Turbulent cold flows gave birth to the first quasars.

How quasars powered by supermassive black holes formed less than a billion years after the Big Bang is still one of the outstanding problems in astrophysics, 20 years after their discovery. Cosmological simulations suggest that rare cold flows converging on primordial haloes in low-shear environments could have created these quasars if they were 10-10 solar masses at birth, but could not resolve their formation. Semi-analytical studies of the progenitor halo of a primordial quasar found that it favours the formation of such seeds, but could not verify if one actually appeared.

HIV status, knowledge and prevention of cervical cancer amongst adolescent girls and women: a secondary data analysis.

Introduction: the objective of this manuscript was to describe the knowledge profiles and determinants of cervical cancer screening among HIV positive and negative adolescent girls and women in Zimbabwe.

Methods: we conducted secondary statistical data analysis to explore the determinants of cervical cancer screening among HIV positive and negative adolescent girls and women using Zimbabwe Demographic Health survey for 2015-16.

Results: a total of 9054 adolescent girls aged 15-19, and women aged 20-49 were included in the analysis and the majority (63%) of them resided in rural areas.

Endoscopic suturing for GI applications: initial results from a prospective multicenter European registry.

Background And Aims: OverStitch devices (OverStitch and OverStitch Sx; Apollo Endosurgery, Inc, Austin, Tex, USA) are used for a wide range of applications. A European registry was created to prospectively collect technical and clinical data regarding both systems to provide procedural outcomes and to find correlation between procedural characteristics and outcomes. This study shows the initial results of the first 3 years of the registry.

Topical ocular drug delivery systems: Innovations for an unmet need.

The eye is an isolated and complex organ, with multiple robust anatomical and physiological barriers on the ocular surface which protect it from noxious insults such as the blink reflex, tear film and corneoscleral tissue layers. However, these also make it difficult for drugs to reach their therapeutic target within the eye, resulting in very low bioavailability in most commercially available ophthalmic drugs. This review will detail the mechanisms present on the ocular surface which impede drug delivery and give an overview of traditional eye drop formulations, as well as methods of improving their bioavailability through viscosity and permeation enhancement.

Outcomes After Independent Trainee Versus Consultant-led Emergency Laparotomy: Inverse Propensity Score Population Dataset Analysis.

Objective: We utilized a population dataset to compare outcomes for patients where surgery was independently performed by trainees to cases led by a consultant.

Summary Of Background Data: Emergency laparotomy is a common, high-risk, procedure. Although trainee involvement to improve future surgeons' experience and ability in the management of such cases is crucial, some studies have suggested this is to the detriment of patient outcomes.

Mental capacity legislation and communication disability: A cross-sectional survey exploring the impact of the COVID-19 pandemic on the provision of specialist decision-making support by UK SLTs.

Background: Mental capacity legislation in the UK is designed to safeguard the rights of people who may need support, or may be unable, to make autonomous decisions. Very limited evidence has been published about the impact of the COVID-19 pandemic on the application of mental capacity legislation and, to our knowledge, none on the ability of speech and language therapists (SLTs) to support people with communication disabilities to engage in decision-making.

Aims: To describe how UK SLTs supported people with communication disabilities to make decisions and participate in mental capacity assessments, best interests decision-making and advance care planning during the COVID-19 pandemic.

Nasogastric tube drainage and pyloric intervention after oesophageal resection: UK practice variation and effect on outcomes.

Background: Over 1500 patients with oesophageal cancer undergo a resection in the UK each year. At surgery, patients commonly have a nasogastric tube (NGT) placed and may undergo a pyloric intervention. There is conflicting evidence on the use of both NGTs and pyloric interventions during oesophageal resections.

The meaning of significant mean group differences for biomarker discovery.

Over the past decade, biomarker discovery has become a key goal in psychiatry to aid in the more reliable diagnosis and prognosis of heterogeneous psychiatric conditions and the development of tailored therapies. Nevertheless, the prevailing statistical approach is still the mean group comparison between "cases" and "controls," which tends to ignore within-group variability. In this educational article, we used empirical data simulations to investigate how effect size, sample size, and the shape of distributions impact the interpretation of mean group differences for biomarker discovery.

Immunotherapy and Sonpavde score validation in advanced upper tract urothelial carcinoma: a retrospective study by the Italian Network for Research in Urologic-Oncology (Meet-URO group).

Few data are available regarding the effectiveness of immune checkpoint inhibitors in advanced upper tract urothelial carcinoma (UTUC) patients. To provide a real-world experience with anti-PD-1/PD-L1-based therapy in UTUC patients, we involved an Italian network in a multicenter retrospective analysis. A total of 78 UTUC patients were enrolled.

Does the nursing curriculum influence feelings of gender-role conflict in a cohort of nursing degree male students?

It is estimated that more than 9% of the global nursing workforce is male and that this share will gradually rise over the next decade. Although there are some positive aspects of having a male nursing workforce, men in the profession still experience discriminatory behaviours and practices. Fortunately, this does not deter a number of men entering undergraduate degree programmes.

Chest drainage after oesophageal resection: A systematic review.

Background: Modern enhanced recovery protocols discourage drain use due to negative impacts on patient comfort, mobility, and recovery, and lack of proven clinical benefit. After oesophagectomy, however, drains are still routinely placed. This review aimed to assess the evidence for, and how best to use chest drains after oesophageal surgery.

ALISA: A microplate assay to measure protein thiol redox state.

Measuring protein thiol redox state is central to understanding redox signalling in health and disease. The lack of a microplate assay to measure target specific protein thiol redox state rate-limits progress on accessibility grounds: redox proteomics is inaccessible to most. Developing a microplate assay is important for accelerating discovery by widening access to protein thiol redox biology.

