Descriptive study of COVID-19 vaccinations and infections within an NHS workforce.

BACKGROUND: Healthcare workers were a priority group for coronavirus disease 2019 (COVID-19) vaccination during the pandemic. Occupational exposure may account for some of the increased risk faced. AIMS: Describe COVID-19 vaccine uptake and infection rates in staff across a large NHS board in Scotland to better understand occupational risk during the pandemic. METHODS: Descriptive cross-sectional study. Demographic data were extracted on 5 August 2021 from 26 058 members of staff. COVID-19 vaccination status and positive polymerase chain reaction (PCR) results were extracted on two separate dates to describe the timeline of staff infections between March 2020 and January 2022. RESULTS: There was high uptake of all three vaccine doses across all demographic groups in hospital staff. PCR positivity decreased with increasing age and Scottish Index of Multiple Deprivation score. Staff and nosocomial COVID-19 infections followed peaks in community infection rates. CONCLUSIONS: NHS Lothian is a typical NHS workforce with good vaccine uptake. Beyond very early cases, there seems to be minimal evidence of occupational acquisition of COVID-19. The large number of nosocomial infections at the start of the pandemic may, in fact, reflect lack of community testing at this time. Despite protection from high vaccine coverage, job type and good Infection Prevention and Control practices, it seems that staff remain at high risk of catching the highly transmissible omicron variant from the community rather than work.

The Impact of BRAF Mutation Status on Survival Outcomes and Treatment Patterns among Metastatic Colorectal Cancer Patients in Alberta, Canada.

Colorectal cancer presents via multiple different clinical phenotypes that can arise from a variety of different genetic and molecular alterations. The aim of this study was to describe survival outcomes and treatment patterns of metastatic colorectal cancer (mCRC) patients by v-raf murine sarcoma viral oncogene homolog B1 (BRAF) mutation status. The Alberta Cancer Registry was used to identify all patients >18 years old who had been diagnosed with mCRC in Alberta between 1 January 2017 and 31 December 2019 and had received at least one cycle of systemic therapy. Treatment patterns were compared between wild-type and mutant BRAF mCRC patients. Cox regression models and Kaplan-Meier curves were created to assess survival differences by both treatment pattern and BRAF status. A total of 488 patients were identified with mCRC, of which 42 (11.4%) were confirmed to have a BRAF mutation. The most common first-line treatment regimen was either capecitabine and oxaliplatin (CAPOX) or leucovorin calcium (folinic acid), fluorouracil, and oxaliplatin (FOLFOX). The median overall survival for mCRC patients was 20.01 months. Mutant BRAF patients had a median survival of 8.21 months compared to 20.03 months among those with wild-type BRAF. BRAF mutations among mCRC patients are associated with a considerably poor prognosis, reinforcing the need for clinical BRAF testing among newly diagnosed patients to better understand their prognosis.

Risk Factors for Early-Onset Colorectal Cancer: A Systematic Review and Meta-analysis.

BACKGROUND & AIMS: Despite the widespread increase in the incidence of early-onset colorectal cancer (EoCRC), the reasons for this increase remain unclear. The objective of this study was to determine risk factors for the development of EoCRC. METHODS: We conducted a systematic literature review and meta-analysis of studies examining non-genetic risk factors for EoCRC, including demographic factors, comorbidities, and lifestyle factors. Random effects meta-analyses were conducted for risk factors that were examined in at least three studies. Heterogeneity was investigated using the Q-test and I2 statistic. RESULTS: From 3304 initial citations, 20 studies were included in this review. Significant risk factors for EoCRC included CRC history in a first-degree relative (RR 4.21, 95% CI 2.61-6.79), hyperlipidemia (RR 1.62, 95% CI 1.22-2.13), obesity (RR 1.54, 95% CI 1.01-2.35), and alcohol consumption (high vs. non-drinkers) (RR 1.71, 95% CI 1.62-1.80). While smoking was suggestive as a risk factor, the association was not statistically significant (RR 1.35, 95% CI 0.81-2.25). With the exception of alcohol consumption, there was considerable heterogeneity among studies (I2 > 60%). Other potential risk factors included hypertension, metabolic syndrome, ulcerative colitis, chronic kidney disease, dietary factors, sedentary behaviour, and occupational exposure to organic dusts, but these were only examined in one or two studies. CONCLUSIONS: The results of this study advance the understanding of the etiology of EoCRC. High-quality studies conducted on generalizable populations and that comprehensively examine risk factors for EoCRC are required to inform primary and secondary prevention strategies.

