Bare Below the Elbows: A comparative study of a tertiary and district general hospital.

A \u27Bare Below the Elbows\u27 (BBTE) dress code policy has been introduced by the majority of NHS trusts in the UK. The aim of this Irish study was to evaluate the impact of an educational intervention on perception of medical attire. The study was carried out in two centres: a tertiary referral centre (Beaumont Hospital) and a district hospital (MRH, Portlaoise). Two questionnaires, incorporating photographic evaluation of appropriate attire for consultants and junior doctors, were completed pre and post BBTE education. One hundred and five patients participated. Analysis pre BBTE education indicated patients considered formal attire and white coats most appropriate for consultants and junior doctors respectively. Post-intervention analysis revealed a significant reduction in the popularity of both (

A Case of Primary Gastric Melanoma Exhibiting a Rare BRAF V600R Mutation

Introduction: Malignant melanoma of the gastrointestinal tract is usually a metastasis from a cutaneous source. Primary gastric melanoma is an extremely rare clinical entity, with few reported cases worldwide. It is often advanced at time of diagnosis and is associated with a dismal outcome.Background: A 76 year old gentleman presenteded with a one month history of fatigue and exertional dyspnoea. Laboratory investigations indicated an anaemia, with a haemoglobin level of 11.0g/dl. Subsequent gastroscopy visualised a large, atypical, crater-like ulcerated lesion distal to the cardia in the proximal stomach.Provisional histology was suggestive of a poorly differentiated adenocarcinoma but subsequent cyto-morphology and immunophenotyping were consistent with melanoma, with positive S100 protein, HMB45 and Melan A. Further molecular genetic testing revealed a V600R mutation in the BRAF gene, which is the first primary gastric melanoma with this mutation to be reported in the literature. Given the rarity of the findings, an extensive secondary work-up was undertaken, which concluded the diagnosis primary gastric melanoma.Discussion: Primary gastric melanoma is a rare disease that can present similarly to other upper gastrointesinal lesions, with weight loss, abdominal pain, malena, and anaemia. Given its rarity, the pathogenesis is poorly understood. Lesions are often endoscopically atypical. Important points to note would include the absence of a primary lesion, as supported by a full skin examination and PET-CT findings, which can help to delineate the limitation to the stomach, thus helping to inform subsequent management

Targeted regeneration of bone in the osteoporotic human femur.

We have recently developed image processing techniques for measuring the cortical thicknesses of skeletal structures in vivo, with resolution surpassing that of the underlying computed tomography system. The resulting thickness maps can be analysed across cohorts by statistical parametric mapping. Applying these methods to the proximal femurs of osteoporotic women, we discover targeted and apparently synergistic effects of pharmaceutical osteoporosis therapy and habitual mechanical load in enhancing bone thickness

Robot Assisted Surgical Ward Rounds: Virtually Always There

Background:  While an explosion in technological sophistication has revolutionized surgery within the operating theatre, delivery of surgical ward-based care has seen little innovation.  Use of telepresence allowing off-site clinicians communicate with patients has been largely restricted to outpatient settings or use of complex, expensive, static devices.  We designed a prospective study to ascertain feasibility and face validity of a remotely controlled mobile audiovisual drone (LUCY) to access inpatients.  This device is, uniquely, lightweight, freely mobile and emulates ‘human’ interaction by swiveling and adjusting height to patients’ eye-level.   Methods: Robot-assisted ward rounds(RASWR) were conducted over 3 months. A remotely located consultant surgeon communicated with patients/bedside teams via encrypted audiovisual telepresence robot (DoubleRoboticstm, California USA).  Likert-scale satisfaction questionnaires, incorporating free-text sections for mixed-methods data collection, were disseminated to patient and staff volunteers following RASWRs.  The same cohort completed a linked questionnaire following conventional (gold-standard) rounds, acting as control group. Data were paired, and non-parametric analysis performed.  Results: RASWRs are feasible (>90% completed without technical difficulty). The RASWR(n=52 observations) demonstrated face validity with strong correlations (r>0.7; Spearman, p-value <0.05) between robotic and conventional ward rounds among patients and staff on core themes, including dignity/confidentiality/communication/satisfaction with management plan. Patients (96.08%, n=25) agreed RASWR were a satisfactory alternative when consultant physical presence was not possible. There was acceptance of nursing/NCHD cohort (100% (n=11) willing to regularly partake in RASWR).  Conclusion: RASWRs receive high levels of patient and staff acceptance, and offer a valid alternative to conventional ward rounds when a consultant cannot be physically present

