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The significance of isolated de novo red patches in the bladder in patients referred with suspected urinary tract cancer: results from the IDENTIFY study
Get PDFObjectives
To assess the contemporary malignancy rate in isolated de novo red patches in the bladder and associated risk factors for better selection of red patch biopsy.
Patients
Patients from the IDENTIFY dataset; Patients referred to secondary care with suspected urinary tract cancer and found to have isolated de novo red patches on cystoscopy.
Methods
We reported the unadjusted cancer prevalence in isolated de novo red patches that were biopsied; multivariable logistic regression was used to explore cancer-associated risk factors including age, sex, smoking, type of haematuria, LUTS, UTIs and a suspicious-looking red patch (as reported by the cystoscopist). Sub-analysis of these by clinical role and experience was performed.
Results
A total of 1110 patients with isolated de novo red patches were included. 41.5% (n = 461) were biopsied, with a malignancy rate of 12.8% (59/461), which was significantly higher in suspicious versus non-suspicious red patches (19.1% vs. 2.81%, p < 0.01). There was a significant association between bladder cancer and age (OR 1.04, 95% CI 1.01–1.07, p = 0.01), smoking history (OR 2.62, 95% CI 1.09–6.27, p = 0.03) and suspicious-looking patch (OR 6.50, 95% CI 2.47–17.1, p < 0.01). The majority of malignancies were in over 60-year-olds. Malignancy rates in suspicious versus non-suspicious red patches did not differ significantly between clinical roles or experiences.
Limitations included subjectivity in classifying a suspicious patch and selection bias as not all patches were biopsied.
Conclusions
Many patients still undergo unnecessary biopsies under general anaesthetic for isolated de novo red patches. Clinicians should consider the patient's age, smoking status and how suspicious-looking the patch is, before deciding on surveillance versus biopsy to improve cancer diagnostic yield
Probing SARS-CoV-2 membrane binding peptide via single-molecule AFM-based force spectroscopy
Get PDFThe SARS-CoV-2 spike protein’s membrane-binding domain bridges the viral and host cell membrane, a critical step in triggering membrane fusion. Here, we investigate how the SARS-CoV-2 spike protein interacts with host cell membranes, focusing on a membrane-binding peptide (MBP) located near the TMPRSS2 cleavage site. Through in vitro and computational studies, we examine both primed (TMPRSS2-cleaved) and unprimed versions of the MBP, as well as the influence of its conserved disulfide bridge on membrane binding. Our results show that the MBP preferentially associates with cholesterol-rich membranes, and we find that cholesterol depletion significantly reduces viral infectivity. Furthermore, we observe that the disulfide bridge stabilizes the MBP’s interaction with the membrane, suggesting a structural role in viral entry. Together, these findings highlight the importance of membrane composition and peptide structure in SARS-CoV-2 infectivity and suggest that targeting the disulfide bridge could provide a therapeutic strategy against infection
Novel fibre-rich breads yield improved glucose release curves and are well accepted by children in primary school breakfast clubs
Get PDFBackground: The average fibre consumption of 4–10-year-old children in the UK is 14.6 g per day, with only 14% of these children reaching the 20 g recommended by the SACN (UK Scientific Advisory Committee on Nutrition), and this ‘fibre gap’ may be most pronounced in communities with the lowest socioeconomic status. School breakfast clubs target children from disadvantaged communities, but their provision may favour lower-fibre foods, due to perceptions that children will reject higher-fibre foods. Our research programme aims to increase the fibre density, digestive-metabolic quality and acceptability of school breakfast provision. Methods: In Study 1, we examined the in vitro digestion of four novel bread products, to determine the relationship between fibre content and glucose release profile, and assess their suitability for sustaining school activity. In Study 2, we introduced the Prograins breads, alongside higher-fibre breakfast cereals and fresh fruit, to primary school breakfast clubs. Results: The Prograins bread products yielded lower peaks and more sustained glucose release curves than the ‘standard’ white bread control. Many children liked and chose the intervention foods, and the average fibre content of children’s breakfasts increased. Conclusions: We conclude from this study that nutritious, fibre-rich bread products can be acceptable to children and that higher-fibre breakfast provision is feasible, and we recommend larger-scale intervention and assessment to validate these real-world findings
Evaluation of the Sensory Friendly Ward Project
