The impact of social determinants on health outcomes in a region in the North of England: a structural equation modelling analysis.

OBJECTIVES: The aim of this study was to identify the impact of social determinants of health on physical and mental health outcomes in a UK population. STUDY DESIGN: Structural equation modelling was used to hypothesise a model of relationships between health determinants and outcomes within a region in the North of England using large-scale population survey data (6208 responses). METHODS: We analysed responses from a population survey to assess the influence of a deprivation-based index at the environmental level, education and income on a behaviour index (smoking, alcohol consumption, physical activity, and dietary habits) and the influence of all these factors on self-reported physical health and the influence of the behaviour index and income on mental wellbeing. RESULTS: The proposed model was well supported by the data. Goodness-of-fit statistics, most notably a low value of the root mean square error of approximation (RMSEA), supported the validity of the proposed relationships (RMSEA = 0.054). The model revealed all examined paths to be statistically significant. Income and education were influential in determining an individual's behaviour index score, which, with income was the most important predictor of both the correlated outcomes of physical health and mental wellbeing (P < 0.001 in all cases). CONCLUSIONS: Findings challenge the traditional view of singular causal pathways, emphasising that interventions should consider the underlying influencing socio-economic conditions, which would influence behaviour and therefore physical and mental wellbeing. The extent to which the model is supported by the data, and the statistical significance of individual relationships accentuates the imperative for comprehensive public health strategies that integrate multiple socio-economic factors.

Pump-probe phase spectroscopy with submilliradian sensitivity and nanosecond time delay using Michelson interferometers.

Using two Michelson interferometers, we describe an experimental scheme for sensitive pump-probe spectral interferometry measurements at long time delays. It has practical advantages over the Sagnac interferometer method typically used when long-time delays are required. First, with the Sagnac interferometer, achieving many nanosecond delays requires expanding the size of the interferometer so that the reference pulse arrives before the probe pulse. Because the two pulses still pass through the same region of the sample, long-lived effects can still affect the measurement. In our scheme, the probe and reference pulses are spatially separated at the sample, alleviating the need for a large interferometer. Second, in our scheme, a fixed delay between probe and reference pulses is straightforward to produce and is continuously adjustable while maintaining alignment. Two applications are demonstrated. First, transient phase spectra are presented in a thin tetracene film with up to 5 ns probe delay. Second, impulsive stimulated Raman measurements are presented in Bi4Ge3O12. The signal-to-noise using the double Michelson technique is comparable to previously described methods with the added advantage of arbitrarily long pump-probe time delays.

Investigating the impact of non-gated thoracic CT prior to CTCA to reduce layered testing.

AIM: To determine the proportion of computed tomography (CT) coronary angiography (CTCA) referrals with coronary artery calcification (CAC) evident on previous non-cardiac CT imaging and how this impacted the diagnostic yield for CTCA, the requirement for additional diagnostic testing, and the associated costs to confirm or refute obstructive coronary artery disease (CAD). MATERIALS AND METHODS: A retrospective review of CTCA examinations was undertaken between 01/05/2018 and 31/05/2020 in which the examinations were cross referenced for previous non-gated thoracic CT at Royal United Hospitals Bath. Major epicardial vessel CAC on baseline CT was re-evaluated by published semi-quantitative methods, giving a per-patient CAC score (mild = 1-3, moderate = 4-6, severe >6). Subsequent incomplete CTCA diagnostic yield, further testing, and cost implications were examined. RESULTS: Of the 2140 CTCA examinations identified, 13% (280/2140) had a preceding non-gated thoracic CT (53% female, age 63 ± 11 years). The incomplete diagnostic rate increased with CAC grade, mild 32%, (RR 12; 95% CI 4-40), moderate 64% (RR 25; 95% CI 8-80), severe 75%, (RR 29; 95% CI 9-94). Additional diagnostic testing occurred in 4% for the mild CAC category, and 14% and 42% for moderate and severe, respectively. When severe CAC was identified on a non-gated thoracic CT a cost saving of £171/patient (dobutamine stress echo [DSE]) and £61/patient (myocardial perfusion scintigraphy [MPS]) was established with a direct to functional testing pathway. CONCLUSIONS: In patients referred for CTCA where severe CAC was identified on a preceding non-gated thoracic CT a direct to functional testing altered management in 42% of cases and was cost-effective.

