Hospital length of stay for COVID-19 patients: Data-driven methods for forward planning.

BACKGROUND: Predicting hospital length of stay (LoS) for patients with COVID-19 infection is essential to ensure that adequate bed capacity can be provided without unnecessarily restricting care for patients with other conditions. Here, we demonstrate the utility of three complementary methods for predicting LoS using UK national- and hospital-level data. METHOD: On a national scale, relevant patients were identified from the COVID-19 Hospitalisation in England Surveillance System (CHESS) reports. An Accelerated Failure Time (AFT) survival model and a truncation corrected method (TC), both with underlying Weibull distributions, were fitted to the data to estimate LoS from hospital admission date to an outcome (death or discharge) and from hospital admission date to Intensive Care Unit (ICU) admission date. In a second approach we fit a multi-state (MS) survival model to data directly from the Manchester University NHS Foundation Trust (MFT). We develop a planning tool that uses LoS estimates from these models to predict bed occupancy. RESULTS: All methods produced similar overall estimates of LoS for overall hospital stay, given a patient is not admitted to ICU (8.4, 9.1 and 8.0 days for AFT, TC and MS, respectively). Estimates differ more significantly between the local and national level when considering ICU. National estimates for ICU LoS from AFT and TC were 12.4 and 13.4 days, whereas in local data the MS method produced estimates of 18.9 days. CONCLUSIONS: Given the complexity and partiality of different data sources and the rapidly evolving nature of the COVID-19 pandemic, it is most appropriate to use multiple analysis methods on multiple datasets. The AFT method accounts for censored cases, but does not allow for simultaneous consideration of different outcomes. The TC method does not include censored cases, instead correcting for truncation in the data, but does consider these different outcomes. The MS method can model complex pathways to different outcomes whilst accounting for censoring, but cannot handle non-random case missingness. Overall, we conclude that data-driven modelling approaches of LoS using these methods is useful in epidemic planning and management, and should be considered for widespread adoption throughout healthcare systems internationally where similar data resources exist.

Spindle cell proliferations of the sigmoid colon, rectum and anus: a review with emphasis on perineurioma.

A wide range of spindle cell proliferations are found uncommonly in the sigmoid colon, rectum and anus. They usually present as polyps, and include reactive lesions and benign and malignant neoplasms which may be primary or metastatic. They are less frequently described in the literature compared to those in the upper gastrointestinal tract, and may be underdiagnosed. The widespread use of sigmoidoscopy in symptomatic patients and bowel cancer screening programmes means that histopathologists must be aware of, and adopt a logical approach to, diagnosing spindle cell proliferations in biopsy and polypectomy specimens. This is particularly relevant given the strong association of some mesenchymal polyps with hereditary cancer syndromes. This review article will focus on perineurioma and the recent debate in relation to its overlap with fibroblastic polyp. The clinical, endoscopic, histological and immunohistochemical features of spindle cell proliferations which should be considered in the differential diagnosis of perineurioma will be discussed. There is also a brief reference to malignant spindle cell tumours of diagnostic importance.

Master/slave optical coherence tomography imaging of eyelid basal cell carcinoma.

Optical coherence tomography (OCT) is fast emerging as an additional non-interventional modality for skin tumor detection and diagnosis. A master/slave flying spot OCT configuration was assembled to detect periocular basal cell carcinomas (BCC). A swept source at 1300 nm and sweeping speed of 50 kHz were used. A three-step process was involved. First, 384 channeled spectra using a mirror were stored for 384 optical path differences at the master stage. Then, the stored channeled spectra (masks) were correlated with the channeled spectrum from the BCC tissue to produce 384 en face OCT images (200×200 pixels) for the optical path difference values used to acquire the masks. Finally, these en face slices were stacked to form a volume to cross-reference BCC tumor margins in the orthogonal plane. Per each eyelid sample, several en face images of 200×200 lateral pixels are produced in the time to scan laterally a complete raster of 1.6 s. Combination of the en face views with the cross-sectioning views allow for better discrimination of BCCs comparable to using cross-sectional imaging alone, as previously reported using the conventional fast-Fourier-transform-based OCT techniques.

