Investigations, management and outcome of neonates presenting with distal intestinal obstruction: challenging the need for contrast enemas.

PURPOSE: To characterise the investigations, management and ultimate diagnosis of neonates with distal intestinal obstruction. METHODS: Retrospective review of term (> 37 weeks) neonates with admission diagnosis of distal intestinal obstruction over 10 years (2012-2022). Patient pathways were identified and associations between presentations, response to treatments and outcome investigated. RESULTS: A total of 124 neonates were identified and all included. Initial management was colonic irrigation in 108, contrast enema in 4, and laparotomy in 12. Of those responding to irrigations none underwent contrast enema. Ultimately, 22 neonates proceeded to laparotomy. Overall, 106 had a suction rectal biopsy and 41 had genetic testing for cystic fibrosis. Final diagnosis was Hirschsprung disease (HD) in 67, meconium ileus with cystic fibrosis (CF) in 9, meconium plug syndrome in 19 (including 3 with CF), intestinal atresia in 10 and no formal diagnosis in 17. Median length of neonatal unit stay was 11 days (7-19). CONCLUSIONS: Initial management of neonates with distal bowel obstruction should be colonic irrigation since this is therapeutic in the majority and significantly reduces the need for contrast enema. These infants should all have suction rectal biopsy to investigate for HD unless another diagnosis is evident. If a meconium plug is passed, testing for CF is recommended. Evaluation and therapy are multimodal and time consuming, placing burden on resources and families.

Uptake and engagement of a clinically moderated digital peer support platform to support the mental well-being older adults: a qualitative investigation.

BACKGROUND: The uptake of traditional mental health services among older adults remains low. Digital peer support offers older adults a resource for engaging with others to independently support their mental well-being. This qualitative study explored the uptake and engagement of a clinically moderated digital peer support platform (Breathing Space) for older adults with depressive symptoms and alcohol use concerns. METHODS: Semi-structured interviews with 30 participants aged 60-80 years explored participants' uptake and engagement with Breathing Space, a novel, moderated, private, and anonymous peer support platform. Data were analysed using reflective thematic analysis and are discussed with reference to the Unified Theory of Acceptance and Use of Technology2. RESULTS: Three themes were constructed to characterize participants' experiences: (i) navigating the complexities of peer-peer online engagement; (ii) the function of anonymity in online connection; and (iii) experiences of app features and content. CONCLUSIONS: Future development of digital peer support for older adults would benefit from the following: (i) co-design with older adults; (ii) providing choice over anonymity and increased options for interacting with peers; (iii) streamlining the basic functionality with popular platforms; (iv) providing options for users to curate their digital experience; and (v) providing telephone support for troubleshooting technical difficulties. Future research should explore the use of digital peer support among older adults who experience social exclusion challenges.

"It's Hard, but We Could Kind of Laugh About It": Exploring the Role of Humor in Brain Cancer Caregiving.

Research exploring the benefits of humor for caregivers is limited and, to date, no qualitative studies have explored the role of humor in brain cancer caregiving. To address this gap, we analyzed transcripts from twenty-one in-depth telephone interviews conducted with brain cancer caregivers from a strengths perspective. Thematic analysis using Braun and Clarke's method revealed that humor functions as (1) an innate element of the self and relationship, (2) an expression of mutual connection and understanding, (3) a way of managing difficult or awkward moments, (4) a form of avoidance or a welcome distraction, and may be (5) helpful, or unhelpful, depending on where someone is in the brain cancer trajectory. Findings suggest that humor represents an important yet complex individual and family strength for health service providers to identify and build upon.

Retrospective screening of routine respiratory samples revealed undetected community transmission and missed intervention opportunities for SARS-CoV-2 in the United Kingdom.

