Visible-Light-Induced Synthesis of Vinyl Sulfones via Decarboxylative Sulfonylation of Cinnamic Acids Using Sulfonylazides/p-Toluenesulfonylmethyl Isocyanide/ß-Keto Sulfones.

An efficient visible-light-induced synthesis of vinyl sulfones has been accomplished via decarboxylative sulfonylation of cinnamic acids using sulfonylazides, p-toluenesulfonylmethyl isocyanide, and ß-keto sulfones as sulfonyl source, in the presence of inexpensive organic photocatalysts like rhodamine B and eosin Y. The reaction is facile, straightforward, and endowed with wide substrate scope and functional group tolerability.

Effect of exercise on fatigue and depression in breastcancer women undergoing chemotherapy: a systematic review and meta-analysis.

This meta-analysis examined the effectiveness of exercise interventions in reducing fatigue and depression among women undergoing chemotherapy for breast cancer. The study followed PRISMA guidelines and analysed seven randomized controlled trials between 2016 and 2022. The results showed that exercise can substantially reduce fatigue levels (MD: -0.40, CI: -0.66, -0.14, P: 0.003), a common side effect of chemotherapy. Although depression did not significantly change (MD: -0.39, CI: -0.98, 0.20, P: 0.19), this study highlights the positive impact of exercise on mental health outcomes. The control group also experienced decreased quality of life (MD: 0.18, CI: 0.01-0.35, P: 0.03), emphasizing the importance of incorporating exercise interventions to improve overall well-being during breast cancer treatment. In addition to primary outcomes, the study revealed that exercise positively affected secondary aspects such as cognitive fatigue, social function, physical function, constipation, and dyspnoea.

Retrograde Conduction in Left Bundle Branch Block: Insights From Left Bundle Branch Pacing.

BACKGROUND: Biventricular pacing is a well-established therapy for patients with heart failure (HF), left bundle branch block (LBBB) and left ventricular (LV) dysfunction. Left bundle branch pacing (LBBP) has emerged as an alternative to biventricular pacing. OBJECTIVES: The aim of this study was to assess the retrograde conduction properties of the left bundle branch in patients with nonischemic cardiomyopathy and LBBB during LBBP and its clinical implications. METHODS: Patients undergoing successful LBBP for nonischemic cardiomyopathy with LV ejection fraction (LVEF) ≤35% and LBBB were included. Continuous recording of His potential was performed using a quadripolar catheter. Unidirectional block was defined as retrograde His bundle activation during LBBP with stimulus to His potential (SH) duration less than or equal to antegrade HV interval and bidirectional block as VH dissociation or SH duration greater than HV interval. HF hospitalization, ventricular arrhythmias, and mortality were documented. RESULTS: A total of 165 patients were included. The mean follow-up duration was 21.8 ± 13.1 months. Bidirectional block (group I) was observed in 82% (n = 136), and these patients were noted to have advanced HF stage and prolonged baseline QRS duration. Unidirectional block (group II) with intact retrograde conduction was observed in 18% (n = 29) and was associated with narrow paced QRS duration and higher LVEF during follow-up. Super-response (LVEF ≥50%) was observed in 54.4% (n = 74) in group I compared with 73.3% (n = 22) in group II (P = 0.03). The OR for LVEF normalization was 4.1 (95% CI: 1.26-13.97; P = 0.02), with unidirectional block compared with bidirectional block in patients with LBBB and LV dysfunction. Adverse clinical outcomes as measured by a composite of HF hospitalization, ventricular arrhythmias, and mortality were significantly higher in group I compared with group II (12.5% vs 0%; P = 0.04). CONCLUSIONS: Bidirectional block in LBBB was characterized by advanced HF symptoms, while unidirectional block was associated with better clinical outcomes after cardiac resynchronization therapy by LBBP.

Evaluation of predictive ability of linear type gonadal traits on reproductive capacity of breeding dairy bulls.

