Coastal survey data for Perranporth Beach and Start Bay in southwest England (2006-2021).

Records of beach morphologic change and concurrent hydrodynamic forcing are needed to understand how coastlines in different environments change over time. This submission contains data for the period 2006 to 2021, for two contrasting macrotidal environments in southwest England: (i) cross-shore dominated, dissipative, sandy Perranporth Beach, Cornwall; and (ii) longshore-dominated, reflective gravel beaches within Start Bay, Devon. Data comprise monthly to annual beach profile surveys, annual merged topo-bathymetries, in addition to observed and numerically modelled wave and water levels. These data provide a valuable resource for modelling the behaviour of coastal types not covered by other currently available datasets.

Cue utilisation reduces the impact of response bias in histopathology.

Histopathologists make diagnostic decisions that are thought to be based on pattern recognition, likely informed by cue-based associations formed in memory, a process known as cue utilisation. Typically, the cases presented to the histopathologist have already been classified as 'abnormal' by clinical examination and/or other diagnostic tests. This results in a high disease prevalence, the potential for 'abnormality priming', and a response bias leading to false positives on normal cases. This study investigated whether higher cue utilisation is associated with a reduction in positive response bias in the diagnostic decisions of histopathologists. Data were collected from eighty-two histopathologists who completed a series of demographic and experience-related questions and the histopathology edition of the Expert Intensive Skills Evaluation 2.0 (EXPERTise 2.0) to establish behavioural indicators of context-related cue utilisation. They also completed a separate, diagnostic task comprising breast histopathology images where the frequency of abnormality was manipulated to create a high disease prevalence context for diagnostic decisions relating to normal tissue. Participants were assigned to higher or lower cue utilisation groups based on their performance on EXPERTise 2.0. When the effects of experience were controlled, higher cue utilisation was specifically associated with a greater accuracy classifying normal images, recording a lower positive response bias. This study suggests that cue utilisation may play a protective role against response biases in histopathology settings.

What can an echocardiographer see in briefly presented stimuli? Perceptual expertise in dynamic search.

BACKGROUND: Experts in medical image perception are able to detect abnormalities rapidly from medical images. This ability is likely due to enhanced pattern recognition on a global scale. However, the bulk of research in this domain has focused on static rather than dynamic images, so it remains unclear what level of information that can be extracted from these displays. This study was designed to examine the visual capabilities of echocardiographers-practitioners who provide information regarding cardiac integrity and functionality. In three experiments, echocardiographers and naïve participants completed an abnormality detection task that comprised movies presented on a range of durations, where half were abnormal. This was followed by an abnormality categorization task. RESULTS: Across all durations, the results showed that performance was high for detection, but less so for categorization, indicating that categorization was a more challenging task. Not surprisingly, echocardiographers outperformed naïve participants. CONCLUSIONS: Together, this suggests that echocardiographers have a finely tuned capability for cardiac dysfunction, and a great deal of visual information can be extracted during a global assessment, within a brief glance. No relationship was evident between experience and performance which suggests that other factors such as individual differences need to be considered for future studies.

Tunable polymer lens.

A new type of solid-state variable focal length lens is described. It is based on shape changes in an elastomeric membrane driven by compression of a reservoir of a polymer gel. A novel fabrication process based on individual lens components allows for customization of lens power based on the desired application. The lens shape as a function of applied compressive strain is measured using direct surface profile measurements. The focal length of a solid state lens was reversibly changed by a factor of 1.9. Calculated back focal lengths of the lens were consistent with experimental measurements.

Evolving a Bayesian Classifier for ECG-based Age Classification in Medical Applications.

OBJECTIVE: To classify patients by age based upon information extracted from their electro-cardiograms (ECGs). To develop and compare the performance of Bayesian classifiers. METHODS AND MATERIAL: We present a methodology for classifying patients according to statistical features extracted from their ECG signals using a genetically evolved Bayesian network classifier. Continuous signal feature variables are converted to a discrete symbolic form by thresholding, to lower the dimensionality of the signal. This simplifies calculation of conditional probability tables for the classifier, and makes the tables smaller. Two methods of network discovery from data were developed and compared: the first using a greedy hill-climb search and the second employed evolutionary computing using a genetic algorithm (GA). RESULTS AND CONCLUSIONS: The evolved Bayesian network performed better (86.25% AUC) than both the one developed using the greedy algorithm (65% AUC) and the naïve Bayesian classifier (84.75% AUC). The methodology for evolving the Bayesian classifier can be used to evolve Bayesian networks in general thereby identifying the dependencies among the variables of interest. Those dependencies are assumed to be non-existent by naïve Bayesian classifiers. Such a classifier can then be used for medical applications for diagnosis and prediction purposes.

