Crystals in the community and the classroom

The growing pressure on school curricula has meant crystals and the science of crystallography have been cut from or made optional for many educational programs. This omission is a serious disservice to the history and understanding of modern sciences, given that crystallography underpins many of the greatest advancements in science over the past century, is a critical component of many modern research papers and patents, and has 29 Nobel Prizes awarded in the field. This contribution describes a simple activity to target classroom and public engagement with crystallography, using marshmallows or equivalent sweets/candy to represent atoms and cocktail sticks to represent bonds, together with examples of how crystals are studied and how they are useful. Though it has a simple basis, this activity can be extended in numerous ways to reflect the aims of the demonstrator, and a few of these are described.

Long Term Patient Reported Quality of Life Outcomes and Patient Satisfaction of 1-Week Hypofractionated Whole Breast Radiation Therapy Using IMRT for Early-Stage Breast Cancer

PURPOSE/OBJECTIVE(S)

Novel whole breast radiation therapy (WBRT) regimens have been recently reported with the aim of improving patient convenience while preserving local control and breast cosmesis. The UK FAST Forward trial showed that 26 Gy in 5 fx using 3D conformal WBRT was equivalent to the standard 3-week regimen. However, the use of inverse planned intensity modulated radiation therapy (IMRT) for this novel ultra-hypofractionated regimen has not been previously studied. We aim to study the patient reported quality of life (QOL) outcomes and patient satisfaction of WBRT using IMRT delivering 26 Gy in 5 fractions.

MATERIALS/METHODS

Patients receiving WBRT with 26 Gy in 5 fractions using IMRT at our institution from 2020 to 2022 were included. Patients were treated with 26 Gy in 5 daily fx with or without a single fx boost of 4-5.2 Gy. IMRT plans were generated using inverse planning with 2 to 3 volumetric modulated arcs (VMAT). To assess patient-reported QOL outcomes, a questionnaire was prospectively administered at 1 month post treatment and yearly thereafter including the EORTC QLQ-BR23 breast cancer module and other patient satisfaction questions. Patient assessment involved a four-point scale (not at all, a little, quite a bit, and very much; very satisfied, moderately satisfied, moderately dissatisfied, and very dissatisfied). Here, we report the 1-year patient reported acute toxicity QOL outcomes and patient satisfaction for those undergoing IMRT based WBRT. Cross-sectional analyses were used to determine the prevalence of "quite a bit" or "very much" effects versus "not at all" or "a little" effects.

RESULTS

A total of 96 patients were included. The median age at diagnosis was 65 years. The most common histology was invasive ductal carcinoma (53.1%). ER-positivity was found in 75.5% patients. Oncoplastic reconstruction was used in 51.0% patients. The median tumor size was 1.5 cm. There were 4/98 (4.3%) node positive patients and 22.5% received adjuvant chemotherapy. Endocrine therapy was used in 74.5% patients. A boost fraction was delivered in 95.9% patients. At the 1-year assessment, only 1/35 (2.9%), 2/35 (5.7%), and 4/35 (11.4%) patients reported "quite a bit" or "very much" breast pain, skin problems, and changes in breast appearance respectively. Additionally, 32/35 (91.4%) patients were either "very satisfied" or "moderately satisfied" with their treatment, while 32/35 (91.4%) patients reported "excellent" (n = 12) or "good" (n = 20) physical appearance of the breast.

CONCLUSION

WBRT using inverse planned IMRT with 26 Gy in 5 fx shows excellent patient reported QOL and patient satisfaction at 1-year post RT. Longer follow up is needed to assess the long-term toxicity, normal tissue effects, and cosmetic outcomes of IMRT based delivery of this ultra-hypofractionated regimen.

