Facilitators and barriers to attending postpartum screening in women with a recent pregnancy complicated by gestational diabetes mellitus: a qualitative study.

OBJECTIVE: Pregnant women with gestational diabetes mellitus (GDM) are 50% more likely to develop type II diabetes (T2D) within 6 months to 2 years after giving birth. Therefore, international guidelines recommend it is best practice for women diagnosed with GDM to attend screening for T2D 6-12 weeks postpartum and every 1-3 years thereafter for life. However, uptake of postpartum screening is suboptimal. This study will explore the facilitators of and barriers to attending postpartum screening for T2D that women experience. STUDY DESIGN: This was a prospective qualitative cohort study using thematic analysis. METHODS: A total of 27 in-depth, semistructured interviews were conducted over the telephone with women who had recent GDM. Interviews were recorded and transcribed, and data were analysed using thematic analysis. RESULTS: Facilitators of and barriers to attending postpartum screening were identified at three different levels: personal, intervention, and healthcare systems level. The most common facilitators identified were concern for their own health and having the importance of screening explained to them by a health professional. The most common barriers identified were confusion over the test and COVID-19. CONCLUSION: This study identified several facilitators of and barriers to attending postpartum screening. These findings will help to inform research and interventions for improving rates of attendance at postpartum screening to reduce the subsequent risk of developing T2D.

Safety of maintaining elective and emergency surgery during the COVID-19 pandemic with the introduction of a Protected Elective Surgical Unit (PESU): A cross-specialty evaluation of 30-day outcomes in 9,925 patients undergoing surgery in a University Health Board.

Background: The COVID-19 pandemic has caused unprecedented health care challenges mandating surgical service reconfiguration. Within our hospital, emergency and elective streams were separated and self-contained Protected Elective Surgical Units were developed to mitigate against infection-related morbidity. Aims of this study were to determine the risk of COVID-19 transmission and mortality and whether the development of Protected Elective Surgical Units can result in significant reduction in risk. Methods: A retrospective observational study of consecutive patients from 18 specialties undergoing elective or emergency surgery under general, spinal, or epidural anaesthetic over a 12-month study period was undertaken. Primary outcome measures were 30-day postoperative COVID-19 transmission rate and mortality. Secondary adjusted analyses were performed to ascertain hospital and Protected Elective Surgical Unit transmission rates. Results: Between 15 March 2020 and 14 March 2021, 9,925 patients underwent surgery: 6,464 (65.1%) elective, 5,116 (51.5%) female, and median age 57 (39-70). A total of 69.5% of all procedures were performed in Protected Elective Surgical Units. Overall, 30-day postoperative COVID-19 transmission was 2.8% (3.4% emergency vs 1.2% elective P < .001). Protected Elective Surgical Unit postoperative transmission was significantly lower than non-Protected Elective Surgical Unit (0.42% vs 3.2% P < .001), with an adjusted likely in-hospital Protected Elective Surgical Unit transmission of 0.04%. The 30-day all-cause mortality was 1.7% and was 14.6% in COVID-19-positive patients. COVID-19 infection, age > 70, male sex, American Society of Anesthesiologists grade > 2, and emergency surgery were all independently associated with mortality. Conclusion: This study has demonstrated that Protected Elective Surgical Units can facilitate high-volume elective surgical services throughout peaks of the COVID-19 pandemic while minimising viral transmission and mortality. However, mortality risk associated with perioperative COVID-19 infection remains high.

A novel internal abdominal oblique muscle flap to close a major abdominal wall defect.

This report describes a novel technique for abdominal wall reconstruction using an internal abdominal oblique muscle flap in an Australian kelpie. En bloc resection of a chondrosarcoma and biopsy scar centred on the 13th rib was performed to include full thickness thoracic wall (12th rib, extending caudally) and lateral abdominal wall (including the vascular pedicle of the external abdominal oblique muscle). The diaphragm was advanced to close the thorax. A flap using the caudal internal abdominal oblique muscle with the base dorsally was elevated and rotated 90° to fill the dorsal defect. The ventral defect was closed using the composite ventral abdominal muscles. The skin was closed primarily. The dog developed a self-resolving seroma. Twelve months postoperatively, the dog was able to engage in agility competitions. A viable muscle flap using the internal abdominal oblique muscle provides a useful alternative to previously described techniques for autogenous closure of a large abdominal wall wound.

