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Shoreline evolution over the last two centuries was analysed for Dundrum Bay, Co. Down, Northern Ireland, using historical and recent shoreline datasets from 1833 to 2020. The area of interest comprises two sandy beaches and vegetated coastal dune fields, Newcastle–Murlough and Ballykinler, separated by an inlet channel which connects the inner with the outer bay. Twenty‐four temporal shorelines were extracted, and a quantitative assessment of their positional uncertainty was performed. This was combined with analysis of foredune volume variations by applying the Structure‐from‐Motion‐Multi‐View‐Stereo technique to 1963 aerial photography and comparing it with a 2014 Light Detection And Ranging (LiDAR) dataset to better inform on links between the sediment dynamics and the observed shoreline changes. Storm events were identified using recorded extreme water levels (EWLs) (1901–2020) and hindcasted wave data (1948–2020). In the first 87 years, the shoreline was largely stable, and change was focused at the inlet area. In the 20th century, localised retreat characterised the western (Newcastle–Murlough) sector, whereas the eastern sector (Ballykinler) experienced general shoreline advance. The rate and extent of shoreline retreat in the western sector increased post‐1997 in concert with accelerated accretion at Ballykinler. The strongest erosional episodes were recorded in 1920–1951, 1997–2005, and 2012–2014. Although no direct link was established between single storms and shoreline retreat rates, the three major retreat periods coincided with several consecutive EWLs or EWLs with a return period greater than 100 years. These were generated by storm directions ranging from south to southwest. The long‐term pattern of shoreline change points to a complex coastal system that is still evolving. [ABSTRACT FROM AUTHOR]

Beachrocks are a common characteristic of tropical and subtropical coastlines. It is known that they have a substantial influence on beach morphodynamics and they are commonly utilised as indicators of palaeo‐sea levels. At the same time, facies variability in beachrocks is understudied and their effect on shoreline evolution is poorly understood. At Mission Rocks on the KwaZulu‐Natal coastline of South Africa a narrow beach with isolated sand patches occupies low points of an otherwise continuous 3 m thick, raised shore platform of sandy and gravelly beachrocks. These beachrocks are in the process of disintegrating into megagravel deposits through chemical and mechanical weathering in a wave‐dominated, high‐energy setting. The breakdown is potentially slowed by a contemporary, fast‐forming beachrock facies, that blankets the surface and fills fractures and potholes within the older platform. The accumulation and cementation of this recent beachrock is the focus of this study. The beachrock is dated by historical evidence to post‐World War II. Data from field observations, petrographic and geochemical methods reveal that the cementing agents of the beachrock were precipitated from marine water in a phreatic setting despite its position above the intertidal zone. Not only does this facies have implications for the interpretation of palaeo‐beachrock as a sea‐level indicator, it also raises further questions regarding modelling of coastal erosion of beaches associated with outcrops of beachrock. [ABSTRACT FROM AUTHOR]

Multiple intertidal bar (MITB) beach systems comprise a succession of subdued, shore‐parallel sandbars, developed under low‐energy conditions in meso‐ to macrotidal settings. Their relatively stable morphologies over long timescales are commonly attributed to a dynamic equilibrium, driven primarily by seasonal morphodynamics. The seasonal behaviour is, however, poorly understood. The relationship between temporal and spatial hydrodynamic forcing and morphological changes was investigated through monthly differential GPS surveys in Dundrum Bay (Northern Ireland) from April 2019 to March 2020, associated with variations in nearshore wave conditions, simulated using the SWAN wave model. During low‐energy summer conditions, southeast waves helped promote MITB stability and a slight increase in bar crest elevation, with the seaward‐most bar buffering and preserving the inner bar system through wave dissipation. In the winter, a progressive increase in wave energy, and a switch in wave direction (southwest to south), initiated the highest rates of cross‐shore bar migration and a lowering of bar crests. While the seaward‐most bar remained largely submerged, the shoreward‐most bar played a key role in protecting the upper‐beach and/or foredune. Winter conditions also forced a newly observed mesoscale longshore drift involving offshore sediment transport in the southwest and onshore transport in the northeast. Cross‐shore variability in MITB behaviour at seasonal timescales was, however, primarily driven by local hydrodynamic conditions, including variations in wave energy and direction. Conversely, alongshore variability was largely influenced by the complex nearshore bathymetry, headlands and an active ebb delta, all interacting with changing hydrodynamic forcing. These results challenge the seasonal equilibrium model for MITB systems and highlight longer‐term patterns of sediment movement. [ABSTRACT FROM AUTHOR]

