Communication with young people in paediatric and adult endocrine consultations: an intervention development and feasibility study.

BACKGROUND: Communication is complex in endocrine care, particularly during transition from paediatric to adult services. The aims of this study were to examine the feasibility of interventions to support young people to interact with clinicians. METHODS: Development and evaluation of a complex intervention in 2 phases: Pre-intervention observational study; Intervention feasibility study. Purposive sample of recordings of 62 consultations with 58 young people aged 11-25 years with long-term endocrine conditions in two paediatric and two adult endocrine clinics. Proportion of time talked during consultations, number and direction of questions asked; Paediatric Consultation Assessment Tool (PCAT); OPTION shared decision making tool; Medical Information Satisfaction Scale (MISS- 21). Young people were invited to use one or more of: a prompt sheet to help them influence consultation agendas and raise questions; a summary sheet to record key information; and the www.explain.me.uk website. RESULTS: Nearly two thirds of young people (63%) chose to use at least one communication intervention. Higher ratings for two PCAT items (95% CI 0.0 to 1.1 and 0.1 to 1.7) suggest interventions can support consultation skills. A higher proportion of accompanying persons (83%) than young people (64%) directed questions to clinicians. The proportion of young people asking questions was higher (84%) in the intervention phase than in the observation phase (71%). CONCLUSIONS: Interventions were acceptable and feasible. The Intervention phase was associated with YP asking more questions, which implies that the availability of interventions could promote interactivity.

Graphene electrodes for adaptive liquid crystal contact lenses.

The superlatives of graphene cover a whole range of properties: electrical, chemical, mechanical, thermal and others. These special properties earn graphene a place in current or future applications. Here we demonstrate one such application - adaptive contact lenses based on liquid crystals, where simultaneously the high electrical conductivity, transparency, flexibility and elasticity of graphene are being utilised. In our devices graphene is used as a transparent conductive coating on curved PMMA substrates. The adaptive lenses provide a + 0.7 D change in optical power with an applied voltage of 7.1 Vrms - perfect to correct presbyopia, the age-related condition that limits the near focus ability of the eye.

Improving acute care for adolescents and young adults on medical admission units: The interventions that matter.

It had become a familiar routine. My seventh admission with diabetic ketoacidosis (DKA) in a year. Each time I was admitted it was the same; a DKA protocol, a diabetes specialist nurse visit, and a few questions from the doctors checking if "everything is okay?" On each admission, I would be discharged home after a couple of days. We all knew I'd be back again within a month or two.

Field-induced refractive index variation in the dark conglomerate phase for polarization-independent switchable liquid crystal lenses.

Liquid crystal lenses are an emerging technology that can provide variable focal power in response to applied voltage. Many designs for liquid-crystal-based lenses are polarization dependent, so that 50% of light is not focused as required, making polarization-independent technologies very attractive. Recently, the dark conglomerate (DC) phase, which is an optically isotropic liquid crystalline state, has been shown to exhibit a large change in refractive index in response to an applied electric field (Δn=0.04). This paper describes computational modeling of the electrostatic solutions for two different types of 100 µm diameter liquid crystal lenses, which include the DC phase, demonstrating that it shows great potential for efficient isotropic optical switching in lenses. A feature of the field dependence of the refractive index change in the DC phase is that it is approximately linear in a certain range, leading to the prediction of excellent optical quality for driving fields in this regime. Interestingly, a simulated microlens is shown to exhibit two modes of operation: a positive lens based upon a uniform bulk change in refractive index at high voltages, and a negative lens resulting from the induction of a gradient index effect at intermediate voltages.

Remote clinical consultations in restorative dentistry-A survey.

