Patient-reported outcomes of immediate implant-based breast reconstruction with and without biological or synthetic mesh.

BACKGROUND: Biological and synthetic meshes may improve the outcomes of immediate implant-based breast reconstruction (IBBR) by facilitating single-stage procedures and improving cosmesis. Supporting evidence is, however, limited. The aim of this study was to explore the impact of biological and synthetic mesh on patient-reported outcomes (PROs) of IBBR 18 months after surgery. METHODS: Consecutive women undergoing immediate IBBR between February 2014 and June 2016 were recruited to the study. Demographic, operative, oncological and 3-month complication data were collected, and patients received validated BREAST-Q questionnaires at 18 months. The impact of different IBBR techniques on PROs were explored using mixed-effects regression models adjusted for clinically relevant confounders, and including a random effect to account for clustering by centre. RESULTS: A total of 1470 participants consented to receive the questionnaire and 891 completed it. Of these, 67 women underwent two-stage submuscular reconstructions. Some 764 patients had a submuscular reconstruction with biological mesh (495 women), synthetic mesh (95) or dermal sling (174). Fourteen patients had a prepectoral reconstruction. Compared with two-stage submuscular reconstructions, no significant differences in PROs were seen in biological or synthetic mesh-assisted or dermal sling procedures. However, patients undergoing prepectoral IBBR reported better satisfaction with breasts (adjusted mean difference +6.63, 95 per cent c.i. 1.65 to11.61; P = 0.009). PROs were similar to those in the National Mastectomy and Breast Reconstruction Audit 2008-2009 cohort, which included two-stage submuscular procedures only. CONCLUSION: This study found no difference in PROs of subpectoral IBBR with or without biological or synthetic mesh, but provides early data to suggest improved satisfaction with breasts following prepectoral reconstruction. Robust evaluation is required before this approach can be adopted as standard practice.

Assessing the Utility of Electroencephalography for Staring Episodes in Children with Autism.

Aim We aim to assess whether electroencephalography (EEG) has a justified role in assessing staring episodes in children with Autism Spectrum Disorder (ASD); investigating for possible diagnosis of epilepsy. Methods This is a retrospective study on an Irish paediatric cohort. We reviewed EEG studies performed on children with ASD referred specifically for staring episodes to Children's Health Ireland at Temple Street between 2010 and 2017. Results There are 120 EEG tests; labelled as follows: 59.1%: normal, 22.5%: abnormal, 16.6%: borderline and 1.6%: 'limited study'. Background abnormalities are seen in 22.5% and interictal epileptiform abnormalities are seen in 16.6%. Absence seizures are captured in none. Conclusions Interictal EEG in ASD patients often yields false positive findings. EEG for investigating staring episodes in children with ASD are probably not useful.

Modelling spatial and temporal variations of annual suspended sediment yields from small agricultural catchments.

Estimates of sediment yield are important for ecological and geomorphological assessment of fluvial systems and for assessment of soil erosion within a catchment. Many regulatory frameworks, such as the Convention for the Protection of the Marine Environment of the North-East Atlantic, derived from the Oslo and Paris Commissions (OSPAR) require reporting of annual sediment fluxes. While they may be measured in large rivers, sediment flux is rarely measured in smaller rivers. Measurements of sediment transport at a national scale can be also challenging and therefore, sediment yield models are often utilised by water resource managers for the predictions of sediment yields in the ungauged catchments. Regression based models, calibrated to field measurements, can offer an advantage over complex and computational models due to their simplicity, easy access to input data and due to the additional insights into factors controlling sediment export in the study sites. While traditionally calibrated to long-term average values of sediment yields such predictions cannot represent temporal variations. This study addresses this issue in a novel way by taking account of the variation from year to year in hydrological variables in the developed models (using annual mean runoff, annual mean flow, flows exceeded in five percentage of the time (Q5) and seasonal rainfall estimated separately for each year of observations). Other parameters included in the models represent spatial differences influenced by factors such as soil properties (% poorly drained soils and % peaty soils), land-use (% pasture or % arable lands), channel slope (S1085) and drainage network properties (drainage density). Catchment descriptors together with year-specific hydrological variables can explain both spatial differences and inter-annual variability of suspended sediment yields. The methodology is demonstrated by deriving equations from Irish data-sets (compiled in this study) with the best model efficiency of 0.84 and best model fit of adjusted R2 of 0.82. Presented approach shows the potential for regression based models to model contemporary suspended sediment yields in small river systems.

