Specific treatment and outcome of urethrorectal fistula associated with type 1 atresia ani in a juvenile male dog

A four-month-old, entire male, German wirehaired pointer presented with tenesmus due to type I atresia ani and with urination observed through this stenosed anal opening. A positive contrast retrograde urethrogram demonstrated a urethrorectal fistula and stricture of the penile urethra. Urine culture revealed heavy mixed bacterial growth, which was treated with appropriate antibiotics. Surgical correction of the congenital urethrorectal fistula was performed via a perineal approach with a 3.5 French catheter placed retrograde into the fistula to facilitate its dissection. The anal stenosis was addressed by surgical anoplasty and the urethral stricture via a scrotal urethrostomy. The dog recovered well with the owner reporting complete resolution of the clinical signs and urination via the urethrostomy site at six months postoperatively. To the authors’ knowledge, this is the first reported case of congenital urethrorectal fistula associated with type 1 atresia ani in a male dog

Addressing obesity in Roma communities: : A community readiness approach

YesParticipation in community programmes by the Roma community is low whilst this community presents with high risk of poor health and low levels of wellbeing. To improve rates of participation in programmes compatibility must be achieved between implementation efforts and levels of readiness in the community. The Community Readiness Model (CRM) is a widely used toolkit which provides an indication of how prepared and willing a community is to take action on specific issues. We present findings from a CRM assessment for the Eastern European Roma community in Bradford, UK on issues related to nutrition and obesity. We interviewed key respondents identified as knowledgeable about the Roma community using the CRM. This approach applies a mixed methodology incorporating readiness scores and qualitative data. A mean community readiness score was calculated enabling researchers to place the community in one of nine possible stages of readiness. Interview transcripts were analysed using a qualitative framework analysis to generate contextual information. An overall score consistent with vague awareness was achieved, which indicates a low level of community readiness. This score suggests there will be a low likelihood of participation in currently available nutrition and obesity programmes. To our knowledge this is the first study to apply the CRM in the Roma community for any issue. We present the findings for each of the six dimensions that make up the CRM together with salient qualitative findings.Better Start Bradfor

Incidental Finding of Sickle Cell Trait From an Everyday Diabetes Test: Should General Health Care Providers and testing centres report, retest, or refer?

The file attached to this record is the author's final peer reviewed version. The Publisher's final version can be found by following the DOI link.The HbA1c test is increasingly widely used as a diagnostic and screening test for diabetes mellitus type 2 (T2DM) but the presence of haemoglobin variants, such as sickle haemoglobin, can interfere with results in some analytical systems. These interferences are occasionally reported by laboratories, leading unprepared patients to suspect they may be sickle cell carriers and seek confirmation through a sickle cell test. Incidental findings of Hb variants, and the reporting thereof, present multiple ethical challenges to laboratories, medical practitioners, patients and their family members, but there appear to be no international or national guidelines on how to deal with the reporting of these findings. This paper explores issues such as whether informed consent is necessary, how the results should be communicated, how the patient may be affected by knowing their carrier status, the timing of communications, complications caused by partial results, and being a ‘healthy carrier’ at the same time as potentially experiencing symptoms

How the Bright and Dark Side of Self-Determination Theory Influence Participants' Life Skills Development in Youth Sport

Objectives: This study investigated whether basic needs satisfaction versus frustration mediated the relationships between autonomy-supportive versus controlling coaching and participants’ life skills development in youth sport. Design: This descriptive study used a cross-sectional research design. To ensure a diverse sample, participants were recruited from a wide range of sports. Methods: British and Irish youth sport participants (N = 309) completed measures of autonomy-supportive and controlling coaching, basic need satisfaction versus frustration (autonomy, competence, and relatedness), and life skills development in sport (teamwork, goal setting, social skills, problem solving, emotional skills, leadership, time management, and communication skills). Results: Correlational analyses showed that coach autonomy support was positively related to participants’ basic need satisfaction and life skills development. Controlling coaching was only positively associated with participants’ basic need frustration. Mediational analyses revealed that satisfaction of the three needs combined mediated the relationships between coach autonomy support and participants’ development of all eight life skills. Relatedness satisfaction mediated the relationships between coach autonomy support and participants’ development of all life skills except for goal setting. Autonomy satisfaction only mediated the relationships between coach autonomy support and time management; whereas, competence satisfaction mediated the relationships between coach autonomy support and participants’ goal setting and emotional skills. Conclusions: Findings indicated that basic need satisfaction is a mechanism that helps explain the relationships between coach autonomy support and sport participants’ life skills development. As such, coaches should create an autonomy-supportive climate that satisfies participants’ three basic needs and may help to develop their life skills

