Biomechanical and ergonomic risks associated with cervical musculoskeletal dysfunction amongst surgeons: A systematic review.

INTRODUCTION: Surgeons are at high risk of developing musculoskeletal symptoms due to a range of factors including, maladaptive positioning and surgical ergonomics. Cervical muscle strain and biomechanical load is most prevalent due to repetitive motions and prolonged static neck positioning. This issue is apparent through reports of prevalence between 10 and 74.4% among surgeons. The aim of this systematic review is to provide an objective assessment of the clinical evidence available and a descriptive analysis of the effects of kinematics and surgical ergonomics on the prevalence of surgeons' cervical musculoskeletal pain. METHODS: This is PRISMA-compliant systematic review of clinical studies assessing the prevalence of cervical musculoskeletal dysfunction in surgeons by searching PUBMED and Ovid EMBASE databases from inception to 19th October 2023. Study quality was graded according to the National Institutes of Health study quality assessment tools. RESULTS: A total of 9 studies were included in the final qualitative analysis. The use of loupes, open surgery and excessive neck flexion (>30°) were associated with cervical dysfunction. Comparison of study outcomes was challenging due to heterogeneity within study methods and the paucity of methodological quality. CONCLUSION: The current literature assessing ergonomic and biomechanical factors predisposing surgeons to cervical musculoskeletal dysfunction is insufficient to provide reliable guidance for clinicians. Although the literature identifies factors contributing to work-related cervical dysfunction, few attempt to evaluate interventions for improved surgical ergonomics. An objective assessment of interventions that prompt postural correction with the aim to improve neck pain in surgeon cohorts is warranted.

An Objective Analysis of Quality and Readability of Online Information for Patients seeking Cosmetic Surgery Abroad.

Increasing numbers of patients are travelling abroad to undergo cosmetic surgery. This is associated with complications that often become the responsibility of clinicians in the patients' home countries. While seemingly lower cost treatments abroad may seem attractive, prospective patients should be made aware of the hidden costs of postoperative complications and their associated morbidity. Many internet sources of information regarding these procedures originate from commercial providers in the form of advertisements, which may not highlight the potential complications to prospective patients. Our study aims to perform an objective analysis of the quality and readability of online information for patients seeking cosmetic surgery abroad using tools such as JAMA and DISCERN scores. We found that the majority of online information available to prospective and current patients regarding travelling abroad for cosmetic surgery is unregulated, distributed by commercial providers and often lacking relevant and reliable information. Due to the strong influence that the internet can have on patients' decision making, it is important that reputable, informative online material is circulated regarding these procedures. Further work needs to be done by professional bodies and medical professionals in the plastic surgery community to improve patient education in this area.

Cross-sectional and longitudinal relationships between cardiorespiratory fitness and health-related quality of life in primary school children in England: the mediating role of psychological correlates of physical activity.

AIMS: The aims were (1) to analyse the cross-sectional and longitudinal associations between children's cardiorespiratory fitness (CRF) and health-related quality of life (HRQoL) and (2) to examine whether these associations were mediated by physical activity self-efficacy and physical activity enjoyment. METHODS: This study involved 383 children (10.0 ± 0.5 years) recruited from 20 primary schools in northwest England. Data were collected on two occasions 12 weeks apart. The number of laps completed in the 20-m Shuttle Run Test was used as the CRF indicator. HRQoL was assessed using the KIDSCREEN-10 questionnaire. Physical activity self-efficacy and enjoyment were assessed with the social-cognitive and Physical Activity Enjoyment Scale questionnaires, respectively. Linear mixed models with random intercepts (schools) assessed associations between CRF and HRQoL cross-sectionally, and longitudinally. Boot-strapped mediation procedures were performed, and indirect effects (IE) with 95% confidence intervals (CI) not including zero considered as statistically significant. Analyses were adjusted for sex, time of the year, socioeconomic status, waist-to-height ratio, maturation, and physical activity. RESULTS: CRF was cross-sectionally associated with HRQoL (ß = 0.09, 95% CI = 0.02, 0.16; p = .015). In the longitudinal analysis, CRF at baseline was associated with HRQoL at 12 weeks after additionally controlling for baseline HRQoL (ß = 0.08, 95% CI = 0.002; p = .15, p = .045). Cross-sectionally, physical activity self-efficacy and enjoyment acted individually as mediators in the relationship between CRF and HRQoL (IE = 0.069, 95% CI = 0.038; p = .105 and IE = 0.045, 95% CI = 0.016; p = .080, respectively). In the longitudinal analysis, physical activity self-efficacy showed a significant mediating effect (IE = 0.025, 95% CI = 0.004; p = .054). CONCLUSION: Our findings highlight the influence of CRF on children's psychological correlates of physical activity and their overall HRQoL.

