Recent Submissions

  • Sarcopenia estimation using psoas major enhances P-POSSUM mortality prediction in older patients undergoing emergency laparotomy: cross-sectional study.

    Simpson, Gregory; orcid: 0000-0002-9779-1747; email:; Wilson, Jeremy; Vimalachandran, Dale; McNicol, Frances; Magee, Conor (2021-04-21)
    Emergency laparotomy is a considerable component of a colorectal surgeon's workload and conveys substantial morbidity and mortality, particularly in older patients. Frailty is associated with poorer surgical outcomes. Frailty and sarcopenia assessment using Computed Tomography (CT) calculation of psoas major area predicts outcomes in elective and emergency surgery. Current risk predictors do not incorporate frailty metrics. We investigated whether sarcopenia measurement enhanced mortality prediction in over-65 s who underwent emergency laparotomy and emergency colorectal resection. An analysis of data collected prospectively during the National Emergency Laparotomy Audit (NELA) was conducted. Psoas major (PM) cross-sectional area was measured at the L3 level and a ratio of PM to L3 vertebral body area (PML3) was calculated. Outcome measures included inpatient, 30-day and 90-day mortality. Statistical analysis was conducted using Mann-Whitney, Chi-squared and receiver operating characteristics (ROC). Logistic regression was conducted using P-POSSUM variables with and without the addition of PML3. Nine-hundred and forty-four over-65 s underwent emergency laparotomy from three United Kingdom hospitals were included. Median age was 76 years (IQR 70-82 years). Inpatient mortality was 21.9%, 30-day mortality was 16.3% and 90-day mortality was 20.7%. PML3 less than 0.39 for males and 0.31 for females indicated significantly worse outcomes (inpatient mortality 68% vs 5.6%, 30-day mortality 50.6% vs 4.0%,90-day mortality 64% vs 5.2%, p < 0.0001). PML3 was independently associated with mortality in multivariate analysis (p < 0.0001). Addition of PML3 to P-POSSUM variables improved area under the curve (AUC) on ROC analysis for inpatient mortality (P-POSSUM:0.78 vs P-POSSUM + PML3:0.917), 30-day mortality(P-POSSUM:0.802 vs P-POSSUM + PML3: 0.91) and 90-day mortality (P-POSSUM:0.79 vs P-POSSUM + PML3: 0.91). PML3 is an accurate predictor of mortality in over-65 s undergoing emergency laparotomy. Addition of PML3 to POSSUM appears to improve mortality risk prediction.
  • Limb preference and personality in donkeys (Equus asinus)

    Díaz, Sergio; orcid: 0000-0002-3070-0097; Murray, Lindsay; orcid: 0000-0002-7810-9546; Rodway, Paul; orcid: 0000-0002-7667-6782 (Informa UK Limited, 2021-02-05)
  • Patient‐relevant health outcomes for hemophilia care: Development of an international standard outcomes set

    van Balen, Erna C.; orcid: 0000-0002-3678-6581; O'Mahony, Brian; Cnossen, Marjon H.; Dolan, Gerard; Blanchette, Victor S.; Fischer, Kathelijn; Gue, Deborah; O'Hara, Jamie; Iorio, Alfonso; orcid: 0000-0002-3331-8766; Jackson, Shannon; et al. (2021-03-06)
    Abstract: Background: Patient‐relevant health outcomes for persons with hemophilia should be identified and prioritized to optimize and individualize care for persons with hemophilia. Therefore, an international group of persons with hemophilia and multidisciplinary health care providers set out to identify a globally applicable standard set of health outcomes relevant to all individuals with hemophilia. Methods: A systematic literature search was performed to identify possible health outcomes and risk adjustment variables. Persons with hemophilia and multidisciplinary health care providers were involved in an iterative nominal consensus process to select the most important health outcomes and risk adjustment variables for persons with hemophilia. Recommendations were made for outcome measurement instruments. Results: Persons with hemophilia were defined as all men and women with an X‐linked inherited bleeding disorder caused by a deficiency of coagulation factor VIII or IX with plasma activity levels <40 IU/dL. We recommend collecting the following 10 health outcomes at least annually, if applicable: (i) cure, (ii) impact of disease on life expectancy, (iii) ability to engage in normal daily activities, (iv) severe bleeding episodes, (v) number of days lost from school or work, (vi) chronic pain, (vii) disease and treatment complications, (viii) sustainability of physical functioning, (ix) social functioning, and (x) mental health. Validated clinical as well as patient‐reported outcome measurement instruments were endorsed. Demographic factors, baseline clinical factors, and treatment factors were identified as risk‐adjustment variables. Conclusion: A consensus‐based international set of health outcomes relevant to all persons with hemophilia, and corresponding measurement instruments, was identified for use in clinical care to facilitate harmonized longitudinal monitoring and comparison of outcomes.
  • Social network analysis of small social groups: Application of a hurdle GLMM approach in the Alpine marmot ( Marmota marmota )

