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Safety and efficacy of erector spinae plane block for perioperative analgesia in posterior spinal fusion surgery for pediatric idiopathic scoliosis: a meta-analysis
No full textBackground
Posterior spinal fusion (PSF) for adolescent idiopathic scoliosis (AIS) is associated with severe postoperative pain leading to prolonged hospital stay and increased analgesic requirements. This meta-analysis aims to evaluate the efficacy of the erector spinae plane block (ESPB) in reducing postoperative pain and opioid consumption in AIS patients undergoing PSF.
Methods
A systematic review and meta-analysis was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. The following databases were searched: MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials (CENTRAL).
Results
Five studies involving a total of 352 patients were included, with 167 in the ESPB group and 185 in the control group. ESPB significantly reduced postoperative pain scores during the initial 24 postoperative hours (SMD = −1.58; CI −2.98 to −0.18; P = 0.03). Opioid consumption was significantly lower both intraoperatively (SMD = −3.72; CI −5.91 to −1.53; P = 0.0009) and postoperatively (SMD = −3.22; CI −5.14 to −1.30; P = 0.001). Rescue analgesia was required less frequently in the ESPB group (OR = 0.15; CI 0.08 to 0.29; P < 0.00001), and the time to first rescue analgesia was significantly longer (SMD = 2.95; CI 0.61 to 5.28; P = 0.01). Secondary outcomes, including incidence of opioid-related side effects, time to ambulation, length of hospital stay, and percentage change in motor-evoked potentials, were comparable between the ESPB and control groups.
Conclusion
Our findings suggest that the erector spinae plane block (ESPB) in PSF for AIS is effective in reducing postoperative pain up to 24 h postoperatively and results in lower overall opioid consumption without a significant increase in complications
Serial recall in spatial acoustic environments: irrelevant sound effect and spatial source alternations
Get PDFThis study investigated serial recall performance in a complex acoustic scene that included spatialised background sounds and location changes within the target sequence to reflect real-life challenges. The focus is on two effects: the irrelevant sound effect (ISE) and the spatial-source alternation effect (SSAE). Both represent impairment in short-term memory performance of to-be-remembered items: the ISE due to irrelevant background sounds, and the SSAE due to location changes within the target sequence. Although distinct, these effects typically occur together in real-world settings, e.g., listening to multiple speakers in noise, but have not been investigated together yet. Building on the theoretical frameworks of these two effects, this study combines principles from both the irrelevant sound effect (ISE) and the spatial-source alternation effect (SSAE) as a step towards enhancing acoustic complexity in established cognitive tasks. Experiment 1 examined auditory-verbal serial recall using spatially alternating target digits presented at a typical rate (1 item/1 s), with either meaningful or meaningless background speech. Results showed an ISE, with meaningful speech causing greater disruption, but no SSAE - possibly due to either the presentation rate or the spatialised audio scene. To further clarify this, Experiment 2 was conducted with a faster presentation rate (1 item/350 ms) consistent with a previous study, and more spatial target locations (monotic, ). An SSAE was revealed for all locations. These findings suggest that the SSAE may mainly be modulated by the presentation rate—given the spatial separation is audible and only emergent at rapid location changes—questioning its applicability to naturalistic listening scenarios. As an attempt to bridge the gap between controlled laboratory settings and more complex listening tasks, these findings help explain how cognitive systems manage competing demands in real-world auditory environments, such as separating speech streams in noise
Integrated Domestic Abuse Courts: Problems and Possibilities for Including the Experiences of Adult and Child Victim-Survivors
No full textMary Carpenter: The Transportation of Victorian Ideology and Juvenile Reform to Colonial India During the Nineteenth Century, Comparison and Contradictions: Approaches from Historical Criminology
