University of Derby

Background Colostomy formation as part of the Hartmann’s procedure is often performed during emergency surgery as a damage limitation measure where attempts at bowel anastomosis and continuity are contraindicated. Hartmann’s reversal (HR) remains challenging and can be attempted through open surgery and various minimally invasive techniques (laparoscopic and robotic platforms). We aimed to analyse outcomes of conventional multi-port laparoscopy (CL) versus single-incision approach (SILS) in patients undergoing HR. Methods A comprehensive online search of various databases was conducted in accordance with PRISMA guidelines including Medline, PubMed, Embase, and Cochrane. Comparative studies of patients undergoing CL and SILS for HR were included. Analysed primary outcomes were total operative time and mortality rate. Secondary outcomes included post-operative complications, length of hospital stay, risk of visceral injury intra-operatively, and re-operation rate. Combined overall effect sizes were calculated using the random-effects model, and the Newcastle–Ottawa Scale (NOS) was used to assess bias. Results Two observational studies matching our inclusion criteria with a total of 160 patients (SILS 100 vs. CL 60) were included. Statistical difference was observed for one outcome measure: operative duration (MD − 44.79 CI − 65.54– − 24.04, P < 0.0001). No significant difference was seen in mortality rate (OR 1.66 CI 0.17–16.39, P = 0.66), overall post-operative complications (OR 0.60 CI 0.28–1.32, P = 0.20), length of stay (MD − 0.22 CI − 4.25–3.82, P = 0.92), Clavien-Dindo III + complications (OR 0.61 CI 0.15–2.53, P = 0.50), risk of visceral injury (OR 1.59 CI 0.30–8.31, P = 0.58), and re-operation rates (OR 0.73 CI 0.08–6.76, P = 0.78). Conclusion Accounting for study limitations, the SILS procedure seems to be quicker with non-inferior outcomes compared with the conventional multi-port approach. This may lead to better patient satisfaction and cosmesis and potentially reduce the risk of future incisional hernia occurrence. However, well-designed, randomised studies are needed to draw more robust conclusions and recommendations.

Purpose Women’s cricket has grown in popularity over the last decade, however despite this there is a paucity of literature examining the female version of the game. Furthermore, no research has examined the physical attributes of female cricketers, particularly adolescents. Therefore, the purpose of this research was to develop a physical profile for u/11, u/13, u15, and u/18 female adolescent cricket players. Methods One hundred and five (age: 13.00 ± 2.37 years, stature: 156.91 ± 12.06 cm, mass: 50.85 ± 10.40 kg) female academy players were profiled for body composition, flexibility, lower and upper body power, sprint speed, and change of direction ability. Results Both the u/11 and u/13 age groups differed significantly ( P < 0.05) to each other and the u/15 and u/18 age groups for stature, lower and upper limb power, and change of direction time. No significant differences ( P < 0.05) were observed for all tests between the u/15 and u/18 age groups. Conclusion The findings of this investigation provide normative data for adolescent female cricketers that can be used by strength and conditioning coaches for the implementation of scientifically based training programs, as well as to set goals to identify progression in physical ability during maturation and training. Additionally, the study is relevant for coaches working within the age group to support their own learning and development within the applied nature of coaching and support of their female athletes.

Coral reefs are hard calcified structures, mainly found in warm tropical water. These ecosystems serve important roles as, for example, a source of food, shelter and nursery for different organisms, and in coastal protection. Reef‐building organisms have evolved to inhabit a narrow ecological niche and thus are particularly susceptible to rapid changes in their environment, for example, under predicted climate‐change scenarios. Anthropogenic climate change is widely accepted as the leading cause of rising ocean temperatures, sea water acidity and sedimentation rate, which all affect a coral's productivity, health and, to some extent, skeletal strength. High‐energy weather events, such as storms and hurricanes, can erode reefs, thereby increasing the amount of suspended sediment and consequently the turbidity of the water. The removal of suspended sediment from the reef is vital for the health of reef producers, and a natural process that removes suspended sediment from reefs are sediment gravity flows. A key factor that controls the ability of sediment gravity flows to transport sediment is cohesion, as cohesion determines the run‐out distance of a flow through changes in its rheological properties. This study examines the cohesive nature of sediment gravity flows laden with fine‐grained CaCO3. These gravity flows laden with mud‐grade calcite are compared with flows carrying non‐cohesive, silt‐sized, silica flour, weakly cohesive kaolinite clay and strongly cohesive bentonite clay, by means of laboratory experiments. The results of these experiments show that the mud‐grade calcite flows behave more akin to the silica‐flour flows by reaching maximum mobility at considerably higher volumetric suspended sediment concentrations (47% for silica flour and 53% for CaCO3) than the kaolinite and bentonite flows (22% for kaolinite and 16% for bentonite). Fine CaCO3 gravity flows can therefore be regarded as physically non‐cohesive, and their high mobility may constitute an effective mechanism for removing suspended sediment from coral reefs, especially at locations where a slope gradient is present, such as at the reef front and forereef. However, biological cohesion, caused by ‘sticky’ extracellular polymer substances produced by micro‐organisms, can render mud‐grade calcite cohesive and sediment gravity flows less mobile. The present study should therefore be seen as a first step towards a more comprehensive analysis of the efficiency of removal of suspended sediment from coral reefs.

