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P324: Case Report: Rare Metastasis of Renal Cell Carcinoma to the Breast – A Diagnostic and Management Challenge
Get PDFOCULAR FINDINGS IN SLOTH BEARS (MELURSUS URSINUS) RESCUED FROM THE DANCING BEAR TRADE IN INDIA
Get PDFThe aim of this study was to descriptively characterize the ophthalmic findings identified in 43 adult sloth bears (Melursus ursinus) rescued from the dancing bear trade in India and examined at two sloth bear rehabilitation centers in Agra and Bannerghatta nr. Bangalore. Animals were selected where ocular disease was suspected except for two bears which were examined while anesthetized for other reasons (fight wound, health check). Full ophthalmic examinations were undertaken under general anesthesia. Ocular ultrasonography, electroretinography, and photography were also performed. Forty-three bears (86 eyes) were examined. Mean Schirmer tear test (STT) = 12+/–6.2 (median 12, 95% CI –0.4–24.4) mm/min. Mean intraocular pressure (IOP) = 11.4+/–3.7 (median 12, 95% CI 4–18.8) mmHg excluding phthisical or grossly hydrophthalmic eyes. Ocular disease perceived to result in uni- or bilateral blindness was common (35 bears) with one or more of the following: phthisis bulbi (19 eyes; 13 bears), cataract (28 eyes; 17 bears), retinal detachment (29 eyes; 21 bears), and retinal degeneration (19 eyes; 16 bears) recorded frequently. Ocular ultrasound recorded mean axial globe diameter in non-phthisical/non-hydrophthalmic eyes as 16.5 +/–1.4 (median 16.4, 95% CI 13.7–19.3) mm and mean axial lens diameter of 4.9 +/–0.1 (median 4.7, 95% CI 4.7–5.1) mm. Blinding ocular disease was common, in particular, phthisis bulbi, retinal degeneration, and retinal detachment. Retinal detachment and phthisis bulbi may relate to blunt force ocular trauma prior to rescue, but ocular tuberculosis (TB) cannot be excluded, and retinal degeneration could result from a poor diet prior to rescue
Enhancing Trace DNA Profile Recovery in Forensic Casework Using the Amplicon RX Post-PCR Clean-up Kit
Get PDFThis study evaluated the effectiveness of the amplicon RX post-PCR clean-up kit in enhancing trace DNA profile recovery from forensic casework samples amplified using the GlobalFiler PCR amplification kit. The impact of post-PCR clean-up on allele recovery and signal intensity was assessed in both trace casework samples and control samples across a range of DNA concentrations. The results showed that the amplicon RX method significantly improved allele recovery compared to the 29-cycle protocol (p = 8.30 × 10−12) and achieved slightly better results than the 30-cycle protocol (p = 0.019). Additionally, the Amplicon RX method demonstrated a significant increase in signal intensity (p = 2.70 × 10−4), reflecting improved sensitivity in detecting trace DNA profiles compared to the 30-cycle protocol. In the evaluation of control samples, the amplicon RX method consistently outperformed both the 29- and 30-cycle protocols, especially at lower DNA concentrations (D3: 0.001 ng/µL). While the performance of all methods declined at the lowest concentration (D4: 0.0001 ng/µL), the Amplicon RX method still demonstrated superior allele recovery (p = 0.014 compared to 29 cycles; p = 0.011 compared to 30 cycles). Therefore, the Amplicon RX method should be widely adopted in forensic laboratories to enhance the analysis of extremely low-template and compromised samples. These findings highlight the potential of the amplicon RX post-PCR clean-up kit to improve trace DNA analysis in forensic casework. Further research is recommended to validate these results and explore its broader application in forensic DNA analysis, particularly in complex DNA mixtures and extremely low-template samples
165 Engagement with splints and orthotics in stroke survivors - the development of a project protocol
No full textPurpose: The service received funding from Stroke Quality Improvement in Rehabilitation (SQuIRe) in 2023 to set up a neurological splinting and orthotics service for stroke patients. The aim of the service evaluation is to understand the factors that influence engagement with splints and orthotics in stroke survivors. Despite recommendations in clinical guidelines (National Clinical Guidelines for Stroke, 2023 and Royal College of Physician Spasticity Guidelines, 2018), clinical experience indicates that continued use of splints and orthotics is variable amongst patients. The objective is to explore the experiences of service users when using their splints and orthotics and identify barriers and facilitators to engagement.
It is anticipated that the findings from the project could help reduce long term complications such as the development of contractures, pain, and pressure ulcers and to maintain independence with walking, transfers, and activities of daily living. Thereby assisting stroke survivors to maintain their independence, reduce carer strain and reduce financial burden to the individual and wider health and social sectors.
Methods: A literature search, Patient and Public Involvement (PPI) group and a Health Inequalities Assessment Toolkit (HIAT) were employed to design the project protocol. The literature search identified previous research studies that investigated the barriers and facilitators of general self-management after stroke and examined current knowledge on the influences upon splint and orthotic use in stroke. This was used to identify the gaps in current research base and develop aims and objectives. A PPI group assisted in the co-production of the protocol by advising on areas such as study design, interview questions and easy read materials. The HIAT integrated an equity lens into the design of the project, including participant recruitment, sampling, and choice of research methods. It explored the health inequalities which could affect participants.