Exploring the role of solvent polarity in mechanochemical Knoevenagel condensation: in situ investigation and isolation of reaction intermediates

Mechanochemistry has proven to be a highly effective method for the synthesis of organic compounds. We studied the kinetics of the catalyst-free Knoevenagel reaction between 4-nitrobenzaldehyde and malononitrile, activated and driven by ball milling. The reaction was investigated in the absence of solvents (neat grinding) and in the presence of solvents with different polarities (liquid-assisted grinding). The reaction was monitored using time-resolved in situ Raman spectroscopy and powder X-ray diffraction (PXRD). Our results indicate a direct relationship between solvent polarity and reaction kinetics, with higher solvent polarity leading to faster product (2-(4-nitrobenzylidone)malononitrile) formation. For the first time, we were able to isolate and determine the structure of an intermediate 2-(hydroxy(4-nitrophenyl)methyl)malononitrile based on PXRD data.

High wavenumber Raman spectroscopy for intraoperative assessment of breast tumour margins

Optimal oncological results and patient outcomes are achieved in surgery for early breast cancer with breast conserving surgery (BCS) where this is appropriate. A limitation of BCS occurs when cancer is present at, or close, to the resection margin - termed a 'positive' margin - and re-excision is recommended to reduce recurrence rate. This is occurs in 17% of BCS in the UK and there is therefore a critical need for a way to assess margin status intraoperatively to ensure complete excision with adequate margins at the first operation. This study presents the potential of high wavenumber (HWN) Raman spectroscopy to address this. Freshly excised specimens from thirty patients undergoing surgery for breast cancer were measured using a surface Raman probe, and a multivariate classification model to predict normal versus tumour was developed from the data. This model achieved 77.1% sensitivity and 90.8% specificity following leave one patient out cross validation, with the defining features being differences in water content and lipid versus protein content. This demonstrates the feasibility of HWN Raman spectroscopy to facilitate future intraoperative margin assessment at specific locations. Clinical utility of the approach will require further research.

Citizen Science to improve healthy and active living among adolescents in four European countries: a protocol of the cluster randomised controlled trial of the Science Engagement to Empower aDolescentS (SEEDS) project

INTRODUCTION

Improving healthy lifestyles of adolescents is challenging. Citizen Science is a way to engage them in the design and delivery of interventions, and may also increase their interest in science, technology, engineering and mathematics (STEM). The Science Engagement to Empower aDolescentS (SEEDS) project aims to use an equity-lens, and engage and empower boys and girls from deprived areas by designing and cocreating interventions to promote healthy lifestyles, and to seed interest in STEM.

METHODS AND ANALYSIS

SEEDS is a cluster randomised controlled trial in four countries (Greece, the Netherlands, Spain and the UK). Each country will recruit six to eight high schools from lower socioeconomic neighbourhoods. Adolescents aged 13-15 years are the target population. High schools will be randomised into intervention or control group. Each country will select 15 adolescents from intervention schools called ambassadors, who will be involved throughout the project.In each country, focus groups with ambassadors and stakeholders will focus on physical activity, snacking behaviour and STEM. The input from focus groups will be used to shape Makeathon events, cocreation events where adolescents and stakeholders will develop the interventions. The resultant intervention will be implemented in the intervention schools during 6 months. In total, we aim to recruit 720 adolescents who will complete questionnaires related to healthy lifestyles and STEM outcomes at baseline (November 2021) and after the 6 months (June 2022).

ETHICS AND DISSEMINATION

The four countries obtained approval from their corresponding Ethics Committees (Greece: Bioethics Committee of Harokopio University; the Netherlands: The Medical Research Ethics Committee of the Erasmus Medical Center; Spain: The Drug Research Ethics Committee of the Pere Virgili Health Research Institute; UK: Sport and Health Sciences Ethics Committee of the University of Exeter). Informed consent will be collected from adolescents and their parents in line with General Data Protection Regulation legislation. The findings will be disseminated by conference presentations, publications in scientific peer-reviewed journals and during (local) stakeholders and public events. Lessons learnt and the main results will also be used to provide policy recommendations.

TRIAL REGISTRATION NUMBER

NCT05002049.

GLIDE Wellcome Open Research Gateway

The Global Infectious Disease Ethics (GLIDE) Collaborative is launching a new Wellcome Open Research (WOR) Gateway, and we as the leaders of GLIDE hope to encourage submissions to this timely and necessary new platform for publishing open access peer-reviewed articles focusing on this area.