The contamination of in situ archaeological remains: A pilot analysis of microplastics in sediment samples using µFTIR.

BACKGROUND: Microplastics (MPs) are found in all environments: aquatic, airborne, and terrestrial. While their presence is not disputed, their potential impacts are not yet known. OBJECTIVE: To undertake a pilot analysis of MP contamination in archaeological sediment samples, taken in the late 1980s from two archaeological excavation sites in the historic city of York (UK) as well as contemporary sources close to the same sites, with respect to the presence (if any), levels, and characteristics of any particles identified. METHODS: This study analysed pre-digested sediment samples as follows: n = 3 from Queens Hotel (QH) site and n = 3 Wellington Row (WR) contemporary core-source, and n = 3 QH and n = 3 WR archival-source samples, alongside procedural controls (n = 8), using µFTIR spectroscopy (size limitation of 5 µm) to detect and characterise any MPs present. RESULTS: In total, 66 MP particles consisting of 16 MP polymer types were identified across both site and contemporary/archived samples. The highest levels of MP particles, 20,588 MP/kg was identified at the lowest sample depth (∼7.35 m) at archived WR, 5910 MP/kg in the mid depth layer (∼5.85 m) at the contemporary QH site. Of the MPs detected in sediment samples overall, polytetrafluoroethylene (PTFE), polybutylene sulfone (PSU), and polypropylene: polyethylene (PE:PP) copolymer polymer types were most abundant; mainly fragmented and irregular shape. CONCLUSIONS: This is believed to be the first evidence of MP contamination in archaeological sediment (or soil) samples with polymers and size ranges measured and while accounting for procedural blanks. These results support the phenomenon of transport of MPs within archaeological stratigraphy, and the characterisation of types, shapes and size ranges identified therein. Through contamination, MPs may compromise the scientific value of archaeological deposits, and environmental proxies suspended within significant sediment, and as such represent a new consideration in the dynamism of, as well as arguments for preserving, archaeological deposits in situ.

Investigation of basal cell carcinoma using dynamic focus optical coherence tomography.

Optical coherence tomography (OCT) is becoming a popular modality for skin tumor diagnosis and assessment of tumor size and margin status. We conducted a number of imaging experiments on periocular basal cell carcinoma (BCC) specimens using an OCT configuration. This configuration employs a dynamic focus (DF) procedure where the coherence gate moves synchronously with the peak of the confocal gate, which ensures better signal strength and preservation of transversal resolution from all depths. A DF-OCT configuration is used to illustrate morphological differences between the BCC and its surrounding healthy skin in OCT images. The OCT images are correlated with the corresponding histology images. To the best of our knowledge, this is the first paper to look at DF-OCT imaging in examining periocular BCC.

Quantitative evaluation of scattering in optical coherence tomography skin images using the extended Huygens-Fresnel theorem.

An optical properties extraction algorithm is developed based on enhanced Huygens-Fresnel light propagation theorem, to extract the scattering coefficient of a specific region in an optical coherence tomography (OCT) image. The aim is to quantitatively analyze the OCT images. The algorithm is evaluated using a set of phantoms with different concentrations of scatterers, designed based on Mie theory. The algorithm is then used to analyze basal cell carcinoma and healthy eyelid tissues, demonstrating distinguishable differences in the scattering coefficient between these tissues. In this study, we have taken advantage of the simplification introduced by the utilization of a dynamic focus OCT system. This eliminates the need to deconvolve the reflectivity profile with the confocal gate profile, as the sensitivity of the OCT system is constant throughout the axial range.

Effects of interventions on depression and anxiety in older people with physical health problems in the criminal justice system: a systematic review.

The demand for health care in older people involved in the criminal justice system is high. The prevalence of mental and physical health conditions for people living in prison is greater than in community populations. After systematically searching 21 databases, we found no targeted interventions to support depression or anxiety for this group of people. 24 studies (including interventions of yoga, creative-arts-based programmes, positive psychology, or mindfulness-based interventions and psychotherapy) did contain people older than 50 years, but this only represented a minority (10%) of the overall study population. No single study reported outcomes of physical health. Future interventions need to consider the needs and views of this vulnerable group. Specific gendered and coproduced interventions are required to enhance the implementation, feasibility, and acceptability of interventions that are delivered in prisons.