In the early phases of the SARS coronavirus type 2 (SARS-CoV-2) pandemic, testing focused on individuals fitting a strict case definition involving a limited set of symptoms together with an identified epidemiological risk, such as contact with an infected individual or travel to a high-risk area. To assess whether this impaired our ability to detect and control early introductions of the virus into the UK, we PCR-tested archival specimens collected on admission to a large UK teaching hospital who retrospectively were identified as having a clinical presentation compatible with COVID-19. In addition, we screened available archival specimens submitted for respiratory virus diagnosis, and dating back to early January 2020, for the presence of SARS-CoV-2 RNA. Our data provides evidence for widespread community circulation of SARS-CoV-2 in early February 2020 and into March that was undetected at the time due to restrictive case definitions informing testing policy. Genome sequence data showed that many of these early cases were infected with a distinct lineage of the virus. Sequences obtained from the first officially recorded case in Nottinghamshire - a traveller returning from Daegu, South Korea - also clustered with these early UK sequences suggesting acquisition of the virus occurred in the UK and not Daegu. Analysis of a larger sample of sequences obtained in the Nottinghamshire area revealed multiple viral introductions, mainly in late February and through March. These data highlight the importance of timely and extensive community testing to prevent future widespread transmission of the virus.

Theories Informing eHealth Implementation: Systematic Review and Typology Classification.

BACKGROUND: Theory-guided approaches to implementation science have informed translation efforts and the acceptance of eHealth (digital health) interventions in clinical care. However, there is scarce evidence on which theories are best suited to addressing the inherent complexity of eHealth implementation. OBJECTIVE: The objectives of this systematic review are to identify theories that inform and explain eHealth implementation and to classify these theories using the typology by Sovacool and Hess for theories of sociotechnical change. METHODS: An electronic search was conducted in the PsycINFO, MEDLINE, Embase, CINAHL, Scopus, Sociological Source Ultimate, Web of Science, ABI/INFORM, EBSCO, and ProQuest databases in June 2019. Studies were included if they were published between 2009 and June 2019; were written in English; reported on empirical research, regardless of study or publication type; reported on one or more theories in the context of eHealth implementation; and were published in a peer-reviewed journal. A total of 2 reviewers independently assessed the titles, abstracts, and full texts. Theories identified were classified using a typology for theories of sociotechnical change, which was considered a useful tool for ordering and analyzing the diverse theoretical approaches as a basis for future theory building. RESULTS: Of the 13,101 potentially relevant titles, 119 studies were included. The review identified 36 theories used to explain implementation approaches in eHealth. The most commonly used approaches were the Technology Acceptance Model (TAM) (n=33) and the Unified Theory of Acceptance and Use of Technology (UTAUT) (n=32). These theories were primarily concerned with individual and interpersonal elements of eHealth acceptance. Less common were theories that reflect the various disorderly social processes and structural dimensions of implementation, such as the normalization process theory (n=17) and the structuration theory (n=6). CONCLUSIONS: Theories currently informing the implementation of eHealth interventions predominantly focus on predicting or explaining end-user acceptance. Theoretical perspectives that capture the dense and intricate relationships and structures required to enact sustainable change are less well represented in the eHealth literature. Given the growing acknowledgment of the inherent complexity of eHealth implementation, future research should develop and test models that recognize and reflect the multidimensional, dynamic, and relational nature of this process.

Tropical Keratopathy (Florida Spots) in Cats.