Laser-Driven Superradiant Ensembles of Two-Level Atoms near Dicke Regime.

We report the experimental observation of a superradiant emission emanating from an elongated dense ensemble of laser cooled two-level atoms, with a radial extent smaller than the transition wavelength. In the presence of a strong driving laser, we observe that the system is superradiant along its symmmetry axis. This occurs even though the driving laser is orthogonal to the superradiance direction. This superradiance modifies the spontaneous emission, and, resultantly, the Rabi oscillations. We also investigate Dicke superradiance in the emission of an almost fully inverted system as a function of the atom number. The experimental results are in qualitative agreement with ab-initio, beyond-mean-field calculations.

Motional Squeezing for Trapped Ion Transport and Separation.

Transport, separation, and merging of trapped ion crystals are essential operations for most large-scale quantum computing architectures. In this Letter, we develop a theoretical framework that describes the dynamics of ions in time-varying potentials with a motional squeeze operator, followed by a motional displacement operator. Using this framework, we develop a new, general protocol for trapped ion transport, separation, and merging. We show that motional squeezing can prepare an ion wave packet to enable transfer from the ground state of one trapping potential to another. The framework and protocol are applicable if the potential is harmonic over the extent of the ion wave packets at all times. As illustrations, we discuss two specific operations: changing the strength of the confining potential for a single ion and separating same-species ions with their mutual Coulomb force. Both of these operations are, ideally, free of residual motional excitation.

High-fidelity laser-free universal control of trapped ion qubits.

Universal control of multiple qubits-the ability to entangle qubits and to perform arbitrary individual qubit operations1-is a fundamental resource for quantum computing2, simulation3 and networking4. Qubits realized in trapped atomic ions have shown the highest-fidelity two-qubit entangling operations5-7 and single-qubit rotations8 so far. Universal control of trapped ion qubits has been separately demonstrated using tightly focused laser beams9-12 or by moving ions with respect to laser beams13-15, but at lower fidelities. Laser-free entangling methods16-20 may offer improved scalability by harnessing microwave technology developed for wireless communications, but so far their performance has lagged the best reported laser-based approaches. Here we demonstrate high-fidelity laser-free universal control of two trapped-ion qubits by creating both symmetric and antisymmetric maximally entangled states with fidelities of [Formula: see text] and [Formula: see text], respectively (68 per cent confidence level), corrected for initialization error. We use a scheme based on radiofrequency magnetic field gradients combined with microwave magnetic fields that is robust against multiple sources of decoherence and usable with essentially any trapped ion species. The scheme has the potential to perform simultaneous entangling operations on multiple pairs of ions in a large-scale trapped-ion quantum processor without increasing control signal power or complexity. Combining this technology with low-power laser light delivered via trap-integrated photonics21,22 and trap-integrated photon detectors for qubit readout23,24 provides an opportunity for scalable, high-fidelity, fully chip-integrated trapped-ion quantum computing.

Development and validation of a risk prediction model for high-risk adenomas at the time of first screening colonoscopy among screening aged Canadians.

The aim of this study was to develop a risk prediction model for high risk adenomas (HRAs) detected at screening colonoscopy based on readily available participant information. The cohort consisted of 3035 participants aged 50 to 74 years with no history of cancer who underwent a primary screening colonoscopy at a centralized colon cancer screening centre between 2008 and 2016. A multivariable logistic regression model was created using CRC risk factors identified from prior research. Model covariates were collected from a baseline questionnaire and included participant demographics (age and sex), lifestyle parameters (body mass index, alcohol, smoking, and vitamin D supplement use) and medical history (family history of CRC and diabetes). Mean participant age was 58.8 years, and 54.7% were male. 249 participants with HRAs were identified (8.2%). An adjusted c-statistic of 0.67 was calculated, and a specificity and negative predictive value of 97.2% (95% CI: 96.5-97.8) and 92.5% (95% CI: 92.2-92.8) for the detection of HRAs, respectively, were achieved using 20% predicted probability as a high-risk threshold. However, only a sensitivity of 12.1% (95% CI: 8.3-16.8) was achieved. Our model has moderate predictive ability, with strengths in being able to rule out those with an absence of HRAs on screening colonoscopy. Maximizing screening efficiency through improved risk prediction can enhance resource allocation. Ultimately, this model has the potential to improve patient care by reducing unnecessary colonoscopies, limiting this invasive procedure to those most likely to have significant findings.

