The SAEORA Flap for Prosthetic Breast Reconstruction: A Novel Flap Design without the Use of Acellular Dermal Matrices.

Background: The gold standard for implant-based breast reconstruction uses acellular dermal matrices (ADMs). They provide improved inferolateral pole coverage, reduced capsular contracture rates, and increased primary expander fill volumes. However, ADMs are costly and have been associated with increased rates of postoperative infection, seroma, hematoma, implant malposition, and mastectomy flap necrosis (MFN). This study describes a novel autologous flap without the need of ADM, the serratus anterior external oblique rectus abdominis (SAEORA) flap, as an alternative in prosthetic-based breast reconstruction. Methods: A retrospective study was conducted on all patients who underwent SAEORA flap breast reconstruction by a single surgeon between January 1, 2013 and May 31, 2020 at a single institution. Patient demographics, diagnosis, treatment, tissue expander (TE) volume, implant size, complications, and results were assessed. Results: Forty-seven patients underwent 78 SAEORA flaps. Sixty-two had TEs placed, and 14 were direct-to-implant. Mean body mass index was 23.1 kg per m². Median primary TE fill volume was 150 mL, and final implant volume average was 450 mL. Mean follow-up was 14.5 months. Complications included infection/cellulitis (7.9%), seroma (6.6%), hematoma (5.2%), and MFN (7.9%). Conclusions: The SAEORA flap is a novel autologous flap and is a viable option for prosthetic-based breast reconstruction, with an acceptable complication profile relative to ADM-based reconstructions. Additionally, SAEORA is MFN-resistant and has been used effectively in salvage of exposed implants or ADM, and in double-bubble deformity correction.

Predicting whaler shark presence and interactions with humans in southern Queensland, Australia.

The Queensland Shark Control Program (QSCP) started in 1962 to reduce the number of shark-human incidents by deploying nets and drumlines across the most popular beaches. The program targets large shark species (white, tiger and bull sharks) that are potentially hazardous to bathers. However, this strategy is lethal for other sharks and marine wildlife, including threatened and endangered species. Thus, finding non-lethal strategies is a priority. To better manage shark-human interactions, establishing a better understanding of the factors that drive shark movement is key. Here we used sea surface temperature (SST), rainfall and distance to rivers as environmental variables to predict the presence of whaler sharks in southern Queensland based on 26 years of catch data from the QSCP. We found that SST is positively corelated to sharks caught by drumlines, while rainfall was associated with the number of sharks captured in shark nets. In addition, more sharks were captured by nets and drumlines further away from rivers, and nets captured roughly 10 times more sharks than drumlines over the period of study. In contrast to tiger sharks, the catch data indicate the number of whalers has not declined over the past 26 years. Our findings suggest that environmental variables can be used to predict the movement of large sharks and by incorporating this knowledge into management plans and public education programs, may ultimately reduce shark-human incidents.

Intensive Blood Pressure Management Preserves Functional Connectivity in Patients with Hypertension from the Systolic Blood Pressure Intervention Randomized Trial.

BACKGROUND AND PURPOSE: The Systolic Blood Pressure Intervention (SPRINT) randomized trial demonstrated that intensive blood pressure management resulted in slower progression of cerebral white matter hyperintensities, compared with standard therapy. We assessed longitudinal changes in brain functional connectivity to determine whether intensive treatment results in less decline in functional connectivity and how changes in brain functional connectivity relate to changes in brain structure. MATERIALS AND METHODS: Five hundred forty-eight participants completed longitudinal brain MR imaging, including resting-state fMRI, during a median follow-up of 3.84 years. Functional brain networks were identified using independent component analysis, and a mean connectivity score was calculated for each network. Longitudinal changes in mean connectivity score were compared between treatment groups using a 2-sample t test, followed by a voxelwise t test. In the full cohort, adjusted linear regression analysis was performed between changes in the mean connectivity score and changes in structural MR imaging metrics. RESULTS: Four hundred six participants had longitudinal imaging that passed quality control. The auditory-salience-language network demonstrated a significantly larger decline in the mean connectivity score in the standard treatment group relative to the intensive treatment group (P = .014), with regions of significant difference between treatment groups in the cingulate and right temporal/insular regions. There was no treatment group difference in other networks. Longitudinal changes in mean connectivity score of the default mode network but not the auditory-salience-language network demonstrated a significant correlation with longitudinal changes in white matter hyperintensities (P = .013). CONCLUSIONS: Intensive treatment was associated with preservation of functional connectivity of the auditory-salience-language network, while mean network connectivity in other networks was not significantly different between intensive and standard therapy. A longitudinal increase in the white matter hyperintensity burden is associated with a decline in mean connectivity of the default mode network.