Measurement differences between turbidity instruments, and their implications for suspended sediment concentration and load calculations: A sensor inter-comparison study.

The use of turbidity for indicating environmentally detrimental levels of suspended and colloidal matter in freshwater systems, and for defining acceptable water quality standards in national and European drinking water regulations, is well established. Turbidity is therefore frequently adopted as a surrogate for suspended sediment concentrations (SSC), or as a relative and objective measure of water clarity in monitoring programmes. Through systematic, controlled experimentation, we tested the response of 12 commercially available turbidity sensors, of various designs, to gauge their measurement consistency when benchmarked against pre-prepared sediment suspensions of known SSC. Results showed that despite calibration to a Formazin standard, sensor responses to identical SSC solutions (in the range of 20-1000 mg L-1) varied considerably. For a given SSC, up to five-fold differences in recorded turbidity were recorded across the tested instruments. Furthermore, inconsistent measurements were identified across instruments, regardless of whether they operated using backscatter or side-scatter optical principles. While the findings may have implications for compliance with turbidity-based water quality standards, they are less likely to be an issue when turbidity is being used as a surrogate for SSC, provided that instrument use remains constant and that instrument drift is not an issue. In this study, a field comparison of a subset of four study sensors showed that despite very different absolute turbidity readings for a given SSC, well correlated and reliable turbidity - SSC ratings were established (as evidenced by r2 coefficients from 0.92 to 0.98). This led to reasonably consistent suspended sediment load estimates of between 64.7 and 70.8 tonnes for a rainfall event analysed. This study highlights the potential for issues to arise when interpreting water turbidity datasets that are often assumed to be comparable, in that measurement inconsistency of the type reported here may remain unknown to water resource decision-makers and practitioners.

A pilot randomized controlled trial comparing effectiveness of prism glasses, visual search training and standard care in hemianopia.

OBJECTIVE: Pilot trial to compare prism therapy and visual search training, for homonymous hemianopia, to standard care (information only). METHODS: Prospective, multicentre, parallel, single-blind, three-arm RCT across fifteen UK acute stroke units. PARTICIPANTS: Stroke survivors with homonymous hemianopia. INTERVENTIONS: Arm a (Fresnel prisms) for minimum 2 hours, 5 days per week over 6 weeks. Arm b (visual search training) for minimum 30 minutes, 5 days per week over 6 weeks. Arm c (standard care-information only). INCLUSION CRITERIA: Adult stroke survivors (>18 years), stable hemianopia, visual acuity better than 0.5 logMAR, refractive error within ±5 dioptres, ability to read/understand English and provide consent. OUTCOMES: Primary outcomes were change in visual field area from baseline to 26 weeks and calculation of sample size for a definitive trial. Secondary measures included Rivermead Mobility Index, Visual Function Questionnaire 25/10, Nottingham Extended Activities of Daily Living, Euro Qual, Short Form-12 questionnaires and Radner reading ability. Measures were post-randomization at baseline and 6, 12 and 26 weeks. RANDOMIZATION: Randomization block lists stratified by site and partial/complete hemianopia. BLINDING: Allocations disclosed to patients. Primary outcome assessor blind to treatment allocation. RESULTS: Eighty-seven patients were recruited: 27-Fresnel prisms, 30-visual search training and 30-standard care; 69% male; mean age 69 years (SD 12). At 26 weeks, full results for 24, 24 and 22 patients, respectively, were compared to baseline. Sample size calculation for a definitive trial determined as 269 participants per arm for a 200 degree2 visual field area change at 90% power. Non-significant relative change in area of visual field was 5%, 8% and 3.5%, respectively, for the three groups. Visual Function Questionnaire responses improved significantly from baseline to 26 weeks with visual search training (60 [SD 19] to 68.4 [SD 20]) compared to Fresnel prisms (68.5 [SD 16.4] to 68.2 [18.4]: 7% difference) and standard care (63.7 [SD 19.4] to 59.8 [SD 22.7]: 10% difference), P=.05. Related adverse events were common with Fresnel prisms (69.2%; typically headaches). CONCLUSIONS: No significant change occurred for area of visual field area across arms over follow-up. Visual search training had significant improvement in vision-related quality of life. Prism therapy produced adverse events in 69%. Visual search training results warrant further investigation.