Worldwide surveillance of self-reported sitting time: a scoping review.

BACKGROUND: Prolonged sitting time is a risk factor for chronic disease, yet recent global surveillance is not well described. The aims were to clarify: (i) the countries that have collected country-level data on self-reported sitting time; (ii) the single-item tools used to collect these data; and (iii) the duration of sitting time reported across low- to high-income countries. METHODS: Country-level data collected within the last 10 years using single-item self-report were included. The six-stage methodology: (1) reviewing Global Observatory for Physical Activity! Country Cards; (2-4) country-specific searches of PubMed, the Demographic and Health Survey website and Google; (5) analysing the Eurobarometer 88.4; and (6) country-specific searches for World Health Organization STEPwise reports. RESULTS: A total of 7641 records were identified and screened for eligibility. Sixty-two countries (29%) reported sitting time representing 47% of the global adult population. The majority of data were from high-income (61%) and middle income (29%) countries. The tools used were the International Physical Activity Questionnaire (IPAQ; n = 34), a modified IPAQ (n = 1) or the Global Physical Activity Questionnaire (GPAQ; n = 27). The median of mean daily sitting times was 4.7 (IQR: 3.5-5.1) hours across all countries. Higher-income countries recorded a longer duration of sitting time than lower-income countries (4.9 vs 2.7 h). CONCLUSIONS: This study provides an updated collation of countries collecting self-reported sitting time data. The daily sitting time findings should be interpreted cautiously. Current surveillance of sitting time is limited by a lack of coverage. Measures of population sitting time that are valid, feasible and sensitive to change should be embedded within global surveillance systems, to help guide future policy, research and practice. TRIAL REGISTRATION: Not applicable.

A retrospective review and multi-specialty, evidence-based guideline for the management of necrotising otitis externa.

BACKGROUND: Necrotising otitis externa is a progressive infection of the external auditory canal which extends to affect the temporal bone and adjacent structures. Progression of the disease process can result in serious sequelae, including cranial nerve palsies and death. There is currently no formal published treatment guideline. OBJECTIVE: This study aimed to integrate current evidence and data from our own retrospective case series in order to develop a guideline to optimise necrotising otitis externa patient management. METHODS: A retrospective review of necrotising otitis externa cases within NHS Lothian, Scotland, between 2013 and 2018, was performed, along with a PubMed review. RESULTS: Prevalent presenting signs, symptoms and patient demographic data were established. Furthermore, features of cases associated with adverse outcomes were defined. A key feature of the guideline is defining at-risk patients with initial intensive treatment. Investigations and outcomes are assessed and treatment adjusted appropriately. CONCLUSION: This multi-departmental approach has facilitated the development of a succinct, systematic guideline for the management of necrotising otitis externa. Initial patient outcomes appear promising.

Association Between Endoscopist Annual Procedure Volume and Colonoscopy Quality: Systematic Review and Meta-analysis.

