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Article: Clinician's Commentary on Schoo et al.

Howes, Nancy

Physiotherapy Canada. Physiotherapie Canada

2017 Volume 69, Issue 2, Page(s) 184–185

MeSH term(s)	Exercise Therapy ; Humans ; Organ Transplantation ; Transplant Recipients ; Transplants
Language	English
Publishing date	2017-05-25
Publishing country	Canada
Document type	Journal Article ; Comment
ZDB-ID	639189-8
ISSN	1708-8313 ; 0300-0508
ISSN (online)	1708-8313
ISSN	0300-0508
DOI	10.3138/ptc.2016-18-CC
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Article ; Online: Evaluating the potential utility of three-dimensional printed models in preoperative planning and patient consent in gastrointestinal cancer surgery.

Povey, M / Powell, S / Howes, N / Vimalachandran, D / Sutton, P

Annals of the Royal College of Surgeons of England

2021 Volume 103, Issue 8, Page(s) 615–620

Abstract: Introduction: The : Materials and methods: Ethical approval was obtained. From a normal computed tomography scan, three-dimensional models of the stomach, pancreas and rectum were rendered and printed on an Ultimaker™ three-dimensional printer. Semi- ... ...

Abstract	Introduction: The Materials and methods: Ethical approval was obtained. From a normal computed tomography scan, three-dimensional models of the stomach, pancreas and rectum were rendered and printed on an Ultimaker™ three-dimensional printer. Semi-structured interviews were performed with surgeons and patients to explore perceived model effectiveness and utility. Likert scales were used to grade responses (1 = strongly disagree; 10 = strongly agree) and qualitative responses recorded. Results: A total of 26 surgeons (9 rectal, 9 oesophagogastric, 8 pancreatic) and 30 patients (median age 62 years, interquartile range, IQR, 68-72 years; 57% male) were recruited. Median surgeon scores were effectiveness for preoperative planning, 6 (IQR 3-7), authenticity, 5 (IQR 3-6), likability, 6 (IQR 4-7), promoting learning, 7 (IQR 5-8), utility, 6 (IQR 5-7) and helping patients, 7 (IQR 5-8). Median patient scores were usefulness to the surgeon, 8 (IQR 7-9), authenticity, 8 (IQR 6-8), likability, 8 (IQR 7-8), helping understanding of condition, 8 (IQR 8-9), helping understanding of surgery, 8 (IQR 7-9) and feeling uncomfortable, 1 (IQR 1-4). Median overall decisional conflict score (0 = no; 100 = high) was 22 (IQR 19-28) and decision effectiveness was 25 (IQR 19-30). Discussion: Overall, patients and surgeons considered that three-dimensional printed models were effective and had potential utility in education and, to a lesser extent, preoperative planning. Patient decisional conflict and effectiveness scores were weighted towards certainty in decision making but had room for improvement, which three-dimensional models may help to facilitate.
MeSH term(s)	Aged ; Attitude of Health Personnel ; Digestive System Surgical Procedures ; Female ; Gastrointestinal Neoplasms/surgery ; Humans ; Informed Consent ; Male ; Middle Aged ; Models, Anatomic ; Pancreas ; Patient Education as Topic ; Preoperative Care ; Printing, Three-Dimensional ; Rectum ; Stomach ; United Kingdom
Language	English
Publishing date	2021-09-08
Publishing country	England
Document type	Journal Article
ZDB-ID	80044-2
ISSN	1478-7083 ; 0035-8843
ISSN (online)	1478-7083
ISSN	0035-8843
DOI	10.1308/rcsann.2020.7102
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Article ; Online: Comparative Assessment of Methane Emissions from Onshore LNG Facilities Measured Using Differential Absorption Lidar.

Innocenti, Fabrizio / Robinson, Rod / Gardiner, Tom / Howes, Neil / Yarrow, Nigel

Environmental science & technology

2023 Volume 57, Issue 8, Page(s) 3301–3310

Abstract: This study provides results from measurements of methane emissions from three onshore LNG liquefaction facilities and two regasification facilities across different regions using the Differential Absorption Lidar (DIAL) technique. The measurement ... ...