    editor: Ebensperger, Luis; Panaccio, Matteo; orcid: 0000-0002-1903-154X; email:; Ferrari, Caterina; Bassano, Bruno; Stanley, Christina R.; orcid: 0000-0002-5053-4831; von Hardenberg, Achaz; orcid: 0000-0002-9899-1687; email: (2021-03-24)
    Abstract: Social network analysis (SNA) has recently emerged as a fundamental tool to study animal behavior. While many studies have analyzed the relationship between environmental factors and behavior across large, complex animal populations, few have focused on species living in small groups due to limitations of the statistical methods currently employed. Some of the difficulties are often in comparing social structure across different sized groups and accounting for zero‐inflation generated by analyzing small social units. Here, we use a case study to highlight how Generalized Linear Mixed Models (GLMMs) and hurdle models can overcome the issues inherent to study of social network metrics of groups that are small and variable in size. We applied this approach to study aggressive behavior in the Alpine marmot (Marmota marmota) using an eight‐year long dataset of behavioral interactions across 17 small family groups (7.4 ± 3.3 individuals). We analyzed the effect of individual and group‐level factors on aggression, including predictors frequently inferred in species with larger groups, as the closely related yellow‐bellied marmot (Marmota flaviventris). Our approach included the use of hurdle GLMMs to analyze the zero‐inflated metrics that are typical of aggressive networks of small social groups. Additionally, our results confirmed previously reported effects of dominance and social status on aggression levels, thus supporting the efficacy of our approach. We found differences between males and females in terms of levels of aggression and on the roles occupied by each in agonistic networks that were not predicted in a socially monogamous species. Finally, we provide some perspectives on social network analysis as applied to small social groups to inform subsequent studies.
  • Vitamin B

    Sobczyńska-Malefora, Agata; orcid: 0000-0001-7349-9517; Delvin, Edgard; McCaddon, Andrew; Ahmadi, Kourosh R; Harrington, Dominic J; orcid: 0000-0003-4786-9240 (2021-04-21)
    Vitamin B (cobalamin) is an essential cofactor for two metabolic pathways. It is obtained principally from food of animal origin. Cobalamin becomes bioavailable through a series of steps pertaining to its release from dietary protein, intrinsic factor-mediated absorption, haptocorrin or transcobalamin-mediated transport, cellular uptake, and two enzymatic conversions ( methionine synthase and methylmalonyl-CoA-mutase) into cofactor forms: methylcobalamin and adenosylcobalamin. Vitamin B deficiency can masquerade as a multitude of illnesses, presenting different perspectives from the point of view of the hematologist, neurologist, gastroenterologist, general physician, or dietician. Increased physician vigilance and heightened patient awareness often account for its early presentation, and testing sometimes occurs during a phase of vitamin B insufficiency before the main onset of the disease. The chosen test often depends on its availability rather than on the diagnostic performance and sensitivity to irrelevant factors interfering with vitamin B markers. Although serum B is still the most commonly used and widely available test, diagnostics by holotranscobalamin, serum methylmalonic acid, and plasma homocysteine measurements have grown in the last several years in routine practice. The lack of a robust absorption test, coupled with compromised sensitivity and specificity of other tests (intrinsic factor and gastric parietal cell antibodies), hinders determination of the cause for depleted B status. This can lead to incorrect supplementation regimes and uncertainty regarding later treatment. This review discusses currently available knowledge on vitamin B , informs the reader about the pitfalls of tests for assessing its deficiency, reviews B status in various populations at different disease stages, and provides recommendations for interpretation, treatment, and associated risks. Future directions for diagnostics of B status and health interventions are also discussed.
  • Women in British Buddhism: Commitment, Connection, Community