Dimensions of linear type traits facilitate selection of livestock for breeding and rearing. To date, use of linear type traits for selection of breeding bulls is highly concentric to scrotal circumference (SC), with probable overlook to other important traits. Present study reported the importance of various gonadal linear type traits on spermatozoa production, age-related changes in gonadal linear type traits of bulls and predictive ability of these traits on bulls' reproductive potentials. Among all gonadal traits, testicular density (TD), scrotal volume (SV), paired testicular weight (PWT) and SC were found most important predictor variables in order, which can discriminate between good/poor breeding bulls, that is, produced frozen semen doses (FSD) or not. Dimensions of gonadal traits increased significantly up to 36 months age and thereafter, development became slow and negligible. In contrast, TD decreased by 30%, 51%, 64%, 68% and 71% at 12, 24, 36, 48 and >49 months age, respectively, from its base value at 6 months. Bulls of lower TD (≤0.88 g/cm3) had significantly higher ejaculate volume (+9%), sperm motility, sperm concentration (+100 million/mL) and sperm output (+26%)/ejaculate as compared to bulls of higher TD (>0.88 g/cm3). Discriminant function was developed using TD, SV, PWT and SC to identify bulls of superior reproductive potentials. It was concluded that among the investigated traits, TD was the strongest to discriminate between FSD and Non-FSD bulls. Therefore, our findings suggested that TD could be more potential trait than SC for dairy bulls' breeding soundness evaluation and assessment of reproductive ability.

Sulfur-Mediated Decarboxylative Amidation of Cinnamic Acids via C═C Bond Cleavage.

A new strategy for the synthesis of amides has been developed using sulfur-mediated decarboxylative coupling of cinnamic acids with amines via oxidative cleavage of the C═C bond.

High performance Pt-anchored MoS2based chemiresistive ascorbic acid sensor.

Ascorbic acid (AA), known as vitamin C, is a vital bioactive compound that plays a crucial role in several metabolic processes, including the synthesis of collagen and neurotransmitters, the removal of harmful free radicals, and the uptake of iron by cells in the human intestines. As a result, there is an absolute need for a highly selective, sensitive, and economically viable sensing platform for AA detection. Herein, we demonstrate a Pt-decorated MoS2for efficient detection of an AA biosensor. MoS2hollow rectangular structures were synthesized using an easy and inexpensive chemical vapor deposition approach to meet the increasing need for a reliable detection platform. The synthesized MoS2hollow rectangular structures are characterized through field effect scanning electron microscopy (FESEM), energy-dispersive spectroscopy elemental mapping, Raman spectroscopy, and x-ray photoelectron spectroscopy. We fabricate a chemiresistive biosensor based on Pt-decorated MoS2that measures AA with great precision and high sensitivity. The experiments were designed to evaluate the response of the Pt-decorated MoS2biosensor in the presence and absence of AA, and selectivity was evaluated for a variety of biomolecules, and it was observed to be very selective towards AA. The Pt-MoS2device had a higher response of 125% against 1 mM concentration of AA biomolecules, when compared to that of all other devices and 2.2 times higher than that of the pristine MoS2device. The outcomes of this study demonstrate the efficacy of Pt-decorated MoS2as a promising material for AA detection. This research contributes to the ongoing efforts to enhance our capabilities in monitoring and detecting AA, fostering advancements in environmental, biomedical, and industrial applications.

Oral cavity cancer and its pre-treatment radiological evaluation: A pictorial overview.

PURPOSE: Oral cavity cancer, primarily squamous cell carcinoma (SCC), is a prevalent malignancy globally, necessitating accurate clinical assessment and staging to enable effective treatment planning. Diagnosis requires biopsy and is followed by surgical resection and reconstruction as the primary therapeutic modality. Imaging plays a pivotal role during this process, aiding in the evaluation of tumour extent, nodal involvement and distant metastases. However, despite its value, both radiologists and clinicians must recognise its inherent limitations. METHODS: This pictorial review article aims to illustrate the application of various imaging modalities in the pre-treatment evaluation of oral cavity SCC and highlights potential pitfalls. It underscores the importance of understanding the anatomical subsites of the oral cavity, the diverse patterns of spread tumours exhibit at each site, alongside the role of imaging in facilitating informed management strategies, while also acknowledging its limitations. RESULTS: The review delves into fundamentals of current staging including nodal involvement, while, emphasising imaging strategies and potential limitations. Finally, it touches on the potential of novel radiomic techniques in characterising tumours and predicting treatment response. CONCLUSIONS: Pre-treatment oral cavity cancer staging reflects an ongoing quest for enhanced diagnostic accuracy and prognostic prediction. Recognising the value of imaging alongside its limitations fosters a multidisciplinary approach to treatment planning, ultimately improving patient outcomes.

