Background Thymic stromal lymphopoietin (TSLP) plays an important role in mediating the type-2-inflammatory response. This study examined how TSLP and interleukin (IL)-4 levels in patients with chronic rhinosinusitis with nasal polyps (CRSwNP) correlated with clinical and postoperative outcomes. Methods Solid-phase sandwich ELISA was used to analyze TSLP and IL-4 levels in mucus (n = 47), plasma (n = 17), polyp (n = 30), inferior (n = 25), and middle (n = 26) turbinate tissue collected during functional endoscopic sinus surgery (FESS) in CRSwNP patients (n = 76) and controls (n = 11). Inclusion criteria includes patients with medical treatment refractory CRSwNP confirmed by endoscopy or maxillofacial CT. Exclusion criteria include history of immunodeficiency, coagulation disorders, fungal sinusitis, or cystic fibrosis. Levels of TSLP and IL-4 were correlated with SNOT-22, UPSIT, and fractional exhaled nitric oxide (FeNO) using MannWhitney U two-tailed test and linear regression with Spearman correlation coefficient test. Results TSLP is elevated in the inferior turbinates (effect size = 2.695, p = 0.0007) of CRSwNP patients compared to controls. IL-4 is expressed at elevated levels in the inferior (effect size = 3.092, p < 0.0001) and middle turbinates (effect size = 2.041, p = 0.019) compared to controls. Mucus TSLP (r = 0.4013, p = 0.0153) and IL-4 (r = 0.6138, p < 0.0001) positively correlate with preoperative FeNO levels. Lower TSLP in the inferior (r = −0.5179, p = 0.0231) and middle turbinates (r = −0.5075, p = 0.0224) and lower IL-4 in the inferior turbinates (r = −0.5205, p = 0.0223) correlate with a greater improvement in SNOT-22 post-FESS. Conclusion TSLP and IL-4 are elevated in patients with CRSwNP and correlated with increased preoperative FeNO levels and decreased sinonasal quality of life benefit after FESS. Expression of TSLP and IL-4 may play a role in guiding postoperative expectations in patients with treatment refractory CRSwNP.

Background:Cystic fibrosis (CF), which is caused by mutations in the cystic fibrosis transmembrane conductance regulator (CFTR) gene is the most common life-limiting autosomal recessive genetic disease in Northern Ireland. Currently, Northern Ireland has approximately 520 people with CF (PwCF) (312 adults, 208 children) and a defective gene carrier rate of 1 in 22 persons, with approximately 86,507 carriers within the general population. Advances in DNA sequencing technology has allowed for better genetic characterisation of CFTR mutations. The aim of this project was to (i) examine current CFTR mutation frequency and type in paediatric and adult CF populations in Northern Ireland, (ii) examine CFTR mutational trends in relation to CF patients' age groups, (iii) compare Northern Ireland CFTR most common allele frequencies with those documented globally and (iv) establish a reference/baseline of CFTR mutation information prior to the effect of CFTR modulator therapy. Methods:Anonymised data comprising of birth year, sex, and known alleles of adult and paediatric individuals (n=520) from the Northern Ireland CF population was examined. Alleles were recorded according to legacy, protein and cDNA name and organised by mutation class and type, in accordance with CFTR2 database nomenclature. Individual known alleles frequencies from the complete Northern Ireland CF population (n=1005) were calculated and compared with the CFTR2 database, globally with CFTR data obtained from CF national registries. Results:Within the Northern Ireland CF population, there were 61 different CFTR mutational variants identified in a population of 1005 alleles. In descending occurrence, the most common was F508del with 626 alleles (62.3%), followed by R117H (8.9%), G551D (5.0%), G542X (3.3%), R560T (2.8%) and P67L (2.2%). The remaining alleles were present at a frequency of <2.0%. The six most frequently detected CFTR mutations accounted for 84.4% of all alleles. Over approximately two and a half decades (1996-2021), 23 CFTR mutations remain shared. Six alleles, which were described in the 1996 CFTR analysis, were absent from the 2021 data, whilst there were additional descriptions of 39 allelic mutations, which occurred in the 2021 analysis, but which were not described in the 1996 analysis. Conclusion:Characterisation of CFTR mutation alleles from people with cystic fibrosis provides essential information to help predict disease severity and effect of targeted CFTR modulator therapy. These 2021 data provide a valuable genetic update from the 1996 data and a reference point on the status of the Northern Ireland CFTR mutation types and frequencies. CFTR modulator therapy has the potential to indirectly alter the current status quo and distribution of CFTR mutation types amongst children of PwCF, due to improved clinical status and fecundity. Revisiting this in a decade from now will allow an estimation of the indirect influence of CFTR modulator therapy on CFTR mutation evolution.

