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A literature review and meta-analysis was performed to assess for difference in rate of complications and need for revision surgery between endoscopic stapler-assisted diverticulotomy and endoscopic carbon dioxide laser diverticulotomy. The hypothesis was that endoscopic stapler-assisted diverticulotomy has a lower complication rate but endoscopic carbon dioxide laser diverticulotomy has a lower need for revision surgery.
Method
This was a systematic review of English-language studies comparing endoscopic stapler-assisted diverticulotomy and endoscopic carbon dioxide laser diverticulotomy for the treatment of Zenker's diverticulum. Meta-analysis of results with regard to rate of pharyngeal perforation, major post-operative complication and need for re-operation was performed.
Results
Nine retrospective studies were included with pooled analysis of 417 endoscopic stapler-assisted diverticulotomy and 413 endoscopic carbon dioxide laser diverticulotomy cases. Meta-analysis found no significant difference in rate of pharyngeal perforation, major complication or need for re-operation between the two groups.
Conclusion
This study demonstrated both endoscopic stapler-assisted diverticulotomy and endoscopic carbon dioxide laser diverticulotomy to be a safe alternative to open surgery for Zenker's diverticulum. Both appear to be similar in terms of adverse events and efficacy. The authors recommend either approach, guided by surgeon's preference and experience, where patients are unsuitable for an open surgery approach.
Mass asymptomatic SARS-CoV-2 nucleic acid amplified testing of healthcare personnel (HCP) was performed at a large tertiary health system. A low period-prevalence of positive HCP was observed. Of those who tested positive, half had mild symptoms in retrospect. HCP with even mild symptoms should be isolated and tested.
We present a detailed analysis of the radio galaxy PKS $2250{-}351$, a giant of 1.2 Mpc projected size, its host galaxy, and its environment. We use radio data from the Murchison Widefield Array, the upgraded Giant Metre-wavelength Radio Telescope, the Australian Square Kilometre Array Pathfinder, and the Australia Telescope Compact Array to model the jet power and age. Optical and IR data come from the Galaxy And Mass Assembly (GAMA) survey and provide information on the host galaxy and environment. GAMA spectroscopy confirms that PKS $2250{-}351$ lies at $z=0.2115$ in the irregular, and likely unrelaxed, cluster Abell 3936. We find its host is a massive, ‘red and dead’ elliptical galaxy with negligible star formation but with a highly obscured active galactic nucleus dominating the mid-IR emission. Assuming it lies on the local M–$\sigma$ relation, it has an Eddington accretion rate of $\lambda_{\rm EDD}\sim 0.014$. We find that the lobe-derived jet power (a time-averaged measure) is an order of magnitude greater than the hotspot-derived jet power (an instantaneous measure). We propose that over the lifetime of the observed radio emission (${\sim} 300\,$Myr), the accretion has switched from an inefficient advection-dominated mode to a thin disc efficient mode, consistent with the decrease in jet power. We also suggest that the asymmetric radio morphology is due to its environment, with the host of PKS $2250{-}351$ lying to the west of the densest concentration of galaxies in Abell 3936.
The aim of this study was to explore the experiences of radiotherapy students on clinical placement, specifically focussing on the provision of well-being support from clinical supervisors.
Materials and methods:
Twenty-five students from the University of the West of England and City University of London completed an online evaluation survey relating to their experiences of placement, involving Likert scales and open-ended questions.
Results:
The quantitative results were generally positive; however, the qualitative findings were mixed. Three themes emerged: (1) provision of information and advice; (2) an open, inclusive and supportive working environment; and (3) a lack of communication, understanding, and consistency.
Findings:
Students’ experiences on placement differed greatly and appeared to relate to their specific interactions with different members of staff. It is suggested that additional training around providing well-being support to students may be of benefit to clinical supervisors.