BACKGROUND & AIMS: In addition to monitoring adverse events (AEs) and post-colonoscopy colorectal cancers (PCCRC), indicators for assessing colonoscopy quality include adenoma detection rate (ADR) and cecal intubation rate (CIR). It is unclear whether there is an association between annual colonoscopy volume and ADR, CIR, AEs, or PCCRC. METHODS: We searched publication databases through March 2019 for studies assessing the relationship between annual colonoscopy volume and outcomes, including ADR, CIR, AEs, or PCCRC. Pooled odds ratios (ORs) were calculated using DerSimonian and Laird random effects models. Sensitivity analyses were performed to assess for potential methodological or clinical factors associated with outcomes. RESULTS: We performed a systematic review of 9235 initial citations, generating 27 retained studies comprising 11,276,244 colonoscopies. There was no association between procedural volume and ADR (OR, 1.00; 95% CI, 0.98-1.02 per additional 100 annual procedures). CIR improved with each additional 100 annual procedures (OR, 1.17; 95% CI, 1.08-1.28). There was a non-significant trend toward decreased overall AEs per additional 100 annual procedures (OR, 0.95; 95% CI, 0.90-1.00). There was considerable heterogeneity among most analyses. CONCLUSIONS: In a systematic review and meta-analysis, we found higher annual colonoscopy volumes to correlate with higher CIR, but not with ADR or PCCRC. Trends toward fewer AEs were associated with higher annual colonoscopy volumes. There are few data available from endoscopists who perform fewer than 100 annual colonoscopies. Studies are needed on extremes in performance volumes to more clearly elucidate associations between colonoscopy volumes and outcomes.

Vitamin D supplementation reduces the occurrence of colorectal polyps in high-latitude locations.

There is suggestive evidence for the role of vitamin D in the development of colorectal cancer (CRC). Due to high latitudes in Canada, many Canadians are vitamin D deficient throughout winter. In this analysis, we examined the association between vitamin D supplement use and high-risk adenomatous polyps (HRAPs). The study population was drawn from the biorepository at the Forzani & MacPhail Colon Cancer Screening Centre (CCSC) in Calgary. Individuals enrolled between 2013 and 2016 between the age of 50 and 74 years (n = 1409) were included. When examining the association between any supplemental vitamin D use and HRAPs, a protective effect is observed with an ORadj of 0.57 (95% CI: 0.33-0.96). Similarly, meeting the recommended daily intake (RDI) of vitamin D (600 IU) is protective against HRAPs with an ORadj of 0.78 (95% CI: 0.62-0.99). This study suggests that adequate vitamin D supplementation reduces the occurrence of colorectal polyps in high-latitude locations.

Versatile laser-free trapped-ion entangling gates.

We present a general theory for laser-free entangling gates with trapped-ion hyperfine qubits, using either static or oscillating magnetic-field gradients combined with a pair of uniform microwave fields symmetrically detuned about the qubit frequency. By transforming into a 'bichromatic' interaction picture, we show that either σ ^ ϕ ⊗ σ ^ ϕ or σ ^ z ⊗ σ ^ z geometric phase gates can be performed. The gate basis is determined by selecting the microwave detuning. The driving parameters can be tuned to provide intrinsic dynamical decoupling from qubit frequency fluctuations. The σ ^ z ⊗ σ ^ z gates can be implemented in a novel manner which eases experimental constraints. We present numerical simulations of gate fidelities assuming realistic parameters.

Adapting implementation strategies: a case study of how to support implementation of healthy canteen policies.

OBJECTIVES: Although evidence-based interventions (EBIs) and effective strategies to implement them exist, they cannot be used by policy makers and practitioners if they do not align with end users' needs. As such, adaptations to EBIs and implementation approaches are likely to occur to increase 'fit' with end users' capacity. This article describes an approach undertaken by a population health service delivery unit in one Australian state to develop an adapted implementation strategy to support the implementation of the mandatory healthy canteen policy (EBI) to all schools located in the service delivery region. STUDY DESIGN: This is a case study of adapting an intervention to improve implementation of the healthy canteen policy. METHODS AND RESULTS: This is a six-step pragmatic, empirically driven approach. The steps include (i) adapt, where appropriate, the EBI to facilitate implementation; (ii) identify end users' capacity for implementation; (iii) identify opportunities to adapt the implementation interventions while preserving meaningful intervention impact; (iv) undertake program adaptation; (v) develop training and resources to support delivery of implementation strategies and; (vi) evaluate the adapted intervention. This article describes the application of these steps by the authors to develop an adapted support strategy consistent with end users' needs. CONCLUSIONS: This study provides some guidance on how to adapt implementation support approaches particularly when EBIs cannot be adapted. Future empirical research providing guidance on making practical adaptation decisions are needed.

National Trends in Colorectal Cancer Incidence Among Older and Younger Adults in Canada.

