A cross-sectional survey of women's views and preferences for preterm birth screening and treatment.

OBJECTIVES: Primary outcomes were to determine; 1) the desire for more patient information from healthcare professionals on preterm birth (PTB) prevention 2) the desire for PTB screening surveillance or participation in research or 3) the acceptability of transvaginal ultrasound (TVUS) or vaginal examinations to predict spontaneous PTB. METHODS: A 19-question, piloted, self-administered survey was completed by unselected pregnant women in a tertiary maternity hospital in Dublin, Ireland. Data was collected to include maternal socio-demographics, past obstetric history, and current pregnancy details, in addition to views and preferences on PTB screening and preventative treatments. Statistical analysis to include binary and multinomial regression was performed by IBM SPSS Statistics for Windows (Version 29.0). RESULTS: 277 women completed the study survey. 9.4% of women had attended the preterm birth surveillance clinic (PSC). 75.1% of respondents indicated a preference for more information from healthcare professionals about PTB. 65% reported that TVUS and vaginal examinations were acceptable in pregnancy. The acceptability of antenatal examinations was significantly influenced by ethnicity; white European (OR 2.58, CI 1.12-5.95, p = 0.003) and Asian (OR 3.39, CI 1.18-9.67, p = 0.02). Discomfort (25.3%) and vaginal bleeding (11.9%) were the most frequently reported concerns about TVUS. 95.7% of unselected women indicated that they would accept treatment to prevent PTB. Vaginal progesterone (53.8%) was preferred treatment compared to cervical cerclage (15.9%) or cervical pessary (16.6%). 55.6% of respondents stated they attend or wish to attend for additional appointments or research opportunities for PTB screening. Women with a previous PTB or second trimester miscarriage were more likely to attend or wish to attend for PTB screening (OR 3.23, CI 1.34-7.79, p = 0.009). CONCLUSION: PTB is an important healthcare priority for pregnant women in Ireland. However, women require more information, counselling and reassurance about the utility and safety of TVUS in PSCs.

Clinical assessment of a point-of-care assay to determine protective vaccinal antibody titers to canine viral diseases.

Guidelines recommend that dogs are vaccinated for canine distemper virus (CDV), canine parvovirus (CPV), and canine adenovirus (CAV) every 3 years. Alternatively, their antibody titers are measured and vaccines given when titers fall below a protective threshold. In this study, a point-of-care (POC) assay was compared to hemagglutination inhibition (for CPV) and virus neutralization (for CAV and CDV) assays to predict the need for revaccination Ninety-two dogs presented for vaccination were enrolled. The POC assay indicated protective titers against CDV in 79/80, CPV in 89/90, and CAV in 91/91 dogs with reference standard antibody measurements that were over a protective threshold. The sensitivity of the POC assay for to detect protective concentrations of CDV antibodies was 99% (95% confidence interval [CI 95%], 93.3-99.9%). Ten dogs were falsely considered protected against CDV by the POC assay with a specificity of 17% (CI 95%, 3.0-44.8%). The sensitivity of the POC assay for protective concentrations of CPV titers was 99% (CI 95%, 93.9-99.9%). The sensitivity of the POC assay to detect protective concentrations of CAV antibodies was 100% (CI 95%, 95.9-100%). Only classifying high-positive CDV and CPV titers on the POC assay as protective improved assay specificity to 100%, but sensitivity decreased to 51% and 76% respectively. This POC assay had a high sensitivity for the detection of protective antibody titers; however, some dogs were falsely categorized as protected, especially for CDV.

Drainage status of grassland peat soils in Ireland: Extent, efficacy and implications for GHG emissions and rewetting efforts.