956 AN AUDIT CONDUCTED LOOKING INTO THE USE OF IV IRON TO TREAT IRON DEFICIENCY ANAEMIA ON THE ELDERLY CARE WARDS

Aims

To assess whether patients on the elderly care wards at NUH (Nottingham University Hospitals) were appropriately given IV (intravenous) iron for Iron deficiency anaemia (IDA). To improve our practice in the investigation and follow up of patients with IDA.

Method

Data was obtained of patients who had IV iron dispensed from June—September 2019. This totalled 146 patients. Digital medical records and Notis results. Server were reviewed and a spread sheet database compiled with patient demographics, presentation, blood results. Co-morbidities, medication, investigations and follow up.

Results

The average age of the patients receiving IV iron on the elderly care wards was 86 (range 74–106). 89 were female and 57 male. The top presenting complaints were; fall (38%), abdominal symptoms of pain, diarrhoea or vomiting (15%), SOB (12%). 30% of patient were on anti-coagulation and 27% were on an anti-platelet with 2% of patient on both. Mean female Hb was 89 (41–129) and male Hb was 91 (49–117). The data showed that 8 out of 81 female patients were given IV iron despite not being anaemic. In 7.5% of cases ferritin, TSAT, iron and transferrin had not been checked. Ferritin was not checked 16%. 82% of patients had no documentation with regards to the rationale for choosing not to proceed with invasive investigation.

Conclusion

Improvement is needed in the way we manage patients with IDA. This audit highlighted the need for continued review of medications—particularly anti-platelets and anti-coagulants. If there is a weak indication consider the risks and benefits. It is important we discuss and document the consideration or unsuitability of invasive investigations and follow up. A proforma is being written to guide clinicians with regards to the appropriate prescribing of IV iron and to guide investigation and follow up.

Covid-19 Epidemic Impact on Clinical Training in Irish GP Training

Aim To describe the effect of the Covid pandemic on the general practice workplace based learning of GP training in Ireland. Methods A prospective national survey of GP trainees who were in their GP practice placements on three separate occasions throughout the winter pandemic of 2020/2021 Results The average response rate to the three surveys was 19.4%. As the pandemic worsened, the number of face to face consultations dropped so that 51% (n=41) of trainees were seeing less than 5 patients face to face by the third survey. Conversely, the number of telephone/video consultations rose so that by the third survey 54% (n=44) of trainees were conducting more than 16 consultations per day remotely. Examinations and GP presentations expected to be daily occurrences diminished as the pandemic grew more severe, such that by the third survey 24-25% of trainees had not conducted a respiratory examination or dealt with new/unexpected hypertension in the previous month. Conclusion This study demonstrates abrupt change to the normal course of their training which was experienced by Irish GP trainees as a result of Covid, with examples from clinical practice. Adaptions of the training programme helped mitigate against the effects of the pandemic.

Co-designing a training package to promote health/oral health for people experiencing homelessness

Background

In Scotland, 31,333 households were assessed as experiencing homelessness in 2019/20. This population present high morbidity and mortality which is a public health issue. Their health needs have been identified within Scottish policy as part of the broad goal of reducing inequalities and poverty. Those experiencing homelessness face multiple exclusions that must be addressed by practitioners from all health and social care sectors. Frontline staff have identified they often do not have adequate information and/or training on wider health issues linked with their client's needs. The aim of this research is to co-produce training resources to support front-line staff to discuss and to promote health and oral health.

Methods

Community-based participatory research that used online workshops to listen to the views of people with lived experience, practitioners and students from health and third sector, and policy makers regarding accessibility of services and practitioner approach towards those experiencing homelessness. Content analysis will be used to identified recurrent themes.

Results

The preliminary findings shown that lack of empathy from practitioners, continuity of care and stigma are barriers to access services. This is informing a co-designed knowledge exchange training packaged to help practitioners to improve knowledge and ability to promote health/oral health and to engage with people experiencing homelessness or at risk of becoming homeless. Educational materials (e-book on health promotion, comics books on barriers to access services, and a guide to promote oral health) compose this training package.

