Prophylactic Laparoscopic Gastrectomy for Hereditary Diffuse Gastric Cancer: A Case Series in a Single Family

This study suggests that a laparoscopic approach for prophylactic total gastrectomy for carriers of CDH1 gene mutation can be performed safely and effectively

Early JWST imaging reveals strong optical and NIR color gradients in galaxies at z∼2z\sim2 driven mostly by dust

Recent studies have shown that galaxies at cosmic noon are redder in the center and bluer in the outskirts, mirroring results in the local universe. These color gradients could be caused by either gradients in the stellar age or dust opacity; however, distinguishing between these two causes is impossible with rest-frame optical photometry alone. Here we investigate the underlying causes of the gradients from spatially-resolved rest-frame $U-V$ vs. $V-J$ color-color diagrams, measured from early observations with the James Webb Space Telescope. We use $1\, \mu m - 4\, \mu m$ NIRCam photometry from the CEERS survey of a sample of 54 galaxies with $M_* / M_\odot>10$ at redshifts $1.7<z<2.3$ selected from the 3D-HST catalog. We model the light profiles in the F115W, F200W and F356W NIRCam bands using \texttt{imcascade}, a Bayesian implementation of the Multi-Gaussian expansion (MGE) technique which flexibly represents galaxy profiles using a series of Gaussians. We construct resolved rest-frame $U-V$ and $V-J$ color profiles. The majority of star-forming galaxies have negative gradients (i.e. redder in the center, bluer in the outskirts) in both $U-V$ and $V-J$ colors consistent with radially decreasing dust attenuation. A smaller population (roughly 15\%) of star-forming galaxies have positive $U-V$ but negative $V-J$ gradients implying centrally concentrated star-formation. For quiescent galaxies we find a diversity of UVJ color profiles, with roughly one-third showing star-formation in their center. This study showcases the potential of JWST to study the resolved stellar populations of galaxies at cosmic noon.Comment: Updated to match published version, new Figure 5 and some text change

Influences on recruitment to randomised controlled trials in mental health settings in England: a national cross-sectional survey of researchers working for the Mental Health Research Network

Background: Recruitment to trials is complex and often protracted; selection bias may compromise generalisability. In the mental health field (as elsewhere), diverse factors have been described as hindering researcher access to potential participants and various strategies have been proposed to overcome barriers. However, the extent to which various influences identified in the literature are operational across mental health settings in England has not been systematically examined. Methods: A cross-sectional, online survey of clinical studies officers employed by the Mental Health Research Network in England to recruit to trials from National Health Service mental health services. The bespoke questionnaire invited participants to report exposure to specified influences on recruitment, the perceived impact of these on access to potential participants, and to describe additional positive or negative influences on recruitment. Analysis employed descriptive statistics, the framework approach and triangulation of data. Results: Questionnaires were returned by 98 (58%) of 170 clinical studies officers who reported diverse experience. Data demonstrated a disjunction between policy and practice. While the particulars of trial design and various marketing and dommunication strategies could influence recruitment, consensus was that the culture of NHS mental health services is not donducive to research. Since financial rewards for recruitment paid to Trusts and feedback about studies seldom reaching frontline services, clinicians were described as distanced from research. Facing continual service change and demanding clinical workloads, clinicians generally did not prioritise recruitment activities. Incentives to trial participants had variable impact on access but recruitment could be enhanced by engagement of senior investigators and integrating referral with routine practice. Comprehensive, robust feasibility studies and reciprocity between researchers and clinicians were considered crucial to successful recruitment. Conclusions: In the mental health context, researcher access to potential trial participants is multiply influenced. Gatekeeping clinicians are faced with competing priorities and resources constrain research activity. It seems that environmental adjustment predicated on equitable resource allocation is needed if clinicians in NHS mental health services are to fully support the conduct of randomised controlled trials. Whilst cultural transformation, requiring changes in assumptions and values, is complex, our findings suggest that attention to practical matters can support this and highlight issues requiring careful consideration

Protocol for the 'e-Nudge trial' : a randomised controlled trial of electronic feedback to reduce the cardiovascular risk of individuals in general practice [ISRCTN64828380]

