Post-craniotomy coronal suture diastases in a transformed lower grade glioma.

Cranial suture diastases are an uncommon clinical entity, with post craniotomy diastases being a previously undescribed finding in literature to our best knowledge. Herein, we report a case of a 28-year-old adult who underwent a second-stage low-grade glioma surgery 7 months after initial surgery. This study presents coronal suture diastases adjacent to the previously performed craniotomy. After literature and pathophysiology review, we found it to be unique and that the craniotomy can resemble the mechanical stress of trauma.

Pandemic lifeworlds: A segmentation analysis of public responsiveness to official communication about Covid-19 in England.

Pandemics such as Covid-19 pose tremendous public health communication challenges in promoting protective behaviours, vaccination, and educating the public about risks. Segmenting audiences based on attitudes and behaviours is a means to increase the precision and potential effectiveness of such communication. The present study reports on such an audience segmentation effort for the population of England, sponsored by the United Kingdom Health Security Agency (UKHSA) and involving a collaboration of market research and academic experts. A cross-sectional online survey was conducted between 4 and 24 January 2022 with 5525 respondents (5178 used in our analyses) in England using market research opt-in panel. An additional 105 telephone interviews were conducted to sample persons without online or smartphone access. Respondents were quota sampled to be demographically representative. The primary analytic technique was k means cluster analysis, supplemented with other techniques including multi-dimensional scaling and use of respondent - as well as sample-standardized data when necessary to address differences in response set for some groups of respondents. Identified segments were profiled against demographic, behavioural self-report, attitudinal, and communication channel variables, with differences by segment tested for statistical significance. Seven segments were identified, including distinctly different groups of persons who tended toward a high level of compliance and several that were relatively low in compliance. The segments were characterized by distinctive patterns of demographics, attitudes, behaviours, trust in information sources, and communication channels preferred. Segments were further validated by comparing the segmentation variable versus a set of demographic variables as predictors of reported protective behaviours in the past two weeks and of vaccine refusal; the demographics together had about one-quarter the effect size of the single seven-level segment variable. With respect to managerial implications, different communication strategies for each segment are suggested for each segment, illustrating advantages of rich segmentation descriptions for understanding public health communication audiences. Strengths and weaknesses of the methods used are discussed, to help guide future efforts.

C5aR2 Regulates STING-Mediated Interferon Beta Production in Human Macrophages.

The complement system mediates diverse regulatory immunological functions. C5aR2, an enigmatic receptor for anaphylatoxin C5a, has been shown to modulate PRR-dependent pro-inflammatory cytokine secretion in human macrophages. However, the specific downstream targets and underlying molecular mechanisms are less clear. In this study, CRISPR-Cas9 was used to generate macrophage models lacking C5aR2, which were used to probe the role of C5aR2 in the context of PRR stimulation. cGAS and STING-induced IFN-ß secretion was significantly increased in C5aR2 KO THP-1 cells and C5aR2-edited primary human monocyte-derived macrophages, and STING and IRF3 expression were increased, albeit not significantly, in C5aR2 KO cell lines implicating C5aR2 as a regulator of the IFN-ß response to cGAS-STING pathway activation. Transcriptomic analysis by RNAseq revealed that nucleic acid sensing and antiviral signalling pathways were significantly up-regulated in C5aR2 KO THP-1 cells. Altogether, these data suggest a link between C5aR2 and nucleic acid sensing in human macrophages. With further characterisation, this relationship may yield therapeutic options in interferon-related pathologies.

Spectral analysis of amplitude and phase echoes in picosecond ultrasonics for strain pulse shape determination.

We introduce a spectral analysis method in picosecond ultrasonics to derive strain pulse shapes in a opaque sample with known optical properties. The method makes use of both the amplitude and phase of optical transient relative reflectance changes obtained, for example, by interferometry. We demonstrate this method through numerical simulation and by analysis of experimental results for a chromium film.

Tomographic reconstruction of picosecond acoustic strain pulses using automated angle-scan probing with visible light.

By means of an ultrafast optical technique, picosecond acoustic strain pulses in a transparent medium are tomographically visualized at GHz frequencies. The strain distribution in BK7 glass is reconstructed from time-domain reflectivity changes of 415-nm probe light as a function of the optical incidence angle with 1 ps temporal and 120 nm spatial resolutions, enabled by automated angle scanning. The latter resolution is achieved owing to the commensurate acoustic wavelength. Applications include imaging strain, carrier and temperature distributions on ultrashort timescales.

