Cancelled operations: a 7-day cohort study of planned adult inpatient surgery in 245 UK National Health Service hospitals.

BACKGROUND: Cancellation of planned surgery impacts substantially on patients and health systems. This study describes the incidence and reasons for cancellation of inpatient surgery in the UK NHS. METHODS: We conducted a prospective observational cohort study over 7 consecutive days in March 2017 in 245 NHS hospitals. Occurrences and reasons for previous surgical cancellations were recorded. Using multilevel logistic regression, we identified patient- and hospital-level factors associated with cancellation due to inadequate bed capacity. RESULTS: We analysed data from 14 936 patients undergoing planned surgery. A total of 1499 patients (10.0%) reported previous cancellation for the same procedure; contemporaneous hospital census data indicated that 13.9% patients attending inpatient operations were cancelled on the day of surgery. Non-clinical reasons, predominantly inadequate bed capacity, accounted for a large proportion of previous cancellations. Independent risk factors for cancellation due to inadequate bed capacity included requirement for postoperative critical care [odds ratio (OR)=2.92; 95% confidence interval (CI), 2.12-4.02; P CONCLUSIONS: A significant proportion of patients presenting for surgery have experienced a previous cancellation for the same procedure. Cancer surgery is relatively protected, but bed capacity, including postoperative critical care requirements, are significant risk factors for previous cancellations

A preliminary evaluation of the use of on-animal sensor data to predict metabolizable energy intake of sheep using Deep Belief Networks

The use of digital technologies in livestock businesses can improve the efficiency of farmers managing welfare and productivity of their animals. One opportunity is to use high resolution livestock behaviour information to inform decision making. Livestock behaviour recorded by sensors such as GPS or accelerometers, can be analysed to capture activities that can inform farm management. In this paper, our focus was on livestock grazing behaviour in relation to the feed supply in extensive grazing systems. We investigated the use of a Deep Belief Network (DBN) to predict the Metabolizable Energy Intake (MEI) of sheep directly using sensors. With the complexity and the availability of more data forms especially in the sensor data, the use of DBN was evaluated as an analytical method that could be applied to improve farmer’s understanding of livestock grazing behaviour and feedbase management by the prediction of MEI values daily. Based on a field experiment, results generated from the DBN achieved with the MSE result of 5.6 to the training dataset and the testing dataset of 11.6. This demonstrated that the DBN method can be undertaken to predict the MEI for sheep using sensor data. Furthermore, by finding out which factors influenced grazing behaviour this study can be used to better interpret biological interactions in grazing systems, and potentially be extended to develop sensor technologies and new analytical methods in other agricultural domains

Neural correlates of positive and negative symptoms through the illness course: an fMRI study in early psychosis and chronic schizophrenia

Psychotic illness is associated with cognitive control deficits and abnormal recruitment of neural circuits subserving cognitive control. It is unclear to what extent this dysfunction underlies the development and/or maintenance of positive and negative symptoms typically observed in schizophrenia. In this study we compared fMRI activation on a standard Stroop task and its relationship with positive and negative symptoms in early psychosis (EP, N = 88) and chronic schizophrenia (CHR-SZ, N = 38) patients. CHR-SZ patients showed reduced frontal, striatal, and parietal activation across incongruent and congruent trials compared to EP patients. Higher positive symptom severity was associated with reduced activation across both trial types in supplementary motor area (SMA), middle temporal gyrus and cerebellum in EP, but not CHR-SZ patients. Higher negative symptom severity was associated with reduced cerebellar activation in EP, but not in CHR-SZ patients. A negative correlation between negative symptoms and activation in SMA and precentral gyrus was observed in EP patients and in CHR-SZ patients. The results suggest that the neural substrate of positive symptoms changes with illness chronicity, and that cognitive control related neural circuits may be most relevant in the initial development phase of positive symptoms. These findings also highlight a changing role for the cerebellum in the development and later maintenance of both positive and negative symptoms

Galaxy Zoo : Building the low-mass end of the red sequence with local post-starburst galaxies

We present a study of local post-starburst galaxies (PSGs) using the photometric and spectroscopic observations from the Sloan Digital Sky Survey and the results from the Galaxy Zoo project. We find that the majority of our local PSG population have neither early- nor late-type morphologies but occupy a well-defined space within the colour-stellar mass diagram, most notably, the low-mass end of the 'green valley' below the transition mass thought to be the mass division between low-mass star-forming galaxies and high-mass passively evolving bulge-dominated galaxies. Our analysis suggests that it is likely that local PSGs will quickly transform into 'red', low-mass early-type galaxies as the stellar morphologies of the 'green' PSGs largely resemble that of the early-type galaxies within the same mass range. We propose that the current population of PSGs represents a population of galaxies which is rapidly transitioning between the star-forming and the passively evolving phases. Subsequently, these PSGs will contribute towards the build-up of the low-mass end of the 'red sequence' once the current population of young stars fade and stars are no longer being formed. These results are consistent with the idea of 'downsizing' where the build-up of smaller galaxies occurs at later epochs.Peer reviewe