How reconfiguration of a minor injuries unit has affected service delivery during the COVID-19 pandemic: a retrospective analysis.

INTRODUCTION: Redeployment of orthopaedic consultants to a minor injuries unit (MIU) during the COVID-19 pandemic provided a unique opportunity to assess the impact of early senior specialist input on patient management. METHODS: Patient demographics, diagnosis, location of injury and disposal method were compared between three 7-day periods: during the April 2020 COVID-19 lockdown (period A), one month prior to period A (period B) and one year prior to period A (period C). Orthopaedic consultants staffed the MIU during period A, and emergency nurse practitioners staffed the MIU during periods B and C. RESULTS: Period A witnessed higher injury severity either due to modified activities or altered healthcare-seeking behaviour during lockdown. For fractures, compared with periods B and C, period A saw a lower rate of referral to fracture clinic (41% vs 100% vs 86%, p<0.001) and higher rate of discharge (38% vs 0% vs 9%, p<0.001). The median time to fracture clinic was also longer (15 days vs 6 days vs 10 days, p<0.001), indicating earlier institution of definitive care. There were no other significant differences between periods with radiology alerts and complaints received remaining largely unchanged. CONCLUSION: Early senior orthopaedic input in the patient journey from MIU had clear benefits, this being most true for fracture diagnoses. Earlier definitive management planning was observed as lower rates of fracture clinic referral, higher rates of discharge and deferred first fracture clinic reviews. This study highlights the benefits of greater partnership between MIU and orthopaedics. As the pandemic subsides and redeployed staff return to normal duties, a modification of this model could be utilised to ensure this partnership is sustainable.

Communicating with health providers and romantic partners: The impact of negative emotions on quality of life for individuals with hidradenitis suppurativa.

Hidradenitis suppurativa (HS) is a chronic, inflammatory, debilitating skin disease that impacts an estimated 1 to 4% of the population; women are twice as likely to be diagnosed as men. There is no cure for HS, and many patients face a lifetime of various healthcare appointments, medical interventions, and personal experiences living with the disease. Objective: This study aimed to explore social, emotional, and medical experiences for individuals with HS, and to understand connections between those experiences and quality of life. Methods: Participants (n = 243) in the community-based convenience sample completed a cross-sectional survey about their experiences and quality of life and reported high rates of anxiety, embarrassment, and depressed mood. These and other negative emotions were commonly experienced during interactions with healthcare providers and romantic partners. Results: Participants who had more negative interactions with providers and partners surrounding their HS tended to experience a lower quality of life. Limitations: Limited generalizability due to convenience sampling. Conclusion: Providers should consider how patients experience patient -provider communication about HS, and how this communication impacts other areas of patients' lives, including quality of life, mental health, and romantic relationships. Future care approaches should prioritize mental health strategies in HS patients' care plans, and establish partnerships between dermatology practices and mental health professionals to aid in the multidisciplinary approach recommended for the treatment of HS.

Off-critical wetting layer divergence at the liquid/vapor interface of binary liquid mixtures.