This article proposes a risk management framework based on the Project Management Institute (PMI) risk management knowledge area to minimize threats in risk environments and identify repurposing operations in commercial aviation. The research method comprises three main steps: (i) the identification of repurposing and risk management methodologies applicable to commercial aviation through a literature review; (ii) the adaptation of the risk management framework for coronavirus disease 2019 (COVID-19); and (iii) a proposed framework for risk management. The developed framework identifies repurposing areas and highlights relative weaknesses that are overlooked in commercial aviation. Thus, it reduces the impact of risk environments such as pandemics, and it emphasizes the importance of considering previous historical events or lessons when generating strategies for new risk situations. Commercial aviation applies repurposing operations and promotes cooperation between supply chain actors in only a few areas. This article provides a methodology for subgroups of airlines and passengers, showing different effects between risk categories to benefit commercial aviation industry subgroups. Moreover, it contributes to risk management and decision-making in commercial aviation. The article’s proposed risk management framework identifies whether a risk environment is local, national, or global. It also allows us to reflect on the sectors involved in commercial aviation, and it recommends forming risk committees to jointly coordinate and monitor risks in order to generate global strategies and identify both areas for repurposing operations and the financial capacity needed to meet demand.

This article focuses on some of the main developments regarding the interviewing of suspects during the past 25 years. It contains a personal commentary on: the 25 years ago publication of the 1999 Milne and Bull book; the evolution of the KREATIV approach in Norway; when to disclose information to suspects; a major decision by Wicklander-Zulawski & Associates; the High-Value Detainee Interrogation Group; the Council of Europe's document; the views of jail inmates; the Méndez Principles; the use of cognitive empathy; the American Psychology-Law Society's consultation document.

Acanthamoeba castellanii is the causative pathogen of a severe eye infection, known as Acanthamoeba keratitis and a life-threatening brain infection, named granulomatous amoebic encephalitis. Current treatments are problematic and costly and exhibit limited efficacy against Acanthamoeba parasite, especially the cyst stage. In parallel to drug discovery and drug repurposing efforts, drug modification is also an important approach to tackle infections, especially against neglected parasites such as free-living amoebae: Acanthamoeba. In this study, we determined whether modifying pentamidine and doxycycline through chitosan-functionalized graphene oxide loading enhances their anti-amoebic effects. Various concentrations of doxycycline, pentamidine, graphene oxide, chitosan-functionalized graphene oxide, and chitosan-functionalized graphene oxide loaded with doxycycline and pentamidine were investigated for amoebicidal effects against pathogenic A. castellanii belonging to the T4 genotype. Lactate dehydrogenase assays were performed to determine toxic effects of these various drugs and nanoconjugates against human cells. The findings revealed that chitosan-functionalized graphene oxide loaded with doxycycline demonstrated potent amoebicidal effects. Nanomaterials significantly (p < 0.05) inhibited excystation and encystation of A. castellanii without exhibiting toxic effects against human cells in a concentration-dependent manner, as compared with other formulations. These results indicate that drug modifications coupled with nanotechnology may be a viable avenue in the rationale development of effective therapies against Acanthamoeba infections.

Traffic data analysis and forecasting is a multidimensional challenge that extracts details from sources such as social media and vehicle sensor data. This study proposes a three-stage framework using Deep Learning (DL) and natural language processing (NLP) techniques to enhance the end-to-end pipeline for traffic event identification and forecasting. The framework first identifies relevant traffic data from social media using NLP, context, and word-level embeddings. The second phase extracts events and locations to dynamically construct a knowledge graph using deep learning and slot filling. A domain-specific large language model (LLM), enriched with this graph, improves traffic information relevancy. The final phase integrates Allen's interval algebra and region connection calculus to forecast traffic events based on temporal and spatial logic. This framework's goal is to improve the accuracy and semantic quality of traffic event detection, bridging the gap between academic research and real-world systems, and enabling advancements in intelligent transport systems (ITS).