Abstract	This study provides results from measurements of methane emissions from three onshore LNG liquefaction facilities and two regasification facilities across different regions using the Differential Absorption Lidar (DIAL) technique. The measurement approach was to quantify, at each facility, emissions from the key functional elements (FEs), defined as spatially separable areas related to different identified processes. The DIAL technique enabled quantification of emissions at the FE level, allowing emission factors (EFs) to be determined for each FE using activity data. The comprehensive data set presented here should not be used for annualization, however shows the potential of what could be achieved with a larger sample size in terms of potential methane reduction and improving inventory accuracy. Among the benefits in obtaining data with this level of granularity is the possibility to compare the emissions of similar FEs on different plants including FEs present in both liquefaction and regasification facilities. Emissions from noncontinuous sources and superemitters can also be identified and quantified enabling more accurate inventory reporting and targeted maintenance and repair. Site throughput during the measurement periods was used to characterize total site EF; on average the methane losses were 0.018% and 0.070% of throughput at the regasification and liquefaction facilities, respectively.
MeSH term(s)	Methane/analysis ; Air Pollutants/analysis ; Natural Gas/analysis
Chemical Substances	Methane (OP0UW79H66) ; Air Pollutants ; Natural Gas
Language	English
Publishing date	2023-02-13
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ISSN	1520-5851
ISSN (online)	1520-5851
DOI	10.1021/acs.est.2c05446
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Article ; Online: Systematic review: management of localised low-grade upper gastrointestinal neuroendocrine tumours.

Exarchou, Klaire / Howes, Nathan / Pritchard, David Mark

Alimentary pharmacology & therapeutics

2020 Volume 51, Issue 12, Page(s) 1247–1267

Abstract: Background: Neuroendocrine tumours (NETs) of the stomach and duodenum are rare, but are increasing in incidence. Optimal management of localised, low-grade gastric and duodenal NETs remains controversial.: Aims: To systematically review recent ... ...

Abstract	Background: Neuroendocrine tumours (NETs) of the stomach and duodenum are rare, but are increasing in incidence. Optimal management of localised, low-grade gastric and duodenal NETs remains controversial. Aims: To systematically review recent literature that has evaluated the management of localised low-grade gastric and duodenal NETs. Methods: A systematic literature search was conducted. Articles were screened and eligible articles fully assessed. Additional articles were identified through the included articles' reference lists. Results: Several relevant retrospective case series were identified, but there was considerable heterogeneity between studies and they reported a variety of parameters. Type I gastric NETs had an excellent prognosis and conservative management approaches such as endoscopic surveillance/resection were appropriate in most cases. Many type III gastric NETs were low grade and appeared to have a better prognosis than has previously been appreciated. Endoscopic rather than surgical resection was therefore effective in some patients who had small, low-grade tumours. Duodenal NETs were more heterogenous. Endoscopic resection was generally safe and effective in patients who had small, low-grade, nonfunctional, non-ampullary tumours. However, some patients, especially those with larger or ampullary duodenal NETs, required surgical resection. Conclusions: Most type I gastric NETs behave indolently and surgical resection is only rarely indicated. Some type III gastric and duodenal NETs have a worse prognosis, but selected patients who have small, localised, nonfunctional, low-grade tumours are adequately and safely treated by endoscopic resection. Due to the complexity of this area, a multidisciplinary approach to management is strongly recommended.
MeSH term(s)	Endoscopy, Gastrointestinal ; Gastrointestinal Neoplasms/diagnosis ; Gastrointestinal Neoplasms/pathology ; Gastrointestinal Neoplasms/therapy ; Humans ; Neoplasm Grading ; Neuroendocrine Tumors/diagnosis ; Neuroendocrine Tumors/pathology ; Neuroendocrine Tumors/therapy ; Prognosis ; Retrospective Studies ; Upper Gastrointestinal Tract/pathology
Language	English
Publishing date	2020-05-11
Publishing country	England
Document type	Journal Article ; Systematic Review
ZDB-ID	639012-2
ISSN	1365-2036 ; 0269-2813 ; 0953-0673
ISSN (online)	1365-2036
ISSN	0269-2813 ; 0953-0673
DOI	10.1111/apt.15765
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Article ; Online: A "Watch and Wait" Strategy Involving Regular Endoscopic Surveillance Is Safe for Many Patients with Small, Sporadic, Grade 1, Non-Ampullary, Non-Functioning Duodenal Neuroendocrine Tumours.

