Factors associated with failed 'test of cure' in the NHS Cervical Screening Programme: A retrospective cohort study.

OBJECTIVE: To determine predictive factors associated with failed 'test of cure' (TOC) in the NHS Cervical Screening Programme (NHSCSP). METHODS: Retrospective cohort study of all patients treated by large loop excision of transformation zone (LLETZ) between 1st April 2014 and 1st April 2019. Those with no documented HPV genotype on referral, no TOC outcome, those having a hysterectomy, chemotherapy and/or radiotherapy were excluded from final analysis. RESULTS: Patients referred with a singular HPV genotype of HPV 16, HPV 18, or HPV Other types (HPV O) were significantly more likely to pass TOC than those referred with multiple HPV genotypes (p < 0.0001). Those with HPV genotypes including HPV O were significantly more likely to fail TOC as compared to those with genotypes of solely HPV 16 and/or 18 (p < 0.0001). Patients aged ≥51 years were significantly more likely to fail TOC when compared to all other age groups (p < 0.0001). CONCLUSION: Age >51 yrs. and infection with multiple hr-HPV types were predictors of post treatment hr-HPV persistence. Knowledge of HPV genotype both at referral, and following treatment, could allow a more individualised, and patient-centred, approach to both the management and follow up of CIN. HPV genotype should be reported as standard on all cervical screening sample results. The term HPV O should not be utilised and instead actual HPV genotype should be reported. This would enable us to optimise not only future research but would also allow future monitoring of the efficacy of vaccination programmes.

Sonographic morphological and qualitative deficits in the elbow ulnar collateral ligament and ulnohumeral joint in throwing arms of asymptomatic collegiate baseball pitchers.

OBJECTIVE: The ulnar collateral ligament (UCL) supports the medial elbow against valgus torque and is commonly injured in baseball pitchers. Changes in UCL morphology and pathology occur with long-term pitching, with more severe findings at higher competition levels. We examined the bilateral differences and the relationship between UCL morphology, pathology, and ulnohumeral joint laxity in asymptomatic collegiate pitchers using ultrasound. MATERIALS AND METHODS: Division I college pitchers (n = 41) underwent ultrasound scans of their bilateral medial elbows, both at rest and in a valgus-stressed position. The presence of enthesopathy, calcifications, and degeneration was assessed qualitatively. UCL thickness and ulnohumeral joint gap were measured with online calipers. The bilateral differences were analyzed using paired t-tests and chi-square analysis, and the relationships between thickness, gapping, and degenerative changes were analyzed using regression analyses. RESULTS: The throwing arm demonstrated greater distal UCL thickness (mean difference (MD) = 0.2 mm (95%CI = 0.1-0.3), p < 0.01), resting and stressed gap (MD = 0.3 mm (95%CI = 0.0-0.7), p = 0.04; MD = 0.4 (95%CI = 0.0-0.9), p = 0.02), and greater prevalence of degeneration and enthesopathy (p = 0.03) compared bilaterally. Enthesopathy and calcifications predicted increased distal UCL thickness (p = 0.04; p = 0.02). Degenerative scores predicted increased stressed-resting ulnohumeral joint gap (p < 0.01). CONCLUSION: In the throwing arms of collegiate pitchers, ultrasound demonstrated UCL thickening, enthesopathy/intra-ligamentous calcification, and greater laxity of the ulnohumeral joint relative to the non-throwing arm. Degeneration of the UCL, not thickness, was related to greater elbow joint gapping. This study demonstrates the utility of ultrasound for examining sonographic characteristics of the UCL in a sample of college pitchers.

People's intended serving behaviour at social vs. non-social meals.

The social facilitation of eating refers to people's tendency to eat more food when dining with others than when dining alone. Recent research suggests that social facilitation may be driven by people's tendency to make more food available even before social meals begin, a phenomenon referred to as social "precilitation." In order to uncover the mechanisms underlying social precilitation, it is helpful to first understand whether people consciously and deliberately make more food available for social meals. Three studies (total N = 792) used an online serving paradigm to investigate this question. Participants were asked to imagine dining alone and dining socially, and indicated how much food they would serve themselves in each scenario. Unexpectedly, participants consistently reported intending to serve themselves smaller portions for social meals than for non-social meals (Study 1). This effect emerged even when they were asked about how someone else would behave (Study 2), and when they were informed that there was plenty of food available at the social meal (Study 3). This research highlights a disconnect between people's intended serving behaviour and the actual serving behaviour observed in laboratory studies, and suggests that people may not be aware of how their behaviour is influenced by the social context. Future research should examine why the disconnect between people's intended and actual serving behaviour occurs, whether it is related to the amount of food provided for social meals, and what implications the disconnect has for people's ability to manage their food intake.

People serve themselves larger portions before a social meal.