The authors used microscopy and synchrotron-based small-angle X-ray scattering analysis (SAXS) to describe lesions macroscopically typical of tropical keratopathy ("Florida spots") from 6 cats on St Kitts. Microscopically, there were varying degrees of epithelial hyperplasia and thinning of the cornea (by 4% to 18%) due to loss of corneal stroma associated with dense accumulations of collagen in the superficial stroma. The collagen fibrils in lesions were wider and had more variable diameters (39.5 ± 5.0 nm, mean ± SD) than in normal corneas (25.9 ± 3.6 nm; P < .01). There were occasional vacuoles (<1 µm) in the corneal epithelial basement membrane but no evidence of inflammation, edema, stromal neovascularization, fibrosis, acid-fast organisms, or structures suggestive of a fungal organism. SAXS analysis showed collagen fibril diameters and variation in size were greater in stroma containing the lesions compared to normal corneas (48.8 ± 4.5 nm vs 35.5 ± 2.6; P < .05). The d-spacing of collagen in the stroma of lesions and normal corneas was the same, but the average orientation index of collagen in lesions was greater (0.428 ± 0.08 vs 0.285 ± 0.03; P < .05). A survey revealed Florida spots lesions were static over time and became less obvious in only 1 of 6 affected cats adopted on St Kitts and taken to areas in the US where lesions are not reported. An anterior stromal collagen disorder with various degrees of epithelial hyperplasia is the pathologic hallmark of lesions clinically identical to Florida spots in cats from St Kitts.

Artificially modified collagen fibril orientation affects leather tear strength.

BACKGROUND: Ovine leather has around half the tear strength of bovine leather and is therefore not suitable for high-value applications such as shoes. Tear strength has been correlated with the natural collagen fibril alignment (orientation index, OI). It is hypothesized that it could be possible to artificially increase the OI of the collagen fibrils and that an artificial increase in OI could increase tear strength. RESULTS: Ovine skins, after pickling and bating, were strained biaxially during chrome tanning. The strain ranged from 2 to 15% of the initial sample length, either uniformly in both directions by 10% or with 3% in one direction and 15% in the other. Once tanned, the leather tear strengths were measured and the collagen fibril orientation was measured using synchrotron-based small-angle X-ray scattering. CONCLUSION: The OI increased as a result of strain during tanning from 0.48 to 0.79 (P = 0.001) measured edge-on and the thickness-normalized tear strength increased from 27 to 43 N mm-1 (P < 0.001) after leather was strained 10% in two orthogonal directions. This is evidence to support a causal relationship between high OI (measured edge-on), highly influenced by thickness, and tear strength. It also provides a method to produce stronger leather. © 2017 Society of Chemical Industry.

Garment Therapy does not Improve Function in Children with Cerebral Palsy: A Systematic Review.

AIMS: To conduct a systematic review asking, does garment therapy improve motor function in children with cerebral palsy? METHODS: A systematic review with meta-analysis was conducted to review the literature. Inclusion criteria involved the wearing of therapy suits/garments in children with cerebral palsy. The primary outcome of interest was movement related function and secondary outcomes included impairment, participation, parental satisfaction and adverse outcomes of garment wear. RESULTS: 14 studies with 234 participants were included, of which 5 studies were included for meta-analysis. Garment therapy showed a nonsignificant effect on post-intervention function as measured by the Gross Motor Function Measure when compared to controls (MD = -1.9; 95% CI = -6.84, 3.05). Nonsignificant improvements in function were seen long-term (MD = -3.13; 95% CI = -7.57, 1.31). Garment therapy showed a significant improvement in proximal kinematics (MD = -5.02; 95% CI = -7.28, -2.76), however significant improvements were not demonstrated in distal kinematics (MD = -0.79; 95% CI = -3.08, 1.49). CONCLUSIONS: This review suggests garment therapy does not improve function in children with cerebral palsy. While garment therapy was shown to improve proximal stability, this benefit must be considered functionally and consider difficulties associated with garment use.

Contemporary retroperitoneal lymph node dissection (RPLND) for testis cancer in the UK - a national study.