Exarchou, Klaire / Moore, Andrew R / Smart, Howard L / Duckworth, Carrie A / Howes, Nathan / Pritchard, D Mark

Neuroendocrinology

2020 Volume 111, Issue 8, Page(s) 764–774

Abstract: Introduction: Duodenal neuroendocrine tumours (d-NETs) are rare but are increasing in incidence. Current ENETS guidelines advocate resection of all localized d-NETs. However, "watch and wait" may be appropriate for some localized, small, grade 1, non- ... ...

Abstract	Introduction: Duodenal neuroendocrine tumours (d-NETs) are rare but are increasing in incidence. Current ENETS guidelines advocate resection of all localized d-NETs. However, "watch and wait" may be appropriate for some localized, small, grade 1, non-functioning, non-ampullary d-NETs. We evaluated whether patients with such d-NETs who chose "watch and wait" involving regular endoscopic surveillance had equivalent disease-related outcomes to patients undergoing endoscopic or surgical resection. Methods: Retrospective review of patients with histologically confirmed d-NETs at Liverpool ENETS Centre of Excellence 2007-2020. Results: Sixty-nine patients were diagnosed with d-NET of which 50 were sporadic, non-functioning, non-ampullary tumours. Patient treatment groups were similar in terms of age, gender, and tumour location and grade, but unsurprisingly, larger tumours (median diameter 17 mm [p < 0.0001]) were found in the surgically treated group. Five patients underwent surgical resection with no evidence of tumour recurrence or disease-related death. Twelve patients underwent endoscopic resection (ER), with 1 local recurrence detected during follow-up. Thirty patients (28 with d-NETs ≤10 mm) underwent "watch and wait" with resection only if tumours increased in size. The d-NETs in 28/30 patients remained stable or decreased in size over a median 27 months (IQR: 15-48, R: 3-98). In 7 patients, the d-NET was completely removed by avulsion during diagnostic biopsy and was not seen at subsequent endoscopies. Only 2 patients showed increased d-NET size during surveillance, of whom only one was fit for ER. No NET-related deaths were documented during follow-up. Conclusions: All of the localized, ≤10 mm, grade 1, non-functioning, non-ampullary d-NETs in this cohort behaved indolently with very low risks of progression and no tumour-related deaths. "Watch and wait," therefore, appears to be a safe alternative management strategy for selected d-NETs.
MeSH term(s)	Aged ; Duodenal Neoplasms/diagnosis ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Neuroendocrine Tumors/diagnosis ; Outcome and Process Assessment, Health Care ; Retrospective Studies ; Watchful Waiting
Keywords	covid19
Language	English
Publishing date	2020-09-16
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	123303-8
ISSN	1423-0194 ; 0028-3835
ISSN (online)	1423-0194
ISSN	0028-3835
DOI	10.1159/000511613
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Article ; Online: Immunonutrition for patients undergoing surgery for head and neck cancer.

Howes, Noah / Atkinson, Charlotte / Thomas, Steven / Lewis, Stephen J

The Cochrane database of systematic reviews

2018 Volume 8, Page(s) CD010954

Abstract: Background: Patients with head and neck cancer are often malnourished. Surgery for such cancers is complex and may be undertaken after a course of radiotherapy. As a result, patients may have postoperative complications such as fistulae and wound ... ...

