Making a difference in the real world. User-centred impact evaluation of an eight-country, community-based early childhood programme.

This paper presents a unique approach to the Impact Evaluation of a project that focused on low-threshold intergenerational play-based interactions in order to support young children from marginalised communities in eight European countries. The approach builds upon the work of Fetterman's Empowerment Evaluation and Patton's Utilization Focused Evaluation and brings them together to form an adapted model of evaluation. We outline in this paper how these two well developed methods of evaluation have been applied to a real world context, that is, the impact evaluation of a complex international project. Our approach highlights the complexities of differing contexts and allows for surprising and unintended consequences to emerge. It results, through double loop learning, a type of feedback loop with the internal stakeholders and implementers that is useful to the project coordination team, with a view to further upscaling of the initiative. Recommendations for policy at local, national and European Union levels were provided to the project and potential external users. However, the predominant feedback was provided at two crucial points along the way; during a stakeholder mapping exercise and during the further development of monitoring data tools.

Unity Makes Strength: Exploring Intraspecies and Interspecies Toxin Synergism between Phospholipases A2 and Cytotoxins.

Toxin synergism is a complex biochemical phenomenon, where different animal venom proteins interact either directly or indirectly to potentiate toxicity to a level that is above the sum of the toxicities of the individual toxins. This provides the animals possessing venoms with synergistically enhanced toxicity with a metabolic advantage, since less venom is needed to inflict potent toxic effects in prey and predators. Among the toxins that are known for interacting synergistically are cytotoxins from snake venoms, phospholipases A2 from snake and bee venoms, and melittin from bee venom. These toxins may derive a synergistically enhanced toxicity via formation of toxin complexes by hetero-oligomerization. Using a human keratinocyte assay mimicking human epidermis in vitro, we demonstrate and quantify the level of synergistically enhanced toxicity for 12 cytotoxin/melittin-PLA2 combinations using toxins from elapids, vipers, and bees. Moreover, by utilizing an interaction-based assay and by including a wealth of information obtained via a thorough literature review, we speculate and propose a mechanistic model for how toxin synergism in relation to cytotoxicity may be mediated by cytotoxin/melittin and PLA2 complex formation.

Does public reporting of the detection of fetal growth restriction improve clinical outcomes: a retrospective cohort study.

OBJECTIVE: To assess the impact of publicly reporting a statewide fetal growth restriction (FGR) performance indicator. DESIGN: Retrospective cohort study from 2000 to 2017. SETTING: All maternity services in Victoria, Australia. POPULATION: A total of 1 231 415 singleton births at ≥32 weeks of gestation. METHODS: We performed an interrupted time-series analysis to assess the impact of publicly reporting an FGR performance indicator on the rate of detection for severe cases of small for gestational age (SGA). Rates of perinatal mortality and morbidity and obstetric intervention were assessed for severe SGA pregnancies and pregnancies delivered for suspected SGA. MAIN OUTCOME MEASURES: Gestation at delivery, obstetric management and perinatal outcome. RESULTS: The public reporting of a statewide FGR performance indicator was associated with a steeper reduction per quarter in the percentage of severe SGA undelivered by 40 weeks of gestation, from 0.13 to 0.51% (P = 0.001), and a decrease in the stillbirth rate by 3.3 per 1000 births among those babies (P = 0.01). Of babies delivered for suspected SGA, the percentage with birthweights ≥ 10th centile increased from 41.4% (n = 307) in 2000 to 53.3% (n = 1597) in 2017 (P < 0.001). Admissions to a neonatal intensive care unit for babies delivered for suspected SGA but with a birthweight ≥ 10th centile increased from 0.8 to 2.0% (P < 0.001). CONCLUSIONS: The public reporting of an FGR performance indicator has been associated with the improved detection of severe SGA and a decrease in the rate of stillbirth among those babies, but with an increase in the rate of iatrogenic birth for babies with normal growth. TWEETABLE ABSTRACT: The public reporting of hospital performance is associated with a reduction in stillbirth, but also with unintended interventions.

Review of external referrals to a regional stroke centre: it is not just about thrombectomy.