Evaluation of remote OMFS assessments in the era of pandemic COVID-19 control measures.

Pandemic COVID-19 has put unprecedented pressure on NHS providers to offer non face-to-face consultation. This study aims to assess acceptability of patients and clinicians towards teleconsultation in oral and maxillofacial surgery compared with an expected face-to-face assessment. 340 telephone clinic patient episodes were surveyed over the initial 7-week period of pandemic-related service restriction. Appointment outcomes from a further 420 telephone consultations were additionally scrutinised. A total of 59.1% of patients expressed a strong preference for teleconsultation with only 13.1% stating a moderate or strong preference for face-to-face assessment. Diagnostic accuracy was highlighted as a concern for both clinicians and patients due to inherent inability to conduct a traditional clinical examination, notable in 43.5% of qualitative comments. Logistical concerns, communications needs and other individual circumstances formed the other emerging themes. The majority of remote consultations (59.5%) were outcomed as requiring further review. A total of 29.3% of patients were discharged. These findings suggest that the increasing use of remote follow-up in carefully selected subgroups can facilitate efficient and acceptable healthcare delivery. Although 'in-person' clinical appointments will continue to be regarded as the default safe and gold standard management modality, OMFS departments should consider significant upscaling of teleconsultation services.

Three Phase-Grating Moiré Neutron Interferometer for Large Interferometer Area Applications.

We demonstrate a three phase-grating moiré neutron interferometer in a highly intense neutron beam as a robust candidate for large area interferometry applications and for the characterization of materials. This novel far-field moiré technique allows for broad wavelength acceptance and relaxed requirements related to fabrication and alignment, thus circumventing the main obstacles associated with perfect crystal neutron interferometry. We observed interference fringes with an interferometer length of 4 m and examined the effects of an aluminum 6061 alloy sample on the coherence of the system. Experiments to measure the autocorrelation length of samples and the universal gravitational constant are proposed and discussed.

Equity implications for sanitation from recent health and nutrition evidence.

Recent evidence points to the possible underestimation of the health and nutrition impact of sanitation. Community sanitation coverage may first need to reach thresholds in the order of 60% or higher, to optimize health and nutrition gains. Increasing coverage of sanitation to levels below 60% of community coverage may not result in substantial gains. For example, moving Indonesia from 60% to 100% improved sanitation coverage could significantly reduce diarrhoea in children under 5 years old (by an estimated 24% reduction in odds ratio for child diarrhoea morbidity) with gains split equally by reaching underserved communities and the unserved within communities. We review the implications of these results across three levels of program implementation - from micro level approaches (that support communities to achieve open defecation-free status), to meso level (sub-national implementation) to macro level approaches for the national enabling environment and the global push to the Sustainable Development Goals. We found significant equity implications and recommend that future studies focus more extensively on community coverage levels and verified community open defecation free status rather than household access alone. Sanitation practitioners may consider developing phased approaches to improving water, sanitation and hygiene in communities while prioritizing the unserved or underserved.

Does quality of life impact the decision to pursue stem cell transplantation for elderly patients with advanced MDS?