Effects of presentation method on the understanding of informed consent.

BACKGROUND/AIM: Knowledge of which presentation methods impart the most information to patients can improve the informed consent discussion. The purpose of this study was to determine if the comprehension and recall of the informed consent discussion varied with presentation method. METHODS: Randomised, prospective study at the University of Arkansas for Medical Sciences. 90 freshmen medical students were randomly assigned to one of three groups and separately went through an informed consent on cataract surgery. Group A heard an informed consent presentation. Group B was shown diagrams while hearing the same presentation. Group C heard the consent and then watched an informational video on cataract surgery. A 10 point multiple choice quiz was administered after the presentation and repeated again 1 week later. RESULTS: Scores from each group were averaged as number correct out of 10 questions. For same day scores, group C scores (7.70 (SD 1.24)) were significantly higher than group A (6.39 (1.63)). One week testing revealed that group C (6.96 (1.62)) recalled more between the two time periods and scored significantly higher than groups A (5.15 (2.11)) and B (5.54 (1.64)). CONCLUSIONS: This study found differences in the participants' ability to recall facts based on the manner in which the material was presented. It clearly demonstrated that the use of visual aids improved the ability to remember facts and risks associated with cataract surgery beyond a verbal presentation alone. It also showed a benefit of the repetition of information as provided by audiovisual presentations that can be used in conjunction with the physician-patient discussion.

Postnatal support for mothers living in disadvantaged inner city areas: a randomised controlled trial.

STUDY OBJECTIVE: To evaluate the effect of two forms of postnatal social support for disadvantaged inner city mothers on maternal and child health outcomes. DESIGN: Randomised controlled trial with economic and process evaluations and follow up at 12 and 18 months. The two intervention groups received either the offer of a year of monthly supportive listening home visits by a support health visitor (SHV), or a year of support from community groups providing drop in sessions, home visiting and/or telephone support (CGS). Each was compared with a control group that received standard health visitor services. SETTING: Two disadvantaged boroughs of London, United Kingdom. PARTICIPANTS: 731 women from culturally diverse backgrounds with infants. MAIN RESULTS: At 12 and 18 months, there was little impact for either intervention on the main outcomes: child injury (SHV: relative risk 0.99; 95% confidence intervals 0.68 to 1.45, CGS: 0.91; 0.61 to1.36), maternal smoking (SHV: 0.86; 0.62 to 1.19, CGS: 0.97; 0.72 to 1.33) or maternal depression (SHV: 0.86; 0.62 to1.19, CGS: 0.93; 0.69 to 1.27). SHV women had different patterns of health service use (with fewer taking their children to the GP) and had less anxious experiences of motherhood than control women. User satisfaction with the SHV intervention was high. Uptake of the CGS intervention was low: 19%, compared with 94% for the SHV intervention. CONCLUSIONS: There was no evidence of impact on the primary outcomes of either intervention among this culturally diverse population. The SHV intervention was associated with improvement in some of the secondary outcomes.

Are trends in the proportions of non-medically indicated inductions different by Medicaid status?