Importance: Recent evidence has shown that although the incidence of colorectal cancer (CRC) is decreasing among older adults, rates have increased in adults younger than 50 years. Given that younger adults are typically classified as at low risk for the disease, this epidemiologic shift is cause for concern. Objective: To analyze Canadian national cancer incidence registries to determine incidence trends for CRC among older and younger adults, updated to 2015. Design, Setting, and Participants: This cohort study determined the incidence of CRC using data from the National Cancer Incidence Reporting System (1969-1992) and the Canadian Cancer Registry (1992-2015). All Canadians diagnosed with CRC from January 1, 1969, through December 31, 2015, were included in this study. Trends among men and women were examined separately and by age category (>50 vs <50 years). Birth cohort models were fit using 5-year groups starting in 1886, with 1936 as the reference cohort. Data were analyzed from May 13, 2018 to May 16, 2018. Main Outcomes and Measures: Annualized percentage changes and incidence rate ratios of CRC. Results: From 1971 to 2015, 688 515 incident cases (52.9% women) of CRC were identified. Although the incidence of CRC has decreased in older men and women, rates among younger men and women have increased since 2006 and 2010, respectively. For women younger than 50 years, incidence has increased with a mean annual percentage change of 4.45% since 2010; for men younger than 50 years, a mean annual percentage change of 3.47% from 2006 through 2015. There was an association between CRC incidence and birth cohort, with more recent cohorts being at greater risk than those born earlier. For men, the risk of colorectal cancer in the youngest cohort is more than double that of the reference (incidence rate ratio, 2.57; 95% CI, 1.32-5.02). Incidence rate ratios were not significant for women (IRR, 2.12; 95% CI, 0.95-4.70) but increased in successively younger cohorts. Conclusions and Relevance: This study found increasing incidence of colorectal cancer diagnoses among Canadian men and women younger than 50 years of age. This increase in incidence among a low-risk population calls for additional research on possible risk factors that may be affecting these younger cohorts. It appears that primary prevention should be the highest priority to reduce the number of younger adults developing CRC in the future.

Trapped-Ion Spin-Motion Coupling with Microwaves and a Near-Motional Oscillating Magnetic Field Gradient.

We present a new method of spin-motion coupling for trapped ions using microwaves and a magnetic field gradient oscillating close to the ions' motional frequency. We demonstrate and characterize this coupling experimentally using a single ion in a surface-electrode trap that incorporates current-carrying electrodes to generate the microwave field and the oscillating magnetic field gradient. Using this method, we perform resolved-sideband cooling of a single motional mode to its ground state.

Opioid-prescribing patterns, storage, handling, and disposal in postoperative pediatric urology patients.

BACKGROUND: Emerging research on surgeons and the opioid epidemic have focused on the adult population. Consequently, little is known regarding opioid-prescribing practices in the pediatric population. The goal of this study is to examine postoperative opioid-prescribing and consumption patterns, as well as storage and disposal trends for specific pediatric urologic procedures. STUDY DESIGN: Patients undergoing surgery associated with specified Current Procedural Terminology codes were retrospectively identified, and details regarding opioid medications were obtained through our pharmacy database. Patients' guardians were contacted two weeks postoperatively to determine opioid usage. Opioids were prescribed at a standard dosing of 0.1 mg/kg per dose or the equivalent. RESULTS: Of the 171 identified patients, 117 patients were successfully contacted, with 67 (39%) completing telephone surveys. The 3 most common pediatric urology procedures were inguinal hernia repair (N = 39), circumcision (N = 27), and cystoscopy (N = 16). Across all procedures, there was an average excess of 9.8 doses prescribed, corresponding to an overprescription rate of 64%. Of the patients prescribed opioids, 41 (62%) had leftover opioid medication two weeks postoperatively. Thirty-two of 41 (78%) patients did not dispose of their leftover medication. Only 13 patients received perioperative counseling on appropriate storage and disposal of opiates. DISCUSSION: Prescribing practices for an array of pediatric urologic procedures are non-standardized and often generously excessive. We show universal overprescribing for all our reviewed urologic procedures. Sixty-two percent of pediatric urology patients did not use their entire prescribed opiate, leaving a significant pool of medicine within the pediatric family home. Given the low incidence of perioperative education, unsurprisingly a majority of our patients improperly handled and disposed off excess opioid medication. CONCLUSION: There is general overprescription of postoperative opioids and poor perioperative opioid education in the pediatric urology population.