No full textMary Carpenter’s reputation as a pioneering Juvenile penal reformer rests primarily on her domestic achievements, particularly the establishment of Red Lodge female reformatory in Bristol. However, her significant contributions to penal reform in colonial India remain substantially underexamined. Between 1865 and 1876, Carpenter undertook four visits to India, culminating in her influential work Six Months in India (1868) which articulated her vision of India’s potential elevation among nations through the British Colonial administration. Female reformers like Carpenter occupied ambiguous positions within colonial administration. Their gender provided both limitation and opportunities within Victorian society, while their racial identity granted them authority over colonised populations. This positioning enabled them to advocate for reform while maintaining fundamental assumptions about British cultural and moral superiority. This chapter examines how Victorian reformers like Carpenter appropriated domestic ideologies and solutions for juvenile penal reform within the colonial context. Through comparative analysis of juvenile reform initiatives in England and India during the nineteenth century, it explores a critical yet neglected dimension of the relationship between imperialism and historical criminology, investigating the complex intersections of gender, class and racial identity within colonial penal discourse
Touching Without Contact: Glove-Mediated Secondary DNA Transfer in Forensic Casework
No full textThe inadvertent transfer of DNA via gloves poses a significant risk to the integrity of forensic evidence, particularly in trace and touch DNA investigations. This study systematically evaluated the extent of DNA contamination on glove surfaces, the effectiveness of common cleaning agents, and the potential for secondary DNA transfer to mock evidence. Twelve participants, pre-classified by DNA shedding status, donned nitrile, latex, and vinyl gloves under controlled laboratory conditions. Glove surfaces were sampled after donning and subjected to four cleaning conditions: no cleaning, 0.3% sodium hypochlorite, RNase AWAY™, and 70% ethanol. DNA was extracted and quantified, and STR profiling was performed to assess the presence and completeness of genetic profiles.
Results demonstrated significant variability in DNA retention based on glove type and cleaning agent. Vinyl gloves retained the highest DNA levels, while nitrile gloves showed the least contamination. Sodium hypochlorite was the most effective cleaning agent, reducing recoverable DNA by up to 94%, followed by RNase AWAY™, with ethanol being the least effective. Notably, even post-cleaning gloves frequently retained sufficient DNA to yield partial STR profiles, underscoring the persistent risk of secondary transfer. Controlled glove-to-cloth contact experiments further confirmed that uncleaned gloves transferred full STR profiles in 80% of cases, while sodium hypochlorite-treated gloves minimized this risk.
Ultraviolet fluorescence visualization revealed contamination hotspots concentrated at the fingertips and palm, highlighting key zones of contact and transfer potential. These findings emphasize the need for standardized glove decontamination protocols, careful selection of glove materials, and contamination-aware handling procedures in forensic workflows. Incorporating these practices will enhance the reliability of trace DNA interpretation and reduce the risk of misattribution in forensic casework
Critical appraisal of a systematic review on biomarkers as diagnostic or prognostic indicators of delirium
Get PDFDelirium is a substantial global health concern. Delirium can lead to longer hospital stays and increased healthcare costs. Effective detection and prevention of delirium is still a major challenge for healthcare organisations globally. This is largely because the cause(s) of the condition are still unknown. There are multiple factors that may contribute to the aetiology of delirium and a range of neurobiological processes that may be associated with its pathophysiology. Evidencing these processes is a significant challenge, as there is a dearth of identification methods. The use of biomarkers has become a popular method in the identification of delirium and its risk of development. The identification of biomarkers associated with delirium may provide insight into its pathophysiology and aid in diagnosis and management. However, there is a lack of research that has synthesised the diagnostic and prognostic value of biomarkers associated with delirium, and how they could be employed to improve patient outcomes. A systematic review by Dunne et al (2021) was undertaken to explore this association of biomarkers and delirium. This commentary aims to critically appraise the methods used within the review by Dunne et al (2021) and expand on the findings in the context of clinical practice
Professional perceptions of barriers and facilitators from the implementation of a neonatal early supported transfer to home intervention for late preterm infants: a qualitative study
Get PDFIntroduction: Late preterm infants may have prolonged stay in hospital due to increased care needs and a lack of community support. A neonatal early supported transfer to home (NEST@Home) intervention was introduced. We explored professional perceptions of barriers and facilitators to implementation of NEST@Home.
