Ice retreat in Wilkes Basin of East Antarctica during a warm interglacial.

Efforts to improve sea level forecasting on a warming planet have focused on determining the temperature, sea level and extent of polar ice sheets during Earth's past interglacial warm periods1-3. About 400,000 years ago, during the interglacial period known as Marine Isotopic Stage 11 (MIS11), the global temperature was 1 to 2 degrees Celsius greater2 and sea level was 6 to 13 metres higher1,3. Sea level estimates in excess of about 10 metres, however, have been discounted because these require a contribution from the East Antarctic Ice Sheet3, which has been argued to have remained stable for millions of years before and includes MIS114,5. Here we show how the evolution of 234U enrichment within the subglacial waters of East Antarctica recorded the ice sheet's response to MIS11 warming. Within the Wilkes Basin, subglacial chemical precipitates of opal and calcite record accumulation of 234U (the product of rock-water contact within an isolated subglacial reservoir) up to 20 times higher than that found in marine waters. The timescales of 234U enrichment place the inception of this reservoir at MIS11. Informed by the 234U cycling observed in the Laurentide Ice Sheet, where 234U accumulated during periods of ice stability6 and was flushed to global oceans in response to deglaciation7, we interpret our East Antarctic dataset to represent ice loss within the Wilkes Basin at MIS11. The 234U accumulation within the Wilkes Basin is also observed in the McMurdo Dry Valleys brines8-10, indicating11 that the brine originated beneath the adjacent East Antarctic Ice Sheet. The marine origin of brine salts10 and bacteria12 implies that MIS11 ice loss was coupled with marine flooding. Collectively, these data indicate that during one of the warmest Pleistocene interglacials, the ice sheet margin at the Wilkes Basin retreated to near the precipitate location, about 700 kilometres inland from the current position of the ice margin, which-assuming current ice volumes-would have contributed about 3 to 4 metres13 to global sea levels.

COVID-19: smoke testing of surgical mask and respirators.

BACKGROUND: Fluid Resistant Surgical Masks have been implemented in UK personal protective equipment (PPE) guidelines for COVID-19 for all care sites that do not include aerosol-generating procedures (AGPs). FFP3 masks are used in AGP areas. Concerns from the ENT and plastic surgery communities out with intensive care units have questioned this policy. Emerging evidence on cough clouds and health care worker deaths has suggested that a review is required. AIMS: To test the efficacy of Fluid Resistant Surgical Mask with and without adaptions for respiratory protection. To test the efficacy of FFP and FFP3 regarding fit testing and usage. METHODS: A smoke chamber test of 5 min to model an 8-h working shift of exposure while wearing UK guideline PPE using an inspiratory breathing mouthpiece under the mask. Photographic data were used for comparison. RESULTS: The Fluid Resistant Surgical Mask gave no protection to inhaled smoke particles. Modifications with tape and three mask layers gave slight benefit but were not considered practical. FFP3 gave complete protection to inhaled smoke but strap tension needs to be 'just right' to prevent facial trauma. Facial barrier creams are an infection risk. CONCLUSIONS: Surgical masks give no protection to respirable particles. Emerging evidence on cough clouds and health care worker deaths suggests the implementation of a precautionary policy of FFP3 for all locations exposed to symptomatic or diagnosed COVID-19 patients. PPE fit testing and usage policy need to improve to include daily buddy checks for FFP3 users.

Outcome of Late Preterm Infants at the University Hospital of the West Indies.

Objective The objective of this study was to determine the outcome of late preterm infants at the University Hospital of the West Indies (UHWI) over a 2-year period. Design and Methods A retrospective, descriptive, case-controlled study was performed. Data were extracted from the maternal and neonatal medical records of 163 late preterm infants and matched term controls. Descriptive analyses were performed comparing morbidity and mortality between the groups. Results There was an overall incidence of 3.8% late preterm births. Late preterm infants were more likely to require admission to the neonatal unit than term controls (odds ratio:13.6; confidence interval: 7.95-23.34; p < 0.001) and they had a longer mean duration of stay (p < 0.05). During admission, late preterm infants had a significantly higher incidence of hypothermia, neonatal jaundice, and need for respiratory support than term controls (p < 0.05). There, however, was no increased risk of mortality. Mothers of late preterm infants had a higher incidence of hypertension in pregnancy, prolonged rupture of membranes (p < 0.001), and operative delivery than mothers of term controls (p < 0.05). Conclusion Late preterm infants at the UHWI were shown to be at increased risk of morbidity. This finding has implications for antenatal care, timing of delivery, and monitoring of these infants postdelivery.