Evaluating the relationship between biotic and sediment metrics using mesocosms and field studies.

An ongoing research challenge is the detection of biological responses to elevated sediment and the identification of sediment-specific bioassessment metrics to evaluate these biological responses. Laboratory mesocosms and field observations in rivers in Ireland were used to evaluate the relationship between a range of biological and sediment metrics and to assess which biological metrics were best at discerning the effects of excess sediment on macroinvertebrates. Results from the mesocosm study indicated a marked decrease in the abundance of sensitive taxa with increasing sediment surface cover. % EPT (Ephemeroptera, Plecoptera, Trichoptera) and % E abundances exhibited the strongest negative correlation with sediment surface cover in the mesocosm study. The field study revealed that % EPT abundance was most closely correlated with % sediment surface cover, explaining 13% of the variance in the biological metric. Both studies revealed weaker relationships with a number of other taxonomy-based metrics including total taxon abundance, total taxon richness and moderate relationships with the Proportion of Sediment-sensitive Invertebrates metric (PSI). All trait-based metrics were poorly correlated with sediment surface cover in the field study. In terms of sediment metrics, % surface cover was more closely related to biological metrics than either re-suspendable sediment or turbidity. These results indicate that % sediment surface cover and % EPT abundance may be useful metrics for assessing the effect of excessive sediment on macroinvertebrates. However, EPT metrics may not be specific to sediment impact and therefore when applied to rivers with multiple pressures should be combined with observations on sediment cover.

The impact of cattle access on ecological water quality in streams: Examples from agricultural catchments within Ireland.

Unrestricted cattle access to rivers and streams represent a potentially significant localised pressure on freshwater systems. However there is no consensus in the literature on the occurrence and extent of impact and limited research has examined the effects on aquatic biota in the humid temperate environment examined in the present study. Furthermore, this is one of the first times that research consider the potential for cattle access impacts in streams of varying water quality in Northern Europe. We investigated the effects of cattle access on macroinvertebrate communities and deposited fine sediment levels, in four rivers of high/good and four rivers of moderate water quality status which drain, low gradient, calcareous grassland catchments in Ireland. We assessed the temporal variability in macroinvertebrates communities across two seasons, spring and autumn. Site specific impacts were evident which appeared to be influenced by water quality status and season. All four high/good water status rivers revealed significant downstream changes in community structure and at least two univariate metrics (total richness and EPT richness together with taxon, E and EPT abundance). Two of the four moderate water status rivers showed significant changes in community structure, abundance and richness metrics and functional feeding groups driven in the main by downstream increases in collectors/gatherers, shredders and burrowing taxa. These two moderate water status rivers had high or prolonged livestock activity. In view of these findings, the potential for some of these sites to achieve at least high/good water quality status, as set out in the EU Water Framework Directive, may be compromised. The results presented highlight the need for additional research to further define the site specific factors and livestock management practices, under different discharge conditions, that increase the risk of impact on aquatic ecology due to these cattle-river interactions.

The association between childhood maltreatment, psychopathology, and adult sexual victimization in men and women: results from three independent samples.