    LLewellyn, Dawn (Informa UK Limited, 2021-04-26)
  • Work, Identity, Place, and Population. A Changing Landscape.

    Bennett, Julia (2020-09-08)
    Taking a biographical approach, this paper uses life history narratives across four generations of families living and working in Wigan, Lancashire to analyse social and cultural changes in working life biographies over the past 80 years. Beginning with those who left school at 14, prior to the 1944 Education Act up to the present, where young people are required to remain in education until 18, the paper examines the decisions people have taken throughout their working lives. Inevitably these are shaped by structural changes, particularly to the industrial landscape. The biographical narratives allow a "bottom up" approach to uncovering changes to life courses over three generations in a northern British former industrial town whilst also exploring the wider relations between self, society and place (conceptualized here as "taskscape") in a post-industrial setting. Key changes over the generations are the increased ability of women to pursue careers in addition to having a family, the decrease in parental influence over career choice, and the loss of a "job for life" and employment opportunities for manual workers. [Abstract copyright: Copyright © 2020 Bennett.]
  • Heuristic assessment of psychological interventions in schools (HAPI Schools)

    Platt, Ian A.; orcid: 0000-0003-2497-6713; email:; Kannangara, Chathurika; orcid: 0000-0001-6955-8158; Carson, Jerome; orcid: 0000-0002-7596-116X; Tytherleigh, Michelle; orcid: 0000-0003-2498-8175 (2021-05-02)
    Abstract: Children spend more time in school than in any other formal setting and, with mental illness in children on the rise, there is more pressure on schools to intervene in student mental health than ever before. In the current study, two phases of semistructured interviews were conducted with school leaders and special educational needs coordinators (Phase 1, N = 23; Phase 2, N = 11), to investigate first‐hand experiences in dealing with student mental illness. Thematic analysis, drawing on Grounded Theory, was used to identify themes. The results identified deprivation as one of the main causes of mental ill‐health in students, with insufficient budgets, inappropriate mental health services, and overly long waiting times as barriers to intervention. Difficulties in identifying appropriate mental health interventions to use in school were also reported. The authors propose a simple four‐point heuristic, for assessing the quality of school‐based mental health interventions to be used by school staff, so that educators can more readily identify appropriate mental health support for their students.
  • Validation of CIP2A as a Biomarker of Subsequent Disease Progression and Treatment Failure in Chronic Myeloid Leukaemia