Surface wetting phenomena impact chemistry, physics, biology, and engineering. The wetting behaviors of partially miscible binary liquid systems are especially complex. Here, we report evidence of universal behavior in the divergence of wetting layer growth at liquid-vapor interfaces of the cyclohexane + aniline, hexane + o-toluidine, and methanol + carbon disulfide systems. Layer growth on the micron scale was followed using visible light scattering from stirred samples. The layer thicknesses were found to diverge with decreasing temperature when coexistence was approached from the one-phase region, but only for solutions richer in the higher density/higher surface tension component. The onset of divergence was <1 K above the bulk coexistence temperature; nearer the critical composition, the onset temperature was the critical temperature itself. All three systems showed identical divergent wetting properties after variable normalization. In contrast, no divergent wetting layer formation was seen in the benzene + 1,2-propanediol or water + phenol systems. The mathematical sign of the Hamaker constant correlates with the contrasting behaviors. Collectively, these results have implications for theoretical descriptions of adsorption layer growth and crossover behavior, for measurements of complete wetting temperatures, and for practical applications.

Association of pre-treatment somatic cell counts with bacteriological cure following diagnosis of intramammary infection.

Antibiotic administration is crucial to ensure the health and productivity of dairy cattle. Mastitis is a disease that is typically a result of an intramammary infection (IMI), and antibiotic regimens are implemented to aid in curing IMI. Diagnosis is usually by detection of elevated milk somatic cell counts (SCC) and/or presence of culturable pathogens in the milk. Antibiotic treatment success is associated with the SCC at the time of treatment, though this correlation is still poorly understood. The objective of this project was to evaluate pre-treatment SCC and its association with IMI cure incidence following a standard antibiotic treatment. We hypothesized that pre-treatment SCC would be significantly lower in cases where the IMI ultimately cured compared to cases where the IMI failed to cure. Milk samples were collected aseptically from lactating cow quarters experiencing clinical or subclinical mastitis (n = 52). Clinical mastitis was diagnosed by a trained milking technician and subclinical mastitis was diagnosed at the quarter level as a SCC > 200,000 cells/mL and presence of bacterical growth in milk at time of treatment. After collection of the day 0 (D0) milk samples, the SCC was enumerated, and the milk sample cultured. Intramammary antibiotic therapy Cetftiofur hydrochloride (Spectramast® LC) was administered once/day for 5 days. Post-treatment samples were collected 14 d (D14) and 28 d (D28) later. A bacteriological cure was confirmed when both the D14 and D28 samples were free of culturable pathogens. The overall cure rate was 46.2%. Interestingly, the cure rates of antibiotic therapy decreased as pre-treatment SCC increased. Quarters that experienced bacteriological cure demonstrated a lower pre-treatment SCC (507,041 cells/mL ± 127.86 SEM, P = 0.01) compared to cows that did not cure, which had high pre-treatment SCC (1,640,392 cells/mL ± 333.28 SEM). Quarters that failed to cure had higher SCC values 28 days post-treatment in comparison to quarters that cured (P < 0.001). Future studies should investigate whether we can develop unique SCC-dependent mastitis treatment protocols which increase mastitis cure rates and enhance overall mammary health.

Improving parlor efficiency in block calving pasture-based dairy systems through the application of a fixed milking time determined by daily milk yield and milking frequency.

Adjusting end-of-milking criteria, in particular applying a maximum milking time determined by expected milk yield at an individual milking session, is one strategy to optimize parlor efficiency. However, this strategy can be difficult to apply practically on farm due to large differences in session milk yield, driven by milking interval, which affects milking routines and can be limited by in-parlor technology. The objective of this study was to test the hypothesis that a single fixed milking time (duration) could be applied at all milking sessions without compromising milk production or udder health for a range of milking intervals. To test the hypothesis, 4 experimental herds were established: (1) herd milked twice a day (TAD) using a 10- and 14-h interval, (2) herd milked TAD using an 8- and 16-h interval, (3) herd milked 3 times in 2 d using a 10-19-19-h interval, and (4) herd milked once a day (OAD). Herds consisted of 40 cows each, and were established for two 6-wk experimental periods, one in peak lactation and the other in mid-late lactation. Within each herd, half the cows had an end-of-milking criterion of 0.35 kg/min (Flow), and the other half had milking ended after a fixed period of time (FixedT) based on the average milking session yield, the daily milk yield divided by average number of milkings per day, irrespective of milking interval. We found no differences in daily milk yield between end-of-milking criteria due to residual milk from one milking likely increasing the proportion of milk in the udder cistern at the next milking session for the FixedT treatment. However, fat yield was compromised when the percentage of the herd with a truncated milking exceeded an estimated 33% at a milking session, which occurred in the TAD 8-16 herd due to the divergence from the average milking interval (in the case of TAD, 12-12 h). Applying a fixed milking time had no detrimental effects on udder health, except in the OAD herd in mid-late lactation, which had both a higher cell count and new intramammary infection rate. This warrants further investigation, although the majority of cultured bacteria were coagulase-negative staphylococci (CNS). Consequently, we conclude that, in general, with appropriate monitoring (e.g., weekly inspection) to ensure the proportion of the herd with truncated milkings does not exceed 33%, farmers in pasture-based dairy systems can use a fixed milking time to improve parlor efficiency.

