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Fact 50: Rape is routinely used as a tool of war, however even in peacetime Military Service Police inadequately report and investigate sexual offences committed by army personnel
No full textThe author shows how the Royal Military Police do not appear to investigate the reports of sexual offending they receive appropriately. Comparing this to the civilian police force, the chapter questions how and if victims can seek justice
European Association of Urology Guidelines on Upper Urinary Tract Urothelial Carcinoma: Summary of the 2025 Update
No full textBackground and objective
We present a summary of the 2025 update for the European Association of Urology (EAU) guidelines for upper urinary tract urothelial carcinoma (UTUC). The aim is to provide practical recommendations on the clinical management of UTUC with a focus on diagnosis, treatment, and follow-up.
Methods
For the 2025 guidelines on UTUC, new and relevant evidence was identified, collated, and appraised via a structured assessment of the literature. Databases searched included Medline, EMBASE, and the Cochrane Libraries. Recommendations within the guidelines were developed by the panel to prioritise clinically important care decisions. The strength of each recommendation was determined according to a balance between desirable and undesirable consequences of alternative management strategies, the quality of the evidence (including the certainty of estimates), and the nature and variability of patient values and preferences.
Key findings and limitations
Key recommendations emphasise the importance of thorough diagnosis, treatment, and follow-up for patients with UTUC. The guidelines stress the importance of appropriate treatment taking into account patient values and preferences. Key updates in the 2025 UTUC guidelines include: significant changes to the recommendations for UTUC diagnosis; complete revision of the sections addressing risk stratification, ureteroscopy, and the surgical approach for radical nephroureterectomy; addition of four new recommendations, two related to kidney-sparing management of localised low-risk UTUC and a further two related to management of high-risk nonmetastatic UTUC; a review and adaptation of recommendation for UTUC follow-up; and addition of a new section addressing quality indicators for UTUC management.
Conclusions and clinical implications
This overview of the 2025 EAU guidelines on UTUC offers valuable insights into risk factors, diagnosis, classification, treatment, and follow-up for UTUC. The guidelines contain information on the management of individual patients according to the current best evidence and are designed for effective integration in clinical practice
Feature learning for bearing prognostics: A comprehensive review of machine/deep learning methods, challenges, and opportunities
Get PDFMechanical bearings are common elements in a wide range of applications, such as wind turbines and manufacturing. Therefore, bearing prognostics are crucial to preventing catastrophic failures and machinery breakdowns. In this context, extracting the influential features is often the most challenging task in the prognosis process. This complexity arises because of the non-linear and non-stationary nature of the acquired vibration signals. Therefore, this paper offers an extensive examination of state-of-the-art feature-learning methods. Initially, the paper introduces a taxonomy of feature learning methods, encompassing both shallow and deep learning approaches. The paper also discusses methods of feature-learning under imbalanced data samples and different operational settings. Furthermore, the paper details the experimental setups of commonly used benchmark datasets to assist scholars and practitioners in understanding the subject area. Finally, the study discusses the challenges associated with calculating bearings’ RUL and suggests potential areas for further research
Interplay of large-scale drift and turbulence in the heliospheric propagation of solar energetic particles
Get PDFThe gradient and curvature of the Parker spiral interplanetary magnetic field give rise to curvature and gradient guiding centre drifts on cosmic rays. The plasma turbulence present in the interplanetary space is thought to suppress the drifts, however the extent to which they are reduced is not clear. We investigate the reduction of the drifts using a new analytic model of heliospheric turbulence where the dominant 2D component has both the wave vector and the magnetic field vector normal to the Parker spiral, thus fulfilling the main criterion of 2D turbulence. We use full-orbit test particle simulations of energetic protons in the modelled interplanetary turbulence, and analyse the mean drift velocity of the particles in heliolatitude. We release energetic proton populations of 10, 100 and 1000~MeV close to Sun and introduce a new method to assess their drift. We compare the drift in the turbulent heliosphere to drift in a configuration without turbulence, and to theoretical estimates of drift reduction. We find that drifts are reduced by a factor 0.2-0.9 of that expected for the heliospheric configuration without turbulence. This corresponds to a much less efficient suppression than what is predicted by theoretical estimates, particularly at low proton energies. We conclude that guiding centre drifts are a significant factor for the evolution of cosmic ray intensities in the heliosphere including the propagation of solar energetic particles in the inner heliosphere
What if the patient reads this? A student guide to writing in the GP electronic patient record
Get PDFBackground
It is common practice for senior medical students in UK General Practice to enter details of their consultations into the electronic patient record (EPR). There is evidence that students benefit educationally from writing in patient records through learning how to make good clinical entries and enhancing their clinical reasoning. In England, since 31 October 2023, patients are given full access to their EPR, including free text notes on their consultations. Despite the importance of high-quality consultation notes, guidance on writing in the patient record is rarely included in medical curricula.
Approach
With patient and public involvement, the UKCCC (UK Council for Clinical Communication in Undergraduate Medical Education) developed a guide for students on writing in patients’ General Practice (GP) notes and disseminated it to all UK medical schools from August to October 2023.
Results
The utility of the guide was evaluated via student and GP tutor surveys. Students and clinical teachers valued the guidance on content, structure, and clarity of consultation notes. A lack of awareness of the guide and suboptimal access and formatting on mobile devices were raised as areas for improvement. Other survey responses, which will inform the development of the next version, suggested adding links to learning resources
Improving the arthritis component of the SLEDAI-2K
No full textObjective
To propose a new definition for SLEDAI arthritis informed by imaging.