    Clark, Richard E.; email:; Basabrain, Ammar A.; email:; Austin, Gemma M.; email:; Holcroft, Alison K.; email:; Loaiza, Sandra; email:; Apperley, Jane F.; email:; Law, Christopher; email:; Scott, Laura; email:; Parry, Alexandra D.; email:; Bonnett, Laura; orcid: 0000-0002-6981-9212; email:; et al. (MDPI, 2021-04-29)
    Background: It would be clinically useful to prospectively identify the risk of disease progression in chronic myeloid leukaemia (CML). Overexpression of cancerous inhibitor of protein phosphatase 2A (PP2A) (CIP2A) protein is an adverse prognostic indicator in many cancers. Methods: We examined CIP2A protein levels in diagnostic samples from the SPIRIT2 trial in 172 unselected patients, of whom 90 received imatinib and 82 dasatinib as first-line treatment. Results: High CIP2A levels correlated with inferior progression-free survival (p = 0.04) and with worse freedom from progression (p = 0.03), and these effects were confined to dasatinib recipients. High CIP2A levels were associated with a six-fold higher five-year treatment failure rate than low CIP2A levels (41% vs. 7.5%; p = 0.0002), in both imatinib (45% vs. 11%; p = 0.02) and dasatinib recipients (36% vs. 4%; p = 0.007). Imatinib recipients with low CIP2A levels had a greater risk of treatment failure (p = 0.0008). CIP2A levels were independent of Sokal, Hasford, EUTOS (EUropean Treatment and Outcome Study), or EUTOS long-term survival scores (ELTS) or the presence of major route cytogenetic abnormalities. No association was seen between CIP2A levels and time to molecular response or the levels of the CIP2A-related proteins PP2A, SET, SET binding protein 1 (SETBP1), or AKT. Conclusions: These data confirm that high diagnostic CIP2A levels correlate with subsequent disease progression and treatment failure. CIP2A is a simple diagnostic biomarker that may be useful in planning treatment strategies.
  • Two high-order time discretization schemes for subdiffusion problems with nonsmooth data

    Wang, Yanyong; Yan, yubin; Yang, Yan (Walter de Gruyter GmbH, 2020-11-13)
    Abstract Two new high-order time discretization schemes for solving subdiffusion problems with nonsmooth data are developed based on the corrections of the existing time discretization schemes in literature. Without the corrections, the schemes have only a first order of accuracy for both smooth and nonsmooth data. After correcting some starting steps and some weights of the schemes, the optimal convergence orders O(k 3–α ) and O(k 4–α ) with 0 &lt; α &lt; 1 can be restored for any fixed time t for both smooth and nonsmooth data, respectively. The error estimates for these two new high-order schemes are proved by using Laplace transform method for both homogeneous and inhomogeneous problem. Numerical examples are given to show that the numerical results are consistent with the theoretical results.
  • Vitamin B12 status in health and disease: a critical review. Diagnosis of deficiency and insufficiency – clinical and laboratory pitfalls

    Sobczyńska-Malefora, Agata; orcid: 0000-0001-7349-9517; Delvin, Edgard; McCaddon, Andrew; Ahmadi, Kourosh R.; Harrington, Dominic J.; orcid: 0000-0003-4786-9240 (Informa UK Limited, 2021-04-21)
  • Toward ‘Vaccine Internationalism’: The Need for an Equitable and Coordinated Global Vaccination Approach to Effectively Combat COVID-19

    Wong, Brian L. H.; email:; Green, Manfred S.; reid, John; Martin-Moreno, Jose M.; Davidovitch, Nadav; Chambaud, Laurent; Leighton, Lore; Sheek-Hussein, Mohamud; Dhonkal, Ranjeet; Otok, Robert; et al. (Frontiers Media S.A., 2021-04-14)
  • Physiological Characteristics of Female Soccer Players and Health and Performance Considerations: A Narrative Review.

    Randell, Rebecca K; orcid: 0000-0003-1141-9766; email:; Clifford, Thomas; Drust, Barry; Moss, Samantha L; Unnithan, Viswanath B; De Ste Croix, Mark B A; Datson, Naomi; Martin, Daniel; Mayho, Hannah; Carter, James M; et al. (2021-04-12)
    Female soccer has seen a substantial rise in participation, as well as increased financial support from governing bodies over the last decade. Thus, there is an onus on researchers and medical departments to develop a better understanding of the physical characteristics and demands, and the health and performance needs of female soccer players. In this review, we discuss the current research, as well as the knowledge gaps, of six major topics: physical demands, talent identification, body composition, injury risk and prevention, health and nutrition. Data on female talent identification are scarce, and future studies need to elucidate the influence of relative age and maturation selection across age groups. Regarding the physical demands, more research is needed on the pattern of high-intensity sprinting during matches and the contribution of soccer-specific movements. Injuries are not uncommon in female soccer players, but targeting intrinsically modifiable factors with injury prevention programmes can reduce injury rates. The anthropometric and physical characteristics of female players are heterogeneous and setting specific targets should be discouraged in youth and sub-elite players. Menstrual cycle phase may influence performance and injury risk; however, there are few studies in soccer players. Nutrition plays a critical role in health and performance and ensuring adequate energy intake remains a priority. Despite recent progress, there is considerably less research in female than male soccer players. Many gaps in our understanding of how best to develop and manage the health and performance of female soccer players remain.
  • Design and finite element simulation of metal-core piezoelectric fiber/epoxy matrix composites for virus detection.

