Postoperative mortality and complications in patients with and without pre-operative SARS-CoV-2 infection: a service evaluation of 24 million linked records using OpenSAFELY.

Surgical decision-making after SARS-CoV-2 infection is influenced by the presence of comorbidity, infection severity and whether the surgical problem is time-sensitive. Contemporary surgical policy to delay surgery is informed by highly heterogeneous country-specific guidance. We evaluated surgical provision in England during the COVID-19 pandemic to assess real-world practice and whether deferral remains necessary. Using the OpenSAFELY platform, we adapted the COVIDSurg protocol for a service evaluation of surgical procedures that took place within the English NHS from 17 March 2018 to 17 March 2022. We assessed whether hospitals adhered to guidance not to operate on patients within 7 weeks of an indication of SARS-CoV-2 infection. Additional outcomes were postoperative all-cause mortality (30 days, 6 months) and complications (pulmonary, cardiac, cerebrovascular). The exposure was the interval between the most recent indication of SARS-CoV-2 infection and subsequent surgery. In any 6-month window, < 3% of surgical procedures were conducted within 7 weeks of an indication of SARS-CoV-2 infection. Mortality for surgery conducted within 2 weeks of a positive test in the era since widespread SARS-CoV-2 vaccine availability was 1.1%, declining to 0.3% by 4 weeks. Compared with the COVIDSurg study cohort, outcomes for patients in the English NHS cohort were better during the COVIDSurg data collection period and the pandemic era before vaccines became available. Clinicians within the English NHS followed national guidance by operating on very few patients within 7 weeks of a positive indication of SARS-CoV-2 infection. In England, surgical patients' overall risk following an indication of SARS-CoV-2 infection is lower than previously thought.

A systematic review of local excision followed by adjuvant therapy in early rectal cancer: are pT1 tumours the limit?

AIM: Total mesorectal excision remains the cornerstone of treatment for rectal cancer. Significant morbidity means local excision may be more appropriate in selected patients. Adjuvant therapy reduces local recurrence and improves survival; however, there is a paucity of data on its impact following local excision, which this systematic review aims to address. METHODS: A systematic search of the MEDLINE, Embase and Cochrane databases using validated terms for rectal cancer, adjuvant therapy and local excision was performed. Included studies focused on local excision with adjuvant therapy for adenocarcinoma of the rectum. Primary outcome measures were local recurrence, survival and morbidity. Studies providing neoadjuvant therapy or local excision alone were excluded. RESULTS: Twenty-two studies described 804 patients. Indications for local excision included favourable histology, patient choice and comorbidities. T1, T2 and T3 tumours accounted for 35.1%, 58.0% and 6.9% of cases, respectively. The most frequent local excision technique was transanal excision (77.7%). Adjuvant therapy included long-course chemoradiation or radiotherapy. Median follow-up was 51 months (range 1-165). The pooled local recurrence was 5.8% (95% CI 3.0-9.5) for pT1, 13.8% (95% CI 10.1-17.9) for pT2 and 33.7% (95% CI 19.2-50.1) for pT3 tumours. The overall median disease-free survival was 88% (range 50%-100%) with a pooled overall morbidity of 15.1% (95% CI 11.0-18.7). CONCLUSIONS: This area remains highly relevant to modern clinical practice. The data suggest that local excision followed by adjuvant therapy can achieve acceptable long-term outcomes in high-risk pT1 tumours, but not in T2 tumours and above in whom radical surgery should be offered.

Exploring social cognition in schizophrenia.

The aim of the study was to compare social cognition between groups of patients diagnosed with schizophrenia and healthy controls and to replicate two previous studies using tests of social cognition that may be particularly sensitive to social cognitive deficits in schizophrenia. Thirty-eight first-admitted patients with schizophrenia and 38 healthy controls solved 11 "imaginary conversation (i.e., theory of mind)" items, 10 "psychological understanding" items, and 10 "practical understanding" items. Statistical tests were made of unadjusted and adjusted group differences in models adjusting for intelligence and neuropsychological test performance. Healthy controls performed better than patients on all types of social cognitive tests, particularly on "psychological understanding." However, after adjusting for intelligence and neuropsychological test performance, all group differences became nonsignificant. When intelligence and global cognitive functioning is taken into account, schizophrenia patients and healthy controls perform similarly on social cognitive tests.

