Long-term cognitive and affective consequences of mild traumatic brain injury: comparison with older adults.

OBJECTIVE: Memory and affective processing were compared in young adults with a remote mild traumatic brain injury (mTBI), to healthy younger and older adults. We evaluated memory performance when encoding was done under multi-tasking (divided attention) conditions, likely to exacerbate cognitive and psychological symptoms in mTBI. METHODS: Participants studied pairs of unrelated words under either full or divided attention conditions. Memory for single words (item memory) and for pairs of words (associative memory) was then assessed in sequential independent recognition tests, under full attention. RESULTS: Associative memory was poorer than item memory, and worse when encoding was done under divided than full attention. The decline in recognition accuracy from full to divided attention conditions on the associative memory test was significantly greater in mTBI compared to young adults and was similar in magnitude to that observed in older adults under full attention. Self-reported mental and total fatigue increased significantly as performance on the memory tests, following the divided attention condition, decreased, but only in the mTBI group. CONCLUSIONS: Results show lingering memory deficits, and suggest that cognitive tasks may be experienced as psychologically more demanding in those with a mTBI, even months or years after injury.

Same-day discharge robot-assisted laparoscopic prostatectomy: feasibility, safety and patient experience.

OBJECTIVES: To report a single centre's experience of the feasibility, safety and patient acceptability of same-day discharge robot-assisted laparoscopic prostatectomy (RALP). SUBJECTS/PATIENTS AND METHODS: Between June 2015 and December 2021, a total of 180 pre-selected consecutive patients underwent RALP with the intention to discharge on the same day as surgery. Cases were performed by two surgeons. An enhanced recovery after surgery (ERAS) programme was used. The feasibility of same-day discharge was analysed, along with the complication rate, oncological outcomes, and postoperative patient experience. RESULTS: Of 180 patients, 169 (93.8%) were successfully discharged on the same day as surgery. The median (range) age was 63 ( 44-74) years. The median (range) console time was 97 (61-256) min and blood loss was 200 (20-800) mL. The resection specimen pathology results were: pT2 69.4%, pT3a 24.4% and pT3b 6.5%. With regard to Gleason Grade Group (GGG), 25.9% had GGG 1, 65.7% had GGG 2-3 and 8.4% had GGG 4-5 disease. Positive surgical margins were present in 25 cases (14.7%), 18 (15.5%) of which occurred in pT2 cases, and seven (13.4%) in pT3 cases. There were no early (<90 days) biochemical relapses (defined as prostate-specific antigen level >0.2 ng/mL). The 30-day readmission rate was 3%. A total of 13 early (0-30 days) complications were observed, five of which were Clavien-Dindo grade ≥3, however, none of these would have been avoided had the patient remained in hospital on the first postoperative night. Of 121 consecutive patients, 107 (88%) returned a satisfaction questionnaire, and 92% of responders stated they preferred recovery at home, with 94% stating they felt ready to go home. CONCLUSION: Robot-assisted laparoscopic prostatectomy combined with an ERAS programme allows patients to be safely discharged home on the same day of their surgery. This is a feasible option, well-liked by patients, with morbidity and oncological outcomes similar to non-day-case or 23 h stay RALP.

How US newspapers view the UK's NHS: a study in international lesson-drawing.

Healthcare on both sides of the Atlantic is a highly charged political and economic subject. This work considers US media coverage of the UK's National Health Service (NHS), an under-researched area. We assess the framing of the NHS in editorials, opinion and feature articles during the time of the Obama administration to show how media can perform the role of lesson-drawing, a theory adopted from public policy research. The study also applies the notion of journalistic habitus in this context. Using these ideas, we address a hypothesis which holds that US coverage is framed around the flaws of the UK's NHS. The paper considers how intermedia editorial and news values operate, with commentators drawing a range of negative lessons in both the Democrat- and Republican-supporting press. We find that the NHS was often posited as a flawed international variant of the single-payer model, where newspapers employed an ahistoric explanation of failure and decline.

Environmental degradation, economic growth and tourism development in Chinese regions.

