Guidelines for day-case surgery 2019: Guidelines from the Association of Anaesthetists and the British Association of Day Surgery.

Guidelines are presented for the organisational and clinical management of anaesthesia for day-case surgery in adults and children. The advice presented is based on previously published recommendations, clinical studies and expert opinion.

Organizational stressors and basic psychological needs: The mediating role of athletes' appraisal mechanisms.

This article reports the first study to quantitatively examine the relationships between the demands encountered by athletes that are associated with the organization within which they are operating, cognitive appraisals, and basic psychological need experiences. Three hundred and fifteen high-level British athletes completed a multisection questionnaire which assessed each of the aforementioned constructs. A series of path analyses provided valuable insight into the way in which the three dimensions (ie, frequency, intensity, and duration) of five organizational stressor categories were evaluated by athletes and, in turn, how such threat or challenge appraisals predicted feelings of need satisfaction and need frustration. Moreover, cognitive stress appraisals were found to mediate the relationship between organizational stressors and psychological need experiences. The role of secondary control appraisals was also explored and found to mediate the relationship between primary cognitive appraisals and basic psychological need experiences. Study limitations, proposed future research directions, and the implications of the findings for applied practitioners are discussed.

Attentional bias modification for acute experimental pain: A randomized controlled trial of retraining early versus later attention on pain severity, threshold and tolerance.

BACKGROUND: Noxious attentional bias is thought to confer vulnerability to pain, suggesting that modifying the bias could reduce pain outcomes. Herein is presented a randomized controlled trial to test the effects of retraining the dot probe attentional bias at short versus long stimulus durations towards neutral stimuli, and away from threat stimuli, on acute pain experience, in comparison with a placebo control group. METHODS: Eighty-one pain-free volunteers, blinded to condition, were randomized to complete either one of two neutral bias modification programs in which words were presented for 500 ms (ABM-500; n = 28) or 1250 ms (ABM-1250; n = 26), or to a sham training program that included both stimulus durations (ABM-Placebo; n = 27). Testing took place in a university laboratory. At post-training, participants completed the pain-inducing 'cold pressor task', and measures of pain severity, threshold and tolerance were taken. Attentional bias was also measured at pre- and post-training. RESULTS: Findings indicated that ABM-500 reliably increased pain threshold and tolerance, in comparison with the control group. In contrast, ABM-1250 did not affect any of the pain outcomes. Expected ABM effects on attentional bias were not evident at the group level, but nevertheless ABM-500 bias reduction was significantly associated with increased pain tolerance. CONCLUSIONS: These findings suggest that retraining attention at short stimulus exposure durations is relatively more efficacious in promoting transfer of attentional retraining effects to real-world acute pain stressors, in comparison with both the longer stimulus duration and ABM-Placebo. SIGNIFICANCE: Testing of the impact of modifying maintained attentional bias on vulnerability to an acute pain stressor. Findings suggested that retraining rapid attentional bias using short exposure durations conferred greater analgesic benefit, in comparison with both the slower bias and sham-training.

Clinical characteristics of canine fibrocartilaginous embolic myelopathy (FCE): a systematic review of 393 cases (1973-2013).

Fibrocartilaginous embolic myelopathy (FCE) is common in dogs; however, there is conflicting information in the veterinary literature regarding clinical characteristics and data on recovery in severe cases is sparse. A systematic review of canine FCE was performed to delineate the natural history of this disease. 322 previously reported cases and 71 previously unreported cases were identified for inclusion. Source publications were identified via PubMed central search and by references from review articles. Previously unreported cases were identified via computerised medical records search at two veterinary institutions. FCE was most common in middle-aged large breed dogs (30 per cent); however, the miniature schnauzer was the most frequently reported individual breed and small breeds comprised 24 per cent of all reported cases. The most common neuroanatomical localisation was a T3-L3 myelopathy (33.1 per cent). Prognosis for recovery of ambulation was good to excellent with 85 per cent of cases regaining the ability to walk unassisted, most within 3 weeks. Persistent neurological deficits were common in patients that recovered ambulation (49.1 per cent). When nociception was absent in the affected limbs at initial presentation, rate of recovery was lower (10 per cent); however, this data is likely biased by limited follow-up in more severe cases. Future prospective studies should evaluate prognosis for more severely affected patients.

Sustaining Health for Wealth: Perspectives for the Post-2015 Agenda: Comment on "Improving the World's Health Through the Post-2015 Development Agenda: Perspectives From Rwanda".

