The Role of Endovenous Thermal Ablation in the Treatment of Varicose Veins

Varicose veins are a common problem affecting approximately 30% of the Western population. The majority of patients present to secondary care complaining of a number of commonly experienced symptoms, however, some present with severe complications of venous disease including venous ulceration. For hundreds of years varicose veins have been treated with compression and surgery. In the last decade, technological advances have lead to the introduction of minimally invasive therapies for varicose veins, with the aim of providing rapid treatment with minimum discomfort to the patient at acceptable cost to the healthcare provider. This study examined the current use of endovenous ablation procedures in the United Kingdom amongst consultant vascular surgeons using an online questionnaire and also explored the patient’s views regarding treatment of varicose veins and potential therapeutic options. Prior to conducting a randomised clinical trial comparing early outcomes following laser and radiofrequency ablation in patients with primary varicose veins, an observational pilot study was carried out in the department. In parallel, the use of disease specific quality of life tools were compared to clinical, anatomical and haemodynamic outcome measures in this cohort of patients. The findings of the study have shown that although endovenous ablation procedures appear to be increasing in popularity, traditional surgery remains the most frequently performed procedure. Overall, patients overall have little knowledge of potential treatment options and the majority would be in favour of a single treatment under a local anaesthetic. However, most would be strongly influenced by the advice and opinion of the surgeon to whom they were referred. Results from the pilot study and a randomised clinical trial showed that radiofrequency ablation is significantly less painful than laser ablation for up to 10 days post procedure. Clinical improvements and gains in quality of life were significantly improved at 6 weeks and 6 months post intervention compared with baseline scores and were comparable between the groups. No significant difference was observed in anatomical outcomes between the two treatments. Although radiofrequency may be less painful than laser ablation, both endovenous thermal ablation treatments result in significant improvements in quality of life and are likely to become increasingly popular in the future

Afatinib use in recurrent epithelial ovarian carcinoma.

•Genomic tumor testing is an important tool in guiding treatment for gynecologic malignancies.•Targetable mutations may lead to new therapies in gynecologic cancer treatment.•Her2/neu mutations in serous ovarian carcinomas can be targeted with ERBB2 inhibitors.•Afatinib shows promising response rates in lung cancers carrying Her2/neu mutations.•Afatinib may be effective in serous ovarian tumors exhibiting Her2/neu or ERBB2 mutations

Interpreting Emojis: Millennials versus Non-Millennials

The presence of emoticons--and now emojis--within written messages has increased since the advent of electronic communication. We conducted a quasi-experiment to learn whether a “smirk” emoji would be interpreted as indicating seductiveness by digital natives (Millennials) and non-digital natives (non-Millennials). We surveyed participants (N = 283) and asked them how they interpreted a message that contained the “smirk” emoji. Millennials were more likely than non-Millennials to infer seductiveness from this emoji. Our data suggest age-related differences in how various nonverbal cues are interpreted within electronic communication mediums

Cognitive-Behavioral Treatment of Recurrent Nonspecific Abdominal Pain in Children: An Analysis of Generalization, Maintenance, and Side Effects

From 10% to 15% of school-aged children experience recurring abdominal pain. This study evaluated the efficacy of a cognitive-behavioral program for the treatment of nonspecific recurrent abdominal pain (RAP) using a controlled group design. The multicomponent treatment program consisted of differential reinforcement of well behavior, cognitive coping skills training, and various generalization enhancement procedures. Multiple measures of pain intensity and pain behavior were conducted, including children's self-monitoring, parent observation, teacher observation, and observation by independent observers. Results showed that both the experimental and the control groups reduced their levels of pain. However, the treated group improved more quickly, the effects generalized to the school setting, and a larger proportion of subjects were completely pain-free by 3- months follow-up (87.5% vs. 37.5%). There was no evidence for any negative side effects of treatment

Rotorcraft Transmission Noise Path Model, Including Distributed Fluid Film Bearing Impedance Modeling

A computational approach for simulating the effects of rolling element and journal bearings on the vibration and sound transmission through gearboxes has been demonstrated. The approach, using ARL/Penn State s CHAMP methodology, uses Component Mode Synthesis of housing and shafting modes computed using Finite Element (FE) models to allow for rapid adjustment of bearing impedances in gearbox models. The approach has been demonstrated on NASA GRC s test gearbox with three different bearing configurations: in the first condition, traditional rolling element (ball and roller) bearings were installed, and in the second and third conditions, the traditional bearings were replaced with journal and wave bearings (wave bearings are journal bearings with a multi-lobed wave pattern on the bearing surface). A methodology for computing the stiffnesses and damping in journal and wave bearings has been presented, and demonstrated for the journal and wave bearings used in the NASA GRC test gearbox. The FE model of the gearbox, along with the rolling element bearing coupling impedances, was analyzed to compute dynamic transfer functions between forces applied to the meshing gears and accelerations on the gearbox housing, including several locations near the bearings. A Boundary Element (BE) acoustic model was used to compute the sound radiated by the gearbox. Measurements of the Gear Mesh Frequency (GMF) tones were made by NASA GRC at several operational speeds for the rolling element and journal bearing gearbox configurations. Both the measurements and the CHAMP numerical model indicate that the journal bearings reduce vibration and noise for the second harmonic of the gear meshing tones, but show no clear benefit to using journal bearings to reduce the amplitudes of the fundamental gear meshing tones. Also, the numerical model shows that the gearbox vibrations and radiated sound are similar for journal and wave bearing configurations