AIMS: To determine the experience of a regional stroke referral centre of external referrals for endovascular thrombectomy (EVT) in patients with symptoms of acute ischaemic stroke (AIS) and large vessel occlusion (LVO). MATERIALS AND METHODS: Data were collected prospectively over two 4-month periods (2017-2018) on consecutive external referrals for EVT. Baseline demographics, imaging findings, and key time parameters were recorded. Reasons for not transferring patients and for not performing EVT were recorded. Key time intervals were calculated and compared between the transferred and non-transferred group with and without intracranial occlusion and between the transferred patients who underwent thrombectomy and those who did not. RESULTS: Two hundred and sixty-two patients were referred. Sixty-one percent (n=159) were accepted and transferred for treatment. Of those transferred, 86% (n=136) had EVT. Fourteen percent (n=23) were unsuitable for EVT on arrival due to no vessel occlusion (48% n=11), poor Alberta Stroke Program Early CT Score (ASPECTS)/established infarct (30%, n=7) haemorrhage (9%, n=2), and clinical recovery (13% n=3). One hundred and three patients (39%) were ineligible for EVT following phone discussion due to absence of intracranial occlusion (59%, n=61), low ASPECTS (22%, n=23), distal occlusion (4%, n=4), low/improving National Institutes of Health Stroke Scale (NIHSS; 10.7%, n=11), and poor modified Rankin Scale (mRS) at baseline (3%, n=3). Patients with LVO but not transferred had longer onset to hospital arrival time compared with those transferred 151.5 versus 91 minutes (p<0.005), with a trend also toward a longer door to CT/CTA 40 minutes versus 30 minutes (p=0.142). CONCLUSION: These data provide valuable insights into the service provision of a comprehensive stroke network. The present rates of EVT and futile transfers are modest compared to published data. Access to neuroradiology and specialised stroke assessment is crucial to optimise time to treatment.

An Unusual Case of a Facial Guard Causing Penetrating Soft Tissue Injury in the Game of Hurling

Aim To highlight the dangers of hurling helmet modification. Methods A case report highlighting the consequences of modifying a hurling helmet from factory settings. Results Photographic evidence of a penetrating injury from helmet modification. Conclusion Rule changes to allow referees to inspect helmets before games take place.

Role of Musculoskeletal Radiology in Modern Sports Medicine.

Musculoskeletal radiology's role in the recent and continued evolution of sports medicine is an exciting and expanding one. In this article we explore a variety of the ways that musculoskeletal radiology contributes to current practices in modern sports medicine, discussing advances across a variety of imaging modalities in the care of both elite athletes and so-called weekend warriors. We describe the technical and ethical factors pertaining to image-guided therapeutic intervention in athletes and speculate on the potential for future developments in the role of imaging in deciding when an athlete may return to participation. We also explore the recent shift to the delivery of imaging facilities at sporting events and in stadiums.

Neuroimaging of central diabetes insipidus-when, how and findings.

Central or neurogenic diabetes insipidus (CDI) is due to deficient synthesis or secretion of antidiuretic hormone (ADH), also known as arginine vasopressin peptide (AVP). It is clinically characterised by polydipsia and polyuria (urine output > 30 mL/kg/day) of dilute urine (< 250 mOsm/L). It is the result of a defect in one of more sites involving the hypothalamic osmoreceptors, supraoptic or paraventricular nuclei of the hypothalamus, median eminence of the hypothalamus, infundibulum or the posterior pituitary gland. A focused MRI pituitary gland or sella protocol is essential. There are several neuroimaging correlates and causes of CDI, illustrated in this review. The most common causes are benign or malignant neoplasms of the hypothalamic-pituitary axis (25%), surgery (20%), head trauma (16%) or familial causes (10%). No cause is identified in up to 30% of cases. Knowledge of the anatomy and physiology of the hypothalamo-neurohypophyseal axis is crucial when evaluating a patient with CDI. Establishing the aetiology of CDI with MRI in combination with clinical and biochemical assessment facilitates appropriate targeted treatment. The aim of the pictorial review is to illustrate the wide variety of causes of CDI on neuroimaging, highlight the optimal MRI protocol and to revise the detailed neuroanatomy and neurophysiology required to interpret these studies.

Are adult carpal angle measurements applicable to the pediatric population in the trauma setting?