Tourism development is recognised as an essential tool in promoting economic growth; however, it may also contribute to environmental degradation. Increased pressure for reducing CO2 emissions poses new challenges to policy-makers who try to promote economic growth and environmental protection in tandem. Since 2010, 19 scenic areas in China have been declared as low-carbon tourism demonstration zones. It follows that investigating whether CO2 emissions originating in the tourism industry could, in fact, compromise sustainable development in China becomes an essential area of study. Whilst this is a key concern to society, there are only a limited number of studies that analyse the environmental impact of tourism and the validity of the tourism-led-growth hypothesis. This study considers both domestic and international tourism and explicitly tests the relationship among tourism development, economic growth and CO2 emissions in China, employing a panel vector autoregressive model and utilising regional data between 2006 and 2017. Results show that the development of either international or domestic tourism contributes to economic growth, however, at the expense of the environment.

Moving Toward a More Comprehensive Analysis of Acceleration Profiles in Elite Youth Football.

In football, having greater acceleration ability may decide the most important moments within matches. Up to now, commonly used acceleration variables have typically been investigated in isolation, with each variable suffering from unique limitations. Subsequently, any findings may provide a limited representation of what specific acceleration demands had actually occurred. Without gaining a comprehensive understanding of acceleration demands in football, it appears difficult to identify how to best monitor and maximize the long-term development of acceleration ability in footballers, all whilst doing so in a safe, sport-specific manner. Moving toward a more comprehensive analysis of acceleration profiles addresses this, as it can provide a more robust, informative understanding of the unique acceleration demands of competitive match-play. This perspective article aims to discuss the benefits of adopting a more comprehensive analysis of the acceleration demands during competitive matches for football players, by simultaneously analyzing high-intensity accelerations, repeated high acceleration ability (RHAA), and average acceleration. We discuss examples of the calculation and application of a more comprehensive acceleration profile at a team level throughout the course of an entire elite youth football season, as well as on an individual level. Monitoring acceleration profiles more comprehensively not only appears important from a training load/injury prevention perspective, but also, equips coaches and conditioning staff with the specific information necessary to develop and prescribe individualized, acceleration-emphasized training protocols that are replicable to the demands of match-play. Examples of such protocols are provided.

Validity of Session Rating of Perceived Exertion Assessed via the CR100 Scale to Track Internal Load in Elite Youth Football Players.

PURPOSE: To assess the convergent validity of the Borg CR100® scale to track internal training load (TL) in youth football players. METHODS: A total of 19 youth football players (age = 15 [1] y, height = 175.9 [12.3] cm, and body mass = 69 [15.4] kg) were monitored for 27 sessions, including training and games. Internal TL was assessed via session rating of perceived exertion (sRPE) and 2 heart-rate-based methods (Banister training impulse and Edwards TL). The correlations between sRPE and heart-rate-based TL, the differences in individual player intercepts and slopes, and the differences between types of sessions (training vs games) were assessed using a general linear mixed model with magnitude-based inferences. RESULTS: Correlations between sRPE and Banister training impulse were very large at overall group level (r = .77; 90% confidence limits, .72-.80) and individual level (range .70-.95). Correlations between sRPE and Edwards TL were very large at overall group level (r = .84; 90% confidence limit, .82-.86) and large to very large at individual level (range .64-.93). A very likely small difference was found in the comparison between games and training sessions for the relationship between sRPE and Banister training impulse. CONCLUSIONS: The Borg CR100 scale is a valid method for monitoring TL in youth football players.

One Climate or Many: Examining the Structural Distinctiveness of Safety, Health, and Stress Prevention Climate Measures.

OBJECTIVE: This study explores the structural distinctiveness of safety, health, and stress prevention climate scales and examines whether these measures predict safety, physical health, and mental health outcomes over time. METHODS: We obtained samples of university students, Amazon Mechanical Turk workers, and firefighters to assess the dimensionality of the three climate foci, and provide content, construct, and criterion validity of the three measures. RESULTS: Findings from our study suggest that the constructs of safety, health, and stress prevention climate are psychometrically distinct, as well as demonstrate content, construct, and criterion validity evidence. CONCLUSION: This study provides preliminary evidence for integrating the constructs of safety, health, and stress prevention climate in the Total Worker Health™ framework for predicting safety-, health-, and stress-related outcomes.

PTEN loss and activation of K-RAS and ß-catenin cooperate to accelerate prostate tumourigenesis.

