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True fertilisation failure in captivity is rare
Get PDFSpecies recovery through captive breeding can be hindered by low reproductive success. However, we know little about the drivers of early reproductive failure in captive populations, due to difficulties distinguishing fertilisation failure from early embryo mortality in most animals. Here, we apply advanced fertility diagnostics on unhatched eggs from 30 avian captive-breeding programs, to assess true rates of fertilisation failure. We find that fertilisation failure is rare across all species, and the main driver of early reproductive failure is early embryo mortality. We also find that macroscopic examination of undeveloped eggs inflates estimates of fertilisation failure rates in breeding programmes. Finally, we find no evidence that fertilisation failure rates are higher in threatened than non-threatened captive birds, providing hope that with careful management, hatching outcomes may be improved in threatened captive populations. Our results show that accurate fertility diagnosis in managed oviparous species provides crucial information on individual reproductive potential, helping the design of more appropriate management interventions to improve recovery
Perioperative Quality Initiative consensus statement recommendations on the definition, development, implementation and outcomes of pre-operative surgery schools
Get PDFIntroduction
Pre-operative group sessions incorporating patient education and behaviour change interventions, known as ‘surgery schools’, are becoming increasingly common before major elective surgery across the world. However, there is a lack of conclusive evidence regarding the effectiveness of surgery schools, and the development and delivery of these complex interventions lacks standardisation.
Methods
In collaboration with the Perioperative Quality Initiative, we aimed to develop evidence- and expertise-based consensus statements and recommendations regarding the definition, design, content, and outcomes of surgery schools. Thirty-two international multidisciplinary experts in surgery school and pre-operative preparation attended a series of virtual meetings based on a modified Delphi methodology. A systematic review and additional targeted literature searches were used to propose statements for the definition, design, content and outcomes of surgery schools. Statements and recommendations were discussed iteratively and refined in multiple rounds, until agreement was reached.
Results
Consensus was reached on a definition of surgery school, as well as three statements and 18 recommendations in relation to: scope; outcomes; intervention development; delivery; inclusivity; and educational content of surgery schools. Seventeen areas were highlighted as priorities for future research.
Discussion
These consensus statements and recommendations are intended to help clinicians and service managers who plan to develop and implement surgery schools. They may improve the quality of those programmes and help to standardise their content. We also hope that this work will influence government strategy and policy in relation to the design, delivery and funding of peri-operative optimisation pathways
Local anaesthetic thoracoscopy practice in the United Kingdom in 2024 - a snapshot survey
No full textIntroduction: Local anaesthetic thoracoscopy (LAT) is widely available in the United Kingdom (UK). It is often the investigation of choice for unexplained exudative pleural effusions. There are no agreed national standards regarding LAT, with many sites following locally developed guidelines. The last survey of UK practice was in 2017. Methods: An electronic survey was circulated to UK Pleural Society (UKPS) members and through direct communication with centres known to be undertaking LAT. Invited centres were requested to distribute the survey further. Results: 37 responses were included. LAT remains the preferred investigation for an undiagnosed exudative pleural effusion (32/37, 87%). The number of trained thoracoscopists ranged from 1 to 6. Thirty centres (81%) had dedicated thoracoscopy lists with varying frequency. Nineteen (51%) centres routinely admitted patients post thoracoscopy (compared to 76% in 2017). Thirty centres (81%) did not routinely administer antibiotics. Thirty-five centres (95%) routinely used sedation, the commonest agent being midazolam, typically in combination with an opiate. Eleven centres (30%) utilised other pre-medications, whilst 8/37 (22%) of centres administered intravenous fluids. Where a minimal effusion is present 27/37 (73%) would induce a pneumothorax. Eleven (29%) centres would perform LAT for pleural infection. Only 11/37 (30%) of centres have on-site thoracic surgical support. Conclusions: There is wide variation in LAT practice amongst UK centres. These results support the need for identifying best practice and standardisation of LAT practices, with outcome reporting. These survey results will form the basis of applications to the national and international respiratory societies to develop relevant standards
