Short-term clinical and manometric outcomes of percutaneous tibial nerve stimulation for faecal incontinence: a large single-centre series.

BACKGROUND: Faecal incontinence (FI) is common, with a significant impact on quality of life. Percutaneous tibial nerve stimulation (PTNS) is a therapy for FI; however, its role has recently been questioned. Here we report the short-term clinical and manometric outcomes in a large tertiary centre. METHODS: A retrospective review of a prospective PTNS database was performed, extracting patient-reported FI outcome measures including bowel diary, the St Marks's Incontinence Score (SMIS) and Manchester Health Questionnaire (MHQ). Successful treatment was > 50% improvement in symptoms, whilst a partial response was 25-50% improvement. High-resolution anorectal manometry (HRAM) results before and after PTNS were recorded. RESULTS: Data were available from 135 patients [119 (88%) females; median age: 60 years (range: 27-82years)]. Overall, patients reported a reduction in urge FI (2.5-1) and passive FI episodes (2-1.5; p < 0.05) alongside a reduction in SMIS (16.5-14) and MHQ (517.5-460.0; p < 0.001). Some 76 (56%) patients reported success, whilst a further 20 (15%) reported a partial response. There were statistically significant reductions in rectal balloon thresholds and an increase in incremental squeeze pressure; however, these changes were independent of treatment success. CONCLUSION: Patients report PTNS improves FI symptoms in the short term. Despite this improvement, changes in HRAM parameters were independent of this success. HRAM may be unable to measure the clinical effect of PTNS, or there remains the possibility of a placebo effect. Further work is required to define the role of PTNS in the treatment of FI.

Injection sclerotherapy for the treatment of haemorrhoids in anticoagulated patients.

BACKGROUND: Symptomatic haemorrhoids (SH) are a common condition; however, conventional outpatient treatment, including rubber band ligation, is contraindicated in patients receiving concurrent anticoagulation. Injection sclerotherapy (IST) has been proposed as a treatment option for these patients. METHODS: A retrospective review of case notes was performed in a colorectal surgery department that sits alongside a tertiary cardiothoracic surgical unit. Patients treated with an IST for SH between 1 April 2014 and 30 November 2021 were identified. Anticoagulation was not stopped in these patients as they were at high risk of developing thromboembolism, except in two patients who required alternative procedures. The primary outcome was symptom resolution, defined as no patient reporting bleeding for at least six months. The secondary outcomes were patient-reported complications, number of IST procedures and number of other procedures performed to achieve symptom resolution. RESULTS: A total of 20 patients with a median age of 64 years (range 35-86, 14 male) who underwent 32 IST treatments were identified. Symptom resolution was achieved in 18 (90%) patients using IST while continuing anticoagulation treatment, with two (10%) patients requiring alternative interventions. Ten patients (50%) required only one IST procedure, and three patients (15%) required two procedures. The remaining five (25%) patients required three or four interventions. The median time between IST treatments was 32 weeks (range 8-133). No complications were reported. CONCLUSION: Our study demonstrates that IST can be considered as a potential treatment option for patients with SH who are at a high risk of thromboembolic disease requiring anticoagulation.

Factors associated with intensity of technology adoption and with the adoption of 4 clusters of precision livestock farming technologies in Irish pasture-based dairy systems.