The ABC of reproductive intentions: a mixed-methods study exploring the spectrum of attitudes towards family building.

STUDY QUESTION: What are the intentions of men and women of reproductive age in the UK regarding reproduction and family building? SUMMARY ANSWER: We identified six main categories of people; Avoiders, Betweeners, Completers, Desirers, Expectants and Flexers, for whom reproduction education strategies should be tailored differently to suit intentions. WHAT IS KNOWN ALREADY: Several studies have highlighted poor fertility awareness across men and women of reproductive age. As the average age of first-time parents continues to rise, there has been a concerted effort from educators, healthcare professionals, charities, reproductive health groups and government policymakers, to improve fertility awareness. In order to ensure that these messages are effective and to deploy the best strategies, it is important to understand people's reproductive health needs. This study therefore aimed to explore different reproductive intentions to aid tailoring of information to help individuals and couples achieve their family building desires. STUDY DESIGN, SIZE, DURATION: We conducted a mixed-method study via a UK-wide cross-sectional survey with 1082 participants and semi-structured interviews of 20 women and 15 men who agreed to follow-up interviews. Interviews lasted an hour on average. Ethics approval from UCL Research Ethics Committee. PARTICIPANTS/MATERIALS, SETTING, METHODS: Survey participants were recruited nationwide via online newspaper and social media adverts. Interviewees were purposely sampled to include men and women from the reproductive age range (18-45 years), varying ethnicity and education background. Survey data were analysed using the Minitab statistical software package. Interview data were transcribed and analysed using the framework method. MAIN RESULTS AND THE ROLE OF CHANCE: From the survey and interviews, we identified six key categories of people, grouped alphabetically, in a user-friendly manner to highlight a spectrum of reproductive intentions: Avoiders describes respondents who have no children and do not want to have children in the future; Betweeners describes those who already have child(ren) and want more in the future but are not actively trying to conceive; Completers describes those who have child(ren) but do not want more; Desirers describes those who are actively trying to conceive or plan to have child(ren) in the future; Expectants describes those who were pregnant at the time of the study; and Flexers describes those who may or may not already have and are unsure but or open to having child(ren) in the future. Analysis of survey data identified the following proportions in our study: Avoiders, 4.7%; Betweeners, 11.3%; Completers, 13.6%; Desirers, 36.9%; Expectants, 4.1%; and Flexers 28.4% and 2.4% preferring not to answer. There was one 'other' group from qualitative analysis, who would like to have children in the future but were unsure whether they could or had changing views. We recommend classifying as 'Desirers' or 'Flexers' for the purposes of fertility education. A majority of the survey population were trying to get pregnant; were pregnant; or planning to have a child in the future-whether actively, passively or simply open to the idea, with interviews providing deep insights into their family building decision-making. LIMITATIONS, REASONS FOR CAUTION: Due to the online recruitment method, there may be a bias towards more educated respondents. WIDER IMPLICATIONS OF THE FINDINGS: We developed a user-friendly, alphabetical categorization of reproductive intentions, which may be used by individuals, healthcare professionals, educators, special interest groups, charities and policymakers to support and enable individuals and couples in making informed choices to achieve their desired intentions, if and when they choose to start a family. STUDY FUNDING/COMPETING INTEREST(S): There was no external funding for this study. The authors report no competing interests. TRIAL REGISTRATION NUMBER: N/A.

Women's experiences of early pregnancy assessment unit services: a qualitative investigation.

