Robot Assisted Surgical Ward Rounds: Virtually Always There

Background:  While an explosion in technological sophistication has revolutionized surgery within the operating theatre, delivery of surgical ward-based care has seen little innovation.  Use of telepresence allowing off-site clinicians communicate with patients has been largely restricted to outpatient settings or use of complex, expensive, static devices.  We designed a prospective study to ascertain feasibility and face validity of a remotely controlled mobile audiovisual drone (LUCY) to access inpatients.  This device is, uniquely, lightweight, freely mobile and emulates ‘human’ interaction by swiveling and adjusting height to patients’ eye-level.   Methods: Robot-assisted ward rounds(RASWR) were conducted over 3 months. A remotely located consultant surgeon communicated with patients/bedside teams via encrypted audiovisual telepresence robot (DoubleRoboticstm, California USA).  Likert-scale satisfaction questionnaires, incorporating free-text sections for mixed-methods data collection, were disseminated to patient and staff volunteers following RASWRs.  The same cohort completed a linked questionnaire following conventional (gold-standard) rounds, acting as control group. Data were paired, and non-parametric analysis performed.  Results: RASWRs are feasible (>90% completed without technical difficulty). The RASWR(n=52 observations) demonstrated face validity with strong correlations (r>0.7; Spearman, p-value <0.05) between robotic and conventional ward rounds among patients and staff on core themes, including dignity/confidentiality/communication/satisfaction with management plan. Patients (96.08%, n=25) agreed RASWR were a satisfactory alternative when consultant physical presence was not possible. There was acceptance of nursing/NCHD cohort (100% (n=11) willing to regularly partake in RASWR).  Conclusion: RASWRs receive high levels of patient and staff acceptance, and offer a valid alternative to conventional ward rounds when a consultant cannot be physically present

Iso-Wetlands: unlocking wetland ecologies and agriculture in prehistory through sulfur isotopes

Iso-Wetlands is a new, NERC-funded collaborative research project involving researchers at UCL Institute of Archaeology, the University of Leeds and the UK Centre for Ecology and Hydrology. The project is developing sulfur isotope analysis of archaeological plants and animals as a new tool for exploring hydrological conditions under which agricultural production was taking place. This development has the potential to improve understanding of water management strategies in the past, particularly in relation to seasonal floodwater agriculture and wetland agriculture (for example, rice paddy systems). The project will open wider possibilities for the use of sulfur isotopes in archaeology and ecology to examine wetland habitat use by both people and animals

“A Hideous Torture on Himself”: Madness and Self-Mutilation in Victorian Literature

This paper suggests that late nineteenth-century definitions of self-mutilation, a new category of psychiatric symptomatology, were heavily influenced by the use of selfinjury as a rhetorical device in the novel, for the literary text held a high status in Victorian psychology. In exploring Dimmesdale’s “self-mutilation” in The Scarlet Letter in conjunction with psychiatric case histories, the paper indicates a number of common techniques and themes in literary and psychiatric texts. As well as illuminating key elements of nineteenth-century conceptions of the self, and the relation of mind and body through ideas of madness, this exploration also serves to highlight the social commentary implicit in many Victorian medical texts. Late nineteenth-century England, like mid-century New England, required the individual to help himself and, simultaneously, others; personal charity and individual philanthropy were encouraged, while state intervention was often presented as dubious. In both novel and psychiatric text, self-mutilation is thus presented as the ultimate act of selfish preoccupation, particularly in cases on the “borderlands” of insanity

Consensus guidelines for the use and interpretation of angiogenesis assays

The formation of new blood vessels, or angiogenesis, is a complex process that plays important roles in growth and development, tissue and organ regeneration, as well as numerous pathological conditions. Angiogenesis undergoes multiple discrete steps that can be individually evaluated and quantified by a large number of bioassays. These independent assessments hold advantages but also have limitations. This article describes in vivo, ex vivo, and in vitro bioassays that are available for the evaluation of angiogenesis and highlights critical aspects that are relevant for their execution and proper interpretation. As such, this collaborative work is the first edition of consensus guidelines on angiogenesis bioassays to serve for current and future reference