The factors that influence utilization of reduced-intensity conditioning (RIC) allogeneic hematopoietic stem cell transplantation (HCT) among medically fit older patients with advanced myelodysplastic syndromes (MDS) are largely unknown. The MDS Transplant-Associated Outcomes (MDS-TAO) study is an ongoing prospective observational study at the Dana-Farber Cancer Institute and Massachusetts General Hospital that enrolls transplant-eligible fit patients aged 60-75 years with advanced MDS and follows them through RIC HCT vs non-HCT treatment. In this analysis of 127 patients enrolled from May 2011 to June 2014, we examined the influence of age, gender, cytogenetics, International Prognostic Scoring System (IPSS) category, performance status, distance from HCT center and baseline patient-reported quality of life (QOL) from the EORTC QLQ-C30 (European Organization for Research and Treatment of Cancer Quality of Life Questionnaire) on the likelihood of receiving RIC HCT using competing risk regression modeling. With a median follow-up of 16 months, 44 patients (35%) had undergone RIC HCT. In multivariable analyses, age (hazard ratio (HR) 0.87 per year, 95% confidence interval (CI): 0.81-0.92, P<0.001) and higher IPSS (intermediate-2/high; HR 2.29, 95% CI: 1.25-4.19, P=0.007) were significantly predictive of receipt of RIC HCT; neither global QOL score nor any QOL subscales scores were predictive. These data suggest that baseline patient-reported QOL has little influence on the decision to undergo RIC HCT for older patients with advanced MDS.

Facultative use of thelytokous parthenogenesis for queen production in the polyandrous ant Cataglyphis cursor.

The evolutionary paradox of sex remains one of the major debates in evolutionary biology. The study of species capable of both sexual and asexual reproduction can elucidate factors important in the evolution of sex. One such species is the ant Cataglyphis cursor, where the queen maximizes the transmission of her genes by producing new queens (gynes) asexually while simultaneously maintaining a genetically diverse workforce via the sexual production of workers. We show that the queen can also produce gynes sexually and may do so to offset the costs of asexual reproduction. We genotyped 235 gynes from 18 colonies and found that half were sexually produced. A few colonies contained both sexually and asexually produced gynes. Although workers in this species can also use thelytoky, we found no evidence of worker production of gynes based on genotypes of 471 workers from the six colonies producing sexual gynes. Gynes are thus mainly, and potentially exclusively, produced by the queen. Simulations of gynes inbreeding level following one to ten generations of automictic thelytoky suggest that the queen switches between or combines thelytoky and sex, which may reduce the costs of inbreeding. This is supported by the relatively small size of inbred gynes in one colony, although we found no relationship between the level of inbreeding and immune parameters. Such facultative use of sex and thelytoky by individual queens contrasts with other known forms of parthenogenesis in ants, which are typically characterized by distinct lineages specializing in one strategy or the other.

Compliance with the minimum dataset of the British Orthodontic Society/British Association of Oral and Maxillofacial Surgeons for record keeping for orthognathic patients: retrospective comparative multicentre audit.

Accurate and timely collection of clinical records is of utmost importance in planning, evaluating, and auditing orthognathic operations. The minimum dataset guidelines of the British Orthodontic Society (BOS) and the British Association of Oral and Maxillofacial Surgeons (BAOMS) were published in an attempt to standardise the collection of clinical records of patients having orthognathic operations. This multicentre retrospective audit aimed to assess and compare compliance with the guidelines in 3 maxillofacial units over a 1-year period. A total of 105 cases were reviewed. Compliance varied. Documentation of altered sensation was consistently poor and too many unnecessary radiographs were taken. There may be a need to circulate the guidelines again to increase awareness and reduce variability between centres.

Professional knowledge of accident and emergency doctors on the management of dental injuries.

BACKGROUND: Accident and emergency (A&E) doctors are often the first to assess dental and dento-alveolar injuries. Early diagnosis and appropriate management is essential for a good long-term prognosis of restored dental aesthetics and function. OBJECTIVE: To evaluate A&E doctors' knowledge of the management of dental injuries, and appropriate onward referral. DESIGN AND SETTING: A cross-sectional survey using a questionnaire sent to A&E doctors of all grades at all nine A&E hospitals in South Wales over a consecutive five-month period. METHOD: Data relating to the level of knowledge of emergency management of dental trauma were analysed. The relationship between doctor's level of experience and previous training received on the management of common dento-alveolar trauma was considered. Data were analysed for Pearson correlation coefficients. RESULTS: The response rate to the questionnaire was 72% (n = 118). There was a negligible correlation between the career grade of the doctors and their knowledge of the management of dental injuries (r = 0.128, p < 0.001). A strong positive linear correlation (r = 0.928, p < 0.001) was found between those with prior training and their knowledge of dental injury management. CONCLUSIONS: The findings from this study suggest that A&E doctors have only partial knowledge of the management of dental injuries, though appropriate training can significantly increase knowledge.