Peatlands have been artificially drained and degraded over 100s of years and have released huge amounts of carbon dioxide (CO2) as a result. In organic grassland soils, raising the water table to prevent such emissions is being proposed to meet national greenhouse gas emission targets for the land use sector. At present, all of these soils (335,000 ha) are assumed to be drained (as no information has been available on their drainage status) within national emission inventory reporting and are therefore responsible for significant emissions (8-9 million tonnes CO2-equivalent annually). The objective of the present study was to collate studies relating to the drainage status of peat soils in Ireland to present alternative scenarios with regard to actual drainage status of organic soils and their estimated emissions. From a drainage design perspective, evidence suggests that relatively small proportions of the grassland peat area was drained effectively using optimal in-field drain spacings required to control the water table at 0.4-0.5 m. Open drains excavated on such soils have limited capacity to laterally control the water table depth beyond short distances. Furthermore, the lack of long-term routine maintenance post installation ensures the redundancy of many drainage systems over time. New drainage installations are therefore likely replacing existing infrastructure and not necessarily increasing the drained area at any given time. This evidence supports literature from the 1980s which state that relatively low proportions of the grassland peat area has been subjected to effective drainage. Scenario testing results showed that likely emissions from the most probable scenario (with total area drained equating to 90,000-120,000 ha) are 3.6-4.7 million tonnes CO2-equivalent, approximately 40-53% of current national emission inventory estimates. The incorporation of such a refinement into the national inventory could offer a significant reduction in estimated GHG emissions from the grassland land use sector in national emission inventory reporting.

New insights for predicting surgery outcome in patients with temporal lobe epilepsy. A systematic review.

Resective surgery is the treatment of choice for one-third of adult patients with focal, drug-resistant epilepsy. This procedure is associated with substantial clinical and cognitive risks. In clinical practice, there is no validated model for epilepsy surgery outcome prediction (ESOP). Meta-analyses on ESOP studies assessing prognostic factors report discrepancies in terms of study design. Our review aims to systematically investigate methodological and analytical aspects of studies predicting clinical and cognitive outcomes after temporal lobe epilepsy surgery. A systematic review of ESOP studies published between 2000 and 2022 from three databases (MEDLINE, Web of Science, and PsycINFO) was completed by following the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. It yielded 4867 articles. Among them, 21 corresponded to our inclusion criteria and were therefore retained in the final review. The risk of bias was assessed using A Tool to Assess Risk of Bias and Applicability of Prediction Model Studies (PROBAST). Data extracted from the 21 studies were analyzed using narrative synthesis and descriptive statistics. Our findings show an increase in the use of multimodal datasets and machine learning analyses in recent ESOP studies, although regression remained the most frequently used approach. We also identified a more frequent use of network notions in recent ESOP studies. Nevertheless, several methodological issues were noted, such as small sample sizes, lack of information on the follow-up period, variability in seizure outcome, and the definition of neuropsychological postoperative change. Of 21 studies, only one provided a clinical tool to anticipate the cognitive outcome after epilepsy surgery. We conclude that methodological issues should be overcome before we move towards more complete models to better predict clinical and cognitive outcomes after epilepsy surgery. Recommendations for future studies to harness the possibilities of multimodal datasets and data fusion, are provided. A stronger bridge between fundamental and clinical research may result in developing accessible clinical tools.

Suspect severe gastroenteritis associated with ingestion of caterpillar setae fragments in a cat.

A 6-month-old male neutered Domestic Shorthair cat was assessed for a 24-h history of anorexia, lethargy, depressed mentation, mild abdominal pain and persistent bradycardia. Abdominal ultrasound revealed marked thickening of the gastric wall, gastric distension, free abdominal fluid, distension and corrugation of the small intestine. Full-thickness histopathological biopsy of the gastric wall demonstrated intralesional chitinous structures whose morphology (size and presence of obvious barbs) supports these structures being urticating hairs (setae). A processionary caterpillar is considered most likely as these are the most common urticating caterpillars in Australia. This is the first case of suspected severe gastroenteritis associated with the ingestion of caterpillar setae fragments in a cat.

SARS-CoV-2 Testing and Patient Waiting Times in the Emergency Department.