One of the most powerful influences on food intake yet identified is the presence of familiar others at an eating occasion: people eat much more when they eat with friends/family than when they eat alone. But why this is the case is unclear. Across two studies (Study 1: N = 98; Study 2: N = 120), we found that the mere anticipation of social interaction is all that is needed to promote the selection of larger meals, and that this occurs even when a person is alone when they make their decision. Adult women served themselves larger portions when they knew they were going to eat socially versus when they knew they were going to eat alone. These data suggest that how other people influence our food intake reaches beyond the specific eating context to affect pre-meal portion size decisions, suggesting that a fundamental shift is required in our thinking about social influences on eating.

Pitch direction on the perception of major and minor modes.

One factor affecting the qualia of music perception is the major/minor mode distinction. Major modes are perceived as more arousing, happier, positive, brighter, and less awkward than minor modes. This difference in emotionality of modes is also affected by pitch direction, with ascending pitch associated with positive affect and decreasing pitch with negative affect. The present study examined whether pitch direction influenced the identification of major versus minor musical modes. In six experiments, participants were familiarized with ascending and descending major and minor modes. We then played ascending and descending scales or simple eight-note melodies and asked listeners to identify the mode (major or minor). Identification of mode was moderated by pitch direction: major modes were identified more accurately when played with ascending pitch, and minor modes were identified better when played with descending pitch. Additionally, we replicated the difference in emotional affect between major and minor modes. The crossover pattern in mode identification may result from dual activation of positive and negative constructs, under specific combinations of mode and pitch direction.

What does it mean to overeat?

"Overeating" is a significant public health concern, but little is known about how lay people conceptualize overeating. This study explored participants' conceptions of overeating. Participants were 175 university students and 296 community members (56% women) who were asked to rate the extent to which several statements reflected the concept of "overeating" (1 = Does not capture the meaning at all; 7 = Captures the meaning perfectly). Results showed that eating outside of hunger was viewed as being most strongly linked to the conceptualization of overeating; mindless eating, eating more than some normative amount, and a lack of restriction were all moderately linked to the conceptualization of overeating; and the quality of the food/eating style was rated as least relevant to the conceptualization of overeating. Participants with a higher BMI, participants who perceived themselves as fat, restrained eaters, and participants with an indication of eating pathology rated all of the constructs as more relevant to the concept of overeating than did their respective counterparts, but their overall pattern of responding was the same. The present research provides some initial insights into people's thoughts on what it means to "overeat," which is important given that simply believing that one has overeaten (regardless of the actual amount consumed) can have adverse psychological and behavioral consequences. These insights provide an avenue for future research to explore whether lay conceptions could be more adaptively reshaped to reduce the negative effects of perceived overeating.

Evaluating the value of intrapartum fetal scalp blood sampling to predict adverse neonatal outcomes: A UK multicentre observational study.

OBJECTIVE: To evaluate the value of fetal scalp blood sampling (FBS) as an adjunct test to cardiotocography, to predict adverse neonatal outcomes. STUDY DESIGN: A multicentre service evaluation observational study in forty-four maternity units in the UK. We collected data retrospectively on pregnant women with singleton pregnancy who received FBS in labour using a standardised data collection tool. The primary outcome was prediction of neonatal acidaemia diagnosed as umbilical cord arterial pH < 7.05, the secondary outcomes were the prediction of Apgar scores<7 at 1st and 5th minutes and admission to the neonatal intensive care unit (NICU). We evaluated the correlation between the last FBS blood gas before birth and the umbilical cord blood and adjusted for time intervals. We constructed 2 × 2 tables to calculate the sensitivity, specificity, positive (PPV) and negative predictive value (NPV) and generated receiver operating curves to report on the Area Under the Curve (AUC). RESULTS: In total, 1422 samples were included in the analysis; pH values showed no correlation (r = 0.001, p = 0.9) in samples obtained within an hour (n = 314), or within half an hour from birth (n = 115) (r=-0.003, p = 0.9). A suboptimal FBS pH value (<7.25) had a poor sensitivity (22%) and PPV (4.9%) to predict neonatal acidaemia with high specificity (87.3%) and NPV (97.4%). Similar performance was noted to predict Apgar scores <7 at 1st (sensitivity 14.5%, specificity 87.5%, PPV 23.4%, NPV 79.6%) and 5th minute (sensitivity 20.3%, specificity 87.4%, PPV 7.6%, NPV 95.6%), and admission to NICU (sensitivity 20.3%, specificity 87.5%, PPV 13.3%, NPV 92.1%). The AUC for FBS pH to predict neonatal acidaemia was 0.59 (95%CI 0.59-0.68, p = 0.3) with similar performance to predict Apgar scores<7 at 1st minute (AUC 0.55, 95%CI 0.51-0.59, p = 0.004), 5th minute (AUC 0.55, 95%CI 0.48-0.62, p = 0.13), and admission to NICU (AUC 0.58, 95%CI 0.52-0.64, p = 0.002). Forty-one neonates had acidaemia (2.8%, 41/1422) at birth. There was no significant correlation in pH values between the FBS and the umbilical cord blood in this subgroup adjusted for sampling time intervals (r = 0.03, p = 0.83). CONCLUSIONS: As an adjunct tool to cardiotocography, FBS offered limited value to predict neonatal acidaemia, low Apgar Scores and admission to NICU.