BACKGROUND:Fecal microbiota transplantation (FMT) is increasingly used in geriatric medicine, including intestinal decolonization of antimicrobial-resistant bacterial pathogens and the treatment of inflammatory bowel disease, graft versus host disease and autism spectrum disorders. The aim of this study was to examine readability of patient-facing FMT information. RESEARCH DESIGN AND METHODS:Readability was calculated using Readable software, examining (i) Flesch Reading Ease (FRE), (ii) Flesch-Kincaid Grade Level (FKGL), (iii) Gunning Fog Index, and (iv) SMOG Index and two text metrics [words/sentence, syllables/word] for 234 sources of FMT information, from four categories (abstracts/hospital information/patient-facing information/clinical trials). RESULTS:Mean readability scores of FMT information for FRE and FKGL were 22.2 ± 1.2 (SEM) (target > 60) and 14.8 ± 0.2 (target < 8), respectively, with mean words/sentence and syllables/word of 19.2 ± 0.4 and 2.0, respectively. There was no significant difference in readability between scientific abstracts and lay summaries. No information was found that had a readability of less than 7th grade (12-13 year olds). CONCLUSION:Readability of FMT information for patients is poor, not reaching readability reference standards. Authors of FMT information should consider using readability calculators when preparing FMT information, so that the final material is within recommended readability reference parameters, to support the health literacy and treatment adherence of readers.

Purpose/Objective(s) This study combines data from three multi-site phase II/III clinical trials focusing on HPV mediated oropharyngeal squamous cell cancer (OPSCC) to develop a predictive model for 12-month post radiotherapy treatment (RT) aspiration. The trials reported outcomes for standard of care (SOC) adjuvant concurrent chemotherapy and intensity-modulated radiation therapy (IMRT), de-escalated adjuvant RT and chemotherapy (DART), and mucosal sparing proton beam therapy (MSPBT). We hypothesized that patient reported outcomes (PROs), clinical, and pathologic factors could identify patients with preserved swallow function 12 months post-RT. Materials/Methods Patients were assessed for swallowing dysfunction using Penetration-Aspiration Scale (PAS) at baseline and 12 months post-RT from a modified barium swallow study (MBSS). Aspiration was defined as PAS > = 6. Patient-reported outcomes (PROs) were measured using the EORTC QLQ HN35 instrument at baseline and 12-month post-RT. Age at RT, sex, ECOG performance status, tumor laterality/location, staging, treatment modality, fractions, dose, and disease recurrence were considered as potential predictors. A multivariate Bayesian logistic regression model with a lasso prior for feature selection was employed to predict 12-month post-RT aspiration. The model was validated using a 25% holdout test cohort, with training and test AUC serving as key performance metrics. An optimal predicted probability cut point calculated using Youden's J based on the training data was used to predict 12-month post-RT aspiration (PAS > = 6) on the test cohort. Results 12-month aspiration rates were similar for the training (8/238 = 3.4%) and test cohort (2/88 = 2.3%). Age at RT, baseline PAS, obesity (BMI > 31), pharyngeal constrictor V4Gy, and 12-month EORTC QLQ HN35 swallowing score were positively associated with the likelihood of aspiration based on 95% credible intervals. Model training AUC was 0.97 (95% CI = 0.97-1.0), and test AUC was 0.90 (0.70-1.0). Using the training-optimized predicted probability cut point to predict aspiration on the test cohort, prediction accuracy was 0.97 (0.90-0.99), specificity was 0.98 (0.92-1.0), sensitivity 0.5 (0.01-0.99), PPV 0.33 (0.01-0.91), and NPV 0.99 (0.92-1.0). Conclusion OPSCC 12-month post-RT aspiration can be reliably predicted using patient demographics, treatment characteristics, and PROs. The model's test NPV of 0.99, provides a novel tool to tailor the intensity of patient intervention during the surveillance phase. Using this validated model could have reduced the number of 12-month MBSS ordered from 88 to 3 (97% reduction) in the test cohort.

