Rupture of a flow aneurysm secondary to spontaneous extracranial to intracranial revascularisation in the posterior fossa following radiation-induced vasculopathy for cerebellar tumour.

Paediatric patients receiving cranial irradiation therapy for brain tumours are at increased risk of cerebrovascular complications. Radiation-induced moyamoya syndrome (MMS) is a well-recognised complication of this. We present a case of an 8-year-old boy with a history of medulloblastoma, who underwent surgical excision followed by post-operative adjuvant oncological treatment. Six years later, he developed cerebellar/intraventricular haemorrhage. He underwent an emergency external ventricular drain (EVD) insertion followed by posterior fossa suboccipital craniotomy. On dural opening, an abnormal vessel was visualised on the surface of the right cerebellar hemisphere, which was not disturbed. No obvious abnormalities were identified intra-operatively. Cerebral catheter angiography confirmed the presence of a right-sided occipital artery (OA) to posterior inferior cerebellar artery (PICA) extracranial to intracranial (EC-IC) bypass with a zone of the distal PICA territory supplied by this EC-IC bypass. A presumed flow aneurysm originated from the bypass in the distal PICA, identified as cause for the haemorrhage. We highlight a rare cause for intracranial haemorrhage in this cohort of patients. Children who have undergone radiotherapy may have exquisitely sensitive cerebral vasculature and need careful vigilance and evaluation for vasculopathic complications following spontaneous haemorrhage.

Blunt traumatic vertebral artery injury: a clinical review.

Blunt traumatic vertebral injury (TVAI) is frequently associated with head and neck injury and is being detected with increasing frequency due to improved imaging of the trauma patient. In a few cases, it can lead to potentially fatal posterior circulation ischaemia There is debate in the literature regarding whether TVAI should be actively screened for and, if so, how. Management of TVAI may be conservative, medical (antiplatelet agents or anticoagulation), endovascular or open surgery. We review the literature concerning the mechanisms and presentation of TVAI following blunt injury and the current screening recommendations. Management strategies proposed are based on the radiological grade and clinical severity of TVAI, where high-grade symptomatic injuries and high-grade injuries in patients where anticoagulation is contraindicated are treated endovascularly and asymptomatic or low-grade injuries are managed with anticoagulation where it is not contraindicated. Follow-up is via CT angiography to assess for resolution of the injury.

Neutron reflection study of bovine beta-casein adsorbed on OTS self-assembled monolayers.

Specular neutron reflection has been used to determine the structure and composition of bovine beta-casein adsorbed on a solid surface from an aqueous phosphate-buffered solution at pH 7. The protein was adsorbed on a hydrophobic monolayer self-assembled from deuterated octadecyltrichlorosilane solution on a silicon (111) surface. A two-layer structure formed consisting of one dense layer of thickness 23 +/- 1 angstroms and a surface coverage of 1.9 milligrams per square meter adjacent to the surface and an external layer protruding into the solution of thickness 35 +/- 1 angstroms and 12 percent protein volume fraction. The structure of the (beta-casein) layer is explained in terms of the charge distribution in the protein.

Here, there and everywhere: psychologists and the training of British Army officers at the Royal Military Academy Sandhurst.

The Department of Communication and Applied Behavioural Science is one of the three departments in the academic faculty at the Royal Military Academy Sandhurst. The aim of the Department is to equip officer cadets with the skills, knowledge and personal qualities in order for them to develop their own potential, as both individuals and leaders in the British Army. The members of the Department have a range of backgrounds, with most having served in various capacities across UK Defence, both in uniformed and/or civilian crown servant contexts. Several members of the faculty are qualified psychologists, while others have related academic and professional backgrounds. The academic and applied discipline of psychology is the fundamental thread that runs through the various courses and projects delivered by the Department. This paper provides a brief overview of the activities undertaken by the Department, with a specific focus on the psychology components of the academic and applied activities. Although mainly serving in academic teaching roles, this paper illustrates the work of the psychologists outside the classroom, such as via field exercises and deployments overseas. It also touches on the importance of the outreach undertaken by the psychologists in the Department, which supports their ongoing research.

Determinants of Radiation Dose in Selective Ophthalmic Artery Chemosurgery for Retinoblastoma.