On fixing international cricket matches

Corruption is hidden action which distorts allocations of resources away from competitive outcomes. Hence the detection of such actions is both difficult yet important. In many economic contexts, agent actions are unobservable by principals and hence detection is difficult; sport offers a well-measured context in which individual actions are documented in great detail. In recent years the sport of cricket, which records a huge volume of statistics, has been beset by a number of corruption scandals surrounding the fixing of matches. We use 18 one day international (ODI) matches that are known to be fixed by one of the teams involved and analyse a wide range of observed statistics from all ODI matches since 1971, in order to determine whether corruption manifests itself in recorded outcomes. We find that corruption does affect a number of observed outcomes in anticipated ways, suggesting that both the increased reporting of statistics, and the statistical analysis of them may be a useful tool in detecting corruption

It’s just not cricket: rules and the gentleman’s game

Cricket offers a wealth of opportunity and potential insights for economists and other researchers. Focusing on the oldest domestic cricket competition, the English County Championship, we discuss issues of demand, home advantage, competitive balance and the importance of winning the pre-match coin toss to determine the playing order. Despite cricket being generally regarded as a sport for traditionalists, the County Championship is remarkable in how often the rule makers have altered its format. We study one recent major change, the replacement of the mandatory pre-match coin toss with an uncontested one, whereby the away team could decide whether to bowl first or face a toss to bat instead. In theory, this ought to have reduced home advantage, made the toss matter more when it was contested, and incentivised teams to prepare better pitches leading to longer matches. We found no evidence of the first or the last of these effects, but matches did become more predictable once the toss was decided. This suggests that the rule makers were right to abandon this experimental change after only four seasons

A randomized, controlled pilot clinical trial of cryopreserved platelets for perioperative surgical bleeding: the CLIP‐I trial

Cryopreservation extends platelet (PLT) shelf life from 5 to 7 days to 2 to 4 years. However, only 73 patients have been transfused cryopreserved PLTs in published randomized controlled trials (RCTs), making safety data insufficient for regulatory approval.The Cryopreserved vs. Liquid Platelet (CLIP) study was a double-blind, pilot, multicenter RCT involving high-risk cardiothoracic surgical patients in four Australian hospitals. The objective was to test, as the primary outcome, the feasibility and safety of the protocol. Patients were allocated to study group by permuted block randomization, with patients and clinicians blinded by use of an opaque shroud placed over each study PLT unit. Up to 3 units of cryopreserved or liquid-stored PLTs were administered per patient. No other aspect of patient care was affected. Adverse events were actively sought.A total of 121 patients were randomized, of whom 23 received cryopreserved PLTs and 18 received liquid-stored PLTs. There were no differences in blood loss (median, 715 mL vs. 805 mL at 24 hr; difference between groups 90 mL [95% CI, -343.8 to 163.8 mL], p = 0.41), but the Bleeding Academic Research Consortium criterion for significant postoperative hemorrhage in cardiac surgery composite bleeding endpoint occurred in nearly twice as many patients in the liquid-stored group (55.6% vs. 30.4%, p = 0.10). Red blood cell transfusion requirements were a median of 3 units in the cryopreserved group versus 4 units with liquid-stored PLTs (difference between groups, 1 unit [95% CI, -3.1 to 1.1 units]; p = 0.23). Patients in the cryopreserved group were more likely to be transfused fresh-frozen plasma (78.3% vs. 27.8%, p = 0.002) and received more study PLT units (median, 2 units vs. 1 unit; difference between groups, 1 unit [95% CI, -0.03 to 2.0 units]; p = 0.012). There were no between-group differences in potential harms including deep venous thrombosis, myocardial infarction, respiratory function, infection, and renal function. No patient had died at 28 days, and postoperative length of stay was similar in each group.In this pilot RCT, compared to liquid-stored PLTs, cryopreserved PLTs were associated with no evidence of harm. A definitive study testing safety and hemostatic effectiveness is warranted