Aim Emergency Departments (EDs) were impacted early in the coronavirus disease 2019 (COVID-19) pandemic, with high attendance numbers. EDs relied upon SARS-CoV-2 reverse-transcriptase polymerase chain reaction (RT-PCR) tests to triage patients and facilitate admission to appropriate wards, meaning positive patients were isolated as early as possible. In October 2020, we introduced a 24-hour SARS-CoV-2 testing service. We examined the impact of this on patient experience times (PETs) in the ED, and on healthcare-associated (HA) COVID-19 infections. Methods Data on PETs before and after the introduction of 24-hour testing were available from the ED. HA COVID-19 infections were reported weekly to the Health Services Executive as a key performance indicator. Results Mean PET prior to the pandemic was 20 hours and dropped to 10 and 13 hours respectively in the first and second wave. A surge in case numbers and ED attendances during the third wave was not reflected in a rise in PETs, with a mean PET of 11 hours, significantly below pre-pandemic levels. HA-COVID-19 infections remained stable between wave one and three (83 v 92). Conclusion The introduction of 24-hour SARS-CoV-2 testing in our ED contributed to a reduction in PETs, facilitated appropriate patient placement at ward level, and kept HA-COVID-19 infections at acceptably low levels.

Temporal changes in cortical microporosity during estrogen deficiency associated with perilacunar resorption and osteocyte apoptosis: A pilot study.

Osteocytes can actively regulate bone microporosity, through either perilacunar resorption or micropetrosis following apoptosis. Osteocyte apoptosis is more prevalent in estrogen deficiency and changes in the lacunar-canalicular network of osteocytes have been reported. Temporal changes in bone mineralisation and osteocytes cellular strains occur, which might be associated with osteocyte-driven microporosity changes, although time dependant changes in bone microporosity are not yet fully understood. In this pilot study we conducted micro-CT analysis, backscatter electron imaging and histological analysis of femoral cortical bone form an ovariectomized rat model of osteoporosis to investigate whether estrogen deficiency causes temporal changes in lacunar and vascular porosity. We also assessed MMP14 expression, lacunar occupancy and mineral infilling, as indicators of perilacunar resorption and micropetrosis. We report temporal changes in cortical microporosity in estrogen deficiency. Specifically, canalicular and vascular porosity initially increased (4 weeks post-OVX), coinciding with the period of rapid bone loss, whereas in the longer term (14 weeks post-OVX) lacunar and canalicular diameter decreased. Interestingly, these changes coincided with an increased prevalence of empty lacunae and osteocyte lacunae were observed to be more circular with a mineralised border around the lacunar space. In addition we report an increase in MMP14+ osteocytes, which also suggests active matrix degradation by these cells. Together these results provide an insight into the temporal changes in cortical microporosity during estrogen deficiency and suggest the likelihood of occurrence of both perilacunar resorption and osteocyte apoptosis leading to micropetrosis. We propose that microporosity changes arise due to processes driven by distinct populations of osteocytes, which are either actively resorbing their matrix or have undergone apoptosis and are infilling lacunae by micropetrosis.

Effect of plasma rich in growth factors on quality of life following mandibular third molar removal: a double-blind randomized controlled trial.

The objective of this study was to investigate the effect of plasma rich in growth factors (PRGF) on patient- and clinician-reported outcomes following mandibular third molar removal. Seventy-four patients requiring surgical removal of a unilateral impacted mandibular third molar under local anaesthesia were recruited into the study. PRGF was prepared for all patients irrespective of study arm allocation. Reviews were conducted 3 days (T1) and 7 days (T2) postoperatively. Primary outcome measures were pain (numerical rating scale, NRS), OHIP-14 (Oral Health Impact Profile-14), and postoperative symptom severity scale (PoSSe) data. Secondary outcome measures including mouth opening, dry socket, socket healing, and analgesic consumption were also explored. The statistical analysis was performed using analysis of covariance and the χ2 test. NRS pain scores were higher in the PRGF group at T1, demonstrating borderline significance (mean difference 1.0; P = 0.06), with no difference at T2. PoSSe scores did not differ between the groups, with the exception of the 'interference with daily activities' subscale at T1, where PRGF group patients scored 1.2 units higher (P = 0.02). OHIP-14 scores demonstrated a 25% increased likelihood of PRGF patients reporting discomfort on eating at T1 (P = 0.02), with no statistical significance at T2. Secondary outcomes did not differ between the groups. No difference in clinical or quality of life outcomes was observed for patients receiving adjunctive PRGF in third molar sockets.

Assessment of the microbial load of airway clearance devices used by a cohort of children with cystic fibrosis.