Results: Service users with a diagnosis of stroke who have been wearing a splint and/or orthotic for at least 2 months will be included in the service evaluation. Potential participants who meet the criteria will be approached by their treating clinician and provided with information about the project. After completing the consent process and contextual information survey participants will be interviewed in their own homes or online.
The service evaluation will undertake an interpretative qualitative approach. Semi structured interviews based on the constructs of Bandura’s Social Cognitive Theory will be used to develop a deeper understanding of the barriers and facilitators to splint and orthotic engagement in stroke survivors. A survey will collect protected characteristics to assist in understanding the social determinants of health and health inequalities affecting the participants. This will also support purposeful sampling and ensure that all characteristics are represented within the project.
Ethical approval has been achieved from University of Central Lancashire.
Conclusion(s): Following ethical approval recruitment of participants has commenced and participant interviews are currently being arranged. The aim is to recruit between 10-12 participants for interview, and complete framework analysis of the findings within 6 months.
Impact: It is anticipated that the results will help provide insight into engagement with splints and orthotics and facilitate service design locally
200 - Behaviour change approaches within digital health technology-based interventions to facilitate early upper limb rehabilitation post stroke: a scoping review
No full textPurpose: Digital health technologies (DHTs) have the potential to support individuals to make changes to their behaviour in the early months following a stroke that will enable engagement with the intensive upper limb rehabilitation that is crucial to their recovery. In the absence of review literature in this area this scoping review aimed to identify and explore the use of behaviour change approaches in DHT-based interventions for upper limb rehabilitation in the first six months after stroke.
Methods: A scoping review was completed in line with current guidelines. A multi-database search was undertaken, using terms relating to behaviour change, DHT, physical rehabilitation, stroke and upper limb. Sources were screened independently by two reviewers against pre-defined eligibility criteria. These included participants who had experienced a stroke in the last six months and the use of a DHT for an upper limb rehabilitation intervention which incorporated a behaviour change approach. Sources were appraised for overall quality. Data was charted from the sources and included the study design and detail about the intervention with a focus on the DHT and behaviour change approaches. The behaviour change technique taxonomy version 1 (BCTTv1) was used to identify and code specific behaviour change techniques. Findings were synthesised using descriptive statistics and presented as text, tables and figures.
Results: Eight of the 809 sources screened (1%) were included in the review. All the sources were experimental studies (8/8, 100%) and three quarters (6/8, 75%) were feasibility studies. Studies had features indicating quality, but common weaknesses were noted. The most frequently identified DHTs were activity monitors (4/8, 50%) and virtual reality (VR) (4/8, 50%). No studies (0/8, 0%) reported a theory, model, or framework for behaviour change. All interventions used the BCTTv1 cluster of feedback and monitoring (8/8, 100%). The most frequent clusters used in activity monitors were feedback and monitoring (4/11, 36%), goals and planning (3/11, 27%) and associations (3/11, 27%), whereas for VR they were feedback and monitoring (4/14, 29%) and reward and threat (4/14, 29%).
Conclusion(s): This scoping review identifies that evidence surrounding the use of behaviour change approaches in DHT-based interventions for upper limb rehabilitation in the first six months after stroke is limited despite the importance of early and intensive rehabilitation and the potential for DHTs to influence behaviour change. Within all the identified sources BCTs associated with feedback and monitoring were identified however none reported underpinning theory. Further research is needed to identify and understand how DHTs can best influence behaviour change in order to optimise early upper limb rehabilitation following a stroke.
Impact: This review raises awareness of the limited evidence about DHT-based interventions in early upper limb stroke rehabilitation which incorporate approaches to change behaviour. This is an important consideration for clinicians at a time when they are being encouraged to move towards DHT-based interventions at pace and are looking for innovative ways to increase the intensity of upper limb rehabilitation without increasing the burden on limited staffing resources
TERT promoter mutations in gliomas: Molecular roles in tumorigenesis, metastasis, diagnosis, prognosis, therapeutic targeting, and drug resistance
No full textTelomerase reverse transcriptase (TERT), a critical player in cellular immortalization, has emerged as a focal point of investigation due to its frequent promoter mutations in various human malignancies. TERT promoter mutations exhibit a significant role in tumorigenesis, fostering unbridled cellular proliferation and survival. This comprehensive review delves into the landscape of TERT promoter mutations and their profound implications in cancer, particularly within the context of gliomas. This article meticulously examines the intricate interplay between TERT promoter mutations and the metastatic cascade, shedding light on their capacity to orchestrate invasive behavior in gliomas. Moreover, this review describes the recent trends in therapeutic targeting of the TERT and dissects the evolving landscape of drug resistance associated with TERT mutations, providing insights into potential therapeutic challenges. In addition, the diagnostic and prognostic implications of TERT promoter mutations in gliomas are scrutinized, unraveling their potential as robust biomarkers. It also discusses the recent advancements in molecular diagnostics, illustrating the promise of TERT mutations as diagnostic tools and prognostic indicators. This review collectively aims to contribute to a deeper understanding of TERT promoter mutations in gliomas, offering a foundation for future research endeavors and paving the way for innovative strategies in glioma management
South-Italian Youth in North-West England: Constructing the “Good Migrant” alongside the “Good Adult”?
