Factors Associated with the Innate Orthopaedic Ability of Veterinary Students

Relatively little is known about the innate surgical ability of veterinary undergraduates. The objective of this study was to investigate if there were differences in the innate surgical ability of a cohort of 142 third-year veterinary undergraduate students to perform a series of simulated orthopaedic surgical tasks, and whether specific factors influenced their innate ability. Participants performed four simulated surgical tasks; ‘depth of plunge’ – an assessment of the ‘plunge’ depth through foam when drilling through the trans cortex of a PVC pipe; ‘3-dimensional drilling’ – an assessment of accuracy when drilling through a block of wood; ‘depth measurement’ – an assessment of the ability to correctly measure the depth of holes in PVC pipe; and ‘fracture reduction’ – where the speed and systematic reduction of a simulated fracture was assessed using a rubric score. Performance for each of these tasks was compared based on the responses to a survey. Results showed considerable variation in the innate ability of students. Previous experience performing manual tasks and using a drill was associated with an improvement in students’ ability to perform one of the four tasks (fracture reduction). Age, gender, handedness, videogame experience, building game experience, exposure to orthopaedic surgery, or desire to pursue surgery as a career were not associated with the performance of any of the tasks. A learning curve was observed for the depth of plunge task. An increased target angle led to decreased drilling accuracy for the 3D drilling task. The innate ability of veterinary students to undertake simulated surgical tasks was largely unaffected by the previous experiences we evaluated

Agent-based modelling of sports riots

Riots originating during, or in the aftermath of, sports events can incur significant costs in damages, as well as large-scale panic and injuries. A mathematical description of sports riots is therefore sought to better understand their propagation and limit these physical and financial damages. In this work, we present an agent-based modelling framework that describes the qualitative features of populations engaging in riotous behaviour. Agents, pertaining to either a 'rioter' or a 'bystander' sub-population, move on an underlying lattice and can either be recruited or defect from their respective subpopulation. In particular, we allow these individual-level recruitment and defection processes to vary with local population density. This agent-based modelling framework provides the unifying link between multi-population stochastic models and density-dependent reaction processes. Furthermore, the continuum description of this ABM framework is shown to be a system of nonlinear reaction-diffusion equations and faithfully agrees with the average ABM behaviour from individual simulations. Finally, we determine the unique correspondence between the underlying individual-level recruitment and defection mechanisms with their population-level counterparts, providing a link between local-scale effects and macroscale rioting phenomena

Modelling mercury oxidation and radiative heat transfer in oxy-coal environments

There is a growing need for secure, flexible and inexpensive energy across the world, however there is also a need to simultaneously curb emissions of greenhouse gasses and toxic pollutants. Fossil fuel combustion is expected to meet a significant portion the world's growing energy demand, however CO2 emissions need to be mitigated to avoid potentially catastrophic effects caused by global warming. Carbon capture and storage (CCS) technologies have been developed to permit the use of fossil fuel combustion in a future with strict controls over greenhouse gas emissions. CCS technologies are still yet to be deployed at large industrial scales, and it is necessary to reduce the efficiency overheads associated with CCS before the technology is economically feasible. Computational modelling can play a significant role in designing and optimising CCS technologies for power generation due to its flexibility and comparatively low costs. The work in this thesis develops and validates models for predicting mercury oxidation and thermal radiation under oxyfuel combustion conditions, which is a promising CCS technology that is competitively placed for large-scale implementation. The oxidation of mercury is a key chemical process in mitigating emissions of the toxic metal, and predicting the principal oxidation pathways will improve the design of control technologies. Thermal radiation, which is the most significant mode of heat transfer at combustion temperatures, is a very important physical mechanism for predicting many properties of combustion, such as gas temperatures, chemical reaction rates and heat fluxes, and thermal radiation models must accurately account for changes in the combustion environment. The models developed and validated in this thesis provide new approaches to predict mercury oxidation and thermal radiation under oxyfuel conditions. The results and conclusions from this work offer clear guidance on methods to model thermal radiation in oxyfuel conditions, and provide new insight on the mercury oxidation mechanism

Quantifying patient- and hospital-level antimicrobial resistance dynamics in Staphylococcus aureus from routinely collected data

