Short-term clinical and manometric outcomes of percutaneous tibial nerve stimulation for faecal incontinence: a large single-centre series.

BACKGROUND: Faecal incontinence (FI) is common, with a significant impact on quality of life. Percutaneous tibial nerve stimulation (PTNS) is a therapy for FI; however, its role has recently been questioned. Here we report the short-term clinical and manometric outcomes in a large tertiary centre. METHODS: A retrospective review of a prospective PTNS database was performed, extracting patient-reported FI outcome measures including bowel diary, the St Marks's Incontinence Score (SMIS) and Manchester Health Questionnaire (MHQ). Successful treatment was > 50% improvement in symptoms, whilst a partial response was 25-50% improvement. High-resolution anorectal manometry (HRAM) results before and after PTNS were recorded. RESULTS: Data were available from 135 patients [119 (88%) females; median age: 60 years (range: 27-82years)]. Overall, patients reported a reduction in urge FI (2.5-1) and passive FI episodes (2-1.5; p < 0.05) alongside a reduction in SMIS (16.5-14) and MHQ (517.5-460.0; p < 0.001). Some 76 (56%) patients reported success, whilst a further 20 (15%) reported a partial response. There were statistically significant reductions in rectal balloon thresholds and an increase in incremental squeeze pressure; however, these changes were independent of treatment success. CONCLUSION: Patients report PTNS improves FI symptoms in the short term. Despite this improvement, changes in HRAM parameters were independent of this success. HRAM may be unable to measure the clinical effect of PTNS, or there remains the possibility of a placebo effect. Further work is required to define the role of PTNS in the treatment of FI.

Factors associated with intensity of technology adoption and with the adoption of 4 clusters of precision livestock farming technologies in Irish pasture-based dairy systems.

Precision livestock farming (PLF) technologies have been widely promoted as important tools to improve the sustainability of dairy systems due to perceived economic, social, and environmental benefits. However, there is still limited information about the level of adoption of PLF technologies (percentage of farms with a PLF technology) and the factors (farm and farmer characteristics) associated with PLF technology adoption in pasture-based dairy systems. The current research aimed to address this knowledge gap by using a representative survey of Irish pasture-based dairy farms from 2018. First, we established the levels of adoption of 9 PLF technologies (individual cow activity sensors, rising plate meters, automatic washers, automatic cluster removers, automatic calf feeders, automatic parlor feeders, automatic drafting gates, milk meters, and a grassland management decision-support tool) and grouped them into 4 PLF technology clusters according to the level of association with each other and the area of dairy farm management in which they are used. The PLF technology clusters were reproductive management technologies, grass management technologies, milking management technologies, and calf management technologies. Additionally, we classified farms into 3 categories of intensity of technology adoption based on the number of PLF technologies they have adopted (nonadoption, low intensity of adoption, and high intensity of adoption). Second, we determined the factors associated with the intensity of technology adoption and with the adoption of the PLF technology clusters. A multinomial logistic regression model and 4 logistic regressions were used to determine the factors associated with intensity of adoption (low and high intensity of adoption compared with nonadoption) and with the adoption of the 4 PLF technology clusters, respectively. Adoption levels varied depending on PLF technology, with the most adopted PLF technologies being those related to the milking process (e.g., automatic parlor feeders and milk meters). The results of the multinomial logistic regression suggest that herd size, proportion of hired labor, agricultural education, and discussion group membership were positively associated with a high intensity of adoption, whereas age of farmer and number of household members were negatively associated with high intensity of adoption. However, when analyzing PLF technology clusters, the magnitude and direction of the influence of the factors in technology adoption varied depending on the PLF technology cluster being investigated. By identifying the PLF technologies in which pasture-based dairy farmers are investing more and by detecting potential drivers and barriers for the adoption of PLF technologies, the current study could allow PLF technology companies, practitioners, and researchers to develop and target strategies that improve future adoption of PLF technologies in pasture-based dairy settings.

Modeling the economic impacts of mobility scores in dairy cows under Irish spring pasture-based management.