Comparison of actionable events detected in cancer genomes by whole-genome sequencing, in silico whole-exome and mutation panels.

BACKGROUND: Next-generation sequencing is used in cancer research to identify somatic and germline mutations, which can predict sensitivity or resistance to therapies, and may be a useful tool to reveal drug repurposing opportunities between tumour types. Multigene panels are used in clinical practice for detecting targetable mutations. However, the value of clinical whole-exome sequencing (WES) and whole-genome sequencing (WGS) for cancer care is less defined, specifically as the majority of variants found using these technologies are of uncertain significance. PATIENTS AND METHODS: We used the Cancer Genome Interpreter and WGS in 726 tumours spanning 10 cancer types to identify drug repurposing opportunities. We compare the ability of WGS to detect actionable variants, tumour mutation burden (TMB) and microsatellite instability (MSI) by using in silico down-sampled data to mimic WES, a comprehensive sequencing panel and a hotspot mutation panel. RESULTS: We reveal drug repurposing opportunities as numerous biomarkers are shared across many solid tumour types. Comprehensive panels identify the majority of approved actionable mutations, with WGS detecting more candidate actionable mutations for biomarkers currently in clinical trials. Moreover, estimated values for TMB and MSI vary when calculated from WGS, WES and panel data, and are dependent on whether all mutations or only non-synonymous mutations were used. Our results suggest that TMB and MSI thresholds should not only be tumour-dependent, but also be sequencing platform-dependent. CONCLUSIONS: There is a large opportunity to repurpose cancer drugs, and these data suggest that comprehensive sequencing is an invaluable source of information to guide clinical decisions by facilitating precision medicine and may provide a wealth of information for future studies. Furthermore, the sequencing and analysis approach used to estimate TMB may have clinical implications if a hard threshold is used to indicate which patients may respond to immunotherapy.

Pedicled hand fillet flap to preserve stump length in below-elbow amputation.

Spare-parts surgery in traumatic amputation sources tissue from the amputated part to cover the residual amputation defect. This case describes a trauma patient requiring below-elbow amputation. Stump closure was accomplished with a pedicled fillet flap derived from the still-attached hand, avoiding donor site morbidity and maximizing stump length.

Source, fate and management of recreational fishing marine debris.

Marine debris, directly and indirectly, threatens marine habitat and biota. Fishing activity is generally recognised as a contributor to marine debris, but the relative input from recreational fishing remains unassessed. Here we provide the first comprehensive literature review of recreational fishing marine debris (RFMD) on a global scale. A systematic literature review identified 70 studies related to RFMD, and plastic and metal respectively were the dominant debris materials found. Nearshore coastal areas and reefs, acted as both sources and sinks of RFMD and a diverse suite of potential impacts such as ghost fishing and entanglement were identified at local scales. Overall, research of RFMD is lacking globally, however, its role in marine debris input is likely underestimated. We recommend more research on the volumes and risks, using a standardised classification approach. Where intervention is required, we suggest cooperative approaches between the sector and authorities.