Introduction Recent studies have suggested that ambulatory management is feasible for acute uncomplicated diverticulitis (AUD); however, there is still no consensus regarding the most appropriate management settings. This study presents a multi-centre experience of managing patients presenting with AUD, specifically focusing on clinical outcomes and comparing ambulatory treatment with in-patient management. Methods A retrospective multi-centre study was conducted across four hospitals in the UK and included all adult patients with computed tomography (CT) confirmed (Hinchey grade 1a) acute diverticulitis over a 12-month period (January – December 2022). Patient medical records were followed up for 1-year post-index episode, and outcomes were compared between those treated through the ambulatory pathway versus inpatient treatment using 1:1 propensity score matching (PSM). All statistical analysis was performed using the R Foundation for Statistical Computing, version 4.4. Results A total of 348 patients with Hinchey 1a acute diverticulitis were included (260 in-patients; 88 ambulatory pathway), of which nearly a third (31.3%) had a recurrent disease. Inpatient management was dominant (74.7%), with a median of 3 days of hospital stay. PSM resulted in 172 patients equally divided between the two care settings. Ambulatory management was associated with a lower readmission rate (P = 0.02 before PSM, P = 0.08 after PSM), comparable surgical (P = 0.57 before PSM, 0% in both groups after PSM) and radiological interventions (P = 0.99 before and after PSM) within one year. In both matched and non-matched groups, a strong association between readmissions and inpatient management was noted in univariate analysis (P = 0.03 before PSM, P = 0.04 after PSM) and multivariate analysis (P = 0.02 before PSM, P = 0.03 after PSM). Conclusion Our study supports the safety and efficacy of managing patients with AUD through a well-designed ambulatory care pathway. In particular, hospital re-admission rates are lower and other outcomes are non-inferior to in-patient treatment. This has implications for substantial cost-savings and better utilisation of limited healthcare resources.

Purposes: To evaluate the association between psychological resilience, depression disorder (DD), and brain functional–structural hybrid connectome in patients with breast cancer before treatment (T0) and at 1 year. Methods: Between February 2017 and October 2019, 172 patients were longitudinally enrolled from a multicenter trial named as Be Resilient to Breast Cancer (BRBC) and completed resting-state functional magnetic resonance imaging (rs-fMRI) and diffusion tensor imaging (DTI) before the T0. Data-driven multivoxel pattern analysis (MVPA) and correlational tractography (CT) were performed to identify distinct functional-structural hybrid connectome. DD was diagnosed by psychiatry physicians according to Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). Psychological resilience was collected by Resilience Scale Specific to Cancer (RS-SC) and tested as the mediation variable between hybrid connectome and DD. Results: Of the total sample of 172, 14.5% (N = 25) were diagnosed with DD. High psychological resilience was associated with a lower risk of DD (hazard ratio (HR) = 0.37, 95% confidence interval (CI), 0.17–0.82, p=0.0368). Frontal pole right (88.0%) in rs-fMRI and arcuate fasciculus_L (75.2%) in DTI were identified as main significant brain areas. Psychological resilience accounted for 10.01%–12.14% of direct effect between brain functional–structural hybrid connectome and 1-year DD. Conclusion: Psychological resilience predicts DD at 1 year and mediates the association between brain functional–structural hybrid connectome and DD at 1 year in patients diagnosed with breast cancer. Trial Registration: ClinicalTrials.gov identifier: NCT03026374

We studied the microbial diversity colonizing limestone rock pools at a Neolithic Monument (Arbor Low, Derbyshire, England). Five pools were analyzed: four located at the megaliths of the stone circle and one pool placed at the megalith at the Gib Hill burial mound 300 m distant. Samples were taken from rock pool walls and sediments, and investigated through molecular metabarcoding. The microbiome consisted of 23 phyla of bacteria (831 OTUs), 4 phyla of archaea (19 OTUs), and 27 phyla of microbial eukarya (596 OTUs). For bacteria, there were statistically significant differences in wall versus sediment populations, but not between pools. For archaea and eukarya, significant differences were found only between pools. The most abundant bacterial phylum in walls was Cyanobacteriota, and Pseudomonadota in sediments. For archaea and microbial eukarya, the dominant phyla were Euryarcheota and Chlorophyta, respectively, in both wall and sediments. The distant pool (P5) showed a markedly different community structure in phyla and species, habitat discrimination, and CHN content. Species sorting and dispersal limitation are discussed as mechanisms structuring the microbiome assemblages and their spatial connectivity. The Arbor Low microbiome is composed of terrestrial representatives common in extreme environments. The high presence of Cyanobacteriota and Chlorophyta in the Arbor Low stones is troubling, as these microorganisms can induce mechanical disruption by penetrating the limestone matrix through endolithic/chasmoendolithic growth. Future research should focus on the metabolic traits of strains to ascertain their implication in bioweathering and/or biomineralization.