BACKGROUND: Childhood maltreatment (CM) has consistently been linked with adverse outcomes including substance use disorders and adult sexual revictimization. Adult sexual victimization itself has been linked with psychopathology but has predominately been studied in women. The current investigation examines the impact of CM and co-occurring psychopathology on adult sexual victimization in men and women, replicating findings in three distinct samples. METHOD: We investigated the association between continuous CM factor scores and adult sexual victimization in the Childhood Trauma Study (CTS) sample (N = 2564). We also examined the unique relationship between childhood sexual abuse (CSA) and adult sexual victimization while adjusting for co-occurring substance dependence and psychopathology. We replicated these analyses in two additional samples: the Comorbidity and Trauma Study (CATS; N = 1981) and the Australian Twin-Family Study of Alcohol Use Disorders (OZ-ALC; N = 1537). RESULTS: Analyses revealed a significant association with CM factor scores and adult sexual victimization for both men and women across all three samples. The CSA factor score was strongly associated with adult sexual victimization after adjusting for substance dependence and psychopathology; higher odds ratios were observed in men (than women) consistently across the three samples. CONCLUSIONS: A continuous measure of CSA is independently associated with adult sexual trauma risk across samples in models that included commonly associated substance dependence and psychopathology as covariates. The strength of the association between this CSA measure and adult sexual victimization is higher in magnitude for men than women, pointing to the need for further investigation of sexual victimization in male community samples.

A randomised controlled trial to compare the clinical and cost-effectiveness of prism glasses, visual search training and standard care in patients with hemianopia following stroke: a protocol.

INTRODUCTION: Homonymous hemianopia is a common and disabling visual problem after stroke. Currently, prism glasses and visual scanning training are proposed to improve it. The aim of this trial is to determine the effectiveness of these interventions compared to standard care. METHODS AND ANALYSIS: The trial will be a multicentre three arm individually randomised controlled trial with independent assessment at 6 week, 12 week and 26 week post-randomisation. Recruitment will occur in hospital, outpatient and primary care settings in UK hospital trusts. A total of 105 patients with homonymous hemianopia and without ocular motility impairment, visual inattention or pre-existent visual field impairment will be randomised to one of three balanced groups. Randomisation lists will be stratified by site and hemianopia level (partial or complete) and created using simple block randomisation by an independent statistician. Allocations will be disclosed to patients by the treating clinician, maintaining blinding for outcome assessment. The primary outcome will be change in visual field assessment from baseline to 26 weeks. Secondary measures will include the Rivermead Mobility Index, Visual Function Questionnaire 25/10, Nottingham Extended Activities of Daily Living, Euro Qual-5D and Short Form-12 questionnaires. Analysis will be by intention to treat. ETHICS AND DISSEMINATION: This study has been developed and supported by the UK Stroke Research Network Clinical Studies Group working with service users. Multicentre ethical approval was obtained through the North West 6 Research ethics committee (Reference 10/H1003/119). The trial is funded by the UK Stroke Association. Trial Registration: Current Controlled Trials ISRCTN05956042. Dissemination will consider usual scholarly options of conference presentation and journal publication in addition to patient and public dissemination with lay summaries and articles. TRIAL REGISTRATION: Current Controlled Trials ISRCTN05956042.

The ability of electrical measurements to predict skin moisturization. I. Effects of NaCl and glycerin on short-term measurements.

Non-invasive methods to evaluate skin hydration by measuring electrical properties are widely used in the cosmetic industry. However, there is still some controversy about factors that affect measurement. For example, concerns have often been expressed about the possible confounding effect of salts, either in the formulation or on the skin. Ionized salts on the skin may increase electrical conductivity and may lead to changes in electrical properties that are not related to increased water content. We have performed a systematic study of the effects of salt, i.e., sodium chloride, and glycerin on the electrical properties of skin as measured by the three most commonly used instruments, the Nova DPM 9003, the Corneometer CM 825, and the Skicon 200. Formulations containing salt from 0-3% and glycerin from 0-10% were tested for their effects at one and two hours after a single application. Salt lowered the readings in the absence of glycerin and increased the reading in the presence of glycerin. For all three instruments, there was a linear correlation between the measurement and the glycerin level in the presence or absence of salt.

