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Onycholysis and paronychia has been associated with chemotherapy treatment for women with breast cancer. Our primary aim was to investigate the effectiveness of different topical interventions to ameliorate nail toxicity. Secondary aims were to explore the full range and severity of possible nail changes associated with taxane-based chemotherapy and the specific impact this had on quality of life, using two novel measures. This was an exploratory randomised controlled trial of three topical interventions (standard care, nail polish or specialist nail drops) for the prevention or reduction of nail changes induced by taxane-based chemotherapy. Outcomes included nail toxicity assessed at three time points (baseline, 3 weeks and 3 months post completion of chemotherapy) using two novel clinical tools (NToX-G12, NToX-QoL) and the Common Terminology Criteria for Adverse Events (CTCAE v3) and EQ-5D-5L. A total of 105 women were recruited (35 in each arm) and monitored up to three months post completion of chemotherapy. Almost 20% of patients were over the age of 60 years. There were 26 withdrawals, the majority from the nail polish arm. Residual Maximum Likelihood REML analysis indicated a significant arm, time and interaction effect for each intervention (p < 0.001). Less nail toxicity was observed in patients receiving specialist nail drops or standard care arms in comparison to those using nail polish. This study provides evidence to support clinicians' suggestions on nail care recommendations based on the patients' needs and preferences. Future investigations into comparing or combining cryotherapy and topical solutions that can support patient's decisions are warranted. [ABSTRACT FROM AUTHOR]

The Late Ordovician marks an epoch of substantial change during Earth’s geologic history. It documents the first mass extinction event of the Phanerozoic, which wiped out a plethora of marine genera. Though signatures of the extinction event are quite evident on the species level, there are many underlying uncertainties as to which factors drove the near destruction of Ordovician marine life. The exact causes and contributing factors of the Late Ordovician Mass Extinction (LOME) are highly debated. Previous studies propose processes such as redox shifts, volcanism, deep-water anoxia, low atmospheric oxygen, or excess CO2 as significant influencers. In this study, we utilized a multi-archive/proxy approach in reconstructing paleoenvironmental, stratigraphic, chronologic, and diagenetic signatures of halite and carbonate sequences from two localities containing the Ordovician–Silurian boundary. Our preliminary findings suggest that an abrupt, multi-pulsed glaciation was probably the main driver of the LOME. However, the exact duration, intensity, and number of cooling pulses are still up to interpretation and will require additional geochemical work to paint the entire picture. Samples were obtained from two localities of similar low paleo-latitudes. Marine halite and carbonate were obtained from the upper Ordovician Red Head Rapids Formation, Hudson Bay Basin, Canada. Another suite of halite was collected from the Ordovician/Silurian Mallowa Salt Formation, Canning Basin, Western Australia. The diagenetic integrity of Red Head Rapids halite and carbonate were assessed through strontium isotope analysis. Since the strontium isotope remains in equilibrium with seawater, we can cross-analyse the preservation potentials of both marine archives. All sample results lay within the ± 0.00006 ‰ natural variation of 87Sr/86Sr measured in modern marine counterparts, providing evidence of primary material and accurate paleo-interpretations. Trace element chemistry study was conducted on halite samples from both localities. Previous studies suggested that the spikes of Hg, Mo, and U concentrations signify the aftermath of a greenhouse event that triggered the expansion of deep-water anoxia. Furthermore, heightened volcanic activity led to significant greenhouse gas emissions and produced a period of warming. Instead, our halite Hg, Mo and U concentrations are extremely low, many below detection limits, which correspond to glacial signatures of an icehouse. Interpretation of the sedimentary cerium anomaly of the Red Head Rapids and Mallowa salts also revealed characteristics of an oxygenated marine environment, with all calculated values below the threshold, typical of anoxia. Rigorous halite fluid inclusion analysis was conducted to qualitatively distinguish between primary and secondary material based on size, shape, orientation, and multiple growth pat­terns. Microthermometry homogenization temperatures derived quantitative distinctions between primary and secondary fluid inclusions of preserved and altered material, respectively. Paleotemperatures of primary fluid inclusions exhibited oscillations that were evident of daily/seasonal variation of inter- and/or glacial times, averaging approximately 24.2°C ± 0.5°C for the latest-Ordovician–earliest-Silurian. Apart from minor fluctuations, we noticed up to four major cool­ing pulses associated with the major glaciation characterizing the latest-Ordovician–earliest-Silurian time. [ABSTRACT FROM AUTHOR]