Bacteriological outcomes following random allocation to quarter-level selection based on California Mastitis Test score or cow-level allocation based on somatic cell count for dry cow therapy.

Intramammary infusion of antimicrobials at the end of lactation (dry cow therapy) has been a cornerstone of mastitis management for many years. However, as only a proportion of cows are infected at this time, treating only those cows likely to be infected is an important strategy to reduce antimicrobial usage and minimize risk of emergence of antimicrobial resistance. Such an approach requires the ability to discriminate between cows and quarters likely to be infected and uninfected. This study compared assignment of cows or quarters to antimicrobial treatment at the end of lactation based on cow composite somatic cell count (SCC; i.e., all quarters of cows with a maximum SCC across lactation >200,000 cells/mL received an antimicrobial; n = 891 cows, SCC-group) or assignment to quarter-level treatment based on a quarter level California Mastitis Test (CMT) score ≥ trace (n = 884 cows; CMT-group) performed immediately before drying off. All quarters of all cows also received an infusion of a bismuth-based internal teat sealant. Milk samples were collected for microbiology following the last milking, and again within 4 d of calving. Clinical mastitis records from dry off to 30 d into the subsequent lactation were collected. Multilevel, multivariable models were used to assess the effect of assignment to antimicrobial treatment. At drying off, a total of 575 (8.8%) and 147 (2.3%) of the 6,528 quarters had a minor, and a major intramammary infection (IMI), respectively. At drying off, 2089/3270 (63.9%) and 883/3311 (26.7%) of quarters were treated with dry cow therapy in the CMT and SCC-groups, respectively. Apparent bacteriological cure proportion for any IMI was higher in quarters assigned to the CMT than the SCC-group (349/368 (0.95, 95% CI 0.92-0.97) versus 313/346 (0.90, 95% CI 0.87-0.93)). New IMI proportion was lower among quarters assigned to the CMT than SCC-group [101/3,212 (0.032, 95% CI 0.025-0.038) versus 142/3,232 (0.044, 95% CI 0.036-0.051)]. The prevalence of any IMI postcalving was lower in quarters assigned to the CMT than SCC-group [119/3,243 (0.037, 95% CI: 0.030-0.044) versus 173/3,265 (0.054, 95% CI: 0.045-0.062)]. There was no difference in incidence of clinical mastitis between treatment groups. The total mass of antimicrobials used was 63% higher in the CMT-group than in the SCC-group (3.47 versus 2.12 mg/kg of liveweight). Selection of quarters for antimicrobial treatment at the end of lactation based on CMT resulted in greater proportion undergoing bacteriological cure, reduced risk of any new IMI and reduced post calving prevalence of any IMI compared with selection of cows based on SCC. However, CMT-based selection resulted in higher antimicrobial use compared with SCC-based selection, and further research is required to analyze the cost benefit and impact on risk of antimicrobial resistance of these 2 strategies.

Risk factors for clinical or subclinical mastitis following infusion of internal teat sealant alone at the end of lactation in cows with low somatic cell counts.