Magnitude, structure and associated factors of illicit cigarette sales in Bangladesh:a pack analysis
Get PDFINTRODUCTION: Bangladesh's cigarette smoking prevalence remained unchanged (around 14%) between 2009 and 2017. Through tax evasion and regulatory non-compliance, illicit trade might have contributed to the status quo. Little is known about the magnitude of illicit cigarettes in Bangladesh. METHODS: We analysed empty cigarette packs collected from retailers and street litter in eight districts in Bangladesh between December 2019 and January 2020. We examined tax stamps on packs to assess tax evasion and printed health warnings, retail prices, sales declarations, misleading descriptors, and duty-free signs to determine packaging law compliance. All but tax-paid and compliant packs were considered illicit. We examined associations between tax evasion and price or non-price factors. Sensitivity and specificity of packaging compliance were measured when used as a proxy for tax evasion. RESULTS: Among 24 363 cigarette packs examined from sampled districts in Bangladesh (23 207 from shops and 1156 from litter), 5.32% (95% CI: 5.04% to 5.60%) evaded taxes, while only 0.77% (95% CI: 0.4% to 1.4%) were non-compliant with packaging laws, totalling 5.62% (95% CI: 4.3% to 7.1%) illicit share. This neither differed statistically significantly between packs collected from shops (5.47%; 95% CI: 4.2% to 7.0%) and those from litter (8.13%; 95% CI: 5.7% to 11.1%) nor between urban (5.15%; 95% CI: 3.5% to 7.3%) and rural (6.16%; 95% CI: 4.2% to 8.7%) areas. Low-price cigarettes (OR: 3.48; 95% CI: 2.10 to 5.75) and those sold in unconventional shops (OR: 1.99; 95% CI: 1.12 to 3.54) were more likely to be tax evaded than high-price cigarettes and those sold in formal shops, respectively. Packaging non-compliance was not a sensitive marker for detecting tax-evaded cigarettes. CONCLUSIONS: Bangladesh has a low share of illicit cigarette packs. While surveillance of the illicit cigarette trade is essential, the government should continue to enhance cigarette taxes without concern for its effect on the illicit trade
The Mutability of Cultural Value: A Critical Analysis
Get PDFThe contemporary cultural value debate has been broadly UK-driven, albeit with European and international dimensions. However, the Covid-19 pandemic and the subsequent focus on sector working conditions has raised urgent questions about the social role and impact of the arts. Starting from the premise that questions of cultural value are subjective, political, and highly contextualised, this article contextualises the debate on cultural value within cultural policy discourse in Ireland and questions the extent to which the concept of cultural value and its related debates are mutable in different national contexts. The article discusses key themes of cultural value in Ireland such as intrinsic value and how identity categories (particularly Irish national identities manifested through culture) co-exist in the specific context of a post-colonial country. Highlighting the significance of data, evaluation, inequality and national identity to evolving notions of cultural value, the article explores the mutability of cultural value across nations
Conversations on participatory heritage praxis:Insights from Thailand, the United Kingdom and Norway
Get PDFDevelopment of a unified system for assessing health related quality of life across the cancer care continuum: the EUonQoL Delphi study to identify priorities for quality of life domains
Get PDFIntroduction
Cancer and cancer treatment have a major impact on health related quality of life (HRQoL). To improve the assessment of HRQoL in patients with cancer and evaluate the impact of policy interventions, the European Oncology Quality of Life (EUonQoL) project aims at developing a digital, patient centred system to assess HRQoL based on evaluations and preferences of cancer patients and survivors: the EUonQoL-kit.
Method
Patients across the cancer care continuum, healthcare professionals and researchers from six European countries (Denmark, France, Germany, Italy, The Netherlands and United Kingdom) were asked to rate the importance of 44 pre-selected HRQoL subdomains over a maximum of three Delphi survey rounds. We evaluated the importance of HRQoL subdomains for three target populations: patients undergoing active treatment, cancer survivors and patients receiving palliative care. The results were discussed during a consensus meeting.
Results
96 patients and 59 healthcare professionals participated in the Delphi study. After three rounds, consensus was reached for 20 subdomains: ability to work, communication with healthcare professionals, diarrhoea, fatigue, fear of recurrence, global health status, impact of treatment side effects, impact on children/family, insomnia, instrumental activities of daily living, maintaining independence, mobility, nausea, overall quality of life, pain, partner relationship, social activity limitations, social isolation, symptom awareness and uncertain prognosis. The subdomains pain and fear of recurrence were rated as important for all three target populations.