Moderate to severe forms of suboptimal mobility on dairy cows are associated with yield losses, whereas mild forms of suboptimal mobility are associated with elevated somatic cell count and an increased risk to be culled. Although the economic consequences of severe forms of suboptimal mobility (also referred as clinical lameness) have been studied extensively, the mild forms are generally ignored. Therefore, the aim of the current study was to determine the economic consequences associated with varying prevalence and forms of suboptimal mobility within spring calving, pasture-based dairy herds. A new submodel predicting mobility scores was developed and integrated within an existing pastured-based herd dynamic model. Using a daily timestep, this model simulates claw disorders, and the consequent mobility score of individual cows. The impact of a cow having varying forms of suboptimal mobility on production and reproduction was simulated. The economic impact was simulated including treatment costs, as well as the production and reproductive impacts of varying levels of suboptimal mobility. Furthermore, different genetic predispositions for mobility issues and their interaction with herd-level management associated with each level of suboptimal mobility were simulated. Overall, 13 scenarios were simulated, representing a typical spring calving, pasture-based dairy herd with 100 cows. The first scenario represents a perfect herd wherein 100% of the cows had mobility score 0 (optimal mobility) throughout the lactation. The remaining 12 scenarios represent a combination of (1) 3 different herd-management levels, and (2) 4 different levels of a genetic predisposition for suboptimal mobility. The analysis showed that a 17% decrease in farm net profit was achieved in the worst outcome (wherein just 5% of the herd had optimal mobility) compared with the perfect herd. This was due to reduced milk yield, increased culling, and increased treatment costs for mobility issues compared the ideal scenario.

The One Minute Preceptor: A Vital Tool During COVID-19.

The One Minute Preceptor (OMP) model of teaching has an important role to play during the COVID-19 pandemic. It's quick and easy to learn and can be applied to any clinical setting. By responding directly to a student's needs, and building on the knowledge they already hold, the OMP is able to offer relevant and opportunistic teaching that the learner can immediately apply. Finally, the OMP can be taught in under two hours meaning medical staff not used to regularly teaching can develop the confidence to offer high quality educational interventions.

Transitioning from cerebrospinal fluid to blood tests to facilitate diagnosis and disease monitoring in Alzheimer's disease.

Alzheimer's disease (AD) is increasingly prevalent worldwide, and disease-modifying treatments may soon be at hand; hence, now, more than ever, there is a need to develop techniques that allow earlier and more secure diagnosis. Current biomarker-based guidelines for AD diagnosis, which have replaced the historical symptom-based guidelines, rely heavily on neuroimaging and cerebrospinal fluid (CSF) sampling. While these have greatly improved the diagnostic accuracy of AD pathophysiology, they are less practical for application in primary care, population-based and epidemiological settings, or where resources are limited. In contrast, blood is a more accessible and cost-effective source of biomarkers in AD. In this review paper, using the recently proposed amyloid, tau and neurodegeneration [AT(N)] criteria as a framework towards a biological definition of AD, we discuss recent advances in biofluid-based biomarkers, with a particular emphasis on those with potential to be translated into blood-based biomarkers. We provide an overview of the research conducted both in CSF and in blood to draw conclusions on biomarkers that show promise. Given the evidence collated in this review, plasma neurofilament light chain (N) and phosphorylated tau (p-tau; T) show particular potential for translation into clinical practice. However, p-tau requires more comparisons to be conducted between its various epitopes before conclusions can be made as to which one most robustly differentiates AD from non-AD dementias. Plasma amyloid beta (A) would prove invaluable as an early screening modality, but it requires very precise tests and robust pre-analytical protocols.

A scoping review of the detection, epidemiology and control of Cyclospora cayetanensis with an emphasis on produce, water and soil.