OBJECTIVE: To explore the experiences of women who had used an Early Pregnancy Assessment Unit (EPAU) service in the UK and make recommendations for their improvement. DESIGN: Qualitative interview study. SETTING: Early Pregnancy Assessment Units in the UK. SAMPLE: A maximum variation sample of women who had consented to be interviewed having attended one of 26 EPAUs involved in the VESPA study in 2018. METHODS: In-depth telephone interviews with 38 women. A thematic framework analysis was conducted, with a focus on how experiences varied according to EPAU service configuration and clinical pathway. MAIN OUTCOME MEASURES: Women's experiences of EPAU services. RESULTS: We found that EPAUs are highly valued, and women's experiences were generally positive. However, women reported a range of issues that negatively affected their experience. These included difficulties accessing the service, insensitive management of the investigation and treatment options of pregnancy loss, poor communication, insufficient information and a lack of support for their psychological health. These issues were not strongly associated with EPAU configuration or clinical pathway. CONCLUSIONS: Recommendations to improve women's experiences include the separation of EPAUs from general maternity services, and we make suggestions on how to remove barriers to access by reviewing opening hours, how to provide sensitive patient management, such as automatically cancelling appointments and scans following pregnancy loss, and how to improve communication, both with women and their partners as well as with other parts of the health service. TWEETABLE ABSTRACT: Early Pregnancy Assessment Units are highly valued by women but aspects of their care experiences, particularly around sensitive management of pregnancy loss, could be improved.

The association between obesity and quality of life: a retrospective analysis of a large-scale population-based cohort study.

BACKGROUND: The relationship between obesity and health-related quality of life (HRQoL) may be confounded by factors such as multimorbidity. The aim of the study was to explore this relationship, controlling for long-term conditions and other health, lifestyle and demographic factors in a general adult population. There was specific interest in the impact of high weight status, measured by body mass index (BMI) levels (obesity, morbid obesity) compared with individuals of normal weight. METHODS: Health, lifestyle and demographic data were collected from 64,631 individuals aged 16 years and over registered in the Yorkshire Health Study; a long-term cohort study. Data were collected in 2 waves: from patients attending GP surgeries in the South Yorkshire region; and using online recruitment across the entire Yorkshire and Humber area. Univariable and multivariable regression methods were utilised to identify factors associated with HRQoL as measured by the EQ-5D summary score. Long-term conditions were tested as both covariates and mediating factors on the causal pathway between obesity and HRQoL. RESULTS: Increasing levels of obesity are associated with reduced HRQoL, although this difference is negligible between those of normal weight and those who are overweight. Individuals with obesity and morbid obesity score 4.9 and 11.3 percentage points less on the EQ-5D summary scale respectively than those of normal weight. Concurrent physical, and particularly mental health-related long-term conditions are substantively related to HRQoL: those with 3 or more reported mental or physical health conditions score 29.8 and 14.6 percentage points less on the EQ-5D summary scale respectively than those with fewer conditions. Long-term conditions can be conceptualised as lying on the causal path between obesity and HRQoL, but there is weak evidence for a partial mediating relationship only. CONCLUSIONS: To conclude, in agreement with the established literature we have found a clear inverse relationship between increasing weight status and decreasing HRQoL and confirmed the mediating role of long-term conditions in the reduction of HRQoL in people with obesity. Nevertheless, a high BMI remains independently related to HRQoL, suggesting that 'healthy people with obesity' may be in transition to an unhealthy future.

Research priority setting in women's health: a systematic review.

BACKGROUND: Developing a shared agenda is an important step in ensuring future research has the necessary relevance. OBJECTIVE: To characterise research priority setting partnerships (PSPs) relevant to women's health. SEARCH STRATEGY: Included studies were identified by searching MEDLINE and the James Lind Alliance (JLA) database. SELECTION CRITERIA: Priority setting partnerships using formal consensus methods. DATA COLLECTION AND ANALYSIS: Descriptive narrative to describe the study characteristics, methods, and results. MAIN RESULTS: Ten national and two international PSPs were identified. All PSPs used the JLA method to identify research priorities. Nine PSPs had published a protocol. Potential research uncertainties were gathered from guidelines (two studies), Cochrane reviews (five studies), and surveys (12 studies). The number of healthcare professionals (31-287), patients (44-932), and others (33-139) who responded to the survey, and the number of uncertainties submitted (52-4767) varied. All PSPs entered confirmed research uncertainties (39-104) into interim priority setting surveys and healthcare professionals (31-287), patients (44-932), and others (33-139) responded. All PSPs entered a short list of research uncertainties into a consensus development meeting, which enabled healthcare professionals (six to 21), patients (eight to 14), and others (two to 13) to identify research priorities (ten to 15). Four PSPs have published their results. CONCLUSION: Future research priority setting studies should publish a protocol, use formal consensus development methods, and ensure their methods and results are comprehensively reported. TWEETABLE ABSTRACT: Research published in @BJOGtweets highlights future research priorities across women's health, including @FertilityTop10, @jamesmnduffy.

