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Inborn errors of thymic stromal cell development and function which are associated with congenital athymia result in life-threatening immunodeficiency with susceptibility to infections and autoimmunity. Athymic patients can be treated by thymus transplantation using cultured donor thymus tissue. Outcomes in patients treated at Duke University Medical Center and Great Ormond Street Hospital (GOSH) over the past three decades have shown that sufficient T-cell immunity can be recovered to clear and prevent infections, but post-treatment autoimmune manifestations are relatively common. Whilst thymus transplantation offers the chance of long-term survival, significant challenges remain to optimise the outcomes for the patients. In this review, we will discuss unmet needs and offer practical guidance based on the experience of the European Thymus Transplantation programme at GOSH. Newborn screening (NBS) for severe combined immunodeficiency (SCID) and routine use of next-generation sequencing (NGS) platforms have improved early recognition of congenital athymia and increasing numbers of patients are being referred for thymus transplantation. Nevertheless, there remain delays in diagnosis, in particular when the cause is genetically undefined, and treatment accessibility needs to be improved. The majority of athymic patients have syndromic features with acute and chronic complex health issues, requiring life-long multidisciplinary and multicentre collaboration to optimise their medical and social care. Comprehensive follow up after thymus transplantation including monitoring of immunological results, management of co-morbidities and patient and family quality-of-life experience, is vital to understanding long-term outcomes for this rare cohort of patients. Alongside translational research into improving strategies for thymus replacement therapy, patient-focused clinical research will facilitate the design of strategies to improve the overall care for athymic patients. [ABSTRACT FROM AUTHOR]

Other sequelae are also relevant and may ultimately have greater impact than primary COVID-19, including long COVID, post-intensive care syndrome, pulmonary embolism and stroke. In this issue of I Anaesthesia i , Shrimpton et al. report a mixed methods study of the perceptions and practices of UK anaesthetists in relation to PPE and COVID-19 [[1]]. News: landmark moment as first NHS patient receives COVID-19 vaccination. Keywords: anaesthetics; COVID-19; resource allocation; respiratory aerosols and droplets; safety EN anaesthetics COVID-19 resource allocation respiratory aerosols and droplets safety 150 154 5 01/10/23 20230201 NES 230201 On 11 March 2020, the World Health Organization formally declared COVID-19 to be a pandemic. [Extracted from the article]

Donor-acceptor dyads and triads comprising core-substituted naphthalene diimide (NDI) chromophores and either phenothiazine or phenoxazine donors are described. Synthesis combined with electrochemical and spectroelectrochemical investigations facilitates characterisation of the various redox states of these molecules, confirming the ability to combine arrays of electron donating and accepting moieties into single species that retain the redox properties of these individual moieties. [ABSTRACT FROM AUTHOR]

National lymphatic filariasis elimination programme (NLFEP) of Federal Ministry of Health sets to provide status of LF in the country before 2020. Borno State, situated in the North East political zone of Nigeria with an estimated population of 4.1million had been enmeshed in insurgency for over a decade. Following an initial mapping between 2008 and 2016 in 16 LGAs out of 27 LGAs, it became imperative that the status of LF in the remaining 11 LGAs of Borno State be ascertained in order to have complete data for planning and policy. Using stratified sampling method, eleven communities were selected from the 11 LGAs namely: Abadam, Ngala, Guzamala, Ngazai, Gubio, Mafa, Jere, Biu, Bayo, Askirin/Uba, and Kwayar Kusar. Blood samples were obtained from consented 990 participants and filarial test strip (FTS) were employed to determine their LF status between November 2017 and February 2018. Of the 990 consented participants only 15 (1.5%) were positive for lymphatic filariasis. Ten cases of hydrocele in men were observed in 4 communities namely Bunari (3), Peta (3), Zaramiramga (2) and Uba (2). Considering the number of positive cases by FTS and hydrocele, result showed that hydrocele accounted for 66.7% of the total positive cases within the positive communities. It is advised that the State health workers should continue to properly educate communities on health programmes including LF preventive measures. Also both Federal Ministry of Health and State Ministry of Health sensitize health partners to start LF treatment and morbidity management in all positive communities to fast track elimination of LF. [ABSTRACT FROM AUTHOR]

Testing for HIV is critical for early diagnosis of HIV infection, providing long‐term good health for the individual and prevention of onward transmission if antiretroviral treatment is initiated early. The main purpose of the 2021 European Guideline on HIV Testing in Genito‐Urinary Settings is to provide advice on testing for HIV infection in individuals aged 16 years and older who present to sexually transmitted infection, genito‐urinary or dermato‐venereology clinics across Europe. The guideline presents the details of best practice and offers practical guidance to clinicians and laboratories to identify and offer HIV testing to appropriate patient groups. [ABSTRACT FROM AUTHOR]

In the JCPP Annual Research Review for 2021, Halldorsson and colleagues (2021) present a systematic review of applied games and virtual reality interventions for treating mental health problems in children and young people, looking at the effectiveness of interventions upon mental health outcomes but also on the experience of using such interventions. In this commentary, we highlight a number of considerations in understanding what research has been achieved so far, and ideas for what needs to be looked at next in further advancing this field. [ABSTRACT FROM AUTHOR]

This article describes the theory and practice of three education courses focusing on critical multicultural education. Two versions of the course take place on the campus of a small liberal arts university in the Midwest region of the United States and the other is based at the same university but operates as a study abroad course in Trinidad and Tobago. Each course offers rich and challenging critical elements of multicultural education. This article describes the development of the curriculum and the strategies involved in the execution of these courses. The Intercultural Development Inventory (IDI) and corresponding Intercultural Development Continuum (IDC) were used to assist in personalized instruction for students, along with Rogerian principles of personal growth and Freire's notion of praxis: action and reflection. Students' comments are included, highlighting the power of these courses. Recommendations are given for providing a more immersive and personalized education in critical multicultural education. [ABSTRACT FROM AUTHOR]