Type II Quasars from the Sloan Digital Sky Survey: V. Imaging host galaxies with the Hubble Space Telescope

Type II quasars are luminous Active Galactic Nuclei whose centers are obscured by large amounts of gas and dust. In this paper we present 3-band HST images of nine type II quasars with redshifts 0.2 < z < 0.4 selected from the Sloan Digital Sky Survey based on their emission line properties. The intrinsic luminosities of these AGN are estimated to be -24 > M_B > -26, but optical obscuration allows their host galaxies to be studied unencumbered by bright nuclei. Each object has been imaged in three continuum filters (`UV', `blue' and `yellow') placed between the strong emission lines. The spectacular, high quality images reveal a wealth of details about the structure of the host galaxies and their environments. Six of the nine galaxies in the sample are ellipticals with de Vaucouleurs light profiles, one object has a well-defined disk component and the remaining two have marginal disks. Stellar populations of type II quasar hosts are more luminous (by a median of 0.3-0.7 mag, depending on the wavelength) and bluer (by about 0.4 mag) than are M* galaxies at the same redshift. When smooth fits to stellar light are subtracted from the images, we find both positive and negative residuals that become more prominent toward shorter wavelengths. We argue that the negative residuals are due to kpc-scale dust obscuration, while most positive residuals are due to the light from the nucleus scattered off interstellar material in the host galaxy. Scattered light makes a significant contribution to the broad band continuum emission and can be the dominant component of the extended emission in the UV in extreme cases.Comment: 51 pages, including 12 grey scale figures, 4 color figures, 5 tables. In press in AJ. Version with higher-resolution images available at http://www.astro.princeton.edu/~nadia/qso2.html. (Minor changes in response to the referee report

Changing expendable bathythermograph fall rates and their impact on estimates of thermosteric sea level rise

A time-varying warm bias in the global XBT data archive is demonstrated to be largely due to changes in the fall rate of XBT probes likely associated with small manufacturing changes at the factory. Deep-reaching XBTs have a different fall rate history than shallow XBTs. Fall rates were fastest in the early 1970s, reached a minimum between 1975 and 1985, reached another maximum in the late 1980s and early 1990s, and have been declining since. Field XBT/CTD intercomparisons and a pseudoprofile technique based on satellite altimetry largely confirm this time history. A global correction is presented and applied to estimates of the thermosteric component of sea level rise. The XBT fall rate minimum from 1975 to 1985 appears as a 10-yr “warm period” in the global ocean in thermosteric sea level and heat content estimates using uncorrected data. Upon correction, the thermosteric sea level curve has reduced decadal variability and a larger, steadier long-term trend

Magnitude and determinants of change in objectively-measured physical activity, sedentary time and sleep duration from ages 15 to 17.5y in UK adolescents: the ROOTS study.