Cyclospora cayetanensis is a parasite causing cyclosporiasis (an illness in humans). Produce (fruits, vegetables, herbs), water and soil contaminated with C. cayetanensis have been implicated in human infection. The objective was to conduct a scoping review of primary research in English on the detection, epidemiology and control of C. cayetanensis with an emphasis on produce, water and soil. MEDLINE® (Web of ScienceTM), Agricola (ProQuest), CABI Global Health, and Food Science and Technology Abstracts (EBSCOhost) were searched from 1979 to February 2020. Of the 349 relevant primary research studies identified, there were 75 detection-method studies, 40 molecular characterisation studies, 38 studies of Cyclospora in the environment (33 prevalence studies, 10 studies of factors associated with environmental contamination), 246 human infection studies (212 prevalence/incidence studies, 32 outbreak studies, 60 studies of environmental factors associated with non-outbreak human infection) and eight control studies. There appears to be sufficient literature for a systematic review of prevalence and factors associated with human infection with C. cayetanensis. There is a dearth of publicly available detection-method studies in soil (n = 0) and water (n = 2), prevalence studies on soil (n = 1) and studies of the control of Cyclospora (particularly on produce prior to retail (n = 0)).

Work Based Assessments (WBAs) amongst UK medical trainees during the COVID-19 pandemic: How have we adapted?

Severe Acute Respiratory Syndrome Coronavirus type 2 (SARS-CoV-2) was recently identified as the RNA virus resulting in the Coronavirus disease (COVID-19). This was following cases of pneumonia identified in Hubei Province in China. The World Health Organisation (WHO) recently declared COVID-19 as a pandemic in March 2020. The COVID-19 pandemic has resulted in medical, financial and social disruption on an international scale. Such disruption has additionally impacted postgraduate medical training. This has been reflected in the attainment of Work Based Assessments amongst medical trainees in the United Kingdom.

Invited review: Cattle lameness detection with accelerometers.

Locomotion scoring is time consuming and is not commonly completed on farms. Farmers also underestimate their herds' lameness prevalence, a knowledge gap that impedes lameness management. Automation of lameness detection could address this knowledge gap and facilitate improved lameness management. The literature pertinent to adding lameness detection to accelerometers is reviewed in this paper. Options for lameness detection systems are examined including the choice of sensor, raw data collected, variables extracted, and statistical classification methods used. Two categories of variables derived from accelerometer-based systems are examined. These categories are behavior measures such as lying and measures of gait. For example, one measure of gait is the time a leg is swinging during a gait cycle. Some behavior-focused studies have reported accuracy levels of greater than 80%. Cow gait measures have been investigated to a lesser extent than behavior. However, classification accuracies as high as 91% using gait measures have been reported with hardware likely to be practical for commercial farms. The need for even higher accuracy and potential barriers to adoption are discussed. Significant progress is still required to realize a system with sufficient specificity and sensitivity. Lameness detection systems using 1 accelerometer per cow and a resolution lower than 100 Hz with gait measurement functions are suggested to balance cost and data requirements. However, gait measurement using accelerometers is rather underdeveloped. Therefore, a high priority should be given to the development of novel gait measures and testing their ability to differentiate lame from nonlame cows.

Associating mobility scores with production and reproductive performance in pasture-based dairy cows.

Lameness in dairy cows can have significant effects on cow welfare, farm profitability, and the environment. To determine the economic and environmental consequences of lameness, we first need to quantify its effect on performance. The objective of this study, therefore, was to determine the associations of various production and reproductive performance measurements (including milk, fat, and protein yield, somatic cell count, calving interval, cow death, or cow slaughter), and mobility scores in spring-calving, pasture-based dairy cows. We collected mobility scores (0 = good, 1 = imperfect, 2 = impaired, and 3 = severely impaired mobility), body condition scores, and production data for 11,116 cows from 68 pasture-based dairy herds. Linear mixed modeling was used to determine the associations between specific mobility scores and milk, fat and protein yield, and somatic cell count and calving interval. Binomial logistic regression was used to determine the association between mobility score and cow death, or slaughter. Significant yield losses of up to 1.4% of the average yield were associated with mobility score 2 and yield losses of up to 4.7% were associated with mobility score 3 during the early scoring period. Elevated somatic cell count was associated with all levels of suboptimal mobility during the late scoring period. Cows with a mobility score of 2 during the early scoring period were associated with longer calving interval length, whereas only cows with a mobility score of 3 during the late scoring period were associated with longer calving interval length. Cows with a mobility score ≥1 were more likely to be culled during both scoring periods. Our study, therefore, shows an association between specific mobility scores and production and reproductive performance in spring-calving, pasture-based dairy cows scored during the summer grazing period.

