Letters to Andrew Inglis Clark, Tasmania, from Everard Digby, Sydney, 14 Sept 1904 and 13 May 1905

Letters to Andrew Inglis Clark, Tasmania, from Everard Digby, Sydney, 14 Sept 1904 and 13 May 1905 regarding articles by Clark in the 'Commonwealth Law Review'. C4/C48-4

Letter to Andrew Inglis Clark, Tasmania, from Everard Digby, Sydney, 14 Sept 1904

Thanking Clark for his offer of a series of articles for the Commonwealth Law Review. However when the Review is older such a series will be dealt with. Meanwhile suggests that Clark submit some papers to see if he can use them. C4/C4

The impact of personalised risk information compared to a positive/negative result on informed choice and intention to undergo colonoscopy following colorectal Cancer screening in Scotland (PERICCS) - a randomised controlled trial:study protocol

Background In Scotland a new, easier to complete bowel screening test, the Faecal Immunochemical Test (FIT), has been introduced. This test gives more accurate information about an individual’s risk of having colorectal cancer (CRC), based on their age and gender, and could lead to fewer missed cancers compared to the current screening test. However, there is no evidence of the effect on colonoscopy uptake of providing individuals with personalised risk information following a positive FIT test. The objectives of the study are: 1) To develop novel methods of presenting personalised risk information in an easy-to-understand format using infographics with involvement of members of the public 2) To assess the impact of different presentations of risk information on informed choice and intention to take up an offer of colonoscopy after FIT 3) To assess participants’ responses to receiving personal risk information (knowledge, attitudes to screening/risk, emotional responses including anxiety). Methods Adults (age range 50–74) registered on the Scottish Bowel Screening database will be invited by letter to take part. Consenting participants will be randomised to one of three groups to receive hypothetical information about their risk of cancer, based on age, gender and faecal haemoglobin concentration: 1) personalised risk information in numeric form (e.g. 1 in 100) with use of infographics, 2) personalised information described as ‘highest’, ‘moderate’ or ‘lowest’ risk with use of infographics, and 3) as a ‘positive’ test result, as is current practice. Groups will be compared on informed choice, intention to have a colonoscopy, and satisfaction with their decision. Follow-up semi-structured qualitative interviews will be conducted, by telephone, with a small number of consenting participants (n = 10 per group) to explore the acceptability/readability and any potential negative impact of the risk information, participants’ understanding of risk factors, attitudes to the different scenarios, and reasons for reported intentions. Discussion Proving personalised risk information and allowing patient choice could lead to improved detection of CRC and increase patient satisfaction by facilitating informed choice over when/whether to undergo further invasive screening. However, we need to determine whether/how informed choice can be achieved and assess the potential impact on the colonoscopy service

The impact of hypothetical PErsonalised Risk Information on informed choice and intention to undergo Colorectal Cancer screening colonoscopy in Scotland (PERICCS)—a randomised controlled trial

Background There is currently no existing evidence on the effects of personalised risk information on uptake of colonoscopy following first line screening for colorectal cancer. This study aimed to measure the impact of providing risk information based on faecal haemoglobin concentration to allow a fully informed choice around whether or not to undergo colonoscopy. Methods Two thousand seven hundred sixty-seven participants from the Scottish Bowel Screening Programme (SBoSP) database, who had not recently been invited for screening, were randomised to receive one of three types of hypothetical risk information materials: (1) numerical risk information (risk categories of one in 40, one in 1600 and one in 3500), (2) categorical risk information (highest, moderate and lowest risk), or (3) positive screening result letter (control group). The primary outcome was the impact of the risk materials on intention to undergo colonoscopy, to allow comparison with the current colonoscopy uptake of 77% for those with a positive screening result in the SBoSP. Secondary outcomes were knowledge, attitudes and emotional responses to the materials. Results Four hundred thirty-four (15.7%) agreed to participate with 100 from the numerical risk group (69.0%), 104 from the categorical risk group (72.2%) and 104 from the control group (71.7%) returning completed materials. Intention to undergo colonoscopy was highest in the highest risk groups for the numerical and categorical study arms (96.8% and 95.3%, respectively), but even in the lowest risk groups was > 50% (58.1% and 60.7%, respectively). Adequate knowledge of colorectal screening and the risks and benefits of colonoscopy was found in ≥ 98% of participants in all three arms. All participants reported that they found the information easy-to-understand. 19.1%, 24.0% and 29.6% of those in the numerical, categorical and control group, respectively, reported that they found the information distressing (p > 0.05). Conclusions Applying the risk categories to existing SBoSP data shows that if all participants were offered an informed choice to have colonoscopy, over two thirds of participants would intend to have the test. Equating to an increase in the number of screening colonoscopies from approx. 14,000 to 400,000 per annum, this would place an unmanageable demand on colonoscopy services, with a very small proportion of cancers and pre-cancers detected. However, the response to the materials were very positive, suggesting that providing risk information to those in lowest and moderate risk groups along with advice that colonoscopy is not currently recommended may be an option. Future research would be required to examine actual uptake