Management of chronic neuropathic pain following mandibular advancement surgery.

This report highlights the management of a rare complication, namely allodynia, which arose following mandibular advancement surgery. A 56-year-old female underwent bilateral sagittal ramus advancement osteotomy. Postoperatively, she developed allodynia corresponding to the distribution of the left inferior alveolar nerve. A hierarchical pathway of topical and pharmacological agents followed by ablative techniques was used without success. Eventually, electrical neuromodulation via a motor cortex stimulator was implemented to manage the symptoms. The report serves to outline treatment options available and the risks associated with this treatment.

Case report: segmental odontomaxillary dysplasia--a rare disorder.

BACKGROUND: Segmental odontomaxillary dysplasia (SOD) is a rare developmental disorder of the maxilla characterised by abnormal growth and maturation of bone, teeth and gingival of the affected segment. Due to the rarity of the disorder, the full range of clinical manifestations is unknown. Since there are concerns that cases may be subject to misdiagnosis, this report aims to increase awareness of the condition among paediatric dentists. CASE REPORT: A 7-year-old boy was initially referred regarding failure of eruption of maxillary primary molars. Characteristic clinical and radiographic findings led to the diagnosis of SOD. Interestingly, the patient presented with unilateral ectopic eyelashes, a finding previously unreported in association with this condition. TREATMENT: Reassurance was provided regarding the benign nature of the condition. While no active intervention was needed at the time of diagnosis, close monitoring is essential. Future management may require surgical, orthodontic and prosthetic input. FOLLOW-UP: A period of four years elapsed between initial presentation of the condition and its definitive diagnosis. No significant increase in the unilateral maxillary swelling was noted. The patient will continue to be monitored on a regular basis. CONCLUSION: SOD is a rare cause of facial asymmetry. Prompt diagnosis can reassure both patient and healthcare professionals. Reporting of cases is encouraged to help determine the full range of clinical manifestations and establish a management protocol.

Who is at risk? Periodontal disease risk analysis made accessible for the general dental practitioner.

The use of odds ratio (OR) in risk analysis is considered a useful means of cross-comparing risk factors by which a disease is influenced. This article outlines the interpretation of reported ORs with respect to periodontal disease, highlighting those factors that are most deserving of consideration. The claim that periodontal disease is implicated in some serious systemic diseases is investigated with respect to the evidence. Data retrieval was carried out, focusing primarily on ORs for factors shown to be positively correlated with the incidence of periodontal disease. Using the available data, a risk evaluation scoring system was proposed (the Cronin/Stassen BEDS CHASM scale). The results of the evaluation support the view that hygiene therapy, smoking cessation and control of the glycaemic state offer the largest and most easily achieved reduction in risk with respect to attachment loss. The literature on systemic diseases indicates that the mechanisms with which periodontitis may interact seem biologically plausible, compellingly so in the cases of coronary heart disease and diabetes mellitus. However, statistical evidence to confirm these suggested interactions is equivocal, with the data retrieved in some instances being less than decisive. Further investigation is recommended.

Allowing autonomous agents freedom.