Binder syndrome.

UNLABELLED: Patients with chondrodysplasia punctata (CDP) usually present with Binder-type features, and often CDP is misdiagnosed as Binder syndrome. This study reviewed the management and outcome of patients with Binder syndrome and CDP in a multidisciplinary setting. METHODS: The notes and radiographs of the patients managed at the Australian Craniofacial Unit with a multidisciplinary setting since 1976 were reviewed, and data were collected on patient demographics, associated medical and surgical problems, subsequent management, and complications. RESULTS: Seventy-seven patients were treated over the 30-year period (5 patients were lost to follow-up); of the remaining 72 patients, 60 (83%) had Binder syndrome, and 12 (17%) were patients with CDP. Forty were males, and 32 were females, with an age range of 6 months to 47 years. Thirteen patients (18%) had a strong family history, and 65 patients (90%) have so far undergone surgical correction, and of those, 35 (54%) have completed their treatment, the longest follow-up time being 18 years. The mean number of surgical procedures was 2.4, and 18 patients (28%) had postoperative complications, which included partial necrosis of the maxilla, osteomyelitis of the mandible, facial nerve and inferior alveolar nerve neuropraxia, nasal bone graft exposure, and cellulitis. DISCUSSION: Because of the phenotypic characteristics shared by both Binder syndrome and CDP, it is most likely that Binder syndrome is not a syndrome, nor is it an entity, but most likely to be an "association." We would advocate that these patients should be managed in a multidisciplinary setting.

Low-moderate prenatal alcohol exposure and risk to child behavioural development: a prospective cohort study.

OBJECTIVE: To examine the association of fetal alcohol exposure during pregnancy with child and adolescent behavioural development. DESIGN: The Western Australian Pregnancy Cohort (Raine) Study recruited 2900 pregnancies (1989-91) and the 14-year follow up was conducted between 2003 and 2006. SETTING: Tertiary obstetric hospital in Perth, Western Australia. POPULATION: The women in the study provided data at 18 and 34 weeks of gestation on weekly alcohol intake: no drinking, occasional drinking (up to one standard drink per week), light drinking (2-6 standard drinks per week), moderate drinking (7-10 standard drinks per week), and heavy drinking (11 or more standard drinks per week). Methods Longitudinal regression models were used to analyse the effect of prenatal alcohol exposure on Child Behaviour Checklist (CBCL) scores over 14 years, assessed by continuous z-scores and clinical cutoff points, after adjusting for confounders. MAIN OUTCOME MEASURE: Their children were followed up at ages 2, 5, 8, 10 and 14 years. The CBCL was used to measure child behaviour. RESULTS: Light drinking and moderate drinking in the first 3 months of pregnancy were associated with child CBCL z-scores indicative of positive behaviour over 14 years after adjusting for maternal and sociodemographic characteristics. These changes in z-score indicated a clinically meaningful reduction in total, internalising and externalising behavioural problems across the 14 years of follow up. CONCLUSIONS: Our findings do not implicate light-moderate consumption of alcohol in pregnancy as a risk factor in the epidemiology of child behavioural problems.

Basal cell carcinoma of the nipple-areola complex.

BACKGROUND: Basal cell carcinoma (BCC) of the nipple-areola complex is uncommon. It has been suggested that BCCs in this region behave more aggressively, with a higher potential for distant spread, than in other anatomical sites. OBJECTIVE: To address questions about etiology, behavior, optimal treatment, and prognosis of this entity. METHODS AND MATERIALS: A literature search identifying all cases of BCC of the nipple and nipple-areola complex in the English literature from 1893 to 2008. RESULTS: Thirty-four cases of BCC of the nipple, areola, or both were identified, mostly affecting middle-aged men. The majority of patients were treated with tissue-sparing surgery. There was a metastatic rate of 9.1%, and one patient died from the disease (3.0%). CONCLUSIONS: The optimal treatment of this condition should be local excision, but patients with this condition should be followed up for primary site recurrence and axillary metastasis, because there is greater incidence than with BCC at other anatomical sites. Furthermore, proven axillary metastasis should be surgically treated.

Sustainable Urban Drainage Systems (SUDS) treatment train assessment tool.