Supersymmetry Breaking in the Early Universe

Supersymmetry breaking in the early universe induces scalar soft potentials with curvature of order the Hubble constant. This has a dramatic effect on the coherent production of scalar fields along flat directions. For the moduli problem it generically gives a concrete realization of the problem by determining the field value subsequent to inflation. However it might suggest a solution if the minimum of the induced potential coincides with the true minimum. The induced Hubble scale mass also has important implications for the Affleck-Dine mechanism of baryogenesis. This mechanism requires large squark or slepton expectation values to develop along flat directions in the early universe. This is generally not the case if the induced mass squared is positive, but does occur if it is negative. The resulting baryon to entropy ratio depends mainly on the dimension of the nonrenormalizable operator in the superpotential which stabilizes the flat direction, and the reheat temperature after inflation. Unlike the original scenario, it is possible to obtain an acceptable baryon asymmetry without subsequent entropy releases.Comment: 11 pages, requires phyzz

Positron Emission Tomography/Computed Tomography with Gallium-68-labeled Prostate-specific Membrane Antigen Detects Relapse After Vascular-targeted Photodynamic Therapy in a Prostate Cancer Model

BACKGROUND: Evaluating the efficacy of focal therapy for prostate cancer is limited by current approaches and may be improved with biological imaging techniques. OBJECTIVE: We assessed whether positron emission tomography/computed tomography with gallium-68-labeled prostate-specific membrane antigen (Ga-PSMA PET/CT) can be used to predict relapse after vascular-targeted photodynamic therapy (VTP). DESIGN, SETTING, AND PARTICIPANTS: A total of 1×10 LNCaP cells were grafted subcutaneously in the flanks of 6-8-wk-old SCID mice. Of 24 mice with measurable tumors 6 wk after tumor implantation, 20 were treated with VTP (150mW/cm) to ablate the tumors. Blood prostate-specific antigen (PSA) levels were assessed, and ⁶⁸Ga-PSMA PET/CT images were performed 1 d before VTP and 1 and 4 wk after. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Local tumor relapse was evaluated by histology, and tumors were analyzed by prostate-specific membrane antigen (PSMA) and PSA immunohistochemistry. T tests and Kruskal-Wallis tests were used to determine significance. RESULTS AND LIMITATIONS: Four weeks after VTP, 11 (65%) mice had complete responses and six (35%) had tumor relapses confirmed by histology (hematoxylin and eosin, and PSMA immunohistochemistry). All mice with local relapse had positive Ga-PSMA PET/CT findings 4 wk after VTP; all complete responders did not. One week after VTP, the relapse detection sensitivity of Ga-PSMA PET/CT was 75%, whereas the sensitivity of PSA was only 33%. Compared with controls, relapsed tumors had a three-fold reduction in the number of cells with strong PSA staining by immunohistochemistry (1.5% vs 4.5%; p=0.01). CONCLUSIONS: In a preclinical prostate cancer model, we show that Ga-PSMA PET/CT can identify and predict relapse earlier than blood PSA level. These findings support further testing in clinical trials. PATIENT SUMMARY: Positron emission tomography/computed tomography with gallium-68-labeled prostate-specific membrane antigen may be used to follow and evaluate treatment outcomes in men who receive focal therapy for prostate cancer

Computational fluid dynamics modeling of symptomatic intracranial atherosclerosis may predict risk of stroke recurrence.

BackgroundPatients with symptomatic intracranial atherosclerosis (ICAS) of ≥ 70% luminal stenosis are at high risk of stroke recurrence. We aimed to evaluate the relationships between hemodynamics of ICAS revealed by computational fluid dynamics (CFD) models and risk of stroke recurrence in this patient subset.MethodsPatients with a symptomatic ICAS lesion of 70-99% luminal stenosis were screened and enrolled in this study. CFD models were reconstructed based on baseline computed tomographic angiography (CTA) source images, to reveal hemodynamics of the qualifying symptomatic ICAS lesions. Change of pressures across a lesion was represented by the ratio of post- and pre-stenotic pressures. Change of shear strain rates (SSR) across a lesion was represented by the ratio of SSRs at the stenotic throat and proximal normal vessel segment, similar for the change of flow velocities. Patients were followed up for 1 year.ResultsOverall, 32 patients (median age 65; 59.4% males) were recruited. The median pressure, SSR and velocity ratios for the ICAS lesions were 0.40 (-2.46-0.79), 4.5 (2.2-20.6), and 7.4 (5.2-12.5), respectively. SSR ratio (hazard ratio [HR] 1.027; 95% confidence interval [CI], 1.004-1.051; P = 0.023) and velocity ratio (HR 1.029; 95% CI, 1.002-1.056; P = 0.035) were significantly related to recurrent territorial ischemic stroke within 1 year by univariate Cox regression, respectively with the c-statistics of 0.776 (95% CI, 0.594-0.903; P = 0.014) and 0.776 (95% CI, 0.594-0.903; P = 0.002) in receiver operating characteristic analysis.ConclusionsHemodynamics of ICAS on CFD models reconstructed from routinely obtained CTA images may predict subsequent stroke recurrence in patients with a symptomatic ICAS lesion of 70-99% luminal stenosis