The key components of a successful model of midwifery-led continuity of carer, without continuity at birth: findings from a qualitative implementation evaluation

Abstract Background Recent UK maternity policy changes recommend that a named midwife supports women throughout their pregnancy, birth and postnatal care. Whilst many studies report high levels of satisfaction amongst women receiving, and midwives providing, this level of continuity of carer, there are concerns some midwives may experience burnout and stress. In this study, we present a qualitative evaluation of the implementation of a midwife-led continuity of carer model that excluded continuity of carer at the birth. Methods Underpinned by the Conceptual Model for Implementation Fidelity, our evaluation explored the implementation, fidelity, reach and satisfaction of the continuity of carer model. Semi-structured interviews were undertaken with midwives (n = 7) and women (n = 15) from continuity of carer team. To enable comparisons between care approaches, midwives (n = 7) and women (n = 10) from standard approach teams were also interviewed. Interviews were recorded, transcribed and analysed using thematic analysis. Results For continuity of carer team midwives, manageable caseloads, extended appointment times, increased team stability, and flexible working patterns facilitated both care provided and midwives’ job satisfaction. Both continuity of carer and standard approach midwives reported challenges in providing postnatal continuity given the unpredictable timing of labour and birth. Time constraints, inadequate staffing and lack of administrative support were reported as additional barriers to implementing continuity of carer within standard approach teams. Women reported continuity was integral to building trust with midwives, encouraged them to disclose mental health issues and increased their confidence in making birth choices. Conclusions Our evaluation highlighted the successful implementation of a continuity of carer model for ante and postnatal care. Despite exclusion of the birth element in the model, both women and midwives expressed high levels of satisfaction in comparison to women and midwives within the standard approach. Implementation successes were largely due to structural and resource factors, particularly the combination of additional time and smaller caseloads of women. However, these resources are not widely available within the resources of maternity unit budgets. Future research should further explore whether a continuity of carer model focusing on antenatal and postnatal care delivery is a feasible and sustainable model of care for all women. </jats:sec

Measurement of the cosmic ray spectrum above 4×10184{\times}10^{18} eV using inclined events detected with the Pierre Auger Observatory

A measurement of the cosmic-ray spectrum for energies exceeding $4{\times}10^{18}$ eV is presented, which is based on the analysis of showers with zenith angles greater than $60^{\circ}$ detected with the Pierre Auger Observatory between 1 January 2004 and 31 December 2013. The measured spectrum confirms a flux suppression at the highest energies. Above $5.3{\times}10^{18}$ eV, the "ankle", the flux can be described by a power law $E^{-\gamma}$ with index $\gamma=2.70 \pm 0.02 \,\text{(stat)} \pm 0.1\,\text{(sys)}$ followed by a smooth suppression region. For the energy ($E_\text{s}$) at which the spectral flux has fallen to one-half of its extrapolated value in the absence of suppression, we find $E_\text{s}=(5.12\pm0.25\,\text{(stat)}^{+1.0}_{-1.2}\,\text{(sys)}){\times}10^{19}$ eV.Comment: Replaced with published version. Added journal reference and DO

Energy Estimation of Cosmic Rays with the Engineering Radio Array of the Pierre Auger Observatory

The Auger Engineering Radio Array (AERA) is part of the Pierre Auger Observatory and is used to detect the radio emission of cosmic-ray air showers. These observations are compared to the data of the surface detector stations of the Observatory, which provide well-calibrated information on the cosmic-ray energies and arrival directions. The response of the radio stations in the 30 to 80 MHz regime has been thoroughly calibrated to enable the reconstruction of the incoming electric field. For the latter, the energy deposit per area is determined from the radio pulses at each observer position and is interpolated using a two-dimensional function that takes into account signal asymmetries due to interference between the geomagnetic and charge-excess emission components. The spatial integral over the signal distribution gives a direct measurement of the energy transferred from the primary cosmic ray into radio emission in the AERA frequency range. We measure 15.8 MeV of radiation energy for a 1 EeV air shower arriving perpendicularly to the geomagnetic field. This radiation energy -- corrected for geometrical effects -- is used as a cosmic-ray energy estimator. Performing an absolute energy calibration against the surface-detector information, we observe that this radio-energy estimator scales quadratically with the cosmic-ray energy as expected for coherent emission. We find an energy resolution of the radio reconstruction of 22% for the data set and 17% for a high-quality subset containing only events with at least five radio stations with signal.Comment: Replaced with published version. Added journal reference and DO