Graphene oxide (GO)/MnO2 nanocomposites were synthesized by adding KMnO4 in a solution of water and ethanol (3:1), containing 10 mg of GO. Brown precipitates were obtained after a continuous stirring for 1 hr. The precipitates were then washed with deionized water (DI) water and dried to obtain the MnO2-GO nanocomposites. Pure MnO2 was also synthesized using the same method without GO for the comparison. X-ray diffraction pattern confirm δ-MnO2 type of MnO2 with birnessite type MnO2 structure. The TEM images show the average diameter of MnO2 nanorods as 15 nm. Electrochemical characterizations were carried out in an aqueous solution of 3M KOH. Charge-discharge studies were carried out between 1A/g to 20 A/g current range. The MnO2-GO nanocomposites showed improved electrochemical performances. The capacitance of MnO2 and MnO2-GO electrodes was found to be as 300 F/g, and 350 F/g, respectively at a current of 0.5 A/g.
Higher activity radioactive wastes remain hazardous for extremely long timescales, of up to hundreds of thousands of years. Disposing of such wastes deep underground presents the internationally accepted best solution for isolating them from the surface environment on associated timescales. Geological disposal programmes need to assess potential releases from such facilities on long timescales to inform siting and design decisions and to help build confidence that they will provide an adequate degree of safety. Assessments of geological disposal include consideration of the wastes, the engineered facility, the host geology and the surface and near-surface environment including the biosphere. This paper presents an overview of recent post-closure biosphere assessment studies undertaken in support of the Nuclear Decommissioning Authority Radioactive Waste Management Directorate disposal system safety case for geological disposal of the United Kingdom's higher activity radioactive wastes. Recent biosphere studies have included: (1) ensuring that the United Kingdom's approach to consideration of the biosphere in safety case studies continues to be fit for purpose, irrespective of which site or sites are considered in the United Kingdom's geological disposal programme; (2) updating projections of global climate and sea level, together with consideration of the potential importance of transitions between climate states; (3) considering geosphere–biosphere interface issues and their representation, including redox modelling and catchment-scale hydrological modelling; and (4) identifying key radionuclides and developing a series of reports describing their behaviour in the biosphere together with an evaluation of associated implications for post-closure assessment calculations.
Rush skeletonweed is emerging as a regionally important weed of winter wheat production in eastern Washington. Field studies were conducted during the 2016 and 2017 crop years to evaluate several auxin herbicides applied at two seasonal timings (fall or spring) for control of rush skeletonweed in winter wheat. Clopyralid (210 g ae ha-1) provided>90% visual control of rush skeletonweed in both years of the study and aminopyralid (10 g ae ha-1) provided>80% visual control. Aminocyclopyrachlor, dicamba, and 2,4-D provided<55% control of rush skeletonweed. Season of application did not meaningfully affect efficacy of any herbicide tested. Wheat yields were reduced by 39 to 69% compared to the non-treated check when aminocyclopyrachlor was applied in the spring. Clopyralid is an effective option for control of rush skeletonweed in Pacific Northwest winter wheat.
The extended timescales involved in the decay of radioactive wastes to safe levels mean that geological disposal facilities must continue to function effectively long into the future. It is therefore essential to consider long-term climate evolution in post-closure performance assessmentsin order to evaluate a geological disposal system's response and robustness to a variety of potential environmental changes, driven by both natural and anthropogenic forcings. In this paper, we illustrate the multiple decay components that characterize the primary driver of climate change– atmospheric CO2 – in response to fossil fuel carbon emissions. We perform a multi-exponential analysis on a series of atmospheric CO2 decay curves predicted by an Earth system model and create an empirical response function that encapsulates the long-term(>1 kyr) removal of excess CO2 from the atmosphere. We present this response function as a simple tool for rapidly projecting the future atmospheric CO2 concentration resulting from any plausible cumulative release of CO2. We discuss the implications ofthe long 'tail' to this atmospheric CO2 decay curve, both in terms of future climate evolution as well as potential impacts on radioactive waste repositories.
