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Neonectria ditissima infects apple trees through wounds, causing European canker. In the UK, the most important entry site for N. ditissima is leaf scar. Specific apple endophytes may contribute to cultivar resistance/tolerance to the pathogen. We assessed the relative effect of location, sampling time (season), and rootstock/scion genotype on bacterial and fungal endophyte communities in the apple leaf scar tissues of current‐season extension shoots and identified Operational Taxonomic Units (OTUs) with differential abundance between canker resistant and susceptible scions, and between rootstocks. Leaf scar tissues were sampled from two orchards at three times (10/2018, 06/2019 and 10/2019) for eight scion cultivars, each grafted onto two rootstocks, for profiling 16S and ITS rRNA regions. Endophyte composition was primarily affected by season (autumn vs. spring) and location (sites and blocks within site). There was a significant reduction in the community size in the spring, particularly for fungi, and species turnover between autumn and spring. This seasonal dynamics suggest that to protect leaf scars from N. ditissima infection in the autumn specific endophytes suppressing canker may have to be augmented annually around the leaf‐fall time. Scion and rootstock genotypes had limited effects on the endophyte community. A group of resistant cultivars differed from a group of susceptible ones in the relative abundance of many bacterial and fungal OTUs, most of which had low reads numbers. Nevertheless, several OTUs with high reads numbers differed in their relative abundance between resistant and susceptible scions, including OTUs from Sphingomonas, Methylobacterium, Vishniacozyma and Rhodotorula babjevae, and warrant further investigation for their potential role in host resistance/tolerance against N. ditissima. [ABSTRACT FROM AUTHOR]

Previous studies examine how unemployment affects socio‐political behaviour, but this literature has scarcely focused on the role of the life‐course. Integrating the frameworks of unemployment scarring and political socialisation, we posit that unemployment experiences, or scars, undermine electoral participation, and that this is exacerbated at younger ages. We test these hypotheses relying on the British Household Panel Survey and Understanding Society datasets (1991–2020), employing panel data analysis approaches as Propensity Score Matching, Individual Fixed Effects, and Individual Fixed Effects with Individual Slopes. Results suggest that unemployment experiences depress electoral participation in the UK, with effect sizes around −5% of a Standard Deviation in turnout. However, this effect varies powerfully by age: the impact of unemployment on electoral participation is stronger at younger ages (−21% SD at age 20), and weaker to not significant after age 35. This is robust across the three main approaches and several robustness checks. Further analyses show that the first unemployment spell matters the most for electoral participation, and that for individuals under 35, there is a scar effect lasting up to 5 years after the first unemployment spell. The life‐course emerges as central to better understand the relationship between labour market hardships and socio‐political behaviour. [ABSTRACT FROM AUTHOR]

Research surrounding the use of decorative tattooing by non-medical professional tattooists as a form of scar camouflage or decoration is limited. This study provides critical and deepening insights into tattoo artists' experiences of tattooing scars, to help inform a more in-depth understanding of its uses from a health and wellbeing perspective. Specifically, it aimed to explore qualitatively, the different methods and techniques used by non-medical tattoo professionals to cover up or decorate scars, which can have a psychological impact on those affected. Six tattoo artists from legitimate UK based studios were identified through snowballing and purposive sampling methods. Data collection involved semi-structured telephone interviews. The data was then transcribed, and thematic analysis was then performed. Five themes were identified: Personal Opinion of Scar Camouflage Tattooing, Tattooing Methods, Scars and Tattooing Risks, Positive Impact, and Understanding of Customer Experience. These themes were then broken down into more specific sub-themes. The discussion considers these findings in relation to theory and existing literature, for example, around understanding of role, and makes recommendations for future study in this field. [ABSTRACT FROM AUTHOR]