Abstract	Background: Patients with head and neck cancer are often malnourished. Surgery for such cancers is complex and may be undertaken after a course of radiotherapy. As a result, patients may have postoperative complications such as fistulae and wound infections, as well as more generalised infections such as pneumonia. One possible way to enhance recovery, and reduce the incidence of these complications, is by improving nutrition. Nutritional formulas that deliver basic nutrients as well as amino acids (arginine and glutamine), ribonucleic acid (RNA) and/or lipids (omega-3 fatty acids) are known as immunonutrition. Objectives: To assess the effects of immunonutrition treatment, compared to standard feeding, on postoperative recovery in adult patients undergoing elective (non-emergency) surgery for head and neck cancer. Search methods: The Cochrane ENT Information Specialist searched the ENT Trials Register; Central Register of Controlled Trials (CENTRAL); PubMed; Ovid Embase; CINAHL; Web of Science; ClinicalTrials.gov; ICTRP and additional sources for published and unpublished trials. The date of the search was 14 February 2018. Selection criteria: We included randomised controlled trials (RCTs) comparing immunonutrition given either preoperatively, postoperatively or perioperatively to adult patients (18 years of age or older) undergoing an elective surgical procedure for head and neck cancer, compared with a control group receiving either standard polymeric nutritional supplements or no supplements. Data collection and analysis: We used the standard methodological procedures expected by Cochrane. The primary outcomes were: length of hospital stay (days), wound infection, fistula formation and adverse events/tolerance of feeds, as defined by trial authors. Secondary outcomes were: all-cause mortality and postoperative complications (as defined by trial authors). We used GRADE to assess the quality of the evidence for each outcome; this is indicated in italics. Main results: We included 19 RCTs (1099 participants). The mean age of participants ranged from 47 to 66 years. Most studies (12/19) had fewer than 25 patients in each treatment group. Most studies (16/19) used immunonutrition formulas containing arginine, but there was variation in the actual products and amounts used, and in the length of intervention postoperatively. Follow-up time for outcome measurement varied considerably across studies, ranging from five days to greater than or equal to 16 months.Primary outcomesWe found no evidence of a difference in the length of hospital stay (mean difference -2.5 days, 95% confidence interval (CI) -5.11 to 0.12; 10 studies, 757 participants; low-quality evidence). Similarly, we found no evidence of an effect of immunonutrition on wound infection (risk ratio (RR) 0.94, 95% CI 0.70 to 1.26; 12 studies, 812 participants; very low-quality evidence). Fistula formation may be reduced with immunonutrition; the absolute risks were 11.3% and 5.4% in the standard care and immunonutrition groups, with a RR of 0.48 (95% CI 0.27 to 0.85; 10 studies, 747 participants; low-quality evidence). We found no evidence of a difference in terms of tolerance of feeds ('adverse events') between treatments (RR 1.33, 95% CI 0.86 to 2.06; 9 studies, 719 participants; very low-quality evidence).Secondary outcomesWe found no evidence of a difference between treatments in all-cause mortality (RR 1.33, 95% CI 0.48 to 3.66; 14 studies, 776 participants; low-quality evidence). Other postoperative complications such as pneumonia and urinary tract infections were not commonly reported. Authors' conclusions: The risk of postoperative fistula formation may be reduced with immunonutrition, but we found no evidence of an effect of immunonutrition on any of the other outcomes that we assessed. The studies included in this review were generally small or at high risk of bias (or both). We judged the overall quality of the evidence to be low for the outcomes length of hospital stay and all-cause mortality, and very low for wound infection and adverse events. Further research should include larger, better quality studies.
MeSH term(s)	Aged ; Arginine/administration & dosage ; Cause of Death ; Fatty Acids/administration & dosage ; Fistula/epidemiology ; Food, Fortified/adverse effects ; Glutamine/administration & dosage ; Head and Neck Neoplasms/complications ; Head and Neck Neoplasms/surgery ; Humans ; Length of Stay ; Malnutrition/etiology ; Malnutrition/therapy ; Middle Aged ; Postoperative Complications/epidemiology ; Postoperative Complications/prevention & control ; Randomized Controlled Trials as Topic ; Surgical Wound Infection/epidemiology
Chemical Substances	Fatty Acids ; Glutamine (0RH81L854J) ; Arginine (94ZLA3W45F)
Language	English
Publishing date	2018-08-30
Publishing country	England
Document type	Journal Article ; Meta-Analysis ; Research Support, Non-U.S. Gov't ; Systematic Review
ISSN	1469-493X
ISSN (online)	1469-493X
DOI	10.1002/14651858.CD010954.pub2
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Article: A monoclonal antibody chromosome marker analysis used to locate a loose smut resistance gene in wheat chromosome 6A.