OBJECTIVES: To assess the patient experience of Remote Clinical Consultations (RCCs) for head and neck cancer and cleft lip and palate patients undergoing specialist restorative dentistry treatment in the context of a secondary care service. METHODS: An online survey was designed; all ninety three patients were invited to participate in its completion following a video or telephone remote clinical consultation with one restorative consultant in Addenbrooke's Hospital between August 2020 and April 2021. The video consultations were carried out via NHS England's Attend Anywhere platform. RESULTS: Sixty three responses were received. Over 70% of patients valued a video or telephone remote clinical consultation rather than an in-person attendance. Patients reported a good experience and would recommend a remote clinical consultation instead of an in-person attendance if no treatment would likely be required. Those who were less likely to recommend a remote clinical consultation were those who had difficulties logging-in to the remote platform or had technical issues. CONCLUSION: While a number of patients still would have preferred a face-to-face attendance, both telephone and video remote consultations were highly valued by patients, and the overall patient experience was that of acceptance. Benefits of remote consultations perceived by patients included having set time to discuss concerns and queries, becoming familiar with a clinician prior to any treatment, saving time, minimising travel and reducing expenses. Barriers to a positive experience included technical difficulties. This survey contributes to the evidence supporting remote clinical consultations as a practical way of delivering specialist consultations in restorative dentistry, it highlights this virtual process largely relates to the practicalities of service provision and highlights the use of remote consultations for specific appointments. CLINICAL SIGNIFICANCE: This study demonstrates patient feedback to a strategy implemented due to adaptations in working methods required as result of the Covid-19 pandemic. Patients were found to have a positive, accepting experience of both telephone and video remote clinical consultations. the study identifies a high patient acceptability and ability to overcome some of the disadvantages of an in-person attendance including saving time, travel and associated expenses while also contributing to a reduction in CO2 emissions and potentially improving clinical efficiency and capacity. These findings add to existing evidence and are indicative that remote consultations provide a practical way of delivering specialist communication in restorative dentistry as part of a unique patient pathway.

Nanofabricated media with negative permeability at visible frequencies.

A great deal of attention has recently been focused on a new class of smart materials--so-called left-handed media--that exhibit highly unusual electromagnetic properties and promise new device applications. Left-handed materials require negative permeability micro, an extreme condition that has so far been achieved only for frequencies in the microwave to terahertz range. Extension of the approach described in ref. 7 to achieve the necessary high-frequency magnetic response in visible optics presents a formidable challenge, as no material--natural or artificial--is known to exhibit any magnetism at these frequencies. Here we report a nanofabricated medium consisting of electromagnetically coupled pairs of gold dots with geometry carefully designed at a 10-nm level. The medium exhibits a strong magnetic response at visible-light frequencies, including a band with negative micro. The magnetism arises owing to the excitation of an antisymmetric plasmon resonance. The high-frequency permeability qualitatively reveals itself via optical impedance matching. Our results demonstrate the feasibility of engineering magnetism at visible frequencies and pave the way towards magnetic and left-handed components for visible optics.

Likelihood of persistent GH deficiency into late adolescence: relationship to the presence of an ectopic or normally sited posterior pituitary gland.

OBJECTIVES: The presence of an ectopic posterior pituitary gland (EPP) in childhood is associated with isolated GH deficiency (IGHD) and multiple pituitary hormone deficiency. GHD in late adolescence has been defined as a peak GH level <5 microg/l. The aim of this study was to identify the likelihood of persistent GHD in late adolescence in patients with an EPP compared with those with a normally sited posterior pituitary (NPP). METHODS: In 18 patients with an EPP and 15 patients with an NPP, clinical, biochemical and radiographic data were collected. RESULTS: In the EPP vs. the NPP group, the change in peak GH levels at the end of growth was less (+0.4[95% confidence interval (CI) - 0.8 to 2.7] vs. +4.1[95%CI + 0.4 to +10.5] microg/l, P-value for ancova = 0.03, after adjustment for age and sex). Using a peak GH level of <5 microg/l as a cut-off for GHD, 66% of EPP subjects compared with 40% of NPP subjects had GHD (P = 0.3). Hundred per cent of EPP subjects had a peak GH level on retesting <10 microg/l, compared with 40% of NPP subjects (P < 0.001). CONCLUSION: It is important to document GH status at the end of growth, even if there is a structural abnormality of the hypothalamic-pituitary axis. The presence of an EPP compared to an NPP increases the likelihood of persistent GHD by 26%. As all EPP patients had a peak GH level of <10 microg/l, the cut-off for persistent GHD in late adolescence may need to be revised.

Dielectric spectroscopy of Polymer Stabilised Ferroelectric Liquid Crystals.

Dielectric measurements were carried out in the frequency range from 20 Hz to 500 kHz on Polymer Stabilised Ferroelectric Liquid Crystals (PSFLCs). Polymerisation in the Smectic A* (Sm A*) and the Smectic C* (Sm C*) phase at equal polymer concentration results in a dielectric strength which is nearly twice the value in the latter case. An increase of the polymer concentration results in a decrease of the dielectric strength and an increase in relaxation frequency. The textural morphology and transmission intensity due to the residual birefringence of the polymer network in the isotropic phase, revealed a correlation between the interactions of the liquid crystal molecules with the polymer network. Results for polymerizing in the tilted Sm C* phase with a large bias field are also reported which show that the structure of the phase in which the system was polymerised affects the dielectric properties. The observed differences in dielectric behaviour can be explained by the polymer network morphology formed due to the interplay of phase and temperature on the stabilised ferroelectric liquid crystal materials.

