Computed Tomography Scanning for Sternal Wound Infections: A Systematic Review

Sternal wound infection (SWI) has always been a significant risk in patients who undergo sternotomies as part of their cardiac surgical procedures. Computed tomography (CT) imaging is often used to diagnose and assess sternal wound infections. Its purpose includes identifying and locating infection and any sternal dehiscence. A systematic literature review across PubMed, Embase, and Ovid was performed according to PRISMA guidelines to identify relevant articles that discussed the utility of CT scanning for SWI, common features identified, patient outcomes and sensitivity/specificity (Figure 1). 25 papers were included. 100% (n=25) of the papers were published in peer-reviewed journals. CT scans in SWIs can be seen as a beneficial aid in diagnosing as well as determining the components of infection. Commonalities were identified such as fluid collection in the mediastinum, free gas, pleural effusions, and sternal dehiscence which point towards the presence of sternal wound infection. CT scanning is a novel and emerging methodology for imaging in SWI and post-sternotomy complications, hence increased research is required to expand the literature on this area as well as the creation of guidelines and cut-offs or signs for radiology professionals to identify and determine the extent of infection. [Abstract copyright: Copyright © 2024 Ulster Medical Society.

P1043 Immunomodulator and advanced therapies for prevention of clinical relapse and loss of response during maintenance phase in Crohn’s disease: A systematic review and network meta-analysis

Background Several effective advanced therapies have been approved for the treatment of Crohn’s disease (CD) in the past two decades. Given lack of adequate head-to head clinical trials it is challenging to position these therapies in the management algorithm. Therefore we performed this network meta-analysis to inform therapeutic decisions. Methods We searched MEDLINE, Embase, and Cochrane Central Register of Controlled Trials between inception and October 2023 for randomised controlled trials (RCTs). Outcomes assessed were clinical relapse (loss of clinical remission), loss of clinical response, adverse events (AE), withdrawal due to AE, and serious AE. We performed random-effects meta-analysis and network meta-analysis (using a frequentist approach), and estimated relative risk (RRs), 95%CI values. We used GRADE to ascertain certainty of evidence. Results A total of 32 RCTs comprising 10,924 patients were included in the analysis. On network meta-analysis of 15 interventions based on prevention of clinical relapse, combination of infliximab (IFX) and azathioprine (AZA) (RR 0.31, 95%CI [0.17-0.56]), IFX (RR 0.62, 95%CI [0.5-0.76], moderate certainty), and adalimumab (RR 0.68, 95%CI [0.55-0.84], moderate certainty) were the only agents that were effective compared to placebo (Figure 1). Methotrexate (RR 0.57, 95%CI [0.32-1.03], low certainty) and azathioprine (RR 0.82, 95%CI [0.62-1.1]), very low certainty) were not effective. On analysis based on prevention of clinical response for nine interventions, there was high certainty evidence for ustekinumab (RR 0.73, 95%CI [0.61-0.86]), upadacitinib (RR 0.64, 95%CI [0.57-0.72]), and moderate certainty of evidence for infliximab (RR 0.71, 95%CI [0.59-0.84]), adalimumab (RR 0.68, 95%CI [0.61-0.75]), certolizumab (RR 0.57, 95%CI [0.47-0.7]), CTP13 (RR 0.46, 95%CI [0.38-0.57]), vedolizumab (RR 0.82, 95%CI [0.68-0.99]), natalizumab (RR 0.54, 95%CI [0.43-0.68]). Tofacitinib was not effective and there was no data available for immunomodulators and combination therapies for this outcome. On analysis of serious adverse events advanced therapies were of no difference to placebo (very low certainty). Conclusion On network meta-analysis immunomodulators and advanced therapies for maintenance phase, combination of anti-TNFs and immunomodulators followed by anti-TNF monotherapy had large effect size with moderate certainty for prevention of clinical relapse. There was moderate to high certainty evidence to suggest newer advanced therapies are effective in prevention of loss of clinical response

First insights into post-pandemic distress in a high secure hospital: Correlates among staff and patients

This preliminary study is designed to gauge the enduring psychological impacts of the COVID-19 pandemic on both patients and staff in a high secure settings. The study involved 31 patients and 34 staff from a high secure setting, who completed assessments to discern the link between COVID-19-related distress and various factors. These evaluations focused on coping strategies, resilience, emotional reactivity, ward atmosphere, and work-related aspects. Results indicated that 31.2% of staff met the clinical cut-off for potential PTSD due to COVID-19-related distress. Emotional reactivity, staff shortages, secondary traumatic stress, and coping strategies were positively correlated with distress, while resilience showed a negative association, suggesting a mitigating role. Notably, distress among patients was comparatively lower, with only 3.2% experiencing significant levels. The authors postulate that increased staff burdens during the pandemic may have led to long-term distress, while their efforts to maintain minimal service disruption potentially shielded patients from psychological impacts, possibly lead to staff 'problem-focused coping burnout'. This highlights the need for in-depth research on the enduring impacts of pandemics, focusing on mechanisms that intensify or alleviate distress. Future studies should focus on identifying effective coping strategies for crisis situations, such as staff shortages, and strategies for post-crisis staff support. Building on evidence of negative impacts on frontline workers and forensic inpatients during the pandemic, this study delved into the longer-term psychological repercussions that persisted post-pandemic. It sheds light on lasting distress levels and their correlates. These insights are crucial for formulating effective responses and strategies for future pandemics or analogous crises, highlighting the need for sustained support for staff grappling with long-term distress arising from such events

Predicting and stabilising the 3D structure of aptamers using computational methods