AIMS: To identify risk factors for subclinical and clinical mastitis in cows with low somatic cell counts (SCC) following infusion with internal teat sealant (ITS) at drying off. METHODS: Cows with no history of clinical mastitis and a maximum SCC <250,000 cells/mL at any herd test in the lactation before drying off were randomly selected from 36 herds. In the final week of lactation, quarter milk samples were collected aseptically from each selected cow for microbiology, and each quarter was then infused with ITS. Clinical mastitis records from 22 herds and herd test data from all herds were collated to determine potential herd- or cow-level explanatory variables for clinical mastitis over the dry period or in the first 60 days of the subsequent lactation, and subclinical mastitis (SCC >200,000 cells/mL; SCM) at the first herd test after calving. Multivariable, multilevel, logistic regression analyses were used to model the data. RESULTS: At drying off, 44/1,514 (2.8%) cows were infected with a major pathogen. Two of 1,001 (0.2%) cows were diagnosed with clinical mastitis over the dry period. There were 128/1,514 (8.5%) cows with SCM at the first herd test after calving. The odds of SCM were greater for cows with a major pathogen present at drying off than those without (OR = 4.7 (95% CI = 2.29-9.65); p < 0.001), and for third or greater lactation than second lactation cows (OR = 3.16 (95% CI = 1.70-5.88); p < 0.001). For every 1L increase in milk yield at the last herd test before drying off the OR for SCM was 1.07 (95% CI = 1.01-1.13); (p = 0.02), and for each 1 unit increase in ln maximum SCC in the lactation before drying off the OR for SCM was 1.54 (95% CI = 1.13-2.10); (p = 0.01). There were 30/976 (3.1%) cows diagnosed with clinical mastitis in the first 60 days after calving. The odds of clinical mastitis were greater for cows producing >15 L/day at the last herd test of the preceding lactation than cows producing <10 L/day (OR = 4.79 (95% CI = 1.48-15.46); p = 0.009); for each 1 unit increase in ln maximum SCC in the previous lactation the OR for clinical mastitis was 1.96 (95% CI = 1.09-3.54); (p = 0.03), and the odds increased with increasing herd-level cow-case lactational incidence of clinical mastitis in the preceding lactation (p = 0.003). CONCLUSIONS AND CLINICAL RELEVANCE: Selection of cows with low SCC for ITS infusion should consider cow milk yield and maximum cow SCC in the preceding lactation.

Destination Design msTRAM: For Greater Reconstructive Certainty.

Performing delayed reconstruction to a unilateral breast while simultaneously performing a balancing procedure on the contralateral side can be the most difficult situation to achieve symmetry. We present here a novel approach to free TRAM-based breast reconstruction using reverse planning and subunit principles with simultaneous balancing reduction mastopexy and immediate nipple reconstruction. METHODS: A retrospective chart review and a BREAST-Q questionnaire of a single surgeon's practice was performed to compare revision rates and patient satisfaction following Destination Design msTRAM reconstruction compared with a historical cohort of patients who received traditional free TRAM reconstruction. RESULTS: The chart review identified 39 patients treated with the traditional unilateral technique from 1997 to 2004 and 88 patients treated with the novel unilateral technique from 2004 to 2017. Traditional technique patients had a breast revision rate of 64.1% and a nipple revision rate of 42.3% after secondary nipple reconstruction. Destination Design patients had a breast revision rate of 44.3% (P = 0.0394) and a nipple revision rate of 37.9% (P = 0.689) after primary nipple reconstruction. The BREAST-Q questionnaire was sent to nine traditional technique patients with 8 responses (89%), and 35 Destination Design patients with 25 responses (71%). Survey results showed that traditional technique and Destination Design patients had an overall breast satisfaction rate of 67.5% and 63.9%, respectively. CONCLUSIONS: The Destination Design msTRAM breast reconstruction technique leads to a statistically significant reduction in breast flap revisions, and allows for equally accurate immediate nipple reconstruction compared with traditional methods with no additional complications. Overall patient satisfaction is comparable with both techniques.

Detecting intramammary infection at the end of lactation in dairy cows.