Background: Various guidelines have highlighted the importance of patients being given information on malignant spinal cord compression (MSCC), both when diagnosed with the condition and as a tool to aid early detection. Aim: To determine patient and staff views on the provision of MSCC information to patients with a diagnosis of or considered to be at high risk of developing MSCC. Methods: Patients with MSCC admitted to a large regional cancer centre in Scotland over a 6-month period were interviewed. Staff were also surveyed using similar questions. Results: Fifty-six patients and fifty staff were recruited. Only 4% of staff reported giving any written information about MSCC to patients with a confirmed diagnosis, although 20% of patients said they received it and 77% wanted it. A total of 54% of staff reported giving prophylactic information about MSCC to patients, although the majority of the patients (86%) said they would have wanted this information. Patients generally did not access additional information about MSCC and were dependent on the limited amount provided by the health care team. Conclusion: Health professionals need to ensure that patients get the information they want, which will allow them to recognize MSCC symptoms early for improved treatment outcomes or to better adapt to a diagnosis. [ABSTRACT FROM AUTHOR]

Background: Various guidelines have highlighted the importance of patients being given information on malignant spinal cord compression (MSCC), both when diagnosed with the condition and as a tool to aid early detection. Aim: To determine patient and staff views on the provision of MSCC information to patients with a diagnosis of or considered to be at high risk of developing MSCC. Methods: Patients with MSCC admitted to a large regional cancer centre in Scotland over a 6-month period were interviewed. Staff were also surveyed using similar questions. Results: Fifty-six patients and fifty staff were recruited. Only 4% of staff reported giving any written information about MSCC to patients with a confirmed diagnosis, although 20% of patients said they received it and 77% wanted it. A total of 54% of staff reported giving prophylactic information about MSCC to patients, although the majority of the patients (86%) said they would have wanted this information. Patients generally did not access additional information about MSCC and were dependent on the limited amount provided by the health care team. Conclusion: Health professionals need to ensure that patients get the information they want, which will allow them to recognize MSCC symptoms early for improved treatment outcomes or to better adapt to a diagnosis. [ABSTRACT FROM AUTHOR]

Background: The attention and cognitive problems seen in individuals with a history of prenatal alcohol exposure often resemble those associated with attention deficit hyperactivity disorder (ADHD), but few studies have directly assessed the unique influence of each on neurobehavioral outcomes. Methods: We recorded event-related potentials (ERPs) during a Go/No-go response inhibition task in young adults with prospectively obtained histories of prenatal alcohol exposure and childhood ADHD. Results: Regardless of prenatal alcohol exposure, participants with childhood ADHD were less accurate at inhibiting responses. However, only the ADHD group without prenatal alcohol exposure showed a markedly diminished P3 difference between No-go and Go, which may reflect a more effortful strategy related to inhibitory control at the neural processing level. Conclusion: This finding supports a growing body of evidence suggesting that the manifestation of idiopathic ADHD symptoms may stem from a neurophysiologic process that is different from the ADHD symptomatology associated with prenatal alcohol exposure. Individuals who have been prenatally exposed to alcohol and present with ADHD symptomatology may represent a unique endophenotype of the disorder, which may require different treatment approaches from those found to be effective with idiopathic ADHD. [ABSTRACT FROM AUTHOR]

The US FDA recognizes that there are many challenges to ensuring that medical devices are used responsibly and safely in the pediatric population. Education plays a key role, and manufacturers and healthcare providers must be informed of medical device issues unique to the pediatric population. Healthcare workers and device manufacturers must recognize that adverse events may differ between the adult and pediatric population and among pediatric subpopulations. Risk mitigation may also differ, and heightened awareness will reduce the potential for adverse events and promote the safe use of medical devices in children. [ABSTRACT FROM AUTHOR]

Abstract: This paper discusses the piloting of a computerised decision aid that provides individualised information about hypertension to patients. The program is based on decision analysis, using decision trees as a way of structuring information. It incorporates the Framingham risk equation to assess a users'' risk of coronary artery disease, together with a detailed assessment of the patient''s current lifestyle and their willingness to change behaviour. Users of the program can decide how much or how little information they access. The program assesses individual''s preferences for different treatment outcomes, before providing them with guidance on what might be the best treatment option for them. The program was evaluated by 10 patients with a diagnosis of mild to moderate hypertension and 8 health care professionals. Overall, both health care professionals and patients assessed the program positively. The use of a decision aid based on decision analysis may be a useful way of providing information to patients in order to promote shared decision making. [Copyright &y& Elsevier]

ABSTRACT At a time when males abused in childhood are coming increasingly to attention of clinical services, we review the literature, describe the process and report on clinical outcomes of a slow open long-term dynamically orientated group for abused adult males. Twenty-nine men referred to the local psychotherapy service for consideration for inclusion in the group are discussed along with some of the most prevailing themes, namely identification with the aggressor, self-esteem, guilt and sexuality. Symptoms were measured using the SCL 90-R and demonstrate relatively high levels of psychological distress in this group at initial assessment. There is significant improvement in global scores, interpersonal sensitivity, depression and psychoticism in the group of 13 men who engaged in therapy for at least six months compared with those who did not. The authors conclude that symptom measurement provides evidence that group psychotherapy is a useful therapeutic approach in a group of men who might otherwise be considered unsuitable for psychotherapeutic interventions due to symptom severity and personality difficulties. [ABSTRACT FROM AUTHOR]