Postural, physical and musculoskeletal impacts of children using personal electronic devices

This white paper outlines: - Why we are conducting research in this area, including key statistics. - The current evidence surrounding the relationship between MSK pain and discomfort in children and the use of PEDs. - What we are doing about the problem and the nature of the research. - How children use PEDs and the potential of them developing MSK pain or discomfort and what does that mean for industry in the future

Demographic trends in the incidence of malignant appendiceal tumours in England between 1995 and 2016:Population-based analysis

AIMS: Recent data suggest that the incidence of malignant appendiceal tumours is increasing. This study aimed to determine temporal trends in the incidence of malignant appendiceal tumours within England and a possible influence by demographic factors. METHODS: All incident cases of appendiceal tumours in patients aged 20 years and above were identified from the National Cancer Registration and Analysis Service database between 1995 and 2016 using ICD-9/10 codes. Cancers were categorized according to histology. Joinpoint regression analysis was used to investigate changes in age-standardized incidence rates by age, sex, histological subtype and index of multiple deprivation quintiles, based on socioeconomic domains (income, employment, education, health, crime, barriers to housing and services and living environment). Average annual per cent changes (AAPCs) were estimated by performing Monte-Carlo permutation analysis. RESULTS: A total of 7333 tumours were diagnosed and 7056 patients were analysed, comprising 3850 (54.6 per cent) neuroendocrine tumours (NETs), 1892 (26.8 per cent) mucinous adenocarcinomas and 1314 (18.6 per cent) adenocarcinoma (not otherwise specified). The overall incidence of appendiceal tumours increased from 0.3 per 100 000 to 1.6 per 100 000 over the study interval. Incidence rate increases of comparable magnitude were observed across all age groups, but the AAPC was highest among patients aged 20–29 years (15.6 per cent, 95 per cent c.i 12.7–18.6 per cent) and 30–39 years (14.2 per cent, 12.2–16.2 per cent) and lowest among those aged 70–79 years (6.8 per cent, 5.7–8.0 per cent). Similar incidence rate increases were reported across all socioeconomic deprivation quintiles and in both sexes. Analysis by grade of NET showed that grade 1 tumours accounted for 63 per cent between 2010 and 2013, compared with 2 per cent between 2000 and 2003. CONCLUSIONS: The incidence rate of malignant appendiceal tumours has increased significantly since 1995 and is mainly attributed to an increase in NETs. The increased diagnosis of low-grade NETs may in part be due to changes in pathological classification systems

Observations of GRB 990123 by the Compton Gamma-Ray Observatory

GRB 990123 was the first burst from which simultaneous optical, X-ray and gamma-ray emission was detected; its afterglow has been followed by an extensive set of radio, optical and X-ray observations. We have studied the gamma-ray burst itself as observed by the CGRO detectors. We find that gamma-ray fluxes are not correlated with the simultaneous optical observations, and the gamma-ray spectra cannot be extrapolated simply to the optical fluxes. The burst is well fit by the standard four-parameter GRB function, with the exception that excess emission compared to this function is observed below ~15 keV during some time intervals. The burst is characterized by the typical hard-to-soft and hardness-intensity correlation spectral evolution patterns. The energy of the peak of the nu f_nu spectrum, E_p, reaches an unusually high value during the first intensity spike, 1470 +/- 110 keV, and then falls to \~300 keV during the tail of the burst. The high-energy spectrum above ~MeV is consistent with a power law with a photon index of about -3. By fluence, GRB 990123 is brighter than all but 0.4% of the GRBs observed with BATSE, clearly placing it on the -3/2 power-law portion of the intensity distribution. However, the redshift measured for the afterglow is inconsistent with the Euclidean interpretation of the -3/2 power-law. Using the redshift value of >= 1.61 and assuming isotropic emission, the gamma-ray fluence exceeds 10E54 ergs.Comment: Submitted to The Astrophysical Journal. 16 pages including 4 figure

Estimation of GRB detection by FiberGLAST

FiberGLAST is one of several instrument concepts being developed for possible inclusion as the primary Gamma-ray Large Area Space Telescope (GLAST) instrument. The predicted FiberGLAST effective area is more than 12,000 cm2 for energies between 30 MeV and 300 GeV, with a field of view that is essentially flat from 0°–80°. The detector will achieve a sensitivity more than 10 times that of EGRET. We present results of simulations that illustrate the sensitivity of FiberGLAST for the detection of gamma-ray bursts