Summary: This article forms part of a series of annual updates that summarizes the evidence base for atopic eczema (AE). It provides a summary of key findings from 28 systematic reviews that were published or indexed during 2017, and focuses on the epidemiology, aetiology and risk factors of AE. AE is the largest single contributor to morbidity associated with skin disease worldwide, once mortality has been excluded. There is a high prevalence of sleep disturbance in individuals with AE and they take more sick leave than controls. While there is a lack of skin bacterial diversity in patients with AE, there is a relative abundance of Staphylococcus aureus and Staphylococcus epidermidis. Compared with controls, affected individuals more often show an IgE response to S. aureus antigens and have higher serum interleukin‐31 levels. Early antibiotic exposure, environmental pollutants, maternal atopy and food allergy are associated with an increased risk of AE, and very preterm birth is associated with decreased risk. Patients with AE have a reduced risk of meningioma, but are more likely to develop attention‐deficit hyperactivity disorder compared with controls. Patients with eosinophilic oesophagitis are significantly more likely than unaffected individuals to have AE. There is no significant overall association between AE and allergic contact dermatitis (ACD), and in children referred for patch testing, ACD was more common in those without AE. Hand eczema is more prevalent in patients with AE. There is no association between AE and Type 2 diabetes, hypertension, stroke or myocardial infarction. Click here for the corresponding questions to this CME article. [ABSTRACT FROM AUTHOR]

Background: Avatar‐based virtual reality therapy is an emerging digital technology that can be used to assist the treatment of common mental health problems. This may be particularly appealing to young people who are highly familiar with digital technologies and may provide a medium to facilitate communication within face‐to‐face therapy. Method: We present two case summaries of young people who used ProReal, who had difficulties engaging in talking therapies. ProReal is a software package providing avatar‐based virtual reality therapy, used as part of talking psychological therapies provided within a CAMHS outpatient clinic. Young people completed pre and postuse routine outcome measures and took part in qualitative interviews assessing their experience of ProReal. Results: Outcome measures showed a reduction over time. The two young people felt ProReal was highly accessible, with both young people positively describing how ProReal helped them externalize their inner worlds to help them to reappraise their thoughts, feelings and experiences. They also reported ProReal being a helpful tool to facilitate communication with the clinician. Conclusion: These case summaries demonstrate how ProReal can be readily integrated into clinical practice and how it can facilitate communication and therapy with young people who find it difficult to express themselves. [ABSTRACT FROM AUTHOR]

Functionalization of boron-dipyrrin (BODIPY) chromophores with pyridine (1) or pyrimidine (2) substituents affords molecules with strong absorbance in the visible spectrum which are also highly fluorescent in solution, in thin films and as powders. Reaction of either 1, a bipyridyl ligand, or 2, a bipyrimidinyl ligand, with CuI in MeCN affords a one-dimensional coordination polymer (3) or a three-dimensional coordination polymer (4), respectively. Although the free ligands, 1 and 2, exhibit fluorescence in the solid-state, metal coordination in the CuI coordination polymers, 3 and 4, leads to quenching despite the retention of the BODIPY core. [ABSTRACT FROM AUTHOR]

Background: Online therapies have been shown to be effective in improving students' mental health. They are cost-effective and therefore have particular advantages in low-income countries like Zambia where mental health resources are limited. This study aimed to explore the perceived impact of the COVID-19 pandemic and the feasibility of implementing an Internet-Based Cognitive Behavioural Therapy (iCBT) intervention ('moodgym') to improve resilience in vulnerable Zambian students. Methods: The study was a qualitative interview study. Participants identifying as having symptoms of low mood and completing a baseline, online survey (n = 620) had the option to volunteer for a semi-structured interview to explore views about their experience of the pandemic and the acceptability and perceived benefits and limitations of using moodgym. Results: A total of 50 students (n = 24 female, n = 26 male) participated in the study. One theme with 4 sub-themes, captured the severe emotional and social impact of the COVID-19 pandemic. A second, very strong theme, with 5 sub-themes, reflected the considerable negative effects of the pandemic on the students' educational experience. This included the challenges of online learning. The third theme, with three subthemes, captured the benefits and acceptability of moodgym, particularly in terms of understanding the relationship between thoughts and feelings and improving academic performance. The fourth theme described the technical difficulties experienced by students in attempting to use moodgym. Conclusion: COVID-19 caused fear and impacted wellbeing in vulnerable students and severely impaired the quality of students' educational experience. The findings suggest that moodgym might be a valuable support to students in a low-income country. [ABSTRACT FROM AUTHOR]

Polycrystalline gallium nitride films, 100 nm to 1 μm thick, were deposited under a range of conditions. Substrate electrode temperatures during sputtering were varied from room temperature to 450 °C, the pressure from 0.15 to 6.0 Pa, the nitrogen fraction of the deposition atmosphere from 10% to 100% and the target bias from -400 to -1800 V. The deposition rates as functions of these conditions are in the range 0.5–25 nm/min. The growth rate is considered to be controlled respectively by the thermally activated desorption from the substrate, changes in the mean free path and concentration of gas particles, differences between the sputter yields of Ga and GaN in Ar and N2, and changes in the ion current and sputter yields. The films are generally columnar, with the grain size increasing with film thickness. The most crystalline films were grown at mid range temperatures, low N2 concentrations, and low target biases, and the most disordered were grown at low pressures. The latter two cases suggest that decreasing the energy of particles incident on the film during deposition results in a more ordered film. The biaxial stress is compressive and shows an increasing trend with the target bias and N2 concentration, reaching 4.7 GPa at 75% N2. Oxygen contamination of 3–30 at. % has a major effect on the optical properties of the films, increasing the band gap values from 3.02 to >4.0 eV and the Urbach tail energies from around 150 to 840 meV and decreasing the refractive index from 2.46 to 2.03. At a 40% N2 deposition fraction, the N:Ga ratio is more or less constant at 1:1. Since the absolute oxygen incorporation rate changes very little, it is the relative film deposition rate which determines the final oxygen concentration. Excess Ga at low N2 concentrations causes a decrease in the band gap and an increase in the Urbach tail energy. [ABSTRACT FROM AUTHOR]