    Wang, Yinli; Shi, Yu; Narita, Fumio (2021-04-07)
    Undoubtedly, the coronavirus disease 2019 (COVID-19) has received the greatest concern with a global impact, and this situation will continue for a long period of time. Looking back in history, airborne transimission diseases have caused huge casualties several times. COVID-19 as a typical airborne disease caught our attention and reminded us of the importance of preventing such diseases. Therefore, this study focuses on finding a new way to guard against the spread of these diseases such as COVID-19. This paper studies the dynamic electromechanical response of metal-core piezoelectric fiber/epoxy matrix composites, designed as mass load sensors for virus detection, by numerical modelling. The dynamic electromechanical response is simulated by applying an alternating current (AC) electric field to make the composite vibrate. Furthermore, both concentrated and distributed loads are considered to assess the sensitivity of the biosensor during modelling of the combination of both biomarker and viruses. The design parameters of this sensor, such as the resonant frequency, the position and size of the biomarker, will be studied and optimized as the key values to determine the sensitivity of detection. The novelty of this work is to propose functional composites that can detect the viruses from changes of the output voltage instead of the resonant frequency change using piezoelectric sensor and piezoelectric actuator. The contribution of this detection method will significantly shorten the detection time as it avoids fast Fourier transform (FFT) or discrete Fourier transform (DFT). The outcome of this research offers a reliable numerical model to optimize the design of the proposed biosensor for virus detection, which will contribute to the production of high-performance piezoelectric biosensors in the future. [Abstract copyright: © 2021 Elsevier B.V. All rights reserved.]
  • Basil Lythgoe. 18 August 1913—18 April 2009

    Jones, J. C. (The Royal Society, 2021-03-03)
    Basil Lythgoe was distinguished as an organic chemist. He began his career at the University of Manchester, where he had studied for his undergraduate and PhD degrees, before moving to University of Cambridge. During this period he collaborated with Alexander Todd on the structural elucidation and total synthesis of the natural nucleosides, and was also noted for his investigation of the structure of the natural substance macrozamin. In 1953 he moved to the chair of organic chemistry at the University of Leeds, running a research group from which several graduate students went on to academic careers of the highest distinction. At Leeds he worked on the structure of the alkaloid taxine 1 and calciferol, among other natural substances. Lythgoe's work was characterized by a combination of insight and high experimental skill.
  • FTO gene–lifestyle interactions on serum adiponectin concentrations and central obesity in a Turkish population

    Isgin-Atici, Kubra; Alsulami, Sooad; Turan-Demirci, Busra; Surendran, Shelini; Sendur, Suleyman Nahit; Lay, Incilay; orcid: 0000-0002-1466-5746; Karabulut, Erdem; Ellahi, Basma; Lovegrove, Julie A.; Alikasifoglu, Mehmet; et al. (Informa UK Limited, 2020-08-04)
  • Reframing how we care for people with persistent non-traumatic musculoskeletal pain. Suggestions for the rehabilitation community