Atlantic reef-building corals and coral reefs continue to experience extensive decline due to increased stressors related to climate change, disease, pollution, and numerous anthropogenic threats. To understand the impact of ocean warming and reef loss on the estimated extinction risk of shallow water Atlantic reef-building scleractinians and milleporids, all 85 valid species were reassessed under the IUCN Red List Categories and Criteria, updating the previous Red List assessment of Atlantic corals published in 2008. For the present assessment, individual species declines were estimated based on the modeled coral cover loss (1989–2019) and projected onset of annual severe bleaching events (2020–2050) across the Atlantic. Species traits were used to scale species’ relative vulnerability to the modeled cover declines and forecasted bleaching events. The updated assessments place 45.88%–54.12% of Atlantic shallow water corals at an elevated extinction risk compared to the previous assessments conducted in 2008 (15.19%–40.51%). However, coral cover loss estimates indicate an improvement in reef coverage compared to the historic time-series used for the 2008 assessments. Based on this, we infer that, although remaining dangerously high, the rate of Atlantic reef coral cover decline has surprisingly slowed in recent decades. However, based on modeled projections of sea-surface temperature that predict the onset of annual severe bleaching events within the next 30 years, we listed 26 (out of 85) species as Critically Endangered in the IUCN Red List. Each of these species had previously been listed under a lower threatened category and this result alone highlights the severe threat future bleaching events pose to coral survival and the reef ecosystems they support.

Applying existing sexing methodologies to different populations, and reporting these findings is important to enhance their applicability and accuracy in real cases across the world. DSP was published in 2005 (Murail et al., 2005) and updated as a DSP2 in 2017 (Brůžek et al., 2017) based on a database of 10 pelvic measurements from 2040 individuals worldwide. These tools have been applied subsequently to various populations, however, its applicability to a dry Spanish population is lacking. 303 hipbones belonging to 157 individuals from the School of Legal Medicine from the University Complutense of Madrid (Spain), of which 140 individuals were documented, were analyzed to investigate the reliability, applicability and accuracy of the DSP2 sex estimation methodology, examining side and sex-based potential differences for the first time. In most of the DSP variables, intra-rater reliability showed excellent results and % applicability was higher than 85.0%. Overall % accuracy was higher than 94.0% regardless of the number or discriminant power of the utilized DSP variables. However, % sexing decreased when less variables or less discriminant ones were used for estimations, reaching 45.51% (left) and 43.31% (right). Regarding sexual dimorphism, females’ results of % applicability, % sexing and % accuracy were higher compared to males. In addition, left os coxae achieved better outcomes (aforementioned percentages) in most of the cases in the sex-pooled sample. Decreasing the mandatory posterior probability by 10% yielded an increase in the % sexing but reduced % accuracy, and thus, does not seem to enhance the approach’s performance. The present study validates the applicability and reliability of DSP for sexing a Spanish population. Future investigations will attempt to assess its applicability within virtual anthropology.