Radioactive Waste Management Limited (RWM) is tasked with implementing geological disposal of the United Kingdom's (UK) higher activity radioactive wastes. This paper describes how RWM's biosphere modelling capability has been extended from a solely terrestrial model to allow potentialcontaminant releases to estuarine, coastal and marine systems around the UK to be represented. The new models aim to strike a balance between being as simple as can be justified, erring on the side of conservative estimates of potential doses, while also representing the features and processesrequired to reflect and distinguish UK coastal systems. Sediment dynamics (including meandering of estuaries and sediment accumulation) are explicitly represented in a simplified form that captures the accumulation and remobilization of radionuclides. Long-term transitions between biospheresystems (such as from a salt marsh to a terrestrial system) are outside the scope of the study. The models and supporting data draw on information about the UK that is representative of present-day conditions and represent potential exposures arising from both occupational and recreationalhabits.?
Generic calculations demonstrate that potential doses to humans arising from releases to estuarine, coastal and marine systems are typically more than two orders of magnitude lower than those for equivalent releases to terrestrial systems via well water and groundwater dischargeto soil. The extended capability (i) ensures that RWM is able to undertake assessments for potential coastal site contexts, if and when required, and (ii) provides RWM with quantitative evidence to support the principal focus on terrestrial releases ( particularly for more generic assessments).
Fourier Transform spectroscopy is able to provide high accuracy atomic parameters needed by many ongoing galactic surveys. Our laboratory has carried out a study of the neutral iron spectrum over the last years to measure oscillator strengths much needed for the calculation of chemical abundances. The main aim of this contribution is to encourage further dialogue with astronomers regarding their current necessities of spectroscopic data, as this would help spectroscopists to prioritise present-day needs within the field.
Preliminary phytolith analysis of ephemeral lake fill sediment at Long Pocket, near Toomba, northeast Queensland, Australia, indicates that a C4-dominated grassland with a minor woody component has been present in the region since ca. 8000 cal yr B.P. Based on the modern distribution of C4 and C3 native grasses in Australia, this suggests that mean summer temperatures of at least 14°C (ca. 10°C cooler than present) were maintained since the early Holocene. This interpretation is comparable with previous studies, which together imply that the establishment of C4-dominated grasses in central and northeast Australia occurred between the last glacial maximum (most likely after ca. 16,000 14C yr B.P.) and ca. 7200 14C yr B.P. (ca. 8000 cal yr B.P.). Taxonomic composition of the grassland appears relatively consistent since the early Holocene at Long Pocket and includes phytoliths comparable with those from modern Arundinoideae, Panicoideae, and Chloridoideae. Rare non-grass phytoliths are also present. A gradual decrease in abundance of saddle phytolith forms (attributed to Chloridoideae grasses) from the base of the record at ca. 6500–7000 cal yr B.P. suggests decreasing aridity throughout the Holocene. This trend could reflect a locally drawn out effect of the end of the postglacial arid period due to the well-drained basalt flow catchment maintaining a local arid habitat for the Chloridoideae grasses.
Morbidity is defined as a state of being unhealthy or of experiencing an aspect of health that is “generally bad for you”, and postoperative morbidity linked to paediatric cardiac surgery encompasses a range of conditions that may impact the patient and are potential targets for quality assurance.
Methods
As part of a wider study, a multi-disciplinary group of professionals aimed to define a list of morbidities linked to paediatric cardiac surgery that was prioritised by a panel reflecting the views of both professionals from a range of disciplines and settings as well as parents and patients.
Results
We present a set of definitions of morbidity for use in routine audit after paediatric cardiac surgery. These morbidities are ranked in priority order as acute neurological event, unplanned re-operation, feeding problems, the need for renal support, major adverse cardiac events or never events, extracorporeal life support, necrotising enterocolitis, surgical site of blood stream infection, and prolonged pleural effusion or chylothorax. It is recognised that more than one such morbidity may arise in the same patient and these are referred to as multiple morbidities, except in the case of extracorporeal life support, which is a stand-alone constellation of morbidity.
