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Abstract Excessive, unregulated usage and reckless disposal of antibiotics have led to the formation of antibiotic resistance in bacteria. Additionally, untreated or partially treated pharmaceutical effluents are discharged into water bodies. With the increasing prevalence of antibiotic resistance across the globe, previously curable diseases are becoming challenging to handle due to the advent of superbugs. It is crucial to ensure complete treatment and removal of antibiotics and pharmaceuticals before discharging them into water bodies. Conventional treatment plants are not specialized in removing such complex, emerging contaminants. The advanced oxidation process is an emerging and promising treatment strategy for the abatement of emerging contaminants such as pharmaceutical compounds. This study explores an electrochemical advanced oxidation process, viz., electro-peroxone for treating ciprofloxacin, a model antibiotic drug. The electro-peroxone system houses electrodes of graphite felt that helps form hydrogen peroxide, an oxidant, in situ. The viability of the carbon-based graphite felt system in reactive oxygen species generation and ciprofloxacin degradation is investigated. A comparison of the electro-peroxone with two benchmark processes, namely, electrolysis and ozonation, is also carried out. Electro-peroxone and ozonation are both quite promising in removing the model contaminant. The in situ generation of H2O2 and •OH is estimated. This is a one-of-a-kind study involving graphite felt as both anode and cathode and achieves an in situ generation of H2O2 of 47 mg/L in 120 min and •OH of 140 µM within 60 min of electro-peroxone. Besides, the efficacy of the system in contaminant degradation is examined at voltammetric and galvanostatic modes of operation. Ozonation and electro-peroxone processes achieved an efficiency between 97% and complete removal of ciprofloxacin in less than an hour. This novel system generates several times higher hydrogen peroxide than the existing graphite electrode system, making it more efficient in radical generation and pollutant abatement. This graphite felt-based electro-peroxone system, on further optimization and up-scaling, can be a promising strategy for abating pharmaceutical compounds and effluents. Graphical Abstract

Aims Irritability is a common symptom in children and adolescents, often resulting in referral to mental health services and is associated with depression. Depression in adolescents and adults at familial risk of, and with depression, is associated with reduced risk-taking on the Cambridge Gambling Task (CGT) particularly when the chance of winning is high. However, little is known about risk-taking in irritability. This study tests the hypothesis that increased irritability is longitudinally associated with later risk-taking behaviour on the CGT; specifically, that increasing irritability is associated with lower risk-taking when the chance of a favourable outcome is high. Methods We conducted a longitudinal study of the biological offspring of parents of children with depression (n = 337). Irritability, the exposure, was measured at wave one using the Child and Adolescent Psychiatric Assessment (CAPA). The primary outcome was risk-taking to obtain reward at varying probability ratios (6:4, 7:3, 8:2 and 9:1) measured by the Cambridge Gambling Task (CGT) at waves two and three. We investigated the longitudinal association between irritability at wave one and average risk-taking at each ratio across waves two and three using multi-level models. The extent to which risk-taking according to probability ratio varied with irritability was tested with interaction terms. We ran univariable models and then multivariable models. Results In univariable (n = 207; Coef. 0.006, 95%CI −0.011–0.023, p = 0.470), and fully adjusted (Coef. 0.011, 95%CI −0.007–0.029, p = 0.213) models there was no evidence of a main association between irritability and risk-taking on the CGT. There was evidence of an interaction between irritability and risk-taking ratio (p = 0.019). In fully adjusted models including the interaction, a one-point increase in irritability was associated with relatively higher risk-taking at the less favourable ratios (6:4 – 0.018 (95%CI −0.002–0.037) and 7:3 – 0.015 (95%CI −0.005–0.035)) relative to the more favourable ratios (9:1 – 0.001 (95%CI −0.019–0.021) and 8:1 – 0.011 (95%CI −0.008-0.031)). Conclusion We found no evidence of relationship between irritability and subsequent risk-taking on the CGT overall. However, there was some evidence that those with higher irritability were relatively more risk-taking when less likely to win compared with when a favourable outcome was more likely. These findings warrant further investigation of the association between prior irritability and later depression in a larger community cohort. If prior irritability and depression are both associated with risk-taking, this strengthens the case for focussing on risk-taking as a potential target for preventive intervention.