Knox, R E / Howes, N K

TAG. Theoretical and applied genetics. Theoretische und angewandte Genetik

2013 Volume 89, Issue 6, Page(s) 787–793

Abstract: Many genes have been located in wheat chromosomes, yet little is known about the location of genes for resistance to Ustilago tritici, which causes loose smut. Crosses were made between the loose smut susceptible alien substitution lines Cadet 6Ag(6A) ... ...

Abstract	Many genes have been located in wheat chromosomes, yet little is known about the location of genes for resistance to Ustilago tritici, which causes loose smut. Crosses were made between the loose smut susceptible alien substitution lines Cadet 6Ag(6A) and Rescue 6Ag(6A) (lines in which Agropyron chromosome 6 is substituted by wheat chromosome 6A) and four cultivars resistant to U. tritici race T19: 'Cadet', 'Kota', 'Thatcher' and 'TD18'. The segregating progeny were tested for reaction to race T19 and for the level of binding with a monoclonal antibody specific to a chromosome 6A-coded seed protein. The antibody, which does not bind to seed protein extracts in the absence of the 6A chromosome, was used as a chromosome marker. An association was established between resistance to race T19 and the presence of chromosome 6A for each of the cultivars tested, indicating that resistance to race T19 resides in chromosome 6A. Ustilago tritici race T19 resistance in 'Cadet' appears to be located in the short arm of chromosome 6A, based on the evaluation of the Cadet 6A long ditelosomic stock, which was susceptible, and the Cadet 6A-short: 6-Agropyron- short alien translocation stock, which was resistant.
Language	English
Publishing date	2013-11-01
Publishing country	Germany
Document type	Journal Article
ZDB-ID	2170-2
ISSN	1432-2242 ; 0040-5752
ISSN (online)	1432-2242
ISSN	0040-5752
DOI	10.1007/BF00223720
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Article ; Online: Safety and effectiveness of antireflux surgery in obese patients.

Tandon, A / Rao, R / Hotouras, A / Nunes, Q M / Hartley, M / Gunasekera, R / Howes, N

Annals of the Royal College of Surgeons of England

2017 Volume 99, Issue 7, Page(s) 515–523

Abstract: Introduction The incidence of gastro-oesophageal reflux disease and obesity has increased significantly in recent years. The number of antireflux procedures being carried out on people with a higher body mass index (BMI) has been rising. Evidence is ... ...

Abstract	Introduction The incidence of gastro-oesophageal reflux disease and obesity has increased significantly in recent years. The number of antireflux procedures being carried out on people with a higher body mass index (BMI) has been rising. Evidence is conflicting for outcomes of antireflux surgery in obese patients in terms of its safety and efficacy. Given the contradictory reports, this meta-analysis was undertaken to establish the outcomes of antireflux surgery (ARS) in obese patients and its associated safety. Methods A systematic electronic search was conducted using the PubMed, MEDLINE
MeSH term(s)	Fundoplication/adverse effects ; Gastroesophageal Reflux/etiology ; Gastroesophageal Reflux/surgery ; Humans ; Laparoscopy/adverse effects ; Obesity/complications ; Obesity/surgery ; Treatment Outcome
Language	English
Publishing date	2017-08-07
Publishing country	England
Document type	Journal Article ; Meta-Analysis ; Review
ZDB-ID	80044-2
ISSN	1478-7083 ; 0035-8843
ISSN (online)	1478-7083
ISSN	0035-8843
DOI	10.1308/rcsann.2017.0144
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Article ; Online: The role of ultrasound in the management of patients with occult groin hernias.

Alabraba, E / Psarelli, E / Meakin, K / Quinn, M / Leung, M / Hartley, M / Howes, N

International journal of surgery (London, England)

2014 Volume 12, Issue 9, Page(s) 918–922

Abstract: Introduction: Groin ultrasound scanning is commonly used to examine patients with obscure groin pain or swelling. A recent study has shown ultrasound has a poor positive predictive value (PPV) in diagnosing groin hernias although earlier studies ... ...