OBJECTIVES: To undertake a comprehensive prospective national study of the outcomes of retroperitoneal lymph node dissection (RPLND) for testis cancer over a 1-year period in the UK. PATIENTS AND METHODS: Data were submitted online using the British Association of Urological Surgeons Section of Oncology Data and Audit System. All new patients undergoing RPLND for testis cancer between March 2012 and February 2013 were studied prospectively. Data were analysed using Tableau software and case ascertainment compared with Hospital Episode Statistics data. RESULTS: In all, 162 men underwent RPLND by 20 surgeons in 17 centres. The mean (range) case volume per centre was 9 (2-32) and the median (range) case volume per surgeon was 6 (1-30). Indications included: residual mass after chemotherapy (73%), primary treatment (6%), relapse (14%), and salvage (7%). The median time to surgery after chemotherapy was 8-12 weeks (<4 - >12 weeks) and 91% of procedures utilised open surgery. The median operating time was 3-4 h (<1.5 - >6 h). Nerve sparing was performed in 67% of patients (19% bilateral, 48% unilateral). The dissection was template in 81% and lumpectomy in 16%; 25% required additional intraoperative procedures including 11% synchronous planned nephrectomy. In all, 157/160 (98%) of recorded RPLND operations were completed. One was terminated due to bleeding and in two the mass could not be removed. There were no deaths within 30 days of surgery. In all, 75% of the men did not require a blood transfusion, 15% required 1-2 units and 10% received >2 units. There were postoperative complications in 10% of the men (Clavien-Dindo Grade I, seven men; Grade II, seven; and Grade III, one). The mean (range) length of stay was 5.5 (1-59) days. Histology showed necrosis in 22%; teratoma differentiated in 42%; and residual cancer in 36%. CONCLUSIONS: This prospective collaborative national study describes for the first time the surgical outcomes after RPLND across the UK. The quality of RPLND in the UK appears high. The study can act as a benchmark for this type of surgery across the world.

Deer leather: analysis of the microstructure affecting pebble.

BACKGROUND: Deer leather has a characteristic pattern, referred to as 'pebble', which is accorded such importance that a lack of it renders a leather defective. Synchrotron-based small-angle X-ray scattering (SAXS), ultrasonic imaging, scanning electron microscopy, and tear tests were used to investigate the structural characteristics of well-pebbled and poorly pebbled cervine leathers. RESULTS: Poorly pebbled leather has a less open structure in the upper grain region than well-pebbled leather. The orientation index (OI) of leather with a poor pebble is less than that of the well-pebbled leather, particularly in the corium. The tear strength is also less for the poorly pebbled leather. CONCLUSIONS: The differences in structure between well- and poorly pebbled cervine leathers are not the same as the structural differences between tight and loose bovine leathers, to which they are sometimes compared. On the contrary, good pebble may reflect an internal structure similar to that of looseness. It is hoped that methods to prevent a reduction in pebbling during the processing of cervine leather may be developed by applying this knowledge of cervine leather's structural characteristics. © 2017 Society of Chemical Industry.

A small angle X-ray scattering study of the structure and development of looseness in bovine hides and leather.

BACKGROUND: Some bovine hides produce poor quality leather, termed loose leather. The structural characteristics of hides and the intermediate processed stages that lead to loose leather are not well understood. In the present study, synchrotron-based small angle X-ray scattering (SAXS) is used to investigate collagen fibril orientation at the different stages of processing (i.e. from hide through to leather) that result in both tight and loose leathers. RESULTS: Tight leather of a relatively isotropic texture has a lower orientation index (OI) than loose leather of a more pronounced stratified texture; conversely, tight pickled hide and wet blue have a higher OI than loose pickled hide and wet blue. There is a greater increase in OI on processing from pickled hide to dry crust (leather) for loose material. This is largely the result of a greater increase in hide thickness prior to pickling for loose hide than tight hide, followed by a greater decrease at the dry crust stage. The collagen fibrils in loose leather and wet blue more readily orient under stress than do those in tight leather. Loose leather has a more pronounced layered structure than tight leather, although this difference is not apparent from SAXS measurements of hide prior to the dry crust stage; it develops during processing. CONCLUSION: The greater swelling of the loose hide during processing disrupts the structure and leads to a more layered collagen arrangement on shrinking at the final dry crust stage. © 2016 Society of Chemical Industry.