Bottle with a message: The role of story writing as an engagement tool to explore children's perceptions of marine plastic litter.

As human behaviors play a crucial role in addressing the global threat of plastic pollution, it is vital to understand perceptions about marine plastic litter (MPL) and to develop interventions encouraging pro-environmental behaviors (PEBs). This study evaluates story writing as a window to explore perceptions and as an engagement activity to boost PEBs. During the COVID-19 lockdowns, schoolchildren from the East Pacific coast participated in this activity, each creating a story and answering a pre-post survey. Qualitative and quantitative analysis of 81 stories and 79 surveys show awareness of sources and impacts. Participants identified land and local pollution as significant contributors to MPL and emphasized bio-ecological impacts, reflecting concern for landscape and wildlife. While the stories presented a diversity of solutions, recycling dominated the surveys. As participants reported an increase in self-assessed knowledge and improved PEBs after this activity, it can be seen as an engagement tool to encourage behavior change.

Multiple anthropogenic stressors in the Galápagos Islands' complex social-ecological system: Interactions of marine pollution, fishing pressure, and climate change with management recommendations.

For decades, multiple anthropogenic stressors have threatened the Galápagos Islands. Widespread marine pollution such as oil spills, persistent organic pollutants, metals, and ocean plastic pollution has been linked to concerning changes in the ecophysiology and health of Galápagos species. Simultaneously, illegal, unreported, and unregulated fishing are reshaping the composition and structure of endemic and native Galápagos pelagic communities. In this novel review, we discuss the impact of anthropogenic pollutants and their associated ecotoxicological implications for Galápagos species in the face of climate change stressors. We emphasize the importance of considering fishing pressure and marine pollution, in combination with climate-change impacts, when assessing the evolutionary fitness of species inhabiting the Galápagos. For example, the survival of endemic marine iguanas has been negatively affected by organic hydrocarbons introduced via oil spills, and endangered Galápagos sea lions exhibit detectable concentrations of DDT, triggering potential feminization effects and compromising the species' survival. During periods of ocean warming (El Niño events) when endemic species undergo nutritional stress, climate change may increase the vulnerability of these species to the impacts of pollutants, resulting in the species reaching its population tipping point. Marine plastics are emerging as a deleterious and widespread threat to endemic species. The Galápagos is treasured for its historical significance and its unparalleled living laboratory and display of evolutionary processes; however, this unique and iconic paradise will remain in jeopardy until multidisciplinary and comprehensive preventative management plans are put in place to mitigate and eliminate the effects of anthropogenic stressors facing the islands today. We present a critical analysis and synthesis of anthropogenic stressors with some progress from local and international institutional efforts and call to action more precautionary measures along with new management philosophies focused on understanding the processes of change through research to champion the conservation of the Galápagos. Integr Environ Assess Manag 2023;19:870-895. © 2022 SETAC.

'Windows of opportunity': exploring the relationship between social media and plastic policies during the COVID-19 Pandemic.

Plastic pollution has reached a crisis point due to ineffective waste management, an over-reliance on single-use plastic items and a lack of suitable plastic alternatives. The COVID-19 Pandemic has seen a dramatic increase in the use of single-use plastics including 'COVID waste' in the form of items specifically intended to help stop the spread of disease. Many governments have utilised COVID-19 as a window of opportunity to reverse, postpone or remove plastic policies off agendas ostensibly in order to 'flatten the curve' of COVID-19 cases. In this paper, we use novel methods of social media analysis relating to three regions (USA, Mexico and Australia) to suggest that health and hygiene were not the only reasons governments utilised this window of opportunity to change plastic policies. Beyond the influence of social media on the plastics agenda, our results highlight the potential of social media as a tool to analyse public reactions to government decisions that can be influenced by industry pressure and a broader political agenda, while not necessarily following responses to consumer behaviour.

Histopathological Mimics of Inflammatory Bowel Disease.