Background: Cardiovascular disease (including coronary heart disease and stroke) is a major cause of death and disability in the United Kingdom, and is to a large extent preventable, by lifestyle modification and drug therapy. The recent standardisation of electronic codes for cardiovascular risk variables through the United Kingdom's new General Practice contract provides an opportunity for the application of risk algorithms to identify high risk individuals. This randomised controlled trial will test the benefits of an automated system of alert messages and practice searches to identify those at highest risk of cardiovascular disease in primary care databases. Design: Patients over 50 years old in practice databases will be randomised to the intervention group that will receive the alert messages and searches, and a control group who will continue to receive usual care. In addition to those at high estimated risk, potentially high risk patients will be identified who have insufficient data to allow a risk estimate to be made. Further groups identified will be those with possible undiagnosed diabetes, based either on elevated past recorded blood glucose measurements, or an absence of recent blood glucose measurement in those with established cardiovascular disease. Outcome measures: The intervention will be applied for two years, and outcome data will be collected for a further year. The primary outcome measure will be the annual rate of cardiovascular events in the intervention and control arms of the study. Secondary measures include the proportion of patients at high estimated cardiovascular risk, the proportion of patients with missing data for a risk estimate, and the proportion with undefined diabetes status at the end of the trial

A systematic review and meta-analysis examining whether changing ovarian sex steroid hormone levels influence cerebrovascular function

Sex differences in cerebrovascular disease rates indicate a possible role for ovarian sex steroid hormones in cerebrovascular function. To synthesise and identify knowledge gaps, a systematic review and meta-analysis was conducted to assess how ovarian sex steroid hormone changes across the lifespan affect cerebrovascular function in women. Three databases (EMBASE, MEDLINE and Web of Science) were systematically searched for studies on adult cerebrovascular function and ovarian sex steroid hormones. Forty-five studies met pre-defined inclusion criteria. Studied hormone groups included hormone replacement therapy (HRT; n = 17), pregnancy (n = 12), menstrual cycle (n = 7), menopause (n = 5), oral contraception (n = 2), and ovarian hyperstimulation (n = 2). Outcome measures included pulsatility index (PI), cerebral blood flow/velocity (CBF), resistance index (RI), cerebral autoregulation, and cerebrovascular reactivity. Meta-analysis was carried out on HRT studies. PI significantly decreased [−0.05, 95% CI: (−0.10, −0.01); p = 0.01] in post-menopausal women undergoing HRT compared to post-menopausal women who were not, though there was considerable heterogeneity (I2 = 96.8%). No effects of HRT were seen in CBF (p = 0.24) or RI (p = 0.77). This review indicates that HRT improves PI in post-menopausal women. However, there remains insufficient evidence to determine how changing ovarian sex steroid hormone levels affects cerebrovascular function in women during other hormonal phases (e.g., pregnancy, oral contraception)

Rest-frame near-infrared sizes of galaxies at cosmic noon: objects in JWST's mirror are smaller than they appeared

Galaxy sizes and their evolution over cosmic time have been studied for decades and serve as key tests of galaxy formation models. However, at $z\gtrsim1$ these studies have been limited by a lack of deep, high-resolution rest-frame infrared imaging that accurately traces galaxy stellar mass distributions. Here, we leverage the new capabilities of the James Webb Space Telescope to measure the 4.4$\mu$m sizes of ${\sim}1000$ galaxies with $\log{\rm{M}_*/\rm{M}_\odot}\ge9$ and $1.0\le z \le 2.5$ from public CEERS imaging in the EGS deep field. We compare the sizes of galaxies measured from NIRCam imaging at 4.4$\mu$m ($\lambda_{\mathrm{rest}}\sim1.6\mu$m) with sizes measured at $1.5\mu$m ($\lambda_{\mathrm{rest}}\sim5500$A). We find that, on average, galaxy half-light radii are $\sim8$% smaller at 4.4$\mu$m than 1.5$\mu$m in this sample. This size difference is markedly stronger at higher stellar masses and redder rest-frame $V-J$ colors: galaxies with ${\rm M}_* \sim 10^{11}\,{\rm M}_\odot$ have 4.4$\mu$m sizes that are $\sim 25$% smaller than their 1.5$\mu$m sizes. Our results indicate that galaxy mass profiles are significantly more compact than their rest-frame optical light profiles at cosmic noon, and demonstrate that spatial variations in age and attenuation are important, particularly for massive galaxies. The trend that we find here impacts our understanding of the size growth and evolution of galaxies, and suggests that previous studies based on rest-frame optical light may not have captured the mass-weighted structural evolution of galaxies. This paper represents a first step towards a new understanding of the morphologies of early massive galaxies enabled by JWST's infrared window into the distant universe.Comment: Accepted to ApJL. 10 pages, 4 figures, 1 table with full size catalog in F150W and F444