Background: University students have high rates of depression, and friends are often the most commonly-used source of support for emotional distress in this population. This study aimed to explore students' ability to provide effective support for their peers with depressive symptoms and the factors influencing the quality of their mental health first aid (MHFA) skills, including students' gender, course of study, and gender of student experiencing depression.Methods: Via an online survey, students at two British universities (N = 483) were quasi-randomly allocated to view a video vignette of either a male or female student depicting symptoms of depression. An open-ended question probed MHFA actions they would take to help the vignette character, which were rated using a standardised scoring scheme based on MHFA guidelines.Results: Students reported low MHFA scores (mean 2.89, out of possible 12). The most commonly reported action was provision of support and information, but only eight (1.6%) students stated an intention to assess risk of harm. Those studying clinically non-relevant degrees with limited mental health content reported poorer MHFA (p = <0.001) and were less confident about their ability to support a friend with depression (p = 0.04). There was no main effect of vignette gender, but within the group of students on non-relevant courses the male vignette received significantly poorer MHFA than the female vignette (p = 0.02). A significant three-way interaction found that male participants studying non-relevant degrees who viewed a male vignette had poorer MHFA compared to females studying non-relevant degrees who viewed the female vignette (p = 0.005).Conclusions: Most students lack the necessary MHFA skills to support friends suffering from symptoms of depression, or to help them get appropriate support and prevent risk of harm. Students on courses which do not include mental health related content are particularly ill-equipped to support male students, with male students receiving the poorest quality MHFA from fellow male students on these courses. MHFA training has the potential to improve outcomes for students with depression, and could have a valuable role in reducing the excess risk of harm seen in male students. [ABSTRACT FROM AUTHOR]

The article offers information on effectiveness of apps claiming to address mental health and well-being. Topics discussed include information on mental health apps which vary considerably in terms of their functionality and intended benefits; importance of clinical aspects of apps in order to consider usability; and information on mental health apps such as BlueIce ensure usability.

Sport is considered a high-risk environment for athletes sustaining injury. Athletes are known to experience negative psychological responses to injury, which can destabilise identity. For athletes, identity is typically constructed around participation in sport, and after injury this identity can be threatened. Within equestrian sport, the addition of a partner athlete also at risk of injury presented a unique circumstance for investigation. The purpose of the present study was to investigate the psychological responses of elite young riders (YR) to the injury of their horses. Five riders competing internationally at YR level for dressage, show jumping and eventing were interviewed about their experiences when their horse suffered serious or career-ending injuries. Interview questions explored athletes' careers, initial reactions to injury, coping mechanisms and return to elite competition. Thematic analysis revealed that riders re-evaluated their identity as elite athletes and experienced a significant sense of loss when their horses became injured. This appraisal of loss led to YR's experiencing denial and guilt at the onset of injury akin to personal injury in athletes. As riders perceive the horse as part of the 'athlete' package, they are at heightened risk of injuryrelated psychological stress when compared to other individual athletes. Riders reported mixed views on common sources of social support, suggesting a need for pre-emptive coping education in addition to intervention resources within equestrian sport to minimise the psychological impact of injury, particularly at YR level. [ABSTRACT FROM AUTHOR]

Summary: This review forms part of a series of annual updates that summarize the evidence base for atopic eczema (AE), providing a succinct guide for clinicians and patients. It provides a summary of key findings from 15 systematic reviews that were published during 2015, and focuses on the epidemiology and methodology issues of AE. For systematic reviews on the prevention and treatment of AE, see Part 2 of this update. The worldwide prevalence of AE during childhood has been calculated to be 7.89% (95% CI 7.88–7.89), based on studies of 1 430 329 children from 102 countries. Children with AE are four times more likely than controls to have allergic rhinitis and asthma [relative risk (RR) = 4.24, 95% CI 3.75–4.79]. Twin studies show the heritability of AE to be about 75%. AE is more prevalent in patients with vitiligo and alopecia, and is positively associated with a high body mass index in America and Asia but not in Europe. Possible relationships between AE and exercise, maternal folate supplementation, maternal stress and autism spectrum disorder (ASD) have been assessed, but more high‐quality studies are needed for definitive conclusions. The Harmonising Outcomes Measures for Eczema (HOME) Initiative is developing a core set of outcome measures for AE trials. Suitable instruments for measuring quality of life are yet to be agreed, and use of Investigator Global Assessment in trials requires standardization. Transparent reporting of AE trials remains problematic. [ABSTRACT FROM AUTHOR]

Equestrian sport is considered a high-risk environment for equine injury. Due to the close bond between horse and rider, it could be theorised that riders may be impacted psychologically by their horses' injuries, as seen in athletic pairs and with companion animal ownership. The extensive time commitment and responsibility of care within equestrian sport means that horse riders' day-to-day life is impacted in a way not seen in other sporting or leisure environments, thus providing a unique opportunity to investigate the psychological responses of riders to their horse's injury. The aims of this study were to investigate the psychological responses that amateur riders experienced when their horses were injured. 308 amateur horse riders (16 male and 292 female, median age 25-30 category) completed the Psychological Response to Sport Injury Inventory (19-item) (PRSII) and questions regarding demographics, investment in equestrian sport, the horse's injury and the length of rehabilitation. Devastation was significantly affected by the weekly time investment of riders (H(3)=8.255, P=0.041) and the length of ownership prior to the injury (H(2)=7.690, P=0.021). 'Devastation', 'feeling cheated', 'restlessness' and 'isolation' were all significantly affected by the length of rehabilitation for the horse (H(7)=70.825, P=0.000, H(7)=37.799, P=0.000, H(7)=37.799, P=0.004, and H(7)=27.486, P=0.000, respectively). These findings suggest that amateur horse riders are at risk of psychological distress when their horse becomes injured. Whilst the industry has developed strategies to support owners following euthanasia which are already in place, psychological support following horse injury may be necessary to buffer psychological 'devastation' within amateur horse owners. [ABSTRACT FROM AUTHOR]

The room-temperature photoluminescence intensity and conductivity of GaN films grown by reactive rf sputtering were improved by the addition of hydrogen during growth. The differential resistivity decreased by two orders of magnitude when 2.4% H2 was added to the deposition gas. The improvement in the photoluminescence intensity occurred together with an increase in the level of oxygen contamination and an apparent increase in the structural disorder. At 0 and 20% H2, respectively, the refractive indices were 2.45 and 1.98, and the bandgaps were 3.06 and 3.64 eV, with the change attributed to oxygenation. [ABSTRACT FROM AUTHOR]

We prove new upper bounds on the multicolour Ramsey numbers of paths and even cycles. It is well known that ( k − 1 ) n + o ( n ) ⩽ R k ( P n ) ⩽ R k ( C n ) ⩽ k n + o ( n ) . The upper bound was recently improved by Sárközy who showed that R k ( C n ) ⩽ k − k 16 k 3 + 1 n + o ( n ) . Here we show R k ( C n ) ⩽ ( k − 1 4 ) n + o ( n ) , obtaining the first improvement to the coefficient of the linear term by an absolute constant. [ABSTRACT FROM AUTHOR]