OBJECTIVE: To determine whether Medicaid status influenced the effect of a quality improvement effort. STUDY DESIGN: Using a data set consisting of the 2006 to 2010 vital statistics data linked with Medicaid status data, we identified non-medically indicated inductions between 36 0/7 and 38 6/7 weeks gestational age and compared rates of non-medically indicated inductions between women with Medicaid and all other payers. We also compared these rates in hospitals that did and did not participate in the Ohio Perinatal Quality Collaborative (OPQC). RESULTS: A total of 232 935 births with gestational ages between 36 0/7 and 38 6/7 weeks were included in this study. In the sample, 32 371 births (13.9%) were non-medically indicated inductions. Overall, rates of non-medically indicated deliveries for all insurance types dropped over the course of the initiative. Interestingly, in OPQC participating hospitals, the Medicaid mothers' rates of non-medically indicated inductions prior to 39 weeks were well below rates for other insurance types prior to the initiative. By the end of the initiative, rates for all insurance types had dropped significantly but non-medically indicated inductions<39 weeks rates dropped more dramatically in the non-Medicaid mothers, resulting in higher rates for Medicaid than for non-Medicaid mothers. CONCLUSIONS: Non-medically indicated deliveries decreased for women irrespective of Medicaid enrollment status. However, non-medically indicated delivery rates did not drop as sharply for women enrolled in Medicaid.

Effects of a delayed steroid injection on ligament healing using a rabbit medial collateral ligament model.

Corticosteroids are known to inhibit collagen synthesis in vitro as well as having a deleterious effect on ligament healing when applied immediately following injury. An acute injection of betamethasone into a transected rabbit medial collateral ligament significantly impaired the biomechanical and histological properties compared to non-injected transected ligaments. Differences in mechanical, histological and biochemical properties were observed up to 3 months following injury and an acute steroid injection. The present study explored the effects of a corticosteroid (betamethasone) injection 7 days following the initial injury. Biomechanical and histomorphometric analyses were carried determine if the previously observed deleterious effects of a corticosteroid injection immediately following injury can be linked to an interference in the inflammatory phase of healing due to the presence of the corticosteroid.

Tumour necrosis factor levels during acute rejection and acute tubular necrosis in renal transplant recipients.

Plasma tumour necrosis factor levels were measured serially in 16 patients following renal transplantation, and in 10 patients on haemodialysis and in 12 patients on peritoneal dialysis. The patients on peritoneal dialysis had lower plasma TNF levels than the patients on haemodialysis. There was a decrease in TNF levels immediately following renal transplantation; this is probably related to the bolus doses of methylprednisolone administered intra-operatively. Patients with acute rejection had higher levels of TNF than non-rejecting patients. The increase in TNF levels in rejecting patients was observed 2 days before the clinical manifestation of acute rejection. There was a marked decrease in TNF levels in rejecting patients in response to treatment with steroids. Patients with delayed graft function had higher levels of TNF on the first post-operative day compared to patients with immediate function. These changes in plasma TNF levels following renal transplantation have important clinical and therapeutic implications.

The Social Support and Family Health Study: a randomised controlled trial and economic evaluation of two alternative forms of postnatal support for mothers living in disadvantaged inner-city areas.

OBJECTIVES: To determine whether increased postnatal support could influence maternal and child health outcomes. DESIGN: This was a randomised controlled trial comparing maternal and child health outcomes for women offered either of the support interventions with those for control women receiving standard services only. Outcome data were collected through questionnaires distributed 12 and 18 months postrandomisation. Process data were also collected. There was also an integral economic evaluation. SETTING AND PARTICIPANTS: Women living in deprived enumeration districts in selected London boroughs were eligible for the trial if they gave birth between 1 January and 30 September 1999. RESULTS: The 731 participants were found to be well matched in terms of socio-economic characteristics and health and support variables (14% of the participants were non-English speaking). Response rates at the two follow-up points were 90% and 82%. At both points there were no differences that could not be attributed to chance on the primary outcomes of maternal depression, child injury or maternal smoking. At the first follow-up, there was reduced use of general practitioners by support health visitor (SHV) children, but increased use of NHS health visitors and social workers by mothers. At the second follow-up, both community group support (CGS) and SHV mothers had less use of midwifery services (fewer were pregnant), and SHV mothers were less worried about their child's health and development. Uptake of the CGS intervention was low: 19%, compared with 94% for the SHV intervention. Satisfaction with the intervention among women in the SHV group was high. Based on the assumptions and conditions of the costing methods, the economic evaluation found no net economic cost or benefit of choosing either of the two interventions. CONCLUSIONS: There was no evidence of impact on the primary outcomes of either intervention. The SHV intervention was popular with women, and was associated with improvement in some of the secondary outcomes. This suggests that greater emphasis on the social support role of health visitors could improve some measures of family well-being. Possible areas for future research include a systematic review of social support and its effect on health; developing and testing other postnatal models of support that match more closely the age of the baby and the changing patterns of mothers' needs; evaluating other strategies for mobilising 'non-professional' support; developing and testing more culturally specific support interventions; developing more culturally appropriate standardised measures of health outcomes; providing longer term follow-up of social support interventions; and exploring the role of social support on the delay in subsequent pregnancy.