Aims Conduct disorder carries significant individual and societal repercussions. Despite heightened risk-taking and challenges in adapting to changing probabilities of choice outcomes being linked to maladaptive behaviours such as conduct disorder, no study to date has examined the association behind childhood decision-making and adolescent conduct disorder. This study seeks to address this gap by exploring the longitudinal association between these two variables. Understanding the mechanisms underlying conduct disorder could help with developing new preventive interventions. Methods We used data from the Millennium Cohort Study, a nationally representative UK cohort; participants included those with complete data on exposure, outcome and confounding variables (n = 7,237). The exposure, childhood decision-making at 11 years was measured using the Cambridge Gambling Task risk-taking and risk-adjustment measures. The outcome, a binary measure of adolescent conduct disorder was created using items from the risky and antisocial behaviour interview sections at age 17. We used logistic regression to examine the association between childhood decision-making and adolescent conduct disorder and adjusted for relevant confounders. Results The univariable model showed that at age 11, each 20-point increase in risk-taking score increased the odds of conduct disorder behaviour at age 17 by 32% (OR = 1.32, 95% CI 1.18–1.44, p < 0.0001). In the multivariable model, there was strong evidence that a 20-point increase in risk-taking at 11 years was associated with 18% higher odds of conduct disorder behaviour at 17 years (OR = 1.18, 95% CI 1.05–1.33, p = 0.005). There was no evidence that this association differed by sex. Risk adjustment at 11 years showed no association with conduct disorder behaviours at age 17 both in the univariable model (OR = 0.96, 95% CI 0.88–1.06, p = 0.440) and the multivariable model (OR = 0.96, 95% CI 0.88–1.06, p = 0.433). Conclusion We found that risk-taking at 11 years was associated with conduct disorder behaviour at 17 years. If causal, our findings suggest that risk-taking might be a potential mechanism underlying adolescent conduct disorder behaviours. This may be useful in informing the design of preventive strategies, such as encouraging positive risk-taking in children and discouraging negative risk-taking behaviours.

Aims Children and young people (CYP) with intellectual and developmental disabilities (IDD) of known genetic origin experience complex physical and mental health problems; IMAGINE-ID has followed a national UK cohort from childhood to early adulthood. Parents completed structured online psychiatric assessments on repeated occasions. From these assessments, semi-automated personalised reports were generated summarising each child's strengths and difficulties, in collaboration with IMAGINE ID participants and the charity UNIQUE. We aimed to discover whether providing a structured summary of our mental health and behavioural assessments would be beneficial to families of children with rare genetic conditions and IDD. Methods 574 of the CYP's caregivers completed an online ‘impact’ survey, five years after receiving their initial report, comprising four areas of potential benefit: Quality of Care (whether the report led to an improvement in the child's quality of mental and/or physical health care); Social Impact (whether the report was used as evidence to support an EHCP, disability benefits etc.), Psychological Impact (whether it led to any change in understanding of the child's condition), and Referrals (whether the report led to a referral for Autism/ADHD etc.). We also invited qualitative feedback. Results 82% of respondents rated the reports as helpful. 35% reported they had led to an improvement in their CYP's quality of care, 24% reported social impact using the report as supporting evidence, 99% reported a psychological impact – a change in their understanding of the child, and 17% used the report to initiate a referral for an assessment of ADHD and/or autism. In our qualitative analysis, families who found the report helpful mentioned it led to ‘reflection’ on their child's condition and that it provided ‘access to benefits’. For those who did not find the report helpful, issues such as ‘it lacked professional input’ and ‘forgetting the contents’ of the report were identified. Conclusion Personalised summary reports, based on a structured assessment of their child's behavioural, social and emotional adjustment, are valued by families of children with rare genetic conditions and IDD and can bring about tangible benefits to the child and the family's access to resources.