Transitional Care Interventions From Hospital to Community to Reduce Health Care Use and Improve Patient Outcomes: A Systematic Review and Network Meta-Analysis.

Importance: Discharge from the hospital to the community has been associated with serious patient risks and excess service costs. Objective: To evaluate the comparative effectiveness associated with transitional care interventions with different complexity levels at improving health care utilization and patient outcomes in the transition from the hospital to the community. Data Sources: CENTRAL, Embase, MEDLINE, and PsycINFO were searched from inception until August 2022. Study Selection: Randomized clinical trials evaluating transitional care interventions from hospitals to the community were identified. Data Extraction and Synthesis: At least 2 reviewers were involved in all data screening and extraction. Random-effects network meta-analyses and meta-regressions were applied. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines were followed. Main Outcomes and Measures: The primary outcomes were readmission at 30, 90, and 180 days after discharge. Secondary outcomes included emergency department visits, mortality, quality of life, patient satisfaction, medication adherence, length of stay, primary care and outpatient visits, and intervention uptake. Results: Overall, 126 trials with 97 408 participants were included, 86 (68%) of which were of low risk of bias. Low-complexity interventions were associated with the most efficacy for reducing hospital readmissions at 30 days (odds ratio [OR], 0.78; 95% CI, 0.66 to 0.92) and 180 days (OR, 0.45; 95% CI, 0.30 to 0.66) and emergency department visits (OR, 0.68; 95% CI, 0.48 to 0.96). Medium-complexity interventions were associated with the most efficacy at reducing hospital readmissions at 90 days (OR, 0.64; 95% CI, 0.45 to 0.92), reducing adverse events (OR, 0.42; 95% CI, 0.24 to 0.75), and improving medication adherence (standardized mean difference [SMD], 0.49; 95% CI, 0.30 to 0.67) but were associated with less efficacy than low-complexity interventions for reducing readmissions at 30 and 180 days. High-complexity interventions were most effective for reducing length of hospital stay (SMD, -0.20; 95% CI, -0.38 to -0.03) and increasing patient satisfaction (SMD, 0.52; 95% CI, 0.22 to 0.82) but were least effective for reducing readmissions at all time periods. None of the interventions were associated with improved uptake, quality of life (general, mental, or physical), or primary care and outpatient visits. Conclusions and Relevance: These findings suggest that low- and medium-complexity transitional care interventions were associated with reducing health care utilization for patients transitioning from hospitals to the community. Comprehensive and consistent outcome measures are needed to capture the patient benefits of transitional care interventions.

Feasibility of comparing medical management and surgery (with neurosurgery or stereotactic radiosurgery) with medical management alone in people with symptomatic brain cavernoma - protocol for the Cavernomas: A Randomised Effectiveness (CARE) pilot trial.

INTRODUCTION: The top research priority for cavernoma, identified by a James Lind Alliance Priority setting partnership was 'Does treatment (with neurosurgery or stereotactic radiosurgery) or no treatment improve outcome for people diagnosed with a cavernoma?' This pilot randomised controlled trial (RCT) aims to determine the feasibility of answering this question in a main phase RCT. METHODS AND ANALYSIS: We will perform a pilot phase, parallel group, pragmatic RCT involving approximately 60 children or adults with mental capacity, resident in the UK or Ireland, with an unresected symptomatic brain cavernoma. Participants will be randomised by web-based randomisation 1:1 to treatment with medical management and with surgery (neurosurgery or stereotactic radiosurgery) versus medical management alone, stratified by prerandomisation preference for type of surgery. In addition to 13 feasibility outcomes, the primary clinical outcome is symptomatic intracranial haemorrhage or new persistent/progressive focal neurological deficit measured at 6 monthly intervals. An integrated QuinteT Recruitment Intervention (QRI) evaluates screening logs, audio recordings of recruitment discussions, and interviews with recruiters and patients/parents/carers to identify and address barriers to participation. A Patient Advisory Group has codesigned the study and will oversee its progress. ETHICS AND DISSEMINATION: This study was approved by the Yorkshire and The Humber-Leeds East Research Ethics Committee (21/YH/0046). We will submit manuscripts to peer-reviewed journals, describing the findings of the QRI and the Cavernomas: A Randomised Evaluation (CARE) pilot trial. We will present at national specialty meetings. We will disseminate a plain English summary of the findings of the CARE pilot trial to participants and public audiences with input from, and acknowledgement of, the Patient Advisory Group. TRIAL REGISTRATION NUMBER: ISRCTN41647111.