Precision livestock farming (PLF) technologies have been widely promoted as important tools to improve the sustainability of dairy systems due to perceived economic, social, and environmental benefits. However, there is still limited information about the level of adoption of PLF technologies (percentage of farms with a PLF technology) and the factors (farm and farmer characteristics) associated with PLF technology adoption in pasture-based dairy systems. The current research aimed to address this knowledge gap by using a representative survey of Irish pasture-based dairy farms from 2018. First, we established the levels of adoption of 9 PLF technologies (individual cow activity sensors, rising plate meters, automatic washers, automatic cluster removers, automatic calf feeders, automatic parlor feeders, automatic drafting gates, milk meters, and a grassland management decision-support tool) and grouped them into 4 PLF technology clusters according to the level of association with each other and the area of dairy farm management in which they are used. The PLF technology clusters were reproductive management technologies, grass management technologies, milking management technologies, and calf management technologies. Additionally, we classified farms into 3 categories of intensity of technology adoption based on the number of PLF technologies they have adopted (nonadoption, low intensity of adoption, and high intensity of adoption). Second, we determined the factors associated with the intensity of technology adoption and with the adoption of the PLF technology clusters. A multinomial logistic regression model and 4 logistic regressions were used to determine the factors associated with intensity of adoption (low and high intensity of adoption compared with nonadoption) and with the adoption of the 4 PLF technology clusters, respectively. Adoption levels varied depending on PLF technology, with the most adopted PLF technologies being those related to the milking process (e.g., automatic parlor feeders and milk meters). The results of the multinomial logistic regression suggest that herd size, proportion of hired labor, agricultural education, and discussion group membership were positively associated with a high intensity of adoption, whereas age of farmer and number of household members were negatively associated with high intensity of adoption. However, when analyzing PLF technology clusters, the magnitude and direction of the influence of the factors in technology adoption varied depending on the PLF technology cluster being investigated. By identifying the PLF technologies in which pasture-based dairy farmers are investing more and by detecting potential drivers and barriers for the adoption of PLF technologies, the current study could allow PLF technology companies, practitioners, and researchers to develop and target strategies that improve future adoption of PLF technologies in pasture-based dairy settings.

Modeling the economic impacts of mobility scores in dairy cows under Irish spring pasture-based management.

Moderate to severe forms of suboptimal mobility on dairy cows are associated with yield losses, whereas mild forms of suboptimal mobility are associated with elevated somatic cell count and an increased risk to be culled. Although the economic consequences of severe forms of suboptimal mobility (also referred as clinical lameness) have been studied extensively, the mild forms are generally ignored. Therefore, the aim of the current study was to determine the economic consequences associated with varying prevalence and forms of suboptimal mobility within spring calving, pasture-based dairy herds. A new submodel predicting mobility scores was developed and integrated within an existing pastured-based herd dynamic model. Using a daily timestep, this model simulates claw disorders, and the consequent mobility score of individual cows. The impact of a cow having varying forms of suboptimal mobility on production and reproduction was simulated. The economic impact was simulated including treatment costs, as well as the production and reproductive impacts of varying levels of suboptimal mobility. Furthermore, different genetic predispositions for mobility issues and their interaction with herd-level management associated with each level of suboptimal mobility were simulated. Overall, 13 scenarios were simulated, representing a typical spring calving, pasture-based dairy herd with 100 cows. The first scenario represents a perfect herd wherein 100% of the cows had mobility score 0 (optimal mobility) throughout the lactation. The remaining 12 scenarios represent a combination of (1) 3 different herd-management levels, and (2) 4 different levels of a genetic predisposition for suboptimal mobility. The analysis showed that a 17% decrease in farm net profit was achieved in the worst outcome (wherein just 5% of the herd had optimal mobility) compared with the perfect herd. This was due to reduced milk yield, increased culling, and increased treatment costs for mobility issues compared the ideal scenario.

An ion-atom merged beams setup at the Cryogenic Storage Ring.

We describe a merged beams experiment to study ion-neutral collisions at the Cryogenic Storage Ring of the Max Planck Institute for Nuclear Physics in Heidelberg, Germany. We produce fast beams of neutral atoms in their ground term at kinetic energies between 10 and 300 keV by laser photodetachment of negative ions. The neutral atoms are injected along one of the straight sections of the storage ring, where they can react with stored molecular ions. Several dedicated detectors have been installed to detect charged reaction products of various product-to-reactant mass ranges. The relative collision energy can be tuned by changing the kinetic energy of the neutral beam in an independent drift tube. We give a detailed description of the setup and its capabilities, and present proof-of-principle measurements on the reaction of neutral C atoms with D2 + ions.

The One Minute Preceptor: A Vital Tool During COVID-19.