Background: The One Health approach involves collaboration across several sectors, including public health, veterinary and environmental sectors in an integrated manner. These sectors may be disparate and unrelated, however to succeed, all stakeholders need to understand what the other stakeholders are communicating. Likewise, it is important that there is public acceptance and support of One Health approaches, which requires effective communication between professional and institutional organisations and the public. To help aid and facilitate such communication, written materials need to be readable by all stakeholders, in order to communicate effectively. There has been an exponential increase in the publication of papers involving One Health, with <5 per year, in the 2000s, to nearly 500 published in 2023. To date, readability of One Health information has not been scrutinised, nor has it been considered as an integral intervention of One Health policy communication. The aim of this study was therefore to examine readability of public-facing One Health information prepared by 24 global organisations. Methods: Readability was calculated using Readable software, to obtain four readability scores [(ⅰ) Flesch Reading Ease (FRE), (ⅱ) Flesch-Kincaid Grade Level (FKGL), (ⅲ) Gunning Fog Index and (ⅳ) SMOG Index] and two text metrics [words/sentence, syllables/word] for 100 sources of One Health information, from four categories [One Health public information; PubMed abstracts; Science in One Health (SOH) abstracts (articles); SOH abstracts (reviews)]. Results: Readability of One Health information for the public is poor, not reaching readability reference standards. No information was found that had a readability of less than 9th grade (around 14 years old). Mean values for the FRE and FKGL were (19.4 ± 1.4) (target >60) and (15.6 ± 0.3) (target <8), respectively, with mean words per sentence and syllables per word of 20.5 and 2.0, respectively. Abstracts with “One Health” in the title were more difficult to read than those without “One Health” in the title (FRE: P = 0.0337; FKGL: P = 0.0087). Comparison of FRE and FKGL readability scores for the four categories of One Health information [One Health public information; PubMed abstracts; SOH abstracts (articles); SOH abstracts (reviews)] showed that SOH abstracts from articles were easier to read than those from SOH reviews. No One Health public-facing information from the 100 sources examined met the FKGL target of ≤8. The most easily read One Health information required a Grade Level of 9th grade (14–15 years old), with a mean Grade Level of 15.5 (university/college level). Conclusion: Considerable work is required in making One Health written materials more readable, particularly for children and adolescents (<14 years of age). It is important that any interventions or mitigations taken to support better public understanding of the One Health approach are not ephemeral, but have longer lasting and legacy value. Authors of One Health information should consider using readability calculators when preparing One Health information for their stakeholders, to check the readability of their work, so that the final material is within recommended readability reference parameters, to support the health literacy and stakeholder-directed knowledge of their readers.

