Exploring the perceived medical ethics and law training needs of UK foundation doctors.

Foundation doctors (FDs) encounter a wide range of ethical and legal issues during their first two years of work. Despite ethics being a key part of most modern undergraduate curricula, FDs can struggle with the issues they see. This study is based on results from an on-line survey answered by 479 UK FDs regarding their medical law and ethics learning needs, and their undergraduate training in this area. Over two-thirds stated they would wish to receive MEL training as an FD on self-discharge against medical advice (∼71%), sedating patients (∼70%), decision making in emergency medicine (∼67%), and withholding and withdrawing treatment (∼66%). Over half of all respondents want MEL training during their Foundation Programme on DNACPR orders (∼63%), dealing with patients with suicidal intent (∼59%), Mental Health Act (∼55%), Deprivation of Liberty Safeguards (∼54%), and end of life care (∼53%). We therefore propose a minimum curriculum for ethics and law training for FDs based on these topics, as well as cases brought by the FDs themselves.

Association between psychological distress and cancer type in patients referred to a psycho-oncology service.

Psychological distress is common in patients with cancer and psychological well-being is increasingly seen as an important component of cancer care. The aim of this study was to examine the relationship between cancer type and subjective distress. The following data were collected from a database of consecutive psycho-oncology referrals to the Liaison Psychiatry service in Cork University Hospital from 2006 to 2015: demographics, cancer diagnosis, Distress Thermometer (DT) score. 2102 out of 2384 referrals were assessed. Of those assessed, the most common cancer diagnoses were breast (23%, n=486) followed by haematological (21%, n=445). There were significant difference in DT score between the different cancer types, (?2(13)=33.685, p=0.001, Kruskal-Wallis test). When adjusted for age, gender and whether or not the cancer was recently diagnosed, there was no significant association between cancer type and psychological distress. In conclusion, cancer type is not associated with level of distress in cancer.

Long-term outcomes for patients with peritoneal acellular mucinosis secondary to low grade appendiceal mucinous neoplasms.

INTRODUCTION: Low grade appendiceal mucinous neoplasms (LAMN) are known to metastasise to the peritoneum resulting in pseudomyxoma peritonei (PMP). Literature suggests that the long-term outcome is dependent on the cellular grade of the peritoneal histology, less is known about the risk to patients with acellular mucinosis (AM) alone. This study aims to review long-term outcomes in patients with PMP treated with Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy (CRS/HIPEC), whose peritoneal histology was AM secondary to LAMN. METHODS: Pathological and treatment outcomes were collected from a prospectively maintained database between 2005 and 2019. Data was collected on patients with LAMN and AM diagnosed following CRS/HIPEC. A single institution performed the surgery and pathology reporting, samples reported by three different pathologists. RESULTS: Of the 2079 patients with any appendiceal neoplasm referred between 2005 and 2019, 809 underwent CRS/HIPEC, 67 (8%) of those had PMP with purely AM secondary to a LAMN. In the AM group the median age was 59, 37 (55%) were female, follow up was for a median 39 (2-145) months. Inpatient mortality occurred in 1 patient (1.5%), disease specific mortality in 2 (3%), recurrence in 2 (3%) and disease progression in 1 (1.5%). CONCLUSION: This study has identified AM secondary to LAMN as a low risk group for recurrence following CRS/HIPEC compared with epithelial pathology. Given such a low rate of recurrence we would recommend low intensity surveillance post CRS/HIPEC. Agreed standardised pathological assessment is required to exclude cellular material in specimens and diagnose AM.

Hospital infection society prevalence survey of Healthcare Associated Infection 2006: comparison of results between Northern Ireland and the Republic of Ireland.

As part of the Third Healthcare Associated Infection (HCAI) Prevalence Survey of the United Kingdom and Ireland, HCAI point prevalence surveys were carried out in Northern Ireland (NI) and the Republic of Ireland (RoI). Here we explore the potential benefits of comparing results from two countries with different healthcare systems, which employed similar methodologies and identical HCAI definitions. Forty-four acute adult hospitals in the RoI and 15 in NI participated with a total of 11 185 patients surveyed (NI 3644 patients and RoI 7541). The overall HCAI prevalence was 5.4 and 4.9 in NI and the RoI, respectively. There was no significant difference in prevalence rates of HCAI, device-related HCAI or HCAI associated with bloodstream infection but there was a difference in meticillin-resistant Staphylococcus aureus-related HCAI (P = 0.02) between the two countries. There were significantly more urinary tract infections and Clostridium difficile infections recorded in NI (P = 0.002 and P < 0.001). HCAIs were more prevalent in patients aged >65 years and in the intensive care unit in both countries. HCAIs were also more prevalent if patients were mechanically ventilated, had had recent non-implant surgery (RoI) or had more recorded HCAI risk factors. This is the first time that HCAI prevalence rates have been directly compared between NI and the RoI. By closely examining similarities and differences between HCAI prevalence rates in both countries it is hoped that this will influence healthcare planning and at the same time reassure the public that HCAI is important and that measures are being taken to combat it.