Maternal opioid use disorder at delivery hospitalization in a rural state: Maine, 2009-2018.

OBJECTIVES: A multistate analysis found Maine had the second highest average annual increase in maternal opioid use disorder (OUD) at delivery hospitalization during 1999-2012. The objective of our analysis was to estimate the prevalence, maternal characteristics, and geographic distribution of OUD at delivery hospitalization in Maine using recent state-level data. STUDY DESIGN: Serially collected cross-sectional population-based data. METHODS: We used diagnosis and procedure codes to identify deliveries among hospital discharges in Maine, 2009-2018 (n = 120,764), and to categorize deliveries according to the prevalence of maternal OUD and selected conditions. We assessed linear trends in OUD at delivery and calculated prevalence ratios (PR) for co-occurring maternal conditions. RESULTS: The prevalence of maternal OUD per 1000 deliveries in Maine increased from 22.7 in 2009 to 34.9 in 2018 (linear trend P value < 0.01), with a mean annual increase of 1.6 (95% confidence interval [CI]: 0.9 to 2.4). The following conditions were more prevalent among women with OUD at delivery: hepatitis C, PR = 45.8 (95% CI: 38.8 to 54.2); other drug abuse or dependence, PR = 16.8 (13.4 to 20.9); alcohol abuse and dependence, PR = 8.5 (5.8 to 12.5); nicotine use, PR = 6.0 (5.9 to 6.2); cannabis use, PR = 5.2 (4.6 to 5.9); anxiety, PR = 2.7 (2.5 to 3.2); and depression, PR = 2.7 (2.4 to 3.1). Women with OUD at delivery were also more likely to reside in small rural areas (27.3% vs 22.5%) and deliver in a hospital with a level III nursery (50.6% vs 34.9%). CONCLUSIONS: Maternal OUD now accounts for 1 in 29 deliveries in Maine and commonly occurs with other medical conditions. Prevention and treatment of OUD among reproductive age women in Maine remains needed.

Associating cow characteristics with mobility scores in pasture-based dairy cows.

The quality of dairy cow mobility can have significant welfare, economic, and environmental consequences that have yet to be extensively quantified for pasture-based systems. The objective of this study was to characterize mobility quality by examining associations between specific mobility scores, claw disorders (both the type and severity), body condition score (BCS), and cow parity. Data were collected for 6,927 cows from 52 pasture-based dairy herds, including mobility score (0 = optimal mobility; 1, 2, or 3 = increasing severities of suboptimal mobility), claw disorder type and severity, BCS, and cow parity. Multinomial logistic regression was used for analysis. The outcome variable was mobility score, and the predictor variables were BCS, type and severity of claw disorders, and cow parity. Three models were run, each with 1 reference category (mobility score 0, 1, or 2). Each model also included claw disorders (overgrown claw, sole hemorrhage, white line disease, sole ulcer, and digital dermatitis), BCS, and cow parity as predictor variables. The presence of most types of claw disorders had odds ratios >1, indicating an increased likelihood of a cow having suboptimal mobility. Low BCS (BCS <3.00) was associated with an increased risk of a cow having suboptimal mobility, and relatively higher parity was also associated with an increased risk of suboptimal mobility. These results confirm an association between claw disorders, BCS, cow parity, and dairy cow mobility score. Therefore, mobility score should be routinely practiced to identify cows with slight deviations from the optimal mobility pattern and to take preventive measures to keep the problem from worsening.

Interaction of preservation methods and radiation sterilization in human skin processing, with particular insight on the impact of the final water content and collagen disruption. Part I: process validation, water activity and collagen changes in tissues cryopreserved or processed using 50, 85 or 98% glycerol solutions.