The sustainable development goals (SDGs) offer a unique opportunity for policy-makers to build on the millennium development goals (MDGs) by adopting more sustainable approaches to addressing global development challenges. The delivery of health services is of particular concern. Most African countries are unlikely to achieve the health MDGs, however, significant progress has been made particularly in the area of child and maternal health due in part to significant external support. The weak global recovery, and persistent inequalities in access to healthcare, however, call into question the sustainability of the achievements made. Building on the principles articulated in Binagwaho and Scott, this commentary argues that addressing inequalities and promoting more integrated approaches to health service delivery is vital for consolidating and sustaining the health sector achievements in Africa.

Boron determination in liver tissue by combining quantitative neutron capture radiography (QNCR) and histological analysis for BNCT treatment planning at the TRIGA Mainz.

The typical primary malignancies of the liver are hepatocellular carcinoma and cholangiocarcinoma, whereas colorectal liver metastases are the most frequently occurring secondary tumors. In many cases, only palliative treatment is possible. Boron neutron capture therapy (BNCT) represents a technique that potentially destroys tumor tissue selectively by use of externally induced, locally confined secondary particle irradiation. In 2001 and 2003, BNCT was applied to two patients with colorectal liver metastases in Pavia, Italy. To scrutinize the rationale of BNCT, a clinical pilot study on patients with colorectal liver metastases was carried out at the University of Mainz. The distribution of the (10)B carrier (p-borono-phenylalanine) in the liver and its uptake in cancerous and tumor-free tissue were determined, focusing on a potential correlation between the uptake of p-borono-phenylalanine and the biological characteristics of cancerous tissue. Samples were analyzed using quantitative neutron capture radiography of cryosections combined with histological analysis. Methodological aspects of the combination of these techniques and results from four patients enrolled in the study are presented that indicate that the uptake of p-borono-phenylalanine strongly depends on the metabolic activity of cells.

Applying a mixed-integer program to model re-screening women who test positive for C. trachomatis infection.

We proposed a mixed-integer program to model the management of C. trachomatis infections in women visiting publicly funded family planning clinics. We intended to maximize the number of infected women cured of C. trachomatis infections. The model incorporated screening, re-screening, and treatment options for three age groups with respective age-specific C. trachomatis infection and re-infection rates, two possible test assays, and two possible treatments. Our results showed the total budget had a great impact on the optimal strategy incorporating screening coverage, test selection, and treatment. At any budget level, the strategy that used a relatively small per-patient budget increase to re-screen all women who tested positive 6 months earlier always resulted in curing more infected women and more cost-saving than the strategy that was optimal under the condition of not including a re-screening option.

A demographic and health profile of gay and bisexual men in a large Canadian urban setting.

The purpose of this study was to provide both a population estimate and a socio-economic and health profile of gay and bisexual men living with HIV/AIDS in a large Canadian urban centre. A random telephone survey was used to determine the number of men in the study area over the age of 20 identifying as gay or bisexual and to characterize their health and socio-economic status. Out of a total of 1,176 completed interviews, 300 males described themselves as gay or bisexual. Projecting this figure on recent census data we estimated the number of men identifying as gay or bisexual in this region of downtown Vancouver, BC, at 5,100. Among these men we found an HIV prevalence rate of 16%, with those who reported a positive serostatus being less likely to be employed full time and more likely to earn less than $20,000 per year. In terms of clinical characteristics, HIV-positive men had a median CD4 cell count of 397 cells/mm(3) and a median viral load of less than 500 copies/ml. Eighty-three per cent of the HIV-positive respondents were on antiretroviral therapy and the median number of drugs taken by these men was three. In summary, random surveys of populations affected by this epidemic are important for policy makers, clinicians and persons caring for those with HIV/AIDS as they paint a clearer picture of who is being affected and help to identify areas where increased services are needed.

Genetic transformation of Trametes versicolor to phleomycin resistance with the dominant selectable marker shble.

We have developed a stable, DNA-mediated transformation system for the white-rot basidiomycete Trametes versicolor based on the dominant selectable marker shble (phleomycin resistance). We employed a vector containing the selectable marker under control of expression sequences from the basidiomycete Schizophyllum commune and a polyethylene glycol/ CaCl2 protoplast-fusion technique to introduce the transforming DNA. This transformation system generated stable phleomycin-resistant transformants at a frequency of four to seven transformants/microg of transforming DNA.