BACKGROUND AND PURPOSE: Retinoblastoma is the most common pediatric ocular neoplasm. Multimodality treatment approaches are commonplace, and selective ophthalmic artery chemosurgery has emerged as a safe and effective treatment in selected patients. Minimizing radiation dose in this highly radiosensitive patient cohort is critical. We explore which procedural factors affect the radiation dose in a single-center cohort of children managed in the UK National Retinoblastoma Service. MATERIALS AND METHODS: A retrospective review was performed of 177 selective ophthalmic artery chemosurgery procedures in 48 patients with retinoblastoma (2013-2017). Medical records, angiographic imaging, and radiation dosimetry data (including total fluoroscopic screening time, skin dose, and dose-area product) were reviewed. RESULTS: The mean fluoroscopic time was 13.5 ± 13 minutes, the mean dose-area product was 11.7 ± 9.7 Gy.cm2, and the mean total skin dose was 260.9 ± 211.6 mGy. One hundred sixty-three of 177 procedures (92.1%) were technically successful. In 14 (7.9%), the initial attempt was unsuccessful (successful in 13/14 re-attempts). Screening time and radiation dose were associated with drug-delivery microcatheter location and patient age; screening time was associated with treatment cycle. CONCLUSIONS: In selective ophthalmic artery chemosurgery, a microcatheter tip position in the proximal or ostial ophthalmic artery and patient age 2 years or younger were associated with reduced fluoroscopic screening time and radiation dose; treatment beyond the first cycle was associated with reduced fluoroscopic screening time.

Experimental platform to facilitate novel back brace development for the improvement of spine stability.

The spine or 'back' has many functions including supporting our body frame whilst facilitating movement, protecting the spinal cord and nerves and acting as a shock absorber. In certain instances, individuals may develop conditions that not only cause back pain but also may require additional support for the spine. Common movements such as twisting, standing and bending motions could exacerbate these conditions and intensify this pain. Back braces can be used in certain instances to constrain such motion as part of an individual's therapy and have existed as both medical and retail products for a number of decades. Arguably, back brace designs have lacked the innovation expected in this time. Existing designs are often found to be heavy, overly rigid, indiscrete and largely uncomfortable. In order to facilitate the development of new designs of back braces capable of being optimised to constrain particular motions for specific therapies, a numerical and experimental design strategy has been devised, tested and proven for the first time. The strategy makes use of an experimental test rig in conjunction with finite element analysis simulations to investigate and quantify the effects of back braces on flexion, extension, lateral bending and torsional motions as experienced by the human trunk. This paper describes this strategy and demonstrates its effectiveness through the proposal and comparison of two novel back brace designs.

Towards a molecular understanding of the water purification properties of Moringa seed proteins.

Seed extracts from Moringa oleifera are of wide interest for use in water purification where they can play an important role in flocculation; they also have potential as anti-microbial agents. Previous work has focused on the crude protein extract. Here we describe the detailed biophysical characterization of individual proteins from these seeds. The results provide new insights relating to the active compounds involved. One fraction, designated Mo-CBP3, has been characterized at a molecular level using a range of biochemical and biophysical techniques including liquid chromatography, X-ray diffraction, mass spectrometry, and neutron reflection. The interfacial behavior is of particular interest in considering water purification applications and interactions with both charged (e.g. silica) and uncharged (alumina) surfaces were studied. The reflection studies show that, in marked contrast to the crude extract, only a single layer of the purified Mo-CBP3 binds to a silica interface and that there is no binding to an alumina interface. These observations are consistent with the crystallographic structure of Mo-CBP3-4, which is one of the main isoforms of the Mo-CBP3 fraction. The results are put in context of previous studies of the properties of the crude extract. This work shows possible routes to development of separation processes that would be based on the specific properties of individual proteins.

Patient-reported quality of life outcomes following treatment for oral cancer.

Patient-reported quality of life (QoL) outcomes have the potential to assist clinicians in providing individually tailored treatment decisions. QoL assessments were collected prospectively for 168 consecutive patients treated for oral cancer between 1 January 2010 and 31 December 2014 using the University of Washington Quality of Life Questionnaire. Patients were followed up for 18 months post-treatment. Sub-group analyses were performed using paired t-tests and analysis of variance (ANOVA) to compare the effects of adjunctive chemoradiotherapy, type of bone resection, and methods of soft and hard tissue flap reconstruction. The greatest statistically significant reduction in QoL for all oral cavity sub-sites was found following the treatment of floor of mouth tumours (-18.9%, P=0.018). Laser excision for matched patient cohorts resulted in improved resultant QoL compared to other excision techniques (P=0.0002). No significant difference in QoL was found when radial forearm and anterolateral thigh flaps were matched, or when fibula and scapula flaps were matched. These findings support the use of laser excision and the avoidance of postoperative radiotherapy if curative intent and survival outcomes are maintained.