Methods
We performed a planned secondary analysis of observational data from a multicentre study evaluating SLE patients with inflammatory joint pain (swelling not required) using various clinical instruments, laboratory tests and ultrasound. For SLEDAI arthritis, assessors (blinded to ultrasound) were asked which of the glossary terms for arthritis in any version of the SLEDAI drove their decision to score for arthritis. These definitions were tested against ultrasound and other clinical variables. ROC analysis was used to test optimal joint count thresholds.
Results
A total of 78/133 patients had arthritis on SLEDAI-2K. In 21/78, clinician-observed swelling was not a reason for scoring (tenderness: 16/21; reported swelling between visits: 4/21; both of these: 1/21). No patient was scored for warmth or erythema alone. In total, 57 (73.1%) patients were scored for SLEDAI arthritis due to observed swelling, 90% had abnormal ultrasound (PPV = 90%, 95%CI: 79, 94). Of 21 patients with SLEDAI arthritis without observed swelling, 48% had abnormal ultrasound (PPV: 48%, 95%CI: 31, 67). Patients with SLEDAI arthritis with swelling had higher ESR, physician MSK-VAS, patient early morning stiffness (EMS)-VAS and IgG compared with other patients. Optimal sensitivity and specificity for ultrasound synovitis was 1 swollen joint using Youden’s criteria.
Conclusions
Our data suggest that the definition of arthritis in SLEDAI be modified to: ‘Inflammatory musculoskeletal pain (symmetrical small joint distribution), with one or more clinically swollen joints witnessed on examination, that is not explained by another arthropathy’
Impact of tillage practices and soil texture on soil health and earthworms in the Pannonian region: A comparative study from Austria and Hungary
Get PDFSoil tillage has major impacts on physical, chemical and biological soil parameters. Two long-term soil tillage experiments in North-East Austria (AT) and Central-North Hungary (HU), both located in the Pannonian region, were studied in 2020 and in 2021. The three soil tillage systems comprised mouldboard ploughing (P), shallow cultivation (C), and no-till (NT) in a completely randomised block design with four blocks. Major differences between AT and HU concerned clay content and pH value (clay: 20 %; 36 % and pH: 7.7; 4.5, respectively). This affected most parameters such as dissolved organic carbon, soil aggregate stability, bulk density, earthworm abundance, and biomass and Shannon index. These parameters decreased with soil tillage intensification at both sites. In addition, for all mentioned parameters, C and P were similar in AT, while in HU this was the case for NT and C. Additionally, epi-anecic Lumbricus terrestris was only found in AT, while endogeic Aporrectodea georgii was only present in HU. Arbuscular mycorrhizal root colonization was not responsive to different tillage practices when sampled in August in AT. In conclusion, reduced soil tillage such as C and NT can show similar affects towards soil health, but site-specific properties such as soil texture need to be considered for a final evaluation
Training trusted professionals: strengthening the response to domestic violence and abuse
No full textThis article reports on an independent evaluation (2017–2021) of a domestic violence and abuse (DVA) training intervention delivered in three geographical areas in England. Initially designed as a standalone training day by the Women’s Aid Federation of England (WAFE), Trusted Professional developed into a whole-organisation approach to working with DVA. The intervention aims to create system change by targeting organisations (housing, children’s social care, health and welfare services) likely to be in contact with victims/survivors to embed a needs-led, strengths-based approach within an organisation.
The evaluation examined how the Trusted Professional intervention was used by practitioners and identified changes in knowledge, skills, confidence and attitudes. Methods included pre- and post- training surveys and interviews with participants, trainers and WAFE co-ordinators. Basic descriptive statistics were used to analyse the quantitative data; qualitative data was transcribed and analysed thematically.
Trusted Professional was regarded positively. Practitioners reported increased knowledge and understanding of DVA alongside improved confidence and skills to respond to victims/survivors, including using non-victim-blaming language. Practitioners recommended refresher training and additional content regarding other forms of abuse or minoritised groups. Recommendations address how the intervention might be better integrated with existing practice, especially for children’s social care professionals, and extended more widely
Deep Brain Stimulation (DBS) and Motor Cortex Stimulation (MCS) for Central Post-Stroke Pain: A Systematic Review And Meta-Analysis
Get PDFIntroduction
Deep Brain Stimulation (DBS) and Motor Cortex stimulation (MCS) are invasive interventions in order to treat various neuropathic pain syndromes such as Central Post-Stroke Pain. While each treatment has varying degree of success, comparative analysis has not yet been performed, and the success rates of these techniques using validated, objective pain scores have not been synthesised.
Methods
A systematic review and meta-analysis was conducted in accordance with PRISMA guidelines. Three databases were searched, and articles published from January 2000 October 2024 were included (last search date 25 October 2024). Meta-Analysis was performed using random effects models. We evaluated the performance of DBS or MCS by assessing studies that reported pain relief using Visual Analogue Scale (VAS) or Numerical Rating Scale (NRS) scores.
Results
Of the 478 articles identified, 32 were included in the analysis (330 patients- 139 DBS, & 191 MCS). The improvement in mean VAS score for patients that underwent DBS post-surgery was 48.6% compared to a score of 53.1% for patients that had MCS. The pooled number of patients who improved after DBS was 0.62 (95% CI, 0.51-0.71, I2=16%). The pooled number of patients who improved after MCS was 0.64 (95% CI, 0.53-0.74, I2=40%).
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Conclusion
The use of neurosurgical interventions such as DBS and MCS are last-resort treatments for Central Post-Stroke Pain, with limited studies exploring and comparing these two techniques. While our study shows that MCS might be a slightly better treatment option, further research would need to be done to determine the appropriate surgical intervention in the treatment of Central Post-Stroke Pain