Looseness in bovine leather: microstructural characterization.

BACKGROUND: A substantial proportion of bovine leather production may be of poor quality, with the leather suffering from a characteristic known as looseness. This defect results in a poor visual appearance and greatly reduced value. The structural mechanism of looseness is not well understood. RESULTS: Samples of loose and tight bovine leather are characterized using small-angle X-ray scattering, ultrasonic imaging, and electron microscopy. The density of fibre packing and orientation of the fibrils are analysed. Tensile strength is also measured. Loose leather is characterized by more highly aligned collagen fibrils. This results in a weaker connection between the layers. There is a looser packing of the fibres in loose leather than in tight leather, with more gaps between fibre bundles, particularly in a region in the lower grain. This region is visible with in situ ultrasonic imaging. Loose leather has a higher tensile strength than tight leather. CONCLUSION: While a high degree of collagen fibril alignment is normally associated with strong leather, it has been shown that too much alignment results in loose leather. Understanding the physical basis of looseness is the first step in identifying looseness in hides and learning how to prevent looseness from developing during leather manufacture. © 2015 Society of Chemical Industry.

Penile Dysmorphic Disorder: Development of a Screening Scale.

Penile dysmorphic disorder (PDD) is shorthand for men diagnosed with body dysmorphic disorder, in whom the size or shape of the penis is their main, if not their exclusive, preoccupation causing significant shame or handicap. There are no specific measures for identifying men with PDD compared to men who are anxious about the size of their penis but do not have PDD. Such a measure might be helpful for treatment planning, reducing unrealistic expectations, and measuring outcome after any psychological or physical intervention. Our aim was, therefore, to validate a specific measure, termed the Cosmetic Procedure Screening Scale for PDD (COPS-P). Eighty-one male participants were divided into three groups: a PDD group (n = 21), a small penis anxiety group (n = 37), and a control group (n = 23). All participants completed the COPS-P as well as standardized measures of depression, anxiety, social phobia, body image, quality of life, and erectile function. Penis size was also measured. The final COPS-P was based on nine items. The scale had good internal reliability and significant convergent validity with measures of related constructs. It discriminated between the PDD group, the small penis anxiety group, and the control group. This is the first study to develop a scale able to discriminate between those with PDD and men anxious about their size who did not have PDD. Clinicians and researchers may use the scale as part of an assessment for men presenting with anxiety about penis size and as an audit or outcome measure after any intervention for this population.

Implant Texture and Capsular Contracture: A Review of Cellular and Molecular Pathways.

Background: Capsular contracture (CC) is a leading cause of morbidity in implant-based breast surgery. Implant surface texture has been implicated in CC development, yet its etiopathogenesis remains unclear. We conducted a systematic review to determine the influence of implant surface texture on cellular and molecular mechanisms involved in the etiopathogenesis of CC. Methods: A systematic review of the MEDLINE, Embase, Web of Science, and Scopus databases was completed to examine the influence of implant texture on cellular and molecular pathways leading to CC. Excluded articles were reviews and those examining solely the clinical presentation of CC. Results: Development of CC includes prolonged inflammation, increased myofibroblast density, parallel arrangement of collagen fibers, and biofilm formation. When compared with textured implants, smooth implants are associated with reduction in parallel collagen, capsule thickness, and sheer frictional force. Microtextured implants trigger a reduced macrophage response and decreased fibroblast activation as compared with smooth and macrotextured surfaces. Bacterial counts on microtextured and smooth surfaces are significantly lower than that of macrotextured surfaces. Both micro- and macrotextured implants have increased matrix metalloproteinases and activation of tumor necrosis factor α pathway, with increased activation of the transforming growth factor ß1 pathway relative to smooth implants. Conclusions: Implant surface texture alters the cellular and molecular mechanisms in the chronic inflammatory process leading to CC. Given the complex biological system of cellular and molecular events in CC, a mathematical model integrating these influences may be optimal to deduce the etiopathogenesis.