Readability of patient-facing information of oral antibiotics detailed in the WHO all oral short (6 months, 9 months) has not been described to date. The aim of this study was therefore to examine (i) how readable patient-facing TB antibiotic information is compared to readability reference standards and (ii) if there are differences in readability between high-incidence countries versus low-incidence countries. Ten antibiotics, including bedaquiline, clofazimine, ethambutol, ethionamide, isoniazid, levofloxacin, linezolid, moxifloxacin, pretomanid, pyrazinamide, were investigated. TB antibiotic information sources were examined, consisting of 85 Patient Information Leaflets (PILs) and 40 antibiotic web resouces. Of these 85 PILs, 72 were taken from the National Medicines Regulator from six countries (3 TB high-incidence [Rwanda, Malaysia, South Africa] + 3 TB low-incidence [UK, Ireland, Malta] countries). Readability data was grouped into three categories, including (i) high TB-incidence countries (n = 33 information sources), (ii) low TB-incidence countries (n = 39 information sources) and (iii) web information (n = 53). Readability was calculated using Readable software, to obtain four readability scores [(i) Flesch Reading Ease (FRE), (ii) Flesch-Kincaid Grade Level (FKGL), (iii) Gunning Fog Index and (iv) SMOG Index], as well as two text metrics [words/sentence, syllables/word]. Mean readability scores of patient-facing TB antibiotic information for FRE and FKGL, were 47.4 ± 12.6 (sd) (target ≥ 60) and 9.2 ± 2.0 (target ≤ 8.0), respectively. There was no significant difference in readability between low incidence countries and web resources, but there was significantly poorer readability associated with PILs from high incidence countries versus low incidence countries (FRE; p = 0.0056: FKGL; p = 0.0095). Readability of TB antibiotic PILs is poor. Improving readability of PILs should be an important objective when preparing patient-facing written materials, thereby improving patient health/treatment literacy.

Corneal techniques for enhancing near and intermediate vision to correct presbyopia include surgical and contact lens treatment modalities. Broad approaches used independently or in combination include correcting one eye for distant and the other for near or intermediate vision, (termed monovision or mini-monovision depending on the degree of anisometropia) and/or extending the eye's depth of focus [1]. This report reviews the evidence for the treatment profile, safety, and efficacy of the current range of corneal techniques for managing presbyopia. The visual needs and expectations of the patient, their ocular characteristics, and prior history of surgery are critical considerations for patient selection and preoperative evaluation. Contraindications to refractive surgery include unstable refraction, corneal abnormalities, inadequate corneal thickness for the proposed ablation depth, ocular and systemic co-morbidities, uncontrolled mental health issues and unrealistic patient expectations. Laser refractive options for monovision include surface/stromal ablation techniques and keratorefractive lenticule extraction. Alteration of spherical aberration and multifocal ablation profiles are the primary means for increasing ocular depth of focus, using surface and non-surface laser refractive techniques. Corneal inlays use either small aperture optics to increase depth of field or modify the anterior corneal curvature to induce corneal multifocality. In presbyopia correction by conductive keratoplasty, radiofrequency energy is applied to the mid-peripheral corneal stroma, leading to mid-peripheral corneal shrinkage and central corneal steepening. Hyperopic orthokeratology lens fitting can induce spherical aberration and correct some level of presbyopia. Postoperative management, and consideration of potential complications, varies according to technique applied and the time to restore corneal stability, but a minimum of 3 months of follow-up is recommended after corneal refractive procedures. Ongoing follow-up is important in orthokeratology and longer-term follow-up may be required in the event of late complications following corneal inlay surgery.

Background: People with cystic fibrosis (CF) may develop clinically significant chronic respiratory infections with Pseudomonas aeruginosa (PA) and non-tuberculous mycobacteria (NTM). Open water has been suggested to be an important source for continuous or intermittent exposure to these pathogens. To date, there has been a paucity of studies examining the relationship between chronic PA and NTM infection in CF patients and surfaces waters, including blue spaces. The aim of this study was therefore to examine the relationship between chronic pulmonary infection with PA and NTMs in children and adults with CF in European countries and area of surface waters, including blue spaces. Methods: European CF registry data detailing incidence of chronic PA and NTM infection in adults and children with CF in Europe (n=41,486 in 24 European countries) was correlated with surface water area data from the same countries (approx. 678,278 km2) employing Spearman coefficients. Results: Correlation of chronic PA infection in children and adults and surface water area were not significant (p=0.0680 and p=0.8448, respectively), as was NTM infection (p=0.7371 and p=0.0712, respectively). Conclusions: Acquistion of PA and its avoidance in people with CF is a complicated dynamic, not solely driven by close association with surface water, but through the integration of several other factors, including mitigations by people with CF to avoid high risk scenarios with surface water. This study was unable to demonstrate a correlation between PA and NTM infection in people with cystic fibrosis and surface water area at a national level. CF patients should continue to be vigilant about potential infection risks posed by water and take evidence-based decisions regarding their behaviour around water to protect them for acquiring these organisms from these sources.