Time-resolved x-ray studies of the dynamics of smectic- A layer realignment by magnetic fields.

While the rotation of smectic layers under an applied field may at first appear to be a relatively simple problem, the dynamic processes involved are rather complex. An applied field produces a torque on the liquid crystal director, but has no direct influence on the smectic layers. If the director is reoriented significantly, however, the layers must also reorient in order to accommodate this (the layered structure is produced by short-range molecular interactions). Indeed, if the liquid crystalline order is not maintained during the realignment then matters become even more complex. In this paper we use time-resolved x-ray scattering to investigate the realignment of smectic- A layers in thin-film devices using a magnetic field. No evidence is found for continuous rotation of the smectic layers under any circumstances in such devices, a result that is not found when using bulk samples. No evidence indicating the formation of the nematic phase is observed during realignment. A molecular-dynamics technique is used to model the system which indicates that the sample becomes significantly disorganized during the realignment process when large angular rotations are induced.

Continuously rotating chiral liquid crystal droplets in a linearly polarized laser trap.

The transfer of optical angular momentum to birefringent particles via circularly polarized light is common. We report here on the unexpected, continuous rotation of chiral nematic liquid crystal droplets in a linearly polarized optical trap. The rotation is non-uniform, occurs over a timescale of seconds, and is observed only for very specific droplet sizes. Synchronized vertical motion of the droplet occurs during the rotation. The motion is the result of photo-induced molecular reorganization, providing a micron sized opto-mechanical transducer that twists and translates.

Unexpected field-induced phase transitions between ferrielectric and antiferroelectric liquid crystal structures.

Liquid crystals are intriguing electrically responsive soft matter systems. We report previously unexplored field-induced changes in the structures of some frustrated liquid crystal phases and describe them theoretically. Specifically, we have discovered using resonant x-ray scattering that the four-layer intermediate smectic phase can undergo either a transition to the ferrielectric (three-layer) phase or to the ferroelectric phase, depending on temperature. Our studies of intermediate phases using electric fields offer a way to test theories that describe ferroelectricity in self-assembling fluids.

Coincident molecular auxeticity and negative order parameter in a liquid crystal elastomer.

Auxetic materials have negative Poisson's ratios and so expand rather than contract in one or several direction(s) perpendicular to applied extensions. The auxetics community has long sought synthetic molecular auxetics - non-porous, inherently auxetic materials which are simple to fabricate and avoid porosity-related weakening. Here, we report, synthetic molecular auxeticity for a non-porous liquid crystal elastomer. For strains above ~0.8 applied perpendicular to the liquid crystal director, the liquid crystal elastomer becomes auxetic with the maximum negative Poisson's ratio measured to date being -0.74 ± 0.03 - larger than most values seen in naturally occurring molecular auxetics. The emergence of auxeticity coincides with the liquid crystal elastomer backbone adopting a negative order parameter, QB = -0.41 ± 0.01 - further implying negative liquid crystal ordering. The reported behaviours consistently agree with theoretical predictions from Warner and Terentjev liquid crystal elastomer theory. Our results open the door for the design of synthetic molecular auxetics.

SOCIETY FOR ENDOCRINOLOGY CLINICAL GUIDANCE: Inpatient management of cranial diabetes insipidus.

Cranial diabetes insipidus (CDI) is a treatable chronic condition that can potentially develop into a life-threatening medical emergency. CDI is due to the relative or absolute lack of the posterior pituitary hormone vasopressin (AVP), also known as anti-diuretic hormone. AVP deficiency results in uncontrolled diuresis. Complete deficiency can lead to polyuria exceeding 10 L/24 h. Given a functioning thirst mechanism and free access to water, patients with CDI can normally maintain adequate fluid balance through increased drinking. Desmopressin (DDAVP, a synthetic AVP analogue) reduces uncontrolled water excretion in CDI and is commonly used in treatment. Critically, loss of thirst perception (through primary pathology or reduced consciousness) or limited access to water (through non-availability, disability or inter-current illness) in a patient with CDI can lead to life-threatening dehydration. This position can be further exacerbated through the omission of DDAVP. Recent data have highlighted serious adverse events (including deaths) in patients with CDI. These adverse outcomes and deaths have occurred through a combination of lack of knowledge and treatment failures by health professionals. Here, with our guideline, we recommend treatment pathways for patients with known CDI admitted to hospital. Following these guidelines is essential for the safe management of patients with CDI.