Conclusions

The training package allows adaptations to different settings and contexts and will be an important resource to be used by practitioners from different fields to prevent and tackle homelessness. Participants are sharing important views related to the need of a human rights and social justice-based approach to health promotion.

Key messages

Development of a co-designed knowledge exchange training package to improve practitioners' knowledge and ability to communicate and to engage with people experiencing homelessness. To empower people experiencing homelessness regarding positive health/oral health behavior change.

The potential impact of post-COVID symptoms in the healthcare sector

BACKGROUND

The phenomenon of post-COVID syndrome (PCS) is evolving from an abstract array of non-specific symptoms to an identifiable clinical entity of variable severity. Its frequency and persistence have implications for service delivery and workforce planning.

AIMS

This study was aimed to assess the prevalence of symptoms consistent with PCS and the subjective degree of recovery in a cohort of healthcare workers, focusing on those who have returned to work.

METHODS

A study population of 1176 was surveyed when attending for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antibody testing. Two sub-groups were identified: those with known (i.e. diagnosed on PCR testing) and assumed (i.e. antibody evidence of previous infection) SARs-CoV-2 infection, at least 12 weeks prior to the study. Each group was asked about their subjective degree of recovery and the nature of their persistent symptoms. Results were analysed via excel and SPSS.

RESULTS

In total, 144 employees showed PCR evidence of previous infection, with 139 of these being infected at least 12 weeks prior to the study. Of these 139, only 19% (n = 26) reported feeling 100% recovered, and 71% reported persistent symptoms. Of those with assumed SARS-CoV-2 infection (n = 78), 32 (41%) were truly asymptomatic since the commencement of the pandemic, while 46 (59%) described symptoms suggestive of possible infection at least 12 weeks prior to the study. Of this latter group, 23% (n = 18) also reported residual symptoms.

CONCLUSIONS

PCS is prevalent among this group, including those not previously diagnosed with COVID-19. Its' frequency and duration present challenges to employers with regards to the management of work availability and performance.

Bridging the age gap in breast cancer: cluster randomized trial of two decision support interventions for older women with operable breast cancer on quality of life, survival, decision quality, and treatment choices

BACKGROUND

Rates of surgery and adjuvant therapy for breast cancer vary widely between breast units. This may contribute to differences in survival. This cluster RCT evaluated the impact of decision support interventions (DESIs) for older women with breast cancer, to ascertain whether DESIs influenced quality of life, survival, decision quality, and treatment choice.

METHODS

A multicentre cluster RCT compared the use of two DESIs against usual care in treatment decision-making in older women (aged at least ≥70 years) with breast cancer. Each DESI comprised an online algorithm, booklet, and brief decision aid to inform choices between surgery plus adjuvant endocrine therapy versus primary endocrine therapy, and adjuvant chemotherapy versus no chemotherapy. The primary outcome was quality of life. Secondary outcomes included decision quality measures, survival, and treatment choice.

RESULTS

A total of 46 breast units were randomized (21 intervention, 25 usual care), recruiting 1339 women (670 intervention, 669 usual care). There was no significant difference in global quality of life at 6 months after the baseline assessment on intention-to-treat analysis (difference -0.20, 95 per cent confidence interval (C.I.) -2.69 to 2.29; P = 0.900). In women offered a choice of primary endocrine therapy versus surgery plus endocrine therapy, knowledge about treatments was greater in the intervention arm (94 versus 74 per cent; P = 0.003). Treatment choice was altered, with a primary endocrine therapy rate among women with oestrogen receptor-positive disease of 21.0 per cent in the intervention versus 15.4 per cent in usual-care sites (difference 5.5 (95 per cent C.I. 1.1 to 10.0) per cent; P = 0.029). The chemotherapy rate was 10.3 per cent at intervention versus 14.8 per cent at usual-care sites (difference -4.5 (C.I. -8.0 to 0) per cent; P = 0.013). Survival was similar in both arms.

CONCLUSION

The use of DESIs in older women increases knowledge of breast cancer treatment options, facilitates shared decision-making, and alters treatment selection. Trial registration numbers: EudraCT 2015-004220-61 (https://eudract.ema.europa.eu/), ISRCTN46099296 (http://www.controlled-trials.com).