Introduction. Antimicrobial resistance (AMR) to all antibiotic classes has been found in the pathogen Staphylococcus aureus . The reported prevalence of these resistances varies, driven by within-host AMR evolution at the patient level, and between-host transmission at the hospital level. Without dense longitudinal sampling, pragmatic analysis of AMR dynamics at multiple levels using routine surveillance data is essential to inform control measures. Gap Statement. The value and limitations of routinely collected hospital data to gain insight into AMR dynamics at the hospital and individual levels simultaneously are unclear. Methodology. We explored S. aureus AMR diversity in 70 000 isolates from a UK paediatric hospital between 2000–2021, using electronic datasets containing multiple routinely collected isolates per patient with phenotypic antibiograms and information on hospitalization and antibiotic consumption. Results. At the hospital level, the proportion of isolates that were meticillin-resistant (MRSA) increased between 2014–2020 from 25–50 %, before sharply decreasing to 30%, likely due to a change in inpatient demographics. Temporal trends in the proportion of isolates resistant to different antibiotics were often correlated in MRSA, but independent in meticillin-susceptible S. aureus . Ciprofloxacin resistance in MRSA decreased from 70–40 % of tested isolates between 2007–2020, likely linked to a national policy to reduce fluoroquinolone usage in 2007. At the patient level, we identified frequent AMR diversity, with 4 % of patients ever positive for S. aureus simultaneously carrying, at some point, multiple isolates with different resistances. We detected changes over time in AMR diversity in 3 % of patients ever positive for S. aureus . These changes equally represented gain and loss of resistance. Conclusion. Within this routinely collected dataset, we found that 65 % of changes in resistance within a patient’s S. aureus population could not be explained by antibiotic exposure or between-patient transmission of bacteria, suggesting that within-host evolution via frequent gain and loss of AMR genes may be responsible for these changing AMR profiles. Our study highlights the value of exploring existing routine surveillance data to determine underlying mechanisms of AMR. These insights may substantially improve our understanding of the importance of antibiotic exposure variation, and the success of single S. aureus clones

Evaluation of the Performance and Economic Viability of a Novel Low Temperature Carbon Capture Process

A novel Advanced Cryogenic Carbon Capture (A3C) process is being developed due to its potential to achieve high CO2 capture efficiencies using low cost but high intensity heat transfer to deliver a much reduced energy consumption and process equipment size. These characteristics, along with the absence of process chemicals, offer the potential for application across a range of sectors. This work presents a techno-economic evaluation for applications ranging from 3% to 30% CO2 content

LES and RANS of air and oxy-coal combustion in a pilot-scale facility: predictions of radiative heat transfer

The development of carbon capture and storage (CCS) technology is important to permit the use of fossil fuels while honouring commitments to curb greenhouse gas emissions. Coal is a valuable global resource, which is widely available around the world, however its detrimental e ect on climate change will limit its use in a future with strict controls over carbon emissions. Oxyfuel combustion is a promising CCS technology that is being actively pursued in the development of large scale demonstration projects. Under the oxyfuel process for CCS, the combustion gas is replaced with a mixture of recycled ue gas and enriched oxygen. The resulting combustion environment can vary signi cantly from traditional air- red combustion. The development of modelling capabilities will greatly improve the optimisation process to develop oxyfuel technology into an economically viable prospect. This study evaluates the use of large eddy simulation (LES) and Reynoldsaveraged Navier Stokes (RANS) models on the prediction of thermal radiation during coal combustion for both air- red and oxyfuel operation in a pilot-scale 250 kWth furnace. The furnace is part of the UKCCSRC Pilot-scale Advanced Capture Technology (PACT) facilities and was designed for detailed analysis of the combustion process. Two radiation models were evaluated during the RANS calculations, the widely used weighted sum of grey gases (WSGG) andthe full-spectrum correlated k (FSCK) model, while the LES case was calculated using the FSCK radiation model. The results show that the LES solutions are in better agreement with measured values than the RANS predictions for both air- red and oxyfuel coal combustion, however LES demands considerably more computational resources

Breast screening atypia and subsequent development of cancer: protocol for an observational analysis of the Sloane database in England (Sloane atypia cohort study).

INTRODUCTION: The National Health Service (NHS) Breast Screening Programme aims to detect cancer earlier when treatment is more effective but can harm women by over diagnosing and overtreating cancers which would never have become symptomatic. As well as breast cancer, a spectrum of atypical epithelial proliferations (atypia) can also be detected as part of screening. This spectrum of changes, while not cancer, may mean that a woman is more likely to develop breast cancer in the future. Follow-up of atypia is not evidence based. We currently do not know which atypia should be detected to avoid future cancer. This study will explore how atypia develops into breast cancer in terms of number of women, time of cancer development, cancer type and severity, and whether this varies for different types of atypia. METHODS AND ANALYSIS: The Sloane cohort study began in April 2003 with ongoing data collection including atypia diagnosed through screening at screening units in the UK. The database for England has 3645 cases (24 September 2020) of epithelial atypia, with follow-up from 1 to 15 years. The outcomes include subsequent invasive breast cancer and the nature of subsequent cancer. Descriptive statistics will be produced. The observed rates of breast cancer at 1, 3 and 6 years for types of atypia will be reported with CIs, to enable comparison to women in the general population. Time to event methods will be used to describe the time to breast cancer diagnosis for the types of atypia, including flexible parametric modelling if appropriate. Patient representatives from Independent Cancer Patients' Voice are included at every stage of the research. ETHICS AND DISSEMINATION: The study has received research ethics approval from the University of Warwick Biomedical and Scientific Research Ethics Committee (BSREC 10/20-21, 8 October 2020), Public Health England office for data release approvals (ODR1718_313) and approval from the English Breast Research Advisory Committee (BSPRAC_031). The findings will be disseminated to breast screening clinicians (via journal publication and conference presentation), to the NHS Breast Screening Programme to update their guidelines on how women with atypia should be followed up, and to the general public

Unresected screen-detected ductal carcinoma in situ: Outcomes of 311 women in the Forget-Me-Not 2 study.