The paper proposes a novel 3R1T cable-driven parallel robot mechanism with a Remote Centre of Motion (RCM) for Minimal Invasive Surgery (MIS). In particular, a cable-driven system designed to drive the rolling and linear motion of the surgical tool is integrated with a 5-bar spherical linkage which is to control the yaw and pitch motions. This design enables to placement of all motors on the base so as to minimize the moment of inertia of the moving structure, therefore leading to high precision. The conceptual and detailed design is first introduced, followed by cable pretension calculation and slippage error analysis, stress analysis on joints, and gravity-induced tool tip deviation. Bespoken components are fabricated using 3D printing and a prototype excluding motors is constructed. Preliminary tests validate the 3R1T mobility. The new robot shows great potential for medical applications.

Within cystic fibrosis microbiology, there is often mismatch between the antibiotic susceptibility result of an isolated bacterial pathogen and the clinical outcome, when the patient is treated with the same antibiotic. The reasoning for this remains largely elusive. Antibiotic susceptibility to four antibiotics (ceftazidime, meropenem, minocycline and trimethoprim-sulfamethoxazole) was determined in consecutive isolates (n = 11) from an adult cystic fibrosis patient, over a 63 month period. Each isolate displayed its own unique resistotype. The first isolate was sensitive to all four antibiotics, in accordance with Clinical and Laboratory Standards Institute methodology and interpretative criteria. Resistance was first detected at four months, showing resistance to ceftazidime and meropenen and intermediate resistance to minocycline and trimethoprim-sulfamethoxazole. Pan resistance was first detected at 18 months (resistotype IV), with three resistotypes (I, II and III) preceding this complete resistotype. The bacterium continued to display further antibiotic susceptibility heterogeneity for the next 45 months, with the description of an additional seven resistotypes (resistotypes V–XI). The Relative Resistance Index of this bacterium over the 63 month period showed no relationship between the development of antibiotic resistance and time. Adoption of mathematical modelling employing multinomial distribution demonstrated that large numbers of individual colony picks (>40/sputum), would be required to be 78% confident of capturing all 11 resistotypes present. Such a requirement for large numbers of colony picks combined with antibiotic susceptibility-related methodological problems creates a conundrum in biomedical science practice, in providing a robust assay that will capture antibiotic susceptibility variation, be pragmatic and cost-effective to deliver as a pathology service, but have the reliability to help clinicians select appropriate antibiotics for their patients. This study represents an advance in biomedical science as it demonstrates potential variability in antibiotic susceptibility testing with Burkholderia cenocepacia. Respiratory physicians and paediatricians need to be made aware of such variation by biomedical scientists at the bench, so that clinicians can contextualise the significance of the reported susceptibility result, when selecting appropriate antibiotics for their cystic fibrosis patient. Furthermore, consideration needs to be given in providing additional guidance on the laboratory report to highlight this heterogeneity to emphasise the potential for misalignment between susceptibility result and clinical outcome.