The ability of electrical measurements to predict skin moisturization. II. Correlation between one-hour measurements and long-term results.

We investigated the ability of short-term (one-hour) electrical measurements with three different commonly used instruments to predict the effects of long-term treatment with glycerin-containing formulations on moderately dry leg skin. We report the moisturizing effects of glycerin on healthy female adult skin in a two-week study as measured by electrical conductance and capacitance, transepidermal water loss (TEWL), and clinical grading of skin dryness. The test formulations contained 1.5% NaCl and levels of glycerin from 0% to 15%. Results obtained with a smaller cohort of ten subjects, one hour after treatment, were predictive of moisturizing efficacy in the two-week period among twenty subjects with dry leg skin. Our results show that single application tests can be predictive of longer-term results with humectant-based moisturizers and that electrical measurements of skin conditions correlate well with skin grades.

Effect of semipermeable membranes on skin barrier repair following tape stripping.

Reports in the literature suggest that the permeability of a wound dressing to water transport is an important variable in the healing of superficial wounds. Factors that influence skin hydration during barrier repair, therefore, are important in the optimization of wound treatments. In this study, the effects of semipermeable films on human skin following a standardized wound (tape stripping) were evaluated using measurements of transepidermal water loss (TEWL), skin hydration, rate of moisture accumulation, and erythema. Wounds treated with semipermeable films underwent more rapid barrier recovery than either unoccluded wounds or wounds under complete occlusion. Barrier films that produced intermediate levels of skin hydration during recovery produced the highest barrier repair rates. The results support the hypothesis; that semipermeable wound dressings augment barrier repair and skin quality by providing an optimized water vapor gradient during the wound healing process. The choice of wound dressing is discussed within the larger context of the design of vapor-permeable fabrics (smart materials) and the new fields of corneotherapy and comfort science.

Altered caspase expression results in delayed neutrophil apoptosis in acute pancreatitis.

Acute pancreatitis (AP) may lead to the development of multiple organ dysfunction syndrome (MODS), especially in severe cases. Resolution of such inflammatory responses is dependent on neutrophil apoptosis. Delays in this apoptotic response are associated with persistent inflammation and subsequent tissue damage. The aim of this study is to determine the effects of AP on neutrophil apoptosis and to investigate the underlying mechanisms involved. Neutrophils and serum were isolated from control (n=10) and from patients with AP (mild, n=35, and severe, n=5). Neutrophil apoptosis was assessed by propidium iodide DNA staining using flow cytometry. Caspase, glutathione-S-transferase (GST), and Mcl-1 protein expression were assessed by SDS-PAGE western blotting. Serum interleukin (IL)-1beta and granulocyte-macrophage colony-stimulating factor (GM-CSF) levels were measured by ELISA. Neutrophils isolated from patients with AP show a significant delay in spontaneous neutrophil apoptosis. Serum factors contributed to this delay with increases in IL-1beta and GM-CSF. Isolated neutrophils were resistant to Fas antibody-induced apoptosis. Caspases represent a central mechanism for spontaneous and Fas antibody-induced neutrophil apoptosis. Procaspase 3 expression was decreased in mild and severe cases, but this effect was independent of serum factors. Increases in GST expression may also contribute to the antiapoptotic effect. Altered caspase expression may represent an additional factor contributing to delayed neutrophil apoptosis. This may contribute to the development of AP and its related complications.

Quinidine-induced pigmentation.

Antimalarial agents have long been known to cause a variety of pigmentary disturbances. Quinidine, a cincha alkaloid and D-isomer of quinine, is widely used for the treatment of ventricular arrhythmias. A paucity of literature, however, exists concerning quinidine-associated hyperpigmentation. We describe a case of focal ceruloderma we believe to be secondary to quinidine therapy.