Reconstructive options in nonmelanomatous skin tumors of the head and neck region are limited in the frail, elderly patient group, where split skin thickness or full thickness grafts may not be a viable option. This study examines the use decellularized cadaveric dermis (DCELL), an acellular dermis product produced in the United Kingdom for the reconstruction of these skin defects. This was a single-center, prospective study of patients undergoing single stage wide local excision of nonmelanomatous skin cancer and reconstruction with decellularized dermis. Our inclusion criteria included any patient that required a curative excision but had risk factors where conventional local flap or free tissue transfer could have a potential adverse outcome. Thirty-seven wounds were treated with DCELL in 31 patients. Mean age was 81.6 years (range 61–94 years) and at the time of operation, 25 patients (80.7%) were ASA 3 or above. The scalp was the most common anatomical area operated on ( n  = 28, 75.7%). The overall proportion of wounds with complete closure was 89.2% (33 out of 37 wounds), with a failure rate of 10.8% (four complete graft failures). Device-related complications included one episode of crusting over the graft which resolved with topical antibiotics, and a hypertrophic scar over the wound edges. Cosmesis was satisfactory in all cases. DCELL demonstrated a very good take rate with equally satisfactory cosmetic outcomes in patients where standard reconstructive approaches may have adverse outcomes. Further research is needed to better define its role in the management of these skin cancers. [ABSTRACT FROM AUTHOR]

This study reviews free tissue transfer (FTT) surgery for both acute wound and reconstructive scar management of burn injuries at a UK burns unit over a 10-year period. Thirty eight patients underwent 46 FTTs, or free flaps, as part of their burn injury pathway. For the cohort of patients, there was one flap failure, which occurred for a secondary scar reconstruction. It is noted that FTT was successful for all seven acute or primary interventions. Anterolateral thigh flap was the most frequently performed (57%); followed by parascapular flaps (22%) of which 43% were pre-expanded. A method of pre-expansion for neck contractures and a novel technique of anchoring this flap to the pre-tracheal fascia are described here. This can provide the patient with good neck contouring by using the capsule to hitch the flap into a good position. It is clear that further work is required to study the prevention of hypertrophic scarring that can occur at the interface between flap and adjacent skin, where occurrence rate in this cohort was 17%. It is proposed that FTT now provides a viable solution both to the coverage of complex burn wounds and to the revision of scar contractures. Consensus over an FTT protocol for the primary management of open burn wounds is seen as the logical next step for this surgical intervention. [ABSTRACT FROM AUTHOR]

Urethral stricture affects 0.9% of men. Initial treatment is urethrotomy. Approximately, half of the strictures recur within 4 yr. Options for further treatment are repeat urethrotomy or open urethroplasty. To compare the effectiveness and cost-effectiveness of urethrotomy with open urethroplasty in adult men with recurrent bulbar urethral stricture. This was an open label, two-arm, patient-randomised controlled trial. UK National Health Service hospitals were recruited and 222 men were randomised to receive urethroplasty or urethrotomy. Urethrotomy is a minimally invasive technique whereby the narrowed area is progressively widened by cutting the scar tissue with a steel blade mounted on a urethroscope. Urethroplasty is a more invasive surgery to reconstruct the narrowed area. The primary outcome was the profile over 24 mo of a patient-reported outcome measure, the voiding symptom score. The main clinical outcome was time until reintervention. The primary analysis included 69 (63%) and 90 (81%) of those allocated to urethroplasty and urethrotomy, respectively. The mean difference between the urethroplasty and urethrotomy groups was –0.36 (95% confidence interval [CI] –1.74 to 1.02). Fifteen men allocated to urethroplasty needed a reintervention compared with 29 allocated to urethrotomy (hazard ratio [95% CI] 0.52 [0.31–0.89]). In men with recurrent bulbar urethral stricture, both urethroplasty and urethrotomy improved voiding symptoms. The benefit lasted longer for urethroplasty. There was uncertainty about the best treatment for men with recurrent bulbar urethral stricture. We randomised men to receive one of the following two treatment options: urethrotomy and urethroplasty. At the end of the study, both treatments resulted in similar and better symptom scores. However, the urethroplasty group had fewer reinterventions. There was no evidence of a difference regarding voiding symptoms in men with recurrent bulbar urethral stricture randomised to urethrotomy or urethroplasty. However, men allocated to urethroplasty had fewer reinterventions than those allocated to urethrotomy. [ABSTRACT FROM AUTHOR]