Effects of local injection of corticosteroids on the healing of ligaments. A follow-up report.

One hundred and one skeletally mature New Zealand White rabbits were used to study the long-term effects of a single injection of corticosteroid on the biomechanical, histological, and biochemical properties of ligament-healing. Two steroid doses were studied, as previously described. The injections were made into a fascial pocket immediately after transection of the ligament. The animals were killed forty-two and eighty-four days after the injury. In our previous investigation, in which we examined the early (inflammatory and proliferative) phases of ligament-healing, the specimens that had been injected with a dose of steroids equivalent to that given to humans demonstrated significantly inferior biomechanical properties and histological organization relative to controls that had not received an injection. In the current study, we examined the later (remodeling and maturation) phases of ligament-healing and found that the tensile strength (the ultimate stress) of the specimens that had been injected with the steroids returned to a value that was equal to that of the controls that had not received an injection; however, the peak load of the specimens that had been injected with steroids remained inferior to that of the controls. This was accompanied by a lag in the histological maturation.

Interpretation of selected accident and emergency radiographic examinations by radiographers: a review of 11000 cases.

Two specially trained radiographers took part in the radiologists' rota for "cold" reporting skeletal radiographs of patients who attended the Accident and Emergency (A&E) Department at times when there was no "hot" reporting service operating, and who were not admitted for treatment or referred to fracture clinics for follow-up. These radiographs had initially been seen by A&E medical staff. At the end of an 18 month period during which the two radiographers reported on 11,322 skeletal examinations, a retrospective search was made to detect interpretive errors. The radiological history of all 11,322 patients was reviewed over a follow-up period of at least 3 months subsequent to the attendance reported by the radiographers. 48% of patients did not re-attend, 42% re-attended for unrelated examinations, and 10% re-attended for repeat examinations of the same anatomical area, or for different procedures (bone scintigraphy or CT) related to the original injury. The second (or subsequent) report was discrepant with that of the first attendance in only 29 cases out of 1103. Of these 29 patients, 13 had occult fractures which were undetectable at first attendance even in retrospect, six had new injuries accounting for the new findings, six had been the subject of false positive calls at an earlier visit, one had a fracture of the hamate missed at first attendance, and in three cases no consensus could be reached as to the cause of the discrepancy, owing to incomplete films or insufficient clinical data. Analysis of the patients' postcodes showed at least 89% were of local origin and only 1% were from outside Yorkshire, suggesting that the review should have identified the great majority of erroneous reports. It is concluded that appropriately trained and supervised radiographers can successfully undertake diagnostic reporting of selected skeletal examinations on A&E patients.

Healing characteristics of a type I collagenous structure treated with corticosteroids.

One hundred twenty-eight skeletally mature New Zealand White rabbits were used to study the effect of a single corticosteroid injection on the biomechanical, biochemical, and histologic aspects of ligamentous healing. Two steroid dosages were used. The amount of the low-dose steroid was calculated by determining the corticosteroid concentration at which fibroblastic synthesis of collagen was inhibited in vitro. A human equivalent dose of betamethasone was used as the high-dose steroid injection. These two steroid doses and a saline control were injected around a transected medial collateral ligament. At 10 days all groups showed significantly inferior biomechanical properties relative to noninjected controls. By 3 weeks the human equivalent steroid dose group continued to demonstrate significantly inferior properties. Histologic and biochemical analyses confirmed the biomechanical results. The clinical relevance of the study was that the delivery of a human equivalent steroid dose into an acutely injured ligament significantly impairs the healing process relative to a noninjected ligament at 10 days and at 3 weeks after injury. This implies that a corticosteroid-treated injured ligament may not be able to withstand the mechanical loads of early vigorous rehabilitation.

Cold hemagglutinin disease in a dog.