This review article discusses the challenges of making a firm histopathological diagnosis of inflammatory bowel disease (IBD) on biopsy and resection material and the importance of its distinction from a range of other inflammatory and infective conditions that may closely mimic IBD. In many cases, the diagnosis of ulcerative colitis or Crohn's disease is straightforward, especially when patients have a typical presentation and characteristic histopathological features. Knowledge of the full clinical history is very important, particularly past and recent medical history, drug history, foreign travel, or known contact with individuals with specific infection. Discussion of all cases of suspected IBD within a multidisciplinary team meeting is required to ensure that clinical, radiological, and pathological features can be correlated. Mimics of IBD can be divided into 4 categories: 1) those due to specific infection, 2) those due to a specific localized inflammatory process, 3) those due to iatrogenic causes, and 4) other rarer causes. Accurate diagnosis of IBD and exclusion of these mimics are crucial for patient management. Once a diagnosis of IBD has been proffered by a pathologist, it is very difficult to "undiagnose" the condition when an alternative diagnosis or "mimic" has been subsequently identified. The histological diagnosis of each of these IBD mimics is discussed in detail, with guidance on how to avoid the pitfall of missing these sometimes very subtle and "difficult to diagnose" conditions.

A Multiannual Record of Gravity Wave Activity in Mars's Lower Atmosphere from On-Planet Observations by the Mars Climate Sounder.

Gravity waves in Mars's atmosphere strongly affect the general circulation as well as middle atmospheric cloud formation, but the climatology and sources of gravity waves in the lower atmosphere remain poorly understood. At Earth, the statistical variance in satellite observations of thermal emission above the instrumental noise floor has been used to enable measurement of gravity wave activity at a global scale. Here is presented an analysis of variance in calibrated radiance at 15.4 µm (635-665 cm-1) from off-nadir and nadir observations by the Mars Climate Sounder (MCS) on board Mars Reconnaissance Orbiter (MRO); a major expansion in the observational data available for validating models of Martian gravity wave activity. These observations are sensitive to gravity waves at 20-30 km altitude with wavelength properties (λ h =10-100 km, λ z > 5 km) that make them likely to affect the dynamics of the middle and upper atmosphere. We find that: (1) strong, moderately intermittent gravity wave activity is scattered over the tropical volcanoes and throughout the middle to high latitudes of both hemispheres during fall and winter, (2) gravity wave activity noticeably departs from climatology during regional and global dust storms; and (3) strong, intermittent variance is observed at night in parts of the southern tropics during its fall/winter, but frequent CO2 ice clouds prevents unambiguous attribution to GW activity. The spatial distribution of wave activity is consistent with topographic sources being dominant, but contributions from boundary layer convection and other convective processes are possible.

Langerhans cell histiocytosis with spinal, pulmonary and pituitary involvement: What about ACTH deficiency without diabetes insipidus? A propos of a case.

Langerhans cell histiocytosis (LCH) is disease process characterized by clonal proliferation of CD1a+ dendritic cells within an inflammatory infiltrate of hematopoietic derived cells. LCH can manifest with a broad spectrum of symptoms and can involve single organs or have a multisystem distribution. Central nervous system (CNS) involvement of LCH can manifest as granulomatous parenchymal or pituitary mass lesions. Focal, space-occupying lesions, such as masses in the meninges, choroid plexus, and brain parenchyma may contain CD1a+ LCH cells, lymphocytes, and macrophages with histology similar to that of extracranial lesions. Here, we describe a rare case of multisystem LCH in an adult patient presenting with spinal lesions and isolated adrenocorticotropic (ACTH) deficiency without diabetes insipidus (DI). In addition, we review the literature summarizing the few reports of hypopituitarism in LCH in the absence of DI.

Development of a nude mouse model for the study of antlerogenesis--mechanism of tissue interactions and ossification pathway.