Background: Symptomatic phimosis is a common childhood urology complaint. Circumcision was traditionally the treatment of choice, but its popularity in cases of non-scarred phimosis has been superseded by more conservative methods like preputioplasty. We sought to examine outcomes of preputioplasty for the treatment of non-scarred pathological phimosis in two UK paediatric surgery tertiary centres.Methods: Retrospective case series selecting cases performed in both departments over a 4 year period (January 2012-December 2015).Inclusion Criteria: non-scarred pathological phimosis treated with preputioplasty.Exclusion Criteria: diffuse scarring of foreskin or presence of balanitis xerotica obliterans (BXO), preputioplasty performed as part of hypospadias repair. Outcome measure was treatment success as evidenced by fully retractile prepuce at follow up. Follow up occurred between 3 and 24 months.Results: We identified 126 patients, 6 were excluded due to the above criteria. Median age was 13.4 years (range 10 months-18 years). Median follow up was 13 months (range 3-24 months). 115 patients (96%) had successful treatment as evidenced by satisfactory post-operative cosmesis and complete resolution of phimosis at follow up. Recurrence of phimosis occurred in 5 patients (4%). Mean time of recurrence was 6 months, with a median age of recurrence of 15.3 years (range 10.7-16.7 years). All patients with recurrence were successfully treated with circumcision.Conclusion: Foreskin conserving methods like preputioplasty are a valid option in the treatment of non-scarred pathological phimosis. [ABSTRACT FROM AUTHOR]

Thermal disease presents a major burden to individual patient morbidity, healthcare cost as well as to over all economy. Burns also also represent a significant per-patient utlilisation of finite healthcare resources. Secondary complications in these patients, such as multiple drug resistant organisms, may have a devastating effect. Laser surgery has recently come of age as an optimal tool in the secondary reconstruction of burn injury, that is able to simultaneously address significant sheet scar tightness, hypertrophic, atrophic, and keloid complications, pruritus, microstomia, ectropion, skin graft honeycombing, and improve range of movement whilst reducing the risk of infection to <1%. Yet, cutaneous laser surgery is often underutilised due to the perceived concerns about the sustainability of a new service with relatively high startup cost. We present a dual methodology to explore this concern: an evidence-based background review of the last 5 years of current best evidence, and a 22-year cost-analysis comparison at an established, high volume UK Centre of reconstructive surgery. We report that fiscal viability for laser surgery services for secondary burn reconstruction is supported by: level 2 (one systematic review) level 4 evidence (2 studies) and level 5 evidence (expert reports). Evidence over 22 years from an established super-regional NHS laser centre shows that introduction of this service led to sustained and substantial cost saving, producing excellent surgical results at a fraction of the cost of traditional surgery. Analysis of the potential dollar-effect of these advantages to the general population supports state investment in expertise and capital equipment as a medium to long-term cost saving strategy, which may also aid re-integrating patients into the workforce making a meaningful contribution to the economy. [ABSTRACT FROM AUTHOR]

Two described specimens of the gastropod Bellerophon tenuifascia J. de C. Sowerby, 1824, from the Carboniferous (Asbian) of the Isle of Man, United Kingdom, preserve repaired injuries resulting from environmental breakage and failed, non-lethal, predatory attacks. Deep scars attributed to predatory attacks are assigned to the ichnofossil Caedichnus and were focused on the mid-dorsal area of the aperture. Abundant small-scale scallops and chipping of growth lamellae distributed around the apertural margin are mainly the result of environmental damage. A deeply incised injury in the aperture of one specimen was probably a fatal injury. [ABSTRACT FROM AUTHOR]

In 2006, Rhiannon Jones and Michael Pinchbeck exhibited fragments from their ongoing practice as research as part of an exhibition at the Surface Gallery (Nottingham). Pinchbeck showed 365 objects wrapped in brown paper and string from a project called The Long and Winding Road that involved driving a car around the country for five years as a venue for one-to-one performance. Jones was showing a video called Archived Actualities that re-traced the routes of 1000 scar stories; accidents shared with her by members of the public. Jones suggests that scars are innately performative through a collision of dialogic triangulation that takes place between the rupturing of skin, the process of scarification and the architectural shifts to sites of accident. This five-year project resulted in a solo exhibition in the UK and the USA where scar story objects were collected and displayed in a gallery context, donated by people who had contributed to the archive, as their stories were retold through a series of live performance works. As part of Pinchbeck's project, the 365 objects were belongings left behind by his brother, who died in an accident in 1998. The piece explored the invisible scars left behind by grief and the literal baggage that makes manifest loss. The objects that were wrapped up lost their emotional charge until they were revealed again during the crushing of the car at the end of the journey, the emotional wreckage becoming literal, memories mangled like the car that housed his brother's story. For this article, both writers reflect on the detritus of their practice as research, and how in some way, Pinchbeck's car and Jones' scar archive 'stage the wreckage' of the events that triggered them. The article explores traces that are embedded into our public presentation of self and other, and are objectified through the act of conversation, in order to ask if objects can carry scars like people carry memories. The article asks what remains after physical and emotional wreckage and proposes that instead of seeing this as sediment of loss we should treasure the detritus. [ABSTRACT FROM AUTHOR]