Diagnosis of vertebral fractures in children: is a simplified algorithm-based qualitative technique reliable?

Background Identification of osteoporotic vertebral fractures allows treatment opportunity reducing future risk. There is no agreed standardised method for diagnosing paediatric vertebral fractures. Objective To evaluate the precision of a modified adult algorithm-based qualitative (ABQ) technique, applicable to children with primary or secondary osteoporosis. Materials and methods Three radiologists independently assessed lateral spine radiographs of 50 children with suspected reduction in bone mineral density using a modified ABQ scoring system and following simplification to include only clinically relevant parameters, a simplified ABQ score. A final consensus of all observers using simplified ABQ was performed as a reference standard for fracture characterisation. Kappa was calculated for interobserver agreement of the components of both scoring systems and intraobserver agreement of simplified ABQ based on a second read of 29 randomly selected images. Results Interobserver Kappa for modified ABQ scoring for fracture detection, severity and shape ranged from 0.34 to 0.49 Kappa for abnormal endplate and position assessment was 0.27 to 0.38. Inter- and intraobserver Kappa for simplified ABQ scoring for fracture detection and grade ranged from 0.37 to 0.46 and 0.45 to 0.56, respectively. Inter- and intraobserver Kappa for affected endplate ranged from 0.31 to 0.41 and 0.45 to 0.51, respectively. Subjectively, observers’ felt simplified ABQ was easier and less time-consuming. Conclusion Observer reliability of modified and simplified ABQ was similar, with slight to moderate agreement for fracture detection and grade/severity. Due to subjective preference for simplified ABQ, we suggest its use as a semi-objective measure of diagnosing paediatric vertebral fracture

Social behaviour in zoo bachelor groups: a case study of related South American fur seals

Appropriate management of social groups is one of the greatest challenges that face zoos and aquaria worldwide. To facilitate breeding programmes, particularly in polygynous species, there is a need to house surplus males in bachelor groups, yet for pinnipeds, the social impact of this management strategy is unknown. The aim of this research was to enhance understanding of sociality in South American fur seals (SAFSs), with a particular focus on social dynamics in a related bachelor group, and consider implications for evidence-based management of this species in zoos. The subjects were four related male seals housed at Bristol Zoo Gardens. Social interaction and nearest neighbour data were collected between February and July 2019. Individuals engaged in both positive and negative social interactions. Positive interactions were more frequent than negative interactions, and no excessive negative interactions were observed. Temporal dynamics were observed in social relationships, and negative interactions did not increase with the onset of the breeding season. Reciprocity in dyadic relationships was variable across the study months, and nearest neighbours were not necessarily reflective of social partners. This research highlights the importance of longitudinal monitoring of social relationships and establishment of baseline social behaviour profiles to support evidence-based species management. We advocate that this research is extended, to further develop our understanding of SAFS social needs within zoo environments, to understand the differences between single-sex and mixed-sex groups and to identify the degree to which the extensive research conducted in other polygynous species (e.g., gorillas) is applicable in the social management of South American fur seals moving forwards

Pressure dependence of the sound velocity in a 2D lattice of Hertz-Mindlin balls: a mean field description