Max Scheler's theory of the hierarchy of values and emotions and its relevance to current psychopathology.

The philosopher Max Scheler (1874-1928) set out a hierarchical theory of values and emotions in the early twentieth century. This inspired Kurt Schneider to distinguish two sorts of depressive illness, each conforming to a Störung (disorder) in different levels of Scheler's hierarchy. No other psychopathologist, except Stanghellini, gave the matter much attention. I believe that Scheler's theory is a rich source of insight into psychopathology, general and neuropsychiatric. I therefore give an account of Scheler's scheme, review its extant applications (Schneider's, Stanghellini's), and present suggestions as to its continuing potential relevance in a wide range of psychopathological conditions.

The nature of delusion: psychologically explicable? psychologically inexplicable? philosophically explicable? Part 2.

The first part of this article dealt with the extant formulations of delusion, psychiatric and psychological, suggestions which, respectively, regard delusion as psychologically inexplicable or explicable. All this was subjected to critique. This second part puts forward informed philosophical thesis whereby delusion can be explained within the philosophical movement known as phenomenology and, in particular, Max Scheler's version of this.

Categorical and associative relations increase false memory relative to purely associative relations.

The goal of the present study was to examine the contributions of associative strength and similarity in terms of shared features to the production of false memories in the Deese/Roediger-McDermott list-learning paradigm. Whereas the activation/monitoring account suggests that false memories are driven by automatic associative activation from list items to nonpresented lures, combined with errors in source monitoring, other accounts (e.g., fuzzy trace theory, global-matching models) emphasize the importance of semantic-level similarity, and thus predict that shared features between list and lure items will increase false memory. Participants studied lists of nine items related to a nonpresented lure. Half of the lists consisted of items that were associated but did not share features with the lure, and the other half included items that were equally associated but also shared features with the lure (in many cases, these were taxonomically related items). The two types of lists were carefully matched in terms of a variety of lexical and semantic factors, and the same lures were used across list types. In two experiments, false recognition of the critical lures was greater following the study of lists that shared features with the critical lure, suggesting that similarity at a categorical or taxonomic level contributes to false memory above and beyond associative strength. We refer to this phenomenon as a "feature boost" that reflects additive effects of shared meaning and association strength and is generally consistent with accounts of false memory that have emphasized thematic or feature-level similarity among studied and nonstudied representations.

The nature of delusion: psychologically explicable? psychologically inexplicable? philosophically explicable? Part 1.

The debate about the nature of delusion has rumbled on for over a century without resolution. The current situation is a stand-off between psychologists, who propose various theories as to the psychological explicability of delusion, and psychiatrists, who generally regard delusion as inexplicable. Our main aim in this 2-part article is to reprise the intellectual atmosphere of German psychopathology in the inter-war and immediate post-war years, when the issues concerning delusion were formulated with more sensitivity to the actual delusions encountered in clinical practice. In Part 1 we mount a critique of psychological and psychiatric theories of delusion.

First rank symptoms of schizophrenia: their nature and origin.

Kurt Schneider's insight nearly 80 years ago that schizophrenia could be demarcated from other psychoses by a small set of particular delusions and hallucinations powerfully influenced diagnostic practice. The theoretical status of such 'first rank symptoms' as a whole, however, has rarely been addressed. But if they are sensitive and specific to the condition, it is about time that their essential nature and potential origin be considered. This is the purpose of the present paper. I argue that these psychopathological phenomena are indeed relatively sensitive and specific to the condition, that their nature can be formulated within a Schelerian model of what constitutes a human being, and that their origin fits anthropological and neuropsychological notions of the make-up of contemporary human beings.

Two-week wait symptoms are prevalent in screened patients with a positive faecal occult blood test but do not predict cancer.