OBJECTIVE: The aim of this study is to assess the applicability of standard adult carpal angle measurements, specifically the scapholunate and capitolunate angles, in the assessment of the pediatric wrist. MATERIALS AND METHODS: The study cohort comprised male and female children who underwent a wrist radiograph for the evaluation of suspected wrist injuries following trauma. A gender- and indication-matched adult cohort was also assessed. To ensure an accurate carpal angle measurement, only individuals with a sufficiently ossified carpus and an adequately positioned lateral wrist radiograph were included. RESULTS: Carpal angle measurements were performed on the lateral wrist radiographs of 256 individuals between the ages of 5 and 17 years (mean 11.2 years, SD ± 2.5 years) and 256 individuals between the ages of 18 and 40 years (mean 28.8 years, SD ± 6.2 years). The mean pediatric scapholunate angle was 47° (SD ± 8) and the mean pediatric capitolunate angle was 11° (SD ± 7). The mean adult scapholunate and capitolunate angles were 48° (SD ± 8°) and 10° (SD ± 6°) respectively. No statistically significant difference was observed between the scapholunate or capitolunate angle measurements in the two groups (p = 0.26 and p = 0.36). CONCLUSION: The study data supports the applicability of standard adult carpal angle values to the pediatric population provided the carpus is sufficiently ossified.

Mathematical Modeling of Diffusion of a Hydrophilic Ionic Fertilizer in Plant Cuticles: Surfactant and Hygroscopic Effects.

The agricultural industry requires improved efficacy of sprays being applied to crops and weeds to reduce their environmental impact and increase financial returns. One way to improve efficacy is by enhancing foliar penetration. The plant leaf cuticle is the most significant barrier to agrochemical diffusion within the leaf. The importance of a mechanistic mathematical model has been noted previously in the literature, as each penetration experiment is dictated by its specific parameters, namely plant species, environmental conditions such as relative humidity and spray formulation including adjuvant addition. A mechanistic mathematical model has been previously developed by the authors, focusing on plant cuticle diffusion of calcium chloride through tomato fruit cuticles including pore swelling, ion binding and evaporation, along with the ability to vary the active ingredient concentration and type, relative humidity and plant species. Here we further develop this model to include adjuvant effects as well as the hygroscopic nature of deliquescent ionic solutions with evaporation on the cuticle surface. These modifications to a penetration and evaporation model provide a novel addition to the literature and allow the model to be applied to many types of evaporating ionic hygroscopic solutions on many types of substrates, not just plant cuticles. We validate our theoretical model results against appropriate experimental data, discuss key sensitivities and relate theoretical predictions to physical mechanisms. The important governing mechanisms influencing surfactant enhanced penetration of ionic active through plant cuticles were found to be aqueous pore radius, pore density, cuticle thickness and initial contact angle of the applied droplet; ion binding, relative humidity and evaporation including hygroscopic water absorption parameters for point of deliquescence. The sensitivity analysis indicated surfactants increase penetration by changing the point of deliquescence of a solution, which alters the water absorption and the initial contact angle, which alters the number of pores under the droplet. The results of the validation and sensitivity analysis imply that this model accounts for many of the mechanisms governing penetration in plant cuticles.

Endobronchial brachytherapy for metastasis from extrapulmonary malignancies as an effective treatment for palliation of symptoms.

PURPOSE: Endobronchial metastasis (EBM) originating from primary cancers outside the lung is rare. External beam radiotherapy is often attempted for control of symptoms with variable effectiveness and retreatment is challenging if symptoms recur. There is limited documentation of high-dose-rate brachytherapy for EBM in the literature. METHODS AND MATERIALS: A prospective database was created from 2006 to 2015. Patients with EBM who received high-dose-rate brachytherapy were included. Cough, dyspnea, chest pain, and hemoptysis were assessed and graded (0-4) at the time of initial consult and in followup. Symptom-free survival and re-expansion were assessed. RESULTS: Thirty-five patients with EBM were identified. Most patients received three fractions of 700 cGy, and 17 patients had prior external beam radiotherapy. Median symptom-free and overall survival were 67 and 117 days. After brachytherapy, improvement in cough was documented in 75.0%, hemoptysis in 76.4%, dyspnea in 60.0% for a median of 3-6 months. Of the 22 patients who had subsequent chest imaging, re-expansion was documented in 32%. There were no significant toxicities reported. CONCLUSIONS: Brachytherapy appears effective in achieving durable symptom control of cough hemoptysis, and dyspnea in patients with EBM and should be considered routinely for palliation where available. Further studies are required to better characterize expected symptom improvement, lung re-expansion rates, and efficacy in comparison with other local treatments.

Thermal territories of the abdomen after caesarean section birth: infrared thermography and analysis.