This article examines the treatment of facial wounds in early modern Britain through a close study of the casebook of St Bartholomew's Hospital surgeon Joseph Binns (d. 1664). It explores surgeons' and related practitioners' special attention to the care and infliction of facial wounds and scarring in their practice, including impairments to facial movement and expression, the use of specific suturing techniques and the reduced use of stitches, and the development of agglutinative medicaments. The face was recognised as a site of immense vulnerability and exposure, requiring particular care, and this vulnerability was mirrored in the capacity for facial scarring to detrimentally advertise a practitioner's skill. This essay reads Binns' unpublished notes against the cases and theoretical ideals set out in published texts from surgeons such as the Scottish Alexander Read, the East India Company surgeon John Woodall, and the London surgeon and physician Daniel Turner. I argue that both the textbooks and Binns' practice demonstrate awareness of the special role of the face in the early modern period, and that this guided the medical approach to disfiguring injuries and conditions. [ABSTRACT FROM AUTHOR]

Introduction: The VisiTag module (CARTO3) provides an objective assessment of radiofrequency (RF) ablation parameters. This study aimed to determine the predictive value and optimal VisiTag threshold settings for prediction of gaps in mature atrial scar, as assessed non‐invasively using cardiac magnetic resonance (CMR) imaging. Methods: Twenty‐four subjects (11 paroxysmal atrial fibrillation) underwent first‐time RF ablation with operators blinded to VisiTag data. Three‐dimensional late gadolinium enhancement (LGE) CMR scans were performed at 3 months (1.3 × 1.3 × 4 mm3). A survey of UK operators defined the standard VisiTag settings ("Force," 8 g; "Time," 10 seconds; "Percentage Time," 50%; "Range," 3 mm; "Impedance" and "Temperature" "off"). Each ablation procedure was exported 27 times, varying single VisiTag parameters from default values. The presence of gaps in VisiTag markers (18 sectors) was assessed for each export and compared with gaps in CMR enhancement. Results: At default settings, VisiTag gaps were specific (97.5%) but less sensitive (50.4%) for CMR gaps. Sensitivity improved at higher thresholds (89.2% at 20 g, 85.6% at 30 seconds, 88.5% impedance 10 Ω, 92.8% temperature 42°C), but with a lower positive predictive value (PPV) (42.3%, 42.7%, 41.1%, and 37.7%, respectively, vs 90.9% at baseline). "Force" thresholds demonstrated stable PPV from 2 to 8 g (P = 0.24), but a rapid fall at forces more than 10 g. The binomial logistic regression model explained 41.7% of gaps; χ2(4), 148; P < 0.0001, correctly classifying 82% of cases (specificity 94.9%, sensitivity 56.8%). Conclusion: Gaps in VisiTags predict gaps in CMR LGE enhancement with high specificity at default settings. Sensitivity may be improved using more stringent thresholds but at the potential cost of unnecessary ablation, particularly when a force more than 10 g is stipulated. [ABSTRACT FROM AUTHOR]

This article examines how the India Office handled cases of destitute Indians, such as sailors and servants, who were stranded in Britain. The empire provided opportunities for work and travel, yet there were no securities for those who were taken advantage of by the system. This article highlights how the India Office was the institution expected to help distressed Indians and yet the secretary of state for India consistently refused to accept official responsibility for them. Nor did the British government try to prevent the problem from occurring in the first place. Instead, the official position taken by the secretary of state for India was to let social institutions intervene, arguing that, as British subjects, Indians could receive relief through the Poor Laws. Workhouses, however, were ill suited to Indians striving to return to their homes. This article addresses these issues through examining three key periods: the early to mid-nineteenth century; a shift in the 1880s when the India Office acknowledged a better policy was needed for the treatment of destitute Indians; and, the turn of the century when a Committee on Distressed Colonial and Indian Subjects was established in 1909. Through a focused study of India Office discourses, this article addresses the ambiguity of imperial policy and assesses how it contributed to competing understandings of British responsibility over imperial subjects. [ABSTRACT FROM AUTHOR]

