Important imaging considerations in the pre-operative assessment of rectal cancer

The role of imaging has become central in the pre-operative decision-making process for patients with rectal cancer. The detailed information that is available from high-resolution imaging studies not only provides prognostic information but also allows the surgeon to anticipate potential pitfalls during the operation. The greater the amount of detail known about the tumour, the more selective one can be in the use of pre-operative radiotherapy, which can reduce unnecessary morbidity for minimal gain. Magnetic resonance imaging (MRI) is the most useful modality for the local staging of rectal cancer as it provides the most detail on the important prognostic factors that influence treatment. These include height of tumour from the anal verge, tumour depth of penetration, nodal disease, venous invasion, involvement of the circumferential resection margin. However, endoanal ultrasound (EAUS) is particularly good at staging early tumours and aids in identifying those that are suitable for local excision. We review the important considerations in the pre-operative staging of rectal cancer.     

‘Pre-Run,Re-Run’: An innovative research capacity building exercise

Within higher education it is ironic that experienced and novice researchers rarely take the opportunity to come together to share their research – whether these be to discuss findings, puzzles or developing projects. Within this paper, an innovative strategy building on these assumptions is described. It is entitled: ‘Pre-run, Re-run’ and is a learning community where specific processes are modelled by all to help build professional communication, collegial respect, and scholarship.Our evaluation showed that there is value in bringing together researchers especially when they have diverse profiles. Also, mixing experience with naivety, by inviting professors and junior staff to fraternize equally, offers the possibility for wide ranging discussion, as well as sharing a range of successful techniques, knowledge of the big picture and ways around obstacles that would otherwise be off-putting for novices. The less experienced perspective can equally be revitalizing because newcomers to scholarship often bring a fresh focus and enthusiasm and energy for practice. While this was a local innovation, which may not be generalizable to all settings, others hoping to bring together disciplines may benefit from utilizing the successful methods to build a productive, mixed research culture.     

Australian football players experiencing groin pain exhibit reduced subscale scores of Activities of Daily Living and Sport and Recreation on the HAGOS questionnaire: A case-control study

ObjectivesTo report normative responses to the HAGOS questionnaire for Australian football players and to determine whether any of the HAGOS questionnaire sub scales can differentiate players with and without groin pain.DesignCase-control.SettingClinical setting.ParticipantsProfessional (n = 66) and semi-professional (n = 9) Australian football (AF) players with current groin pain (n = 16) and controls (n = 57) without current groin pain.Main outcome measureThe HAGOS subscales were compared between players with and without groin pain using the Wilcoxon rank-sum test with effect sizes (ES) calculated. Floor and ceiling effects were examined. A post-hoc factor analysis was undertaken.ResultsParticipants with current groin pain showed lower Physical Function of Daily Living (PFDL) and Physical Function in Sport and Recreation (PFSR) subscale scores (p < 0.05, ES: 0.77 and 0.90 respectively). Any groin pain (current and/or historical) lowered the Pain and Quality of Life (QOL) subscale scores (p < 0.05, ES: 0.38 and 0.72 respectively). Factor analysis showed 8 significant factors with one main factor identified representing items describing forceful activities (Eigenvalue = 18.02, Proportion = 0.49).ConclusionsThe HAGOS can distinguish AF players with current groin pain in the PFDL and PFSR subscales but not in the other four subscales. Any current or historical groin pain lowers scores on the QOL and Pain sub scales.Level of evidenceAetiology, Individual Case-Control Study, Level 3b     

Fathers in neonatal units: Improving infant health by supporting the baby-father bond and mother-father coparenting

The Family Initiative's International Neonatal Fathers Working Group, whose members are the authors of this paper, has reviewed the literature on engaging fathers in neonatal units, with the aim of making recommendations for improving experience of fathers as well as health outcomes in neonatal practice. We believe that supporting the father-baby bond and supporting co-parenting between the mother and the father benefits the health of the baby, for example, through improved weight gain and oxygen saturation and enhanced rates of breastfeeding. We find, however, that despite much interest in engaging with parents as full partners in the care of their baby, engaging fathers remains sub-optimal. Fathers typically describe the opportunity to bond with their babies, particularly skin-to-skin care, in glowing terms of gratitude, happiness and love. These sensations are underpinned by hormonal and neurobiological changes that take place in fathers when they care for their babies, as also happens with mothers. Fathers, however, are subject to different social expectations from mothers and this shapes how they respond to the situation and how neonatal staff treats them. Fathers are more likely to be considered responsible for earning, they are often considered to be less competent at caring than mothers and they are expected to be “the strong one”, providing support to mothers but not expecting it in return. Our review ends with 12 practical recommendations for neonatal teams to focus on: (1) assess the needs of mother and father individually, (2) consider individual needs and wants in family care plans, (3) ensure complete flexibility of access to the neonatal unit for fathers, (4) gear parenting education towards co-parenting, (5) actively promote father-baby bonding, (6) be attentive to fathers hiding their stress, (7) inform fathers directly not just via the mother, (8) facilitate peer-to-peer communication for fathers, (9) differentiate and analyse by gender in service evaluations, (10) train staff to work with fathers and to support co-parenting, (11) develop a father-friendly audit tool for neonatal units, and (12) organise an international consultation to update guidelines for neonatal care, including those of UNICEF.     