Living-donor kidney transplantation is the "gold standard" treatment for many individuals with end-stage renal failure. Superior outcomes for the graft and the transplant recipient have prompted the implementation of new strategies promoting living-donor kidney transplantation, and the number of such transplants has increased considerably over recent years. Living donors are undoubtedly exposed to risk. In his editorial "underestimating the risk in living kidney donation", Walter Glannon suggests that more data on long-term outcomes for living donors are needed to determine whether this risk is permissible and the extent to which physicians and transplant surgeons should promote living-donor kidney transplantation. In this paper I argue that it is not clear that medical professionals have underestimated this risk, nor is it clear that more data on long-term outcomes are needed in order to determine whether it is permissible for individual autonomous agents to expose themselves to this or, indeed, any risk. The global shortage of organs available for transplantation ultimately means that every year thousands of individuals who value their life die needlessly. This is an unacceptable loss of human life. Saving life is one of the most wonderful things an individual can do for another. Promoting any strategy that will assist in saving life and preventing human suffering within acceptable moral limits is legitimate.

Just How Big is the Schism Between the Health Sector and the Water and Sanitation Sector in Developing Countries?

Water, sanitation and hygiene are all key aspects to a healthy environment but often they suffer from a lack of coherence within the sector itself and also a lack of synergy with the health sector. This is not acceptable given one quarter of all child deaths are directly attributable to water-borne disease. This lack of synergy is evident at many different layers including planning, resource allocation and donor commitment. Developing countries must, in consultation with their communities, examine their biggest health risks and allocate resources accordingly. Sustained dialogue and increased in-depth analysis are needed to find consensus and an improved synergy across these vital sectors.

A review of water and sanitation provision in refugee camps in association with selected health and nutrition indicators--the need for integrated service provision.

The first global overview of basic water and sanitation indicators in refugee camps is presented (using data from 2003-2006) and compared with selected health and nutrition indicators. This demonstrates that average levels of water and sanitation provision are acceptable at camp level but many refugee operations are suffering from gaps that cross-cut these sectors; e.g. typically poor sanitation provision is corresponding with low per capita availability of water. These findings were confirmed at household level with two household surveys undertaken in African refugee camps; households reporting a case of diarrhoea within the previous 24 hours collect on average 26% less water than those not reporting any cases. In addition, typically higher levels of morbidity of one infectious agent are also reflected across other infectious agents; this is reinforced by comparing the relationship between morbidity and nutrition status from selected camps. The importance that hygiene, environmental conditions and local settings have on health (both of refugees and also local communities) is underlined. Interventions to improve indicators across the water, sanitation, health and nutrition sectors rely not only on increased and sustained resources but must entail an integrated approach to simultaneously tackle short-comings across all these vital sectors.

Follow up and evaluation of the Victorian first-trimester combined screening programme for Down syndrome and trisomy 18.

OBJECTIVE: The objective of this study was to follow up and evaluate the statewide first-trimester combined screening programme for Down syndrome and trisomy 18 at Genetic Health Services Victoria, Australia. DESIGN: Retrospective population cohort. SETTING: Maternal Serum Screening Laboratory records. SAMPLE: All women screened between February 2000 and June 2002 (16,153 pregnancies). METHODS: Screening results were matched to Victorian perinatal and birth defect data via record linkage, with an ascertainment of 96.8% of pregnancy outcomes. Manual follow up with health professionals increased ascertainment to more than 99%. MAIN OUTCOME MEASURES: Fetal Down syndrome or trisomy 18, and combined screen results, to calculate test characteristics. RESULTS: Using a risk threshold of 1 in 300 at time of ultrasound, the sensitivities for standard first-trimester combined screening and augmented 13-week combined screening for Down syndrome were 87.3 and 90.5% and the false-positive rates (FPR) were 4.1 and 3.9%, respectively. The sensitivity for trisomy 18 was 66.7% (10/15, 95% CI 42.8-90.5%) with a 0.4% FPR and 15.2% positive predictive value (1 in 250 risk threshold). CONCLUSIONS: The combined use of record linkage and manual follow-up techniques was effective in ascertaining more than 99% of pregnancy outcomes for calculations of accurate test characteristics of the combined screen. The sensitivity for Down syndrome at Genetic Health is comparable to similar populations. However, the sensitivity for trisomy 18 is lower than that elsewhere, which may reflect the overall low birth prevalence of trisomy 18 and associated small numbers in this particular cohort.