An audit of local discrepancy rates in acute abdominal CT: does subspecialist reporting reduce discrepancy rates?

AIM: To assess the discrepancy rates (DR) for patients undergoing abdominopelvic computed tomography (CT) for acute non-traumatic abdominal pain who have a subsequent emergency laparotomy in a large university teaching hospital, in particular identifying the differences between subgroups of reporters, to assess factors that may influence the discrepancy rates, to examine the pathologies with the highest discrepancy rate, to identify learning points, and give recommendations on current practice. MATERIALS AND METHODS: The surgical data and CT reports of 1,176 patients who underwent urgent laparotomy after CT from 2014-2018 in a large university hospital were analysed retrospectively. A major discrepancy was defined as an error of fact in the radiology report, which led to incorrect management or patient harm. RESULTS: Registrars have higher DR than consultants (6.86% versus 2.77%). The major DR for consultants met national standards (<5%). The major DRs for registrars met the national audit standard (<10%), but not the National Emergency Laparotomy Audit (NELA) standard (<5%). When comparing between reporter subgroups, gastrointestinal (GI) radiologists have a lower major DR than general radiologists (1.22% versus 3.44%). GI radiologists were also found to correct more registrar provisional reports. The existence of a documented preoperative discussion between radiologists and surgeons was associated with a lower DR. CONCLUSIONS: DR for registrars and consultants are below the national audit standard. Several factors associated with a lower DR in acute abdominopelvic CT were also identified, including reporting by consultants, reporting by GI radiologists and preoperative discussions between the radiologist and surgeon.

Can subcentimetre ultrasound detected angiomyolipomas be safely disregarded?

AIM: To optimise follow-up by dismissing lesions on baseline ultrasound (US) if renal lesions conform to US criteria of an angiomyolipoma (AML). METHOD AND MATERIALS: The present study was a 10-year retrospective review of patients who were found to have incidental hyperechoic renal lesions on US to ascertain the outcome from subsequent imaging, clinical encounters, and cancer registrations. Exclusions included renal calculi, tuberous sclerosis, Von-Hippel-Lindau, or a known cancer. RESULTS: After excluding 39 patients, 1,493 patients were identified. One hundred and sixty had more than one lesion with 87 patients having bilateral lesions. Regardless of indication, 889 patients had subsequent imaging within 5 years (59.5%). The average size of all AMLs was 13.2 mm. In the group with lesions that were <10 mm (807), 438 had imaging follow-up with an average follow-up time of 1.5 years. Mean lesion size in this group was 7 mm, with an average increase of <0.5 mm on follow-up. No lesions were found to be malignant on subsequent imaging nor did any of these patients have a subsequent renal cancer diagnosis registered at local multidisciplinary team meetings. CONCLUSION: No incidental subcentimetre hyperechoic renal lesion with imaging characteristics of an AML demonstrated significant growth or developed into a malignancy on follow-up.

Predictors for 30-day mortality and complications following radiologically inserted gastrostomies: a single centre, large cohort review.