Patient satisfaction with robotic surgery.

This study is a service evaluation of the robotic-assisted surgery service within the Gynaecology Oncology department at Sheffield Teaching Hospitals. The aim is not only to evaluate and improve this new service within the department, but also to add to the available literature that reviews patient satisfaction with robotic-assisted surgery. An anonymous questionnaire was developed with questions taken from the NHS User Experience Survey Question Bank and additional questions in the same format specific to robotic-assisted surgery. This was posted to the first 140 patients to have undergone robotic-assisted surgery within Gynae Oncology at STH. One hundred completed questionnaires were returned. Over 90% of patients were pleased with the care that they received pre-operatively and felt that they have enough input into the decisions made about treatment. Half of patients (51%) reported having pain post-procedure, with a quarter of these patients experiencing severe pain. The majority of patients (72%) felt that their length of stay in hospital was of the right duration. Almost all patients (99%) were pleased with the overall care that they received and 91% would recommend robotic-assisted surgery as a modality. Patients are very satisfied with the care that they receive when undergoing robotic-assisted surgery within Gynae Oncology at our center and the majority of patients would recommend robotic-assisted surgery as a modality.

Factors that influence patient preference for mode of delivery following an obstetric anal sphincter injury.

PURPOSE: A common indication for elective caesarean is previous obstetric anal sphincter injury (OASI). This study aims to identify factors that influence womens' preferences regarding mode of delivery (MoD) in a subsequent pregnancy following an OASI. METHODS: 100 consecutive women who sustained an OASI completed a questionnaire when attending postnatal follow up at a perineal trauma clinic. They also completed ePAQ-PF to assess pelvic floor symptoms. Data was collated and percentages generated for each response. A chi-squared calculation was used for preferred MoD. RESULTS: In total, 75 women were Primiparous and 25 Multiparous. 20% of women were advised to have a caesarean, with the remainder advised either a vaginal delivery or further investigations. 79% of women had a 3a/3b tear and 21% of women had a 3c/4th degree OASI. Based on women's preferences, those who sustained a 3c/4th degree tear were more likely to opt for CS than a 3a/b degree tear (p<0.001). Bowel symptoms per se did not correlate with choice of MoD in either group. In women with 3c/4th OASI vaginal or sexual symptoms did not impact on the decision regarding choice of delivery but in women who sustained a 3a/b tear the impact on sexual function appears to be the commonest symptom in those who wished a caesarean section. CONCLUSION: Women with 3c/4th OASI are more likely to accept a planned CS. Bowel symptoms appear to have little impact on this but in women with lower grade tears sexual symptoms have the greatest impact on preferred MoD.

Cigarette Smoke and Estrogen Signaling in Human Airway Smooth Muscle.

AIMS: Cigarette smoke (CS) in active smokers and second-hand smoke exposure exacerbate respiratory disorders such as asthma and chronic bronchitis. While women are known to experience a more asthmatic response to CS than emphysema in men, there is limited information on the mechanisms of CS-induced airway dysfunction. We hypothesize that CS interferes with a normal (protective) bronchodilatory role of estrogens, thus worsening airway contractility. METHODS: We tested effects of cigarette smoke extract (CSE) on 17ß-estradiol (E2) signaling in enzymatically-dissociated bronchial airway smooth muscle (ASM) obtained from lung samples of non-smoking female patients undergoing thoracic surgery. RESULTS: In fura-2 loaded ASM cells, CSE increased intracellular calcium ([Ca(2+)]i) responses to 10µM histamine. Acute exposure to physiological concentrations of E2 decreased [Ca(2+)]i responses. However, in 24h exposed CSE cells, although expression of estrogen receptors was increased, the effect of E2 on [Ca(2+)]i was blunted. Acute E2 exposure also decreased store-operated Ca(2+) entry and inhibited stromal interaction molecule 1 (STIM1) phosphorylation: effects blunted by CSE. Acute exposure to E2 increased cAMP, but less so in 24h CSE-exposed cells. 24h CSE exposure increased S-nitrosylation of ERα. Furthermore, 24h CSE-exposed bronchial rings showed increased bronchoconstrictor agonist responses that were not reduced as effectively by E2 compared to non-CSE controls. CONCLUSION: These data suggest that CS induces dysregulation of estrogen signaling in ASM, which could contribute to increased airway contractility in women exposed to CS.