Multidisciplinary management of locally advanced and metastatic cutaneous squamous cell carcinoma

Non-melanoma skin cancers are the most prevalent form of cancer, with cutaneous squamous cell carcinoma (cscc) being the 2nd most common type. Patients presenting with high-risk lesions associated with locally advanced or metastatic cscc face high rates of recurrence and mortality. Accurate staging and risk stratification for patients can be challenging because no system is universally accepted, and no Canadian guidelines currently exist. Patients with advanced cscc are often deemed ineligible for either or both of curative surgery and radiation therapy (rt) and, until recently, were limited to off-label systemic cisplatin-fluorouracil or cetuximab therapy, which offers modest clinical benefits and potentially severe toxicity. A new systemic therapy, cemiplimab, has been approved for the treatment of locally advanced and metastatic cscc. In the present review, we provide recommendations for patient classification and staging based on current guidelines, direction for determining patient eligibility for surgery and rt, and an overview of the available systemic treatment options for advanced cscc and of the benefits of a multidisciplinary approach to patient management.

Perioperative intravenous contrast administration and the incidence of acute kidney injury after major gastrointestinal surgery: prospective, multicentre cohort study

BACKGROUND

This study aimed to determine the impact of preoperative exposure to intravenous contrast for CT and the risk of developing postoperative acute kidney injury (AKI) in patients undergoing major gastrointestinal surgery.

METHODS

This prospective, multicentre cohort study included adults undergoing gastrointestinal resection, stoma reversal or liver resection. Both elective and emergency procedures were included. Preoperative exposure to intravenous contrast was defined as exposure to contrast administered for the purposes of CT up to 7 days before surgery. The primary endpoint was the rate of AKI within 7 days. Propensity score-matched models were adjusted for patient, disease and operative variables. In a sensitivity analysis, a propensity score-matched model explored the association between preoperative exposure to contrast and AKI in the first 48 h after surgery.

RESULTS

A total of 5378 patients were included across 173 centres. Overall, 1249 patients (23·2 per cent) received intravenous contrast. The overall rate of AKI within 7 days of surgery was 13·4 per cent (718 of 5378). In the propensity score-matched model, preoperative exposure to contrast was not associated with AKI within 7 days (odds ratio (OR) 0·95, 95 per cent c.i. 0·73 to 1·21; P = 0·669). The sensitivity analysis showed no association between preoperative contrast administration and AKI within 48 h after operation (OR 1·09, 0·84 to 1·41; P = 0·498).

CONCLUSION

There was no association between preoperative intravenous contrast administered for CT up to 7 days before surgery and postoperative AKI. Risk of contrast-induced nephropathy should not be used as a reason to avoid contrast-enhanced CT.

Primary excision margins, sentinel lymph node biopsy, and completion lymph node dissection in cutaneous melanoma: a clinical practice guideline

Background

For patients who are diagnosed with early-stage cutaneous melanoma, the principal therapy is wide surgical excision of the primary tumour and assessment of lymph nodes. The purpose of the present guideline was to update the 2010 Cancer Care Ontario guideline on wide local excision margins and sentinel lymph node biopsy (slnb), including treatment of the positive sentinel node, for melanomas of the trunk, extremities, and head and neck.

Methods

Using Ovid, the medline and embase electronic databases were systematically searched for systematic reviews and primary literature evaluating narrow compared with wide excision margins and the use of slnb for melanoma of the truck and extremities and of the head and neck. Search timelines ran from 2010 through week 25 of 2017.

Results

Four systematic reviews were chosen for inclusion in the evidence base. Where systematic reviews were available, the search of the primary literature was conducted starting from the end date of the search in the reviews. Where systematic reviews were absent, the search for primary literature ran from 2010 forward. Of 1213 primary studies identified, 8 met the inclusion criteria. Two randomized controlled trials were used to inform the recommendation on completion lymph node dissection.Key updated recommendations include:■ Wide local excision margins should be 2 cm for melanomas of the trunk, extremities, and head and neck that exceed 2 mm in depth.■ slnb should be offered to patients with melanomas of the trunk, extremities, and head and neck that exceed 0.8 mm in depth.■ Patients with sentinel node metastasis should be considered for nodal observation with ultrasonography rather than for completion lymph node dissection.