Time-domain Brillouin imaging of sound velocity and refractive index using automated angle scanning.

We present a picosecond optoacoustic technique for mapping both the longitudinal sound velocity v and the refractive index n in solids by automated measurement at multiple probe incidence angles in time-domain Brillouin scattering. Using a fused silica sample with a deposited titanium film as an optoacoustic transducer, we map v and n in the depth direction. Applications include the imaging of sound velocity and refractive index distributions in three dimensions in inhomogeneous samples such as biological cells.

Refraction, beam splitting and dispersion of GHz surface acoustic waves by a phononic crystal.

We exploit a time-resolved ultrafast optical technique to study the propagation of point-excited surface acoustic waves on a microscopic two-dimensional phononic crystal in the form of a square lattice of holes in a silicon substrate. Constant-frequency images and the dispersion relation are extracted, and the latter measured in detail in the region around the phononic band gap. Mode conversion and refraction at the interface between the phononic crystal and surrounding non-structured silicon substrate is studied at constant frequencies. Symmetric phonon beam splitting, for example, is shown to lead to a striking Maltese-cross pattern when phonons exit a square region of phononic crystal excited near its center.

Sound velocity mapping from GHz Brillouin oscillations in transparent materials by optical incidence from the side of the sample.

Time-domain Brillouin scattering (TDBS) is an all-optical experimental technique for investigating transparent materials based on laser picosecond ultrasonics. Its application ranges from imaging thin-films, polycrystalline materials and biological cells to physical properties such as residual stress, temperature gradients and nonlinear coherent nano-acoustic pulses. When the sample refractive index is spatially uniform and known in TDBS, analysis by windowed Fourier transforms allows one to depth-profile the sound velocity. Here, we present a new method in TDBS for extracting sound velocity without a knowledge of the refractive index, by use of probe light obliquely incident on a side face-as opposed to the usual top face-of the sample. We demonstrate this method using a fused silica sample with a titanium transducer film and map the sound velocity in the depth direction. In future, it should be possible to map the sound velocity distribution in three dimensions in inhomogeneous samples, with applications to the imaging of biological cells.

Magnetic resonance imaging has a limited role in investigating odynophagia if examination is normal: A binary logistic regression analysis of 484 patients presenting to a tertiary head and neck clinic.

INTRODUCTION: Investigation of head and neck cancers places a significant burden on the National Health Service and effective resource allocation is of perpetual importance. Existing risk calculators are designed to stratify the likelihood of underlying malignancy according to symptoms, but are less relevant in secondary care as they do not integrate clinical examination findings (e.g. naso-endoscopy). We looked to evaluate the utility of magnetic resonance imaging (MRI) in investigating patients with unilateral odynophagia and a normal clinical examination. METHODS: A retrospective analysis was conducted over a 54-month period; 484 consecutively-recruited adult patients who underwent MRI of the neck for suspected malignancy were included. Imaging reports, case notes, and histopathology results were reviewed. Patients with previously diagnosed/treated malignancy, undergoing surveillance, or those with pathology of the salivary glands, oral cavity or thyroid gland, were excluded. A multivariate binary logistical regression model was performed to calculate the odds ratios and probabilities of malignancy for each presenting symptom, with and without negative nasoendoscopy findings. RESULTS: The overall incidence of malignancy within the cohort was 173/484 patients (35.7%; 95% CI 31.5%-40.2%) with no cases of malignancy in patients presenting with odynophagia and a normal nasoendoscopy (0/39). The presence of a neck lump was significantly associated with malignancy, (odds ratio [OR] 2.03, p = .001; 95% CI 1.59-2.58), as was dysphagia (OR 1.52, p = .009; 95% CI 1.11-2.11). Conversely, globus was found to have an inverse association (OR 0.41, p < .001; 95% CI 0.24-0.70). SUMMARY: New patients presenting with odynophagia alone and normal endoscopy or globus have a low likelihood of underlying malignancy, justifying reassurance and follow-up in the event of persistent symptoms. Contrariwise, patients with a neck lump, dysphagia, odynophagia and multiple concurrent aerodigestive tract symptoms, or an abnormal endoscopy have a high likelihood of underlying malignancy and should be investigated accordingly.

