Ireland is currently unknown. The survey aims to address this knowledge deficit and ascertain the extent, benefits, risks, barriers and clinical role of text messaging in Irish general practice. Methods An online survey was emailed to 1,375 members of the Irish College of General Practitioners (ICGP). Results A total of 536 GPs completed the questionnaire; a response rate of 40%. Overall, 66% (n=353) of respondents text patients and 27% have a written policy for texting patients. Texting is used primarily to send test results (71%), to advise the patient to phone the practice (52%) and as appointment reminders (43%). Discussion GPs text messaging patients is widespread. Complex issues to resolve include consent, confidentiality, children/young adults and the clinical content of text messages. Guidance is required to enable GPs and patients harness the benefits of text messaging, while minimising potential risks.

The financial burden for the surgical management of osteoradionecrosis

Osteoradionecrosis (ORN) remains a difficult clinical problem. In large refractory cases surgery appears to be the only option but it does not guarantee a cure and is expensive. Cost analysis of 31 patients who had resection with or without reconstruction of their mandible was £892,357. The largest cost was in-patient stay, which accounted for 62% of the total. This article explores in detail the expenditure associated with major ORN surgery and its subsequent implications.

Recombinant β-defensin 126 promotes bull sperm binding to bovine oviductal epithelia

Primate β-defensin 126 regulates the ability of spermatozoa to bind to oviductal epithelial cells in vitro. Bovine β-defensin 126 (BBD126) exhibits preferential expression in the cauda epididymis of the bull, but there have been few studies on its functional role in cattle. The aim of the present study was to examine the role of BBD126 in bull sperm binding to bovine oviductal epithelial cell (BOEC) explants. BBD126 has been shown to be highly resistant to the standard methods of dissociation used in other species and, as a result, corpus epididymal spermatozoa, which have not been exposed to the protein, were used to study the functional role of BBD126. Corpus epididymal spermatozoa were incubated with recombinant (r) BBD126 in the absence or presence of anti-BBD126 antibody. Addition of rBBD126 significantly enhanced the ability of epididymal spermatozoa to bind to BOEC explants (P < 0.05). Anti-BBD126 antibody blocked the BBD126-mediated increase in sperm binding capacity. Ejaculated spermatozoa, which are coated with native BBD126 protein but also a large number of seminal plasma proteins in vivo, were incubated with rBBD126 in the absence or presence of the anti-BBD126 antibody. Addition of rBBD126 significantly enhanced the ability of ejaculated spermatozoa to bind to BOEC explants (P < 0.05), whereas rBBD126 also reduced corpus sperm agglutination (P < 0.05). These results suggest that, similar to the role of its analogue in the macaque, spermatozoa with more BBD126 in their acrosome may represent spermatozoa with more oviduct binding capacity.

Postnatal depression: Can visual media and dramatisation of a young woman's experiences, enable student health care professionals develop knowledge to enhance clinical practice skills?

Introduction

Since the presentation of the symptoms of postnatal depression (PND) can vary; healthcare professionals must receive the appropriate level of training to develop the knowledge required for the effective assessment and referral of women. Yet, healthcare professionals may have limited knowledge in perinatal mental health and students may lack practice opportunities to develop the knowledge and clinical skills. For these reasons, the use of alternative learning resources within perinatal mental health education is vital.

Objectives

To explore the use of visual media in perinatal mental health education.

Aims

Against the background of increasing concerns about the ability of professionals to assess women with PND, this paper will consider how using dramatisation as a teaching approach can enable students to develop their knowledge and guide clinical skill development.

Methods

Three separate groups of senior student midwives and health visitors were asked to evaluate a dramatisation developed from women's lived experience of PND. Pre and post verbal evaluation of the drama were undertaken with the use of focus groups guided by semi-structured questions. Ethical approval was granted by the university.

Results

Following thematic analysis three issues were identified:

–the role of the healthcare professional;

–improvements needed in care;

–issues of education and training.

Conclusions

Against the background of limited placement experience and opportunity for assessment of PND, the use of visual media can improve student healthcare professionals’ learning; with the use of structured facilitation, there is a great potential for multidisciplinary learning.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

In vitro addition of docosahexaenoic acid improves the quality of cooled but not frozen-thawed stallion semen

The aim of the present study was to assess the effect of the addition of docosahexaenoic acid (DHA) on the in vitro quality of cooled and frozen-thawed stallion semen. In Experiment 1, semen from 10 stallions was collected (three ejaculates per stallion). Semen was diluted to 100×10⁶ spermatozoa mL^-1 with 0.02mM vitamin E (VE) and 0, 1, 10 or 20ng mL^-1 DHA and frozen. Semen was thawed and total motility (TM), rapid progressive motility (PM), acrosome integrity, membrane fluidity and morphology were assessed. In Experiment 2, semen from three stallions was collected (three ejaculates per stallion) and frozen as in Experiment 1, but VE and DHA were added after thawing. TM and PM were assessed at 30, 60 and 120min and viability, acrosome integrity and membrane fluidity were evaluated at 30min. In Experiment 3, semen from five stallions was collected (one to three ejaculates per stallion), diluted to 20×10⁶ spermatozoa mL^-1 and stored at 4°C. After 1, 24, 48 and 72h, TM, PM, viability, membrane fluidity and lipid peroxidation were assessed. The addition of DHA had no effect on frozen semen (Experiments 1 and 2) but improved TM, PM and membrane fluidity in cooled stallion semen.