Modern antiretroviral therapy improves life expectancy of gay and bisexual males in Vancouver's West End.

This study was undertaken to evaluate the life expectancy of gay and bisexual men in the West End of Vancouver, British Columbia during two time periods. Mortality data for males were obtained for the periods 1990 to 1992 and 1995 to 1997 and population estimates were obtained from the 1991 and 1996 Census. The proportion of the male population over 20 years of age estimated to be gay and bisexual was derived from a random telephone survey. Mortality patterns were assessed by comparing changes in life expectancy at age 20 years between the periods, and by examining the life expectancy lost attributed to HIV/AIDS. Between the periods there was 3.8 +/- 3.4 years increase in life expectancy among gay and bisexual men. At exact age 20 years, life expectancy increased from 37.0 +/- 3.5 years during the period 1990 to 1992 to 40.8 +/- 2.4 years during the period 1995 to 1997. The loss of life expectancy attributed to HIV/AIDS at this age was 13.8 +/- 3.9 during the first period and 9.8 +/- 3.6 years during the second period. This gain is most likely the result of the improved efficacy of antiretroviral therapies.

Cloning and sequencing of a gene encoding cellobiose dehydrogenase from Trametes versicolor.

Cellobiose dehydrogenase (CDH) is an enzyme produced under lignocellulose-degrading conditions by Trametes versicolor strain 52J (Tv) and several other wood-degrading fungi, including Phanerochaete chrysosporium (Pc). In order to understand better the nature and properties of this enzyme, we isolated a genomic clone of Tv cdh using heterologous probes derived from the sequence of Pc cdh. DNA sequence analysis revealed that Tv cdh consists of 3091 bp of coding sequence interrupted by 14 introns. Southern blotting showed that the gene was present in a single copy in the strain of Tv analyzed. Tv cdh was shown by Northern blot analysis to be expressed as a single transcript under cellulolytic conditions. RT-PCR of poly(A)+ RNA isolated under cellulolytic conditions was used to generate a near full-length cDNA copy of the cdh mRNA. The deduced protein encoded by Tv cdh consists of 768 amino acids (aa), including a predicted 19 aa signal peptide. The protein had 73% identity to the corresponding protein from Pc, which is the only other CDH-encoding gene that has been cloned. Based upon its deduced primary structure and alignment to similar sequences, Tv CDH shares a general structural organization with Pc CDH and other hemoflavoenzymes. Amino acid residues H-109 and M-61 in the N-terminal heme domain are hypothesized to function in heme binding; the C-terminal flavin domain contained a consensus sequence for flavin binding between residues 217-222. Although the protein is known to bind to cellulose, no obvious homology to bacterial or fungal cellulose binding domains was observed. However, a strong homology was observed to a region of Pc CDH that is hypothesized to be involved in cellulose binding.

Adult attachment processes: individual and couple perspectives.

This paper overviews a new approach to understanding the range of difficulties experienced in close attachment relationships in adulthood. Drawing on the work of Bowlby, four prototypic adult attachment patterns are defined in terms of the intersection of two underlying dimensions, the positivity of the person's self-image and the positivity of the person's image of others (Bartholomew, 1990; Bartholomew & Horowitz, 1991). The distinct interpersonal difficulties associated with each attachment pattern are described. Findings are presented indicating that individual differences in attachment have implications for the quality of adults' romantic relationships, and that attachment theory may be helpful in understanding violent spousal relationships. Five current issues in the study of adult attachment are addressed: the stability of attachment patterns, the associations between attachment and general personality factors, the relative merits of categorical and prototype assessments of attachment, the identification of multiple attachments in adulthood, and the specificity of adult attachment patterns. It is suggested that the four-category model of adult attachment is especially sensitive to the range and complexity of attachment-related difficulties experienced in adulthood.

Deletion of the Schizophyllum commune A alpha locus: the roles of A alpha Y and Z mating-type genes.