This paper outlines a rationale and scoring system for the stormwater treatment train assessment tool (STTAT) which is a proposed regulatory tool for Sustainable Urban Drainage Systems (SUDS). STTAT provides guidance and regulatory consistency for developers about the requirements of planners and the Scottish Environment Protection Agency (SEPA). The tool balances the risks of pollution to the receiving water body with the treatment provided in a treatment train. It encourages developers to take SUDS into account early, avoiding any misunderstanding of SUDS requirements at the planning stage of a development. A pessimistic view on pollution risks has been adopted since there may be a change of land use on the development in the future. A realistic view has also been taken of maintenance issues and the 'survivability' of a SUDS component. The development of STTAT as a response to the requirements of the Water Framework Directive is explored, the individual scores being given in tabular format for receiving water and catchment risks. Treatment scores are proposed for single SUDS components as well as multiple components within treatment trains. STTAT has been tested on a range of sites, predominantly in Scotland where both development and receiving water information was known. The operational tool in use by SEPA is presented.

Embodied Motherhood: Exploring Body Image in Pregnant and Parenting Youth.

STUDY OBJECTIVE: There is a paucity of research on body image in pregnant and parenting youth (PPY). Study objectives were to examine: (1) profiles of PPY regarding body image, depression, and eating behaviors and any effects of age and pregnancy status on results; and (2) PPY perceptions of body image. DESIGN, SETTING, PARTICIPANTS, INTERVENTIONS, AND MAIN OUTCOME MEASURES: Demographic data and scores from measures related to self-esteem, body esteem, eating behaviors, and depression were collected from 101 PPY from 2 urban centers. Two focus group sessions were held to further explore survey findings. Sessions were audio-recorded and transcribed verbatim for analysis. RESULTS: Participants (mean age, 19.8 years) reported a history of depression (79/101; 78.2%), anxiety (75/101; 74.3%), drug/alcohol abuse (45/101; 44.6%), and eating disorder (32/101; 31.7%). Parenting (nonpregnant; n = 64) participants had lower body esteem (P = .041) and more eating disorder behaviors (P = .026) compared with pregnant (n = 37) participants. A history of depression or eating disorder both independently increased risk for lower body esteem and self-esteem and higher depressive symptoms in pregnant youth. Four dominant themes emerged from qualitative data: (1) adapting to rapidly changing bodies; (2) inter-relationship between body image and mood; (3) added attention and perceptions of pressure to return to prepregnancy body size; and (4) reconciling change and striving to find a new normal. CONCLUSION: This study highlights the importance of exploring past and current body image, mood, and eating disorder behavior in PPY for risk of current mental health issues. Future research exploring prepregnancy depression, eating disorder, body esteem, and depression in pregnant youth are needed.

Tyrosine kinase activity, cytoskeletal organization, and motility in human vascular endothelial cells.

Tyrosine phosphorylation of cytoskeletal proteins occurs during integrin-mediated cell adhesion to extracellular matrix proteins. We have investigated the role of tyrosine phosphorylation in the migration and initial spreading of human umbilical vein endothelial cells (HUVEC). Elevated phosphotyrosine concentrations were noted in the focal adhesions of HUVEC migrating into wounds. Anti-phosphotyrosine Western blots of extracts of wounded HUVEC monolayers demonstrated increased phosphorylation at 120-130 kDa when compared with extracts of intact monolayers. The pp125FAK immunoprecipitated from wounded monolayers exhibited increased kinase activity as compared to pp125FAK from intact monolayers. The time to wound closure in HUVEC monolayers was doubled by tyrphostin AG 213 treatment. The same concentration of AG 213 interfered with HUVEC focal adhesion and stress fiber formation. AG 213 inhibited adhesion-associated tyrosine phosphorylation of pp125FAK in HUVEC. Tyrphostins AG 213 and AG 808 inhibited pp125FAK activity in in vitro kinase assays. pp125FAK immunoprecipitates from HUVEC treated with both of these inhibitors also had kinase activity in vitro that was below levels seen in untreated HUVEC. These findings suggest that tyrosine phosphorylation of cytoskeletal proteins may be important in HUVEC spreading and migration and that pp125FAK may mediate phosphotyrosine formation during these processes.

Riparian wetlands for enhancing the self-purification capacity of streams.