Purpose/Objective(s)There is a lack of evidence-based recommendations for patient work up, counseling, and management of mucoepidermoid carcinoma of the oropharynx (OPMEC). We aim to perform a systematic review and summarize the demographics, clinical presentation, histology, treatment, and oncologic outcomes of OPMEC.Materials/MethodsOvid MEDLINE(R) and Epub Ahead of Print, In-Process & Other Non-Indexed Citations, and Daily, Ovid Ebase, Ovid Cochrane Central Register of Controlled Trials, and Scopus were searched for articles published through July 7, 2023. The search strategy was designed and conducted by a medical librarian following PRISMA guidelines. Review articles, national database studies, abstracts, and studies that did not report any of the outcomes of interest were excluded. The review was conducted by two independent reviewers (GAC and AEB) and conflicts were resolved by the senior author (KVA).ResultsA total of 23 publications were included with 76 patients. When reported, sex was predominantly female (27/51, 52%) with a mean age of 48 years (19 – 76). OPMEC was most common in the base of tongue (40/51, 78%) and most patients had an oropharynx mass on exam at presentation. Tumor stage was poorly documented but was frequently T1/2 when reported (25/37, 69%). Histological grade was most often reported as intermediate grade (31/70, 44%). There was a total of 32 patients with nodal involvement. One publication (n= 25) reported 68% (17/25) of patients who underwent neck dissection had pathologic lymph nodes. When pathologic lymph nodes were reported, the majority of tumors were intermediate grade (10/19, 52%). For only 26 patients, treatment was described. Among these, the primary treatment modality was surgery only (14/26, 53%) or surgery with adjuvant radiotherapy (9/26, 34%). Three additional patients were reported to receive chemotherapy during their treatment, but it is unclear if this was for primary treatment or recurrence. 55% (11/20) of final margins reported were positive. Follow-up length varied significantly (mean 35 months, range 0-146) and the overall survival was found to be 88% (range 0-100) at the time of publication, with two deaths not attributed to OPMEC and one likely attributed to OPMEC. Only one publication (n=26) included specific findings on survival outcomes, with 75% 5-year and 65% 10-year overall survival and 86% 5-year and 86% 10-year distant recurrence-free-survival.ConclusionThe heterogeneity of studies highlights the lack of evidence supporting the understanding and management of OPMEC. OPMEC most often presents in middle aged females as a base of tongue mass and has a high potential for nodal metastasis, especially when the primary tumor is intermediate grade or higher. Oncologic outcomes appear to be fair following surgery with or without adjuvant therapy. However, further research is needed to develop an evidence-based treatment strategy for patients with OPMEC.

BackgroundTuberculosis (TB) continues be the leading cause of death globally due to an infectious agent. There is a paucity of data describing the readability of patient-facing TB information for service users. The aim of this study was to calculate the readability of multiple global TB information sources.MethodsInformation on tuberculosis (n = 150 sources) included nine categories, Patient-facing information: WHO publications (n = 17), International governments (n = 19), Hospitals (n = 10), Non-government organisations (NGOs)/charities (n = 20), Cochrane Plain Language Summaries (n = 20); LabTestsOnlineUK (n = 4) and Scientific-facing information: Clinical trials (n = 20), Cochrane abstracts (n = 20), Scientific abstracts (n = 20). Readability was calculated using Readable software, defined by (i) Flesch Reading Ease (FRE), (ii) Flesch-Kincaid Grade Level (FKGL), (iii) Gunning Fog Index and (iv) SMOG Index and two text metrics [words/sentence, syllables/word].ResultsMean readability values for TB information for the FRE and FKGL were 35.6 ± 1.6 (standard error of mean (SEM)) (US Target ≥60; UK Target ≥90) and 12.3 ± 0.3 (US Target ≤8; UK Target ≤6), respectively, with mean words per sentence and syllables per word of 17.2 and 1.8, respectively. Cochrane Plain Language Summaries had similar readability scores to their matching scientific abstract (p = 0.15). LabTestsOnlineUK yielded a mean FRE score of 51.5 ± 1.2, a mean FKGL score of 10.2 ± 0.5 and text metric scores of 16.7 ± 2.3 and 1.6, for words per sentence and syllables per word, respectively. In descending order, TB information from international governments, hospitals and LabTestsOnlineUK were the most readable (FRE = 57.9, 54.1 and 51.5, respectively), whereas scientific abstracts and Cochrane abstracts were the most difficult to read (13.0 and 30.2, respectively).ConclusionPatient-facing TB information analysed had poor readability. Effective communication of biomedical science concepts and information relating to TB is vital for service users to enhance their health literacy of tuberculosis, thereby promoting better clinical outcomes. Biomedical scientists are important custodians of scientific information for their service user populations, including other healthcare professionals within the TB multidisciplinary (MDT) team and patient service users. When preparing TB information, this should be checked and modified in real time employing readability calculators, to align with health readability targets.