Growth Factor Liberation and DPSC Response Following Dentine Conditioning.

Liberation of the sequestrated bioactive molecules from dentine by the action of applied dental materials has been proposed as an important mechanism in inducing a dentinogenic response in teeth with viable pulps. Although adhesive restorations and dentine-bonding procedures are routinely practiced, clinical protocols to improve pulp protection and dentine regeneration are not currently driven by biological knowledge. This study investigated the effect of dentine (powder and slice) conditioning by etchants/conditioners relevant to adhesive restorative systems on growth factor solubilization and odontoblast-like cell differentiation of human dental pulp progenitor cells (DPSCs). The agents included ethylenediaminetetraacetic acid (EDTA; 10%, pH 7.2), phosphoric acid (37%, pH <1), citric acid (10%, pH 1.5), and polyacrylic acid (25%, pH 3.9). Growth factors were detected in dentine matrix extracts drawn by EDTA, phosphoric acid, and citric acid from powdered dentine. The dentine matrix extracts were shown to be bioactive, capable of stimulating odontogenic/osteogenic differentiation as observed by gene expression and phenotypic changes in DPSCs cultured in monolayer on plastic. Polyacrylic acid failed to solubilize proteins from powdered dentine and was therefore considered ineffective in triggering a growth factor-mediated response in cells. The study went on to investigate the effect of conditioning dentine slices on growth factor liberation and DPSC behavior. Conditioning by EDTA, phosphoric acid, and citric acid exposed growth factors on dentine and triggered an upregulation in genes associated with mineralized differentiation, osteopontin, and alkaline phosphatase in DPSCs cultured on dentine. The cells demonstrated odontoblast-like appearances with elongated bodies and long extracellular processes extending on dentine surface. However, phosphoric acid-treated dentine appeared strikingly less populated with cells, suggesting a detrimental impact on cell attachment and growth when conditioning by this agent. These findings take crucial steps in informing clinical practice on dentine-conditioning protocols as far as treatment of operatively exposed dentine in teeth with vital pulps is concerned.

Understanding the unusual reorganization of the nanostructure of a dark conglomerate phase.

The dark conglomerate (DC) phase exhibited by a bent-core liquid crystal shows remarkable properties including an electric-field tunable chiral domain structure and a large (0.045) reduction of refractive index, while maintaining an optically dark texture when observed under crossed polarizers. A detailed investigation of the system is presented, leading to a model that is fully consistent with the experimental observations. It reports the observation of two distinct regimes in the DC phase: a higher temperature regime in which the periodicity measured by small angle x-ray scattering decreases slightly (0.5%) and a lower temperature regime where it increases considerably (16%). Also, the paper discusses the unusual electric-field-induced transformations observed in both the regimes. These changes have threshold fields that are both temperature and frequency dependent, though the phenomena are observed irrespective of device thickness, geometry, and the alignment layer. The electro-optic behavior in the DC phase corresponds to a number of structural changes leading to unusual changes in physical properties including a small (1%) increase in periodicity and a doubling of the average dielectric permittivity. We propose a model of the DC phase where in the ground state the nanostructure of the phase exhibits an anticlinic antiferroelectric organization. Under an electric field, it undergoes a molecular rearrangement without any gross structural changes leading to an anticlinic ferroelectric order while keeping the overall sponge-like structure of the DC phase intact.

The impact of cancer therapy on the endocrine system in survivors of childhood brain tumours.

Survival rates are improving following cancer therapy for childhood brain tumours. There is therefore a growing cohort of survivors at risk of late effects of cancer therapy. Endocrine problems are very common in these patients. The recognition and prompt management of these are essential to prevent further morbidity and impairment of quality of life. Cranial radiation can damage hypothalamic-pituitary function, most frequently affecting GH status; however, higher radiation doses may cause more widespread hypothalamic-pituitary damage. Early puberty secondary to cranial irradiation is now being managed with gonadotrophin-releasing hormone analogues to improve final height. Prompt diagnosis and management of GH deficiency may improve final height outcome; continued GH therapy beyond final height aids the achievement of adult body composition (lean body mass and bone mass) and GH therapy in adulthood improves quality of life. Both cranial irradiation alone and with spinal irradiation can result in radiation damage to the thyroid resulting in hypothyroidism and thyroid nodules, a high proportion of which are malignant. Gonadal damage secondary to spinal irradiation and adjuvant chemotherapy may have long-term consequences including infertility.