The One Minute Preceptor (OMP) model of teaching has an important role to play during the COVID-19 pandemic. It's quick and easy to learn and can be applied to any clinical setting. By responding directly to a student's needs, and building on the knowledge they already hold, the OMP is able to offer relevant and opportunistic teaching that the learner can immediately apply. Finally, the OMP can be taught in under two hours meaning medical staff not used to regularly teaching can develop the confidence to offer high quality educational interventions.

Diagnostic accuracy of ultrasound in the paediatric population with acute right iliac fossa pain, our District General Hospital experience.

AIM: This project aimed to evaluate the role of ultrasound scan (USS) in children presenting with acute onset right iliac fossa (RIF) pain and suspected appendicitis. METHODS: We retrospectively studied 100 consecutive children undergoing USS for RIF pain. Children with low to moderate clinical probability of appendicitis were seen by the surgical team and subsequently underwent USS by a radiologist or a sonographer with a special interest in paediatric USS. The clinical findings, blood tests, and radiological diagnosis led to a decision to operate, observe or discharge. USS findings were subsequently verified with the final histology. The six-month follow-up data of these patients were also analysed. RESULTS: 35 males, median age of 11 years (range 4-17), and 65 females, median age of 14 years (range 6-18) were included. A total of 23 appendicectomies were performed. On histology appendicitis was confirmed in 20, including 16 pre-operatively diagnosed on USS. 6 of these appendicectomies were performed on clinical suspicion with normal USS. 1 patient was diagnosed with neuroendocrine tumour of the appendix. Only 2 negative appendicectomies were performed. 62 patients were discharged without intervention. USS sensitivity was 74%, and specificity was 92% for appendicitis. An additional 16 patients were identified with alternate pathology including 5 ovarian cysts. CONCLUSION: Appendicitis was more common in male patients; however, there was no difference in overall disease prevalence in male or female paediatric patients. Thus, USS is a valuable tool to exclude appendicitis in children with low to moderate probability.

The effects of cueing episodic future thinking on delay discounting in children, adolescents, and adults.

Discounting the value of delayed rewards such that even a relatively small, immediately available reward is preferred to a larger delayed reward is a commonly observed human trait. Children are particularly steep discounters of delayed rewards as evidenced by delay of gratification studies. In recent years, however, a growing literature indicates that cueing individuals to imagine personal future events attenuates their discounting of delayed rewards. The present studies extend this literature by examining whether cueing future thinking promotes patient choices in children and adolescents. In Experiment 1 we found that cueing future thinking had no effect on 8-11-year-olds' (n = 177) delay discounting of either real or hypothetical rewards. In Experiment 2 we found that cueing adolescents (12-14-year-olds, n = 126) and adults (n = 122) to think about personal future events decreased their discounting of delayed rewards relative to three other conditions: a no cue control, an episodic memory condition and a novel 'future other' condition in which individuals imagine future events that might happen to a significant other person in their life. Cueing adults and adolescents to think about personal future events did not however affect how connected they felt to their future selves or their subjective sense of how close future time points felt to them - two constructs that have previously been shown to be related to delay discounting.

Safety of elective paediatric surgery during the coronavirus disease 2019 pandemic.

INTRODUCTION: Corona-virus Disease 2019 (COVID-19) has had a huge impact on the delivery of healthcare worldwide, particularly elective surgery. There is a lack of data regarding risk of postoperative COVID-19 infection in children undergoing elective surgery, and regarding the utility of pre-operative COVID-19 testing, and preoperative "cocooning" or restriction of movements. The purpose of this present study was to examine the safety of elective paediatric Otolaryngology surgery during the COVID-19 pandemic with respect to incidence of postoperative symptomatic COVID-19 infection or major respiratory complications. MATERIALS AND METHODS: Prospective cohort study of paediatric patients undergoing elective Otolaryngology surgery between September and December 2020. Primary outcome measure was incidence of symptomatic COVID-19 or major respiratory complications within the 14 days after surgery. Parents of prospectively enrolled patients were contacted 14 days after surgery and enquiry made regarding development of postoperative symptoms, COVID-19 testing, or diagnosis of COVID-19. RESULTS: 302 patients were recruited. 125 (41.4%) underwent preoperative COVID-19 RT-PCR testing. 66 (21.8%) restricted movements prior to surgery. The peak 14-day COVID-19 incidence during the study was 302.9 cases per 100,000 population. No COVID-19 infections or major respiratory complications were reported in the 14 day follow-up period. CONCLUSION: The results of our study support the safety of elective paediatric Otolaryngology surgery during the pandemic, in the setting of community incidence not exceeding that observed during the study period.