Current regulatory requirements demand an in-depth understanding and validation of protocols used in tissue banking. The aim of this work was to characterize the quality of split thickness skin allografts cryopreserved or manufactured using highly concentrated solutions of glycerol (50, 85 or 98%), where tissue water activity (aw), histology and birefringence changes were chosen as parameters. Consistent aw outcomes validated the proposed processing protocols. While no significant changes in tissue quality were observed under bright-field microscopy or in collagen birefringence, in-process findings can be harnessed to fine-tune and optimize manufacturing outcomes in particular when further radiation sterilization is considered. Furthermore, exposing the tissues to 85% glycerol seems to derive the most efficient outcomes as far as aw and control of microbiological growth.

Expression patterns of HENMT1 and PIWIL1 in human testis: implications for transposon expression.

This study aimed to define the expression patterns of HENMT1 and PIWI proteins in human testis and investigate their association with transposon expression, infertility sub-type or development of testicular germ cell tumours (TGCTs). Testis biopsies showing normal spermatogenesis were used to identify normal localisation patterns of HENMT1 and PIWIL1 by immunolocalisation and RT-PCR after laser microdissection. 222 testis biopsies representing normal spermatogenesis, hypospermatogenesis, spermatogenic arrests, Sertoli cell-only (SCO) tumours and TGCTs were analysed by RT-qPCR for expression of HENMT1/PIWIL1/PIWIL2/PIWIL3/PIWIL4 and LINE-1 Additionally, HENMT1-overexpressing TCam2 seminoma cell lines were analysed for the same parameters by RT-qPCR. We found that HENMT1 and PIWIL1 are coexpressed in pachytene spermatocytes and spermatids. Expression of HENMT1, PIWIL1 and PIWIL2 was mainly dependent on germ cell content but low levels of expression were also detected in some SCO samples. Levels of HENMT1, PIWIL1 and PIWIL2 expression were low in TGCT. Samples with HENMT1, PIWIL2 and PIWIL4 expression showed significantly (P < 0.05) lower transposon expression compared to samples without expression in the same histological group. HENMT1-overexpressing TCam2 cells showed lower LINE-1 expression than empty vector-transfected control lines. Our findings support that the transposon-regulating function of the piRNA pathway found in the mouse is conserved in adult human testis. HENMT1 and PIWI proteins are expressed in a germ-cell-specific manner and required for transposon control.

Radiative Rotational Lifetimes and State-Resolved Relative Detachment Cross Sections from Photodetachment Thermometry of Molecular Anions in a Cryogenic Storage Ring.

Photodetachment thermometry on a beam of OH^{-} in a cryogenic storage ring cooled to below 10 K is carried out using two-dimensional frequency- and time-dependent photodetachment spectroscopy over 20 min of ion storage. In equilibrium with the low-level blackbody field, we find an effective radiative temperature near 15 K with about 90% of all ions in the rotational ground state. We measure the J=1 natural lifetime (about 193 s) and determine the OH^{-} rotational transition dipole moment with 1.5% uncertainty. We also measure rotationally dependent relative near-threshold photodetachment cross sections for photodetachment thermometry.

Permanent Childhood Hearing Impairment: Aetiological Evaluation of Infants identified through the Irish Newborn Hearing Screening Programme.

The Newborn Hearing Screening Programme (NHSP) was established in Cork University Maternity Hospital (CUMH) in April 2011. Between April 2011 and July 2014, 42 infants were identified with a Permanent Childhood Hearing Impairment (PCHI). Following this diagnosis, infants underwent a paediatric assessment according to recognised guidelines with the intention of identifying the underlying aetiology of the PCHI. The aim of this study was to assess the findings of this aetiological workup via retrospective chart review. PCHI data was obtained from the eSP database. This is a web based information system (eSP) used to track each baby through the screening and referral process A retrospective chart review of these patients was performed. Sixteen (38%) infants were diagnosed with a bilateral sensorineural hearing loss. Two infants had congenital CMV infection. A Connexin 26 gene mutation was detected in one infant. Two infants were diagnosed with Waardenburg syndrome, One with Pendred syndrome and one with Pfeiffer syndrome. Five babies underwent cochlear implantation. Through adherence to the recommended protocol a possible cause of PCHI may be determined. This study has identified areas of future improvement for this service in Ireland.