Living with Stress: A Lesson from the Enteric Pathogen Salmonella enterica.

The ability to sense and respond to the environment is essential for the survival of all living organisms. Bacterial pathogens such as Salmonella enterica are of particular interest due to their ability to sense and adapt to the diverse range of conditions they encounter, both in vivo and in environmental reservoirs. During this cycling from host to non-host environments, Salmonella encounter a variety of environmental insults ranging from temperature fluctuations, nutrient availability and changes in osmolarity, to the presence of antimicrobial peptides and reactive oxygen/nitrogen species. Such fluctuating conditions impact on various areas of bacterial physiology including virulence, growth and antimicrobial resistance. A key component of the success of any bacterial pathogen is the ability to recognize and mount a suitable response to the discrete chemical and physical stresses elicited by the host. Such responses occur through a coordinated and complex programme of gene expression and protein activity, involving a range of transcriptional regulators, sigma factors and two component regulatory systems. This review briefly outlines the various stresses encountered throughout the Salmonella life cycle and the repertoire of regulatory responses with which Salmonella counters. In particular, how these Gram-negative bacteria are able to alleviate disruption in periplasmic envelope homeostasis through a group of stress responses, known collectively as the Envelope Stress Responses, alongside the mechanisms used to overcome nitrosative stress, will be examined in more detail.

Structure and Strength of Bovine and Equine Amniotic Membrane.

Thin, strong scaffold materials are needed for surgical applications. New materials are required, particularly those readily available, such as from non-human sources. Bovine amniotic membrane (antepartum) and equine amniotic membrane (postpartum) were characterized with tear and tensile tests. The structural arrangement of the collagen fibrils was determined by small-angle X-ray scattering, scanning electron microscopy, and ultrasonic imaging. Bovine amnion had a thickness-normalized tear strength of 12.6 (3.8) N/mm, while equine amnion was 14.8 (5.3) N/mm. SAXS analysis of the collagen fibril arrangement yielded an orientation index of 0.587 (0.06) and 0.681 (0.05) for bovine and equine, respectively. This may indicate a relationship between more highly aligned collagen fibrils and greater strength, as seen in other materials. Amnion from bovine or equine sources are strong, thin, elastic materials, although weaker than other collagen tissue materials commonly used, that may find application in surgery as an alternative to material from human donors.

Collagen dehydration.

Type I collagen is a ubiquitous structural protein in animal tissues. It is normally present in a hydrated form. However, collagen is very dependent on associated water for its mechanical properties. In skin, where type I collagen is dominant, there is a longstanding concern that the skin and therefore collagen may partially dry out and result in structural degradation. Here we show that dehydration of type I collagen fibrils, using 2-propanol, results in a two-stage dehydration process. Initially, the fibrils do not change length, i.e. the D-period remains constant, but shrinkage occurs within the fibrils by an increase in the gap region and a decrease in the overlap region within a D-band and a shortening of the helical turn distance and fibril diameter. Only with further dehydration does the length of the collagen fibril decrease (a decrease in D-period). This mechanism explains why collagen materials are resistant to gross structural change in the early stages of dehydration and shows why they may then suffer from sudden external shrinkage with further dehydration.

Supporting friends and family of adults with a primary brain tumour: A systematic review.