Background Participant non-response is a source of bias in all research, especially in randomised controlled trials. Participants followed up remotely can have high non-response rates. Four such trials have been conducted of a cover letter with content informed by behaviour change theory to overcome hypothesised barriers to responding to a mailed questionnaire. Pooled results to date have suggested further research to be worthwhile. We conducted an embedded randomised study within a trial of such cover letters in the hope that we would improve response rates to our postal quality of life questionnaires. Methods One hundred forty-eight participants in the CODIFI2 diabetic foot ulcer sampling trial were randomised 1:1 to receive one of two different cover letters at follow-up timepoints: either a standard cover letter accompanying their postal follow-up questionnaires or to an ‘enhanced’ (theory-informed) cover letter. Questionnaires were mailed at 39, 52 and (for some participants) 104 weeks post randomisation. Outcome measures were response to mailing at each timepoint. Analysis was restricted to those for whom a questionnaire and letter was issued. Owing to limited recruitment, a reduced analysis plan, comprising solely observed response rates and 95% confidence intervals for difference in response rates was followed. Post hoc, we added our week 52 results to an already-published meta-analysis. Results Sixty-seven out of 74 enhanced cover letter group (Enhanced) and 67/74 standard cover letter group (Standard) participants who had not already died or withdrawn were sent their first mailing at 39 weeks. The 39-week response rates were 47/67 (70.1%) and 39/67 (58.2%) for Enhanced and Standard participants, respectively. At week 52, the response rates were 45/64 (70.3%) and 35/63 (55.6%) for Enhanced and Standard participants, respectively. At week 104, the response rates were 24/33 (72.7%) and 19/33 (57.6%) for the Enhanced and Standard participants, respectively. Adding our week 52 results to a published meta-analysis increased the pooled estimate of differences in response rates to 0.04 (− 0.01 to 0.09) favouring enhanced letters. Conclusion While this embedded randomised controlled trial observed greater response rates at all times among those randomised to the enhanced letter, the reduced sample size meant that these results are imprecise. Trial registration ISRCTN registry ISRCTN74929588. Registered on 5 March 2019.

This paper reports a longitudinal study, organized around national surveys and institution-based case studies, of 'enrichment' in post-16 colleges across England and Wales. These institutions transect general and vocational education pathways, whose curricula are organized respectively around subject disciplines and employment skills. Drawing on social justice perspectives and understandings of curriculum theory and cultural reproduction, the study initially analysed enrichment practices positioned as additional to subject-based curricula. However, extending thematic analysis through cross-case comparison, the study uncovered an additional , complementary role of enrichment: in some specialist/general education settings, teacher-led, practice-based extensions of subject curricula, complemented by agentic networking opportunities, facilitated middle-class higher education transitions; vocational enrichment, responding instead to 'learner support' imperatives and socializing young people into employment routines, sustained the normative transitions to work that characterize vocational pathways. These distinctive complementary logics mirror the inequalities of epistemic access identified by curriculum theory, suggesting that these extend beyond formal curricula. On the other hand, some marginal practices, including broader, more critical preparation for adulthood and work, suggest possibilities to advance social justice, transgressing the academic/vocational divide. Whilst unequal societies persistently sustain this divide, activities outside formal curricula may support more agentic and socially just transitions to adult-hood and working life. ARTICLE HISTORY

Introduction: Colorectal cancer (CRC) is the fourth most common malignancy in the UK and represents a high-volume diagnostic and clinical burden on the National Health Service (NHS). To maximise the use of limited diagnostic resources and increase efficiency, the colorectal services at University Hospitals North Midlands Trust (UHNM) developed the triage-to-test (TTT) service with risk stratification for diagnostic testing in patients with suspected colorectal cancer using faecal immunochemical testing (FIT) result. Our retrospective cohort study looked at the pick-up rate of colorectal cancer (CRC) and non-colorectal cancer (non-CRC) in FIT-negative patients. Methods: The study was a retrospective review of all symptomatic patients over 18 years of age who had undergone FIT testing in the community between 1 November 2021 and 11 February 2022 and who were referred directly to the UHNM colorectal pathway from primary care (n=2,374). FIT negativity was set at <9.9 μg/g of faeces, as per the National Institute for Health and Care Excellence (NICE) DG30 guidelines. Patients were investigated and risk stratified in accordance with their FIT result and presenting symptoms. Results: About 61.5% of patients referred were FIT negative (n=1,459) and 38.5% were FIT positive (n=915). Of those FIT-negative patients, 82 were excluded as their clinical outcomes were pending at the time of analysis. FIT positivity conferred a greater likelihood of colorectal cancer when compared with FIT-negative patients (p<0.0001). FIT-negative patients were most likely to have no significant pathology (32.5%, n=474). Incidence of colorectal cancer in the FIT-negative group was 0.5% (n=7) compared with 9.8% (n=89) in the FIT-positive group (odds ratio: 5.252, 95% CI: 4.012-6.875). Within the FIT-negative cohort, five patients were diagnosed with rectal cancer, one proximal descending colon cancer and one caecal cancer. Conclusion : The use of a FIT-negative TTT pathway ensures that any symptomatic patients presenting with red flag symptoms can be investigated appropriately. It also provides reassurance to clinicians who have an ethical duty to investigate patients in whom they suspect sinister pathology. Moreover, a triage-to-Test pathway reduces outpatient capacity burden on healthcare trusts as they may send patients directly for investigation.