Understanding and manipulating emergent phases, which are themes at the forefront of quantummaterials research, rely on identifying their underlying symmetries. This general principle has been particularly prominent in materials with coupled electronic and magnetic degrees of freedom, in which magnetic order influences the electronic band structure and can lead to exotic topological effects. However, identifying symmetry of a magnetically ordered phase can pose a challenge, particularly in the presence of small domains. Here we introduce a multimodal approach for determining magnetic structures, which combines symmetry-sensitive optical probes, scattering, and group-theoretical analysis. We apply it to EuIn2As2, a material that has received attention as a candidate axion insulator. While first-principles calculations predict this state on the assumption of a simple collinear antiferromagnetic structure, subsequent neutron-scattering measurements reveal a much more intricate magnetic ground state characterized by two coexisting magnetic wave vectors reached by successive thermal phase transitions. The proposed high- and low-temperature phases are a spin helix and a state with interpenetrating helical and Neel antiferromagnetic order termed a "broken helix," respectively. Employing a multimodal approach, we identify the magnetic structure associated with these two phases of EuIn2As2. We find that the highertemperature phase is characterized by a variation of the magnetic moment amplitude from layer to layer, with the moment vanishing entirely in every third Eu layer. The lower-temperature structure is similar to the broken helix, with one important difference: Because of local strain, the relative orientation of the magnetic structure and the lattice is not fixed. Consequently, the symmetry required to protect the axion phase is not generically protected in EuIn2As2, but we show that it can be restored if the magnetic structure is tuned with uniaxial strain. Finally, we present a spin Hamiltonian that identifies the spin interactions that account for the complex magnetic order in EuIn2As2. Our work highlights the importance of a multimodal approach in determining the symmetry of complex order parameters.

Readability of COVID-19 information from 35 cruise lines was examined. Mean Flesch Reading Ease and Flesch-Kincaid Grade Level scores (±standard error of mean) were 46.6 ± 1.3 (target ≥60) and 10.9 ± 0.3 (target ≤ 8.0), respectively. Two (6%) cruise lines met readability reference targets. Readability tools may aid in preparing more easily read passenger-facing health-related information on existing infections, including COVID-19, other respiratory infections, as well as gastroenteritis (e.g. norovirus), as well as providing a methodology for improving the readability of information prepared for newly emerging infectious diseases.

Purpose/Objective(s)Management of locoregionally advanced (LA) human papillomavirus-positive oropharyngeal squamous cell carcinoma (HPV(+)OPSCC) often entails induction chemotherapy (IC) followed by definitive chemoradiation. The standard IC regimen for head and neck cancer, docetaxel, cisplatin, and 5-fluorouracil (TPF), has a high rate of toxicity. Due to the chemosensitivity of HPV(+)OPSCC, platinum-taxane doublets are often used as IC with less toxicity. No study to date has compared TPF to a platinum-taxane doublet IC regimen. The goal of this study is to compare response rates, overall survival (OS), and complications of TPF and platinum-taxane doublet IC regimens in patients with HPV(+)OPSCC undergoing treatment with curative intent.Materials/MethodsIn this retrospective analysis, patients with treatment-naive HPV(+)OPSCC treated with induction TPF were compared to patients treated with an induction platinum-taxane doublet. Tumor characteristics, responses to IC and chemoradiation, rate of hospitalization, and OS were collected.Results59 patients (22 TPF and 37 platinum-taxane doublet) from July 2010 to December 2022 were included. 30 patients received carboplatin/paclitaxel and 7 cisplatin/docetaxel. The average age was 61.1 years (range 46–83) and 84.7% of patients were male. Staging is shown in Table 1. There were no differences in completion of IC (81.2% completed TPF vs. 91.2% completed platinum doublet, p = 0.407). All patients responded to IC with a higher rate of complete response (CR) in the TPF group (TPF CR 38.1% vs. platinum doublet CR 8.8%; TPF partial response (PR) 61.9% vs. platinum doublet PR 91.2%; p = 0.014). There was no difference in response after completion of definitive chemoradiation (TPF: CR 77.2%, PR 9.1%, progression or metastasis 13.6% vs. platinum doublet: CR 75.7%, PR 16.2%, progression or metastasis 8.1%; p = 0.660). There were also no differences in hospitalizations for adverse events (36.3% in TPF vs. 40.5% in platinum doublet, p = 0.789) or recurrence (13.6% in TPF vs. 2.7% in platinum doublet, p = 0.141). The 5-year OS was 81.9% in the TPF group and 81.5% in the platinum doublet group; there was no significant difference in OS (p = 0.495).ConclusionCompared to patients who received IC with TPF, patients who received a platinum-taxane doublet regimen had similar OS, response after definitive chemoradiation, rate of hospitalizations, and rate of recurrence. IC with a platinum-taxane doublet for LA-HPV(+)OPSCC appears to be non-inferior to TPF and could be a de-escalation strategy for patients who are not candidates for TPF. Further prospective comparison in a clinical trial is warranted.

