Rapid Evaporative Ionisation Mass Spectrometry of Electrosurgical Vapours for the Identification of Breast Pathology: Towards an Intelligent Knife for Breast Cancer Surgery

Background: Re-operation for positive resection margins following breast-conserving surgery occurs frequently (average = 20–25%), is cost-inefficient, and leads to physical and psychological morbidity. Current margin assessment techniques are slow and labour intensive. Rapid evaporative ionisation mass spectrometry (REIMS) rapidly identifies dissected tissues by determination of tissue structural lipid profiles through on-line chemical analysis of electrosurgical aerosol toward real-time margin assessment. Methods: Electrosurgical aerosol produced from ex-vivo and in-vivo breast samples was aspirated into a mass spectrometer (MS) using a monopolar hand-piece. Tissue identification results obtained by multivariate statistical analysis of MS data were validated by histopathology. Ex-vivo classification models were constructed from a mass spectral database of normal and tumour breast samples. Univariate and tandem MS analysis of significant peaks was conducted to identify biochemical differences between normal and cancerous tissues. An ex-vivo classification model was used in combination with bespoke recognition software, as an intelligent knife (iKnife), to predict the diagnosis for an ex-vivo validation set. Intraoperative REIMS data were acquired during breast surgery and time-synchronized to operative videos. Results: A classification model using histologically validated spectral data acquired from 932 sampling points in normal tissue and 226 in tumour tissue provided 93.4% sensitivity and 94.9% specificity. Tandem MS identified 63 phospholipids and 6 triglyceride species responsible for 24 spectral differences between tissue types. iKnife recognition accuracy with 260 newly acquired fresh and frozen breast tissue specimens (normal n = 161, tumour n = 99) provided sensitivity of 90.9% and specificity of 98.8%. The ex-vivo and intra-operative method produced visually comparable high intensity spectra. iKnife interpretation of intra-operative electrosurgical vapours, including data acquisition and analysis was possible within a mean of 1.80 seconds (SD ±0.40). Conclusions: The REIMS method has been optimised for real-time iKnife analysis of heterogeneous breast tissues based on subtle changes in lipid metabolism, and the results suggest spectral analysis is both accurate and rapid. Proof-of-concept data demonstrate the iKnife method is capable of online intraoperative data collection and analysis. Further validation studies are required to determine the accuracy of intra-operative REIMS for oncological margin assessment

Do influenza and pneumococcal vaccines prevent community-acquired respiratory infections among older people with diabetes and does this vary by chronic kidney disease? A cohort study using electronic health records

Objective: We aimed to estimate the effectiveness of influenza and 23-valent pneumococcal polysaccharide vaccination on reducing the burden of community-acquired lower respiratory tract infection (LRTI) among older people with diabetes, and whether this varied by chronic kidney disease status. Research design and methods: We used linked UK electronic health records for a retrospective cohort study of 190,492 patients ≥65 years with diabetes mellitus and no history of renal replacement therapy, 1997–2011. We included community-acquired LRTIs managed in primary or secondary care. Infection incidence rate ratios were estimated using Poisson regression. Pneumococcal vaccine effectiveness (VE) was calculated as (1 – effect measure). To estimate influenza VE a ratio-of-ratios analysis (winter effectiveness/summer effectiveness) was used to address confounding by indication. Final VE estimates were stratified according to estimated glomerular filtration rate and proteinuria status. Results: Neither influenza nor pneumococcal vaccine uptake varied according to CKD status. Pneumococcal VE was 22% (95%CI: 11–31) against community-acquired pneumonia for the first year after vaccination, but was negligible after five years. In the ratio-of-ratios analysis, current influenza vaccination had 7% effectiveness for preventing community-acquired LRTI (95%CI: 3–12). Pneumococcal vaccine effectiveness was lower among patients with a history of proteinuria than among patients without proteinuria (p=0.04), but otherwise this study did not identify variation in pneumococcal or influenza VE by markers of CKD. Conclusions: The public health benefits of influenza vaccine may be modest among older people with diabetes. Pneumococcal vaccination protection against community-acquired pneumonia declines swiftly: alternative vaccination schedules should be investigated

Methanotrophy potential versus methane supply by pore water diffusion in peatlands