The increasing demand for water and energy in South Africa, and the capacity constraints and restrictions of both resources, have led to a rapid increase in their cost. The manufacturing industry remains South Africa's third-largest consumer of water and second-largest consumer of national energy. The improvement of water and energy efficiency is becoming an increasingly important theme for both organisational success and national economic sustainability. This paper presents the 'lean based water and energy stream mapping framework' developed for the manufacturing industry, with the specific objective of decreasing its water and energy intensity. As with the traditional value stream mapping tool, the water and energy stream mapping focuses on eliminating water- and energy-specific wastes within a process. Water and energy waste categories that will be used in conjunction with the framework will also be discussed. The key objective of this paper is to detail the process of creating the water and energy stream mapping, and the statistical forecasting methodology used to develop the baseline water and energy demand data. The outcome of the implementation of the framework is the future state water and energy stream mapping, which is effectively a blueprint for increased water and energy efficiency within a studied process. [ABSTRACT FROM AUTHOR]

This study investigated the perception of leadership styles and employee restive behaviour by secondary school teachers in a Nigerian setting. Participants were 309 secondary school teachers (males = 41.42%; females = 58.58%; age range between 36 and 52 years;M= 42.48;SD= 3.93). The participants completed the Leadership Behaviour Descriptive Questionnaire (LBDQ-XII) and the Employee Restiveness Predictive Scale (ERPS). Multiple linear regression was utilised to predict teachers’ restive behaviour from the consideration and initiating structure aspect of leadership style. Results suggested that initiating structure leadership style was a positive predictor of positive employee restive behaviour, while consideration leadership style negatively predicted positive employee restive behaviour. Perceived leadership style has an influence on employee restive behaviour. [ABSTRACT FROM PUBLISHER]

HLA-B*14:53 was found in a UK European normal blood donor prior to registration on the Welsh Bone Marrow Donor Registry. It differs from B*14:13 by one base (103G>T) in exon 2 resulting in a substitution of alanine (A) in B*14:13 to serine (S) in B*14:53. Unique among current HLA-B*14 alleles, B*14:53 and B*14:13 share a motif of 59 bases between positions 361 and 419 in exon 3. This motif is present in numerous HLA-B alleles the commonest overall being B*08:01, suggesting that both B*14:53 and B*14:13 arose from intralocus gene conversion events with B*08:01. Thus, B*14:53 probably arose from B*14:01:01 (which has TCC at codon 11 (S), while B*14:13 arose from B*14:02:01:01 which has GCC at codon 11 (A). Additionally, the two likely B*14:53-bearing and B*14:13-bearing haplotypes are typical of B*14:01:01-bearing and B*14:02:01:01-bearing haplotypes, respectively. Serological testing, using 49 antisera with HLA-B64, or B64, B65 reactivity, showed that the B*14:53 specificity did not react as a B64 (B*14:01) specificity and may appear as a short/weak HLA-B14. This implies that residues additional to S at position 11 are involved in HLA-B64 serological identity; for example, the motif 11S 97W 116F is possessed by B*14:01 and many other B*14 products (and B*39:79 plus some HLA-C products) but not B65 (B*14:02) or the B*14:53 specificity. B*14:53 was found in a random HLA sequence-based typed population of 32 530 normal subjects indicating a low precision allele frequency of 0.000015 in subjects resident in Wales. [ABSTRACT FROM AUTHOR]

A synthetic strategy involving a combination of tetra-thionation and amine substitution in the bay region of a perylene diimide (PDI) leads to remarkable examples of neutral PDIs with intense absorption maxima in the near infrared. Generation of the corresponding monoanions red shifts the absorption profile to give short-wavelength infrared bands. [ABSTRACT FROM AUTHOR]

Background: Data linkage studies find that depression before or after a breast cancer diagnosis predicts reduced survival. This study aimed to determine whether depression or bipolar recorded in routine hospital admission data independently predicts survival in English breast cancer patients and whether onset in relation to cancer diagnosis is significant.Methods: Data on 77,173 women diagnosed with breast cancer (ICD-10 C50) in South East England, 2000-2009, were included. Of these, 131 women had a diagnosis of bipolar affective disorder (ICD-10 F31) and 955 of depression (either depressive episodes (ICD-10 F32) or depressive disorder (ICD-10 F33)) recorded in Hospital Episode Statistics between 3 years before and a year following cancer diagnosis. Kaplan-Meier plots were used to examine overall survival. Cox regression analyses were carried out overall and separately for mood disorder diagnoses before and after the cancer diagnosis and adjusted for confounding variables.Results: A record of depression was a predictor of worse overall survival in breast cancer patients (adjusted HR = 1.33, 95% CI: 1.20-1.48, p < 0.001), while the effect of bipolar was not statistically significant (adjusted HR = 1.33, 95% CI: 0.97-1.82, p = 0.079). New recordings of depression and bipolar diagnoses following a cancer diagnosis appeared better predictors of overall survival than a prior history of either.Conclusions: There is evidence that English breast cancer patients with depression and bipolar recorded in routine hospital data have worse overall survival than those without these mood disorders. Further work exploring the concordance of records within administrative health data with clinical diagnosis and cause-specific death within these patient groups is needed. [ABSTRACT FROM AUTHOR]