BACKGROUND: Self-reported physical activity (PA) and sleep duration (SLP) change markedly throughout adolescence. We sought to quantify changes in objectively-measured PA, sedentary time (ST) and SLP through adolescence, and to investigate baseline body composition and baseline activity levels as determinants of change. METHODS: Individually calibrated combined heart rate and movement sensing was used to estimate PA energy expenditure (PAEE), SLP, daily ST and time in light (LPA), moderate (MPA), vigorous (VPA), and moderate-to-vigorous physical activity (MVPA) in 144 adolescents (50% boys) of mean age 15.1(±0.3)y at baseline and 17.5(±0.3)y at follow-up. Changes in PA (ΔPA), ST (ΔST) and SLP (ΔSLP) were calculated as follow-up minus baseline values. Waist circumference (WC) was measured at baseline and follow-up, as was fat mass index (FMI) and fat-free mass index (FFMI) by a pooled estimation method including bio-impedance. Comparison of baseline and follow-up activity was made by mixed-model ANOVA. Linear regression adjusted for baseline demographics, total and weekend hours of monitor wear time and the seasons of activity measurements, was used to investigate baseline body composition as determinants of ΔPA, ΔST and ΔSLP. A further model adjusted for baseline of the outcome assessed baseline activity as a predictor of behaviour change, and investigated associations for baseline body composition independent of the baseline level of the outcome. RESULTS: From baseline to follow-up levels of MPA and VPA declined (p ≤ 0.039). The annual decline in MVPA was equivalent to -4.5 and -3.0 min/d in boys and girls, respectively. Baseline FMI, FFMI and WC were positively associated with ΔLPA and negatively associated with ΔST in boys when adjusted for baseline of the outcome (p ≤ 0.037 for all). SLP increased from baseline to follow-up (p = 0.004) but ΔSLP was not associated with baseline body composition (p ≥ 0.13). For all variables, higher baseline levels were associated with greater declines over time (p ≤ 0.003). CONCLUSIONS: Levels of higher-intensity PA decline from mid-to-late adolescence, whereas the duration of sleep increases. Changes in LPA and ST may be associated with baseline body composition, but the baseline level of the outcome is consistently the strongest predictor of changes in adolescent activity.This work was supported by the Medical Research Council [Unit Programme grant numbers MC_U106179476 and MC_UU_12015/3], the Wellcome Trust [grant 074296/ Z/04/Z] and the British Heart Foundation [grant FS/12/58/29709 to KWi].This is the final version. It was first published by Springer at http://link.springer.com/article/10.1186%2Fs12966-015-0222-4

Prospective associations between sedentary time, sleep duration and adiposity in adolescents.

OBJECTIVE: The objective of this study was to investigate whether objectively measured sedentary time and sleep duration are associated with changes in adiposity from mid- to late adolescence. METHODS: Students (n = 504, 42% boys) were recruited from schools in Cambridgeshire, UK. At baseline (mean age 15.0 ± 0.3 years), sedentary time was objectively measured by ≥3 days of combined heart rate and movement sensing. Concurrently, sleep duration was measured by combined sensing in conjunction with self-reported bed times. Fat mass index (FMI; kg/m(2)) was estimated at baseline and follow-up (17.5 ± 0.3 years) by anthropometry and bioelectrical impedance. FMI change (ΔFMI) was calculated by subtracting the baseline from follow-up values. Linear regression models adjusted for basic demographics, moderate-to-vigorous physical activity (MVPA), and depressive symptoms were used to investigate associations of sedentary time and sleep duration (mutually adjusted for one another) with ΔFMI. RESULTS: FMI increased by 0.5 and 0.6 kg/m(2) in boys and girls, respectively, but there was no association between sedentary time and ΔFMI in either gender (p ≥ 0.087), and no association between sleep duration and ΔFMI in girls (p ≥ 0.61). In boys, each additional hour of baseline sleep significantly reduced the ΔFMI by 0.13 kg/m(2) (p = 0.049), but there was little evidence for this association after adjusting for MVPA and depressive symptoms (p = 0.15). CONCLUSIONS: Sedentary time may not determine changes in adiposity from mid- to late adolescence, nor may sleep duration in girls. However, sleep length may be inversely associated with adiposity gain in boys, depending on whether the relationship is confounded or mediated by MVPA and depression.This work was supported by the Medical Research Council (Unit Programme number MC_UU_12015/3), the Wellcome Trust (grant 074296/Z/04/Z) and the British Heart Foundation (grant FS/12/58/29709 to KW).This is the final version of the article. It first appeared from Elsevier via http://dx.doi.org/10.1016/j.sleep.2015.02.53