Conclusions

Recommendations for primary excision margins, sentinel lymph node biopsy, and completion lymph node dissection in patients with cutaneous melanoma have been updated based on the current literature.

Exploring patients' and carers' views about the clinical use of ketamine to inform policy and practical decisions: mixed-methods study

BACKGROUND

Only one-third of patients with major depressive disorder achieve remission. One new and promising treatment, ketamine, may prove challenging to implement because of its abuse potential. Although clinicians' views have been sought, we need patients' views before large scale roll-out is considered.

AIMS

To explore patients' and carers' views to inform policy and practical decisions about the clinical use of ketamine.

METHOD

We carried out a mixed-methods study using data from 44 participants in 21 focus groups in three sessions and an online survey with patients, carers and advocates during a consultation day. Focus groups explored participant's views about ketamine as a form of treatment and the best way for ketamine to be prescribed and monitored. The qualitative data were analysed by two patient-researchers using an exploratory framework analysis and was supplemented by a survey.

RESULTS

The ten themes generated were monitoring, information, effect on daily life, side-effects, recreational use, effectiveness, appropriate support, cost, stigma and therapy. Participants wanted better evidence on the safety of ketamine after long-term use and felt that monitoring was required. Collecting this information would provide evidence for ketamine's safe use and administration. There were, however, concerns about the misuse of this information. Practical issues of access were important: repeated travelling to clinics and a lack of sufficiently informed medical staff were key barriers.

CONCLUSIONS

Clinicians have some similar and some different views to those of patients, carers and advocates, which need to be considered in any future roll-out of ketamine.

DECLARATION OF INTEREST

R.M. has had UK National Institute for Health Research grant funding to study ketamine, is participating in trials of esketamine, runs a clinic that provides ketamine treatment, and has consulted for Johnson & Johnson and Eleusis.

Burden of neurodegenerative diseases in the Eastern Mediterranean Region, 1990-2016: findings from the Global Burden of Disease Study 2016

BACKGROUND AND PURPOSE

The Eastern Mediterranean Region (EMR) is experiencing a demographic shift towards rapid aging at a time of political unrest. We aimed to estimate the burden of neurodegenerative disorders and its relationship with sociodemographic index in the EMR countries from 1990 to 2016.

METHODS

Using data from the Global Burden of Disease Study 2016, we calculated country-specific trends for prevalence, mortality, disability-adjusted life-years (DALY), years of life lost and years lived with disability (YLD) for Alzheimer's disease/other dementias and Parkinson's disease in the EMR during 1990-2016.

RESULTS

In the EMR, the age-standardized prevalence rate of Alzheimer's disease/other dementias and Parkinson's disease was estimated at 759.8/100 000 (95% uncertainty intervals, 642.9-899.9) and 87.1/100 000 (95% uncertainty intervals, 69.8-108.2) people in 2016, demonstrating 0.01% and 42.3% change from 1990, respectively. Neurodegenerative disorders contributed to 5.4% of total DALY and 4.6% of total YLD among the older EMR population (70 years of age or older in 2016). Age-standardized DALY due to Parkinson's disease were strongly correlated with the sociodemographic index level (r = 0.823, P < 0.001). The YLD:DALY ratio of neurodegenerative diseases declined during this period in the low-income but not the high-income EMR countries.

CONCLUSIONS

Our findings demonstrated an increasing trend in the burden of dementias and Parkinson's disease in most EMR countries between 1990 and 2016. With aging of the EMR populations, countries should target the modifiable risk factors of neurodegenerative diseases to control their increasing burden.

Ethyl Glucuronide as a Long-term Alcohol Biomarker in Fingernail and Hair. Matrix Comparison and Evaluation of Gender Bias

Aims

This work aimed to assess the performance of hair and fingernail ethyl glucuronide (EtG) measurement for use as a biomarker of alcohol consumption in persons with known drinking history across a range of drinking behaviours.