Characterization of the flow of anisotropic colloidal particles using energy-dispersive X-ray diffraction.

The technique of energy-dispersive X-ray diffraction to study the orientation of microscopic crystalline particles dispersed in a liquid has been described recently. This complements previous neutron diffraction studies by permitting measurements at higher spatial resolution. Work with synchrotron radiation and high-energy X-rays has allowed studies on liquid dispersions flowing in pipes with a thickness of about 1 cm and a spatial resolution of 100 mum. Kaolinite is often found as a dispersion of monocrystalline, microscopic plates. The crystallographic layer structure is commensurate with the particle shape: the 00l direction is normal to the plane of the plates. Measurements of diffraction of the flowing liquid dispersion in a pipe oriented in various directions to the incident beam can be used to deduce the average orientation and order parameters of the particles. The competing effects of alignment with walls and in flow fields were observed. Further work has measured the orientation near a bend in a pipe.

Health-related quality of life after maxillectomy: obturator rehabilitation compared with flap reconstruction.

Health-related quality of life (QoL) reported by patients has the potential to improve care after ablative surgery of the midface, as existing treatment algorithms still generally revolve around outcomes assessed traditionally only by clinicians. Decisions in particular relate to reconstruction with a flap compared with rehabilitation with an obturator, the need for adjuvant treatment, and morbidity related to the size of the defect. We prospectively collected health-related QoL assessments for 39 consecutive patients treated by maxillectomy between 01 January 2010 and 31 December 2014 using the University of Washington Quality of Life Questionnaire, and who had a mean (SD) duration of follow-up of 14 (4). We made sub-group analyses using paired t tests and analysis of variance (ANOVA) to compare reconstruction with a flap with rehabilitation with obturators, size of the vertical defect, and whether adjuvant treatment with radiotherapy or chemoradiotherapy adversely affected it. Overall there was a significant decrease in health-related QoL after treatment compared with before (p<0.001), but there was no significant difference in the effects of any of the paired reconstructive and rehabilitation treatments on it. Obturators remain an important option for rehabilitation in selected patients in addition to reconstruction with a flap. We found that neither increasing the size of the vertical defect (in an attempt to ensure clear margins) nor the use of postoperative radiotherapy seemed to have any adverse effect on QoL. More patients are required before we can conclude that the potential survival benefits of such measures may outweigh any adverse effects.

Pumping of water with ac electric fields applied to asymmetric pairs of microelectrodes.

Bulk fluid flow induced by an ac electric potential with a peak voltage below the ionization potential of water is described. The potential is applied to an ionic solution with a planar array of electrodes arranged in pairs so that one edge of a large electrode is close to an opposing narrow electrode. During half the cycle, the double layer on the surface of the electrodes charges as current flows between the electrodes. The electrodes charge in a nonuniform manner producing a gradient in potential parallel to the surface of the electrodes. This gradient drives the ions in the double layer across the surface of the electrode and this in turn drags the fluid across the electrode surface. The anisotropic nature of the pairs of electrodes is used to produce a net flow of fluid. The flow produced is approximately uniform at a distance from the electrodes that is greater than the periodicity of the electrode array. The potential and frequency dependence of this flow is reported and compared to a simple model. This method of producing fluid flow differs from electrical and thermal traveling-wave techniques as only a low voltage is required and the electrode construction is much simpler.

Cord-care practice in Scotland.