On a kinetic opinion formation model for pre-election polling.

Motivated by recent successes in model-based pre-election polling, we propose a kinetic model for opinion formation which includes voter demographics and socio-economic factors like age, sex, ethnicity, education level, income and other measurable factors like behaviour in previous elections or referenda as a key driver in the opinion formation dynamics. The model is based on Toscani's kinetic opinion formation model (Toscani G. 2006 Kinetic models of opinion formation. Commun. Math. Sci. 4, 481-496.) and the leader-follower model of Düring et al. (Düring B. et al. 2009 Boltzmann and Fokker-Planck equations modelling opinion formation in the presence of strong leaders. Proc. R. Soc. A 465, 3687-3708.), and leads to a system of coupled Boltzmann-type equations and associated, approximate Fokker-Planck-type systems. Numerical examples using data from general elections in the UK show the effect different demographics have on the opinion formation process and the outcome of elections. This article is part of the theme issue 'Kinetic exchange models of societies and economies'.

Beyond the control of the care home: A meta-ethnography of qualitative studies of Infection Prevention and Control in residential and nursing homes for older people.

OBJECTIVE: This study aimed to develop interpretive insights concerning Infection Prevention and Control (IPC) in care homes for older people. DESIGN: This study had a meta-ethnography design. DATA SOURCES: Six bibliographic databases were searched from inception to May 2020 to identify the relevant literature. REVIEW METHODS: A meta-ethnography was performed. RESULTS: Searches yielded 652 records; 15 were included. Findings were categorized into groups: The difficulties of enacting IPC measures in the care home environment; workload as an impediment to IPC practice; the tension between IPC and quality of life for care home residents; and problems dealing with medical services located outside the facility including diagnostics, general practice and pharmacy. Infection was revealed as something seen to lie 'outside' the control of the care home, whether according to origins or control measures. This could help explain the reported variability in IPC practice. Facilitators to IPC uptake involved repetitive training and professional development, although such opportunities can be constrained by the ways in which services are organized and delivered. CONCLUSIONS: Significant challenges were revealed in implementing IPC in care homes including staffing skills, education, workloads and work routines. These challenges cannot be properly addressed without resolving the tension between the objectives of maintaining resident quality of life while enacting IPC practice. Repetitive staff training and professional development with parallel organisational improvements have prospects to enhance IPC uptake in residential and nursing homes. PATIENT OR PUBLIC CONTRIBUTION: A carer of an older person joined study team meetings and was involved in writing a lay summary of the study findings.

Developing Best Practice Guidance for Discharge Planning Using the RAND/UCLA Appropriateness Method.

Background: Discharge from acute mental health inpatient units is often a vulnerable period for patients. Multiple professionals and agencies are involved and processes and procedures are not standardized, often resulting in communication delays and co-ordination failures. Early and appropriate discharge planning and standardization of procedures could make inpatient care safer. Aim: To inform the development of a multi-component best practice guidance for discharge planning (including the 6 component SAFER patient flow bundle) to support safer patient transition from mental health hospitals to the community. Methods: Using the RAND/UCLA Appropriateness method, a panel of 10 professional stakeholders (psychiatrists, psychiatric nurses, clinical psychologists, pharmacists, academics, and policy makers) rated evidence-based statements. Six hundred and sixty-eight statements corresponding to 10 potential components of discharge planning best practice were rated on a 9-point integer scale for clarity, appropriateness and feasibility (median ≥ 7-9) using an online questionnaire then remote online face-to-face meetings. Results: Five of the six "SAFER" patient flow bundle components were appropriate and feasible for inpatient mental health. One component, "Early Flow," was rated inappropriate as mental health settings require more flexibility. Overall, 285 statements were rated as appropriate and feasible. Forty-four statements were considered appropriate but not feasible to implement. Discussion: This consensus study has identified components of a best practice guidance/intervention for discharge planning for UK mental health settings. Although some components describe processes that already happen in everyday clinical interactions (i.e., review by a senior clinician), standardizing such processes could have important safety benefits alongside a tailored and timely approach to post-discharge care.

Gigahertz Optomechanical Photon-Phonon Transduction between Nanostructure Lines.