Effects of antiplatelet therapy on stroke risk by brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases: subgroup analyses of the RESTART randomised, open-label trial

Background Findings from the RESTART trial suggest that starting antiplatelet therapy might reduce the risk of recurrent symptomatic intracerebral haemorrhage compared with avoiding antiplatelet therapy. Brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases (such as cerebral microbleeds) are associated with greater risks of recurrent intracerebral haemorrhage. We did subgroup analyses of the RESTART trial to explore whether these brain imaging features modify the effects of antiplatelet therapy

Evaluating the Effects of SARS-CoV-2 Spike Mutation D614G on Transmissibility and Pathogenicity.

Global dispersal and increasing frequency of the SARS-CoV-2 spike protein variant D614G are suggestive of a selective advantage but may also be due to a random founder effect. We investigate the hypothesis for positive selection of spike D614G in the United Kingdom using more than 25,000 whole genome SARS-CoV-2 sequences. Despite the availability of a large dataset, well represented by both spike 614 variants, not all approaches showed a conclusive signal of positive selection. Population genetic analysis indicates that 614G increases in frequency relative to 614D in a manner consistent with a selective advantage. We do not find any indication that patients infected with the spike 614G variant have higher COVID-19 mortality or clinical severity, but 614G is associated with higher viral load and younger age of patients. Significant differences in growth and size of 614G phylogenetic clusters indicate a need for continued study of this variant

Effects of antiplatelet therapy after stroke due to intracerebral haemorrhage (RESTART): a randomised, open-label trial

Background: Antiplatelet therapy reduces the risk of major vascular events for people with occlusive vascular disease, although it might increase the risk of intracranial haemorrhage. Patients surviving the commonest subtype of intracranial haemorrhage, intracerebral haemorrhage, are at risk of both haemorrhagic and occlusive vascular events, but whether antiplatelet therapy can be used safely is unclear. We aimed to estimate the relative and absolute effects of antiplatelet therapy on recurrent intracerebral haemorrhage and whether this risk might exceed any reduction of occlusive vascular events. Methods: The REstart or STop Antithrombotics Randomised Trial (RESTART) was a prospective, randomised, open-label, blinded endpoint, parallel-group trial at 122 hospitals in the UK. We recruited adults (≥18 years) who were taking antithrombotic (antiplatelet or anticoagulant) therapy for the prevention of occlusive vascular disease when they developed intracerebral haemorrhage, discontinued antithrombotic therapy, and survived for 24 h. Computerised randomisation incorporating minimisation allocated participants (1:1) to start or avoid antiplatelet therapy. We followed participants for the primary outcome (recurrent symptomatic intracerebral haemorrhage) for up to 5 years. We analysed data from all randomised participants using Cox proportional hazards regression, adjusted for minimisation covariates. This trial is registered with ISRCTN (number ISRCTN71907627). Findings: Between May 22, 2013, and May 31, 2018, 537 participants were recruited a median of 76 days (IQR 29–146) after intracerebral haemorrhage onset: 268 were assigned to start and 269 (one withdrew) to avoid antiplatelet therapy. Participants were followed for a median of 2·0 years (IQR [1·0– 3·0]; completeness 99·3%). 12 (4%) of 268 participants allocated to antiplatelet therapy had recurrence of intracerebral haemorrhage compared with 23 (9%) of 268 participants allocated to avoid antiplatelet therapy (adjusted hazard ratio 0·51 [95% CI 0·25–1·03]; p=0·060). 18 (7%) participants allocated to antiplatelet therapy experienced major haemorrhagic events compared with 25 (9%) participants allocated to avoid antiplatelet therapy (0·71 [0·39–1·30]; p=0·27), and 39 [15%] participants allocated to antiplatelet therapy had major occlusive vascular events compared with 38 [14%] allocated to avoid antiplatelet therapy (1·02 [0·65–1·60]; p=0·92). Interpretation: These results exclude all but a very modest increase in the risk of recurrent intracerebral haemorrhage with antiplatelet therapy for patients on antithrombotic therapy for the prevention of occlusive vascular disease when they developed intracerebral haemorrhage. The risk of recurrent intracerebral haemorrhage is probably too small to exceed the established benefits of antiplatelet therapy for secondary prevention