AIM: To measure the 30-day mortality and delayed complication rates following radiologically inserted gastrostomy (RIG) placement and determine the predictive risk factors for 30-day mortality and delayed complications to aide pre-procedure informed consent. MATERIALS AND METHODS: Retrospective analysis was undertaken of RIG insertions between July 2012 and August 2017 at a single tertiary centre, which included 373 patients (56% male; median age: 65 years, range: 19-92 years). Data were collected from electronic databases on patient demographics, RIG indication, all-cause mortality, complication rates, patient co-morbidities, and biochemical/haematological parameters. Multivariate analysis was performed to identify predictive risk factors for complications and mortality. RESULTS: The RIG procedural success rate was 97.9%. The overall 30-day mortality rate was 7.8%; associated with pre-procedural haemoglobin <130 g/l in men (p=0.030, odds ratio [OR] 23.38), white cell count >11×109/l (p=0.001, OR 4.18), C-reactive protein >10 mg/l (p=0.003, OR 10.10) and international normalised ratio (INR) >1.2 (p=0.03, OR 4.63). Inpatient RIG referrals were associated with 10% 30-day mortality; compared to 1.1% for outpatients (p=0.028, OR 9.51). The incidence of immediate and delayed complications was 2.4% and 42.1%, respectively. Neuromuscular disease was associated with gastrostomy dislodgement (p=0.0001, OR 4.99) and fracture (p=0.0009, OR 13.45), cerebrovascular disease with gastrostomy dislodgement (p=0.009, OR 2.51), cardiovascular disease with sepsis 30-days post-RIG (p=0.02, OR 2.94), and diabetes mellitus with gastrostomy dislodgement (p=0.0001, OR 29.45), fracture (p=0.027, OR 5.63) and stoma site infections (p=0.0003, OR 7.16). CONCLUSION: RIG 30-day mortality was significantly associated with inpatient procedures compared to outpatient, and a range of biochemical/haematological parameters that suggest infection pre-intervention. It is advised that the markers of infection and catabolism are investigated pre-intervention, which may reduce mortality and complication rates.

Rapidly progressive amyotrophic lateral sclerosis is associated with microglial reactivity and small heat shock protein expression in reactive astrocytes.

AIMS: Amyotrophic lateral sclerosis (ALS) is a chronic neurodegenerative disease characterized by progressive loss of motor neurons, muscle weakness, spasticity, paralysis and death usually within 2-5 years of onset. Neuroinflammation is a hallmark of ALS pathology characterized by activation of glial cells, which respond by upregulating small heat shock proteins (HSPBs), but the exact underlying pathological mechanisms are still largely unknown. Here, we investigated the association between ALS disease duration, lower motor neuron loss, TARDNA-binding protein 43 (TDP-43) pathology, neuroinflammation and HSPB expression. METHODS: With immunohistochemistry, we examined HSPB1, HSPB5, HSPB6, HSPB8 and HSP16.2 expression in cervical, thoracic and sacral spinal cord regions in 12 ALS cases, seven with short disease duration (SDD), five with moderate disease duration (MDD), and ten age-matched controls. Expression was quantified using ImageJ to examine HSP expression, motor neuron numbers, microglial and astrocyte density and phosphorylated TDP-43 (pTDP-43+) inclusions. RESULTS: SDD was associated with elevated HSPB5 and 8 expression in lateral tract astrocytes, while HSP16.2 expression was increased in astrocytes in MDD cases. SDD cases had higher numbers of motor neurons and microglial activation than MDD cases, but similar levels of motor neurons with pTDP-43+ inclusions. CONCLUSIONS: Increased expression of several HSPBs in lateral column astrocytes suggests that astrocytes play a role in the pathogenesis of ALS. SDD is associated with increased microgliosis, HSPB5 and 8 expression in astrocytes, and only minor changes in motor neuron loss. This suggests that the interaction between motor neurons, microglia and astrocytes determines neuronal fate and functional decline in ALS.

Optimising MRI small bowel techniques.

Magnetic resonance imaging (MRI)-based techniques have emerged as the preferred technique for the diagnostic evaluation of the small intestine, particularly in the adult population. The lack of ionising radiation makes MRI ideal for use in younger patients or in cases that require repeated follow-up investigations. Imaging of the small intestine may be carried out using the intubation (enteroclysis) or the ingestion (enterography) techniques. Enterography examinations are more acceptable to patients and may provide similar diagnostic accuracy compared to intubation methods. In this review, methods of improving and optimising MRI of the small intestine are described.