Aberrant phosphoinositide 3-kinase (PI3K), mitogen-activated protein kinase (MAPK) and WNT signalling are emerging as key events in the multistep nature of prostate tumourigenesis and progression. Here, we report a compound prostate cancer murine model in which these signalling pathways cooperate to produce a more aggressive prostate cancer phenotype. Using Cre-LoxP technology and the probasin promoter, we combined the loss of Pten (Ptenfl/fl ), to activate the PI3K signalling pathway, with either dominant stabilized ß-catenin [Catnb+/lox(ex3) ] or activated K-RAS (K-Ras+/V12 ) to aberrantly activate WNT and MAPK signalling, respectively. Synchronous activation of all three pathways (triple mutants) significantly reduced survival (median 96 days) as compared with double mutants [median: 140 days for Catnb+/lox(ex3) Ptenfl/fl ; 182 days for Catnb+/lox(ex3) K-Ras+/V12 ; 238 days for Ptenfl/fl K-Ras+/V12 ], and single mutants [median: 383 days for Catnb+/lox(ex3) ; 407 days for Ptenfl/fl ], reflecting the accelerated tumourigenesis. Tumours followed a stepwise progression from mouse prostate intraepithelial neoplasia to invasive adenocarcinoma, similar to that seen in human disease. There was significantly elevated cellular proliferation, tumour growth and percentage of invasive adenocarcinoma in triple mutants as compared with double mutants and single mutants. Triple mutants showed not only activated AKT, extracellular-signal regulated kinase 1/2, and nuclear ß-catenin, but also significantly elevated signalling through mechanistic target of rapamycin complex 1 (mTORC1). In summary, we show that combined deregulation of the PI3K, MAPK and WNT signalling pathways drives rapid progression of prostate tumourigenesis, and that deregulation of all three pathways results in tumours showing aberrant mTORC1 signalling. As mTORC1 signalling is emerging as a key driver of androgen deprivation therapy resistance, our findings are important for understanding the biology of therapy-resistant prostate cancer and identifying potential approaches to overcome this. Copyright © 2017 Pathological Society of Great Britain and Ireland. Published by John Wiley & Sons, Ltd.

Steroids, drugs and stuttering priapism; the rock-and-roll lifestyle of a 24-year-old man.

The authors present a case of a 24-year-old, poorly controlled insulin-dependent type 1 diabetic Caucasian man who presented to the emergency department, with a painful erection of 36 h duration that had failed to resolve with conservative management. This was the patient's seventh priapism, with his most recent attendance 1 week previously for which he underwent a distal cavernosal shunt. He admitted to taking several recreational drugs, including marijuana and cocaine, during the preceding few days, in addition to the long-term use of the oral anabolic steroid oxandrolone. He had no family history of sickle cell disease or trait. On examination, a tensely erect penis was noted. A diagnosis of stuttering priapism was made and 750 mL of blood subsequently drained via a distal corporoglandular shunt resulting in successful detumescence.

Management of lower urinary tract symptoms in men.

Lower urinary tract symptoms in men are common, increase with age and can become bothersome, causing significant morbidity such as urinary retention or the need for surgery. This article outlines how to assess a man with lower urinary tract symptoms and when to refer to a specialist, and summarizes current treatment options.

Radial scar lesions of the breast diagnosed by needle core biopsy: analysis of cases containing occult malignancy.

AIM: To identify and review cases of false negative needle core biopsy (NCB) in the preoperative investigation of radial scar/complex sclerosing lesion (RS/CSL) lesions - that is, benign NCB from RS/CSL which contained malignancy on excision. METHODS AND RESULTS: A total of 11 false negative NCB in RS/CSL lesions from 281 (3.9%) were identified (6 cases: B1, 2 cases: B2 and 3 cases: B3). In 6 of 11 cases a radial scar or stromal sclerosis was seen in NCB. Localisation biopsy showed duct carcinoma in situ in six cases, duct carcinoma in situ with invasive carcinoma in three and invasive carcinoma in two. In all 11 cases, needle tracks were identified as missing the malignant epithelium by a mean of 5 mm (median:4 mm; range:1-20 mm). In 9 of 11 cases, the malignancy was missed by <6 mm. CONCLUSIONS: Despite evidence of accurate targeting of lesions, the use of NCB instead of fine needle aspiration cytology has not eliminated the problem of false negative biopsy in RS/CSL, and excision is recommended.