Evaluation of Patients Referred for Abnormal Digital Rectal Examination With Normal Prostate-Specific Antigen on Best Timed Pathway for Prostate Cancer.

Introduction Currently, there is no recommendation for adjustments to the Best Timed Pathway for Prostate cancer (BTiPP) depending on whether the referral is for raised prostate-specific antigen (PSA) or malignant-feeling prostate on digital rectal examination (DRE). Therefore, all patients undergo MRI scanning. We aim to establish if patients with abnormal DRE only (without raised PSA) should have an adjusted pathway by comparing the biopsy rate and diagnostic yield after an MRI scan.

Degradation of chlorinated solvents with reactive iron minerals in subsurface sediments from redox transition zones.

Reactive iron (Fe) mineral coatings found in subsurface reduction-oxidation transition zones (RTZs) contribute to the attenuation of contaminants. An 18.3-m anoxic core was collected from the site, where constituents of concern (COCs) in groundwater included chlorinated solvents.

Peak radial growth of diffuse-porous species occurs during periods of lower water availability than for ring-porous and coniferous trees.

Climate models project warmer summer temperatures will increase the frequency and heat severity of droughts in temperate forests of Eastern North America. Hotter droughts are increasingly documented to affect tree growth and forest dynamics, with critical impacts on tree mortality, carbon sequestration and timber provision. The growing acknowledgement of the dominant role of drought timing on tree vulnerability to water deficit raises the issue of our limited understanding of radial growth phenology for most temperate tree species.

Bacteriuria resistance patterns and the suitability of urinalysis as an initial diagnostic tool in a post-antibiotic era.

Aims: Urinalysis is used as a first-line investigation throughout healthcare to indicate bacteriuria and guide treatment of potential urinary tract infections. In light of rising bacterial multi-resistance, we aim to analyse its diagnostic accuracy, determine its usefulness in a present-day setting and evaluate current antibiotic resistance patterns across a Trust population.

Methods: A retrospective case series of 712 paired urinalysis and urine culture results was obtained over a 1-month period.

Roles of reactive iron mineral coatings in natural attenuation in redox transition zones preserved from a site with historical contamination.

In this study, a protocol was developed to identify reduction-oxidation (redox) transition zones in an effort to exploit natural source zone depletion processes. A sediment core with a total length of 18-m was collected from a site with historical contamination that includes chlorinated benzenes where the redox condition was preserved. In the four redox transition zones investigated, reactive iron coatings are characterized with a suite of analyses under anaerobic conditions.

Identifying redox transition zones in the subsurface of a site with historical contamination.

Reactive iron mineral coatings found throughout reduction-oxidation (redox) transition zones play an important role in contaminant transformation processes. This research focuses on demonstrating a process for effectively delineating redox transition zones at a site with historical contamination. An 18.

Impacts of cryogenic sampling processes on iron mineral coatings in contaminated sediment.

This study focused on comparing iron mineral coatings found in contaminated sediments from a cryogenic (Cryo Core) core versus an Anaerobic Core (collected under oxygen-free and ambient conditions). After thawing the Cryo Core in an oxygen-free glovebox, a suite of analyses was applied on sediments from both cores: pH, redox potential, X-ray fluorescence (XRF), X-ray diffraction (XRD), and field-emission scanning electron microscopy (FESEM) with energy dispersive X-ray analyzer (EDX). Among the iron minerals identified, crystalline pyrite was found throughout the Cyro Core sediment samples, which is in contrast to that observed for the Anaerobic Core.

Application of hardwood biochar as a reactive capping mat to stabilize mercury derived from contaminated floodplain soil and riverbank sediments.

Hardwood biochar (pyrolyzed at 700 °C), a potential candidate for Hg removal, has been proposed for use as reactive capping mats along groundwater discharge zones or riverbanks to control release of Hg from contaminated riverbank sediments. Frequent flooding and drainage in fluvial settings can influence the effectiveness of remediation systems in contaminated riverbank sediments and floodplain soils. This study evaluated the effectiveness of Hg removal using hardwood biochar under hydrogeochemical conditions representative of those present within a reactive capping mat installed in a fluvial setting.

The drinking water contaminant dibromoacetonitrile delays G1-S transition and suppresses Chk1 activation at broken replication forks.

Chlorination of drinking water protects humans from water-born pathogens, but it also produces low concentrations of dibromoacetonitrile (DBAN), a common disinfectant by-product found in many water supply systems. DBAN is not mutagenic but causes DNA breaks and elevates sister chromatid exchange in mammalian cells. The WHO issued guidelines for DBAN after it was linked with cancer of the liver and stomach in rodents.

A systematic review of the literature on cystodistension in bladder pain syndrome.

Introduction And Hypothesis: There is significant variability in technique for cystodistension and an international discrepancy in the role in its treatment of bladder pain syndrome (BPS). The authors evaluate the evidence base for the use of cystodistension for BPS with particular reference to patient-related outcomes.

Methods: In accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analysis statement, a prospective search and evaluation protocol was prepared and registered with the PROSPERO database (ID CRD42017053710).

Modeling Correlated Discrete Uncertainties in Event Trees with Copulas.

Modeling the dependence between uncertainties in decision and risk analyses is an important part of the problem structuring process. We focus on situations where correlated uncertainties are discrete, and extend the concept of the copula-based approach for modeling correlated continuous uncertainties to the representation of correlated discrete uncertainties. This approach reduces the required number of probability assessments significantly compared to approaches requiring direct estimates of conditional probabilities.

Medicaid personal care services for children with intellectual disabilities: what assistance is provided? When is assistance provided?