Best Management Practices (BMPs) are increasingly used to restore river water quality but design guidance is limited. An alternative approach to remediating diffuse pollution loads is to identify the most polluting high flows from pollutographs and hydrographs and spill these flows into riparian treatment wetlands for treatment before drainage back into the watercourse. The approach is demonstrated for two contrasting catchments in Scotland impacted by diffuse pollution. The Caw Burn receives industrial estate drainage with high suspended solids, hydrocarbons, BOD and ammoniacal-nitrogen concentrations. Applying the proposed design criteria demonstrated that the existing retrofit BMP system at the site is undersized (4950 m2) compared to the required wetland area (11,800 m2), but accommodating the additional area is likely to be expensive. The second case-study is Brighouse Bay where bathing waters are impacted by faecal indicator organisms derived primarily from livestock runoff. In this catchment the riparian wetland area required to retain runoff so that E. coli bacteria would die-off to concentrations below bathing water standards was estimated to be 3-6ha (0.5-1% of catchment area). Further refinement and testing of the design approach is required, including consideration of other factors such as vegetation type, ownership and maintenance, to develop a more holistic approach to river restoration.

Breast implant associated anaplastic large cell lymphoma: The UK experience. Recommendations on its management and implications for informed consent.

BACKGROUND: Breast implant-associated anaplastic large-cell lymphoma (BIA-ALCL) is a rare, Non-Hodgkin lymphoma arising in the capsule of breast implants. BIA-ALCL presents as a recurrent effusion and/or mass. Tumours exhibit CD30 expression and are negative for Anaplastic Lymphoma Kinase (ALK). We report the multi-disciplinary management of the UK series and how the stage of disease may be used to stratify treatment. METHODS: Between 2012 and 2016, 23 cases of BIA-ALCL were diagnosed in 15 regional centres throughout the UK. Data on breast implant surgeries, clinical features, treatment and follow-up were available for 18 patients. RESULTS: The mean lead-time from initial implant insertion to diagnosis was 10 years (range: 3-16). All cases were observed in patients with textured breast implants or expanders. Fifteen patients with breast implants presented with stage I disease (capsule confined), and were treated with implant removal and capsulectomy. One patient received adjuvant chest-wall radiotherapy. Three patients presented with extra-capsular masses (stage IIA). In addition to explantation, capsulectomy and excision of the mass, all patients received neo-/adjuvant chemotherapy with CHOP as first line. One patient progressed on CHOP but achieved pathological complete response (pCR) with Brentuximab Vedotin. After a mean follow-up of 23 months (range: 1-56) all patients reported here remain disease-free. DISCUSSION: BIA-ALCL is a rare neoplasm with a good prognosis. Our data support the recommendation that stage I disease be managed with surgery alone. Adjuvant chemotherapy may be required for more invasive disease and our experience has shown the efficacy of Brentuximab as a second line treatment.

Discovery of an expanded set of avian leukosis subgroup E proviruses in chickens using Vermillion, a novel sequence capture and analysis pipeline [corrected].

Transposable elements (TEs), such as endogenous retroviruses (ERVs), are common in the genomes of vertebrates. ERVs result from retroviral infections of germ-line cells, and once integrated into host DNA they become part of the host's heritable genetic material. ERVs have been ascribed positive effects on host physiology such as the generation of novel, adaptive genetic variation and resistance to infection, as well as negative effects as agents of tumorigenesis and disease. The avian leukosis virus subgroup E family (ALVE) of endogenous viruses of chickens has been used as a model system for studying the effects of ERVs on host physiology, and approximately 30 distinct ALVE proviruses have been described in the Gallus gallus genome. In this report we describe the development of a software tool, which we call Vermillion, and the use of this tool in combination with targeted next-generation sequencing (NGS) to increase the number of known proviruses belonging to the ALVE family of ERVs in the chicken genome by 4-fold, including expanding the number of known ALVE elements on chromosome 1 (Gga1) from the current 9 to a total of 40. Although we focused on the discovery of ALVE elements in chickens, with appropriate selection of target sequences Vermillion can be used to develop profiles of other families of ERVs and TEs in chickens as well as in species other than the chicken.

Early nonresponse to fluoxetine as a predictor of poor 8-week outcome.

OBJECTIVE: The purpose of this study was to quantify the proportion of patients who show no response to a fixed dose of fluoxetine after 2, 4, and 6 weeks of treatment and then respond by week 8. METHOD: In an open trial, 143 outpatients who met DSM-III-R criteria for major depressive disorder were treated with a regimen of fluoxetine, 20 mg/day. The authors analyzed the proportion of patients who had less than a 20% decrease from baseline in their scores on the Hamilton Rating Scale for Depression after 2, 4, and 6 weeks and who went on to have a 50% or greater reduction by week 8. A last-observation-carried-forward strategy was used to calculate conditional probabilities of 8-week response. Kaplan-Meier survival analysis was used to estimate probabilities of response at week 8 given degrees of response at week 2. RESULTS: Eighty-two subjects (57.3%) who started the trial responded by week 8. Of those subjects who showed no improvement at weeks 2, 4, and 6, the proportions of responders at week 8 were 36.4%, 18.9%, and 6.5%, respectively. The Kaplan-Meier estimate of 8-week response given nonresponse at week 2 was 0.45. CONCLUSIONS: The proportion of patients with no response to antidepressant treatment by 4 or 6 weeks who responded by week 8 was substantially less than that for subjects who had at least a partial response. Nonresponse as early as week 2 predicted 8-week outcome.