Coherent Absorption of N00N States

Recent results in deeply subwavelength thickness films demonstrate coherent control and logical gate operations with both classical and single-photon light sources. However, quantum processing and devices typically involve more than one photon and nontrivial input quantum states. Here we experimentally investigate two-photon N00N state coherent absorption in a multilayer graphene film. Depending on the N00N state input phase, it is possible to selectively choose between single- or two-photon absorption of the input state in the graphene film. These results demonstrate that coherent absorption in the quantum regime exhibits unique features, opening up applications in multiphoton spectroscopy and imaging.

The use of a negative pressure wound management system in perineal wound closure after extralevator abdominoperineal excision (ELAPE) for low rectal cancer

BACKGROUND

Perineal wound healing is a significant challenge after extralevator abdominoperineal excision (ELAPE) due to a high rate of wound breakdown. Negative pressure therapy has proven benefits in open wounds, and recently a negative pressure system has been developed for use on closed wounds at high risk of breakdown, such as apronectomy and hysterectomy. The aim of the present study was to determine whether negative pressure therapy applied to closed perineal wounds after ELAPE improved wound healing and compare outcomes to the published literature and outcomes from a historical cohort of patients who had undergone 'standard' abdominoperineal resection (APR) and primary closure of the perineal wounds.

METHODS

Prospective data on consecutive patients having ELAPE in the period from November 2012 to April 2015 were collected. The pelvic floor defect was reconstructed with biologic mesh. The adipose tissue layer was closed with vicryl sutures, a suction drain was left in the deep layer, the subcuticular layer and skin were closed, and the negative pressure system was applied. Any wound breakdown within the first 30 days postoperatively was recorded.

RESULTS

Of the 32 consecutive ELAPE patients whose perineal wounds were closed within 30 days with the use of the negative pressure system, there was 1 patient with major perineal wound breakdown and 2 patients with a 1 cm superficial wound defect, which needed no further treatment. In the remaining 29 (90 %) patients, the perineal wounds healed fully without complications. Twenty-five patients underwent standard APR in 2010-2011 with primary closure of their perineal wounds. Ten out of 25(40 %) of patients who had undergone standard APR and primary closure of perineal wounds had major wound complications (p = 0.01).

CONCLUSIONS

Our results suggest that after ELAPE the application of a negative pressure system to the perineal wound closed with biologic mesh may reduce perineal wound complications and may reduce the need for major perineal reconstruction.

Use of antiretroviral treatment among people living with HIV in Australia between 1997 and 2012

Current international targets aim for 90% of people diagnosed with HIV to be on antiretroviral treatment (ART). This paper aims to identify sociodemographic and attitudinal factors associated with ART non-use over time in three samples of Australian people living with HIV (PLHIV). Data for this paper were derived from an Australian cross-sectional survey of PLHIV that was repeated at three different time points: 1997, 2003, and 2012. There were approximately 1000 respondents to each survey (n = 3042 in total). The survey included approximately 250 items related broadly to health and well-being, ART use, and attitudes towards ART use. Univariate and multivariate logistic regression analyses were used. While the proportion of participants using ART increased between 1997 and 2012 (78.8-87.6%, p < .001), there was a decrease between 1997 and 2003 to 70.6% (p < .001). Factors linked to ART non-use remained steady over those 15 years. In all cohorts, people less likely to be using ART were younger and had a more recent diagnosis of HIV. In 2003 and 2012, people in full-time employment were less likely to be using ART, while those whose main source of income was a pension or social security were more likely to be using ART. Multivariate models showed that, at each time point, a belief in the health benefits of delayed ART uptake was associated with non-use. These findings suggest that there may be barriers to ART uptake that have persisted over time despite changes to clinical guidelines that now encourage early uptake.