Conclusions
It is feasible to define a range of paediatric cardiac surgical morbidities for use in routine audit that reflects the priorities of both professionals and parents. The impact of these morbidities on the patient and family will be explored prospectively as part of a wider ongoing, multi-centre study.
To estimate HCV seroprevalence in subpopulations of women delivering live-born infants in the North Thames region in England in 2012, an unlinked anonymous (UA) cross-sectional survey of neonatal dried blood spot samples was conducted. Data were available from 31467 samples from live-born infants received by the North Thames screening laboratory. Thirty neonatal samples had HCV antibodies, corresponding to a maternal seroprevalence of 0·095% (95% confidence interval 0·067–0·136). Estimated HCV seroprevalences in women born in Eastern Europe, Southern Asia and the UK were 0·366%, 0·162% and 0·019%, respectively. For women born in Eastern Europe seroprevalence was highest in those aged around 27 years, while in women born in the UK and Asia-Pacific region, seroprevalence increased significantly with age. HCV seroprevalence in UK-born women whose infant's father was also UK-born was 0·016%. One of the 30 HCV-seropositive women was HIV-1 seropositive. Estimated HCV seroprevalence for women delivering live-born infants in North Thames in 2012 (0·095%) was significantly lower than that reported in an earlier UA survey in 1997–1998 (0·191%). Data indicate that the cohort of UK-born HCV-seropositive women is ageing and that, in this area of England, most perinatally HCV-exposed infants were born to women themselves born in Southern Asia or Eastern Europe.
Objective: To assess the impact of childhood conduct disorder (CD) and intelligence quotient (IQ) on later substance use in adolescence.
Methods: Neuropsychological and structured diagnostic evaluations were initially administered to 32 children with disruptive behavior disorder when they were 7–11 years of age. They were then re-evaluated on average 6.7 years later using an array of interviews and rating scales with a focus on substance use.
Results: Early CD and IQ scores together accounted for a significant proportion of the variance in later substance use (R2=.248). In addition, there was a significant CD and Verbal IQ interaction (R2=.164) such that high Verbal IQ was linked to increased substance use in adolescents who had childhood CD.
Conclusion: These data indicate that the presence of conduct disorder may interact with high Verbal IQ during childhood in such a way as to predict later adolescent substance use in disruptive behavior disorder populations.
Several regulatory bodies have approved a health claim on the cholesterol-lowering effects of oat β-glucan at levels of 3·0 g/d. The present study aimed to test whether 1·5 g/d β-glucan provided as ready-to-eat oat flakes was as effective in lowering cholesterol as 3·0 g/d from oats porridge. A 6-week randomised controlled trial was conducted in eighty-seven mildly hypercholesterolaemic ( ≥ 5 mmol/l and < 7·5 mmol/l) men and women assigned to one of three diet arms (25 % energy (E%) protein; 45 E% carbohydrate; 30 E% fat, at energy requirements for weight maintenance): (1) minimal β-glucan (control); (2) low-dose oat β-glucan (1·5 g β-glucan; oats low – OL) or (3) higher dose oat β-glucan (3·0 g β-glucan; oats high – OH). Changes in total cholesterol and LDL-cholesterol (LDL-C) from baseline were assessed using a linear mixed model and repeated-measures ANOVA, adjusted for weight change. Total cholesterol reduced significantly in all groups ( − 7·8 (sd 13·8) %, − 7·2 (sd 12·4) % and − 5·5 (sd 9·3) % in the OH, OL and control groups), as did LDL-C ( − 8·4 (sd 18·5) %, − 8·5 (sd 18·5) % and − 5·5 (sd 12·4) % in the OH, OL and control groups), but between-group differences were not significant. In responders only (n 60), β-glucan groups had higher reductions in LDL-C ( − 18·3 (sd 11·1) % and − 18·1 (sd 9·2) % in the OH and OL groups) compared with controls ( − 11·7 (sd 7·9) %; P = 0·044). Intakes of oat β-glucan were as effective at doses of 1·5 g/d compared with 3 g/d when provided in different food formats that delivered similar amounts of soluble β-glucan.