OBJECTIVE: To identify the range of policies, practices and rationale for umbilical-cord stump care in the NHS in Scotland. DESIGN: A postal questionnaire survey completed in two stages. The first stage elicited the views of Heads of Midwifery/Senior Midwives, and the second stage the views of midwives, enrolled nurses and nursery nurses. SETTING: NHS units in Scotland providing intrapartum care. They were separated into large and small units with small units having < or = 1000 deliveries per year (n = 178), and large units > 1000 deliveries per year (n = 300). PARTICIPANTS: The Heads of Midwifery/Senior Midwives from the 51 units were invited to participate in the study and 49 (96.1%) replied. In stage two 512 maternity unit employees were sent questionnaires and 390 (76.2%) replied. These were six enrolled nurses, 20 nursery nurses and 360 midwives and four respondents of unspecified occupation. MEASUREMENTS: The existence of cord-care policies and their rationale. FINDINGS: About half of the units that responded had a written policy. Large units were four times more likely than small units to have a written policy. Both managers and staff reported that the most common policy/agreed practice was no specific care (cord observed and only cleaned if soiled). Where a written policy existed, less than one-half of the Heads of Midwifery/Senior Midwives and less than one third of the staff reported that the basis for this policy was research. KEY CONCLUSIONS: Units with a written policy are in the minority and small units are far less likely to have such a policy. Wide variation exists in policy, practice and rationale. Diversity within and between units creates anxiety and disillusionment for practitioners. It may also cause confusion for patients who are exposed to different cord-care practices either as these change over time or because they use different units. IMPLICATIONS FOR PRACTICE: The midwifery profession must examine this area of practice and determine how to address this lack of evidence. Further research is required to determine the most effective method of cord care and how best to put the findings into practice. Outstanding questions which beg further investigation are: How do cords heal and separate and what bacteria are naturally involved in this process? What constitutes an infected cord as opposed to a colonised cord?

Can anxiety in pregnant women be measured using the State-Trait Anxiety Inventory.

OBJECTIVE: To explore the stability of the State-Trait Anxiety Inventory (STAI), which was used to explain shifts in women's priorities for intrapartum care. DESIGN: A comparative survey of women's priorities for intrapartum care, using a self-complete questionnaire at two intervals, 34 weeks gestation and 10 days postpartum. The questionnaire incorporated the full 40 item STAI. SETTING: Aberdeen, Scotland. PARTICIPANTS: 217 women presenting at Aberdeen Maternity Hospital at 34 weeks gestation who were 'booked' for delivery within the hospital, and who lived within Aberdeen city. One hundred and thirty-six were expecting their first baby and 81 were expecting their second. MEASUREMENTS: Women's priorities for intrapartum care as ascertained at 34 weeks gestation and 10 days postpartum; shifts in priorities observed during this time period; and factors, such as anxiety (measured by the STAI), which could explain these shifts. FINDINGS: Regardless of parity, women had significantly lower A-Trait scores postnatally than antenatally, when compared over a relatively short time period. Differences between nulliparous and parous women were found where the time lapse, between completion of the scales, was more than 45 days. For nulliparous women significant differences in A-Trait scores were still evident in the 45-56 day interval, but not in the later interval of 57-91 days. Parous women appeared to follow the opposite trend, however the numbers were considerably smaller. CONCLUSION: The findings reported in this paper are derived from a study assessing women's priorities for intrapartum care. Anxiety was not a primary outcome measure in this study, but rather a factor which was measured as a possible explanation for shifts in priorities. However, the findings suggest that the STAI may not be stable around the time of delivery. In particular, the test-retest reliability of the STAI A-Trait scale appears to be quite low. IMPLICATIONS: The study reported here raises the need for further research in this area and cautions against the unqualified use of this tool until its performance, specifically in the context of pregnant or recently-delivered women, has been thoroughly assessed.

A national survey of women's views of their maternity care in Scotland.

OBJECTIVE: A survey of women's views of their care was undertaken as part of a national audit of maternity services in Scotland. The overall aim of the audit was to determine the extent to which recommendations from recent national policy documents had been adopted in practice. DESIGN: A cross-sectional study seeking the views of all women giving birth throughout Scotland during a 10-day period in September 1998. PARTICIPANTS: All women giving birth in Scotland within the survey period were eligible to participate in the study. Women unable to complete the questionnaire in English, women for whom the midwife deemed it inappropriate, and women who delivered but no longer resided in Scotland by their 10th postnatal day were excluded. DATA COLLECTION: A self-complete questionnaire given to the woman by her community midwife for completion on her 10th postnatal day. DATA ANALYSIS: Analysis was carried out using the statistical package SPSS for Windows. Descriptive statistics were produced for all variables. Statistical tests of significance were not used, as this was primarily a descriptive survey. FINDINGS: Of the 1152 questionnaires returned, 1137 were suitable for analysis. This gave a response rate of 69% of the eligible population (1639). Most women (80%) had the majority of their antenatal care in the community but only one third had a choice about this. Sixty-nine per cent of women received care from one or two people. However, only 37% had a choice about who these people were. The majority of women gave birth in hospital (99%). Sixty-one per cent felt that they had a choice about where they could have their baby. However, fewer women had a choice about having a home birth (41%) or a DOMINO delivery (23%). Just over half the women felt that it was important to be cared for by a midwife that they had met during pregnancy but only 12% of women achieved this. Sixty-two per cent of women had talked to a health professional about what happened during labour and delivery but less than half had spoken with a professional who was present during her labour or birth. CONCLUSIONS: Considerable efforts have been made to improve information and choice for women. However, it is clear that further work is needed if women are to be offered informed choice in the provision of their maternity care.