The failure of a sentinel node biopsy due to an absence of nodal uptake of nuclear isotope in consecutive melanomas in a single patient - a physiological aberration.

Nodal metastasis is an independent prognostic factor in patients with melanoma. Sentinel lymph node biopsy (SNB) is a recommended component of the management of patients with AJCC stage T1b or above. The dermal scar is injected with a Technetium-99 m (99MTc) Nanocolloid, a radiotracer that drains into sentinel nodes to be identified on a preoperative SPECT/CT scan. Intraoperatively the sentinel nodes are located using a gamma probe and patent blue dye. A 79-year-old male was referred to the Plastics Outpatient Department for management of a biopsy proven pT4b melanoma on the right flank and a suspicious lesion on the right shoulder. He was scheduled for a SNB and wide local excision of the flank melanoma and excisional biopsy of the shoulder lesion. He received injections of 99MTc Nanocolloid around the flank biopsy scar, however, preoperative, and intraoperative attempts to locate a node using radiological and surgical techniques were unsuccessful. The biopsy of the shoulder lesion sent for histopathology revealed a pT1b melanoma. A subsequent second SNB on the shoulder melanoma was unsuccessful, as 99MTc Nanocolloid failed to drain into a sentinel node for a second time. The drainage function of lymphatic vessels declines with age however the complete failure of nodal uptake is exceptionally rare. Novel radiotracers such as 99MTc Tilmanocept have shown superior lymph node tracking in recent tracers.

Data-driven approaches for genetic characterization of SARS-CoV-2 lineages

The genome of the Severe Acute Respiratory Syndrome coronavirus 2 (SARS-CoV-2), the pathogen that causes coronavirus disease 2019 (COVID-19), has been sequenced at an unprecedented scale, leading to a tremendous amount of viral genome sequencing data. To understand the evolution of this virus in humans, and to assist in tracing infection pathways and designing preventive strategies, we present a set of computational tools that span phylogenomics, population genetics and machine learning approaches. To illustrate the utility of this toolbox, we detail an in depth analysis of the genetic diversity of SARS-CoV-2 in first year of the COVID-19 pandemic, using 329,854 high-quality consensus sequences published in the GISAID database during the pre-vaccination phase. We demonstrate that, compared to standard phylogenetic approaches, haplotype networks can be computed efficiently on much larger datasets, enabling real-time analyses. Furthermore, time series change of Tajimas D provides a powerful metric of population expansion. Unsupervised learning techniques further highlight key steps in variant detection and facilitate the study of the role of this genomic variation in the context of SARS-CoV-2 infection, with Multiscale PHATE methodology identifying fine-scale structure in the SARS-CoV-2 genetic data that underlies the emergence of key lineages. The computational framework presented here is useful for real-time genomic surveillance of SARS-CoV-2 and could be applied to any pathogen that threatens the health of worldwide populations of humans and other organisms.

The mutational landscape of SARS-CoV-2 variants diversifies T cell targets in an HLA supertype-dependent manner

The rapid, global dispersion of SARS-CoV-2 since its initial identification in December 2019 has led to the emergence of a diverse range of variants. The initial concerns regarding the virus were quickly compounded with concerns relating to the impact of its mutated forms on viral infectivity, pathogenicity and immunogenicity. To address the latter, we seek to understand how the mutational landscape of SARS-CoV-2 has shaped HLA-restricted T cell immunity at the population level during the first year of the pandemic, before mass vaccination. We analyzed a total of 330,246 high quality SARS-CoV-2 genome assemblies sampled across 143 countries and all major continents. Strikingly, we found that specific mutational patterns in SARS-CoV-2 diversify T cell epitopes in an HLA supertype-dependent manner. In fact, we observed that proline residues are preferentially removed from the proteome of prevalent mutants, leading to a predicted global loss of SARS-CoV-2 T cell epitopes in individuals expressing HLA-B alleles of the B7 supertype family. In addition, we show that this predicted global loss of epitopes is largely driven by a dominant C-to-U mutation type at the RNA level. These results indicate that B7 supertype-associated epitopes, including the most immunodominant ones, were more likely to escape CD8+ T cell immunosurveillance during the first year of the pandemic. Together, our study lays the foundation to help understand how SARS-CoV-2 mutants shape the repertoire of T cell targets and T cell immunity across human populations. The proposed theoretical framework has implications in viral evolution, disease severity, vaccine resistance and herd immunity.