OBJECTIVE: To develop and refine qualitative mapping and quantitative analysis techniques to define 'thermal territories' of the post-partum abdomen, the caesarean section site and the infected surgical wound. In addition, to explore women's perspectives on thermal imaging and acceptability as a method for infection screening. METHOD: Prospective feasibility study undertaken at a large University teaching hospital, Sheffield UK. Infrared thermal imaging of the abdomen was undertaken at the bedside on the first two days after elective caesarean section. Target recruitment: six women in each of three body mass index (BMI) categories (normal, 18.5-24.9 kg/m²; overweight 25-29.9 kg/m²; obese ≥30 kg/m²). Additionally, women presenting to the ward with wound infection were eligible for inclusion in the study. Perspectives on the use of thermal imaging and its practicality were also explored via semi-structured interviews and analysed using thematic content analysis. RESULTS: We recruited 20 women who had all undergone caesarean section. From the booking BMI, eight women were obese (including two women with infected wounds), seven women were overweight and five women had a normal BMI. Temperature (ºC) profiling and pixel clustering segmentation (hierarchical clustering-based segmentation, HCS) revealed characteristic features of thermal territories between scar and adjacent regions. Differences in scar thermal intensity profiles exist between healthy scars and infected wounds; features that have potential for wound surveillance. The maximum temperature differences (∆T) between healthy skin and the wound site exceed 2º C in women with established wound infection. At day two, two women had a scar thermogram with features observed in the 'infected' wound thermogram. CONCLUSION: Thermal imaging at early and later times after caesarean birth is feasible and acceptable. Women reported potential benefits of the technique for future wound infection screening. Thermal intensity profiling and HCS for pixel cluster dissimilarity between scar and adjacent healthy skin has potential as a method for the development of techniques targeted to early infection surveillance in women after caesarean section.

The effect of primary midwife-led care on women's experience of childbirth: results from the COSMOS randomised controlled trial.

OBJECTIVE: To determine the effect of primary midwife-led care ('caseload midwifery') on women's experiences of childbirth. DESIGN: Randomised controlled trial. SETTING: Tertiary care women's hospital in Melbourne, Australia. POPULATION: A total of 2314 low-risk pregnant women. METHODS: Women randomised to caseload care received antenatal, intrapartum and postpartum care from a primary midwife, with some care provided by a 'back-up' midwife. Women in standard care received midwifery-led care with varying levels of continuity, junior obstetric care or community-based medical care. MAIN OUTCOME MEASURES: The primary outcome of the study was caesarean section. This paper presents a secondary outcome, women's experience of childbirth. Women's views and experiences were sought using seven-point rating scales via postal questionnaires 2 months after the birth. RESULTS: A total of 2314 women were randomised between September 2007 and June 2010; 1156 to caseload and 1158 to standard care. Response rates to the follow-up questionnaire were 88 and 74%, respectively. Women in the caseload group were more positive about their overall birth experience than women in the standard care group (adjusted odds ratio 1.50, 95% CI 1.22-1.84). They also felt more in control during labour, were more proud of themselves, less anxious, and more likely to have a positive experience of pain. CONCLUSIONS: Compared with standard maternity care, caseload midwifery may improve women's experiences of childbirth. TWEETABLE ABSTRACT: Primary midwife-led care ('caseload midwifery') improves women's experiences of childbirth.

Ice sheets. Reverse glacier motion during iceberg calving and the cause of glacial earthquakes.

Nearly half of Greenland's mass loss occurs through iceberg calving, but the physical mechanisms operating during calving are poorly known and in situ observations are sparse. We show that calving at Greenland's Helheim Glacier causes a minutes-long reversal of the glacier's horizontal flow and a downward deflection of its terminus. The reverse motion results from the horizontal force caused by iceberg capsize and acceleration away from the glacier front. The downward motion results from a hydrodynamic pressure drop behind the capsizing berg, which also causes an upward force on the solid Earth. These forces are the source of glacial earthquakes, globally detectable seismic events whose proper interpretation will allow remote sensing of calving processes occurring at increasing numbers of outlet glaciers in Greenland and Antarctica.

The Z0011 Trial: Is this the end of axillary ultrasound in the pre-operative assessment of breast cancer patients?