Summary: There is equipoise regarding the use of prothrombin complex concentrate vs. fresh frozen plasma in bleeding patients undergoing cardiac surgery. We performed a pilot randomised controlled trial to determine the recruitment rate for a large trial, comparing the impact of prothrombin complex concentrate vs. fresh frozen plasma on haemostasis (1 h and 24 h post‐intervention), and assessing safety. Adult patients who developed bleeding within 24 h of cardiac surgery that required coagulation factor replacement were randomly allocated to receive prothrombin complex concentrate (15 IU.kg−1 based on factor IX) or fresh frozen plasma (15 ml.kg−1). If bleeding continued after the first administration of prothrombin complex concentrate or fresh frozen plasma administration, standard care was administered. From February 2019 to October 2019, 180 patients were screened, of which 134 (74.4% (95%CI 67–81%)) consented, 59 bled excessively and 50 were randomly allocated; 25 in each arm, recruitment rate 35% (95%CI 27–44%). There were 23 trial protocol deviations, 137 adverse events (75 prothrombin complex concentrate vs. 62 fresh frozen plasma) and 18 serious adverse events (5 prothrombin complex concentrate vs. 13 fresh frozen plasma). There was no increase in thromboembolic events with prothrombin complex concentrate. No patient withdrew from the study, four were lost to follow‐up and two died. At 1 h after administration of the intervention there was a significant increase in fibrinogen, Factor V, Factor XII, Factor XIII, α2‐antiplasmin and antithrombin levels in the fresh frozen plasma arm, while Factor II and Factor X were significantly higher in the prothrombin complex concentrate group. At 24 h, there were no significant differences in clotting factor levels. We conclude that recruitment to a larger study is feasible. Haemostatic tests have provided useful insight into the haemostatic changes following prothrombin complex concentrate or fresh frozen plasma administration. A definitive trial is needed to ascertain the benefits and safety for each. [ABSTRACT FROM AUTHOR]

There is increased interest in the use of prothrombin complex concentrate (PCC) to treat bleeding in patients who do not require reversal of vitamin K antagonists. Here, we describe in detail the coagulation abnormalities before administration of intervention(s) and during bleeding episodes, and we compare the correction of these abnormalities between different doses of interventions. [Extracted from the article]

This study examines the validity of the Delis-Kaplan Executive Function System (D-KEFS) in a traumatic brain injury (TBI) population compared to participants with orthopaedic injuries and normative controls. The utility of the D-KEFS was examined using a between groups design. One hundred patients with mild uncomplicated to severe TBI were recruited from a consecutive cohort of patients admitted as inpatients to a UK Major Trauma Centre and compared to 823 participants from the D-KEFS normative sample and 26 participants with orthopaedic injuries. Data were filtered for performance validity. Sample discrimination was calculated from D-KEFS subtest scores and derived index scores. Sensitivity to TBI severity was established. The TBI participants performed significantly lower on the D-KEFS Trail Making Test, Colour Word Interference, Colour Word Switching, Letter Fluency and Verbal Fluency Category Switching Total Words Correct. The D-KEFS index scores discriminated between TBI, orthopaedic and normative participants with large and moderate effect sizes, respectively. The D-KEFS demonstrated a dose-response relationship with TBI severity. These effects were robust to differences in premorbid intellectual functioning; however, D-KEFS performance was sensitive to performance on tests of mental processing speed. The use of a D-KEFS index score provides a robust and reliable discrimination of TBI patients from healthy control participants. This discrimination is not accounted for by premorbid intellect or the non-specific effects of trauma. The clinical and conceptual implications of these findings are considered., (© 2023 The British Psychological Society.)

Formula fed infants experience gastrointestinal infections at higher rates than breastfed infants, due in part to bacteria in powdered infant formula (PIF) and bacterial contamination of infant feeding equipment. The United Kingdom National Health Service (UK NHS) has adopted the World Health Organization recommendation that water used to reconstitute PIF is ≥70°C to eliminate bacteria. We used community science methods to co-design an at home experiment and online questionnaire ('research diary') to explore the safety of PIF preparation compared to UK NHS guidelines. 200 UK-based parents of infants aged ≤12 months were recruited; 151 provided data on PIF preparation, and 143 were included in the analysis of water temperatures used to reconstitute PIF. Only 14.9% (n = 11) of 74 PIF preparation machines produced a water temperature of ≥70°C compared with 78.3% (n = 54) of 69 kettle users (p < 0.001). The mean temperature of water dispensed by PIF preparation machines was 9°C lower than kettles (Machine M = 65.78°C, Kettle M = 75.29°C). Many parents did not always fully follow NHS safer PIF preparation guidance, and parents did not appear to understand the potential risks of PIF bacterial contamination. Parents should be advised that the water dispensed by PIF preparation machines may be below 70°C, and could result in bacteria remaining in infant formula, potentially leading to gastrointestinal infections. PIF labelling should advise that water used to prepare PIF should be ≥70°C and highight the risks of not using sufficiently hot water, per WHO Europe advice. There is an urgent need for stronger consumer protections regarding PIF preparation devices., (© 2023 The Authors. Maternal & Child Nutrition published by John Wiley & Sons Ltd.)