Aims The prevalence of emotional problems, such as depressive and anxiety disorders, increases sharply during adolescence. There is evidence for familial clustering of mental health problems during early childhood and adulthood, however no studies have investigated whether adolescent mental health problems cluster within families. This study tests the hypotheses that i) emotional problems during adolescence cluster within families, and that ii) conduct, peer and hyperactivity problems, prosocial behaviour and overall emotional and behavioural difficulties during adolescence also cluster within families. Methods We used cross-sectional data from a nationally representative survey of UK households, collected between 2019 and 2021, with 4,088 participants aged 10–16 years. Analyses included 1,241 participants who had complete outcome data and complete data on all covariates of interest. The Strengths and Difficulties Questionnaire (SDQ) was used to examine emotional problems, as well as conduct, peer and hyperactivity problems, prosocial behaviour and total difficulties. Multilevel modelling was used to: estimate clustering of i) emotional problems and ii) conduct, peer and hyperactivity problems, prosocial behaviour and total difficulties, within families, after adjusting for several individual- and family-level covariates associated with adolescent mental health problems (including individual and family demographics, school and sibling bullying, quality of parent-child relationship, parent mental health and parent romantic relationship satisfaction). Results After adjusting for known covariates of adolescent mental health problems, there was substantial clustering of adolescent emotional problems (ICC: 0.439; CI95%: 0.36–0.52; SE: 0.042) and overall adolescent emotional and behavioural difficulties (ICC: 0.417; CI95%: 0.34–0.50; SE: 0.043) within families. There was also evidence of clustering of adolescent peer problems (ICC: 0.374; CI95%: 0.28–0.48; SE: 0.051), hyperactivity (ICC: 0.332; CI95%: 0.25–0.42; SE: 0.044), prosocial behaviour (ICC: 0.263; CI95%: 0.18–0.37; SE: 0.048) and conduct problems (ICC: 0.232; CI95%: 0.14–0.35; SE: 0.053) within families after adjustment. Conclusion We found strong evidence that adolescent emotional problems cluster within families even after accounting for individual- and family-level covariates which are associated with adolescent mental health problems. Over 40% of the variation was accounted for at the family level. This indicates how the contextual characteristics of the family environment may influence the mental health of young people. As such, social policy aiming to prevent or improve the mental health of young people should focus on family context.

Aims Irritability is common and easily identified in childhood. It is transdiagnostic and a common reason for referral to mental health services. Irritability which does not decrease during early childhood is associated with adolescent depression. We hypothesised that irritability would be associated with increased risk-taking overall but reduced risk-taking in response to loss. Methods We used data from the Millennium Cohort Study, a population-based cohort of 18,552 children born in 2000–02. We examined whether irritability at 3, 5 and 7 years is associated with risk-taking on the CGT using multilevel mixed effect generalised linear models (MEGLMs). We also calculated the change in irritability between 3–7 years for each participant using multilevel mixed models. We then examined the association between this change measure and risk-taking on the CGT using MEGLMs. Analyses were adjusted for a broad range of confounders. Results We found that children whose irritability did not decrease as would be expected from 3 to 7 years were more likely to stake a higher number of points per trial on the CGT at 11 years. This increase was most evident when the previous trial had been won. Irritability at 7 years was associated with staking a higher number of points per trial on the CGT (coefficient 0.52, 95%CI −0.04–1.08, p = 0.067) in fully adjusted model, whereas irritability at 3 and 5 years were not (3 years – coefficient 0.02, 95%CI -0.62–0.65, p = 0.961; 5 years – coefficient 0.14, 95%CI −0.45–0.73, p = 0.641). There was evidence of an interaction between irritability at seven years and whether the previous trial was won (p = 0.014). Childhood irritability which did not decrease between 3–7 years was associated with staking a higher number of points per trial on the CGT (coefficient 1.36, 95%CI 0.44–2.28, p = 0.004); there was evidence of an interaction between change in irritability and whether the previous trial was won (p = 0.056). Conclusion This is the first longitudinal population-based study examining the relationship between changes in irritability during early childhood and risk-taking behaviour measured by the CGT. Our findings illustrate that irritability in children is characterised by an increase in risk-taking at age 11 years, reflecting differences in how children behave in relation to rewards and losses based on prior irritability. Further understanding of how the processes such as risk-taking which link childhood phenotypes such as irritability, relate to future mental health, may enable the development of new interventions focussing on reactions to rewards and losses.

A 60-year-old patient presented with complaints of difficulty in chewing and deteriorating systemic health [Table/Fig-1]. The medical history revealed squamous cell carcinoma affecting the right part of the maxilla and mandible, which was surgically treated 15 years ago. The surgical intervention involved the removal of the maxillary alveolus, tuberosity, mandibular condyle, and coronoid process, extending up to the mandibular midline. Soft tissue reconstruction was performed to address the maxillary defect. There was a recurrence of the carcinoma, which was managed through radiotherapy. The patient had controlled diabetes and hyperthyroidism and was on medication for these conditions. On examination, a hemimaxillectomy without oronasal fistula and a hemimandibulectomy that included the condyle were observed. Decayed root stumps with periapical radiolucencies [Table/Fig-2] were extracted. The presence of a scar band in the right cheek ruled out the possibility of placing zygomatic or pterygoid implants. Furthermore, the patient expressed unwillingness to undergo an extensive and invasive reconstructive surgery due to personal reasons.