The purpose of this dissertation was to predict and stabilise the three-dimensional (3D) structure of aptamers. The focus was in the area of bioinformatics. A guideline was provided on how to obtain 3D images of aptamers, predict the binding site and stabilise the aptamer’s structures. Such a study is of importance to facilitate in vivo experiments by using computational methods to determine if stabilising agents and shortened aptamer sequences interfere with the predicted binding site. Research methods included a literature search and creating a protocol on which software and webserver to use, combined with the collection and analysis of figures. The 2D (two dimensional) structures were obtained through Mfold alongside RNAComposer to obtain the PDB file containing the predicted 3D structure. The aptamer’s 3D structures were visualised with YASARA, PyMOL and Chimera. The findings provided evidence that shortening the aptamer’s sequence stabilised the structures. The predicted binding sites show that the ligand binds in the stem-loop region. The main conclusions drawn from this project were that computational methods can be used to analyse and gain insight into 3D aptamer structures. Some common challenges and technological difficulties, such as modifying an aptamer, were discussed. This project recommended Mfold to be used to obtain the secondary structure of aptamers, whereas for the tertiary structure PyMOL and YASARA were the easiest to navigate in providing a clear and detailed structure

Universality in eye movements and reading: A replication with increased power

Liversedge, Drieghe, Li, Yan, Bai and Hyönä (2016) reported an eye movement study that investigated reading in Chinese, Finnish and English (languages with markedly different orthographic characteristics). Analyses of the eye movement records showed robust differences in fine grained characteristics of eye movements between languages, however, overall sentence reading times did not differ. Liversedge et al. interpreted the entire set of results across languages as reflecting universal aspects of processing in reading. However, the study has been criticized as being statistically underpowered (Brysbaert, 2019) given that only 19-21 subjects were tested in each language. Also, given current best practice, the original statistical analyses can be considered to be somewhat weak (e.g., no inclusion of random slopes and no formal comparison of performance between the three languages). Finally, the original study did not include any formal statistical model to assess effects across all three languages simultaneously. To address these (and some other) concerns, we tested at least 80 new subjects in each language and conducted formal statistical modelling of our data across all three languages. To do this, we included an index that captured variability in visual complexity in each language. Unlike the original findings, the new analyses showed shorter total sentence reading times for Chinese relative to Finnish and English readers. The other main findings reported in the original study were consistent. We suggest that the faster reading times for Chinese subjects occurred due to cultural changes that have taken place in the decade or so that lapsed between when the original and current subjects were tested. We maintain our view that the results can be taken to reflect universality in aspects of reading and we evaluate the claims regarding a lack of statistical power that were levelled against the original article

Using Eye-Tracking to Demonstrate Children's Attention to Detail when Evaluating Low-Fidelity Prototypes.

This study used eye tracking glasses to better understand how children explore low-fidelity prototypes in the context of user experience studies and to explore the potential of eye tracking in this context. The main research question that was being explored was whether the aesthetic refinement, either wireframe or high-resolution images, would affect children’s self-report and if so, or if not, what could be learned from knowing where children looked when exploring the prototypes. The results showed that the aesthetic refinement had little influence over the children’s overall ratings of the game. The eye tracking data demonstrated that there were no differences in the time spent viewing the prototypes and most of the children focused on both the visuals and text on all the pages. However, there were a higher number of fixations recorded in the wireframe prototype compared to the photo-realistic version. This paper contributes to the design of prototypes through an understanding of how children interact with prototypes, demonstrating the importance of the text along with the visuals when evaluating game concepts with children. Further research is required to understand the differences and whether similar results are replicated with different games

A Contrastive Pragmatics Study of Invitations in British English and Japanese

This study offers a cross-cultural pragmatics perspective on invitations. It explores invitation sequences in a symmetrical invitation-refusal situation, performed by 20 female native speakers of British English and 20 female native speakers of Japanese, from a discursive approach using role plays. The qualitative analysis of the data obtained from the adapted version of conversation analysis revealed some similarities and differences in turn designs of the English and the Japanese invitations. Although pre-sequences were highly frequent in the English data, they were more so in the Japanese data. The analysis of the linguistic formats of the invitations in the two sets of data revealed that an approach to handle uncertainty seen in the cases where the invitation was initiated with a preface differed - the English speakers used a syntactic solution whereas the Japanese speakers used a sequential solution. These findings highlight the importance of analysing speech acts in situated interactions

Criteria and indicators for Centers of Clinical Excellence in stroke recovery and rehabilitation: A global consensus facilitated by ISRRA

Background The aim of the International Stroke Recovery and Rehabilitation Alliance is to create a world where worldwide collaboration brings major breakthroughs for the millions of people living with stroke. A key pillar of this work is to define globally relevant criteria for centers that aspire to deliver excellent clinical rehabilitation and generate exceptional outcomes for patients. Objectives This paper presents consensus work conducted with an international group of expert stroke recovery and rehabilitation researchers, clinicians, and people living with stroke to identify and define criteria and measurable indicators for Centers of Clinical Excellence (CoCE) in stroke recovery and rehabilitation. These were intentionally developed to be ambitious and internationally relevant, regardless of a country’s development or income status, to drive global improvement in stroke services. Methods Criteria and specific measurable indicators for CoCE were collaboratively developed by an international panel of stroke recovery and rehabilitation experts from 10 countries and consumer groups from 5 countries. Results The criteria and associated indicators, ranked in order of importance, focused upon (i) optimal outcome, (ii) research culture, (iii) working collaboratively with people living with stroke, (iv) knowledge exchange, (v) leadership, (vi) education, and (vii) advocacy. Work is currently underway to user-test the criteria and indicators in 14 rehabilitation centers in 10 different countries. Conclusions We anticipate that use of the criteria and indicators could support individual organizations to further develop their services and, more widely, provide a mechanism by which clinical excellence can be articulated and shared to generate global improvements in stroke care