Objectives To estimate the carriage of Neisseira meningitidis (meningococci) in expectorated sputum from people with cystic fibrosis (CF) and to evaluate potential ramifications of such carriage for the health and (NM) wellbeing of physiotherapists performing airway clearance techniques. Design Descriptive observational study. Main outcome measures Meningococcal carriage rate, CFTR mutation type and time to first meningococcal culture were determined. Results Microbiological data was examined from 100 patients from birth to present (31/12/2021), equating to 2455 patient years. NM was isolated from 6/100 (6%) adult CF patients who had F508del/F508del (homozygous), F508del/other (heterozygous) and other mutations. The median and mean time to first isolation of NM was 213 months and 230 months (standard deviation = 27.6 months), respectively, shortest time was 209 months, longest time 278 months. Conclusions Physiotherapists should be aware of the risks to themselves of acquiring Neisseria meningtidis from CF patients' respiratory aerosols, whilst performing airway clearance techniques. Physiotherapists with underlying medical conditions or with specific concerns about meningococcal disease should discuss their circumstances with their occupational health team, to ensure optimal protection. (c) 2024 Chartered Society of Physiotherapy. Published by Elsevier Ltd. All rights reserved.

BackgroundRespiratory infection is a major cause of disease severity in people with cystic fibrosis (PwCF). This project aimed to establish the CF community's opinion regarding cross infection (CI), nebuliser hygiene, antimicrobial resistance, personal impact of microbiological findings and the role of the microbiology laboratory.MethodsA questionnaire was completed anonymously (n = 280; PwCF (n = 128), parents (n = 123); friends/family/carers/charity personnel (n = 29)) from 13 countries. Readability scores (Flesch Reading Ease (FRE), Flesch Kincaid Grade Level (FKGL)) were determined for CI/IP&C information from six national CF charities and 21 scientific abstracts.ResultsRespondents (72.5%) indicated knowledge of laboratory aspects of CF microbiology was important, however implications of microbiological findings on personal health/well-being were of higher importance (p < 0.0001). Cross infection/infection prevention & control (CI/IP&C) was of highest importance (95.6% respondents) with 27.3% indicating they were not given adequate information, particularly in older respondents (50 y+) (p = 0.006) versus young adults (16-29 y) and respondents from the Middle East versus N. America (p = 0.022) and Europe (p = 0.045). Responses highlighted how CI/IP&C health literacy could be enhanced. Respondents (77.3%), particularly females (p < 0.0001), indicated they would increase the frequency of nebuliser disinfection following guidance on infection risks/best practice, therefore an educational video was prepared. CI/IP&C readability scores (mean ± sd) from CF charities (FRE 52.5 ± 10.8; FKGL 9.7 ± 2.3) were more readable (p < 0.0001) than scientific abstracts (FRE 13.3 ± 11.1; FKGL 16.9 ± 2.3), however not meeting the targets (FRE≥60 and FKGL≤8).ConclusionThere is a requirement for further CI/IP&C evidence-based guidance, policies/guidelines, education awareness, best practice in the home environment and multi-modal communication, enabling the CF community to make informed choices on lifestyle behaviours.