Conclusion
Subdomains that were considered important for the assessment of HRQoL in patients with cancer can be summarised into: physical symptoms, mobility & activity, future outlook, social roles & activities, family & relationships, social isolation, self-efficacy, overall HRQoL, and healthcare experience. The importance of the subdomains differed for patients in different phases of the cancer care continuum. These findings were used for the creation of the first version of the EUonQoL-Kit, as a base for its further development
Perceived discrimination in healthcare settings is associated with medication side-effects and adherence: a cross-sectional survey representing the four largest ethnic groups in the UK
Get PDFMany medication side effects are the result of negative patient expectations rather than the pharmacological action of the drugs, thus triggering a “nocebo effect.” Negative expectations can be generated by contextual factors that contribute to the perceived quality of care. Research shows that perceived discrimination in healthcare settings among Black, Asian, and other Minority Ethnic (BAME) groups is associated with lower perceived quality of care. Yet, no work has considered whether perceived discrimination contributes to experiences of nocebo effects among BAME groups, leading to potentially poorer medication adherence and health outcomes. We conducted an online cross-sectional survey of 801 participants representing the four largest UK racial/ethnic groups (Asian, Black, Mixed, and White) who had been prescribed a new medication in a general practitioner (GP) consultation in the previous 6 months. Participants’ perceived discrimination during their GP consultation was significantly and positively associated with their side-effect experience, and significantly and negatively associated with their adherence to the prescribed medication, with side-effect expectations significantly mediating these relationships. There was a significant interaction between ethnicity and perceived discrimination: participants who identified as mixed race were less likely to report side effects than White participants who experienced the same level of discrimination. Future longitudinal studies are needed to confirm the identified causal relationships and to explore the types of perceived discrimination BAME individuals are experiencing in health care to help develop interventions to reduce nocebo effects
Coeval Transverse and Axial Sediment Delivery to the Northern Hikurangi Trough During the Late Quaternary
Get PDFSubduction trenches receive sediment from sediment gravity flows sourced from transverse pathways and trench parallel axial transport pathways. Understanding the interplay between axial and transverse sediment transport in shaping stratigraphic architectures is hindered by the episodic nature of sedimentary gravity flows and limited datasets, yet such insights are crucial for reconstructing sedimentary flow pathways and interpreting sedimentary records. We investigate sediment routing pathways to the northern Hikurangi Trough of New Zealand using a combination of multibeam, 2D and 3D seismic reflection and International Ocean Discovery Program core data from Site U1520. Site U1520's location downstream of axial and transverse conduits of sediment delivery makes it an excellent location to observe how these processes interact in deep marine settings. We characterise regional basin floor geomorphology and sub-surface architecture of the upper ~110 m siliciclastic sequence of the Hikurangi Trough deposited over the past ~42 ka (Seismic Unit 1; SU1). Sediment delivery to the trough is fed by sediment gravity flows sourced from both the shelf-incising transverse Māhia Canyon to the south-west and the axial Hikurangi Channel to the south. Flows sourced from these systems have a strong influence on the geomorphology of the region and are responsible for forming large-scale bathymetric features such as erosional scours and sediment waves. Sedimentary features identified within SU1 indicate that sediment transport via the transverse Māhia Canyon was more significant than that of the axial Hikurangi Channel throughout the last 42 ka, particularly during the last glacial period when sea levels were lower, and sedimentation rates were extremely high (up to ~20 m/kyr). This study emphasises the need for a nuanced consideration of transverse and axial systems and how they may influence sediment records and the geomorphic characteristics of trench systems
The wear measurement of journal bearing coatings that are poor reflectors using ultrasound analytical signals
Get PDFIn journal bearings, the soft coatings are designed to facilitate running in and served as a low friction sacrificial layer in case of lubricant starvation. Ultrasound methods have shown the feasibility for in-situ monitoring of the coatings acoustically dissimilar to the bearing shell substrate. However, some coating materials, notably bronze alloys, always show a low acoustic reflection at coating-substrate interface. This paper proposes a “Reflection Package” analysis method based on Hilbert transform and analytical signal to measure the thickness and wear of coatings with low acoustic reflection interface. Finite element simulations were performed to study ultrasound behaviour in this case. For experimental validation, the journal bearing shells with 250 μm bronze-lead alloy (Cu-Pb) coating were subjected to ultrasound inspection under various conditions, including dry-running, excessive dry-running and in-situ condition. The wear depth was obtained by comparing the thickness before and after operation and the dynamic wear progression was demonstrated for these in-situ tests. Compared to microscopic results from sectioned bearings, ultrasound results were generally accurate to within ±15 μm. This study provides a method for measuring bearing wear during real-time operation, especially when the acoustic impedance of the coating is similar to that of the bearing steel. It broadens the ultrasound wear measurement of various materials and has the potential to be applied to the safety monitoring of rotating components in important or inaccessible structures
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