Delivering successful randomized controlled trials in surgery:methods to optimize collaboration and study design

Randomized controlled trials in surgery are notoriously difficult to design and conduct due to numerous methodological and cultural challenges. Over the last 5 years, several UK-based surgical trial-related initiatives have been funded to address these issues. These include the development of Surgical Trials Centers and Surgical Specialty Leads (individual surgeons responsible for championing randomized controlled trials in their specialist fields), both funded by the Royal College of Surgeons of England; networks of research-active surgeons in training; and investment in methodological research relating to surgical randomized controlled trials (to address issues such as recruitment, blinding, and the selection and standardization of interventions). This article discusses these initiatives more in detail and provides exemplar cases to illustrate how the methodological challenges have been tackled. The initiatives have surpassed expectations, resulting in a renaissance in surgical research throughout the United Kingdom, such that the number of patients entering surgical randomized controlled trials has doubled

Distilled: The Narrative Transformed (Exhibition Catalogue)

Inspired by place and process, Pinkney Herbert\u27s work is a spirited exploration in color and line derived from the sights, sounds, and energies of the two principal cities – Memphis and New York – in which this body of work was created. Graffiti-like gestures scrawl atop digital prints, which are collaged and integrated into his paintings. In this 30-year survey, we follow Pinkney Herbert on his transformative journey from the narrative into abstraction

Electron beam computed tomography (EBCT) funding protocol

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An international assessment of the adoption of enhanced recovery after surgery (ERAS (R)) principles across colorectal units in 2019-2020

Aim The Enhanced Recovery After Surgery (ERAS (R)) Society guidelines aim to standardize perioperative care in colorectal surgery via 25 principles. We aimed to assess the variation in uptake of these principles across an international network of colorectal units. Method An online survey was circulated amongst European Society of Coloproctology members in 2019-2020. For each ERAS principle, respondents were asked to score how frequently the principle was implemented in their hospital, from 1 ('rarely') to 4 ('always'). Respondents were also asked to recall whether practice had changed since 2017. Subgroup analyses based on hospital characteristics were conducted. Results Of hospitals approached, 58% responded to the survey (195/335), with 296 individual responses (multiple responses were received from some hospitals). The majority were European (163/195, 83.6%). Overall, respondents indicated they 'most often' or 'always' adhered to most individual ERAS principles (18/25, 72%). Variability in the uptake of principles was reported, with universal uptake of some principles (e.g., prophylactic antibiotics; early mobilization) and inconsistency from 'rarely' to 'always' in others (e.g., no nasogastric intubation; no preoperative fasting and carbohydrate drinks). In alignment with 2018 ERAS guideline updates, adherence to principles for prehabilitation, managing anaemia and postoperative nutrition appears to have increased since 2017. Conclusions Uptake of ERAS principles varied across hospitals, and not all 25 principles were equally adhered to. Whilst some principles exhibited a high level of acceptance, others had a wide variability in uptake indicative of controversy or barriers to uptake. Further research into specific principles is required to improve ERAS implementation

The counterrotating core and the black hole mass of IC1459

The E3 giant elliptical galaxy IC1459 is the prototypical galaxy with a fast counterrotating stellar core. We obtained one HST/STIS long-slit spectrum along the major axis of this galaxy and CTIO spectra along five position angles. We present self-consistent three-integral axisymmetric models of the stellar kinematics, obtained with Schwarzschild's numerical orbit superposition method. We study the dynamics of the kinematically decoupled core (KDC) in IC1459 and we find it consists of stars that are well-separated from the rest of the galaxy in phase space. The stars in the KDC counterrotate in a disk on orbits that are close to circular. We estimate that the KDC mass is ~0.5% of the total galaxy mass or ~3*10^9 Msun. We estimate the central black hole mass M_BH of IC1459 independently from both its stellar and its gaseous kinematics. Some complications probably explain why we find rather discrepant BH masses with the different methods. The stellar kinematics suggest that M_BH = (2.6 +/- 1.1)*10^9 Msun (3 sigma error). The gas kinematics suggests that M_BH ~ 3.5*10^8 Msun if the gas is assumed to rotate at the circular velocity in a thin disk. If the observed velocity dispersion of the gas is assumed to be gravitational, then M_BH could be as high as ~1.0*10^9 Msun. These different estimates bracket the value M_BH = (1.1 +/- 0.3)*10^9 Msun predicted by the M_BH-sigma relation. It will be an important goal for future studies to assess the reliability of black hole mass determinations with either technique. This is essential if one wants to interpret the correlation between the BH mass and other global galaxy parameters (e.g. velocity dispersion) and in particular the scatter in these correlations (believed to be only ~0.3 dex). [Abridged]Comment: 51 pages, LaTeX with 19 PostScript figures. Revised version, with three new figures and data tables. To appear in The Astrophysical Journal, 578, 2002 October 2