BACKGROUND: Positive expiratory pressure (PEP) devices are an important element of the management of cystic fibrosis, and of other respiratory diseases. Whereas there have been reports in the literature of contamination of airway clearance devices and their surfaces by microbial pathogens, there is little evidence available regarding such contamination and its contribution to respiratory infection. AIM: To establish whether pathogenic bacteria can contaminate PEP devices in the context of normal cleaning and maintenance practices. METHODS: Patients' home-use clearance devices were brought to a routine clinic appointment and collected for microbiology sampling and analysis. The patients were provided with replacement devices. Nineteen such devices were collected from 17 patients, reflecting use of multiple devices by some patients. Swabs were taken and cultured from each patient's used device, the patient's airway, as well as from new unopened and unused devices that acted as controls. RESULTS: Seven of 19 devices (37%) tested positive for presence of pathogenic bacteria. Device-cleaning methods varied among patients and non-sterilization methods were found to be ineffective at removing pathogens. Microbial species found on the devices did not correlate with those identified from airway swabs. CONCLUSION: This study demonstrates the presence of pathogens on positive expiratory pressure devices. The potential for transmission of these pathogens to the patient's airway and the risk of infection remains unclear and requires further study.

Field scale estimates of soil carbon stocks on ten heavy textured farms across Ireland.

The world's soils store vast amounts (≈2,500 GT) of Carbon which acts as a vital sink to counterbalance the effects of increasing atmospheric carbon dioxide. There have been fruitful efforts to quantify soil Carbon stocks at national scales, which are required for policy level decisions but lack the high resolution required to support farm specific decisions. It is hypothesised that farm scale evaluations of soils can provide insight that is masked in national scale studies and can allow for spatially explicit management approaches to optimise soil Carbon storage and sequestration, such that it can be prioritized within profitable production systems. The objective of the present study was to estimate Carbon stocks on a range of heavy textured soils at field and farm scale and to quantify Carbon storage relative to national scale estimates. Ten grassland dairy farms (mean area of 52.2 Ha) were surveyed, sampled and classified to determine soil types and quantify soil Carbon stores. The level of Carbon present (mean: 346.0 T/Ha) at these sites was greater than previous averages on such soils quantified at national scale (by a factor of 1.1-3.9 depending on soil type). Furthermore, if Carbon saturation potential was realised, the amount of Carbon stored could be increased by an average of 792.1 T/Ha in each profile (from 346.0 to 1138.1 T/Ha). Current management has fostered the retention of large stores of soil Carbon on such soils/farms which co-exist within highly productive farm systems. As there is a societal demand to retain and enhance soil carbon stores to mitigate climate change, high Carbon soils should be identified and, under appropriate policies, commodified to offer a direct incentive to retain soil Carbon. The value of this resource should be recognised and polices to ensure a spatially explicit approach for soil Carbon management should be adopted.

Do established infection prevention and control measures prevent spread of SARS-CoV-2 to the hospital environment beyond the patient room?

The role of the hospital environment in the transmission of infection is well described. With an emerging infection whose mode of transmission is under investigation, strict infection prevention and control measures, including patient isolation, hand hygiene, personal protective equipment that is doffed on exiting the patient room, and environmental cleaning should be implemented to prevent spread. Environmental testing demonstrated that COVID-19 patients contaminated the patient area (11/26, 42.3% of tests) but contamination of general ward areas was minimal (1/30, 3%) and the virus was detected after cleaning on one item only (1/25, 4%) which was noted to be in disrepair.

Secondary alterations in bone mineralisation and trabecular thickening occur after long-term estrogen deficiency in ovariectomised rat tibiae, which do not coincide with initial rapid bone loss.