Cold hemagglutinin disease, a form of autoimmune hemolytic anemia caused by cold-acting erythrocyte autoantibodies, was diagnosed in a dog. Cold-acting antibodies differ from warm-acting antibodies in several ways, including temperature-dependent reactivity below 32 C. The autoantibody in this case (immunoglobulin M) was in the serum in higher than normal concentrations and was reactive at temperatures approaching freezing. The course of the disease was chronic and was characterized by cyanosis and necrosis of the body extremities. Immunosuppressive therapy with corticosteroids was successful in alleviating the clinical signs and reducing the autoantibody activity in the dog. The cause of this disorder was not determined.

Determination of dexamethasone and corticosterone half-lives in male broilers.

Normal broiler males were used in a series of experiments to determine the rate of disappearance of dexamethasone, a synthetic corticoid, and corticosterone, the quantitatively most important glucocorticoid in the bird. Determination of the half-life (T1/2) of these compounds following an intravenous bolus injection was by high performance liquid chromatography. Half-lives for dexamethasone and corticosterone were found to be 36 and 22 min, respectively. The slower rate of disappearance from the blood may help to explain the ability of dexamethasone to overcome some of the problems associated with hyperthermic stress in birds. This method of quantitating exogenously administered steroids is applicable not only to basic research but also to analyses by inspection and regulatory agencies.

The effects of cooling large white turkey embryos on growth and white blood cell development.

In each of two experiments, trays containing 15 developing turkey eggs were cooled for 1 h at 18 C on a specific day of incubation or left within the incubator (controls). Ten embryos from each treatment were bled on Day 23 of incubation, at which time all embryos were killed with CO2 gas, weighed, and sexed. Packed cell volumes and differential white blood cell (WBC) counts were performed on all blood samples. A single, brief cooling episode during incubation did not significantly (P greater than .05) affect BW or hematocrit values in 23-day-old turkey embryos. Based on a differential classification of WBC in the blood smears of these turkey embryos, there were 82, 10, 8, less than 1, and less than 1% of heterophils, lymphocytes, basophils, eosinophils, and monocytes, respectively. Circulating heterophils, the most numerous WBC in turkey embryos, were significantly (P less than or equal to .05) reduced in all embryos cooled during the latter half of incubation. This effect was mirrored in the total WBC numbers counted. The effect of cooling on the other classes of turkey embryonic WBC, which represent about 20% of the circulating WBC, were more variable.

Normal growth and white blood cell development in large white turkey embryos.

Two experiments were conducted to determine normal growth and hematological values for turkey embryos. In each experiment, differential white blood cell counts, hematocrits, sex, and body weights were recorded for 10 Nicholas Large White turkey embryos beginning at Day 12 and at select days thereafter through Day 25 of incubation. Because there were so few white blood cells present in the turkey embryonic blood, differential white blood cell counts were scored by two observers. Each observer counted for a fixed time, 5 min, rather than to a specific number of cells. A significant difference (P less than or equal to .05) due to embryo age was found for BW, hematocrit, heterophils, lymphocytes, basophils, and total white blood cell counts. Significant differences due to sex of the embryo or day by sex interaction were not found for BW, hematocrit, heterophils, eosinophils, basophils, and total white blood cell counts. A significant day by sex interaction was found for lymphocytes. No significant differences were observed between either of the main effects or their interaction for the monocyte totals. The predominant circulating white blood cell in turkey embryos was the heterophil not the lymphocyte.

The female athlete.

Women's participation in sporting activities is now diverse with new opportunities arising yearly. As a result, care of the the female athlete's unique medical concerns has become an important challenge and issue to the primary care physician. The major focus when caring for the female athlete should be the diagnosis and treatment of the female athlete triad. The components of the triad--disordered eating, amenorrhea, and osteoporosis--can have serious implications for the health of the female athlete. Appropriate prevention and screening methods for early diagnosis of the female athlete triad require future study and improvement. Healthy pregnant, postpartum, and breastfeeding women can continue to maintain physical activity. Musculoskeletal injuries from sports are, in general, not gender specific but are more often sport specific. One exception is the increased prevalence of anterior cruciate ligament injuries occurring in women soccer and basketball players. The exact cause of this is unknown but is continuing to be investigated.