Focal But Not Diffuse Fibrosis Burden Predicts CRT Remodeling Response Introduction Many heart failure patients with dyssynchrony do not reverse remodel (RR) in response to cardiac resynchronization therapy (CRT). The presence of focal and diffuse interstitial myocardial fibrosis may explain this high nonresponse rate. T1 mapping is a new cardiac magnetic resonance imaging (CMR) technique that overcomes the limitations of conventional contrast CMR and provides reliable quantitative assessment of diffuse myocardial fibrosis. The study tested the hypothesis that focal and diffuse fibrosis quantification would correlate with a lack of left ventricular (LV) RR to CRT. Methods and Results In a prospective study of 48 consecutive patients (27 ischemic cardiomyopathy, 21 dilated cardiomyopathy) LV scar burdens were quantified (scar core and gray zone using late gadolinium enhancement LGE CMR; interstitial fibrosis using T1 mapping) before CRT implant. LV RR was defined by a ≥ 15% reduction in LV end-systolic volume 6 months postimplant. Twenty-seven (56%) patients were responders with RR. Association between scar quantification and LV RR was assessed using the Poisson regression model. Univariate analysis showed that QRS duration/morphology, scar core, and gray zone volumes expressed as % of LV mass and extracellular volume index (ECV) (a measure of interstitial fibrosis from T1 mapping) to be significant predictors of LV RR. Multivariable-adjusted analyses demonstrated scar core quantification (≥13.7% LV mass) to be the only independent predictor of LV RR (prevalence ratio 0.40, P = 0.038). Conclusions Focal scar burden detected by LGE CMR is associated with a poor response to CRT. Diffuse interstitial fibrosis assessment by T1 mapping, however, is not independently predictive of CRT response. [ABSTRACT FROM AUTHOR]

The successful evolution of paediatric liver transplantation means that increasing numbers of young people survive into adulthood. Non-adherence to medication regimens leading to liver dysfunction, graft loss and patient death are prevalent in this vulnerable group. Insight into young people’s experiences of living with a liver transplant (LTx) is vital to improve outcomes and guide future work in this area. Through semi-structured interviews, this study explored the experiences of living with a LTx for 13 young people transplanted as children and adolescents. Interviews were analysed using interpretative phenomenological analysis, revealing that young people felt different from their peers as a result of their LTx. Young people’s perceptions of their scar, experiences of illness symptoms and taking medications acted as triggers of differences. This led to an ongoing struggle to be normal when faced with typical activities for young people and to attempts to take back control. Findings support the implementation of routine psychosocial screening to identify additional support needs and the development of a peer mentoring programme to allow young people to gain social support, thus reducing feelings of being different. It is hoped that such initiatives will have positive consequences for quality of life, self-management and adherence to medications. [ABSTRACT FROM PUBLISHER]

The article discusses the familial relationships of South Asian seafarers (commonly known as Lascars) in both South Asia and Britain. It explores how the family was both involved in and affected by their migration. The impact of lengthy absences caused by long voyages and migration to Britain upon families in the sending countries is considered. In particular, the impact upon intra-family dynamics and gender relations is investigated. The article also explores the role of the family in the migration and questions whether this disrupted family life. Finally, South Asian seafarers' marital relationships and family lives in Britain are reconsidered. The article demonstrates the shortcomings of viewing these relationships from a functionalist perspective alone. [ABSTRACT FROM PUBLISHER]

Lascars, or Asian sailors, were no strangers to legal entanglements in London, where thousands of them were stranded in the early nineteenth century. However, in the 1850s, the lascar crews of five ships prosecuted European officers and seamen for crimes committed at sea. This study draws upon documentation for these cases at every step of the legal process, exploring how lascars used London's mid-Victorian criminal justice system, and how institutions such as the Thames Police Court and the Old Bailey handled these unusual, complex cases. These court cases mark a watershed point in lascar history, linking the study of Asian mariners of the late eighteenth and early nineteenth centuries with studies of the later steamship era. [ABSTRACT FROM PUBLISHER]

The article discusses various aspects of the Woundcare4Heroes (WC4H) conference which was held on October 13, 2017 in London, England, and it mentions topics such as trauma aftercare for ex-military personnel, scar treatment, and post-amputation management, as well as presentations by individuals such as surgeon Dr. Shehan Hettiaratchy and burns nurse consultant Jacky Edwards. Professor Jackie Stephen-Hayne and clinical nurse specialist Cassandra McLaughlin are assessed.