BACKGROUND AND AIM: The natural history of ductal carcinoma in situ (DCIS) is poorly understood. The aim of this cohort study was to determine the outcomes of women who had no surgery for screen-detected DCIS in the 6 months following diagnosis. METHODS: English breast screening databases were retrospectively searched for women diagnosed with DCIS without invasive cancer at screening and who had no record of surgery within 6 months of diagnosis. These were cross-referenced with cancer registry data. Details of the potentially eligible women were sent to the relevant breast screening units for verification and for completion of data forms detailing clinical, radiological and pathological findings, non-surgical treatment and subsequent clinical course. RESULTS: Data for 311 eligible women (median age 62 years) were available. 60 women developed invasive cancer, 56 ipsilateral and 4 contralateral. Ipsilateral invasion risk increased approximately linearly with time for at least 10 years. The 10-year cumulative risk of ipsilateral invasion was 9% (95% CI 4-21%), 39% (24-58%) and 36% (24-50%) for low, intermediate and high grade DCIS respectively and was higher in younger women, in those with larger DCIS lesions and in those with microinvasion. Most invasive cancers that developed were grade 2 or 3. CONCLUSION: The findings suggest that active surveillance may be a reasonable alternative to surgery in patients with low grade DCIS but that women with intermediate or high grade disease should continue to be offered surgery. This highlights the importance of reproducible grading of DCIS to ensure patients receive appropriate treatment

Prediction of the radiative heat transfer in small and large scale oxy-coal furnaces

Predicting thermal radiation for oxy-coal combustion highlights the importance of the radiation models for the spectral properties of gases and particles. This study numerically investigates radiation behaviours in small and large scale furnaces through refined radiative property models, using the full-spectrum correlated k (FSCK) model and Mie theory based data, compared with the conventional use of the weighted sum of grey gases (WSGG) model and the constant values of the particle radiation properties. Both oxy-coal combustion and air-fired combustion have been investigated numerically and compared with combustion plant experimental data. Reasonable agreements are obtained between the predicted results and the measured data. Employing the refined radiative property models achieves closer predicted heat transfer properties to the measured data from both furnaces. The gas-phase component of the radiation energy source term obtained from the FSCK property model is higher within the flame region than the values obtained by using the conventional methods. The impact of using non-grey radiation behaviour of gases through the FSCK is enhanced in the large scale furnace as the predicted gas radiation source term is approximately 2-3 times that obtained when using the WSGG, while the same term is in much closer agreement between the FSCK and the WSGG for the pilot-scale furnace. The predicted total radiation source term (from both gases and particles) is lower in the flame region after using the refined models, which results in a hotter flame (approximately 50-150 K higher in this study) compared with results obtained from conventional methods. In addition, the predicted surface incident radiation reduces by using the refined radiative property models for both furnaces, in which the difference is relevant with the difference in the predicted radiation properties between the two modelling techniques. Numerical uncertainties resulting from the influences of combustion model, turbulent particle dispersion and turbulence modelling on the radiation behaviours are discussed

Risk factors for the development of invasive cancer in unresected ductal carcinoma in situ.

BACKGROUND: The natural history of ductal carcinoma in situ (DCIS) remains uncertain. The risk factors for the development of invasive cancer in unresected DCIS are unclear. METHODS: Women diagnosed with DCIS on needle biopsy after 1997 who did not undergo surgical resection for ≥1 year after diagnosis were identified by breast centres and the cancer registry and outcomes were reviewed. RESULTS: Eighty-nine women with DCIS diagnosed 1998-2010 were identified. The median age at diagnosis was 75 (range 44-94) years with median follow-up (diagnosis to death, invasive disease or last review) of 59 (12-180) months. Twenty-nine women (33%) developed invasive breast cancer after a median interval of 45 (12-144) months. 14/29 (48%) with high grade, 10/31 (32%) with intermediate grade and 3/17 (18%) with low grade DCIS developed invasive cancer after median intervals of 38, 60 and 51 months. The cumulative incidence of invasion was significantly higher in high grade DCIS than other grades (p = .0016, log-rank test). Invasion was more frequent in lesions with calcification as the predominant feature (23/50 v. 5/25; p = .042) and in younger women (p = .0002). Endocrine therapy was associated with a lower rate of invasive breast cancer (p = .048). CONCLUSIONS: High cytonuclear grade, mammographic microcalcification, young age and lack of endocrine therapy were risk factors for DCIS progression to invasive cancer. Surgical excision of high grade DCIS remains the treatment of choice. Given the uncertain long-term natural history of non-high grade DCIS, the option of active surveillance of women with this condition should be offered within a clinical trial