Remote triage incorporating symptom‐based risk stratification for suspected head and neck cancer referrals: A prospective population‐based study

Background Remote triage for suspected head and neck cancer (HNC) referrals was adopted by many institutions during the initial peak of the coronavirus disease 2019 pandemic. Its safety in this population has not been established. Methods A 16-week, prospective, multicenter national service evaluation was started on March 23, 2020. Suspected HNC referrals undergoing remote triage in UK secondary care centers were identified and followed up for a minimum of 6 months to record the cancer status. Triage was supported by risk stratification using a validated calculator. Results Data for 4568 cases were submitted by 41 centers serving a population of approximately 26 million. These represented 14.1% of the predicted maximum referrals for this population outside of pandemic times, and this gave the study a margin of error of 1.34% at 95% confidence. Completed 6-month follow-up data were available for 99.8% with an overall cancer rate of 5.6% (254 of 4557). The rates of triage were as follows: urgent imaging investigation, 25.4% (n = 1156); urgent face-to-face review, 27.8%; (n = 1268); assessment deferral, 30.3% (n = 1382); and discharge, 16.4% (n = 749). The corresponding missed cancers rates were 0.5% (5 of 1048), 0.3% (3 of 1149), 0.9% (12 of 1382), and 0.9% (7 of 747; P = .15). The negative predictive value for a nonurgent triage outcome and no cancer diagnosis was 99.1%. Overall harm was reported in 0.24% (11 of 4557) and was highest for deferred assessments (0.58%; 8 of 1382). Conclusions Remote triage, incorporating risk stratification, may facilitate targeted investigations for higher risk patients and prevent unnecessary hospital attendance for lower risk patients. The risk of harm is low and may be reduced further with appropriate safety netting of deferred appointments

Mixed convection and thermodynamic irreversibilities in MHD nanofluid stagnation-point flows over a cylinder embedded in porous media

The impingement of CuO-water nanofluid flows upon a cylinder subject to a uniform magnetic field with constant surface temperature and embedded in porous media is investigated for the first time in literature. The surface of the cylinder can feature uniform or non-uniform mass transpiration and is hotter than the incoming nanofluid flow. The gravitational effects are taken into account and the three-dimensional governing equations of mixed convection in curved porous media, under magnetohydrodynamic effects, are reduced to those solvable by a finite difference scheme. Through varying a mixed convection parameter, the situations dominated by forced, mixed and free convection are examined systematically. The numerical solutions of these equations reveal the flow velocity and temperature fields as well as the Nusselt number and induced shear stress. These are then used to calculate the rate of entropy generation within the system by viscous and heat transfer irreversibilities. The results show that Nusselt number increases with increasing the concentration of nanoparticles, while it slightly deceases through intensifying the magnetic parameter. Non-uniform transpiration is shown to strongly affect the average rate of heat transfer. Importantly, it is demonstrated that the specific mode of heat convection can majorly influence the intensity of entropy generation and that the irreversibilities are much larger under natural convection compared to those in mixed and forced convection. Calculation of Bejan number shows that this is due to more pronounced relative contribution of viscous irreversibilities when free convection effects dominate the mixed convection process

Molecular and Functional Ecology of Sponges and Their Microbial Symbionts

Sponge-microbe symbiotic interactions are important features of modern marine ecosystems. It is likely that these ancient partnerships are as old as the phylum Porifera. Powerful new tools have exposed remarkable microbial diversity within sponge tissues. We are now able to study the composition and structure of the microbial communities at unprecedented levels of resolution. We also recognize that the partnership cannot be disaggregated and should be considered as an integrated holobiont. New hypotheses (e.g., the sponge loop hypothesis) have opened exciting avenues for future experimental work that link holobiont performance from micro- to macro-perspectives. This type of research has taken on added significance given that our planet is experiencing accelerating rates of ocean warming and ocean acidification. It is essential that we examine how sponges respond to environmental stressors that are increasing in intensity and frequency. This review focuses on the molecular and functional ecology of sponge-based microbial symbioses. We discuss the coevolutionary processes that operate to generate partner specificity or to maintain promiscuous partnerships and consider reciprocal selective forces that shape the material exchanges that occur between the partners. We focus attention on the functional ecological role the holobiont plays in marine habitats. The role that the symbionts play in host physiology, and ultimately in the function of sponges on marine ecosystems, is also discussed. We stand to gain important basic information about symbiotic interactions through the detailed study of sponge-microbe interactions, but important practical lessons will be afforded to resource managers who are looking for strategies to protect aquatic habitats worldwide.Peer reviewe