Get PDFThis evaluation aimed to test the proposals of the Sensory Friendly Inpatient Environments project within a range of high dependency adult mental health services across Leeds and Bradford. This project was a collaboration between Bradford District Care NHS Foundation Trust and Advonet / Autism AIM to improve the sensory experience of inpatient mental health wards through dedicated roles, resources, lived experience input, training, pathways and procedures
Changing food waste regimes in Africa’s transition to export-oriented production: the case of Tanzanian avocado
Get PDFAfrican nations are increasingly focusing on exporting high-value crops. However, a major challenge exists: high rates of food waste within supply chains. The problem is often seen as a technological issue—a lack of proper infrastructure and coordination creates inefficiencies. This research takes a different perspective, focusing on social relations within the supply chain. It uses the concept of “food waste regimes” to understand the underlying structures, relationships, and systems that cause food waste, with a focus on Tanzania’s avocado trade. The goals of the research are to: (1) Identify the factors contributing to food waste within Tanzania’s avocado supply chains, particularly in the context of export-oriented production; (2) Explore how these factors change as production shifts towards exports; (3) Analyse the fairness (equity) of how waste burdens are distributed among those involved. We adopted a “follow the thing” approach, combining interviews and observations across both domestic and export avocado supply chains in Tanzania. The research reveals that interactions between various aspects of the supply chain—practices, physical properties of the product (avocado perishability), and established institutions—influence where food waste occurs and who shoulders the burden of that waste. The research exposes how unequal power dynamics between participants lead to some actors bearing a disproportionate amount of the risk and cost of food waste. By taking a social relations approach, this research highlights that tackling food waste and social inequality are intertwined issues. The paper suggests potential areas for future research and intervention to address these interconnected challenges
Providing an e-cigarette starter kit for smoking cessation and reduction as adjunct to usual care to smokers with a mental health condition:findings from the ESCAPE feasibility study
Get PDFBACKGROUND: Smoking rates in the UK have declined steadily over the past decades, masking considerable inequalities, as little change has been observed among people with a mental health condition. This trial sought to assess the feasibility and acceptability of supplying an electronic cigarette (e-cigarette) starter kit for smoking cessation as an adjunct to usual care for smoking cessation, to smokers with a mental health condition treated in the community, to inform a future effectiveness trial. METHODS: This randomised controlled feasibility trial, conducted March-December 2022, compared the intervention (e-cigarette starter kit with a corresponding information leaflet and demonstration with Very Brief Advice) with a 'usual care' control at 1-month follow-up. Participants were ≥ 18 years, receiving treatment for any mental health condition in primary or secondary care in three Mental Health Trusts in Yorkshire and one in London, UK. They were also willing to address their smoking through either cessation or reduction of cigarette consumption. The agreed primary outcome measure was feasibility (consent ~ 15% of eligible participants; attrition rate < 30%). Acceptability, validated sustained abstinence and ≥ 50% cigarette consumption reduction at 1-month, were also evaluated and qualitative interviews conducted to further explore acceptability in this population. RESULTS: Feasibility targets were partially met; of 201 eligible participants, 43 (mean age = 45.2, SD = 12.7; 39.5% female) were recruited (21.4%) and randomised (intervention:48.8%, n = 21; control:51.2%, n = 22). Attrition rate was 37.2% at 1-month follow-up and was higher (45.5%) in the control group. At follow-up (n = 27), 93.3% (n = 14) in the intervention group and 25.0% (n = 3) in the control group reported e-cigarette use. The intervention was well received with minimal negative effects. In intention-to-treat analysis, validated sustained abstinence at 1-month was 2/21 (9.5%) and 0/22 (0%) and at least 50% reduction in cigarette consumption 13/21 (61.9%) and 3/22 (13.6%), for the intervention and control group, respectively. Qualitative analysis of participant interviews (N = 5) showed the intervention was broadly acceptable, but they also highlighted areas of improvements for the intervention and trial delivery. CONCLUSIONS: Offering an e-cigarette starter kit to smokers with a mental health condition treated in the community was acceptable and largely feasible, with harm reduction outcomes (i.e. switching from cigarette smoking to e-cigarette use and substantial reduction in cigarette consumption) favouring the intervention. The findings of the study will be used to help inform the design of a main trial. TRIAL REGISTRATION: Registry: ISRCTN. REGISTRATION NUMBER: ISRCTN17691451. Date of registration: 30/09/2021