Early phosphoproteomic changes for adverse outcome pathway development in the fathead minnow (Pimephales promelas) brain.

Adverse outcome pathways (AOPs) are conceptual frameworks that organize and link contaminant-induced mechanistic molecular changes to adverse biological responses at the individual and population level. AOPs leverage molecular and high content mechanistic information for regulatory decision-making, but most current AOPs for hormonally active agents (HAAs) focus on nuclear receptor-mediated effects only despite the overwhelming evidence that HAAs also activate membrane receptors. Activation of membrane receptors triggers non-genomic signaling cascades often transduced by protein phosphorylation leading to phenotypic changes. We utilized label-free LC-MS/MS to identify proteins differentially phosphorylated in the brain of fathead minnows (Pimephales promelas) aqueously exposed for 30 minutes to two HAAs, 17α-ethinylestradiol (EE2), a strong estrogenic substance, and levonorgestrel (LNG), a progestin, both components of the birth control pill. EE2 promoted differential phosphorylation of proteins involved in neuronal processes such as nervous system development, synaptic transmission, and neuroprotection, while LNG induced differential phosphorylation of proteins involved in axon cargo transport and calcium ion homeostasis. EE2 and LNG caused similar enrichment of synaptic plasticity and neurogenesis. This study is the first to identify molecular changes in vivo in fish after short-term exposure and highlights transduction of rapid signaling mechanisms as targets of HAAs, in addition to nuclear receptor-mediated pathways.

On the Chemistry and Physical Properties of Flux and Floating Zone Grown SmB6 Single Crystals.

Recent theoretical and experimental findings suggest the long-known but not well understood low temperature resistance plateau of SmB6 may originate from protected surface states arising from a topologically non-trivial bulk band structure having strong Kondo hybridization. Yet others have ascribed this feature to impurities, vacancies, and surface reconstructions. Given the typical methods used to prepare SmB6 single crystals, flux and floating-zone procedures, such ascriptions should not be taken lightly. We demonstrate how compositional variations and/or observable amounts of impurities in SmB6 crystals grown using both procedures affect the physical properties. From X-ray diffraction, neutron diffraction, and X-ray computed tomography experiments we observe that natural isotope containing (SmB6) and doubly isotope enriched ((154)Sm(11)B6) crystals prepared using aluminum flux contain co-crystallized, epitaxial aluminum. Further, a large, nearly stoichiometric crystal of SmB6 was successfully grown using the float-zone technique; upon continuing the zone melting, samarium vacancies were introduced. These samarium vacancies drastically alter the resistance and plateauing magnitude of the low temperature resistance compared to stoichiometric SmB6. These results highlight that impurities and compositional variations, even at low concentrations, must be considered when collecting/analyzing physical property data of SmB6. Finally, a more accurate samarium-154 coherent neutron scattering length, 8.9(1) fm, is reported.

LENS: A New Pulsed Neutron Source for Research and Education.

A new pulsed neutron source is under construction at the Indiana University Cyclotron Facility (IUCF). Neutrons are produced via (p,n) reactions by a low-energy proton beam incident on a thin beryllium target. The source is tightly coupled to a cold methane moderator held at a temperature of 20 K or below. The resulting time-averaged cold neutron flux is expected to be comparable to that of the Intense Pulsed Neutron Source (IPNS) facility at Argonne National Laboratory. The initial experimental suite will include instrumentation for small angle neutron scattering (SANS), moderator studies, radiography, and zero-field spin-echo SANS.

Biomechanical considerations of prosthodontic therapy: the urgency of research into alveolar bone responses.

The prognosis of natural and implant abutments depends in part on the complementary and/or antagonistic biomechanic and calcium homeostatic functions of the adjacent alveolar bone. Whereas bone morphology is determined by peak strains, strain rates, and strain distributions, infrequent error strains on abutments have a greater impact on the adjacent alveolar bone than those generated during "normal" activity. Alveolar responses depend on the immediate prevailing systemic and local demands, although unexpected abutment failures will continue until such influences have been investigated further.

A study of multiracial malocclusions.