On the Stability of Reported Pregnancy Intentions from Pregnancy to 1 Year Postnatally: Impact of Choice of Measure, Timing of Assessment, Women's Characteristics and Outcome of Pregnancy.

OBJECTIVES: Retrospective, cross-sectional estimates of pregnancy intention, as used in the Demographic Health Survey (DHS), are the global norm. The London Measure of Unplanned Pregnancy (LMUP) is a newer, psychometrically validated measure which may be more reliable. This paper assesses the reliability of the LMUP and the DHS question over the first postnatal year and explores the effects of maternal characteristics or pregnancy outcome on reported pregnancy intention. METHODS: We compared the test-retest reliability of the LMUP (using the AC coefficient) and DHS question (using the weighted Kappa) over the first postnatal year using data from Malawian women. We investigated the effect of maternal characteristics and pregnancy outcome using t-tests, Chi squared or Fisher's exact tests, and calculated odds ratios to estimate effect size. RESULTS: The DHS question was associated with a statistically significant decrease in the prevalence of unplanned pregnancies from 1-to-12 months postnatally; the LMUP was not. The LMUP had moderate to substantial reliability (0.51-0.66); the DHS had moderate reliability (0.56-0.58). The LMUP's stability was not related to any of the factors examined; the stability of the DHS varied by marital status (p = 0.033), number of children (p = 0.048) and postnatal depression (p < 0.001). Both underestimated unintended pregnancy postnatally vis-à-vis the LMUP in pregnancy. CONCLUSIONS FOR PRACTICE: The LMUP is a more reliable measure of pregnancy intention than the DHS in the first postnatal year and does not vary by maternal characteristics or pregnancy outcome. The LMUP should become the gold-standard for measuring pregnancy intention and should be collected in pregnancy or at the first postnatal opportunity.

A retrospective review of registrar out-of-hours reporting in a university hospital: the effect of time and seniority on discrepancy rates.

AIM: To assess the influence of time, intensity, and trainee seniority on radiology registrars' major and minor discrepancy rates during weekend reporting at a university teaching hospital. MATERIALS AND METHODS: A 12-month retrospective review was performed of out-of-hours trainee provisional reports for computed tomography (CT) and magnetic resonance imaging (MRI) in a university teaching hospital. From Friday 9.00 pm to Sunday 9.00 pm, the out-of-hours service is provided by a single registrar rotating every 12 hours. A busy shift was defined as more than 24 reports issued during the shift. A senior trainee was defined as having more than 2 years' experience on the on-call rota. Reports were compared to subsequent subspecialist consultant review with all discrepancies collected. Discrepancy rates were calculated for junior/senior registrars, time of shift, and for busy/less busy shifts. RESULTS: The total discrepancy rate was 11.1%, with a major discrepancy rate of 3%. Junior registrars had a lower total discrepancy rate (9.7% versus 12.2%, p=0.0065). Although there was no difference between major discrepancies, junior trainees made fewer minor discrepancies (7.1% versus 8.93%, p=0.03). The discrepancy rate was higher at night (12.3% versus 10.4%, p=0.0418). On a less busy shift, more discrepancies were made (12.8% versus 10%, p=0.0001). CONCLUSION: The major discrepancy rate of trainees is low. More discrepancies are made at night, and trainee seniority does not mitigate this problem. Night shifts are less busy in comparison to day shifts, which may explain why less busy shifts appear to yield more mistakes.

Straight-to-test faecal tagging CT colonography for exclusion of colon cancer in symptomatic patients under the English 2-week-wait cancer investigation pathway: a service review.