Lean Body Mass Associated with Upper Body Strength in Healthy Older Adults While Higher Body Fat Limits Lower Extremity Performance and Endurance

Impaired strength adversely influences an older person’s ability to perform activities of daily living. A cross-sectional study of 117 independently living men and women (age = 73.4 ± 9.4 year; body mass index (BMI) = 27.6 ± 4.8 kg/m²) aimed to assess the association between body composition and: (1) upper body strength (handgrip strength, HGS); (2) lower extremity performance (timed up and go (TUG) and sit to stand test (STS)); and (3) endurance (6-minute walk (SMWT). Body composition (% fat; lean body mass (LBM)) was assessed using bioelectrical impedance. Habitual physical activity was measured using the Minnesota Leisure Time Physical Activity Questionnaire (MLTPA) and dietary macronutrient intake, assessed using 24 h recalls and 3-day food records. Regression analyses included the covariates, protein intake (g/kg), MLTPA, age and sex. For natural logarithm (Ln) of right HGS, LBM (p < 0.001) and % body fat (p < 0.005) were significant (r² = 46.5%; p < 0.000). For left LnHGS, LBM (p < 0.000), age (p = 0.036), protein intake (p = 0.015) and LnMLTPA (p = 0.015) were significant (r² = 0.535; p < 0.000). For SMW, % body fat, age and LnMLTPA were significant (r² = 0.346; p < 0.000). For STS, % body fat and age were significant (r² = 0.251; p < 0.000). LBM is a strong predictor of upper body strength while higher % body fat and lower physical activity are associated with poorer outcomes on tests of lower extremity performance.     

The western Australian court diversion service: Client profile and predictors of program completion,sentencing and re‐offending

The Western Australian Court Diversion Service (CDS) is a post‐conviction / pre‐sentence program that aims to divert substance‐using offenders from the prison system and into treatment programs. It has been in operation since 1988, though a formal evaluation has not been conducted. The present study evaluated the outcomes for offenders referred to the program in relation to program completion, sentencing and re‐offending. It utilised a quasi‐experimental within groups design using data from client files from January 1998 to June 1999. Offenders who had higher motivation, attended treatment regularly and had less than 20 prior convictions were more likely to complete the program. A custodial sentence was more likely if the offender was male, had committed a serious offence, had more than 30 prior convictions, had lower motivation and had not completed the CDS program. Predictors of re‐offending included lower motivation and a previous custodial sentence. The offender's level of motivation to change and number of prior convictions were significant predictors of all three outcomes: program completion, sentencing and re‐offending. The findings highlight the importance of considering offender characteristics when assessing eligibility for diversion programs, addressing offender motivation within diversion programs and considering issues of which offenders are most likely to benefit from which programs.     

Vortex fluidic mediated synthesis of polysulfone

Polysulfone (PSF) was prepared under high shear in a vortex fluidic device (VFD) operating in confined mode, and its properties compared with that prepared using batch processing. This involved reacting the pre-prepared disodium salt of bisphenol A (BPA) with a 4,4′-dihalodiphenylsulfone under anhydrous conditions. Scanning electron microscopy (SEM) established that in the thin film microfluidic platform, the PSF particles are sheet-like, for short reaction times, and fibrous for long reaction times, in contrast to spherical like particles for the polymer prepared using the conventional batch synthesis. The operating parameters of the VFD (rotational speed of the glass tube, its tilt angle and temperature) were systematically varied for establishing their effect on the molecular weight (M_w), glass transition temperature (T_g) and decomposition temperature, featuring gel permeation chromatography (GPC), differential scanning calorimetry (DSC) and thermal gravimetric analysis (TGA) respectively. The optimal VFD prepared PSF was obtained at 6000 rpm rotational speed, 45° tilt angle and 160 °C, for 1 h of processing with M_w ∼10 000 g mol⁻¹, T_g ∼158 °C and decomposition temperature ∼530 °C, which is comparable to the conventionally prepared PSF.

Polysulfone (PSF) was prepared under high shear in a vortex fluidic device (VFD) operating in confined mode. This involved reacting the pre-prepared disodium salt of bisphenol A (BPA) with a 4,4′-dihalodiphenylsulfone under anhydrous conditions.