Introduction There are many different lesion sets that are used for the surgical ablation of atrial fibrillation (AF). One such pattern is the ‘box set’, a single ring of scar delivered anterior to the pulmonary veins, which aims to electrically isolate the posterior wall from the rest of the heart. However it remains unclear whether posterior wall isolation (PWI) is an effective lesion set for maintenance of sinus rhythm and whether it is necessary to achieve complete bidirectional block. We investigated the long-term integrity of the ‘box set’ lesion created during surgical AF ablation by epicardial High Intensity Focussed Ultrasound (HIFU). All patients had documented persistent or recurrent paroxysmal AF prior to surgery. We correlated this with subsequent success or failure in the abolition of atrial fibrillation. Methods With regional ethical and R&D approval, 101 patients who had previously undergone HIFU AF ablation greater than 4 years ago were screened for inclusion in the study. 17 patients agreed to late electrophysiological study: 11 with on-going AF and 6 in normal sinus rhythm. Clinical history and 7-day holters were used to define the NSR group. We performed a diagnostic EP study using a transseptal approach in fully anticoagulated patients (INR>2.0 and ACT maintained at >300s). A catheter was placed in the coronary sinus (CS) and a circular multipolar mapping catheter was used to map the left atrium and pulmonary veins. Patients in atrial fibrillation were cardioverted. We recorded whether posterior wall (PW) and pulmonary vein (PV) isolation had been achieved at the surgical procedure. In selected cases we recorded a voltage map using either CARTO (Biosense- Webster) or NavX (St Jude Medical) to identify areas of ablation scar. Results All 11 patients with AF had absence of PW+PV isolation with fractionated electrograms recorded across the PW. In the 6 patients with long-term freedom from AF, PW+PV isolation was confirmed in 4 (67%) and in 1 there was prolonged conduction across the box-set lesion with CS to PW activation time of around 200ms versus 45ms from mid-CS to left atrial appendage. Of the 4 patients with confirmed PW+PV isolation, 1 had dissociated spontaneous atrial potentials within the box set area and the other 3 had electrical silence throughout with inability to capture the posterior wall pacing at 10mA at multiple sites. Conclusions There appears to be a clear correlation between the successful restoration of long-term sinus rhythm and isolation / delayed conduction from the pulmonary veins and posterior wall. Given the advent of hybrid atrial fibrillation ablation techniques designed to deliver this lesion set, these findings are timely and highly relevant. [ABSTRACT FROM AUTHOR]

The International Conference on Harmonization considers older people a 'special population', as they differ from younger adults in terms of comorbidity, polypharmacy, pharmacokinetics and greater vulnerability to adverse drug reactions (ADRs). Medical practice is often based on single disease guidelines derived from clinical trials that have not included frail older people or those with multiple morbidities. This presents a challenge caring for older people, as drug doses in trials may not be achievable in real world patients and risks of ADRs are underestimated in clinical trial populations. The majority of ADRs in older people are Type A, potentially avoidable and associated with commonly prescribed medications. Several ADRs are particularly associated with major adverse consequences in the elderly and their reduction is therefore a clinical priority. Falls are strongly associated with benzodiazepines, neuroleptics, antidepressants and antihypertensives. There is good evidence for medication review as part of a multifactorial intervention to reduce falls risk in community dwelling elderly. Multiple medications also contribute to delirium, another multifactorial syndrome resulting in excess mortality particularly in frail older people. Clostridium difficile associated with use of broad spectrum antibiotics mainly affects frail older people and results in prolonged hospital stay with substantial morbidity and mortality. Antipsychotics increase the risk of stroke by more than three-fold in patients with dementia. Inappropriate prescribing can be reduced by adherence to prescribing guidelines, suitable monitoring and regular medication review. Given the heterogeneity within the older population, providing individualized care is pivotal to preventing ADRs. [ABSTRACT FROM AUTHOR]

The article offers guidelines on how surgeons spot signs of abuse among children. Information about various classifications of abuse are discussed including physical abuse, emotional abuse, and sexual abuse. Details about different signs of physical abuse are mentioned including fractures, bruises, and behavioural problems.

Introduction There is evidence that dedicated units that provide comprehensive geriatric assessment can reduce inpatient falls and other iatrogenic harm1. The Emergency Department (ED) in Morriston Hospital has 90,000 attendances a year. 4,000 patients >65 years presented with falls. Between January 2018–November 2021, ED reported 207 incidents of falls via the Health Board Datix System. Intervention Phase 1 In April 2018, the Older Person's Assessment Service (OPAS) (Geriatrician led Multidisciplinary team) began a liaison service to ED, taking referrals from the medical and ED teams for patients presented with frailty syndromes. Phase 2 In June 2020, OPAS was allocated a dedicated Emergency Frailty Unit within the Emergency Department footprint, allowing patients to be assessed rapidly by a specialist team and nursed in a specialist environment. Results Between June 2020–November 2021, the service saw 1,317 new patients. The average age of an OPAS patient was 83 years and had a Rockwood Clinical Frailty Scale Score of >5. 73% of patients presented with falls as a primary presenting complaint. Between June 2020–November 2021, there was one reported fall within the unit. The mean incident reported of inpatient falls in ED in phase 2 (M = 5.50, SD = 2.66) is statistically significantly higher than phase 1 (M = 3.96, SD = 1.87), t(42) = −2.26, p = 0.03. The service did not show any impact on the incidence of inpatient falls in ED. Conclusion The unit was an effective intervention to prevent falls for the patients it assessed within the unit but had no impact on inpatient falls within the main ED. The impact of this service is difficult to determine given the low reported falls in ED. 1. Fox MT, Persaud M, Maimets I et al. J Am Geriatr Soc, 2012, 60:2237–2,245. [ABSTRACT FROM AUTHOR]

Glioblastoma is the most common and lethal primary malignant brain tumor in adults. The tumor suppressor gene PTEN is deleted, mutated or hypermethylated in more than 60% of glioblastoma cases resulting in hyperactivation of the phosphoinositide 3-kinase pathway, which leads to sustained PI(3,4,5)P3 signaling, and thereby hyperactivation of Akt and other effectors. PI(3,4,5)P3 is also hydrolyzed to PI(3,4)P2 by inositol polyphosphate 5-phosphatases such as SKIP, but the role this pathway has in glioblastoma is unknown. Microarray expression profiling of SKIP in human glioblastoma has revealed both increased and decreased SKIP gene expression. Here we have screened PTEN-deficient glioblastoma for SKIP protein expression by immunohistochemistry and report that SKIP expression is increased in some cases or decreased relative to normal brain. Using the U-87MG PTEN-deficient cell line we show that SKIP knockdown did not further enhance cell proliferation or survival. However, SKIP overexpression in U-87MG cells suppressed anchorage-independent cell growth and growth factor-induced PI(3,4,5)P3/Akt signaling. Although, SKIP knockdown did not affect cell proliferation or survival, cell migration was significantly retarded, associated with significantly increased PI(4,5)P2 signals, and decreased phosphorylation of the actin-regulatory protein cofilin, a PI(4,5)P2-binding protein. Notably, overexpression of SKIP also inhibited migration of U-87MG cells to a similar degree as observed with PTEN reconstitution, however, via distinct mechanisms. PTEN reconstitution promoted sustained lamellipodia generation and focal adhesion formation. In contrast, SKIP overexpression reduced sustained lamellipodia formation, talin incorporation into focal adhesions and recruitment of PI(4,5)P2-binding proteins to the plasma membrane. Notably, analysis of two independent ONCOMINE microarray data sets revealed a significant correlation between increased SKIP mRNA expression in glioblastoma and improved long-term survival. Therefore, SKIP expression in glioblastoma may affect the local invasion of PTEN-deficient tumors. [ABSTRACT FROM AUTHOR]