Relationship between method of anastomosis and anastomotic failure after right hemicolectomy and ileo-caecal resection: an international snapshot audit

Aim The anastomosis technique used following right-sided colonic resection is widely variable and may affect patient outcome. This study aimed to assess the association between leak and anastomosis technique (stapled vs handsewn). Method This was a prospective, multicentre, international audit including patients undergoing elective or emergency right hemicolectomy or ileo-caecal resection operations over a 2-month period in early 2015. The primary outcome measure was the presence of anastomotic leak within 30 days of surgery, determined using a prespecified definition. Mixed effects logistic regression models were used to assess the association between leak and anastomosis method, adjusting for patient, disease and operative cofactors, with centre included as a random-effect variable. Results This study included 3208 patients, of whom 78.4% (n = 2515) underwent surgery for malignancy and 11.7% (n = 375) underwent surgery for Crohn's disease. An anastomosis was performed in 94.8% (n = 3041) of patients, which was handsewn in 38.9% (n = 1183) and stapled in 61.1% (n = 1858). Patients undergoing hand-sewn anastomosis were more likely to be emergency admissions (20.5% handsewn vs 12.9% stapled) and to undergo open surgery (54.7% handsewn vs 36.6% stapled). The overall anastomotic leak rate was 8.1% (245/3041), which was similar following handsewn (7.4%) and stapled (8.5%) techniques (P = 0.3). After adjustment for cofactors, the odds of a leak were higher for stapled anastomosis (adjusted OR = 1.43; 95% CI: 1.04-1.95; P = 0.03). Conclusion Despite being used in lower-risk patients, stapled anastomosis was associated with an increased anastomotic leak rate in this observational study. Further research is needed to define patient groups in whom a stapled anastomosis is safe.This is the peer-reviewed version of the article: Pinkney, T.; Battersby, N.; Bhangu, A.; Chaudhri, S.; El-Hussuna, A.; Frasson, M.; Nepogodiev, D.; Singh, B.; Kovačević, B.; Autora), (i Jos Puno. Relationship between Method of Anastomosis and Anastomotic Failure after Right Hemicolectomy and Ileo-Caecal Resection: An International Snapshot Audit. Colorectal Disease 2017, 19 (8), O296–O311. [https://doi.org/10.1111/codi.13646

WFPC2 Observations of the Cooling Flow Elliptical in Abell 1795

We present WFPC2 images of the core of the cooling flow cD galaxy in Abell 1795. An irregular, asymmetric dust lane extends 7 \h75 kpc in projection to the north-northwest. The dust shares the morphology observed in the H$\alpha$ and excess UV emission. We see both diffuse and knotty blue emission around the dust lane, especially at the ends. The dust and emission features lie on the edge of the radio lobes, suggesting star formation induced by the radio source or the deflection of the radio jets off of pre-existing dust and gas. We measure an apparent R$_V$ significantly less than 3.1, implying that the extinction law is not Galactic in the dust lane, or the presence of line emission which is proportional to the extinction. The dust mass is at least 2$\times10^{5} h_{75}^{-2}$ M\solar\ and is more likely to be 6.5$\times10^{5} h_{75}^{-2}$ M\solar.Comment: 14 pages, LaTeX, Figure 4 included, Postscript Figs. 1-3 available at ftp://astro.nmsu.edu/pub/JASON/A1795/, accepted for publication in ApJ Letter

Rotation of the cluster of galaxies A2107

We present indications of rotation in the galaxy cluster A2107 by a method that searches for the maximum gradient in the velocity field in a flat disk-like model of a cluster. Galaxies from cumulative sub-samples containing more and more distant members from the cluster centre, are projected onto an axis passing through the centre and we apply a linear regression model on the projected distances $x$ and the line-of-sight velocities $V$. The axis with the maximum linear correlation coefficient $r_{max} = \max [ r(V,x) ]$ defines the direction of the maximum velocity gradient, and consequently it presents the major axis of the apparently elliptical cluster. Because the effects of rotation are subtle, we put strong emphasis on the estimation of the uncertainties of the results by implementing different bootstrap techniques. We have found the rotational effects are more strongly expressed from distances $0.26 \div 0.54$ Mpc from the cluster centre. The total virial mass of the cluster is (3.2\pm0.6)\times10^{14} {\cal M}_{\sun}, while the virial mass, corrected for the rotation, is (2.8\pm0.5) \times 10^{14}{\cal M}_{\sun}.Comment: 7 pages, 9 figures gzipped tar file. to be published in MNRA