Management of a large pleomorphic adenoma of the parotid gland.

The surgical management of an extensive pleomorphic adenoma arising within deep lobe of the parotid gland is presented.

Cutaneous metastasis to the head and neck from colonic carcinoma.

A case of metastatic facial skin involvement from colonic carcinoma is reported where, despite radiotherapy given preoperatively, the tumour continued to grow. The patient remained disease free for 8 months after excision and reconstruction, but died of pulmonary metastases.

Synchronous unilateral parotid neoplasms of different histological types.

The occurrence of multiple tumours in the salivary glands is an unusual phenomenon and the simultaneous development of tumours different types is extremely rare. Two cases are presented with synchronous tumours of the parotid gland of different histological types. The first was a Warthin tumour in combination with a metastatic lung carcinoma and the second was a pleomorphic adenoma in combination with non-Hodgkin's malignant lymphoma.

Head and neck skin involvement by non-cutaneous head and neck cancers: free flap reconstruction.

INTRODUCTION: Patients with skin involvement from head and neck cancer have a poor prognosis, with a median survival time of 2 months. METHOD AND RESULTS: During a 9 year period, 31 patients with skin involvement above the clavicle by non-cutaneous malignant tumours of the head and neck were treated. In 19 males and 12 females with a mean age of 62 years, the parotid gland (32%) and the oral cavity (29%) were the commonest sites of primary disease and 77% of the cases were squamous cell carcinomas. Twenty-six had recurrent disease, 20 had received previous radiotherapy and all underwent surgical resection with free flap reconstruction, the commonest being the radial forearm (78%). Complete histological clearance was achieved in 53% of the cases, and adjuvant post-operative irradiation was given to 60%. With this form of management, palliation was extended to a mean survival of 23 months. Six patients are currently alive and disease free at a mean follow up of 4.5 years. CONCLUSIONS: Patients with head and neck skin involvement by non-cutaneous head and neck malignancies have a very poor prognosis, but surgical resection combined with free microvascular flap reconstruction and planned post-operative radiotherapy, can offer good long-term palliation.

Early post-operative brachytherapy and free flap reconstruction in the management of sarcomas.

Brachytherapy delivered within the early post-operative period has been associated with delayed healing and wound breakdown. The objective of this study was to determine whether reconstruction with a microvascular free flap reduced the incidence of wound breakdown after early post-operative brachytherapy and wide excision of soft tissue sarcomas. Four patients with sarcomas underwent excision and free flap reconstruction. Brachytherapy was administered in the early post-operative period using Iridium-192 wires via tubes inserted intraoperatively. In three of the four patients the wounds healed uneventfully, demonstrating that brachytherapy can be delivered in the early post-operative period following free flap reconstruction without an increase in the frequency of wound breakdown. There has been no local recurrence to date in this group of patients.

Malignant transformation of oral lichen planus.

AIMS: To investigate the malignant potential of oral lichen planus (OLP), a common mucocutaneous disease of unknown aetiology. The malignant potential of OLP is still controversial, with studies reporting malignant transformation rates of between 0 and 5.6%. We also aimed to identify factors that might be associated with malignant transformation. METHODS: We retrospectively reviewed the records of 832 patients with histologically confirmed OLP treated at the Dental Hospital, Newcastle upon Tyne during the period 1983-1996. RESULTS: Of these 832 patients, a total of seven (0.8%) developed intra-oral squamous cell carcinoma (SCC), including three cases of carcinoma in situ. It was noted that OLP patients with SCC are more likely to be women, relatively young and have a low tobacco and alcohol intake. However, they had a good long-term prognosis. CONCLUSIONS: We conclude that the risk of malignant transformation in OLP is real but not high. Clinicians should have a higher index of suspicion of the possibility of malignancy developing in OLP, because such patients are different from typical patients who develop oral malignancy. Follow-up for at least 6 years is recommended.