Transitioning from cerebrospinal fluid to blood tests to facilitate diagnosis and disease monitoring in Alzheimer's disease.

Alzheimer's disease (AD) is increasingly prevalent worldwide, and disease-modifying treatments may soon be at hand; hence, now, more than ever, there is a need to develop techniques that allow earlier and more secure diagnosis. Current biomarker-based guidelines for AD diagnosis, which have replaced the historical symptom-based guidelines, rely heavily on neuroimaging and cerebrospinal fluid (CSF) sampling. While these have greatly improved the diagnostic accuracy of AD pathophysiology, they are less practical for application in primary care, population-based and epidemiological settings, or where resources are limited. In contrast, blood is a more accessible and cost-effective source of biomarkers in AD. In this review paper, using the recently proposed amyloid, tau and neurodegeneration [AT(N)] criteria as a framework towards a biological definition of AD, we discuss recent advances in biofluid-based biomarkers, with a particular emphasis on those with potential to be translated into blood-based biomarkers. We provide an overview of the research conducted both in CSF and in blood to draw conclusions on biomarkers that show promise. Given the evidence collated in this review, plasma neurofilament light chain (N) and phosphorylated tau (p-tau; T) show particular potential for translation into clinical practice. However, p-tau requires more comparisons to be conducted between its various epitopes before conclusions can be made as to which one most robustly differentiates AD from non-AD dementias. Plasma amyloid beta (A) would prove invaluable as an early screening modality, but it requires very precise tests and robust pre-analytical protocols.

Work Based Assessments (WBAs) amongst UK medical trainees during the COVID-19 pandemic: How have we adapted?

Severe Acute Respiratory Syndrome Coronavirus type 2 (SARS-CoV-2) was recently identified as the RNA virus resulting in the Coronavirus disease (COVID-19). This was following cases of pneumonia identified in Hubei Province in China. The World Health Organisation (WHO) recently declared COVID-19 as a pandemic in March 2020. The COVID-19 pandemic has resulted in medical, financial and social disruption on an international scale. Such disruption has additionally impacted postgraduate medical training. This has been reflected in the attainment of Work Based Assessments amongst medical trainees in the United Kingdom.

A scoping review of the detection, epidemiology and control of Cyclospora cayetanensis with an emphasis on produce, water and soil.

Cyclospora cayetanensis is a parasite causing cyclosporiasis (an illness in humans). Produce (fruits, vegetables, herbs), water and soil contaminated with C. cayetanensis have been implicated in human infection. The objective was to conduct a scoping review of primary research in English on the detection, epidemiology and control of C. cayetanensis with an emphasis on produce, water and soil. MEDLINE® (Web of ScienceTM), Agricola (ProQuest), CABI Global Health, and Food Science and Technology Abstracts (EBSCOhost) were searched from 1979 to February 2020. Of the 349 relevant primary research studies identified, there were 75 detection-method studies, 40 molecular characterisation studies, 38 studies of Cyclospora in the environment (33 prevalence studies, 10 studies of factors associated with environmental contamination), 246 human infection studies (212 prevalence/incidence studies, 32 outbreak studies, 60 studies of environmental factors associated with non-outbreak human infection) and eight control studies. There appears to be sufficient literature for a systematic review of prevalence and factors associated with human infection with C. cayetanensis. There is a dearth of publicly available detection-method studies in soil (n = 0) and water (n = 2), prevalence studies on soil (n = 1) and studies of the control of Cyclospora (particularly on produce prior to retail (n = 0)).