Expanding on the limited work in supportive care for friends and family caregivers of adults with a primary brain tumour, this review sought to examine all available evidence since 2010 on the efficacy and feasibility of supportive interventions for this population including non-controlled studies. A systematic review of the literature was conducted on the feasibility and effectiveness/efficacy of supportive interventions for brain cancer caregivers in line with PRISMA guidelines. 13 studies met the eligibility criteria and were identified for inclusion. Most interventions employed tailored psychoeducation, and expert involvement via psychotherapy or care coordination. Only two interventions demonstrated clinically significant improvements. Findings indicate that dyadic yoga programs, and programs that enhance caregiver mastery to manage patient behavioural problems, may lead to improvements in some clinical outcomes. Results highlight the diverse nature of supportive interventions and indicate that support for primary brain tumour caregivers is currently suboptimal. Our findings illustrate an overall low certainty of evidence, with a need for more adequately powered randomised controlled trials. As the complexities of brain cancer care-giving are an obstacle to standardised interventions, this review underscores the need for future trials to incorporate complimentary qualitative research methodologies.

Human parainfluenza 2 & 4: Clinical and genetic epidemiology in the UK, 2013-2017, reveals distinct disease features and co-circulating genomic subtypes.

BACKGROUND: Human Parainfluenza viruses (HPIV) comprise of four members of the genetically distinct genera of Respirovirus (HPIV1&3) and Orthorubulavirus (HPIV2&4), causing significant upper and lower respiratory tract infections worldwide, particularly in children. However, despite frequent molecular diagnosis, they are frequently considered collectively or with HPIV4 overlooked entirely. We therefore investigated clinical and viral epidemiological distinctions of the relatively less prevalent Orthorubulaviruses HPIV2&4 at a regional UK hospital across four autumn/winter epidemic seasons. METHODS: A retrospective audit of clinical features of all HPIV2 or HPIV4 RT-PCR-positive patients, diagnosed between 1st September 2013 and 12th April 2017 was undertaken, alongside sequencing of viral genome fragments in a representative subset of samples. RESULTS: Infection was observed across all age groups, but predominantly in children under nine and adults over 40, with almost twice as many HPIV4 as HPIV2 cases. Fever, abnormal haematology, elevated C-reactive protein and hospital admission were more frequently seen in HPIV2 than HPIV4 infection. Each of the four seasonal peaks of either HPIV2, HPIV4 or both, closely matched that of RSV, occurring in November and December and preceding that of Influenza A. A subset of viruses were partially sequenced, indicating co-circulation of multiple subtypes of both HPIV2&4, but with little variation between each epidemic season or from limited global reference sequences. CONCLUSIONS: Despite being closest known genetic relatives, our data indicates a potential difference in associated disease between HPIV2 and HPIV4, with more hospitalisation seen in HPIV2 mono-infected individuals, but a greater overall number of HPIV4 cases.

Enterovirus D68 epidemic, UK, 2018, was caused by subclades B3 and D1, predominantly in children and adults, respectively, with both subclades exhibiting extensive genetic diversity.

Enterovirus D68 (EV-D68) has recently been identified in biennial epidemics coinciding with diagnoses of non-polio acute flaccid paralysis/myelitis (AFP/AFM). We investigated the prevalence, genetic relatedness and associated clinical features of EV-D68 in 193 EV-positive samples from 193 patients in late 2018, UK. EV-D68 was detected in 83 (58 %) of 143 confirmed EV-positive samples. Sequencing and phylogenetic analysis revealed extensive genetic diversity, split between subclades B3 (n=50) and D1 (n=33), suggesting epidemiologically unrelated infections. B3 predominated in children and younger adults, and D1 in older adults and the elderly (P=0.0009). Clinical presentation indicated causation or exacerbation of respiratory distress in 91.4 % of EV-D68-positive individuals, principally cough (75.3 %), shortness of breath (56.8 %), coryza (48.1 %), wheeze (46.9 %), supplemental oxygen required (46.9 %) and fever (38.9 %). Two cases of AFM were observed, one with EV-D68 detectable in the cerebrospinal fluid, but otherwise neurological symptoms were rarely reported (n=4). Both AFM cases and all additional instances of intensive care unit (ICU) admission (n=5) were seen in patients infected with EV-D68 subclade B3. However, due to the infrequency of severe infection in our cohort, statistical significance could not be assessed.