Background and Aims: The United Kingdom (UK) Psychoactive Substances Act (PSA), implemented on the 26 th  May 2016, made the production, supply and sale of all non-exempted psychoactive substances illegal. The aim of this study was to measure trends in hospital presentations for severe toxicity following analytically confirmed synthetic cannabinoid receptor agonist (SCRA) exposure before and after implementation of the PSA., Design: Observational study., Setting: Thirty-four hospitals across the UK participating in the Identification of Novel Psychoactive Substances (IONA) study., Participants: A total of 627 (79.9% male) consenting individuals who presented to participating hospitals between July 2015 and December 2019 with severe acute toxicity and suspected novel psychoactive substances exposure., Measurements: Toxicological analyses of patient samples were conducted using liquid-chromatography tandem mass-spectrometry. Time-series analysis was conducted on the monthly number of patients with and without analytically confirmed SCRA exposure using Poisson segmented regression., Findings: SCRAs were detected in 35.7% (n = 224) of patients. After adjusting for seasonality and the number of active sites, models showed no clear evidence of an upward or downward trend in the number of SCRA exposure cases in the period before (incidence rate ratio [IRR], 1.12; 95% CI, 0.99-1.26; P = 0.068) or after (IRR, 0.97; 95% CI, 0.94-1.01; P = 0.202) the implementation of the PSA. There was also no clear evidence of an upward or downward trend in non-SCRA exposure cases before (IRR, 1.12; 95% CI, 0.98-1.27; P = 0.105) or after (IRR, 1.01; 95% CI, 0.98-1.04; P = 0.478) implementation of the PSA., Conclusions: There is no clear evidence of an upward or downward trend in the number of patients presenting to UK hospitals with severe acute toxicity following analytically confirmed synthetic cannabinoid receptor agonist exposure since the implementation of the Psychoactive Substances Act., (© 2022 The Authors. Addiction published by John Wiley & Sons Ltd on behalf of Society for the Study of Addiction.)

Background: Atypical endometrial hyperplasia (AEH) is the precursor lesion in endometrial carcinoma, the most common gynaecological malignancy in New Zealand, with inequities in disease burden and outcome for Māori and Pacific women., Aims: In women diagnosed with AEH at two hospitals, to audit five standards of care for surgical management and time-to-treatment, and identify variation in care by ethnicity and other factors., Materials and Methods: Demographic, referral, diagnostic and treatment characteristics were collected for women with a new AEH diagnosis between 1/1/2019 and 31/12/2020. Surgical management and time-to-treatment were audited against Royal College of Obstetricians and Gynaecologists and New Zealand Ministry of Health Faster Cancer Treatment recommendations., Results: Of 124 participants, 60% were Pacific, 86% premenopausal, and 80% had obesity. For 55 women managed surgically, surgical standards of care were met. There were delays between referral, diagnosis and treatment - only 18% and 56% of women met the 62-day (referral to treatment) and 31-day (decision-to-treat to treatment) targets, respectively. Wait times were prolonged for women who had dilation and curettage (vs pipelle), magnetic resonance imaging (MRI) (vs no MRI), and surgery (vs medical management). Ethnic disparities were not identified for any standard., Discussion: Delays to treatment were found throughout women's journeys. Hospital services can streamline their clinical pathways for women referred for abnormal uterine bleeding, flagging obesity as a high suspicion for cancer indicator, increasing access to endometrial sampling in primary care and establishing 'one-stop-shop' outpatient assessment with empiric initiation of intrauterine progestogen., (© 2022 The Authors. Australian and New Zealand Journal of Obstetrics and Gynaecology published by John Wiley & Sons Australia, Ltd on behalf of Royal Australian and New Zealand College of Obstetricians and Gynaecologists.)