This study delineates the time sequence of changes in bone tissue mineralisation in ovariectomised rats. We report that changes in bone mineral distribution arise secondary to the initial rapid bone loss but coincide with trabecular thickening. We propose that these changes compensate for elevated stresses in remaining trabeculae after bone resorption. INTRODUCTION: Recent studies have shown that osteoporosis is not simply a disease of bone loss and microarchitectural degradation but that important changes in tissue composition also occur. Such changes may be a secondary response to early bone loss, but the time sequence of changes in bone mineral distribution is not fully understood. The objective of this study was to quantify the temporal effects of estrogen deficiency on trabecular mineral distribution in the tibia of ovariectomised (OVX) rats. METHODS: Weekly in vivo micro-CT scans and morphometric and bone mineral density distribution analyses of the proximal tibia were conducted for the first 4 weeks of estrogen deficiency and then at 8, 14 and 34 weeks. RESULTS: Here we report that although trabecular bone volume and architecture are significantly deteriorated within the first 4 weeks of estrogen deficiency, there is no change in the distribution of bone mineral within trabeculae during this initial period. The rate of bone loss in OVX animals dramatically reduced between week 4 and week 14, which coincided with the initiation of increases in trabecular thickness and mineralisation in the OVX group. CONCLUSIONS: Together this study reveals for the first time that alterations in bone mineralisation and trabecular thickening arise secondary to the initial rapid bone loss. We propose that these secondary mineralisation changes act to reinforce the trabecular network in an attempt to compensate for the increased loading that ensues after severe bone loss. This study provides an insight into temporal changes in bone mineral distribution in estrogen deficiency.

Real-Time PCR and LAMP Assays for the Detection of Spores of Alternaria solani and Sporangia of Phytophthora infestans to Inform Disease Risk Forecasting.

Real-time loop-mediated isothermal amplification (LAMP) assays for the detection of sporangia of the causal pathogen of late blight, Phytophthora infestans, and spores of the main causal pathogen of early blight, Alternaria solani, were developed to facilitate the in-field detection of airborne inoculum to improve disease forecasting. These assays were compared with an existing real-time PCR assay for P. infestans and a newly developed real-time PCR assay for A. solani. Primers were designed for real-time LAMP of P. infestans and A. solani. The specificity of the P. infestans real-time LAMP assay was similar to that of an existing real-time PCR assay: DNA of P. infestans was consistently amplified as was DNA of the taxonomically closely related species Phytophthora mirabilis, Phytophthora phaseoli, and Phytophthora ipomoea; no amplification of DNA from the potato pathogens Phytophthora erythroseptica or Phytophthora nicotianae occurred. Real-time LAMP and PCR assays were developed for A. solani, and the specificity was compared with an existing conventional PCR assay. Importantly, the A. solani real-time LAMP and PCR assays did not amplify the species Alternaria alternata. However, cross-reactivity with Alternaria dauci was observed with the real-time PCR assay and Alternaria brassicae with the real-time LAMP assay. The sensitivity of all assays for the detection of DNA extracted from sporangia/spores of the target pathogens was evaluated. The P. infestans real-time LAMP assay reliably detected 5 pg of DNA, equivalent to ∼1 sporangia per reaction. By comparison, 20 fg of DNA was detectable with the existing real-time PCR assay. In the case of A. solani, real-time LAMP detected 4.4 pg of DNA, equivalent to ∼1 spore per reaction, and real-time PCR detected 200 fg of DNA. In-field air samplers were deployed in two trial plots planted with potato: one infected with P. infestans, and the other infected with A. solani. Four additional samplers were located in commercial potato fields. Air samples were taken through the season, and detection of airborne inoculum of P. infestans and A. solani with both real-time PCR and LAMP was assessed.

Is ultra wide-field retinal imaging alone appropriate for retinal angioma screening in lower risk subjects attending Von Hippel-Lindau (VHL) clinics?

Purpose: To determine if non-mydriatic ultra wide-angle digital retinal imaging alone is effective for screening subjects considered to be at 50% or lower risk for developing retinal angiomas.Methods: Digital records and retinal images of subjects attending a regional Von-Hippel-Lindau disease multi-disciplinary clinic over a 12 month period were reviewed. Individuals were stratified for risk of developing retinal angiomas on the basis of age, clinical features and genetic risk. The image quality and necessity for subsequent mydriatic fundoscopy were assessed.Results: Eighty subjects from 55 pedigrees attended the VHL clinic over 12 months. Of these, 44 (55%) were considered to be at lower risk for retinal angiomatosis: 34 (77%) because they had reached at least 30 years of age without developing an angioma, 16 with a presenting solitary tumour of the type associated with VHL but no identifiable gene mutation, and 12 with a family history giving them a 50% risk of carrying a gene mutation. Eighteen patients fulfilled two low risk criteria. All were able to comply with imaging but poor image quality (limited view of the inferior retinal far-periphery) required subsequent dilated fundoscopy in five (6%) eyes of three patients.Conclusions: Non-mydriatic ultra wide-field retinal imaging enabled satisfactory assessment in over 95% of lower-risk VHL subjects. Virtual clinics or remote imaging of lower-risk subjects may improve both the efficiency and flexibility in the provision of multi-disciplinary VHL services and the patient experience.