The 3,4-methylenedioxymethamphetamine enhances early visual processing for salient socio-emotional stimuli.

The 3,4-methylenedioxymethamphetamine (MDMA) has long been used non-medically, and it is currently under investigation for its potential therapeutic benefits. Both uses may be related to its ability to enhance empathy, sociability, emotional processing and its anxiolytic effects. However, the neural mechanisms underlying these effects, and their specificity to MDMA compared to other stimulants, are not yet fully understood. Here, using electroencephalography (EEG), we investigated the effects of MDMA and a prototypic stimulant, methamphetamine (MA), on early visual processing of socio-emotional stimuli in an oddball emotional faces paradigm. Specifically, we examined whether MDMA or MA enhance the processing of facial expressions, compared to placebo, during the early stages of visual perception. MDMA enhanced an event-related component that is sensitive to detecting faces (N170), specifically for happy and angry expressions compared to neutral faces. MA did not affect this measure, and neither drug altered other components of the response to emotional faces. These findings provide novel insights into the neural mechanisms underlying the effects of MDMA on socio-emotional processing and may have implications for the therapeutic use of MDMA in the treatment of social anxiety and other psychiatric disorders.

Design of a Humidity Sensor for a PPE Kit Using a Flexible Paper Substrate.

The present work reports the rapid sweat detection inside a PPE kit using a flexible humidity sensor based on hydrothermally synthesized ZnO (zinc oxide) nanoflowers (ZNFs). Physical characterization of ZNFs was done using scanning electron microscopy (SEM), X-ray diffraction (XRD), Fourier transmission infrared spectroscopy (FTIR), UV-visible, particle size analysis, Raman analysis, and X-ray photoelectron spectroscopy (XPS) analysis, and the hydrophilicity was investigated by using contact angle measurement. Fabrication of a flexible sensor was done by deposition on the paper substrate using the spin coating technique. It exhibited high sensitivity and low response and recovery times in the humidity range 10-95%RH. The sensor demonstrated the highest sensitivity of 296.70 nF/%RH within the humidity range 55-95%RH, and the rapid response and recovery times were also calculated and found as 5.10/1.70 s, respectively. The selectivity of the proposed sensor was also analyzed, and it is highly sensitive to humidity. The humidity sensing characteristics were theoretically witnessed in terms of the highest occupied molecular orbital (HOMO) and lowest unoccupied molecular orbital (LUMO) and electronic properties of sensing materials in ambient and humid conditions. These theoretical results are evidence of the interaction of ZnO with humidity. Overall, the present study provides a scope of architecture-enabled paper-based humidity sensors for the detection of sweat levels inside PPE kits for health workers.

Catalytic synergy of WS2-anchored PdSe2 for highly sensitive hydrogen gas sensor.