Deep learning for EEG-based Motor Imagery classification: Accuracy-cost trade-off.

Electroencephalography (EEG) datasets are often small and high dimensional, owing to cumbersome recording processes. In these conditions, powerful machine learning techniques are essential to deal with the large amount of information and overcome the curse of dimensionality. Artificial Neural Networks (ANNs) have achieved promising performance in EEG-based Brain-Computer Interface (BCI) applications, but they involve computationally intensive training algorithms and hyperparameter optimization methods. Thus, an awareness of the quality-cost trade-off, although usually overlooked, is highly beneficial. In this paper, we apply a hyperparameter optimization procedure based on Genetic Algorithms to Convolutional Neural Networks (CNNs), Feed-Forward Neural Networks (FFNNs), and Recurrent Neural Networks (RNNs), all of them purposely shallow. We compare their relative quality and energy-time cost, but we also analyze the variability in the structural complexity of networks of the same type with similar accuracies. The experimental results show that the optimization procedure improves accuracy in all models, and that CNN models with only one hidden convolutional layer can equal or slightly outperform a 6-layer Deep Belief Network. FFNN and RNN were not able to reach the same quality, although the cost was significantly lower. The results also highlight the fact that size within the same type of network is not necessarily correlated with accuracy, as smaller models can and do match, or even surpass, bigger ones in performance. In this regard, overfitting is likely a contributing factor since deep learning approaches struggle with limited training examples.

High Intensity Interval Training (HIIT) Improves Cardiorespiratory Fitness (CRF) in Healthy, Overweight and Obese Adolescents: A Systematic Review and Meta-Analysis of Controlled Studies.

Background: High Intensity Interval Training (HIIT) is a sustainable and effective method for improving Cardiorespiratory Fitness (CRF) in adolescents. HIIT is proven to produce equal or greater improvements in CRF when compared to moderate intensity continuous exercise (MICE) in adolescents. Methods: The studies included were considered eligible if: (1) Participants were adolescents (11-18 years old); (2) Examined changes in CRF measured either directly or indirectly; (3) Included a non-exercising control group or MICE comparison group; (4) Participants were matched at enrolment; (5) Reported HIIT protocol information; (6) Provided HIIT intensity. A meta-analysis was conducted to determine the effect of HIIT on CRF. Meta-regression and moderator analyses were performed out to quantitatively examine moderators of protocol design on CRF improvements. Results: HIIT displays a moderate effect to improve CRF (g = 0.86, 95% CI 0.518-1.106, p < 0.001). Neither study duration (weeks), nor total or weekly accumulated HIIT volume (min) displayed any significant moderation effect on pooled improvement on CRF (p > 0.05). Conclusions: HIIT is an effective method to improve CRF in adolescents, irrespective of body composition. Notably, meta regression analysis identified that prolonged high volume HIIT programs are similarly effective to short term low volume HIIT programs. This becomes of particular interest for those involved in school curricula, where short HIIT exercise may provide a pragmatic adjunct to the health benefits of Physical Education (PE) lessons.

Sprint Interval Training and the School Curriculum: Benefits Upon Cardiorespiratory Fitness, Physical Activity Profiles, and Cardiometabolic Risk Profiles of Healthy Adolescents.

BACKGROUND: This study examined the impact of a 4-week school-based sprint interval training program on cardiorespiratory fitness (CRF), daily physical activity (PA) behavior, and cardiometabolic risk (CMR) outcomes in adolescents. METHODS: A total of 56 adolescents (22 females) were allocated to either an intervention (n = 22; 17.0 [0.3] y) or control group (n = 30; 16.8 [0.5] y). Intervention group performed 5 to 6, 30 second "all out" running sprints, interspersed with 30-second rest intervals, 3 times per week, for 4 consecutive weeks, whereas control group performed their normal physical education lessons. CRF was estimated from the 20-m multistage fitness test and PA behavior was determined using accelerometry. Fasting blood samples were obtained to measure biochemical markers of CMR. RESULTS: Significant group × time interactions were observed for CRF (5.03 [1.66 to 8.40]; P < .001; d = 0.95), sedentary time (136.15 [91.91 to 180.39]; P = .004; d = 1.8), moderate PA (57.20 [32.17 to 82.23]; P < .001; d = 1.5), vigorous PA (5.40 [4.22 to 6.57]; P < .001; d = 1.2), fasting insulin (0.37 [-0.48 to 1.21]; P = .01; d = 1.0), homeostasis model of assessment-insulin resistance (0.26 [0.15 to 0.42]; P < .001; d = 0.9), and clustered CMR score (0.22 [-0.05 to 0.68]; P < .001; d = 10.63). CONCLUSION: Findings of this study indicate that 4 weeks of school-based sprint interval training improves CRF, improves PA profiles, and maintains CMR in adolescents during the school term.