Impact of patient decision aids on appropriate and timely access to hip or knee arthroplasty for osteoarthritis: a randomized controlled trial.

OBJECTIVE: To evaluate the effectiveness of patient decision aids (PtDA) compared to usual education on appropriate and timely access to total joint arthroplasty in patients with osteoarthritis. METHOD: A randomized controlled trial (RCT) with patients undergoing orthopedic screening. Control and intervention arms received usual education; intervention arm also received a PtDA and a surgeon preference report. Wait times (primary outcome) were described using stratified Kaplan-Meier survival curves with patients censored at the time of death or loss to follow-up, and multivariable Cox proportional hazards regression. Secondary outcomes were compared using stratified Cochran-Mantel-Haenszel chi-squared tests. RESULTS: 343 patients were randomized to intervention (n = 174) or control (n = 169). The typical patient was 66 years old, retired, living with someone, and 51% had high school education or less. The intervention was associated with a trend towards reduction in wait time (hazard ratio (HR) 1.25, 95% confidence interval (CI) 0.99-1.60, P = 0.0653). Median wait times were 3 weeks shorter in intervention than in control at the community site with no difference at the academic site. Good decision quality was reached by 56.1% intervention and 44.5% control (Relative risk (RR) 1.25; 95% CI 1.00-1.56, P = 0.050). Surgery rates were 73.2% intervention and 80.5% controls (RR 0.91: 95% CI 0.81-1.03) with 12 intervention (7.3%) and eight control participants (4.9%) returning to have surgery within 2 years (P = 0.791). CONCLUSION: Compared to controls, decision aid recipients had shorter wait times at one site, fewer surgeries, and were more likely to reach good decision quality, but overall effect was not statistically significant. TRIALS REGISTRATION: The full trial protocol is available at ClinicalTrials.Gov (NCT00911638).

Photodissociation of an Internally Cold Beam of CH

We have studied the photodissociation of CH^{+} in the Cryogenic Storage Ring at ambient temperatures below 10 K. Owing to the extremely high vacuum of the cryogenic environment, we were able to store CH^{+} beams with a kinetic energy of ∼60 keV for several minutes. Using a pulsed laser, we observed Feshbach-type near-threshold photodissociation resonances for the rotational levels J=0-2 of CH^{+}, exclusively. In comparison to updated, state-of-the-art calculations, we find excellent agreement in the relative intensities of the resonances for a given J, and we can extract time-dependent level populations. Thus, we can monitor the spontaneous relaxation of CH^{+} to its lowest rotational states and demonstrate the preparation of an internally cold beam of molecular ions.

Comparison of the detection of periodontal pathogens in bacteraemia after tooth brushing by culture and molecular techniques.

BACKGROUND: The prevalence and amounts of periodontal pathogens detected in bacteraemia samples after tooth brushing-induced by means of four diagnostic technique, three based on culture and one in a molecular-based technique, have been compared in this study. MATERIAL AND METHODS: Blood samples were collected from thirty-six subjects with different periodontal status (17 were healthy, 10 with gingivitis and 9 with periodontitis) at baseline and 2 minutes after tooth brushing. Each sample was analyzed by three culture-based methods [direct anaerobic culturing (DAC), hemo-culture (BACTEC), and lysis-centrifugation (LC)] and one molecular-based technique [quantitative polymerase chain reaction (qPCR)]. With culture any bacterial isolate was detected and quantified, while with qPCR only Porphyromonas gingivalis and Aggregatibacter actinomycetemcomitans were detected and quantified. Descriptive analyses, ANOVA and Chi-squared tests, were performed. RESULTS: Neither BACTEC nor qPCR detected any type of bacteria in the blood samples. Only LC (2.7%) and DAC (8.3%) detected bacteraemia, although not in the same patients. Fusobacterium nucleatum was the most frequently detected bacterial species. CONCLUSIONS: The disparity in the results when the same samples were analyzed with four different microbiological detection methods highlights the need for a proper validation of the methodology to detect periodontal pathogens in bacteraemia samples, mainly when the presence of periodontal pathogens in blood samples after tooth brushing was very seldom.