In a previous study (Li et al., 2001. J Exp Zool 290:18-30) a nude mouse model was established to investigate deer antler development. In that study we found nude mice could support the singularly implanted antlerogenic periosteum (AP) to form pedicle-like, but not antler-like, bony protuberances. To further develop the model and at the same time to use the updated model for the investigation of antler formation, three experiments were carried out in this study. The results showed that (1) antler-like protuberances were successfully induced on the nude mouse heads via subcutaneous co-transplantation of AP and deer skin, and subsequent exposure through wounding of the deer xenografts; (2) deer skin epidermis and its attached half thickness of dermis were sufficient to interact with the AP, and the interactions were capable of transforming adult scalp skin into velvet; (3) the putative initial inductive molecules were primarily derived from the AP cellular layer, rather than fibrous layer; (4) initiation of the ossification center in the avascular cartilage of each mouse "antler" took place via metaplasia, rather than classical endochondral ossification. Further research is required to identify means for effective stimulation of calcification of the "mouse antlers" in order to create the opportunity to investigate antler regeneration using the nude mouse model. Overall, the nude mouse model, once further developed, has the potential to become a powerful tool to study underlying mechanism of antlerogenesis and organogenesis/regeneration in general.

The routine use of histochemical stains in gastrointestinal pathology: a UK-wide survey.

AIMS: A survey was conducted into the routine use of special stains on gastrointestinal (GI) biopsy specimens in histopathology departments within the National Health Service. The aim was to compare the sole use of haematoxylin and eosin (H&E) staining with the use of H&E and special stains, according to the biopsy site. METHODS AND RESULTS: One hundred and sixty-seven histopathology departments in the UK were contacted using an e-mail questionnaire. Valid return rate was 55%. Sixty-eight percent of departments employ H&E only for oesophageal biopsy specimens. Gastric specimens are stained using only H&E in 47% of departments and 53% use H&E combined with special stains. Duodenal, small and large bowel biopsy specimens are mostly stained with H&E. CONCLUSIONS: The results show that the routine use of special stains in GI pathology in the UK is highly variable, especially for oesophageal and gastric biopsy specimens. The literature indicates that special stains in GI specimens can enhance sensitivity and specificity for the detection of pathological abnormalities, especially metaplasia and infections. The diversity of staining practice highlights the need to provide robust and evidence-based guidelines for the routine use of special stains to ensure universal best practice.

Serial exhaled nitric oxide measurements in the assessment of laboratory animal allergy.

BACKGROUND: Laboratory animal allergy (LAA) may cause eosinophilic airway inflammation, for which exhaled nitric oxide (FE(NO)) measurements are sensitive and specific. Our objective was to assess whether serial FE(NO) measurements might detect exposure-related inflammation in laboratory animal workers. METHODS. Fifty laboratory animal workers participated. Measurements of FE(NO) and spirometry were obtained at baseline (Friday) and twice-daily following a weekend with no animal contact. RESULTS: Eleven of 50 subjects had work-related symptoms, and 2 of 11 had positive serology for LAA. Baseline FE(NO) was high (> 150 ppb) in the two seropositive subjects and increased progressively during the working week in one subject, confirming exposure-driven airway inflammation. In seronegative subjects, mean FE(NO) levels were 19.8 (standard deviation [SD], 20.1) and 21.7 (SD, 20.8) in the symptomatic and nonsymptomatic groups, respectively, with no significant changes in FE(NO) over time. CONCLUSION: Serial FE(NO) measurements may provide complementary information in the assessment of possible occupational sensitisation. The sensitivity and specificity of this approach to diagnosing occupational asthma requires further evaluation.

Recurrence of an NSAID-induced diaphragmatic disease of the small intestine.

A 74-year-old woman was referred to the surgical team from clinic, reporting of a 1-week history of vomiting and abdominal distension on a background of previous large bowel resection for a flare up of diverticulitis with a suspicion of diaphragm disease of the small intestine diagnosed at the same time. She was initially managed conservatively owing to the likely diagnosis of adhesion(s) leading to small bowel obstruction, but a CT of the abdomen a day later revealed a recurrence of diaphragmatic disease of the small bowel causing an obstruction, most likely due to chronic non-steroidal anti-inflammatory drug use. She was taken to theatre for an emergency laparotomy and small bowel resection due to previous resections, from which she made a good recovery; she was discharged from hospital 8 days later.

Assessment of lymph node involvement in colorectal cancer.