The aim of this study was to examine the relationship between sport participation, global self-esteem and physical self-concept in female adolescent equestrian athletes. 239 participants (239 females aged 12-20 years old, 15.96±2.422 years) completed the Physical Self-Description Questionnaire (PSDQ) and a modified version of the Sport Activity Questionnaire through an online survey. Seven of the original 11 PSDQ subscales were chosen to be analysed: physical activity, body fat, sports competence, global physical self-concept, appearance, flexibility and global self- esteem. Global self-esteem and appearance were significantly affected by participant age (H(2) = 7.27, P<0.05 and H(2) = 9.58, P<0.01, respectively). Physical activity was significantly affected by discipline (H(4) = 13.39, P<0.05). Implications of these findings suggest that equestrian sport could act as a contributor to self-esteem in female adolescents and as such more emphasis on psychosocial development within the British Equestrian Federation's Long Term Athlete Development programme (LTAD) and the training of equestrian coaches needs to be implemented by governing bodies. [ABSTRACT FROM AUTHOR]

This paper describes a root cause failure investigation of a corroded AISI 304L stainless steel pipeline used to carry hydrocarbon gas. The corrosion was originally identified due to a leakage observed after removal of a section of lagging insulation. The investigation revealed however a three stage mechanism of attack had occurred; both intergranular cracking and transgranular cracking was present originating from both the internal and external surfaces. The process of attack occurred due to SSC from the internal surface resulting in CUI; the attack to the external surface then initiated SCC. A complex process of corrosion mechanisms was initially attributed to CUI, it was however due to internally initiated corrosion due to the combination of water carryover and the presence of corrosive species highlighting the importance of forensic examinations in oil and gas failures. [ABSTRACT FROM AUTHOR]

The article offers an overview of the importance of a harbour site at Salamis, Cyprus, highlighting photographic evidence of shipsheds which were built by King Evagoras in the fourth century BCE. A background of the harbour site is provided which was built for Evagoras' fleet of triremes that illustrates the power struggle between Athens, Sparta, and the Persian Empire. Also discussed are several evidences of ancient city wall of Salamis.

Treatment of the ortho-phenylene diamine C6H4-1,2-{N(H)Tripp}2 (1, PDAH2, Tripp = 2,4,6-triisopropylphenyl) with two equivalents of MR (M = Li, R = Bun; M = Na or K, R = CH2C6H5) afforded the dimetallated alkali metal ortho-phenylene diamide dianion complexes [(PDALi2)(THF)3] (2), [{(PDANa2)(THF)2}2] (3), and [{(PDAK2)(THF)3}2] (4). In contrast, treatment of 2 with two equivalents of rubidium or cesium 2-ethylhexoxide, or treatment of 1 with two equivalents of MR (M = Rb or Cs, R = CH2C6H5) did not afford the anticipated dialkali metal ortho-phenylene diamide dianion derivatives and instead formally afforded the monometallic ortho-diiminosemiquinonate radical anion species [PDAM] (M = Rb, 5; M = Cs, 6). The structure of 2 is monomeric with one lithium coordinated to the two nitrogen centres and the other lithium η4-coordinated to the diazabutadiene portion of the PDA scaffold. Similar structural cores are observed for 3 and 4, except that the larger sodium and potassium ions give dimeric structures linked by multi-hapto interactions from the PDA backbone phenyl ring to an alkali metal centre. Complex 5 was not characterised in the solid state, but the structure of 6 reveals coordination of cesium ions to both PDA amide centres and multi-hapto interactions to a PDA backbone phenyl ring in the next unit to generate a one-dimensional polymer. Complexes 2-6 have been variously characterised by X-ray crystallography, multi-nuclear NMR, FTIR, and EPR spectroscopies, and CHN microanalyses. [ABSTRACT FROM AUTHOR]

This paper considers N×N matrices of the form A? =A+?B, where A is self-adjoint, ??C and B is a non-self-adjoint perturbation of A . We obtain some monodromy-type results relating the spectral behaviour of such matrices in the two asymptotic regimes |?|→8 and |?|→0 under certain assumptions on B . We also explain some properties of the spectrum of A ? for intermediate sized ? by considering the limit N→8, concentrating on properties that have no self-adjoint analogue. A substantial number of the results extend to operators on infinite-dimensional Hilbert spaces. \ [ABSTRACT FROM AUTHOR]

This paper considers N × N matrices of the form Aγ=A+γB, where A is self-adjoint, γ∈C and B is a non-self-adjoint perturbation of A. We obtain some monodromy-type results relating the spectral behaviour of such matrices in the two asymptotic regimes |γ| → ∞ and |γ| → 0 under certain assumptions on B. We also explain some properties of the spectrum of Aγ for intermediate-sized γ by considering the limit N → ∞, concentrating on properties that have no self-adjoint analogue. A substantial number of results extend to operators on infinite-dimensional Hilbert spaces. [ABSTRACT FROM AUTHOR]

The synthesis and separation of the 1,6- and 1,7- isomers of N,N'-bis(alkyl)diadamantylthio-3,4,9,10-perylenetetracarboxylic acid diimide are reported. Investigations of the structural, electrochemical, spectroscopic, and spectroelectrochemical properties of the isomers reveal a sequence of electrochemically and chemically reversible reduction processes for both isomers. Three X-ray crystal structures are reported including a pair of 1,6- and 1,7-isomers demonstrating the twist of the perylene core in the solid state. Our studies thoroughly characterize the mono- and direduced states of the two isomers allowing unequivocal characterization of the reduced species by UV-vis and IR spectroscopic measurements. EPR studies also allow direct identification of the monoreduced PTCDI species and spectroscopic measurements confirm the delocalization of electronic density around the carbonyl moieties of the reduced species. [ABSTRACT FROM AUTHOR]