Methods

EtG concentrations were assessed from the hair and fingernails of 50 study participants. Alcohol consumption of the previous 90 days was assessed by participant interview using the alcohol timeline follow-back method. EtG concentration was determined using LC–MS-MS using a method which was validated and accredited to ISO/IEC 17025 standards.

Results

There was significant correlation between alcohol consumption and EtG concentrations found in hair and fingernail samples across the study group (n = 50). From participants testing positive for EtG (male n = 14, female n = 13) no significant difference was found between male and female EtG levels in either hair or fingernails. Across all participants there was no significant difference in hair or fingernail EtG concentration between male (n = 23) and females (n = 27).

Conclusions

Our results support the use of EtG to indicate alcohol consumption over the previous 90 days, or ~3 months as is the normal practice in hair analysis. The results confirm that fingernails can be a useful alternative matrix where hair samples are not available.

Patient indications for Mohs micrographic surgery: a clinical practice guideline

Objective

The purpose of the present work was to develop evidence-based indications for Mohs micrographic surgery in patients with a diagnosis of skin cancer.

Methods

The guideline was developed by Cancer Care Ontario's Program in Evidence-Based Care, together with the Melanoma Disease Site Group and the Surgical Oncology Program, through a systematic review of relevant literature, patient- and caregiver-specific consultation, and internal and external reviews.

Recommendation 1

Given a lack of high-quality, comparative evidence, surgery (with postoperative or intraoperative margin assessment) or radiation (for those who are ineligible for surgery) should remain the standard of care for patients with skin cancer.

Recommendation 2

Mohs micrographic surgery is recommended for patients with histologically confirmed recurrent basal cell carcinoma of the face and is appropriate for primary basal cell carcinomas of the face that are larger than 1 cm, have aggressive histology, or are located on the H zone of the face.

Recommendation 3

Mohs micrographic surgery should be performed by physicians who have completed a degree in medicine or equivalent, including a Royal College of Physicians and Surgeons of Canada Specialist Certificate or equivalent, and have received advanced training in Mohs micrographic surgery.

Unravelling the spatial dependency of the complex solid-state chemistry of Pb in a paint micro-sample from Rembrandt's Homer using XRD-CT

X-ray diffraction computed tomography (XRD-CT) has been used to identify the nature of crystalline surface deposits in Rembrandt's Homer.

Ankylosing Spondylitis Response to TNF Inhibition Is Gender Specific: A 6-Year Cohort Study

Aim Recent studies have suggested gender-specific differences with respect to both baseline disease activity and severity in ankylosing spondylitis (AS). Tumour necrosis factor inhibitors (TNFi) have shown significant benefit in AS but there may be gender-specific differences regarding responses to TNFi therapy. Methods AS patients with active disease despite adequate trials of NSAIDs were commenced on TNFi and followed in a biologic clinic between 2004 and 2011. Response to treatment was measured based on clinical and serological outcomes. Baseline radiographic data were also collected where available. Results 147 AS patients commenced TNFi therapy and were followed in a biologic clinic between 2004 and 2011. One-hundred and six (72%) of the patients were male and 90 (61%) were current or ex-smokers. The specific TNFi prescribed included etanercept (74 patients, 50.3%), adalimumab (51 patients, 34.7%), infliximab (21 patients, 14.2%) and golimumab (1 patient, 0.7%). The median mSASSS score was 11 (interquartile range 5-35). At baseline, the metrology indices (BASMI) were significantly lower in women (2.6 v 4; p=0.01) but all other clinical indices were similar. At 3 months, female patients had significantly worse median disease activity and functional indices (BASDAI: 4 v 2; p<0.01; BASFI: 3 v 2; p=0.03) than male patients. In addition, females had higher median ESR (19 v 6; p<0.01) which correlated with their disease activity indices (r=0.42, p=0.02). Discussion Despite similar disease activity at baseline, post-TNFi therapy women had significantly higher disease activity. Furthermore, ESR levels in women during therapy correlated with their clinical disease activity scores. Further exploration of these gender-specific differences is crucial for a greater understanding of the pathogenesis of AS as well as development of targeted therapies.