Journal ArticlePublished by Copernicus Publications on behalf of the European Geosciences UnionAuthor(s) 2009.Low affinity methanotrophic bacteria consume a significant quantity of methane in wetland soils in the vicinity of plant roots and at the oxic-anoxic interface. Estimates of the efficiency of methanotrophy in peat soils vary widely in part because of differences in approaches employed to quantify methane cycling. High resolution profiles of dissolved methane abundance measured during the summer of 2003 were used to quantity rates of upward methane flux in four peatlands situated in Wales, UK. Aerobic incubations of peat from a minerotrophic and an ombrotrophic mire were used to determine depth distributions of kinetic parameters associated with methane oxidation. The capacity for methanotrophy in a 3 cm thick zone immediately beneath the depth of nil methane abundance in pore water was significantly greater than the rate of upward diffusion of methane in all four peatlands. Rates of methane diffusion in pore water at the minerotrophic peatlands were small (<10%) compared to surface emissions during June to August. The proportions were notably greater in the ombrotrophic bogs because of their typically low methane emission rates. Methanotrophy appears to consume entirely methane transported by pore water diffusion in the four peatlands with the exception of 4 of the 33 gas profiles sampled. Flux rates to the atmosphere regardless are high because of gas transport through vascular plants, in particular, at the minerotrophic sites. Cumulative rainfall amount 3-days prior to sampling correlated well with the distance between the water table level and the depth of 0 μmol l-1 methane, indicating that precipitation events can impact methane distributions in pore water. Further work is needed to characterise the kinetics of methane oxidation spatially and temporally in different wetland types in order to determine generalized relationships for methanotrophy in peatlands that can be incorporated into process-based models of methane cycling in peat soils.Natural Environment Research Council (NERC)Royal Societ

Online lessons new platforms for teaching-learning

Unprecedented situations demand novel responses. The Covid-19 pandemic has pushed the education sector into redefining its outlook, priorities, and modus operandi. The English language team at Vidya Bhawan Education Resource Centre (VBERC)—the academic partner of two major projects, Siksha Sambal Project (SSP) with Hindustan Zinc Ltd. and Saikshik Samvardhan Karyakram (SSK) with IndiGo Reach—has similarly been pushed into unfamiliar territory and new learning experiences

Intra-operative Raman spectroscopy and ex vivo Raman mapping for assessment of cartilage degradation

The development of a label-free, non-destructive and safe analytical method such as Raman spectroscopy for assessing cartilage degradation is highly desirable. Compared to non-optical imaging modalities, Raman mapping offers a more sensitive means of directly assessing the chemical composition of cartilage in three-dimensional space and the potential to monitor cartilage degeneration to inform intervention and treatment strategies. Herein, we report the application of Raman spectroscopic methods ex vivo and at arthroscopy to identify molecular alterations in cartilage specimens containing minor focal lesions characteristic of the early disease phase. Our initial ex vivo analysis, obtained by single-point Raman spectroscopy of cartilage samples, supports previous findings based on S-O stretching vibration bands associated with sulphated glycosaminoglycans (sGAGs). We extended the analyses to the high-wavenumber region where we observed that vibrational bands assigned to C-H and O-H stretching modes discriminated early cartilage alterations from healthy cartilage samples. Furthermore, we performed a proof-of-concept in-clinic study using a custom-built optical probe to acquire Raman spectral measurements for the first time in patients undergoing arthroscopy of knee joints. Spectra were obtained with adequate signal-to-noise ratios that similarly discriminated between lesion and adjacent cartilage sites and identified reductions in sGAGs in apparently healthy cartilage. Building on this, we present initial results from Raman mapping to spatially resolve the molecular constituents of cartilage through its depth and across a lesion. Mapping revealed a non-uniform and reduced sGAG distribution within the lesion and peripheral cartilage that was otherwise visually normal, similar to the in-clinic observations, showing that the degradative influence of the lesion extended beyond its border. This was accompanied by a decreased fluorescence signal intensity, which suggests that fluorescence may provide valuable information as an adjunct to the Raman signal in discriminating normal and degenerating cartilage. This work demonstrates the value of Raman mapping over single-point Raman measurements for the analysis of the anisotropy of articular cartilage and highlights the potential of the technology for in vivo articular joint arthroscopy applications