AIM: To present the initial 12 months of data of a straight-to-test (STT) computed tomography colonography (CTC) protocol as the first-line investigation for change in bowel habit (CIBH) and iron deficiency anaemia (IDA) in patients over 60 referred directly from primary care. MATERIALS AND METHODS: In 12 months, 1,792 STT CTC for IDA and CIBH were performed. No colonoscopies were performed as the primary investigation in this cohort. Data from this cohort were gathered prospectively. RESULTS: The colorectal cancer (CRC) detection rate was 4.9% and polyp detection rate was 13.5%. The CRC rate increased related to age (p=0.001), the CRC detection rate was 2.6% in patients aged 60-69 years, compared to 4.9%, 7.4%, and 11.4% in the 70-79, 80-89, and >90 years age groups. The CRC rate was higher in patients with IDA compared to CIBH (6.8% versus 3.9%, p=0.017). There were significantly more left-sided cancers (p=0.0165). Non-colonic cancers were found in 4.3% of patients and 6.8% had incidental findings that required further investigation and 11.9% had a new, potentially significant, incidental finding. CONCLUSION: These results are comparable to colonoscopy in terms of diagnostic accuracy and similar to those of CTC in published multicentre trials. This exciting model of care within radiology enables earlier testing, reduces waiting times, with fewer outpatient appointments, and results in good clinician and patient satisfaction.

Changes in hardness and resilience of i-gelTM cuffs with temperature: a benchtop study.

The i-gelTM is a supraglottic airway with a gel-like thermoplastic cuff. It has been suggested that the seal around the larynx improves following insertion. Perhaps the most intuitive hypothesis proposed for this is that cuff softening occurs during warming from ambient to body temperature. We investigated this using a food industry texture analyser over a wide temperature range. Size 2 and 3 i-gels were secured to a platform within a temperature-controlled water bath, which was in turn mounted on a texture analyser test stand. Both water and i-gel cuff temperatures were recorded. A spherical probe was advanced 4 mm into the surface of each i-gel at a rate of 1 mm.s-1 , then retracted at the same rate while the upward pressure on the probe was recorded. Three runs made at each of the 11 temperatures (10 °C to 60 °C, 5 °C increments) gave 105,864 data points, from which values for hardness (the peak force on the probe at maximum indentation), and resilience (the rate at which the material recovers its original shape) were calculated. Over 10 to 60 °C, the smallest hardness value expressed as a proportion of the largest was 88.2% and 89.8% for size 2 and 3 i-gels, respectively, and for resilience these were 92.8% and 86.2%, respectively. Over room temperature to body temperature range (21-37.4 °C), hardness decreased by 3.15% and increased by 0.47% for i-gel sizes 2 and 3, respectively, whereas resilience values decreased by 1.85% and 2.68%, respectively. Cuff hardness and resilience did generally reduce with warming, but the effect was minimal over temperature ranges that may be encountered during clinical use.

Assessment of the inferior mesenteric vein diameter as a surrogate marker to evaluate response to neoadjuvant chemoradiotherapy for locally advanced rectal adenocarcinoma.

AIM: Neoadjuvant chemoradiotherapy for locally advanced rectal cancer aims to downstage prior to definitive management. Repeat imaging assessment of the tumour post-therapy has implications for treatment. Our aim was to assess if the inferior mesenteric vein (IMV) diameter measured on CT can be used as a surrogate marker for evaluation of tumour response to neoadjuvant treatment. METHOD: IMV diameter was assessed in patients with and without locally advanced rectal cancer, pre- and post-radiotherapy, to ascertain if IMV diameter is a surrogate marker of tumour response. RESULTS: IMV diameter was 5.9 mm in patients with rectal cancer vs 4.7 mm in patients without (P = 0.0001). The baseline IMV diameter was significantly higher for cases with local lymphadenopathy [N0 5.2 mm vs N1/2 6 mm (P = 0.0059)] and extramural venous invasion (EMVI) [negative 5.4 mm vs positive 6.4 mm (P = 0.0001)]. Post-radiotherapy there was a significant decrease in the IMV diameter in cases with treatment response compared to non-responders: the percentage change in IMV diameter was a 17.54% decrease vs 1.39% increase (P = 0.0001). These results were reproduced on comparing between magnetic resonance tumour regression grades using ANOVA (P = 0.0001). There was also a significant decrease in IMV diameter when assessing lymph node (LN) and EMVI response vs non-responders (P = 0.0001 and 0.0001 respectively). CONCLUSION: Patients with rectal cancer have a dilated IMV compared with patients without rectal cancer. We confirm that IMV diameter is a potential surrogate marker of LN status and EMVI at baseline. IMV diameter is also a marker of tumour, LN and EMVI response to chemoradiotherapy.