We report on the nature and timing of services provided to children with an intellectual disability (ID) identified by a new comprehensive assessment and care planning tool used to evaluate children's needs for Medicaid Personal Care Services (PCS) in Texas. The new assessment procedure resulted from a legal settlement with the advocacy community. Participants in the study were 1,109 children ages 4-20 with an intellectual disability diagnosis who were assessed between January and April of 2010.

Efficacy of a mobile lithotripsy service: a one-year review of 222 patients.

Objective: Extracorporeal shockwave lithotripsy (ESWL) is the management of choice for ureteric and renal stones 20 mm or smaller, with a stone clearance rate of up to 89%. This study determined whether such a high success rate could apply to centres using mobile ESWL, by reviewing the performance at one centre that provides such a service.

Material And Methods: Between July 2011 and July 2012, 222 patients (median age 51 years, range 18-90 years) underwent one to five sessions of ESWL for ureteric and renal stones (mean size 15 mm, range 4-22 mm).

Personal care services provided to children with special health care needs (CSHCN) and their subsequent use of physician services.

Background: Medicaid Personal Care Services (PCS) help families meet children's needs for assistance with functional tasks. However, PCS may have other effects on a child's well-being, but research has not yet established the existence of such effects.

Objectives: To investigate the relationship between the number of PCS hours a child receives with subsequent visits to physicians for evaluation and management (E&M) services.

An unusual case of chronic urinary retention and bladder diverticulum presenting with unilateral lower limb swelling.

A 64-year-old man presented with 1 month of gradual-onset left leg swelling and lower urinary tract symptoms including enuresis, frequency and poor stream. He was initially treated for suspected cellulitis, however, he returned 2 weeks later with persistence of his symptoms. Routine biochemical investigation revealed renal failure (Cr 623, Ur 29.

Cerebral cavernous malformation: a diagnostic challenge in a young patient with intracerebral haemorrhage.

An 18-year-old Caucasian man presented with a sudden onset right hemiparesis. On examination, he had objective evidence of an upper motor neuron lesion affecting the right side of his body. CT scan showed a left thalamic haemorrhage.

Summarizing activity limitations in children with chronic illnesses living in the community: a measurement study of scales using supplemented interRAI items.

Background: To test the validity and reliability of scales intended to measure activity limitations faced by children with chronic illnesses living in the community. The scales were based on information provided by caregivers to service program personnel almost exclusively trained as social workers. The items used to measure activity limitations were interRAI items supplemented so that they were more applicable to activity limitations in children with chronic illnesses.

A Greenhouse Gas and Soil Carbon Model for Estimating the Carbon Footprint of Livestock Production in Canada.

To assess tradeoffs between environmental sustainability and changes in food production on agricultural land in Canada the Unified Livestock Industry and Crop Emissions Estimation System (ULICEES) was developed. It incorporates four livestock specific GHG assessments in a single model. To demonstrate the application of ULICEES, 10% of beef cattle protein production was assumed to be displaced with an equivalent amount of pork protein.

Severity of children's intellectual disabilities and Medicaid personal care services.

Objectives: This research investigated the relationship between a child's reported intellectual disability (ID) level and caregivers' reports of the child's health status to predict Medicaid Personal Care Services (PCS) hours authorized for that child. We also investigated how activity limitations in the home varied with the level of ID.

Design: The sample included 1,108 community-residing children with a reported level of ID in the Texas Medicaid system and who were assessed for the PCS program.

Medicaid Personal Care Services and caregivers' reports of children's health: the dynamics of a relationship.

Objective: To investigate the relationship between Medicaid Personal Care Services (PCS) and caregivers' reports of activity (activities of daily living [ADL]) limitations for children with chronic health problems.

Data Sources/study Setting: Primary data collected in 2008 and 2009. A state Medicaid program was the setting.

Reliability and the measurement of activity limitations (ADLs) for children with special health care needs (CSHCN) living in the community.

Purpose: Meeting the personal care challenges of children with special health care needs (CSHCN) living in the community demands a reliable assessment of their abilities to perform activities of daily living (ADLs). This research investigates factors affecting the inter-rater reliability of functional assessments of CSHCN conducted in the home.

Methods: Dual-standardised assessments were conducted with 236 community-dwelling CSHCN seeking or receiving Medicaid Personal Care Services (PCS) in a single state in USA.

Vomiting-induced surgical emphysema and pneumomediastinum: a self-remitting or life-threatening condition?

A previously well 18-year-old male presented with a 3-day history of vomiting, abdominal pain and increasing neck swelling. X-rays demonstrated both pneumomediastinum and cervical surgical emphysema and initial efforts were centred upon excluding Boerhaave syndrome (vomiting-induced oesophageal rupture). Upper gastrointestinal endoscopy and contrast CT scans excluded breech of the oesophagus but did, however, confirm dilated small bowel.

An unusual combination of sciatic and popliteal artery aneurysms.

A 68-year-old male presented with an asymptomatic pulsatile swelling on the back of his left thigh. Angiography revealed this to be aneurysmal degeneration of a persistent sciatic artery (PSA), an embryological variant whereby the primitive vascular tree persists as the main blood supply to the lower limb. Initial treatment was with an inlay graft to exclude the aneurysm from the circulation.

Modeling caregivers' perceptions of children's need for formal care: physical function, intellectual disability, and behavior.

Background: Like most caregivers, informal caregivers for children (typically parents) with special needs supply the majority of the care provided. Formal care is sometimes needed to supplement informal caregivers' efforts. For those interested in children with special needs, there is a paucity of research on those factors affecting the amount of formal care that caregivers' request.