Hydrogen (H2) is widely used in industrial processes and is one of the well-known choices for storage of renewable energy. H2 detection has become crucial for safety in manufacturing, storage, and transportation due to its strong explosivity. To overcome the issue of explosion, there is a need for highly selective and sensitive H2 sensors that can function at low temperatures. In this research, we have adequately fabricated an unreported van der Waals (vdWs) PdSe2/WS2 heterostructure, which exhibits exceptional properties as a H2 sensor. The formation of these heterostructure devices involves the direct selenization process using chemical vapor deposition (CVD) of Pd films that have been deposited on the substrate of SiO2/Si by DC sputtering, followed by drop casting of WS2 nanoparticles prepared by a hydrothermal method onto device substrates including pre-patterned electrodes. The confirmation of the heterostructure has been done through the utilization of powder X-ray diffraction (XRD), depth-dependent X-ray photoelectron spectroscopy (XPS) and field-emission scanning electron microscopy (FE-SEM) techniques. Also, the average roughness of thin films is decided by Atomic Force Microscopy (AFM). The comprehensive research shows that the PdSe2/WS2 heterostructure-based sensor produces a response that is equivalent to 67.4% towards 50 ppm H2 at 100 °C. The response could be a result of the heterostructure effect and the superior selectivity for H2 gas in contrast to other gases, including NO2, CH4, CO and CO2, suggesting tremendous potential for H2 detection. Significantly, the sensor exhibits fast response and a recovery time of 31.5 s and 136.6 s, respectively. Moreover, the explanation of the improvement in gas sensitivity was suggested by exploiting the energy band positioning of the PdSe2/WS2 heterostructure, along with a detailed study of variations in the surface potential. This study has the potential to provide a road map for the advancement of gas sensors utilizing two-dimensional (2D) vdWs heterostructures, which exhibit superior performance at low temperatures.

Esophageal chemoradiotherapy with concurrent nivolumab: Pilot results in the palliative treatment of oligometastatic disease.

AIMS: Many patients diagnosed with esophageal cancer have dysphagia from their primary tumor and de novo metastatic disease. The purpose of this study was to test the safety and efficacy of nivolumab given concurrently with hypofractionated chemoradiotherapy to patients with oligometastatic and obstructing esophageal tumors. METHODS: Patients were enrolled in a planned single-arm, phase 2 clinical trial. Eligible participants had previously untreated oligometastatic (≤5 metastases on fludeoxyglucose-18 positron emission tomography scan outside the primary tumor radiotherapy field) esophageal or gastroesophageal carcinoma, dysphagia, and Eastern Cooperative Oncology Group performance status 0-1. Treatment was with 2 weeks of concurrent hypofractionated radiotherapy (30 Gy/10#) to the primary tumor, weekly carboplatin AUC2, weekly paclitaxel 50 mg/m2, and q2weekly nivolumab 240 mg, followed by nivolumab 480 mg continuing q4weekly until disease progression or 24 months total. A single metastasis was treated with stereotactic radiotherapy (SBRT) (24 Gy/3#) in week 7. RESULTS: Five patients were recruited before trial closure to new participants for logistical reasons. Existing participants continued treatment per protocol as a pilot study at one center. All five patients completed chemoradioimmunotherapy and SBRT. All patients derived an improvement in their dysphagia. Two patients completed 24 months of nivolumab without disease progression. Grade 3 adverse events (AEs) occurred in 3 patients, however, there were no grade 4 AEs, AEs due to SBRT, or AEs of special interest as defined by the protocol. CONCLUSION: Pilot results from five patients at one center found that treatment was well tolerated and effective for dysphagia relief. The efficacy of hypofractionated chemoradiotherapy with concurrent checkpoint inhibition should be tested in a multicentre study.

Perspective analysis of assistive robots for elderly in India.

PURPOSE: Assistive technology for elderly are advancing, and this study aimed to analyse the Indian perspective on utilising assistive robot technology for aiding elderly individuals. MATERIALS AND METHODS: A population-based survey was undertaken to collect data from three perspectives: Relatives of the elderly, Healthcare professionals and Elderly individuals. The survey gathered 389 responses. The responses are statistically analysed, and data is visualised with different plots for better understanding. RESULTS: It is observed that the older people rate with less conviction on the use of technology when compared to the relatives and healthcare professionals. Out of the three target groups, the elderly individuals had the most correlating attributes to purchasing the robot. Also, healthcare personnel, relatives, and older people gave 82%, 63% and 55% affirmatives to the question on purchasing the robot, respectively. And the cost of the robot is preferred to be under 6 lakh rupees. CONCLUSIONS: Though the younger generation has more orientation towards technology, older people are skeptical about handling computer gadgets or robots. However, there are significant expectations and concerns expressed by three target groups such as conversational, navigational, reminder features, security and malfunction concerns.