OBJECTIVES: The Z0011 trial questioned the role of axillary ultrasound (AxUS) in preoperative staging of breast cancer in patients with ≤2 positive sentinel lymph nodes (SLN). The purpose of this study was to correlate the number of abnormal nodes on AxUS with final nodal burden and determine the utility of AxUS with sampling (AxUS + S) in preoperative staging. METHODS: Six hundred and seventy-nine patients underwent pre-operative AxUS. Suspicious nodes were sampled. Negative axillae proceeded to SLN biopsy. The number of abnormal nodes identified on ultrasound and final histology as well as sensitivity and specificity for AxUS + S were calculated. Subgroup analysis was performed on Z0011 eligible patients. RESULTS: Two hundred and ninety-six patients had positive axillary nodes on final histology with 169 detected by AxUS + S (sensitivity 86.2%, specificity 100%, PPV 100 %, NPV 71.9%). Patients with nodal metastases identified by AxUS had a mean burden of 7.3 nodes on histology (1 node on AxUS = 5.2 nodes on histology, 2 nodes on AxUS = 7.5 nodes, >2 nodes = 10.1 nodes). Patients diagnosed on SLNB had a mean burden of 2.2 nodes. CONCLUSION: A single nodal metastasis detected on AxUS + S correlated with a mean of 5.2 nodes on final histology highlighting that AxUS remains essential in guiding appropriate management of the axilla in breast cancer. KEY POINTS: • Axillary ultrasound +/- sampling is an essential technique in preoperative axillary staging. • Axillary ultrasound findings correlate with final histological axillary node disease burden. • Axillary ultrasound can help triage patients who require axillary lymph node dissection. • The role of axillary ultrasound in breast cancer staging continues to evolve.

Prevention of gestational diabetes in pregnant women with risk factors for gestational diabetes: a systematic review and meta-analysis of randomised trials.

BACKGROUND: Gestational diabetes mellitus can be defined as 'glucose intolerance or hyperglycaemia with onset or first recognition during pregnancy.' OBJECTIVE: The objective of our systematic review was to see if there was any intervention that could be used for primary prevention of gestational diabetes mellitus in women with risk factors for gestational diabetes mellitus. SEARCH STRATEGY: Major databases were searched from 1966 to Aug 2012 without language restriction. SELECTION CRITERIA: Randomised trials comparing intervention with standard care in women with risk factors for gestational diabetes were included. Meta-analysis was performed in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analysis statement. The primary outcome assessed was the incidence of gestational diabetes. DATA COLLECTION AND ANALYSIS: Data from included trials were extracted independently by two authors and analysed using Rev-Man 5. MAIN RESULTS: A total of 2422 women from 14 randomised trials were included; which compared diet (four randomised trials), exercise (three randomised trials), lifestyle changes (five randomised trials) and metformin (two randomised trials) with standard care in women with risk factors for gestational diabetes mellitus. Dietary intervention was associated with a statistically significantly lower incidence of gestational diabetes (Odds ratio 0.33, 95% CI 0.14 to 0.76) and gestational hypertension (Odds ratio 0.28, 95% CI 0.09, 0.86) compared to standard care. There was no statistically significant difference in the incidence of gestational diabetes mellitus or in the secondary outcomes with exercise, lifestyle changes or metformin use compared to standard care. CONCLUSIONS: The use of dietary intervention has shown a statistically significantly lower incidence of gestational diabetes mellitus and gestational hypertension compared to standard care in women with risk factors for gestational diabetes mellitus.

Screening, diagnosis and management of gestational diabetes mellitus: A national survey.

BACKGROUND AND METHODS: We conducted a National survey between February and June 2012 to evaluate the practices concerning screening, diagnosis and management of Gestational Diabetes (GDM) in England. RESULTS: A total of 102/126 (80%) maternity units responded. The National Institute of Health and Clinical Excellence (NICE) recommended screening criteria were used by 83% of units. All the units performed 2 h 75 g oral glucose tolerance test (OGTT) between 24 and 28 weeks. There was a wide variation in the diagnostic blood glucose values used by different units. About 86% of units used a 2 h blood glucose value of ≥7.8 mmol/l and 45% of units used fasting value ≥6.1 mmol/l to diagnose GDM. Only 26% of units advised self-monitoring of blood glucose pre meal and 1 h post-meal, whereas 64% of units advised monitoring 2 h after the meal. Metformin was started when women did not respond to dietary measures in 101 units (99%). Regular growth scans every four weeks from 28 weeks onwards were performed by 99 units (97%). Women on metformin with no complications were offered induction of labour at 38 completed weeks in 97 units (95%). 84 maternity units (82.3%) offered OGTT six weeks postnatally. CONCLUSION: Our survey has shown consistency in screening using the NICE criteria, use of 2 h 75 g OGTT at 24-28 weeks, in providing dietary support, use of metformin and ultrasound for fetal growth. But there is wide variation in the criteria used to diagnose GDM, self-monitoring of blood glucose, induction of labour and six weeks postnatal testing.