Structural and functional consequences of removing the N-terminal domain from the magnesium chelatase ChlH subunit of Thermosynechococcus elongatus

Magnesium chelatase (MgCH) initiates chlorophyll biosynthesis by catalysing the ATP-dependent insertion of Mg2+ into protoporphyrin. This large enzyme complex comprises ChlH, I and D subunits, with I and D involved in ATP hydrolysis, and H the protein that handles the substrate and product. The 148 kDa ChlH subunit has a globular N-terminal domain attached by a narrow linker to a hollow cage-like structure. Following deletion of this ~18 kDa domain from the Thermosynechoccus elongatus ChlH, we used single particle reconstruction to show that the apo- and porphyrin-bound forms of the mutant subunit consist of a hollow globular protein with three connected lobes; superposition of the mutant and native ChlH structures shows that, despite the clear absence of the N-terminal ‘head’ region, the rest of the protein appears to be correctly folded. Analyses of dissociation constants shows that the ΔN159ChlH mutant retains the ability to bind protoporphyrin and the Gun4 enhancer protein, although the addition of I and D subunits yields an extremely impaired active enzyme complex. Addition of the Gun4 enhancer protein, which stimulates MgCH activity significantly especially at low Mg2+ concentrations, partially reactivates the ΔN159ChlH–I–D mutant enzyme complex, suggesting that the binding site or sites for Gun4 on H do not wholly depend on the N-terminal domain

Improving the inclusion of an under-served group in trials: development and implementation of the INCLUDE Impaired Capacity to Consent Framework

Background: For the potential benefits of trials to reach all that they should, trials must be designed to ensure that those taking part reflect the population who will receive the intervention. However, adults with impaired capacity to consent are frequently excluded from trials — partly because researchers are unfamiliar with the legal and ethical frameworks and lack the necessary methodological expertise. Researchers identified a need for guidance on designing more inclusive trials. Building on the NIHR INCLUDE initiative, we developed the INCLUDE Impaired Capacity to Consent Framework to help researchers design inclusive trials. Methods: The framework was developed over five phases: (1) establishing the scope and content of the framework and adapting the INCLUDE Ethnicity Framework for this population; (2) scoping the relevance of the framework to different populations and piloting in a range of trials; (3) consulting people living with impairing conditions and carers to explore their views about the framework and identify missing content areas; (4) refining the framework; and (5) the development of an implementation toolkit of resources to support researchers using the framework. Results: The framework has two parts: a set of four key questions to help researchers identify who should be included in their trial, and a series of worksheets covering intervention design, recruitment and consent processes, data collection and analysis, and public involvement and dissemination. It is supported by a summary of the ethical and legal frameworks and a website of resources on capacity and consent. Implementation resources include infographics and animations, a library of completed frameworks, and facilitated workshops for researchers. The framework and toolkit were launched at a webinar (November 2022), with polling demonstrating an increase in attendees’ awareness about research involving adults lacking capacity. A post-webinar survey found that stakeholders viewed the framework and toolkit as valuable tools to facilitate greater inclusion of this under-served population in trials. The framework is available online: https://www.capacityconsentresearch.com/include-impaired-capacity-to-consent-framework.html. Conclusions: The INCLUDE Impaired Capacity to Consent Framework and implementation toolkit can support researchers to design more inclusive trials and other types of research studies. Further engagement, including with funders who are key to ensuring uptake, and evaluation is needed

Deadly Partners: Interdependence of Alcohol and Trauma in the Clinical Setting

Trauma is the leading cause of death for Americans aged 1 to 45. Over a third of all fatal motor vehicle collisions and nearly eighty percent of completed suicides involve alcohol. Alcohol can be both a cause of traumatic injury as well as a confounding factor in the diagnosis and treatment of the injured patient. Fortunately, brief interventions after alcohol-related traumatic events have been shown to decrease both trauma recidivism and long-term alcohol use. This review will address the epidemiology of alcohol-related trauma, the influence of alcohol on mortality and other outcomes, and the role of prevention in alcohol-related trauma, within the confines of the clinical setting

Introduction: Interrogating the 'everyday' politics of emotions in international relations

The focus on the everyday in this Special Issue reveals different kinds of emotional practices, their political effects and their political contestation within both micro- and macro-politics in international relations. The articles in this Special Issue address the everyday negotiation of emotions, shifting between the reproduction of hegemonic structures of feelings and emancipation from them. In other words, the everyday politics of emotions allows an exploration of who gets to express emotions, what emotions are perceived as (il)legitimate or (un)desirable, how emotions are circulated and under what circumstances. Consequently, we identify two thematic strands which emerge as central to an interrogation of ‘everyday’ emotions in international relations and which run through each of the contributions: first, an exploration of the relationship between individual and collective emotions and, second, a focus on the role of embodiment within emotions research and its relationship with the dynamics and structures of power