Characteristics and pathways of long-stay patients in high and medium secure settings in England : a secondary publication from a large mixed-methods study

Background: Many patients experience extended stays within forensic care, but the characteristics of long-stay patients are poorly understood. Aims: To describe the characteristics of long-stay patients in high and medium secure settings in England. Method: Detailed file reviews provided clinical, offending and risk data for a large representative sample of 401 forensic patients from 2 of the 3 high secure settings and from 23 of the 57 medium secure settings in England on 1 April 2013. The threshold for long-stay status was defined as 5 years in medium secure care or 10 years in high secure care, or 15 years in a combination of high and medium secure settings. Results: 22% of patients in high security and 18% in medium security met the definition for ‘long-stay’, with 20% staying longer than 20 years. Of the long-stay sample, 58% were violent offenders (22% both sexual and violent), 27% had been convicted for violent or sexual offences whilst in an institutional setting, and 26% had committed a serious assault on staff in the last 5 years. The most prevalent diagnosis was schizophrenia (60%) followed by personality disorder (47%, predominantly antisocial and borderline types); 16% were categorised as having an intellectual disability. Overall, 7% of the long-stay sample had never been convicted of any offence, and 16.5% had no index offence prompting admission. Although some significant differences were found between the high and medium secure samples, there were more similarities than contrasts between these two levels of security. The treatment pathways of these long-stay patients involved multiple moves between settings. An unsuccessful referral to a setting of lower security was recorded over the last 5 years for 33% of the sample. Conclusions: Long-stay patients accounted for one fifth of the forensic inpatient population in England in this representative sample. A significant proportion of this group remain unsettled. High levels of personality pathology and the risk of assaults on staff and others within the care setting are likely to impact on treatment and management. Further research into the treatment pathways of longer stay patients is warranted to understand the complex trajectories of this group

Characteristics and pathways of long-stay patients in high and medium secure settings in England; a secondary publication from a large mixed-methods study

Background: Many patients experience extended stays within forensic care, but the characteristics of long-stay patients are poorly understood. Aims: To describe the characteristics of long-stay patients in high and medium secure settings in England. Method: Detailed file reviews provided clinical, offending and risk data for a large representative sample of 401 forensic patients from 2 of the 3 high secure settings and from 23 of the 57 medium secure settings in England on 1 April 2013. The threshold for long-stay status was defined as 5 years in medium secure care or 10 years in high secure care, or 15 years in a combination of high and medium secure settings. Results: 22% of patients in high security and 18% in medium security met the definition for “long-stay,” with 20% staying longer than 20 years. Of the long-stay sample, 58% were violent offenders (22% both sexual and violent), 27% had been convicted for violent or sexual offences whilst in an institutional setting, and 26% had committed a serious assault on staff in the last 5 years. The most prevalent diagnosis was schizophrenia (60%) followed by personality disorder (47%, predominantly antisocial and borderline types); 16% were categorised as having an intellectual disability. Overall, 7% of the long-stay sample had never been convicted of any offence, and 16.5% had no index offence prompting admission. Although some significant differences were found between the high and medium secure samples, there were more similarities than contrasts between these two levels of security. The treatment pathways of these long-stay patients involved multiple moves between settings. An unsuccessful referral to a setting of lower security was recorded over the last 5 years for 33% of the sample. Conclusions: Long-stay patients accounted for one fifth of the forensic inpatient population in England in this representative sample. A significant proportion of this group remain unsettled. High levels of personality pathology and the risk of assaults on staff and others within the care setting are likely to impact on treatment and management. Further research into the treatment pathways of longer stay patients is warranted to understand the complex trajectories of this group