2D∕3D registration algorithm for lung brachytherapy.

PURPOSE: A 2D∕3D registration algorithm is proposed for registering orthogonal x-ray images with a diagnostic CT volume for high dose rate (HDR) lung brachytherapy. METHODS: The algorithm utilizes a rigid registration model based on a pixel∕voxel intensity matching approach. To achieve accurate registration, a robust similarity measure combining normalized mutual information, image gradient, and intensity difference was developed. The algorithm was validated using a simple body and anthropomorphic phantoms. Transfer catheters were placed inside the phantoms to simulate the unique image features observed during treatment. The algorithm sensitivity to various degrees of initial misregistration and to the presence of foreign objects, such as ECG leads, was evaluated. RESULTS: The mean registration error was 2.2 and 1.9 mm for the simple body and anthropomorphic phantoms, respectively. The error was comparable to the interoperator catheter digitization error of 1.6 mm. Preliminary analysis of data acquired from four patients indicated a mean registration error of 4.2 mm. CONCLUSIONS: Results obtained using the proposed algorithm are clinically acceptable especially considering the complications normally encountered when imaging during lung HDR brachytherapy.

The nature and stability of the Au(110)/electrochemical interface produced by flame annealing.

It is shown using reflection anisotropy spectroscopy (RAS) that following flame annealing and immersion in pure water, the Au(110) surface adopts a (1×1) structure and that this structure is preserved in a 0.1 M H(2)SO(4) environment. The surface transforms to the (1×2) reconstruction following the application of a potential of 0.0 V versus SCE (a saturated calomel electrode). This surface is unstable and the RAS profile changes over periods of 15 min and 1 h in a manner which suggests that changes are occurring in the structure and distribution of [11(-)0] steps. Over longer periods the RAS transforms towards a profile attributed to a surface associated with the specific adsorption of anions.

Translating obstetrics and gynaecology undergraduate experience into career aspiration: an audit of Royal College of Obstetricians and Gynaecologists (RCOG) medical student placement standards.

In 2006, the Royal College of Obstetricians and Gynaecologists (RCOG) published a list of undergraduate placement standards in an effort to improve the obstetrics and gynaecology (O&G) undergraduate experience and reverse declining interest in the specialty among UK graduates. We surveyed 3rd-year medical students undertaking O&G placements to investigate how appropriate they felt the RCOG placement standards were. We present the first evaluation of these standards and discuss their potential role in improving the undergraduate O&G experience. We also sought to examine the influence of undergraduate O&G exposure on interest in entering the specialty and the effect of gender on perceived learning experience. Students rated the RCOG standards as highly appropriate, and significant differences in clinical exposure and career intentions were seen between genders. Overall, students demonstrated greater interest in pursuing O&G than has previously been documented, which may represent a wider upturn in interest in the speciality.

Controlling the formation of a monolayer of cytochrome P450 reductase onto Au surfaces.

The conditions necessary for the formation of a monolayer and a bilayer of a mutated form (P499C) of human cytochrome P450 reductase on a Au(110)/electrolyte interface have been determined using a quartz crystal microbalance with dissipation, atomic force microscopy, and reflection anisotropy spectroscopy (RAS). The molecules adsorb through a Au-S linkage and, for the monolayer, adopt an ordered structure on the Au(110) substrate in which the optical axes of the dipoles contributing to the RAS signal are aligned roughly along the optical axes of the Au(110) substrate. Differences between the absorption spectrum of the molecules in a solution and the RAS profile of the adsorbed monolayer are attributed to surface order in the orientation of dipoles that contribute in the low energy region of the spectrum, a roughly vertical orientation on the surface of the long axes of the isoalloxazine rings and the lack of any preferred orientation in the molecular structure of the dipoles in the aromatic amino acids. Our studies establish an important proof of principle for immobilizing large biological macromolecules to gold surfaces. This opens up detailed studies of the dynamics of biological macromolecules by RAS, which have general applications in studies of biological redox chemistry that are coupled to protein dynamics.