The application of ergonomics to consumer product evaluation.

Consumer products may be evaluated by technical tests or by ergonomics assessments. If an ergonomics assessment is required, then three types of test are available to the researcher. These are the user trial, the expert appraisal and the performance test. These three methods are described briefly and some advantages, disadvantages and issues arising from each are discussed. It is concluded that although the user trial will always assume an important role for the evaluation of many products, expert appraisals and performance tests can prove to be cost effective methods in certain circumstances. Some controversial areas requiring further research are highlighted.

Labour-intensive civil construction.

This paper presents the results of a literature review of the ergonomics of labour-intensive civil construction. The work capacity of Asian and European workers is compared. Metabolic rates and other factors limiting productivity presented in the literature are summarised. Comparison is made with the results of productivity measurements taken in India and Indonesia. The considerable scope and need for further work in this field is outlined.

Constipation and soiling--outcome of treatment at one year.

AIM: To assess the outcome at one year of a cohort of patients referred to outpatient clinics with soiling. METHOD: Retrospective case note audit of 34 children referred to hospital outpatients over a four month period with soiling stated as the main problem in the referral letter. RESULTS: After one year, 29% of the 34 children studied were discharged to patient satisfaction, 38% defaulted from follow up, 24% were still attending outpatient clinics and 9% had been referred back to source. Coexisting pathologies, in particular enuresis and family stress, were found in several of the children. At the time of referral, 44% of new patients and 89% of re-referrals bad symptoms present for longer than 12 months. Only 18% of the children were receiving treatment at the time referral was made. CONCLUSION: Constipation is often undiagnosed until the problem is well established with soiling present, which makes treatment a long and often difficult process. It is necessary to consider the wider social and family issues when managing a child with constipation and soiling. Hospital based general medical and surgical outpatient clinics may not be the ideal setting in which to deal with these problems.

Maternal serum proteome changes between the first and third trimester of pregnancy in rural southern Nepal.

Characterization of normal changes in the serum proteome during pregnancy may enhance understanding of maternal physiology and lead to the development of new gestational biomarkers. In 23 Nepalese pregnant women who delivered at term, two-dimensional difference in-gel electrophoresis (DIGE) was used to assess changes in relative protein abundance between paired serum samples collected in the first and third trimesters. One-hundred and forty-five of over 700 protein spots in DIGE gels (pI 4.2-6.8) exhibited nominally significant (p < 0.05) differences in abundance across trimesters. Additional filtering using a Bonferroni correction reduced the number of significant (p < 0.00019) spots to 61. Mass spectrometric analysis detected 38 proteins associated with gestational age, cytoskeletal remodeling, blood pressure regulation, lipid and nutrient transport, and inflammation. One new protein, pregnancy-specific ß-glycoprotein 4 was detected. A follow-up isotope tagging for relative and absolute quantitation (iTRAQ) experiment of six mothers from the DIGE study revealed 111 proteins, of which 11 exhibited significant (p < 0.05) differences between trimesters. Four of these proteins: gelsolin, complement C1r subcomponent, α-1-acid glycoprotein, and α-1B-glycoprotein also changed in the DIGE analysis. Although not previously associated with normal pregnancy, gelsolin decreased in abundance by the third trimester (p < 0.01) in DIGE, iTRAQ and Western analyses. Changes in abundance of proteins in serum that are associated with syncytiotrophoblasts (gelsolin, pregnancy-specific ß-1 glycoprotein 1 and ß-2-glycoprotein I) probably reflect dynamics of a placental proteome shed into maternal circulation during pregnancy. Measurement of changes in the maternal serum proteome, when linked with birth outcomes, may yield biomarkers for tracking reproductive health in resource poor settings in future studies.