The prevalance of a number of malocclusion traits was investigated for 1,000 modern British caucasoid, 70 medieval British, 60 Anglo-Saxon, 100 negroid and 100 mongoloid dentitions. Marked contrasts were evident in the sagittal, vertical and transverse occlusal and spacing anomalies between the various samples, with dental crowding being particularly prevalent in the modern British caucasoid sample and spacing between the teeth in the Anglo-Saxon sample. The method of quantification of malocclusions was shown to be applicable for other epidemiologic studies.

A note on the variation in the timing of deciduous tooth eruption.

A survey was carried out on the timing of deciduous tooth eruption based upon 3600 Caucasian children in three heterogeneous samples from Birmingham, Sheffield and Gloucester and a small more or less homogeneous sample from Biddulph (North Staffordshire). These data were compared with the eruption times derived from a sample of 600 British Negro children. Generally, the deciduous teeth of Negroes erupted before those of Caucasians, although the actual eruption times in each sample exhibited a greater degree of variability than is appreciated by most dental workers.

A preliminary study of craniofacial classification.

Cephalographic evaluations often hinge on univariate statistical analyses of their component dimensions. These analyses generally depict a progressive increase in cephalometric form with age. Such analyses are, however, complicated by the varied inter-dimensional correlations. But when the cephalometric dimensions were combined together in cluster analysis, complex associations between various age groups were noted in the 1-18 year range. Such multivariate analyses revealed far more complex craniofacial age changes than traditionally envisaged. These data therefore indicated the need for further investigation of such "normocephalic gold standards" before their value in craniofacial evaluation can be established.

Sulconazole nitrate cream 1 percent for treating tinea cruris and corporis.

Sulconazole nitrate 1 percent cream, a new imidazole derivative, was tested in 117 Colombian Army soldiers with tinea cruris/corporis under hot, humid conditions. The results of two clinical trials demonstrate that sulconazole applied once daily was as effective as clotrimazole applied twice daily. After three weeks of therapy 100 percent of the patients treated either once or twice daily with sulconazole showed negative findings on potassium hydroxide preparations and cultures from lesions. Although sulconazole was well tolerated and caused no adverse reactions, four of twenty-seven clotrimazole-treated patients showed reactions consisting of erosive primary irritation. Sulconazole nitrate 1 percent cream appears to be highly effective in the treatment of tinea cruris/corporis when applied once or twice daily and may be very useful in hot and humid conditions where contact irritation reactions occur more often.

Summary of symposium on dental perspectives--International Year of the Child.

Children's dental health needs, an oral health index, the importance of communal fluoridation, and manpower distribution were discussed.

Dental fees.

Traditional economic theories impact on the viability of a practice. Yet the relationships between revenues generated and dental service fees are more complex than traditionally envisaged. Whereas long-term fee strategies and short term tactics may be instituted to stimulate service demands, the significance of non-fee determinants (e.g. professional skills) cannot be underestimated.

In search for excellence: an effective strategy for dentistry.

Traditional market strategies no longer stimulate sufficient dental service demands to maintain full employment for all members of the profession. However, the dental needs of adults, particularly older adults, continue to escalate. A more effective strategy should be focused on the provision of services that consistently exceed the expectations of patients.

A study of craniofacial form.

There are differences in the craniofacial skeleton, dental arch, and tooth dimensions between brachycephalics and dolichocephalics. Furthermore, the craniofacial complex appears to be more intergrated biologically in dolichocephalics than brachycephalics.

A study of the craniofacial skeleton.

Multivariate analysis of craniofacial profiles demonstrated the complex interaction between the brain case and facial skeleton during growth and between various occlusal categories. Only by investigating craniofacial growth data still further will it be possible to establish normative standard growth patterns that can withstand critical scientific appraisal.

A cephalometric study.

Multivariate analysis of the craniofacial skeleton from subjects with Angle's four occlusal categories showed a similar pattern but with varying degrees of separation depending upon which parameters were included in the analysis. Generally it appeared that the maxillary jaw and mandibular arch parameters contributed most to the discrimination to the four categories of subjects examined in this study.

The role of cluster analysis on traditional cephalometric dimensions.

In order to categorize (classify) craniofacial forms, varying linear dimensional arrays from a series of pretreatment cephalographs ('A' records) were subjected to cluster analysis. The derived subgroups (clusters) not only showed inconsistencies in their component patients, but also their 'nearest neighbors', i.e. cases identified as being most similar to one another. This study, therefore, emphasized the need to devise more appropriate cephalometric appraisal techniques for patient categorization (diagnosis).

The immune response to oral infections.

This article summarizes some of the important interactions between the immune system and inflammatory process, with the primary focus on the host response to infection. A subsequent brief review of the pathogenesis of periodontal disease serves to illustrate the relevance of these interactions to our understanding of disease.