The Morphology of Galaxies in the Baryon Oscillation Spectroscopic Survey

We study the morphology of luminous and massive galaxies at 0.3<z<0.7 targeted in the Baryon Oscillation Spectroscopic Survey (BOSS) using publicly available Hubble Space Telescope imaging from COSMOS. Our sample (240 objects) provides a unique opportunity to check the visual morphology of these galaxies which were targeted based solely on stellar population modelling. We find that the majority (74+/-6%) possess an early-type morphology (elliptical or S0), while the remainder have a late-type morphology. This is as expected from the goals of the BOSS target selection which aimed to predominantly select slowly evolving galaxies, for use as cosmological probes, while still obtaining a fair fraction of actively star forming galaxies for galaxy evolution studies. We show that a colour cut of (g-i)>2.35 selects a sub-sample of BOSS galaxies with 90% early-type morphology - more comparable to the earlier Luminous Red Galaxy (LRG) samples of SDSS-I/II. The remaining 10% of galaxies above this cut have a late-type morphology and may be analogous to the "passive spirals" found at lower redshift. We find that 23+/-4% of the early-type galaxies are unresolved multiple systems in the SDSS imaging. We estimate that at least 50% of these are real associations (not projection effects) and may represent a significant "dry merger" fraction. We study the SDSS pipeline sizes of BOSS galaxies which we find to be systematically larger (by 40%) than those measured from HST images, and provide a statistical correction for the difference. These details of the BOSS galaxies will help users of the data fine-tune their selection criteria, dependent on their science applications. For example, the main goal of BOSS is to measure the cosmic distance scale and expansion rate of the Universe to percent-level precision - a point where systematic effects due to the details of target selection may become important.Comment: 18 pages, 11 figures; v2 as accepted by MNRA

Machine learning optimised hyperspectral remote sensing retrieves cotton nitrogen status

Hyperspectral imaging spectrometers mounted on unmanned aerial vehicle (UAV) can capture high spatial and spectral resolution to provide cotton crop nitrogen status for precision agriculture. The aim of this research was to explore machine learning use with hyperspectral datacubes over agricultural fields. Hyperspectral imagery was collected over a mature cotton crop, which had high spatial (~5.2 cm) and spectral (5 nm) resolution over the spectral range 475–925 nm that allowed discrimination of individual crop rows and field features as well as a continuous spectral range for calculating derivative spectra. The nominal reflectance and its derivatives clearly highlighted the different treatment blocks and were strongly related to N concentration in leaf and petiole samples, both in traditional vegetation indices (e.g., Vogelman 1, R2 = 0.8) and novel combinations of spectra (R2 = 0.85). The key hyperspectral bands identified were at the red-edge inflection point (695–715 nm). Satellite multispectral was compared against the UAV hyperspectral remote sensing’s performance by testing the ability of Sentinel MSI to predict N concentration using the bands in VIS-NIR spectral region. The Sentinel 2A Green band (B3; mid-point 559.8 nm) explained the same amount of variation in N as the hyperspectral data and more than the Sentinel Red Edge Point 1 (B5; mid-point 704.9 nm) with the lower 10 m resolution Green band reporting an R2 = 0.85, compared with the R2 = 0.78 of downscaled Sentinel Red Edge Point 1 at 5 m. The remaining Sentinel bands explained much lower variation (maximum was NIR at R2 = 0.48). Investigation of the red edge peak region in the first derivative showed strong promise with RIDAmid (R2 = 0.81) being the best index. The machine learning approach narrowed the range of bands required to investigate plant condition over this trial site, greatly improved processing time and reduced processing complexity. While Sentinel performed well in this comparison and would be useful in a broadacre crop production context, the impact of pixel boundaries relative to a region of interest and coarse spatial and temporal resolution impacts its utility in a research capacity