GH-deficient survivors of childhood cancer: GH replacement during adult life.

Childhood survivors of cancer are prone to a number of adverse sequelae related to the therapeutic interventions undertaken to achieve remission. The endocrine system is frequently affected; hypothalamo-pituitary dysfunction, in particular GH deficiency, is common after cranial irradiation. It is unclear to what extent GH deficiency contributes to the abnormalities observed in adult survivors of childhood cancer, and whether GH replacement reverses these anomalies. We compared 27 GH-deficient survivors of childhood cancer with 27 adult age- and sex-matched controls and went on to replace GH in the patient group to determine whether GH resulted in improvements of the baseline abnormalities. The GH-deficient survivors of childhood cancer had an adverse lipid profile (total cholesterol, 5.4 vs. 4.6 mM, P = 0.004; high-density lipoprotein cholesterol, 1.05 vs. 1.6 mM, P < 0.001; and triglycerides, 1.3 vs. 1.0 mM, P < 0.001) and were osteopenic (lumbar spine z-score, -1.53 vs. -0.31 SD score, P < 0.001; femoral neck z-score, -1.23 vs. -0.27 SD score, P = 0.02); additionally, the female subgroup had an increased percentage body fat (43.6 vs. 32.8%, P = 0.016). In keeping with the selection criterion, quality of life in the patient cohort, relative to the healthy controls, was severely impaired [adult GH-deficiency assessment (AGHDA), 15.5 (range, 8-25) vs. 1 (range, 0-19), P < 0.0001; psychological general well-being schedule, 67.5 (range, 18-86) vs. 89.0 (range, 51-104), P < 0.0001]. After 12 months of GH replacement, small (but significant) improvements were observed in body composition in the male subgroup (waist-hip ratio, 0.871 vs. 0.863, P < 0.05); and in the female cohort, total cholesterol (6.0 vs. 5.2 mM, P = 0.01) and triglyceride (2.1 vs. 1.4 mM, P = 0.01) levels fell. Bone mineral density improved in only one of the four sites studied (ultradistal radius, -1.21 vs. -1.09, P = 0.048) after a median duration of GH therapy of 18 months. Quality of life improved dramatically by 3 months (AGHDA, 15.5 vs. 10.0, P < 0.001), and the improvement was maintained at 12 months (AGHDA, 15.5 vs. 9.0, P < 0.001). Importantly, there was no clinical suggestion of tumor recurrence during the 12 months of GH replacement. The minor improvements observed in body composition, the lipid profile, and bone mineral density in GH-deficient adult survivors of childhood cancer after 12-18 months of physiological GH replacement suggest that GH deficiency may not be the major etiological factor in their pathogenesis; the converse seems to be true for the quality of life status of these individuals. We propose that, as in patients with hypopituitarism caused by pituitary disease, the main indication for GH replacement in GH-deficient survivors of childhood cancer should be severe impairment of quality of life.

Severe thyroid eye disease associated with primary hypothyroidism and thyroid-associated dermopathy.

Four unusual cases of patients are described with severe thyroid eye disease (TED) who presented with primary hypothyroidism and thyroid-associated dermopathy (TAD). All four patients had moderate or severe TED and elevated circulating thyrotropin (TSH) receptor antibodies.

The absorption of polarized light by vertebrate photoreceptors.

A physiologically realistic model has been constructed for a theoretical study of the mechanisms by which the vertebrate visual system absorbs linearly polarized light. Using a 4 x 4 matrix technique, analytic solutions to Maxwell's equations have been deduced for rod and cone photoreceptors, allowing calculation of the absorbance as a function of wavelength for a variety of illumination geometries. With the use of experimentally measured optical parameters, the calculated absorbance spectra show excellent agreement in both magnitude and form with microspectrophotometric data. Moreover, failing to correct for the true nature of reflection or scattering in the sample, results in the elevated absorbance commonly seen at shorter wavelengths in experimental measurements. Finally, calculated dichroic ratios also accurately predict experimental results, mirroring the differences seen between rods and cones.