Lymph node metastasis informs prognosis and is a key factor in deciding further management, particularly adjuvant chemotherapy. It is core to all contemporary staging systems, including the widely used tumor node metastasis staging system. Patients with node-negative disease have 5-year survival rates of 70%-80%, implying a significant minority of patients with occult lymph node metastases will succumb to disease recurrence. Enhanced staging techniques may help to identify this subset of patients, who might benefit from further treatment. Obtaining adequate numbers of lymph nodes is essential for accurate staging. Lymph node yields are affected by numerous factors, many inherent to the patient and the tumour, but others related to surgical and histopathological practice. Good lymph node recovery relies on close collaboration between surgeon and pathologist. The optimal extent of surgical resection remains a subject of debate. Extended lymphadenectomy, extra-mesenteric lymph node dissection, high arterial ligation and complete mesocolic excision are amongst the surgical techniques with plausible oncological bases, but which are not supported by the highest levels of evidence. With further development and refinement, intra-operative lymphatic mapping and sentinel lymph node biopsy may provide a guide to the optimum extent of lymphadenectomy, but in its present form, it is beset by false negatives, skip lesions and failures to identify a sentinel node. Once resected, histopathological assessment of the surgical specimen can be improved by thorough dissection techniques, step-sectioning of tissue blocks and immunohistochemistry. More recently, molecular methods have been employed. In this review, we consider the numerous factors that affect lymph node yields, including the impact of the surgical and histopathological techniques. Potential future strategies, including the use of evolving technologies, are also discussed.

Positron emission tomography in the quantification of cellular and biochemical responses to intrapulmonary particulates.

Inhaled mineral dusts and fibres can cause chronic pulmonary inflammation, often leading to permanent scarring with loss of function, but the mechanisms involved remain obscure. There are currently no good methods for monitoring inflammatory processes in situ. Positron emission tomography (PET) of suitable intravenously injected radiolabelled markers provides non-invasive and repeatable methods of quantifying biochemical and cellular responses. We have developed animal models of fibrotic and non-fibrotic pulmonary response to particulate instillation and characterised these by histology. Different components of the inflammatory response have been investigated by PET: (1) [(18)F]-labelled fluoro-deoxyglucose, a positron emitting glucose analogue, accumulates in cells in proportion to their glucose uptake; ex vivo microautoradiography indicates that neutrophils are the cells responsible for an increased signal during pulmonary inflammation; a persistently high uptake is associated with lung scarring. (2) The radioligand [(11)C]-R-PK11195 binds to benzodiazepine-like receptors abundant in macrophages; following particulate instillation, the [(11)C]-R-PK11195 PET signal tracks with lung macrophage accumulation and also localises to regions consistent with macrophage clearance; poor macrophage clearance is associated with fibrosis. (3) [(18)F]-fluoroproline is likely a substrate for extracellular matrix production, especially proline-rich collagen; during active scarring, the rate of lung uptake of fluoroproline is elevated. Localisation of radioactivity in the lung has been validated ex vivo by microautoradiography of tritium analogues of each of the positron emitting tracers. The use of PET to monitor different inflammatory processes by repeated scanning of the same animal or individual is helping to identify key events in the fibrotic process.

Selective laser trabeculoplasty as a replacement for medical therapy in open-angle glaucoma.

PURPOSE: To evaluate selective laser trabeculoplasty (SLT) as a replacement for medical therapy in controlled open-angle glaucoma. DESIGN: Prospective, non-randomized, interventional clinical trial. METHODS: SLT was performed inferiorly in 66 eyes of 66 patients with medically controlled primary open-angle glaucoma (OAG) or exfoliation glaucoma, and no history of glaucoma surgery. The primary outcome was number of medications at 6 and 12 months while maintaining a pre-determined target intraocular pressure (IOP). RESULTS: The mean of the differences in medications from baseline was 2.0 (95% confidence interval = 1.8-2.3) at 6 months, and 1.5 (1.27-1.73) at 12 months (P < .0001). The group mean of medications was 2.8 +/- 1.1 at baseline, 0.7 +/- 0.9 at 6 months, and 1.5 +/- 0.9 at 12 months (P < .0001). Reduction in medications was attained in 64 of 66 eyes (97%) at 6 months, and 52 of 60 (87%) at 12 months. CONCLUSION: SLT enabled a reduction in medicine in controlled OAG over 12 months.