    Lewis, Jeremy S.; orcid: 0000-0001-7870-9165; Stokes, Emma K.; Gojanovic, Boris; orcid: 0000-0001-5075-9371; Gellatly, Pamela; orcid: 0000-0001-7401-2096; Mbada, Chidozie; orcid: 0000-0003-3666-7432; Sharma, Saurab; orcid: 0000-0002-9817-5372; Diener, Ina; orcid: 0000-0001-7426-4840; O’Sullivan, Peter
    There have been repeated calls to re-evaluate how clinicians provide care for people presenting with persistent non-traumatic musculoskeletal conditions. One suggestion is to move away from the ‘we can fix and cure you’ model to adopting an approach that is more consistent with approaches used when managing other persistent non-communicable diseases; education, advice, a major focus on self-management including lifestyle behavioural change, physical activity and medications as required. Currently the global delivery of musculoskeletal care has many of the elements of a ‘super wicked problem’, namely conflict of interest from stake-holders due to the consequences of change, prevailing expectation of a structural diagnosis and concomitant fix for musculoskeletal pain, persistent funding of high risk, more expensive care when low risk more economic viable options that don’t impact on the quality of outcome exist, and an unquestionable need to find a solution now with the failure resulting in a growing social and economic burden for future generations. To address these issues, 100 participants included clinicians, educators and researchers from low-, middle- and high-income countries, 8 presenters representing the physiotherapy, sport medicine and the orthopaedic professions and the insurance industry, together with 3 people who shared their lived experiences of persistent musculoskeletal pain, discussed the benefits and barriers of implementing change to address this problem. This paper presents the results from the stakeholders’ contextual analysis and forms the basis for the proposed next steps from an action and advocacy perspective.
  • Volatile Liquid Detection by Terahertz Technologies

    Baxter, Harry W; Worrall, Adam A; Pang, Jie; Chen, Riqing; email:; Yang, Bin; email: (Frontiers Media S.A., 2021-04-08)
    The prospect of being able to move through security without the inconvenience of separating liquids from bags is an exciting one for passengers, and there are important operational benefits for airports as well. Here, two terahertz (THz) systems, 100 GHz sub-THz line scanner and attenuation total reflection-based THz time domain spectroscopy (TDS), have been used to demonstrate the capability of identifying different liquid samples. Liquid samples’ THz complex permittivities are measured and their differences have contributed to the variation of 100 GHz 2D images of volatile liquids with different volumes inside of cannister bottles. The acquired attenuation images at 100 GHz can easily be used to distinguish highly absorbed liquids (Water, Ethanol, Fuel Treatment Chemicals) and low loss liquids (Petrol, Diesel, Kerosene and Universal Bottle Cleaner). The results give a promising feasibility for mm-wave imager and THz spectroscopy to efficiently identify different volatile liquids.
  • Evaluation of a ‘drop box’ doorstep assessment service to aid remote assessments for COVID-19 in general practice

    Irving, Greg; orcid: 0000-0002-9471-3700; Lawson, David; Tinsley, Adele; Parr, Helen; Whittaker, Cheryl; Jones, Hayley; Cox, Stephen (BMJ Publishing Group, 2021-03-28)
    COVID-19 is an established threat whose clinical features and epidemiology continues to evolve. In an effort to contain the disease, the National Health Service has adopted a digital first approach in UK general practice resulting in a significant shift away from face-to-face consultations. Consequently, more consultations are being completed without obtaining objective recording of vital signs and face-to-face examination. Some regions have formed hot hubs to facilitate the review of suspected COVID-19 cases and keep their practice site ‘clean’ including the use of doorstep observations in avoiding the risk of face-to-face examination. To support the safe, effective and efficient remote assessment of suspected and confirmed patients with COVID-19, we established a doorstep assessment service to compliment telephone and video consultations. This allows physiological parameters such as temperature, pulse, blood pressure and oxygen saturation to be obtained to guide further triage. Quality improvement methods were used to integrate and optimise the doorstep assessment and measure the improvements made. The introduction of a doorstep assessment service increased the proportion of assessments for patients with suspected COVID-19 in routine care over weeks. At the same time we were able to dramatically reduce face-to-face assessment over a 6-week period by optimising through a range of measures including the introduction of a digital stethoscope. The majority of patients were managed by their own general practitioner following assessment supporting continuity of care. There were no adverse events during the period of observation; no staff absences related to COVID-19. Quality improvement methods have facilitated the successful integration of doorstep assessments into clinical care.

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