High-frequency surface phonons have a myriad of applications in telecommunications and sensing, but their generation and detection have often been limited to transducers occupying micron-scale regions because of the use of two-dimensional transducer arrays. Here, by means of transient reflection spectroscopy we experimentally demonstrate optically coupled nanolocalized gigahertz surface phonon transduction based on a gold nanowire emitter arranged parallel to linear gold nanorod receiver arrays, that is, quasi-one-dimensional emitter-receivers. We investigate the response up to 10 GHz of these individual optoacoustic and acousto-optic transducers, respectively, by exploiting plasmon-polariton longitudinal resonances of the nanorods. We also demonstrate how the surface phonon detection efficiency is highly dependent on the nanorod orientation with respect to the phonon wave vector, which constrains the symmetry of the detectable modes, and on the nanorod acoustic resonance spectrum. Applications include nanosensing.

Ultra-processed foods and binge eating: A retrospective observational study.

OBJECTIVES: There is increasing evidence of the impact of ultra-processed foods on multiple metabolic and neurobiological pathways, including those involved in eating behaviors, both in animals and in humans. In this study we aimed to explore ultra-processed foods and their link with disordered eating in a clinical sample. METHODS: This was a single site, retrospective observational study in a specialist eating disorder service using self-report on the electronic health records. Patients with a Diagnostic and Statistical Manual of Mental Disorders (fifth edition) diagnosis of anorexia nervosa (AN), bulimia nervosa (BN), or binge eating disorder (BED) were randomly selected from the service database in Oxford from 2017 to 2019. The recently introduced NOVA classification was used to determine the degree of industrial food processing in each patient's diet. Frequencies of ultra-processed foods were analyzed for each diagnosis at each mealtime and during episodes of binging. RESULTS: A total of 70 female and 3 male patients were included in the study; 22 had AN, 25 BN, and 26 BED. Patients with AN reported consuming 55% NOVA-4 foods, as opposed to approximately 70% in BN and BED patients. Foods that were consumed in a binge pattern were 100% ultra-processed. CONCLUSION: Further research into the metabolic and neurobiological effects of ultra-processed food intake on disordered eating, particularly on binging, is needed.

Facial trauma aggravating paediatric orbital cellulitis.

We describe a case of paediatric orbital cellulitis with subperiosteal abscess following blunt facial trauma. Clinical features of orbital cellulitis developed on day 1 post-trauma. A subperiosteal collection subsequently formed lateral to the globe, causing significant ocular compromise. Surgical drainage and sinus washout were performed via external incisions, with satisfactory outcome. This case highlights how trauma may represent a non-sinogenic aggravating factor in orbital cellulitis. We describe how a subperiosteal abscess may vary depending on its aetiology, and how the surgical approach can be modified to locate and drain a laterally sited subperiosteal abscess.

A multicentre prospective audit of bedside hydration in hospital.

INTRODUCTION: access to water at the bedside is a cornerstone of patient care. Among bedbound inpatients, water within reach at the bedside is a basic human dignity and one that ought not to be neglected. AIM: the authors sought to identify the extent to which accessible hydration facilities were provided to a bedbound inpatient population. METHODS: a cross-sectional, point-prevalent audit of hospitalised medical inpatients across five centres was conducted. Data were collected between meal times and noted baseline demographics and admission details, adequacy of oral hydration provision at the bedside and, where provision was inadequate, factors associated with this. RESULTS: across a total surveyed patient population of 559 we identified 138 patients who were bedbound. Among these bedbound patients, 6% (n=8) had no water provided at the bedside. However, 7 of these were deemed to be unable to swallow safely. In total, 44 (32%) of the 138 bedbound patients were unable to reach the water at their bedside; 18 of these patients would have been able to drink for themselves had the water been in reach. CONCLUSION: there is significant room for improvement in ensuring patients who are immobile are able to reach drinking apparatus at the bedside. In the five centres surveyed, approximately one in five bedbound patients with no contraindication are unable to reach an essential means of hydration.

Case Report: Colorectal cancer metastasis to a cervical lymph node - an unusual source of a neck lump.

Colorectal cancer (CRC) is the third most common cancer worldwide, and approximately 25% of patients already have metastases at the time of diagnosis. The most common metastatic sites for CRCs are the liver, lung, bone and brain and peritoneum. Cervical lymph node metastases in CRC are rare, particularly in the absence solid organ involvement. Here we present a case of a 73-year-old female patient who, following resection of a poorly differentiated caecal adenocarcinoma, re-presented four years later with a left level IV lymph node which was ultimately found to contain metastatic adenocarcinoma.