The development of a rapid and reliable method (SAPSWash): For the extraction and recovery of spermatozoa from superabsorbent polymer containing products.

This work presents a rapid and reliable method to recover spermatozoa from Super Absorbent Polymers (SAPs) commonly found in sanitary protection products such as nappies and sanitary towels. The use of salt solutions was investigated and a protocol was developed using a calcium chloride (CaCl2) solution to release semen deposited onto a selected SAP containing product. The method was tested on ultra-sanitary towel samples treated with a known amount of semen. A range of treatments were examined; some samples were prepared and immediately frozen for storage and others were allowed to air dry overnight to replicate the condition of similar items recovered for examination in sexual offence cases. The method allowed the collection of low yields of spermatozoa, but these were still sufficient for microscopic identification of intact heads and to obtain ESI17 DNA profiles from all the samples. This report presents the method, the results obtained and discusses prospective adaptations to the method for validation to implement the method into forensic casework.

Associating mobility scores with production and reproductive performance in pasture-based dairy cows.

Lameness in dairy cows can have significant effects on cow welfare, farm profitability, and the environment. To determine the economic and environmental consequences of lameness, we first need to quantify its effect on performance. The objective of this study, therefore, was to determine the associations of various production and reproductive performance measurements (including milk, fat, and protein yield, somatic cell count, calving interval, cow death, or cow slaughter), and mobility scores in spring-calving, pasture-based dairy cows. We collected mobility scores (0 = good, 1 = imperfect, 2 = impaired, and 3 = severely impaired mobility), body condition scores, and production data for 11,116 cows from 68 pasture-based dairy herds. Linear mixed modeling was used to determine the associations between specific mobility scores and milk, fat and protein yield, and somatic cell count and calving interval. Binomial logistic regression was used to determine the association between mobility score and cow death, or slaughter. Significant yield losses of up to 1.4% of the average yield were associated with mobility score 2 and yield losses of up to 4.7% were associated with mobility score 3 during the early scoring period. Elevated somatic cell count was associated with all levels of suboptimal mobility during the late scoring period. Cows with a mobility score of 2 during the early scoring period were associated with longer calving interval length, whereas only cows with a mobility score of 3 during the late scoring period were associated with longer calving interval length. Cows with a mobility score ≥1 were more likely to be culled during both scoring periods. Our study, therefore, shows an association between specific mobility scores and production and reproductive performance in spring-calving, pasture-based dairy cows scored during the summer grazing period.

Investigating physiotherapy stakeholders' preferences for the development of performance-based assessment in practice education.

OBJECTIVES: Discrete choice experiments (DCEs) are used in healthcare to measure the relative importance that stakeholders give to different features (or attributes) of medical treatments or services. They may also help to address research questions in health professional education. Several challenges exist regarding the performance-based assessment process (PBA) employed in physiotherapy practice-based education, a process which determines students' readiness for independent practice. Evidence highlights many commonalities among these challenges, but it is unknown which factors are the most important to stakeholders. The use of DCE methodology may provide answers and help to prioritise areas for development. Thus, this study employed DCE to identify clinical educators', practice tutors and physiotherapy students' preferences for developing the PBA process in physiotherapy. DESIGN: Attributes (aspects of the PBA process known to be important to stakeholders) were derived from focus group interviews conducted with three groups; physiotherapy students, clinical educators (practising clinicians) and practice tutors (dedicated educational roles in the workplace). These attributes included the PBA tool, grading mechanisms, assessors involved, and, feedback mechanisms. Preferences for each group were calculated using a logistic regression model. RESULTS: Seventy-two students, 124 clinical educators and 49 practice tutors (n=245) participated. Priorities identified centred primarily on the mandatory inclusion of two assessors in the PBA process and on refinement of the PBA tool. CONCLUSION: Employment of DCE enabled the prioritisation of stakeholder-informed challenges related to PBA in physiotherapy practice-based education. This corroborates findings from previous qualitative work and facilitates a prioritised pathway for development of this process.