Induction of Neointima Formation by Platelet Derived Angiogenesis Fraction in a Small Diameter, Wide Pore, PTFE Graft

Enhancement of endothelialization and patency of a small diameter (2 mm), wide pore, PTFE graft was attempted by coating the luminal surface with a platelet derived angiogenesis fraction (PDAF) and implanting it in a rat model. PDAF was delivered to the grafts by combining it with a carrier polymer. PDAF-treated grafts were initially implanted in the retroperitoneum for 21 days followed by removal of one for histology and in situ end to side bypass to the infrarenal aorta for the other. Vascularized grafts were examined at 14 days for patency and 100 days for patency and histology. Significant differences were noted in transmural ingrowth of capillaries and tissue at 21 days post implantation in PDAF-treated verses untreated grafts. Similarly, near significance was noted in capillary ingrowth and significance was noted in tissue ingrowth at 100 days in PDAF-treated grafts. Despite favorable trends particularly early in the time course, no significant differences in graft patency, endothelialization, or hydroxyproline content was demonstrated between PDAF-treated and untreated grafts. Results of this preliminary study are encouraging for further study of PDAF-treated PTFE grafts and the potential that rapid vascularized neointima formation results improved in graft patency rates.

Recyclable switching between nonporous and porous phases of a square lattice (sql) topology coordination network

A 2D switching material holds great potential for exceptional working capacity of gas storage.

Final year dental students in New Zealand: Self-reported confidence levels prior to BDS graduation

BACKGROUND AND OBJECTIVES

It is expected that the graduating dental student will have acquired the skills and knowledge to confidently treat most circumstances that they may encounter in private practice. The aims of this study were to evaluate final year dental students' self-reported levels of confidence in expected core skills just prior to graduation and to explore their career intentions both directly after graduating as well as in the longer term.

METHODS

After ethical approval was obtained, a survey and participant information sheet was distributed to all final year undergraduate dental students in 2014. Statistical analysis was carried out using SPSS version 22.0 with the alpha value set at 0.05.

RESULTS

The response rate was 69% (58/84). Most (44.8%) were going to be working in New Zealand private practices with 34.5% definitely considering specializing. The majority reported high self-confidence levels for sealant restorations (96.6%) and radiography (94.8%), while very few were confident in carrying out soft tissue biopsies (1 .8%) or restoring dental implants and treating medical emergencies (10.5%). Some gender differences were found.

CONCLUSIONS

The general finding was that most NZ graduates perceived themselves to be confident in managing the most fundamental aspects of general practice. Similar to their counterparts around the world, they will benefit from further mentoring and additional exposure to the more complex clinical tasks such as the restoration of implants and soft tissue biopsies.

A compact and versatile dynamic flow cryostat for photon science

We have developed a helium gas flow cryostat for use on synchrotron tender to hard X-ray beamlines. Very efficient sample cooling is achieved because the sample is placed directly in the cooling helium flow on a removable sample holder. The cryostat is compact and easy to operate; samples can be changed in less than 5 min at any temperature. The cryostat has a temperature range of 2.5-325 K with temperature stability better than 0.1 K. The very wide optical angle and the ability to operate in any orientation mean that the cryostat can easily be adapted for different X-ray techniques. It is already in use on different beamlines at the European Synchrotron Radiation Facility (ESRF), ALBA Synchrotron Light Facility (ALBA), and Diamond Light Source (DLS) for inelastic X-ray scattering, powder diffraction, and X-ray absorption spectroscopy. Results obtained at these beamlines are presented here.

Selective Adsorption of Sulfur Dioxide in a Robust Metal-Organic Framework Material

Selective adsorption of SO₂ is realized in a porous metal-organic framework material, and in-depth structural and spectroscopic investigations using X-rays, infrared, and neutrons define the underlying interactions that cause SO₂ to bind more strongly than CO₂ and N₂ .

Sociometry and Athletic Status of Adolescents, Critical Review of Research Literature

A review of literature on the relationship between measures of social acceptability and motor characteristics is presented: data inconsistencies are commented on and a plea made for further disciplined studies.