Quasicrystal Nanosheet/α-Fe2O3 Heterostructure-Based Low Power NO2 Sensors: Experimental and DFT Studies.

Industrial emissions, environmental monitoring, and medical fields have put forward huge demands for high-performance and low power consumption sensors. Two-dimensional quasicrystal (2D QC) nanosheets of metallic multicomponent Al70Co10Fe5Ni10Cu5 have emerged as a promising material for gas sensors due to their excellent catalytic and electronic properties. Herein, we demonstrate highly sensitive and selective NO2 sensors developed by low-cost and scalable fabrication techniques using 2D QC nanosheets and α-Fe2O3 nanoparticles. The sensitivity (ΔR/R%) of the optimal amount of 2D QC nanosheet-loaded α-Fe2O3 sensor was 32%, which is significantly larger about 3.5 times than bare α-Fe2O3 sensors for 1 ppm of NO2 at 150 °C operating temperature. The sensors exhibited p-type conduction, and resistance was reduced when exposed to NO2, an oxidizing gas. The enhanced sensing characteristics are a result of the formation of nanoheterojunctions between 2D QC and α-Fe2O3, which improved the charge transport and provided a large sensing signal. In addition, the heterojunction sensor demonstrated excellent NO2 selectivity over other oxidizing and reducing gases. Furthermore, density functional theory calculation examines the adsorption energy and charge transfer between NO2 molecules on the α-Fe2O3(110) and QC/α-Fe2O3(110) heterostructure surfaces, which coincides well with the experimental results.

Optimization of Newtonian fluid pressure in microcantilever integrated flexible microfluidic channel for healthcare application.

The demand for microfluidic pressure sensors is ever-increasing in various industries due to their crucial role in controlling fluid pressure within microchannels. While syringe pump setups have been traditionally used to regulate fluid pressure in microfluidic devices, they often result in larger setups that increase the cost of the device. To address this challenge and miniaturize the syringe pump setup, the researcher introduced integrated T-microcantilever-based microfluidic devices. In these devices, microcantilevers are incorporated, and their deflections correlate with the microchannel's pressure. When the relative pressure of fluid (plasma) changes, the T-microcantilever deflects, and the extent of this deflection provides information on fluid pressure within the microchannel. In this work, finite element method (FEM) based simulation was carried out to investigate the role of material, and geometric parameters of the cantilever, and the fluid viscosity on the pressure sensing capability of the T-microcantilever integrated microfluidic channel. The T-microcantilever achieves a maximum deflection of 127µm at a 5000µm/s velocity for Young's modulus(E) of 360 kPa of PDMS by employing a hinged structure. On the other hand, a minimum deflection of 4.05 × 10-5µm was attained at 5000µm/s for Young's modulus of 1 TPa for silicon. The maximum deflected angle of the T-cantilever is 20.46° for a 360 kPa Young's modulus while the minimum deflection angle of the T-cantilever is measured at 13.77° for 900 KPa at a fluid velocity of 5000µm s-1. The T-cantilever functions as a built-in microchannel that gauges the fluid pressure within the microchannel. The peak pressure, set at 8.86 Pa on the surface of the cantilever leads to a maximum deflection of 0.096µm (approximately 1µm) in the T-cantilever at a 1:1 velocity ratio. An optimized microfluidic device embedded with microchannels can optimize fluid pressure in a microchannel support cell separation.

Resistive switching in benzylammonium-based Ruddlesden-Popper layered hybrid perovskites for non-volatile memory and neuromorphic computing.

Artificial synapses based on resistive switching have emerged as a promising avenue for brain-inspired computing. Hybrid metal halide perovskites have provided the opportunity to simplify resistive switching device architectures due to their mixed electronic-ionic conduction, yet the instabilities under operating conditions compromise their reliability. We demonstrate reliable resistive switching and synaptic behaviour in layered benzylammonium (BzA) based halide perovskites of (BzA)2PbX4 composition (X = Br, I), showing a transformation of the resistive switching from digital to analog with the change of the halide anion. While (BzA)2PbI4 devices demonstrate gradual set and reset processes with reduced power consumption, the (BzA)2PbBr4 system features a more abrupt switching behaviour. Moreover, the iodide-based system displays excellent retention and endurance, whereas bromide-based devices achieve a superior on/off ratio. The underlying mechanism is attributed to the migration of halide ions and the formation of halide vacancy conductive filaments. As a result, the corresponding devices emulate synaptic characteristics, demonstrating the potential for neuromorphic computing. Such resistive switching and synaptic behaviour highlight (BzA)2PbX4 perovskites as promising candidates for non-volatile memory and neuromorphic computing.