The absence of eye and irradiation post-enucleation may result in problems like dryness of the eye sockets, itching and crusting. This may lead to poor prosthesis adaptation and a lack of patient acceptance of the prosthesis. To combat the most common problem of dryness, patients are advised artificial tears to use as teardrops or ocular prostheses along with a tear reservoir. This case series describes methods of fabricating ocular prosthesis indicated in different scenarios: the modified stock ocular and a custom-made ocular prosthesis when tearing secretion is enough in the eye socket and an ocular prosthesis with a tear reservoir in cases showing reduced tear secretion. A novel technique of fabricating hollow lightweight ocular prostheses having the sustained prolonged release of artificial tears has been described.

Complete edentulism is one of the most common problems encountered by geriatric individuals. With advanced aging, despite attempts made to retain natural dentition, loss of entire teeth is yet observed. For precise denture fabrication, a digital sensor device was used during the making procedure. The use of sensor device aided in better appreciation and more retentiveness of denture.

Abstract Background Many children with an intellectual or developmental disability (IDD) have associated autism spectrum disorders (ASD), as well as an increased risk of mental health difficulties. In a cohort with IDD of genetic aetiology, we tested the hypothesis that excess risk attached to those with ASD + IDD, in terms of both children's mental health and parental psychological distress. Methods Participants with a copy number variant or single nucleotide variant (5–19 years) were recruited via UK National Health Service. 1904 caregivers competed an online assessment of child mental health and reported on their own psychological wellbeing. We used regression to examine the association between IDD with and without co‐occurring ASD, and co‐occurring mental health difficulties, as well as with parental psychological distress. We adjusted for children's sex, developmental level, physical health, and socio‐economic deprivation. Results Of the 1904 participants with IDD, 701 (36.8%) had co‐occurring ASD. Children with both IDD and ASD were at higher risk of associated disorders than those with IDD alone (ADHD: OR = 1.84, 95% confidence interval [CI] 1.46–2.32, p

Accountability encompasses multiple aspects such as responsibility, justification, reporting, traceability, audit, and redress so as to satisfy diverse requirements of different stakeholders— consumers, regulators, developers, etc. In order to take into account needs of different stakeholders and thus, to put into practice accountability in Artificial Intelligence, the notion of empathy can be quite effective. Empathy is the ability to be sensitive to the needs of someone based on understanding their affective states and intentions, caring for their feelings, and socialization, which can help in addressing the social-technical challenges associated with accountability. The goal of this paper is twofold. First, we elucidate the connections between empathy and accountability, drawing find- ings from various disciplines like psychology, social science, and organizational science. Second, we suggest potential pathways to incorporate empathy.

Fallopian tube fistula with the bladder can mimic an enterovaginal fistula. A 34-year-old woman presented with continuous urinary incontinence after hysterectomy. A cystogram confirmed a vesicovaginal fistula and a possible additional intestinal communication. Further imaging, however, ruled out an enterovaginal fistula and diagnosed a fallopian tube prolapse with salpingovesicovaginal fistula. This case demonstrates the importance of multiple imaging modalities in identifying and clearly delineating the anatomy of gynecologic fistulous connections. The case illustrates the fact that while salpingovesical fistula is a rare complication of hysterectomy, it is an important consideration in one's differential diagnosis.

Objective Football players are at risk of developing hip osteoarthritis (OA). Cam morphology (present in almost two of every three football players) may explain this heightened risk, but there is limited research on its role in hip OA development in younger athletes. Knowledge of this relationship will advance our understanding of the aetiology of hip OA in football players. We aimed to study the relationship between cam morphology size and MRI-defined cartilage defects and labral tears, and if this relationship differs by symptomatic state in young adult football players.Methods For this case–control study, 182 (288 hips) symptomatic (hip and/or groin pain >6 months and positive flexion-adduction-internal-rotation (FADIR) test) and 55 (110 hips) pain-free football players (soccer or Australian football) underwent anteroposterior and Dunn 45° radiographs, and 3-Tesla MRI. Cam morphology size was defined using alpha angle, and cartilage defects and labral tears were scored semiquantitatively. Presence, location and score (severity) of cartilage defects and labral tears were determined. Each participant completed the International Hip Outcome Tool 33 and Copenhagen Hip and Groin Outcome Score.Results Greater alpha angle was associated with cartilage defects (OR 1.03, 95% CI 1.01 to 1.04) and labral tears (OR 1.02, 95% CI 1.01 to 1.04). Greater alpha angle was associated with superolateral cartilage defects (OR 1.03, 95% CI 1.02 to 1.05) and superior labral tears (OR 1.03, 95% CI 1.02 to 1.05). The association of alpha angle with MRI-defined cartilage defects and labral tears was no greater in football players with symptoms than in those without (p=0.189–0.937)Conclusion Cam morphology size was associated with cartilage defects and labral tears in young adult football players with and without pain. This study provides evidence that cam morphology may contribute to the high prevalence of hip OA in football players. Prospective studies of football players are now needed to establish if cam morphology causes progression of cartilage defects and labral tears and development of hip OA.