Exploring psychosocial predictors of STI testing in University students.

BACKGROUND: To explore university students' Sexually Transmitted Infection (STI) testing knowledge, psychosocial and demographic predictors of past STI testing behaviour, intentions to have an STI test, and high risk sexual behaviour, to inform interventions promoting STI testing in this population. METHODS: A cross-sectional, quantitative online survey was conducted in March 2016, recruiting university students from North East Scotland via an all-student email. The anonymous questionnaire assessed student demographics (e.g. sex, ethnicity, age), STI testing behaviours, sexual risk behaviours, knowledge and five psychological constructs thought to be predictive of STI testing from theory and past research: attitudes, perceived susceptibility to STIs, social norms, social fear and self-efficacy. RESULTS: The sample contained 1294 sexually active students (response rate 10%) aged 18-63, mean age = 23.61 (SD 6.39), 888 (69%) were female. Amongst participants, knowledge of STIs and testing was relatively high, and students held generally favourable attitudes. 52% reported ever having an STI test, 13% intended to have one in the next month; 16% reported unprotected sex with more than one 'casual' partner in the last six months. Being female, older, a postgraduate, longer UK residence, STI knowledge, perceived susceptibility, subjective norms, attitudes and self-efficacy all positively predicted past STI testing behaviour (p < 0.01). Perceived susceptibility to STIs and social norms positively predicted intentions to have an STI test in the next month (p < 0.05); perceived susceptibility also predicted past high-risk sexual behaviour (p < 0.01). CONCLUSIONS: Several psychosocial predictors of past STI testing, of high-risk sexual behaviour and future STI intentions were identified. Health promotion STI testing interventions could focus on male students and target knowledge, attitude change, and increasing perceived susceptibility to STIs, social norms and self-efficacy towards STI-testing.

How reliable is the vomer flap in early hard palate repair?

Hard palate closure with a vomer flap at the time of lip repair has been widely adopted. A recent study by Deshpande et al. showed a high rate of failure of the vomer flap and led the authors to abandon the technique. We conducted a retrospective study of vomer flap healing in a consecutive series of cases performed by the senior author (D.O.). The case records of 71 patients who underwent repair of unilateral cleft lip and palate with a vomer flap at the time of lip repair were studied. Vomer flap healing was assessed and documented by the senior author at the time of definitive palate closure, and this was recorded. Adequate records were available for 66 cases. Twelve patients (18%) had associated syndromes and were included in the analysis. The median age at the time of lip and vomer flap repair was 3.5 months, and that at the time of palate repair was 8 months. At definitive palatoplasty, the vomer flap was intact in 62 patients (94%). Four patients (6%) had partial or complete failure of the vomer flap. All failures occurred in cases where the vomer flap was sutured directly to the nasal mucosa, a technique since abandoned in favour of double-breasting the flap to the raw surface of the oral mucosa. Five patients had incomplete healing of the palate following definitive palatoplasty, two of whom had a previous vomer flap failure. Contrary to Deshpande et al., we found the vomer flap to be highly reliable in closing the hard palate at the time of primary lip repair.

The Avocado Hand.

Accidental self-inflicted knife injuries to digits are a common cause of tendon and nerve injury requiring hand surgery. There has been an apparent increase in avocado related hand injuries. Classically, the patients hold the avocado in their non-dominant hand while using a knife to cut/peel the fruit with their dominant hand. The mechanism of injury is usually a stabbing injury to the non-dominant hand as the knife slips past the stone, through the soft avocado fruit. Despite their apparent increased incidence, we could not find any cases in the literature which describe the "avocado hand". We present a case of a 32-year-old woman who sustained a significant hand injury while preparing an avocado. She required exploration and repair of a digital nerve under regional anaesthesia and has since made a full recovery.