Distinct neuroanatomical and neuropsychological features of Down syndrome compared to related neurodevelopmental disorders: a systematic review

ObjectivesWe critically review research findings on the unique changes in brain structure and cognitive function characteristic of Down syndrome (DS) and summarize the similarities and differences with other neurodevelopmental disorders such as Williams syndrome, 22q11.2 deletion syndrome, and fragile X syndrome.MethodsWe conducted a meta-analysis and systematic literature review of 84 studies identified by searching PubMed, Google Scholar, and Web of Science from 1977 to October 2022. This review focuses on the following issues: (1) specific neuroanatomic and histopathological features of DS as revealed by autopsy and modern neuroimaging modalities, (2) language and memory deficits in DS, (3) the relationships between these neuroanatomical and neuropsychological features, and (4) neuroanatomic and neuropsychological differences between DS and related neurodevelopmental syndromes.ResultsNumerous post-mortem and morphometric neuroimaging investigations of individuals with DS have reported complex changes in regional brain volumes, most notably in the hippocampal formation, temporal lobe, frontal lobe, parietal lobe, and cerebellum. Moreover, neuropsychological assessments have revealed deficits in language development, emotional regulation, and memory that reflect these structural changes and are more severe than expected from general cognitive dysfunction. Individuals with DS also show relative preservation of multiple cognitive, linguistic, and social domains compared to normally developed controls and individuals with other neurodevelopmental disorders. However, all these neurodevelopment disorders exhibit substantial heterogeneity among individuals.ConclusionPeople with Down syndrome demonstrate unique neurodevelopmental abnormalities but cannot be regarded as a homogenous group. A comprehensive evaluation of individual intellectual skills is essential for all individuals with neurodevelopment disorders to develop personalized care programs

SIRT1-dependent myoprotective effects of resveratrol on muscle injury induced by compression

© 2015 Sin, Yung, Yip, Chan, Wong, Tam and Siu. Our current understanding on the molecular mechanisms by which sustained compression induces skeletal muscle injury is very limited. This study aimed to test the hypothesis that activation of SIRT1 by the natural antioxidant resveratrol could deactivate apoptotic and catabolic signaling in skeletal muscle exposed to moderate compression. Two cycles of 6-h constant pressure at 100 mmHg was applied to the tibialis region of right, but not left hindlimbs of Sprague Dawley rats pre-treated with DMSO (vehicle control) or resveratrol with/without sirtinol. Skeletal muscle tissues lying underneath and spatially corresponding to the compressed sites were collected for analyses. Resveratrol prevented the compression-induced manifestations of pathohistological damages including elevations of the number of interstitial nuclei and area of interstitial space and ameliorated oxidative damages measured as 4-hydroxy-2-nonenal (4HNE) and nitrotyrosine in skeletal muscle. In parallel, resveratrol augmented the expression level and activity of SIRT1 and phosphorylation levels of Foxo3a and Akt while suppressed the increases in protein abundances of p53, Bax, MAFbx, and ubiquitin, enzymatic activities of caspase 3 and 20S proteasome, and apoptotic DNA fragmentation in the compressed muscle. These favorable myoprotective effects of resveratrol were diminished upon pharmacological blockade of SIRT1 by using sirtinol. These novel data support the hypothesis that the anti-apoptotic and anti-catabolic effects of resveratrol on compression injury in skeletal muscle required the action of SIRT1.Link_to_subscribed_fulltex

Molecular line mapping of the giant molecular cloud associated with RCW 106 - II. Column density and dynamical state of the clumps

We present a fully sampled C^{18}O (1-0) map towards the southern giant molecular cloud (GMC) associated with the HII region RCW 106, and use it in combination with previous ^{13}CO (1-0) mapping to estimate the gas column density as a function of position and velocity. We find localized regions of significant ^{13}CO optical depth in the northern part of the cloud, with several of the high-opacity clouds in this region likely associated with a limb-brightened shell around the HII region G333.6-0.2. Optical depth corrections broaden the distribution of column densities in the cloud, yielding a log-normal distribution as predicted by simulations of turbulence. Decomposing the ^{13}CO and C^{18}O data cubes into clumps, we find relatively weak correlations between size and linewidth, and a more sensitive dependence of luminosity on size than would be predicted by a constant average column density. The clump mass spectrum has a slope near -1.7, consistent with previous studies. The most massive clumps appear to have gravitational binding energies well in excess of virial equilibrium; we discuss possible explanations, which include magnetic support and neglect of time-varying surface terms in the virial theorem. Unlike molecular clouds as a whole, the clumps within the RCW 106 GMC, while elongated, appear to show random orientations with respect to the Galactic plane.Comment: 17 pages, to appear in MNRA