Observation of image pair creation and annihilation from superluminal scattering sources

The invariance of the speed of light is one of the foundational pillars of our current understanding of the universe. It implies a series of consequences related to our perception of simultaneity and, ultimately, of time itself. Whereas these consequences are experimentally well studied in the case of subluminal motion, the kinematics of superluminal motion lack direct evidence or even a clear experimental approach. We investigate kinematic effects associated with the superluminal motion of a light source. By using high-temporal-resolution imaging techniques, we directly demonstrate that if the source approaches an observer at superluminal speeds, the temporal ordering of events is inverted and its image appears to propagate backward. Moreover, for a source changing its speed and crossing the interface between subluminal and superluminal propagation regions, we observe image pair annihilation and creation, depending on the crossing direction. These results are very general and show that, regardless of the emitter speed, it is not possible to unambiguously determine the kinematics of an event from imaging and time-resolved measurements alone. This has implications not only for light, but also, for example, for sound and other wave phenomena.

Geometries for the coherent control of four-wave mixing in graphene multilayers

Deeply sub-wavelength two-dimensional films may exhibit extraordinarily strong nonlinear effects. Here we show that 2D films exhibit the remarkable property of a phase-controllable nonlinearity, i.e., the amplitude of the nonlinear polarisation wave in the medium can be controlled via the pump beam phase and determines whether a probe beam will "feel" or not the nonlinearity. This is in stark contrast to bulk nonlinearities where propagation in the medium averages out any such phase dependence. We perform a series of experiments in multilayer graphene that highlight some of the consequences of the optical nonlinearity phase-dependence, such as the coherent control of nonlinearly diffracted beams, single-pump-beam induced phase-conjugation and the demonstration of a nonlinear mirror characterised by negative reflection. The observed phase sensitivity is not specific to graphene but rather is solely a result of the dimensionality and is therefore expected in all 2D materials.

Postnatal MRI Brain in Infants Treated for Twin-Twin Transfusion Syndrome

Untreated twin-twin transfusion syndrome (TTTS) is associated with significant mortality and neurological impairment. Fetoscopic laser surgery (FLS) is the treatment of choice. We sought to assess intracranial abnormalities in TTTS twins following treatment. In this prospective, blinded study MRI scans were performed on 3 groups; (1) monochorionic diamniotic (MCDA) twins with TTTS who had undergone FLS (n = 10), (2) MCDA twins without TTTS (n = 8) and (3) dichorionic twins (n = 8). Scans were scored as either normal or abnormal. The primary outcome was a composite of abnormal MRI brain or intrauterine fetal demise. The primary outcome occurred in 6/10 (60%) of the TTTS group versus 3/8 (37.5%) in the MCDA group. The primary outcome was significantly different across all study groups [p = 0.029; X2 = 7.112]. We found that twins treated for TTTS are more likely to have abnormalities on MRI brain at term than other twin groups. This group merits term-corrected MRI as part of their postnatal assessment.

Evaluation of dengue virus strains for human challenge studies

Discordance between the measured levels of dengue virus neutralizing antibody and clinical outcomes in the first-ever efficacy study of a dengue tetravalent vaccine (Lancet, Nov 2012) suggests a need to re-evaluate the process of pre-screening dengue vaccine candidates to better predict clinical benefit prior to large-scale vaccine trials. In the absence of a reliable animal model and established correlates of protection for dengue, a human dengue virus challenge model may provide an approach to down-select vaccine candidates based on their ability to reduce risk of illness following dengue virus challenge. We report here the challenge of flavivirus-naïve adults with cell culture-passaged dengue viruses (DENV) in a controlled setting that resulted in uncomplicated dengue fever (DF). This sets the stage for proof-of-concept efficacy studies that allow the evaluation of dengue vaccine candidates in healthy adult volunteers using qualified DENV challenge strains well before they reach field efficacy trials involving children. Fifteen flavivirus-naïve adult volunteers received 1 of 7 DENV challenge strains (n=12) or placebo (n=3). Of the twelve volunteers who received challenge strains, five (two DENV-1 45AZ5 and three DENV-3 CH53489 cl24/28 recipients) developed DF, prospectively defined as ≥2 typical symptoms, ≥48h of sustained fever (>100.4°F) and concurrent viremia. Based on our study and historical data, we conclude that the DENV-1 and DENV-3 strains can be advanced as human challenge strains. Both of the DENV-2 strains and one DENV-4 strain failed to meet the protocol case definition of DF. The other two DENV-4 strains require additional testing as the illness approximated but did not satisfy the case definition of DF. Three volunteers exhibited effusions (1 pleural/ascites, 2 pericardial) and 1 volunteer exhibited features of dengue (rash, lymphadenopathy, neutropenia and thrombocytopenia), though in the absence of fever and symptoms. The occurrence of effusions in milder DENV infections counters the long-held belief that plasma leakage syndromes are restricted to dengue hemorrhagic fever/dengue shock syndromes (DHF/DSS). Hence, the human dengue challenge model may be useful not only for predicting the efficacy of vaccine and therapeutic candidates in small adult cohorts, but also for contributing to our further understanding of the mechanisms behind protection and virulence.