AIM: Lower gastrointestinal (LGI) symptoms are prevalent in patients screened for bowel cancer yet do not predict a finding of cancer. This study evaluates symptoms in patients with these characteristics against the 2-week wait (2ww) criteria to determine whether they predicted cancer in these patients. METHOD: A prospective cohort study was performed. Patients with a positive faecal occult blood (FOB) test attending our unit over a 7-month period were included. Data on symptom prevalence, frequency and duration were collected and assessed against the 2ww criteria. Associations between symptom prevalence and patient outcome were investigated using the χ(2) test. RESULTS: Three hundred and ninety-seven patients were included and 37 (9%) were found to have colorectal cancer (CRC). The prevalence of undefined LGI symptoms was 71% and appeared comparable between those with and without CRC (65 vs 72%, P = 0.385). 2ww symptoms were reported in 147 (37%), with 2ww change in bowel habit in 10% and 2ww rectal bleeding in 31%. 2ww symptom prevalence was similar in those with and without cancer (38 vs 37%, P = 0.915). No significant differences in overall 2ww prevalence or prevalence of individual 2ww symptoms were demonstrated between those with a normal colonoscopy or one showing cancer, polyps or other pathology. Twenty nine per cent of patients with 2ww symptoms had reported these to their GP. CONCLUSION: Undefined LGI symptoms are prevalent in FOB-positive patients but do not predict CRC. 2ww symptoms are also highly prevalent, yet similarly fail to predict cancer. Further efforts to increase public awareness of cancer symptoms are required, whilst false reassurance from a negative FOB result should be discouraged.

Repeat 2-week wait referrals for colorectal cancer.

AIM: The inappropriate use of the '2-week wait' pathway for suspected colorectal cancer (CRC2ww) may overload urgent clinics and delay the assessment and investigation of other patients. Those who have been previously referred and investigated for suspected colorectal cancer may present one group that does not warrant repeat urgent referral. This paper aims to identify the incidence and diagnostic yield of repeat CRC2ww referrals. METHOD: All CRC2ww patients referred to our unit over a 4-year period were identified retrospectively. Referral indication, outcome and instances of repeat referral were identified from multidisciplinary team, endoscopy and imaging databases. RESULTS: In all, 2735 CRC2ww referrals were made over the study period. Of these, 122 were repeated CRC2ww referrals, with the incidence increasing from 2% in 2008 to 6% in 2010 (P = 0.0006). The median time to repeat referral was 1070 days. After initial referral 267 cancers were detected, including 212 colorectal cancers. The diagnostic yield was lower but not significantly so after repeated referral (six cancers) compared with initial referral (5%vs 10%, P = 0.07). CONCLUSION: The incidence of repeat referral is low but the diagnostic yield is not insignificant. Exclusion of these patients from urgent assessment and investigation will not significantly reduce workload and may risk missing some patients with cancer.

Making syntax of sense: number agreement in sentence production.

Grammatical agreement flags the parts of sentences that belong together regardless of whether the parts appear together. In English, the major agreement controller is the sentence subject, the major agreement targets are verbs and pronouns, and the major agreement category is number. The authors expand an account of number agreement whose tenets are that pronouns acquire number lexically, whereas verbs acquire it syntactically but with similar contributions from number meaning and from the number morphology of agreement controllers. These tenets were instantiated in a model using existing verb agreement data. The model was then fit to a new, more extensive set of verb data and tested with a parallel set of pronoun data. The theory was supported by the model's outcomes. The results have implications for the integration of words and structures, for the workings of agreement categories, and for the nature of the transition from thought to language.

A call for more dialogue and more details.

Pickering & Garrod (P&G) argue that contemporary models of language use are inadequate. This has resulted largely because of an experimental focus on monologue rather than dialogue. I agree with the need for increased experimentation that focuses on the interplay between production and comprehension. However, I have some concerns about the Interactive Alignment model that the authors propose.

Some attractions of verb agreement.