On domain walls in a Ginzburg-Landau non-linear S^2-sigma model

The domain wall solutions of a Ginzburg-Landau non-linear $S^2$-sigma hybrid model are unveiled. There are three types of basic topological walls and two types of degenerate families of composite - one topological, the other non-topological- walls. The domain wall solutions are identified as the finite action trajectories (in infinite time) of a related mechanical system that is Hamilton-Jacobi separable in sphero-conical coordinates. The physical and mathematical features of these domain walls are thoroughly discussed.Comment: 26 pages, 18 figure

Deceptive counterfeit risk in global supply chains

The study investigates deceptive counterfeits in the global supply chains. It explores perceived sources of counterfeits, their impact and identifies risk mitigation strategies in Business-to-Business procurement. An online survey was used to collect data from 140 procurement professionals targeted at a national purchasing body and affiliated UK purchasing groups. The study findings show that counterfeit breaches are increasing, especially in low-cost spare parts, sourced from tier-two suppliers based in developing countries. Counterfeits lead to high costs, delays, lost sales, product recalls and even legal action. Network transparency, cost of quality and pre-supply evaluation approaches and supplier relationship management are the most effective mitigation strategies to overcome deceptive counterfeit risk in global supply chains. The study contributes to supply chain academics and practitioners’ growing research interest in counterfeit risk

Recreational angling as a pathway for invasive non-native species spread: awareness of biosecurity and the risk of long distance movement into Great Britain

AbstractIdentifying and establishing the relative importance of different anthropogenic pathways of invasive non-native species (INNS) introduction is critical for effective management of their establishment and spread in the long-term. Angling has been identified as one of these pathways. An online survey of 680 British anglers was conducted to establish patterns of movement by British anglers abroad, and to establish their awareness and use of biosecurity practices. The survey revealed that 44% of British anglers travelled abroad for fishing, visiting 72 different countries. France was the most frequently visited country, accounting for one-third of all trips abroad. The estimated time taken to travel from Western Europe into Great Britain (GB) is within the time frame that INNS have been shown to survive on damp angling equipment. Without biosecurity, it is therefore highly likely that INNS could be unintentionally transported into GB on damp angling gear. Since the launch of the Check, Clean Dry biosecurity campaign in GB in 2011, the number of anglers cleaning their equipment after every trip has increased by 15%, and 80% of anglers now undertake some form of biosecurity. However, a significant proportion of the angling population is still not implementing sufficient, or the correct biosecurity measures to minimize the risk of INNS dispersal on damp angling equipment. With the increase in movement of anglers abroad for fishing, further work is required to establish the potential for INNS introduction through this pathway.</jats:p

Colon cancer care and survival: income and insurance are more predictive in the USA, community primary care physician supply more so in Canada

Background: Our research group advanced a health insurance theory to explain Canada’s cancer care advantages over America. The late Barbara Starfield theorized that Canada’s greater primary care-orientation also plays a critically protective role. We tested the resultant Starfield-Gorey theory by examining the effects of poverty, health insurance and physician supplies, primary care and specialists, on colon cancer care in Ontario and California. Methods: We analyzed registry data for people with non-metastasized colon cancer from Ontario (n = 2,060) and California (n = 4,574) diagnosed between 1996 and 2000 and followed to 2010. We obtained census tract-based socioeconomic data from population censuses and data on county-level physician supplies from national repositories: primary care physicians, gastroenterologists and other specialists. High poverty neighborhoods were oversampled and the criterion was 10 year survival. Hypotheses were explored with standardized rate ratios (RR) and tested with logistic regression models. Results: Significant inverse associations of poverty (RR = 0.79) and inadequate health insurance (RR = 0.80) with survival were observed in the California, while they were non-significant or non-existent in Ontario. The direct associations of primary care physician (RRs of 1.32 versus 1.11) and gastroenterologist (RRs of 1.56 versus 1.15) supplies with survival were both stronger in Ontario than California. The supply of primary care physicians took precedence. Probably mediated through the initial course of treatment, it largely explained the Canadian advantage. Conclusions: Poverty and health insurance were more predictive in the USA, community physician supplies more so in Canada. Canada’s primary care protections were greatest among the most socioeconomically vulnerable. The protective effects of Canadian health care prior to enactment of the Affordable Care Act (ACA) clearly suggested the following. Notwithstanding the importance of insuring all, strengthening America’s system of primary care will probably be the best way to ensure that the ACA’s full benefits are realized. Finally, Canada’s strong primary care system ought to be maintained

Science in the UK - whereto now?

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