PrEdiction of Risk and Communication of outcomE followIng major lower limb amputation – a collaboratiVE study (PERCEIVE): Protocol for the PERCEIVE qualitative study

INTRODUCTION: Deciding whether to proceed with a major lower limb amputation is life-changing and complex, and it is crucial that the right decision is made at the right time. However, medical specialists are known to poorly predict risk when assessing patients for major surgery, and there is little guidance and research regarding decisions about amputation. The process of shared decision-making between doctors and patients during surgical consultations is also little understood. Therefore, the aim of this study is to analyse in depth the communication, consent, risk prediction and decision-making process in relation to major lower limb amputation. METHODS AND ANALYSIS: Consultations between patients and surgeons at which major lower limb amputation is discussed will be audio-recorded for 10–15 patients. Semi-structured follow-up interviews with patients (and relatives/carers) will then be conducted at two time points: as soon as possible/appropriate after a decision has been reached regarding surgery, and approximately 6 months later. Semi-structured interviews will also be conducted with 10–15 healthcare professionals working in the UK National Health Service (NHS) involved in amputation decision-making. This will include surgeons, anaesthetists and specialist physiotherapists at 2–4 NHS Health Boards/Trusts in Wales and England. Discourse analysis will be used to analyse the recorded consultations; interviews will be analysed thematically. Finally, workshops will be held with patients and healthcare professionals to help synthesise and interpret findings. ETHICS AND DISSEMINATION: The study has been approved by Wales REC 7 (20/WA/0351). Study findings will be published in international peer-reviewed journal(s) and presented at national and international scientific meetings. Findings will also be disseminated to a wide NHS and lay audience via presentations at meetings and written summaries for key stakeholder groups

The PERCEIVE quantitative study: PrEdiction of Risk and Communication of outcome following major lower limb amputation: protocol for a collaboratiVE study

BACKGROUND: Accurate prediction of outcomes following surgery with high morbidity and mortality rates is essential for informed shared decision-making between patients and clinicians. It is unknown how accurately healthcare professionals predict outcomes following major lower-limb amputation (MLLA). Several MLLA outcome-prediction tools have been developed. These could be valuable in clinical practice, but most require validation in independent cohorts before routine clinical use can be recommended. The primary aim of this study is to evaluate the accuracy of healthcare professionals’ predictions of outcomes in adult patients undergoing MLLA for complications of chronic limb-threatening ischaemia (CLTI) or diabetes. Secondary aims include the validation of existing outcome-prediction tools. METHOD: This study is an international, multicentre prospective observational study including adult patients undergoing a primary MLLA for CLTI or diabetes. Healthcare professionals’ accuracy in predicting outcomes at 30-days (death, morbidity and MLLA revision) and 1-year (death, MLLA revision and ambulation) will be evaluated. Sixteen existing outcome-prediction tools specific to MLLA will be examined for validity. Data collection began on 1 October 2020; the end of follow-up will be 1 May 2022. The C-statistic, Hosmer–Lemeshow test, reclassification tables and Brier score will be used to evaluate the predictive performance of healthcare professionals and prediction tools, respectively. STUDY REGISTRATION AND DISSEMINATION: This study will be registered locally at each centre in accordance with local policies before commencing data collection, overseen by local clinician leads. Results will be disseminated to all centres, and any subsequent presentation(s) and/or publication(s) will follow a collaborative co-authorship model

GRB 090426: The Environment of a Rest-Frame 0.35-second Gamma-Ray Burst at Redshift z=2.609

We present the discovery of an absorption-line redshift of z = 2.609 for GRB 090426, establishing the first firm lower limit to a redshift for a gamma-ray burst with an observed duration of <2 s. With a rest-frame burst duration of T_90z = 0.35 s and a detailed examination of the peak energy of the event, we suggest that this is likely (at >90% confidence) a member of the short/hard phenomenological class of GRBs. From analysis of the optical-afterglow spectrum we find that the burst originated along a very low HI column density sightline, with N_HI < 3.2 x 10^19 cm^-2. Our GRB 090426 afterglow spectrum also appears to have weaker low-ionisation absorption (Si II, C II) than ~95% of previous afterglow spectra. Finally, we also report the discovery of a blue, very luminous, star-forming putative host galaxy (~2 L*) at a small angular offset from the location of the optical afterglow. We consider the implications of this unique GRB in the context of burst duration classification and our understanding of GRB progenitor scenarios.Comment: Submitted to MNRA