Disseminated Sporotrichosis in a Bilby (Macrotis lagotis).

A male bilby (Macrotis lagotis) was presented to the Murdoch University Veterinary Anatomical Pathology Service following humane destruction due to severe lethargy. The bilby was emaciated with a focal ulcerated skin lesion on the dorsal tail base. Multifocal to coalescing foci of pyogranulomatous and often necrotizing inflammation was present within multiple organs, including the tail wound, adrenal glands, kidneys, lungs, brain, testes, lymph nodes, heart, liver, spleen and salivary glands. Admixed were abundant intrahistiocytic and extracellular pleomorphic yeast (round, oval and cigar-shaped) up to 6 µm diameter, often with a thin clear halo and occasional narrow-based budding. The diagnosis of disseminated sporotrichosis was confirmed via culture and sequencing of the internal transcribed spacer region of the causative agent, Sporothrix schenckii sensu lato. The route of entry of infection was considered most likely to have been via cutaneous inoculation of the tail base wound. To the authors' knowledge, this report describes the first known case of sporotrichosis in a native Australian animal.

Evaluation of a theory-based concussion education program for secondary school student-athletes in Ireland.

Concussion education is an important aspect of concussion prevention. The purpose of this study was to investigate the effect of a novel, theory of planned behavior (TPB)-driven concussion education program on secondary school athletes' concussion-reporting relevant cognitions immediately post-intervention and at 3 months follow-up. Data were collected from 428 secondary school athletes during the 2016-2017 academic year: 229 were assigned to an intervention group of which 59 (25.76%) completed assessments at all timepoints; 199 were assigned to a control group of which 153 (76.88%) completed assessments at all timepoints. Using repeated measures ANOVAs, we examined differences in athletes' concussion-reporting cognitions, by group and gender. The program had a significant positive effect on athletes' knowledge (P < 0.01), perceived behavioral control over concussion recognition and reporting (P < 0.01), and reporting intention (P < 0.01). These results were maintained at 3 months follow-up, with the exception of perceived behavioral control. The program did not have a significant effect on athletes' attitudes toward concussion reporting and subjective reporting norms. Results suggest that the TPB may be a useful framework to inform the development of more effective educational programs. There is a need for multi-layered interventions that aim to create sporting environments that encourage positive concussion care seeking behaviors.

Activating KIR Haplotype Influences Clinical Outcome Following HLA-Matched Sibling Hematopoietic Stem Cell Transplantation.

Natural killer cells are thought to influence the outcome of hematopoietic stem cell transplant (HSCT), impacting on relapse, overall survival, graft versus host disease and the control of infection, in part through the complex interplay between the large and genetically diverse killer immunoglobulin-like receptor (KIR) family and their ligands. This study examined the relationship between KIR gene content and clinical outcomes including the control of opportunistic infections such as cytomegalovirus in the setting of human leucocyte antigen (HLA)-matched sibling HSCT in an Australian cohort. The presence of the KIR B haplotype which contain more activating receptors in the donor, in particular centromeric B haplotype genes (Cen-B), was associated with improved overall survival of patients with acute myeloid leukemia (AML) undergoing sibling HSCT and receiving myeloablative conditioning. Donor Cen-B haplotype was also associated with reduced acute graft versus host disease grades II-IV whereas donor telomeric-B haplotype was associated with decreased incidence of CMV reactivation. In contrast, we were not able to demonstrate a reduced rate of relapse when the donor had KIR Cen-B, however relapse with a donor Cen-A haplotype was a competing risk factor to poor overall survival. Here we show that the presence of donor activating KIR led to improved outcome for the patient, potentially through reduced relapse rates and decreased incidence of acute GvHD translating to improved overall survival. This article is protected by copyright. All rights reserved.