Abstract	Introduction: Groin ultrasound scanning is commonly used to examine patients with obscure groin pain or swelling. A recent study has shown ultrasound has a poor positive predictive value (PPV) in diagnosing groin hernias although earlier studies reported PPV values as high as 100%. Our aims were to calculate ultrasound's accuracy in diagnosing occult groin hernias in symptomatic patients and assess how management of these patients is affected by ultrasound result. Methods: We retrospectively analysed 375 symptomatic adult patients, who between February 2008 and March 2010, had ultrasound to diagnose groin hernias when clinical examination was inconclusive. Patients were identified on a prospective radiology database and all groin ultrasounds were performed by either one consultant radiologist or one radiographer. Results: Ultrasound was positive in 199 patients, of which 118 underwent surgery. Using operative findings as the gold standard, ultrasound's PPV for groin hernias was 70% (95% CI: 62-78%). Ultrasound was equivocal in 42 patients of which hernias were diagnosed in 7 of the 10 who had surgery. Ultrasound was negative in 151 patients of which none were later diagnosed with hernias during 3 years' median follow-up. Conclusion: Ultrasound is poor in diagnosing occult groin hernias with a PPV of 70% suggesting a 30% chance of negative groin exploration. The equivocal ultrasound group requires careful follow-up as a considerable number were later diagnosed with hernia. The absence of subsequent hernia diagnosis in the negative ultrasound group suggests it may be a useful rule-out test to exclude occult groin hernias in symptomatic patients.
MeSH term(s)	Adult ; Aged ; Aged, 80 and over ; Female ; Groin ; Hernia, Inguinal/complications ; Hernia, Inguinal/diagnostic imaging ; Hernia, Inguinal/surgery ; Herniorrhaphy ; Humans ; Male ; Middle Aged ; Patient Selection ; Pelvic Pain/diagnostic imaging ; Pelvic Pain/etiology ; Predictive Value of Tests ; Retrospective Studies ; Treatment Outcome ; Ultrasonography ; Young Adult
Language	English
Publishing date	2014
Publishing country	England
Document type	Journal Article
ZDB-ID	2212038-5
ISSN	1743-9159 ; 1743-9191
ISSN (online)	1743-9159
ISSN	1743-9191
DOI	10.1016/j.ijsu.2014.07.266
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Article: Chromosome doubling of haploids of common wheat with caffeine.

Thomas, J / Chen, Q / Howes, N

Genome

2008 Volume 40, Issue 4, Page(s) 552–558

Abstract: Treatment of dividing plant cells with caffeine inhibits their cytokinesis, thereby inducing the formation of binucleate cells that contain polyploid nuclei. This study was undertaken to determine whether caffeine treatments would induce chromosome ... ...

Abstract	Treatment of dividing plant cells with caffeine inhibits their cytokinesis, thereby inducing the formation of binucleate cells that contain polyploid nuclei. This study was undertaken to determine whether caffeine treatments would induce chromosome doubling and seed set in haploids of common wheat (Triticum aestivum L. em. Thell.) through the further development of diploid nuclei. Ten sterile wheat haploid plants, obtained through the agency of corn (Zea mays L.) pollination, were multiplied by vegetative propagation (subdivision of well-tillered plants) to produce about 50 crowns per haploid. Washed and trimmed crowns were treated with 0.3, 1.0, 3.0, and 10.0 g∙L−1 caffeine for 3, 6, 12, and 24 h. While treatment with 0.3 g∙L−1 caffeine did not restore fertility, higher concentrations of caffeine resulted in pollen shedding and substantial seed set compared with untreated controls. Many combinations of caffeine concentration and duration produced comparable results; however, treatment with 3 g∙L−1 for 24 h was the most effective caffeine treatment on the basis of the number of seeds recovered, as well as the size and incidence of fertile sectors. Compared with a standard colchicine treatment (3-h immersion in 2 g∙L−1 colchicine dissolved in 0.5% dimethyl sulfoxide), all caffeine treatments produced fewer seeds, principally because colchicine-doubled sectors were often large, while caffeine-doubled sectors were numerous but generally small. In conclusion, caffeine produced useful numbers of seeds for all clones; gliadin banding patterns and chromosome counts indicated that genetic and cytogenetic stability of the doubling process were equal or superior for caffeine compared with colchicine.
Language	English
Publishing date	2008-04-22
Publishing country	Canada
Document type	Journal Article
ZDB-ID	639031-6
ISSN	1480-3321 ; 0831-2796
ISSN (online)	1480-3321
ISSN	0831-2796
DOI	10.1139/g97-072
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