Methods: Neonatal healthcare professionals in England participated in group interviews based on the Consolidated Framework for Implementation Research. Data were analysed using thematic analysis.
Findings: Perceived barriers included lack of facilities, poor clinical buy-in, budget restraints, staff shortages, absence of policy, and a lack of commissioning support. Perceived facilitators to implementation included healthcare professional’s positive attitudes, pre-discharge planning, parent education, parent training, and loan of monitoring equipment.
Conclusion: This study identified individual, interpersonal, and organisational features that may facilitate or impede the NEST@Home intervention. Further research is needed to identify how this intervention impacts outcomes, and to understand the experience of parents receiving NEST@Home
Replicating and Extending Hemispheric Asymmetries in Auditory Distraction: No Metacognitive Awareness for the Left-Ear Disadvantage for Changing-State Sounds
Get PDFIn two experiments investigating hemispheric asymmetries in auditory distraction, the spatial location of to-be-ignored sound was manipulated. Prior studies indicated a left-ear disadvantage for changing-state sequences during short-term serial recall but lacked a direct measure of the changing-state effect. Experiment 1 compared changing-state with steady-state sequences in a visual-verbal serial recall task, confirming that left-ear disruption resulted from the acoustically varying nature of the sound, emphasizing right hemisphere dominance for processing acoustic variation in unattended stimuli. Experiment 2 replicated these findings and explored participants' metacognitive awareness of auditory distractors' disruptive potential. While participants were aware that changing-state sequences were more disruptive than steady-state sequences, they lacked awareness of the left-ear disadvantage. The study suggests individuals have metacognitive awareness of the disruptive impact of changing-state over steady-state sound but not of the accompanying left-ear disadvantage, raising implications for theoretical accounts of auditory distraction
Exploring inter-professional roles in the provision of UK outpatient transient ischaemic attack services
No full textBackground:
Suspected transient ischaemic attack is a diagnostic challenge, yet requires timely diagnosis for secondary stroke prevention.
Aims:
To understand variability of organisational processes, roles, education and clinical decision making in the UK's transient ischaemic attack services.
Methods:
Healthcare professionals were surveyed online in 2021 with descriptive data analysis. Interviews were conducted with a purposive sample. Three researchers thematically analysed interview data.
Findings:
Survey responses were received from 43 transient ischaemic attack services. 70% conducted remote consultations, 28% face-to-face, and 2% mixed. Clinicians with varying roles, skills and experience provided transient ischaemic attack services. All services involved a consultant physician with experience in stroke. Ten interviews confirmed the survey results and highlighted variability regarding clinical decision making, service composition, resources, learning opportunities and mode of consultation.
Conclusions:
Variability in transient ischaemic attack service workforce and service organisation influenced diagnostic decisions. The possible impact of such variability on clinical outcomes and approaches to reducing it require further research
Neurological, psychological, psychosocial complications of long-COVID and their management
Get PDFSince it first appeared, Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) has had a significant and lasting negative impact on the health and economies of millions of individuals all over the globe. At the level of individual health too, many patients are not recovering fully and experiencing a long-term condition now commonly termed ‘long-COVID’. Long-COVID is a collection of symptoms which must last more than 12 weeks following initial COVID infection, and which cannot be adequately explained by alternate diagnoses. The neurological and psychosocial impact of long-COVID is itself now a global health crisis and therefore preventing, diagnosing, and managing these patients is of paramount importance. This review focuses primarily on: neurological functioning deficits; mental health impacts; long-term mood problems; and associated psychosocial issues, among patients suffering from long-COVID with an eye towards the neurological basis of these symptoms. A concise account of the clinical relevance of the neurological and psychosocial impacts of long-COVID, the effects on long-term morbidity, and varied approaches in managing patients with significant chronic neurological symptoms and conditions was extracted from the literature, analysed and reported. A comprehensive account of plausible pathophysiological mechanisms involved in the development of long-COVID, its management, and future research needs have been discussed