The first example of a Donor-spacer-Acceptor tryad, based upon a molybdenum-ene-l,2-dithiolate unit as the Donor and a naphthalene-diimide as the Acceptor, has been synthesized and its photophysical properties investigated. Synthesis required the preparation of a new pro-ligand containing a protected ene-l,2-dithiolate bound through a phenyl linkage to a naphthalenetetracarboxylicdiimide (NDI) group. Deprotection of this pro-ligand by base hydrolysis, followed by reaction with [Cp2MoCl2], produced the new dyad [Cp2Mo(SC(H)C(C6H4-NDI)S)] (2). Electrochemical studies showed that 2 can be reversibly oxidized to [2]+ and reduced to [2]-, [2]2-, and [2]3-. These studies, augmented by UV/vis, IR, and electron paramagnetic resonance (EPR) spectra of electrochemically generated [2]+ and [2]-, show that the highest occupied molecular orbital (HOMO) of 2 is ene-l,2-dithiolate-based and the lowest unoccupied molecular orbital (LUMO) is NDI-based; these conclusions are supported by density functional theory (DFT) calculations for the electronic ground state on a model of 2 which also showed that these two parts of the molecule are electronically distinct. The dynamics of the excited states of 2 in CH2Cl2 solution were investigated by picosecond time-resolved IR spectroscopy following irradiation by a 400 nm ~120 fs laser pulse. These investigations were complemented by an ultrafast transient absorption spectroscopic study from 420 to 760 nm of the nature of the excited states of 2 in CH2Cl2 solution following irradiation by a 383 nm ~120 fs laser pulse. These studies showed that irradiation of 2 at both 400 and 383 nm leads to the formation of the [(Cp)2{Mo(dt)}+-Ph-{NDI}-] charge-separated state as a result of a cascade electron transfer initiated by the formation of an 'NDI* excited state. iNDI* rapidly (ca. 0.2 ps) forms the local charge transfer state [Cp2Mo(dt)-{Ph}+-{NDI}~] which has a lifetime of about 1.7 ps and decays to produce the ground state and the charge-separated state [(Cp)2{Mo(dt)}+ -Ph-{NDI}-]; the latter has an appreciablS lifetime, about 15 ns in CH2Cl2 at room temperature. [ABSTRACT FROM AUTHOR]

Abstract: The Julia Creek dunnart is a rare solitary marsupial that displays regular stereotyped pacing in captivity. An effective captive breeding programme has been hindered by the lack of an efficient housing system. An initial experiment examined the feasibility of housing in pairs, by mixing animals of different ages and sex for a 2h period, and providing a barrier between the two animals in the initial joining period. Pairs of young animals hid more than old ones (86% vs. 59% of time, P =0.003), whereas old pairs spent more time running (4% vs. 0% of time, P =0.03) and had more feeding (0.33 vs. 0.05, P =0.002) and exploring (0.3 vs. 0.1) events. The barrier did not affect aggression but it increased the behavioural similarity of the two animals. A second experiment examined the behavioural responses to pairing of single sex male and female pairs over a six week period, and the provision of a running wheel for locomotion. Two out of eight pairs of animals had to be separated due to aggressive interactions, and the remaining paired animals exhibited more stereotypic pacing (63 vs. 4 events/6h, P =0.01) and self-grooming (871 vs. 191 events/6h, P <0.001) than singles. The wheel reduced the number of pacing bouts from 4.8 to 1.9/6h (P =0.05), and the total distance travelled (wheel+pacing) increased from 1.3 to 3.9km/6h. Females ran further in the wheel than males (43 vs. 12m/6h, P <0.01), and they had fewer agonistic interactions with their pen mates when they were provided with a wheel (6 vs. 169/6h, P <0.01). Males ran further by stereotyped pacing than females (0.23 vs. 0.02km/6h, P =0.02). Pairing of animals was therefore not suitable in small cages utilised for the captive breeding programme because it resulted in aggression and stereotyped behaviour. However, provision of a running wheel can help to reduce stereotyped pacing. [Copyright &y& Elsevier]

This article summarises the archaeological evidence for the existence of Evagoras' naval harbour at Salamis in North Cyprus, which ancient texts credit him with building c.410-400 BC. Based on a critical examination of previous surveys and his own on-site observations, the author concludes there is indicative evidence of a constructed harbour c.800 m long, which was divided into two basins by a stone jetty, separated from the city by a stone wall and with some evidence of ship-sheds at its north end. [ABSTRACT FROM AUTHOR]

Abstract: The effects of in vitro preconditioning protocols on the ultimate survival of myoblasts implanted in an in vivo tissue engineering chamber were examined. In vitro testing: L6 myoblasts were preconditioned by heat (42 °C; 1.5 h); hypoxia (<8% O2; 1.5 h); or nitric oxide donors: S-nitroso-N-acetylpenicillamine (SNAP, 200 μM, 1.5 h) or 1-[N-(2-aminoethyl)-N-(2-aminoethyl)amino]-diazen-1-ium-1,2-diolate (DETA-NONOate, 500 μM, 7 h). Following a rest phase preconditioned cells were exposed to 24 h hypoxia, and demonstrated minimal overall cell loss, whilst controls (not preconditioned, but exposed to 24 h hypoxia) demonstrated a 44% cell loss. Phosphoimmunoblot analysis of pro-survival signaling pathways revealed significant activation of serine threonine kinase Akt with DETA-NONOate (p < 0.01) and heat preconditioning (p < 0.05). DETA-NONOate also activated ERK 1/2 signaling (p < 0.05). In vivo implantation: 100,000 preconditioned (heat, hypoxia, or DETA-NONOate) myoblasts were implanted in SCID mouse tissue engineering chambers. 100,000 (not preconditioned) myoblasts were implanted in control chambers. At 3 weeks, morphometric assessment of surviving myoblasts indicated myoblast percent volume (p = 0.012) and myoblasts/mm2 (p = 0.0005) overall significantly increased in preconditioned myoblast chambers compared to control, with DETA-NONOate-preconditioned myoblasts demonstrating the greatest increase in survival (p = 0.007 and p = 0.001 respectively). DETA-NONOate therefore has potential therapeutic benefits to significantly improve survival of transplanted cells. [Copyright &y& Elsevier]