To reduce antimicrobial use, infusion of antimicrobials into only infected cows at the end of lactation (selective dry cow therapy) is preferable to infusion of every cow with antimicrobials. Use of selective dry cow antimicrobial therapy requires differentiation of probably infected from uninfected cows to enable treatment allocation. Milk somatic cell count (SCC) has been used to distinguish between cows with and without intramammary infection (IMI). However, SCC may be influenced by milk yield, stage of lactation, breed, and herd-level variables such as prevalence of infection. Cut points for SCC, to distinguish between cows with and without an IMI, may need to differ between cow age groups and breeds, or among herds. This study evaluated associations between SCC and major pathogen IMI in one or more quarters of 2,606 cows from 36 herds in 4 regions of New Zealand. In the last week of lactation, cows selected at random had milk samples collected from each quarter, and the teat-end condition and hygiene of the udder were scored. Herd- and cow-level data including age, breed, milk volume, and SCC at each production were recorded, and bulk tank milk SCC and volume of milk shipped were collated. At cow level, the association between average, maximum, and last cow-composite SCC, and presence of a major pathogen IMI in one or more quarters of cows, was examined using receiver operator curves. Predictive logistic regression models were then developed that included potential effect modifiers such as age, milk yield, and bulk tank milk SCC. The population average prevalence of major pathogen IMI was 7.2% of cows (95% confidence interval = 5.9-8.6), and this varied significantly between herds. The average, maximum, and last cow-composite SCC of lactation were all predictive of presence of a major pathogen IMI and did not differ in their ability to discriminate infected from uninfected cows. However, the optimal cut points for the last SCC, the maximum SCC, and average SCC were 108, 152, and 105 × 1,000 cells/mL, respectively. Inclusion of age, bulk tank SCC, and history of clinical mastitis improved overall model fit. However, inclusion of these variables did not improve the discriminatory power of maximum cow-composite SCC used alone. We conclude that cow-composite SCC on its own resulted in sensitivities and specificities of between 0.76 and 0.86, and 0.71 to 0.80, respectively, for determination of presence of major pattern IMI, and the predictive value was not improved by addition of other predictor variables.

Overriding water table control on managed peatland greenhouse gas emissions.

Global peatlands store more carbon than is naturally present in the atmosphere1,2. However, many peatlands are under pressure from drainage-based agriculture, plantation development and fire, with the equivalent of around 3 per cent of all anthropogenic greenhouse gases emitted from drained peatland3-5. Efforts to curb such emissions are intensifying through the conservation of undrained peatlands and re-wetting of drained systems6. Here we report eddy covariance data for carbon dioxide from 16 locations and static chamber measurements for methane from 41 locations in the UK and Ireland. We combine these with published data from sites across all major peatland biomes. We find that the mean annual effective water table depth (WTDe; that is, the average depth of the aerated peat layer) overrides all other ecosystem- and management-related controls on greenhouse gas fluxes. We estimate that every 10 centimetres of reduction in WTDe could reduce the net warming impact of CO2 and CH4 emissions (100-year global warming potentials) by the equivalent of at least 3 tonnes of CO2 per hectare per year, until WTDe is less than 30 centimetres. Raising water levels further would continue to have a net cooling effect until WTDe is within 10 centimetres of the surface. Our results suggest that greenhouse gas emissions from peatlands drained for agriculture could be greatly reduced without necessarily halting their productive use. Halving WTDe in all drained agricultural peatlands, for example, could reduce emissions by the equivalent of over 1 per cent of global anthropogenic emissions.

Perinatal anxiety and depressive symptoms and perception of child behavior and temperament in early motherhood.

The perinatal period is a vulnerable time for the development of psychopathology, particularly mood and anxiety disorders. In the study of maternal anxiety, important questions remain regarding the association between maternal anxiety symptoms and subsequent child outcomes. This study examined the association between depressive and anxiety symptoms, namely social anxiety, panic, and agoraphobia disorder symptoms during the perinatal period and maternal perception of child behavior, specifically different facets of development and temperament. Participants (N = 104) were recruited during pregnancy from a community sample. Participants completed clinician-administered and self-report measures of depressive and anxiety symptoms during the third trimester of pregnancy and at 16 months postpartum; child behavior and temperament outcomes were assessed at 16 months postpartum. Child development areas included gross and fine motor skills, language and problem-solving abilities, and personal/social skills. Child temperament domains included surgency, negative affectivity, and effortful control. Hierarchical multiple regression analyses demonstrated that elevated prenatal social anxiety symptoms significantly predicted more negative maternal report of child behavior across most measured domains. Elevated prenatal social anxiety and panic symptoms predicted more negative maternal report of child effortful control. Depressive and agoraphobia symptoms were not significant predictors of child outcomes. Elevated anxiety symptoms appear to have a distinct association with maternal report of child development and temperament. Considering the relative influence of anxiety symptoms, particularly social anxiety, on maternal report of child behavior and temperament can help to identify potential difficulties early on in mother-child interactions as well as inform interventions for women and their families.