In English, words like scissors are grammatically plural but conceptually singular, while words like suds are both grammatically and conceptually plural. Words like army can be construed plurally, despite being grammatically singular. To explore whether and how congruence between grammatical and conceptual number affected the production of subject-verb number agreement in English, we elicited sentence completions for complex subject noun phrases like The advertisement for the scissors. In these phrases, singular subject nouns were followed by distractor words whose grammatical and conceptual numbers varied. The incidence of plural attraction (the use of plural verbs after plural distractors) increased only when distractors were grammatically plural, and revealed no influence from the distractors' number meanings. Companion experiments in Dutch offered converging support for this account and suggested that similar agreement processes operate in that language. The findings argue for a component of agreement that is sensitive primarily to the grammatical reflections of number. Together with other results, the evidence indicates that the implementation of agreement in languages like English and Dutch involves separable processes of number marking and number morphing, in which number meaning plays different parts.

Seeking one's heading through eye movements.

A study of eye movements during simulated travel toward a grove of four stationary trees revealed that observers looked most at pairs of trees that converged or decelerated apart. Such pairs specify that one's direction of travel, called heading, is to the outside of the near member of the pair. Observers looked at these trees more than those that accelerated apart; such pairs do not offer trustworthy heading information. Observers also looked at gaps between trees less often when they converged or diverged apart, and heading can never be between such pairs. Heading responses were in accord with eye movements. In general, if observers responded accurately, they had looked at trees that converged or decelerated apart; if they were inaccurate, they had not. Results support the notion that observers seek out their heading through eye movements, saccading to and fixating on the most informative locations in the field of view.

Heading judgments in minimal environments: the value of a heuristic when invariants are rare.

Observers made systematic heading judgments in two experiments simulating their translation through an environment with only two trees. When those trees converged or decelerated apart, observers tended to follow the invariant information and make heading judgments outside the near member of the pair. When those trees accelerated apart, however, observers tended to follow the heuristic information and make judgments outside the far member, although this result was tempered by the angular separation between the trees and their relative acceleration. The simultaneous existence and use of invariants and heuristics are discussed in terms of different metatheoretical approaches to perception.

Images, imagination, and movement: pictorial representations and their development in the work of James Gibson.

For more than 30 years James Gibson studied pictures and he studied motion, particularly the relationship between movement through an environment and its visual consequences. For the latter, he also struggled with how best to present his ideas to students and fellow researchers, and employed various representations and formats. This article explores the relationships between the concepts of the fidelity of pictures (an idea he first promoted and later eschewed) and evocativeness as applied to his images. Gibson ended his struggle with an image of a bird flying over a plane surrounded by a spherical representation of a vector field, an image high in evocativeness but less than completely faithful to optical flow.

A bridging study for oxytetracycline in the edible fillet of rainbow trout: analysis by a liquid chromatographic method and the official microbial inhibition assay.

Oxytetracycline (OTC) is a drug approved by the U.S. Food and Drug Administration (FDA) to control certain diseases in salmonids and catfish. OTC is also a likely control agent for diseases of other fish species and for other diseases of salmonids and catfish not currently on the label. One requirement for FDA to extend and expand the approval of this antibacterial agent to other fish species is residue depletion studies. The current regulatory method for OTC in fish tissue, based on microbial inhibition, lacks sensitivity and specificity. To conduct residue depletion studies for OTC in fish with a liquid chromatographic method, a bridging study was required to determine its relationship with the official microbial inhibition assay. Triplicate samples of rainbow trout fillet tissue fortified with OTC at 0.3, 0.6, 1.2, 2.4, 4.8, and 9.6 ppm and fillet tissue with incurred OTC at approximately 0.75, 1.5, and 3.75 ppm were analyzed by high-performance liquid chromatography (HPLC) and the microbial inhibition assay. The results indicated that the 2 methods are essentially identical in the tested range, with mean coefficients of variation of 1.05% for the HPLC method and 3.94% for the microbial inhibition assay.

Morbid objectivization in psychopathology.

The fundamental problems of schizophrenia are wrongly formulated unless one takes heed of the major philosophical revolution which Kant initiated with the publication of the Critique of Pure Reason in 1781. Virtually all major philosophers since then have adhered to the view that the mind objectifies whatever energy fields/atoms, etc., are 'out there'. The thesis put forward in this lecture will be that schizophrenia is a condition in which this process proceeds too far. Evidence from the psychopathology of body, time and world is offered in support of such morbid objectivization.