Comparative Study of the Colonization of Chromolaena and Tobacco Plants by Bacteria safensis CS4 using Different Methods of Inoculation.

BACKGROUND AND OBJECTIVES: This study entails the effectiveness of colonization of bacterial endophytes following inoculation of the cells in plants. METHODOLOGY: Different methods of inoculation including seed immersion, root immersion and foliar spray were studied on Chromolaena odorata and Nicotiana tabacum for 10, 20 and 30 days. This was to ascertain the colonization ability of the endophytic strain amongst the two set of plants. The foliar parts of the plants were assessed post inoculation for the presence of the bacteria strain, followed by the growth parameters in the plant. Significant differences at p<0.05 of colonization were established by the different inoculation methods. RESULTS: Foliar spray demonstrated the highest colonization in both Chromolaena and tobacco plants followed by root immersion. Leaf inoculation in tobacco plant demonstrated a positive colonization which is not significant. However, seed inoculation provided colonization in Chromolaena plant at 10, 20 and 30 days post inoculation at a frequency lower than that of tobacco. With root immersion in Chromolaena, there was colonization at 10 days post inoculation, no colonization at 20 days post inoculation, but colonization re-appeared at 30 days (PI). Growth index measured demonstrated a positive relationship between the inoculation of the endophyte and the growth parameters which included stem length and germination rate. CONCLUSION: This study, therefore, showed that the bacteria strain B. safensis CS4 can effectively be horizontally transferred into tobacco and Chromolaena plants using different methods. Foliar spraying demonstrated the optimal colonization of the strain in the plant leaves.

Improving surgical training by identifying the most common feedback trainees receive for index cases.

BACKGROUND: To make surgical training more effective, a proven method is needed to provide feedback to residents on their surgeries. Residency programs may make up for limited training time in the operating room by improving feedback that trainees receive about cases. OBJECTIVE: The goals of this study were (1) to determine if an online tool to communicate feedback for attendings and trainees shows face validity and (2) to use an online tool to identify the most common feedback trainees receive after performing orchiopexy and hypospadias repair by survey. METHODS: In 2016, determining whether an online tool to provide pediatric urology trainees feedback after surgery shows face validity begun. The tool was launched at the authors' institutions. Then, attendings, fellows, and postgraduate year 4-5 trainees of 65 resident training programs were surveyed for their observations on preparing for and performing orchiopexy and hypospadias repair using the study tool to identify common feedback. RESULTS: The results of using the tool to provide feedback shows face validity are as follows: feedback was exchanged between attendings and trainees on orchiopexy (n = 28) and hypospadias (n = 22). Anecdotally, the tool was easy to use. The results of using the tool to identify the most common feedback trainees receive by survey are as follows: from a pool of 65 institutions, 37 attendings and 28 trainees were enrolled who made 219 observations. Most trainees prepare using undocumented online resources (17/28, 67%) instead of speaking with their attendings or cotrainees (11/28, 33%). For orchiopexy, most respondents reported that trainees need to improve skills for hernia ligation (observations: attending = 28/45, 62%; and trainee = 17/26, 65%) and strategies for hernia exposure (observations: attending = 17/27, 62%; and trainee = 7/12, 58%). For hypospadias, most respondents reported that trainees need to improve skills for neourethroplasty (observations: attending = 31/53, 58%; and trainee = 10/16, 62%) and strategies for repair choice (observations: attending = 15/22, 68%; and trainee = 12/18, 67%) (chi-squared, all P = NS). DISCUSSION: It was shown that both trainees and attendings agree on the areas of surgical strategy and execution which require improvement. With this study, it is also shown that the online feedback tool developed shows face validity in allowing attendings and trainees to communicate before and after surgery. CONCLUSIONS: The most common feedback pediatric urology trainees receive for routine pediatric urology surgery is identified. Online tools that emphasize remediations to address a trainee's specific feedback needs are to be built, so that they will be able to improve their skills at their next case.