Open access follow-up care for early breast cancer: a randomised controlled quality of life analysis.

This study evaluated the acceptability of a supportive model of follow-up. One hundred and twelve women recovering from breast cancer were randomised to receive standard breast clinic aftercare (Control n = 56) or on demand by open access aftercare by breast care nurses (Intervention n = 56). Participants attended a support-based psycho-educational programme delivered in four half-day group sessions. Three quality of life questionnaires (EORTC QLQ-C30, QLQ-BR23, HADS) were administered at baseline and 6-monthly intervals for 2 years. Multilevel linear regression modelling methods were used for evaluation. Age was found to be a statistically significant predictor of quality of life in several sub-scales. Increasing age was negatively associated with sexual functioning, systematic therapy side effects and physical functioning, and positively associated with future perspective. Aftercare assignment was not found to be a statistically significant predictor. Women treated for early breast cancer were not disadvantaged by allocation to the open access supportive care model in terms of quality of life experienced. The model for follow-up was demonstrated to be a feasible alternative to routinised hospital-based follow-up and adds to the evidence for stratified follow-up for low-risk cancer patients, incorporating self-management education. Stratified follow-up pathways are viewed as a preferable approach.

The Task and Relational Dimensions of Online Social Support.

Online support groups are attractive to individuals suffering from various types of mental and physical illness due to their accessibility, convenience, and comfort level. Individuals coping with depression, in particular, may seek social support online to avoid the stigma that accompanies face-to-face support groups. We explored how task and relational messages created social support in online depression support groups using Cutrona and Suhr's social support coding scheme and Bales's Interaction Process Analysis coding scheme. A content analysis revealed emotional support as the most common type of social support within the group, although the majority of messages were task rather than relational. Informational support consisted primarily of task messages, whereas network and esteem support were primarily relational messages. Specific types of task and relational messages were associated with different support types. Results indicate task messages dominated online depression support groups, suggesting the individuals who participate in these groups are interested in solving problems but may also experience emotional support when their uncertainty is reduced via task messages.

Exploring pressures, tissue reperfusion and body positioning: a pilot evaluation.

OBJECTIVE: To assess the relationship in healthy adults and critically ill patients between: patient position, body mass index (BMI), patient body temperature, interface pressure (IP) and tissue reperfusion (TR). Also to determine the relationship in critically ill patients between: Sequential Organ Failure Assessment (SOFA) score, Braden Scale score for predicting pressure injury risk, Acute Physiology and Chronic Health Evaluation II (APACHE II) severity of disease classification score, IP and TR. METHODS: This study took place in a 27-bed intensive care unit (ICU) of an Australian tertiary hospital. IP and TR outcomes were measured at the sacrum and greater trochanter. Repeated measures analyses of variance (ANOVAs) and doubly multivariate repeated measures ANOVAs were conducted using peak pressure index (PPI), peak time (PT), settled time constant (STC) and normalised hyperaemic area (NHA) measures of TR as outcomes. Participant type, body mass index (BMI), Braden and APACHE II scores and patient body temperature were considered as between-groups factors and covariates. RESULTS: We recruited 23 low- and high-acuity ICU patients and nine healthy adult volunteers. Not all IP readings could be obtained from ICU patients. TR readings were collected from all recruited patients, but not all TR measurements were mutually uncorrelated. Controlling for age, PPI readings differed between participant types (p=0.093), with the highest values associated with high-acuity patients and the lowest with healthy adults; the association was not substantive when controlling for age and BMI. Age was a significant variable (p=0.008), with older participants having higher scores than younger ones. No statistically significant associations between any measured parameter and TR variables were observed. However, temperature was revealed to be related to TR (p=0.091). CONCLUSIONS: Although not powered to detect significant effects, this pilot analysis has determined several associations of importance, with differences in outcomes observed between low- and high-acuity ICU patients; and between ICU patients and healthy volunteers.