We study the dependence on the external pressure $P$ of the velocities $v_{L,T}$ of long wavelength sound waves in a confined 2D h.c.p. lattice of 3D elastic frictional balls interacting via one-sided Hertz-Mindlin contact forces, whose diameters exhibit mild dispersion. The presence of an underlying long range order enables us to build an effective medium description which incorporates the radial fluctuations of the contact forces acting on a single site. Due to the non linearity of Hertz elasticity, self-consistency results in a highly non-linear differential equation for the "equation of state" linking the effective stiffness of the array with the applied pressure, from which sound velocities are then obtained. The results are in excellent agreement with existing experimental results and simulations in the high and intermediate pressure regimes. It emerges from the analysis that the departure of $v_{L}(P)$ from the ideal $P^{1/6}$ Hertz behavior must be attributed primarily to the fluctuations of the stress field, rather than to the pressure dependence of the number of contacts

Neurological update: COVID-19

Abstract: Coronavirus Disease 2019 is predominantly a disorder of the respiratory system, but neurological complications have been recognised since early in the pandemic. The major pathophysiological processes leading to neurological damage in COVID-19 are cerebrovascular disease, immunologically mediated neurological disorders and the detrimental effects of critical illness on the nervous system. It is still unclear whether direct invasion of the nervous system by the Severe Acute Respiratory Syndrome Coronavirus 2 occurs; given the vast numbers of people infected at this point, this uncertainty suggests that nervous system infection is unlikely to represent a significant issue if it occurs at all. In this review, we explore what has been learnt about the neurological complications of COVID-19 over the course of the pandemic, and by which mechanisms these complications most commonly occur

Diagnostic accuracy of DXA compared to conventional spine radiographs for the detection of vertebral fractures in children

Objectives In children, radiography is performed to diagnose vertebral fractures and dual energy x-ray absorptiometry (DXA) to assess bone density. In adults, DXA assesses both. We aimed to establish whether DXA can replace spine radiographs in assessment of paediatric vertebral fractures. Methods Prospectively, lateral spine radiographs and lateral spine DXA of 250 children performed on the same day were independently scored by three radiologists using the simplified algorithm based qualitative technique and blinded to results of the other modality. Consensus radiograph read and second read of 100 random images were performed. Diagnostic accuracy, inter/intraobserver and intermodality agreements, patient/carer experience and radiation dose were assessed. Results Average sensitivity and specificity (95% confidence interval) in diagnosing one or more vertebral fractures requiring treatment was 70% (58%-82%) and 97% (94%- 100%) respectively for DXA and 74% (55%-93%) and 96% (95%-98%) for radiographs. Fleiss’ kappa for interobserver and average kappa for intraobserver reliability were 0.371 and 0.631 respectively for DXA and 0.418 and 0.621 for radiographs. Average effective dose was 41.9µSv for DXA and 232.7µSv for radiographs. Image quality was similar. Conclusion Given comparable image quality and non-inferior diagnostic accuracy, lateral spine DXA should replace conventional radiographs for assessment of vertebral fractures in children

Granular Packings: Nonlinear elasticity, sound propagation and collective relaxation dynamics

Experiments on isotropic compression of a granular assembly of spheres show that the shear and bulk moduli vary with the confining pressure faster than the 1/3 power law predicted by Hertz-Mindlin effective medium theories (EMT) of contact elasticity. Moreover, the ratio between the moduli is found to be larger than the prediction of the elastic theory by a constant value. The understanding of these discrepancies has been a longstanding question in the field of granular matter. Here we perform a test of the applicability of elasticity theory to granular materials. We perform sound propagation experiments, numerical simulations and theoretical studies to understand the elastic response of a deforming granular assembly of soft spheres under isotropic loading. Our results for the behavior of the elastic moduli of the system agree very well with experiments. We show that the elasticity partially describes the experimental and numerical results for a system under compressional loads. However, it drastically fails for systems under shear perturbations, particularly for packings without tangential forces and friction. Our work indicates that a correct treatment should include not only the purely elastic response but also collective relaxation mechanisms related to structural disorder and nonaffine motion of grains.Comment: 21 pages, 13 figure