Objectives This study aimed to explore the experiences of parents caring for children with intellectual and developmental disabilities (IDD) during the UK national lockdown in spring 2020, resulting from the COVID-19 pandemic.Design Participants were identified using opportunity sampling from the IMAGINE-ID national (UK) cohort and completed an online survey followed by a semistructured interview. Interviews were analysed using thematic analysis.Setting Interviews were conducted over the telephone in July 2020 as the first UK lockdown was ending.Participants 23 mothers of children with intellectual and developmental disabilities aged 5–15 years were recruited.Results Themes reported by parents included: managing pre-existing challenges during a time of extreme change, having mixed emotions about the benefits and difficulties that arose during the lockdown and the need for appropriate, individualised support.Conclusions Our findings confirm observations previously found in UK parents of children with IDD and provide new insights on the use of technology during the pandemic for schooling and healthcare, as well as the need for regular check-ins.

According to World Health Organization statistics of 2011, infectious diseases remain in the top five causes of mortality worldwide. However, despite sophisticated research tools for microbial detection, rapid and accurate molecular diagnostics for identification of infection in humans have not been extensively adopted. Time-consuming culture-based methods remain to the forefront of clinical microbial detection. The 16S rRNA gene, a molecular marker for identification of bacterial species, is ubiquitous to members of this domain and, thanks to ever-expanding databases of sequence information, a useful tool for bacterial identification. In this study, we assembled an extensive repository of clinical isolates (n = 617), representing 30 medically important pathogenic species and originally identified using traditional culture-based or non-16S molecular methods. This strain repository was used to systematically evaluate the ability of 16S rRNA for species level identification. To enable the most accurate species level classification based on the paucity of sequence data accumulated in public databases, we built a Naïve Bayes classifier representing a diverse set of high-quality sequences from medically important bacterial organisms. We show that for species identification, a model-based approach is superior to an alignment based method. Overall, between 16S gene based and clinical identities, our study shows a genus-level concordance rate of 96% and a species-level concordance rate of 87.5%. We point to multiple cases of probable clinical misidentification with traditional culture based identification across a wide range of gram-negative rods and gram-positive cocci as well as common gram-negative cocci.

Background: With increasing numbers of referrals to health services for assessment of Autism Spectrum Disorder (ASD), the Developmental and Well-Being Assessment (DAWBA) has been suggested as a useful screening instrument to assist in prioritising patients for review. It is an online interview for parents that has been previously validated for ASD in a non-clinical community sample of twins. Our study aimed to evaluate its predictive validity in a complex clinically-referred sample of children with suspected high-functioning autism. Methods: The sample comprised 136 children (females = 53; males = 83) who were referred for ASD assessment at the Social Communication Disorder Clinic (SCDC) at Great Ormond Street Hospital. Parents completed the DAWBA online prior to undergoing a multi-disciplinary team (MDT) assessment. This included completing the Developmental, Dimensional and Diagnostic Interview (3di) and the Autism Diagnostic Observation Schedule (ADOS). Two clinicians independently rated the DAWBA using DSM-5 diagnostic criteria and compared results to the MDT outcome, which was considered gold standard. Results: Compared with an MDT assessment, the DAWBA interview demonstrated good sensitivity (0.91) but poor specificity (0.12). Overall, 64% of cases were accurately assigned as case/non-case. Estimates of positive (0.66) and negative (0.43) predictive validity were influenced by the relatively high prevalence of ASD in the study sample (65%). Conclusion: The DAWBA online interview has excellent sensitivity in a clinical population of complex neurodevelopmental disorders, containing a high prevalence of ASD, but specificity was poor. As the SCDC offers tertiary opinions on disputed cases of suspected ASD, the population cohort limits the generalisability of these results. Further evaluation is required in community child mental health or paediatric services.