Wavelet‐Based Stochastic Model for the Generation of Fully Nonstationary Bidirectional Seismic Accelerograms
Get PDFA new stochastic methodology is proposed for the generation of bidirectional horizontal components of artificial, fully nonstationary, site- and spectrum-compatible seismic accelerograms through a nonseparable process. The model operates in the time-frequency domain and combines spectral representation techniques with signal processing tools. The basis of the methodology involves the generation of spectrum-compatible stationary artificial accelerogram signals whose nonstationarity is then modeled with a time-frequency modulating function that is based on a seed ground motion record. At the core of the proposed methodology lies the use of the Continuous Wavelet Transform (CWT). Specifically, the CWT method is used to perform time-frequency analysis and to define the nonstationary component. The proposed methodology provides any required number of seismic accelerograms whose temporal and spectral modulation is consistent with the characteristics of the site of interest. Furthermore, the model is extended to the case of pairs of bidirectional horizontal components. This is accomplished by probabilistically generating two orthogonal spectra whose geometric mean spectrum is compatible with a target spectrum. This procedure also takes into account the correlation structure of spectral acceleration pairs in orthogonal directions at different periods based on empirical models. The bidirectional components are then generated with the proposed site and spectrum-based methodology. An online tool that implements the proposed methodology is freely provided
Modelling the effects of vegetation and urban form on air quality in real urban environments: A systematic review of measurements, methods, and predictions
Get PDFAir pollution poses a significant threat to public health and well-being. In recent decades, researchers have used direct measurements and predictive modelling to assess urban air quality. However, the impact of vegetation and urban form on air quality remains uncertain, particularly regarding their interconnected roles. This paper systematically reviews studies on real urban environments, focusing on how vegetation and urban form influence air quality assessment and prediction. It highlights key variables and their importance, as reported in the literature, and identifies areas needing further research to improve predictions of vegetation’s effects on urban air quality in relation to urban morphology
What doesn’t kill you makes you stronger? Examining relationships between early-life stress, later-life inflammation and mortality risk in skeletal remains
Get PDFObjectives
This paper explores conflicting perspectives on the adaptive significance of phenotypic plasticity during fetal and early postnatal development and the impact that stressors experienced during this critical early-life period have on later-life morbidity and mortality risk.
Methods
The sample (n = 216) comprised archeologically-recovered human skeletons. A geometric morphometric (GM) method was employed to evaluate first permanent molar (M1) fluctuating asymmetry (FA) and provide a proxy for early-life stress. Shifts in later-life physiology were inferred through two inflammatory lesions: periosteal new bone formation (PNBF) and periodontal disease (PD). To explore mortality risk, age-at-death was estimated through dental development for skeletally immature individuals (n = 104) and through senescent skeletal changes for mature skeletons (n = 112).
Results
Significant differences were found in M1 FA between groups, with the immature cohort associated with elevated FA. Within-group analysis revealed age-at-death in the immature group had a significant positive relationship with M1 FA and PD presence. In the mature group, alongside sex and the co-occurrence of PD and PNBF, FA was a significant predictor of a shorter life. Higher FA was also associated with active and bilaterally expressed PNBF.
Conclusions
It is theorized that early-life stress, if survived, programmed a hyperinflammatory response to environmentally-mediated physiological perturbations which increased the chances of survival during subsequent development but also elevated later-life mortality risk. Findings demonstrate a complicated relationship between developmental stress and physiological shifts that helps to illustrate the adaptive significance of early-life programming and support the Thrifty Phenotype hypothesis
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