Incidence and relevance of clinically indeterminate nonregional lymph nodes in the treatment of oesophageal cancer.

Objectives: Metastatic involvement of nonregional supraclavicular or superior mediastinal lymph nodes in distal oesophageal cancer is rare but has important implications for prognosis and management. The management of nonregional lymph nodes which appear indeterminate on CT and FDG PET-CT (subcentimeter nodes or those with preserved normal morphology, but increased FDG avidity) can present a diagnostic dilemma. This study investigates the incidence, work-up and clinical significance of nonregional clinically indeterminate FDG avid lymph nodes.

Validity and reliability of innovative field measurements of tibial accelerations and spinal kinematics during cricket fast bowling.

The use of inertial sensors in fast bowling analysis may offer a cheaper and portable alternative to current methodologies. However, no previous studies have assessed the validity and reliability of such methods. Therefore, this study aimed to assess the validity and reliability of collecting tibial accelerations and spinal kinematics using inertial sensors during in vivo fast bowling.

Conceptual knowledge of the associativity principle: A review of the literature and an agenda for future research.

Individuals use diverse strategies to solve mathematical problems, which can reflect their knowledge of arithmetic principles and predict mathematical expertise. For example, '6 + 38 - 35' can be solved via '38 - 35 = 3' and then '3 + 6 = 9', which is a shortcut-strategy derived from the associativity principle. The shortcut may be critical for understanding algebra, however approximately 50% of adults fail to use it.

Consensus recommendations for the standardized histopathological evaluation and reporting after radical oesophago-gastrectomy (HERO consensus).

Background: Variation in the approach, radicality, and quality of gastroesophageal surgery impacts patient outcomes. Pathological outcomes such as lymph node yield are routinely used as surrogate markers of surgical quality, but are subject to significant variations in histopathological evaluation and reporting. A multi-society consensus group was convened to develop evidence-based recommendations for the standardized assessment of gastroesophageal cancer specimens.

Thinking through the multimodal treatment of localized oesophageal cancer: the point of view of the surgeon.

Purpose Of Review: This review examines current developments and controversies in the multimodal management of oesophageal cancer, with an emphasis on surgical dilemmas and outcomes from the surgeon's perspective.

Recent Findings: Despite the advancement of oncological neoadjuvant treatments, there is still no consensus on what regimen is superior. The majority of patients may still fail to respond to neoadjuvant therapy and suffer potential harm without any survival advantage as a result.

Differential influence of antibiotic therapy and other medications on oncological outcomes of patients with non-small cell lung cancer treated with first-line pembrolizumab versus cytotoxic chemotherapy.

Background: Some concomitant medications including antibiotics (ATB) have been reproducibly associated with worse survival following immune checkpoint inhibitors (ICIs) in unselected patients with non-small cell lung cancer (NSCLC) (according to programmed death-ligand 1 (PD-L1) expression and treatment line). Whether such relationship is causative or associative is matter of debate.

Methods: We present the outcomes analysis according to concomitant baseline medications (prior to ICI initiation) with putative immune-modulatory effects in a large cohort of patients with metastatic NSCLC with a PD-L1 expression ≥50%, receiving first-line pembrolizumab monotherapy.

Revising the European Society of Gastrointestinal Endoscopy (ESGE) research priorities: a research progress update.

Background: One of the aims of the European Society of Gastrointestinal Endoscopy (ESGE) is to encourage high quality endoscopic research at a European level. In 2016, the ESGE research committee published a set of research priorities. As endoscopic research is flourishing, we aimed to review the literature and determine whether endoscopic research over the last 4 years had managed to address any of our previously published priorities.

Non-oncological outcomes following limb salvage surgery in patients with knee sarcoma: a scoping review.

Purpose: Limb salvage surgery is a surgical procedure for tumour resection in bone and soft-tissue cancers. Guidelines aim to preserve as much function and tissue of the limb as possible. Surgical outcome data is routinely available as part of surgical reporting processes.

The lung immuno-oncology prognostic score (LIPS-3): a prognostic classification of patients receiving first-line pembrolizumab for PD-L1 ≥ 50% advanced non-small-cell lung cancer.

Background: To stratify the prognosis of patients with programmed cell death-ligand 1 (PD-L1) ≥ 50% advanced non-small-cell lung cancer (aNSCLC) treated with first-line immunotherapy.

Methods: Baseline clinical prognostic factors, the neutrophil-to-lymphocyte ratio (NLR), PD-L1 tumour cell expression level, lactate dehydrogenase (LDH) and their combination were investigated by a retrospective analysis of 784 patients divided between statistically powered training (n = 201) and validation (n = 583) cohorts. Cut-offs were explored by receiver operating characteristic (ROC) curves and a risk model built with validated independent factors by multivariate analysis.

The Wessex Dementia Friendly Pharmacy Framework.

Objectives: To develop and launch a dementia friendly framework for community pharmacies in the Wessex region of England.

Methods: A framework consisting of essential (mandatory) and additional (non-mandatory) criteria were devised by local stakeholders and external scrutiny from the Alzheimer's Society. The framework was designed to allow pharmacy teams to achieve essential criteria without the need for approval by others (e.

Radiofrequency ablation for Barrett's oesophagus related neoplasia with the 360 Express catheter: initial experience from the United Kingdom and Ireland-preliminary results.

Background: Radio-frequency ablation (RFA) for Barrett's oesophagus (BE)-related neoplasia is currently used after endoscopic resection of visible neoplasia. The HALO 360 balloon has been used to ablate long segment BE. The Barrx™ 360 Express RFA self-sizing catheter ('RFA Express') may potentially allow quicker ablation times and improved treatment outcomes.