A retrospective study was performed to identify dogs with cerebrospinal fluid-filled cavitatory lesions on MRI. Six dogs were included and the lesions were classified. In the three dogs in the present study with hydranencephaly, unilateral but complete loss of the temporal and parietal lobes was noted and had almost complete loss of the occipital and frontal lobes of a cerebral hemisphere. In the three dogs with porencephaly, there was unilateral incomplete loss of the parietal lobe and one dog had additional partial loss of the temporal and frontal lobes. Two of the dogs with porencephaly had seizures; the third showed no associated clinical signs. The dogs with hydranencephaly had mentation changes and circled compulsively. The two porencephalic dogs with seizures were treated with phenobarbitone. One of the dogs with hydranencephaly showed increased frequency and duration of circling; one dog's clinical signs did not progress and the third dog was euthanased due to increasing aggression. The dog with increased circling had ventriculoperitoneal shunt placement and the circling frequency reduced. [ABSTRACT FROM AUTHOR]

Background:Reliable information can improve patients' knowledge of chemotherapy. As internet chemotherapy information (ICI) is increasingly viewed as a valuable patient education tool, we investigated the impact of ICI on patient care and analysed health professionals' (HPs') attitudes towards ICI.Methods:The following questionnaires were distributed: (1) self-administered questionnaire randomly given to 261 patients receiving chemotherapy (80% returned); and (2) separate questionnaire given to 58 HPs at the same UK Oncology Centre (83% returned).Results:Just over half of the patient respondents accessed the internet regularly. They were younger, with higher incomes and qualifications. Key search topics included chemotherapy modes of action, symptom management and treatment success, and most considered ICI useful. More than half wanted to discuss ICI with HPs but most did not get the opportunity. Although the majority of HP respondents supported the need for patients to retrieve ICI, most questioned the accuracy of ICI and did not routinely recommend its use.Conclusion:This study has shown that ICI is generally perceived by patients to be a valuable information resource. Given the potential impact of ICI, the following should be addressed in future studies: (1) inequalities in accessing ICI; (2) maintaining the quality of ICI (with clear guidance on recommended websites); (3) bridging the gap between the perception of ICI by patients and HPs; (4) integration of ICI with traditional consultation models. [ABSTRACT FROM AUTHOR]

ABSTRACT The XMM Cluster Survey (XCS) is a serendipitous search for galaxy clusters using all publicly available data in the XMM-Newton Science Archive. Its main aims are to measure cosmological parameters and trace the evolution of X-ray scaling relations. In this paper we describe the data processing methodology applied to the 5776 XMM observations used to construct the current XCS source catalogue. A total of 3675 > 4σ cluster candidates with >50 background-subtracted X-ray counts are extracted from a total non-overlapping area suitable for cluster searching of 410 deg2. Of these, 993 candidates are detected with >300 background-subtracted X-ray photon counts, and we demonstrate that robust temperature measurements can be obtained down to this count limit. We describe in detail the automated pipelines used to perform the spectral and surface brightness fitting for these candidates, as well as to estimate redshifts from the X-ray data alone. A total of 587 (122) X-ray temperatures to a typical accuracy of <40 (<10) per cent have been measured to date. We also present the methodology adopted for determining the selection function of the survey, and show that the extended source detection algorithm is robust to a range of cluster morphologies by inserting mock clusters derived from hydrodynamical simulations into real XMMimages. These tests show that the simple isothermal β-profiles is sufficient to capture the essential details of the cluster population detected in the archival XMM observations. The redshift follow-up of the XCS cluster sample is presented in a companion paper, together with a first data release of 503 optically confirmed clusters. [ABSTRACT FROM AUTHOR]

Background: This study aimed to examine the incidence and survival of lung cancer patients from several different ethnic groups in a large ethnically diverse population in the United Kingdom.Methods: Data on residents of South East England diagnosed with lung cancer between 1998 and 2003 were extracted from the Thames Cancer Registry database. Age- and socioeconomic deprivation-standardised incidence rate ratios were calculated for males and females in each ethnic group. Overall survival was examined using Cox regression, adjusted for age, socioeconomic deprivation, stage of disease and treatment. Results are presented for White, Indian, Pakistani, Bangladeshi, Black Caribbean, Black African and Chinese patients, apart from female survival results where only the White, South Asian and Black ethnic groups were analysed.Results: Compared with other ethnic groups of the same sex, Bangladeshi men, White men and White women had the highest incidence rates. Bangladeshi men had consistently higher survival estimates compared with White men (fully adjusted hazard ratio 0.46; P<0.001). Indian (0.84; P=0.048), Black Caribbean (0.87; P=0.47) and Black African (0.68; P=0.007) men also had higher survival estimates. South Asian (0.73; P=0.006) and Black (0.74; P=0.004) women had higher survival than White women.Conclusion: Smoking prevention messages need to be targeted for different ethnic groups to ensure no groups are excluded. The apparent better survival of South Asian and Black patients is surprising, and more detailed follow-up studies are needed to verify these results. [ABSTRACT FROM AUTHOR]

Fewer than 100 cases of traumatic lumbar hernias are described in the English literature. The herniation has been described as a consequence of a combination of local tangential shearing forces combined with an acute increase in intra-abdominal pressure secondary to sudden deceleration sustained during blunt abdominal trauma. Delayed diagnosis is not uncommon, as nearly a quarter of these are missed at initial presentation. These hernias are best managed by operative intervention; however, there is no well-defined treatment strategy regarding either the timing or the type of repair. Several approaches, including laparoscopy, have been described to repair these defects. Various techniques, including primary repair, musculoaponeurotic reconstruction, and prosthetic mesh repair, have been described. These repairs are usually complicated because of the lack of musculoaponeurotic tissue inferiorly near the iliac crest. We describe here two cases of traumatic lumbar hernia managed by initial watchful waiting and subsequent elective repair using a combined laparoscopic and open technique and one with and one without bone anchor fixation. [ABSTRACT FROM AUTHOR]

Background: Breast cancer 5-year relative survival is low in the North East London Cancer Network (NELCN).Methods: We compared breast cancer that was diagnosed during 2001-2005 with that in the rest of London.Results: North East London Cancer Network women more often lived in socioeconomic quintile 5 (42 vs 21%) and presented with advanced disease (11 vs 7%). Cox regression analysis showed the survival difference (hazard ratio: 1.27, 95% confidence interval (CI): 1.15-1.41) reduced to 1.00 (95% CI: 0.89-1.11) after adjustment for age, stage, socioeconomic deprivation, ethnicity and treatment. Major drivers were stage and deprivation. Excess mortality was in the first year.Conclusion: Late diagnosis occurs in NELCN. [ABSTRACT FROM AUTHOR]