No full textThis chapter explores the identity construction dynamics that take place among young South-Italians living in North-West England: it looks, in particular, at these youths’ processes of becoming and embedding. Based on semi-structured interviews with young South-Italians in Preston (Lancashire), the chapter contributes to the literature on youth transitions and post-2008 intra-European migrations, emphasising the interconnectedness of migration and becoming. The chapter shows how these youths’ emerging adulthood and their embedding in the host society have been shaped by the local field of Italian migration and by the models of “good adult” and “good migrant” circulating within it. South-Italians constructed their identities as “good adults” and “good migrants” in response to the conduct of “other Italians”, who were considered to be bad models of becoming and embedding. Being a “good migrant” and a “good emerging adult” meant displaying a work ethic, an existential sense of purpose, and commitment to the host society: these practices and values contrasted with the alleged immaturity, precariousness, and stagnation of “other Italians”. Such identity construction processes resulted in the diversification and the conflictual reshaping of the local field of Italian migration and produced an ambiguous and contrasted adjustment to the neoliberal order of migration in Europe
Anatomic versus reverse total shoulder replacement for patients with osteoarthritis and intact rotator cuff: the RAPSODI-UK randomised controlled trial protocol
No full textIntroduction: Shoulder osteoarthritis most commonly affects older adults, causing pain, reduced function and quality of life. Total shoulder replacements (TSRs) are indicated once other non-surgical options no longer provide adequate pain relief. Two main types of TSRs are widely used: anatomic TSR (aTSR) and reverse TSR (rTSR). It is not clear whether one TSR type provides better short- or long-term outcomes for patients, and which, if either, is more cost-effective for the National Health Service (NHS). Methods and analysis: RAPSODI-UK is a multi-centre, pragmatic, two-parallel arm, superiority randomised controlled trial comparing the clinical- and cost-effectiveness of aTSR versus rTSR for adults aged 60+ with a primary diagnosis of osteoarthritis, an intact rotator cuff and bone stock suitable for TSR. Participants in both arms of the trial will receive usual post-operative rehabilitation. We aim to recruit 430 participants from approximately 28 NHS sites across the UK. The primary outcome is the Shoulder Pain and Disability Index (SPADI) at 2 years post-randomisation. Outcomes will be collected at 3, 6, 12, 18 and 24 months after randomisation. Secondary outcomes include the pain and function subscales of the SPADI, the Oxford Shoulder Score, health-related quality of life (EQ-5D-5L), complications, range of movement and strength, revisions and mortality. The between-group difference in the primary outcome will be derived from a constrained longitudinal data analysis model. We will also undertake a full health economic evaluation and conduct qualitative interviews to explore perceptions of acceptability of the two types of TSR and experiences of recovery with a sample of participants. Ethics and dissemination: Ethics committee approval for this trial was obtained (London - Queen Square Research Ethics Committee, Rec Reference 22/LO/0617) on 4 October 2022. The results of the main trial will be submitted for publication in a peer-reviewed journal and using other professional and media outlets. Trial registration number: ISRCTN12216466
Experimental and RSM-based optimization of sustainable concrete properties using glass powder and rubber fine aggregates as partial replacements
No full textTo promote sustainability in concrete production, this study investigates the combined use of glass powder (GP) and rubber fine aggregates (RF) as partial replacements for cement and natural fine aggregates (NF), respectively. The study aligns with several Sustainable Development Goals (SDGs). Ten mixtures were developed using Central Composite Design (CCD) within the Response Surface Methodology (RSM) framework, with GP and RF replacement levels ranging from 0 % to 35 %. Replacing cement with 15 % GP improved compressive strength, tensile strength, and stiffness due to pozzolanic reactivity and packing effects, while higher levels (25–35 %) reduced performance because of increased water demand and dilution. RF replacement up to 15 % maintained workability and strength; beyond this, mechanical properties declined due to RF’s low specific gravity (1.06 g/cm3), weak bonding, and higher porosity. The optimal mix, GP15RF15, achieved a slump of 92 mm, 28-day compressive strength of 40.1 MPa, tensile strength of 5.3 MPa, and modulus of elasticity of 25,914.5 MPa, comparable to the control mix. Correlation analysis showed strong positive relationships among compressive strength, tensile strength, and stiffness (r ≥ 0.99), while RF content had strong negative correlations (r = −0.75 to −0.77). Optimization using the desirability function yielded a score of 1.000, with prediction errors below 1.35 %. The results confirm the viability of GP–RF concrete as a durable and eco-efficient alternative for non-prestressed structural components and general infrastructure