Flexible gauge length intrinsic fiber-optic strain sensor using broadband interferometry [Invited].

Monitoring strain is important in precision engineering applications that require maintaining the precise alignments of structures over time, such as those found in machine tools and metrology frames. We present a fiber-optic strain measurement technique based upon broadband interferometry that is variously configurable in terms of gauge length and sensitivity. This is achieved by the use of an unbalanced interrogation interferometer configuration that alleviates the cavity length limit imposed by the temporal coherence of the system. We also demonstrate that dispersion in fiber sensors based on intrinsic Fabry-Perot interferometers must be considered to optimize performance. The possibility of multisensor interrogation using the same optical system is also reported.

Rectal cancer lateral pelvic sidewall lymph nodes: a review of controversies and management.

BACKGROUND: The management of lateral pelvic lymphadenopathy in low rectal cancer poses an oncological and technical challenge. Interpretation of the literature is confounded by different approaches to management in the East and West, and a lack of randomized data from which to draw accurate conclusions regarding the optimal approach. Recent collaboration between Eastern and Western centres has increased the standardization of care. Despite this, significant differences in international guidelines remain. The aim of this review was to appraise the available literature and propose a management algorithm. METHODS: A literature review of all relevant studies was performed to summarize the historical evidence, as well as establish the significance of clinically positive lateral pelvic sidewall nodes, and the role of neoadjuvant chemoradiotherapy and lateral pelvic node dissection. A management algorithm was developed based on this review of the literature. RESULTS: The management of pelvic sidewall lymphadenopathy in rectal cancer is non-standardized, with geographical differences. The mechanism of lateral lymphatic spread is well defined; the risk increases with lower tumour height and advanced T category. Existing data indicate that acceptable disease-free and overall survival can be achieved by neoadjuvant chemoradiotherapy with selective lateral pelvic node dissection. CONCLUSION: Suspicious lateral pelvic sidewall nodes, particularly in the internal iliac chain, should be considered as resectable locoregional disease, and surgery offered for enlarged nodes that do not respond to neoadjuvant chemoradiotherapy.

ANTECEDENTES: El tratamiento de las adenopatías en la pared pélvica lateral en el céncer de recto inferior plantea un desafío oncológico y técnico. La interpretación de la literatura es confusa por los diferentes abordajes en Oriente y Occidente y la falta de estudios aleatorizados a partir de los cuales extraer conclusiones precisas sobre cuél es el enfoque óptimo. La reciente colaboración entre los centros orientales y occidentales ha aumentado la estandarización del tratamiento. A pesar de ello, persisten diferencias significativas en las guías internacionales. El objetivo de esta revisión fue evaluar la literatura disponible y proponer un algoritmo terapéutico. MÉTODOS: Se realizó una revisión de la literatura de todos los estudios relevantes para resumir las evidencias existentes, así como para determinar la importancia de las adenopatías de la pared lateral pélvica clínicamente positivas, el papel de la quimiorradioterapia neoadyuvante (neoadjuvant chemoradiotherapy, NCRT) y de la linfadenectomía pélvica lateral (lateral pelvic node dissection, LPND). Se desarrolló un algoritmo de tratamiento basado en esta revisión de la literatura. RESULTADOS: El tratamiento de las adenopatías de la pared lateral de la pelvis en el céncer de recto no esté estandarizado y sigue habiendo diferencias geogréficas. El mecanismo de la diseminación linfética lateral esté bien definido con un mayor riesgo en los tumores de recto inferior y con un estadio T avanzado. Los datos existentes demuestran que se puede obtener una supervivencia libre de enfermedad y global aceptables mediante NCRT con LPND selectiva. CONCLUSIÓN: Las adenopatías sospechosas en la pared lateral de la pelvis, en particular en la cadena ilíaca interna, deben considerarse enfermedad locorregional resecable y se debe ofrecer cirugía para los ganglios aumentados de tamaño que no responden a la NCRT.