Development and Licensing of Avian Vaccines - Perspective from the Vaccine Industry.

Veterinary vaccines need to be authorized by relevant authorities before they can be used in the field. This paper briefly describes the development and authorization process of vaccines. It also highlights important regulatory trends, challenges and opportunities from the veterinary vaccine industry standpoint in EU, US, Asia and Latin America, with a specific focus on avian vaccines' relevant topics.

Desarrollo y concesión de licencias para vacunas aviares: Perspectiva de la industria de producción de vacunas. Las vacunas veterinarias deben ser autorizadas por las autoridades pertinentes antes de que puedan usarse en el campo. Este artículo describe brevemente el proceso de desarrollo y autorización de vacunas. También destaca importantes tendencias regulatorias, desafíos y oportunidades desde el punto de vista de la industria de vacunas veterinarias en la Unión Europea, los Estados Unidos, Asia y América Latina, con un enfoque específico en los temas relevantes de las vacunas aviares.

2D nanomaterials for realization of flexible and wearable gas sensors: A review.

Gas sensors are extensively employed for monitoring and detection of hazardous gases and vapors. Many of them are produced on rigid substrates, but flexible and wearable gas sensors are needed for intriguing usage including the internet of things (IoT) and medical devices. The materials with the greatest potential for the fabrication of flexible and wearable gas sensing devices are two-dimensional (2D) semiconducting nanomaterials, which consist of graphene and its substitutes, transition metal dichalcogenides, and MXenes. These types of materials have good mechanical flexibility, high charge carrier mobility, a large area of surface, an abundance of defects and dangling bonds, and, in certain instances adequate transparency and ease of synthesis. In this review, we have addressed the different 2D nonmaterial properties for gas sensing in the context of fabrication of flexible/wearable gas sensors. We have discussed the sensing performance of flexible/wearable gas sensors in various forms such as pristine, composite and noble metal decorated. We believe that content of this review paper is greatly useful for the researchers working in the research area of fabrication of flexible/wearable gas sensors.

Biodiesel-Derived Waste Glycerol as a Green Template for Creating Mesopores in the ZSM-5 Catalyst for Aromatics Production Applications.

The present study provides a novel sustainable approach for the synthesis of the ZSM-5 catalyst using biodiesel-derived waste glycerol as a green template as well as a mesopore creator, which is here reported for the first time, to the best of our knowledge. The use of bioglycerol in the preparation of ZSM-5 (Zn-Z-G and Zn-Z-T) materials exhibited a typical MFI zeolite structure, indicating glycerol played a similar role to that of a typical (TPA+) template in the formation of the ZSM-5 zeolite structure. The Zn-Z-G material also exhibited a large mesopore in the ZSM-5 pore structure, suggesting that glycerol played both template and mesopore creator roles. Interestingly, Zn-Z-GT prepared by the dual-template route using bioglycerol along with typical TPA+ showed a MFI zeolite structure with special catalytic features such as hierarchical micromesopores and well-balanced acid sites. These results reveal that the use of bioglycerol along with a typical TPA+ template had a promotional effect on creating such special properties in the Zn-Z-GT material. The Zn-Z-GT catalyst exhibited excellent catalytic performance in the naphtha aromatization reaction, resulting in achieving ∼58 wt % of the aromatic product and useful gas byproduct (14 wt %) with a minimum coke content (∼4 wt %) in a 12 h reaction period ascribed to its combined effect of hierarchical micromesopores and well-balanced acidity with optimum Lewis acid sites. The liquid product possessing high alkyl-aromatics with a high octane value (RON ∼ 109) produced in the present study can be used as an octane booster for liquid gasoline. The high alkyl-aromatics (>50 wt %) content of the liquid product also attracts various petrochemical applications. The effective utilization of waste bioglycerol as a green template and mesopore creator for the preparation of Zn-Z-GT can exhibit sustainability in the resultant material.