The A alpha locus is one of four master regulatory loci that determine mating type and regulate sexual development in Schizophyllum commune. We have made a plasmid containing a URA1 gene disruption of the A alpha Y1 gene. Y1 is the sole A alpha gene in A alpha 1 strains. We used the plasmid construction to produce an A alpha null (i.e., A alpha delta) strain by replacing the genomic Y1 gene with URA1 in an A alpha 1 strain. To characterize the role of the A alpha genes in the regulation of sexual development, we transformed various A alpha Y and Z alleles into A alpha delta strains and examined the acquired mating types and mating abilities of the transformants. These experiments demonstrate that the A alpha Y gene is not essential for fungal viability and growth, that a solitary Z A alpha mating-type gene does not itself activate development, that A beta proteins are sufficient to activate the A developmental pathway in the absence of A alpha proteins and confirm that Y and Z genes are the sole determinants of A alpha mating type. The data from these experiments support and refine our model of the regulation of A-pathway events by Y and Z proteins.

Social-emotional adjustment and patterns of alcohol use among young adults.

Individual differences in social-emotional adjustment, jointly defined by levels of distress and self-restraint, were used to evaluate (a) patterns of alcohol use, (b) reasons for use, and (c) associated problems in two college samples of young adults (N = 287 and N = 215). As hypothesized, low self-restraint was associated with high levels of alcohol use, drinking to increase positive affect, and high levels of alcohol-related problems. Subjective distress was not related to levels of use; however, it was associated with drinking to escape negative moods and social discomfort and with excessive alcohol-related problems. Both high distress and low self-restraint predicted problem drinking beyond what could be accounted for by quantity or frequency of alcohol use or by peers' use. Within Weinberger and Schwartz's (1990) six-group typology, reactive individuals (high distress-low restraint) were especially likely to be problem drinkers, even when compared to groups with equivalent alcohol use. In a separate study, knowledgeable peers' reports validated the differences between reactive and repressive individuals, the two groups most likely to have inaccurate self-reports.

The A alpha mating-type locus of Schizophyllum commune: structure and function of gene X.

Gene X maps immediately right of gene Y at the A alpha mating-type locus in Schizophyllum commune. Alleles X1, X3 and X4 were isolated, subcloned, and sequenced. The structure of the alleles and their relationship to the A alpha locus is described. The deduced X isoforms possess no recognized motifs common to other polypeptides and no significant similarity to any sequences in the protein data-bases. X alleles do not activate A-regulated development when transformed into recipient strains possessing different A alpha mating types or when these transformants are mated with tester strains. An X1-disrupted construction yielded a high frequency (33%) of homologous gene replacements. X-disrupted mutants have wild-type phenotypes and mate normally. Both the functional analyses and sequence data for X1, X3, and X4 suggest that the right boundary of the A alpha mating-type locus falls between A alpha Y and X. We propose that the Z and Y genes constitute the A alpha locus in its entirety.

To PEEP or not to PEEP?

It is well recognised that reducing positive end expiratory pressure (PEEP) leads to an increase in the tidal volume and minute volume in ventilated neonates. The magnitude of this effect is perhaps not commonly appreciated, however. Effectively, PEEP is four times as potent as peak inflation pressure (PIP) in bringing about changes in tidal volume. The influence of changes in PEEP and PIP on tidal volume and the relative magnitude of each are considered. Twenty one preterm infants were studied on 38 separate occasions. All were sedated, paralysed, and ventilated, 19 for hyaline membrane disease. A 1 cm H2O reduction in PEEP was twice as potent as a 2 cm H2O increase in PIP in achieving an increase in tidal volume (14 v 7%). Similarly, increasing PEEP by 1 cm H2O was twice as effective as a 2 cm H2O decrease in PIP in reducing tidal volume (13 v 6%). Small (0.5-1 cm H2O) changes in PEEP can often be used to improve ventilation and carbon dioxide elimination. Levels of PEEP of 4-5 cm H2O may, at times, impair gas exchange and contribute to overdistension.

Interpersonal problems, attachment styles, and outcome in brief dynamic psychotherapy.

The Inventory of Interpersonal Problems (IIP) has been used to identify dysfunctional patterns in interpersonal interactions. Interpersonal problems can be organized in two dimensions, and the two-dimensional space can be divided into eight equal sectors (octants). Subscales of the IIP describe each of these octants. The instrument has been used to identify (a) interpersonal problems that are discussed most often in a brief dynamic psychotherapy and (b) problems that are treated most easily. The results show that problems in the "exploitable" octant improve most frequently, whereas problems in the "dominating," "vindictive," and "cold" octants do not improve as readily. Attachment styles in adulthood were examined (following a model proposed by Bowlby), and different attachment styles were found to correspond to different types of interpersonal problems. Finally, these variables were related to the ability to describe other people clearly. The article also discusses implications for brief dynamic psychotherapy.