Situational anxiety in head and neck cancer: Rates, patterns and clinical management interventions in a regional cancer setting.

INTRODUCTION: Research indicates that the immobilisation mask required for radiation therapy (RT) for head and neck cancers can provoke intense anxiety. However, little is known about the rates of this anxiety, whether it changes over a course of treatment and how it is managed in clinical practice. This study aimed to describe the rates and patterns of situational anxiety in patients undergoing RT for head and neck cancer and the use of anxiety management interventions in current clinical practice in a major regional cancer setting in New South Wales, Australia. METHODS: Situational anxiety rates and patterns were assessed at five time points using the State-Trait Anxiety Inventory prior to treatment planning (SIM), the first three treatment sessions (Tx 1, Tx 2 and Tx 3) and treatment 20 (Tx 20). Sessions were observed to record the use of general supportive interventions (music and support person) and anxiety-specific interventions (break from the mask, relaxation techniques and anxiolytic medication). Sociodemographic and clinical information was extracted from the medical record. RESULTS: One hundred and one patients were recruited. One-third had clinically significant anxiety at any of the first three time points (33.3-40%), and a quarter at Tx 3 (26.4%) and Tx 20 (23.4%). Of the sample, 55.4% had available data for categorisation into one of four pattern groups: 'No Anxiety' (46.4%); 'Decreasing Anxiety' (35.7%); 'Increasing Anxiety' (7.1%); and 'Stable High Anxiety' (10.7%). Most participants had social support present at SIM (53.5%) and listened to music during treatment (86.7-92.9%). Few participants received relaxation techniques alone (1.2-2.3%). Anxiolytic medication was provided for 10% of patients at some stage during the treatment journey and 5% required a break from the mask at SIM, with frequency decreasing throughout the treatment course. CONCLUSIONS: In this regional cancer setting, situational anxiety was common, but generally decreased throughout treatment. Some patients experience persistent or increasing anxiety, with up to 10% of patients receiving specific anxiety management interventions.

Civilian Ballistic Arthrotomies: Infection Rates and Operative Versus Nonoperative Management.

OBJECTIVES: The purpose of this study was to determine whether a significant difference existed in the rate of infection after ballistic traumatic arthrotomy managed operatively compared with those managed without surgery. DESIGN: Retrospective cohort study. SETTING: Academic Level I Trauma Center. PATIENT SELECTION CRITERIA: Patients with ballistic traumatic arthrotomies of the shoulder, elbow, wrist, hip, knee, or ankle who received operative or nonoperative management. OUTCOME MEASURES AND COMPARISONS: The rates of infection and septic arthritis in those who received operative or nonoperative management. RESULTS: One hundred ninety-five patients were studied. Eighty patients were treated nonoperatively (Non-Op group), 16 patients were treated with formal irrigation and debridement in the operating room (I&D group), and 99 patients were treated with formal I&D and open reduction and internal fixation (ORIF) (I&D + ORIF group). Patients in all 3 groups received local wound care and systemic antibiotics. No patients in the Non-Op or I&D group developed an infection. Six patients in the I&D + ORIF group developed extra-articular postoperative infections requiring additional interventions. CONCLUSIONS: The infection rate in the I&D + ORIF group was consistent with the infection rates reported in orthopaedic literature after fixation alone. In addition, none of the infections were cases of septic arthritis. This suggests that traumatic arthrotomy does not increase the risk for infection beyond what is expected after fixation alone. Importantly, the Non-Op group represented a series of 80 patients who were treated nonoperatively without developing an infection, indicating that I&D may not be necessary to prevent infection after ballistic arthrotomy. The results suggest that septic arthritis after civilian ballistic arthrotomy is a rare complication regardless of the choice of treatment. LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.