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High-entropy pyrochlore iridates A2Ir2O7 with multiple trivalent A cations were synthesized. The parent ternary A2Ir2O7 displays a variety of electronic phases depending on the size of A cations; Pr2Ir2O7 with a large A cation shows semimetallic behavior down to low temperatures, whereas A2Ir2O7 with smaller A cations, such as Nd2Ir2O7 and Eu2Ir2O7, displays a (semi)metal to magnetic insulator transition as a function of temperature. By further reducing the A cation size, smaller than Y3+, A2Ir2O7 becomes a Mott insulator, and long-range magnetic order takes place below room temperature. The metal–insulator transition and magnetic ordering turned out to be robust against strong disorder induced by the mixing of more than five A-cations in the high-entropy A2Ir2O7. The transition temperatures were found to scale with the average ionic radius of multiple A-cations. In contrast, high-entropy A2Ir2O7 including Bi3+ exhibits metallic behavior down to 2 K, which is likely associated with the presence of oxygen vacancies as in the parent Bi2Ir2O7. Although these indicate that the overall electronic structure of A2Ir2O7 remains intact in the presence of high-entropy configuration at the A-site, the transport properties suggest that fine details of the band structure may be modulated by local distortion. Strong disorder at the A-site of complex oxides may be exploited as a tool to control electronic properties. [ABSTRACT FROM AUTHOR]

Background: Injectable anaesthetic agents, topical creams and aqueous solutions have previously been used to anaesthetise the tympanic membrane for minor ear procedures. Topical creams take 20–30 minutes to work and injectable anaesthetics can cause canal swelling. The effectiveness of lidocaine spray has not previously been investigated in patients undergoing minor ear procedures. Methods: Eighteen participants attending for out-patient grommet insertion or intratympanic steroid injection were prospectively recruited for this study over six months. Post-operatively, they were asked about their perceived level of pain and overall experience. Results: The median level of pain measured on an 11-point visual analogue scale was 2 out of 10. Forty-four per cent reported the overall experience as pleasant, with the remainder selecting slightly unpleasant (66 per cent). All participants stated they would undergo the procedure again. Conclusion: Xylocaine spray is simple to administer, rapid-acting and well tolerated by patients for anaesthesia of the tympanic membrane during minor ear procedures in the out-patient setting. [ABSTRACT FROM AUTHOR]

We report on a new polymorph of silver antimonate AgSbO 3 discovered with the use of high-pressure high-temperature synthesis at 16 GPa and 1380 °C. The crystal structure is determined from X-ray powder diffraction, and we find this new high-pressure phase crystallizes in monoclinic space group C 2/ c with the following values: a = 8.4570(3) Å, b = 9.8752(3) Å, c = 8.9291(3) Å, β = 91.1750(12)°, and V = 745.56(4) Å 3 . We synthesized the high-pressure (16 GPa) AgSbO 3 phase from the ilmenite phase as a precursor. This high-pressure monoclinic AgSbO 3 consists of a three-dimensional network of corner- and edge-sharing SbO 6 octahedra with channels along the c -direction containing Ag atoms. We also synthesize AgSbO 3 in the defect pyrochlore phase at 4 GPa from the same ilmenite precursor and compare the Raman spectra and the cation-anion bonding of all three AgSbO 3 phases. The absence of a cubic perovskite form of AgSbO 3 even at pressures of ≤16 GPa is likely due to the covalency of the Sb-O bonds and the moderate electronegativity of Ag + . Hybridization of Ag d and O p orbitals results in a variation of Ag-O distances that correlates with the band gap, which is in qualitative agreement with the density of states around the Fermi level from our density functional calculations. We compare AgSbO 3 with other ABX 3 compounds to elucidate the dependence of the structure on the constituent atoms.

Objectives: Tonsillectomy is the most common operation performed by otolaryngologists in the UK, despite this we have a poor understanding of the post-operative recovery. We aimed to investigate post-operative bleeding and pain following paediatric tonsillectomy using a patient diary., Design: Prospective observational cohort study., Setting: Multi-centre study involving 12 secondary and tertiary otolaryngology units across the North of England. Patients were recruited from 1st March 2020 to 30th June 2022. Multilevel ordered logistic regression model statistics were performed., Participants: Children (≥4 years, ≤16 years) undergoing tonsillectomy (with or without adenoidectomy) for benign pathology., Main Outcome Measures: Frequency and severity of post-operative bleeding. Intensity and pattern of post-operative pain., Results: In total 297 children were recruited, with 91 (30.6%) diaries eligible for analysis. Post-operative bleeding occurred in 44% of children. Most frequently blood in the saliva was reported (82.9%). Increasing age significantly increased bleeding odds by 17% per year (p = .001). Bleeding frequency decreased with higher surgeon grade (p = .003) and when performing intracapsular coblation tonsillectomy (p = .02) compared with other techniques. Lower age and intracapsular coblation tonsillectomy, against other techniques, significantly reduced rates of pain post-operatively (p < .0001 and p = .0008)., Conclusion: A high level of low-level post-operative bleeding was observed. Pain scores remained high for 5 days post-operatively then gradually reduce to normal by day 13. Intracapsular coblation tonsillectomy appears to be superior to all other techniques in terms of reducing post-operative bleeding and pain. These findings should be used to guide patients in the consent process to inform them of the expected nature of post-surgical recovery., (© 2023 The Authors. Clinical Otolaryngology published by John Wiley & Sons Ltd.)

Abstract: Addiction is a highly misunderstood and stigmatized chronic illness frequently encountered by health care providers during routine medical care. People with substance use disorders, in particular, face extraordinary stigma and bias when interacting with health care providers, including nurses. Stigma associated with addiction contributes to health inequities and is recognized as a significant barrier to people seeking and receiving necessary health care. Since patients often spend the most time with nurses in the clinical setting, nurses are ideally positioned to address addiction stigma. However, many nurses lack knowledge about addiction, stigma, and the impact of the words they use, whether in conversation or in clinical documentation. This article reviews the consequences of addiction stigma (labeling, stereotyping, or discrimination) and the steps nurses can take to reduce biases related to substance use. A case scenario based on our experience will be used to guide a discussion of opportunities for nurses to intervene and improve care., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Background: Empathy is a core skill essential to patient-centred care. Yet a decline in empathy throughout undergraduate medical education is well recognised. The mainstay of existing teaching approaches to foster medical students' empathic ability has largely focused on the cognitive domain of empathy within the context of communication skills learning. However, there is growing evidence for educational initiatives that better evoke students' affective emotional responses., Approach: A student-led educational initiative was created to enhance medical students' understanding of empathy through undertaking different experiential approaches. Eight medical students were invited to participate in an empathy workshop that involved two experiential approaches: personal simulation, and patient narrative, selected given their expected focus on the affective domain., Evaluation: A subsequent focus group discussion explored students' reactions, learning, and intended future change in practice. Discussions were coded and analysed for descriptive themes. Both initiatives were reported to generate students' empathic responses. Personal simulation evoked more affective domains whilst patient narratives additionally created cognitive empathic insight into the impact of the patient's condition. Students also reported intended changes to their future consulting practices., Conclusions: Although this is a small-scale exploration of medical students' experiences of empathy-related teaching initiatives, it offers insight into how each initiative could target different aspects of empathy. Data support the use of even brief experiential teaching to improve medical students' empathy during their undergraduate training. We provide recommendations for clinical educators who are considering designing similar initiatives within their undergraduate medical curricula., (© 2022 The Authors. The Clinical Teacher published by Association for the Study of Medical Education and John Wiley & Sons Ltd.)

A pilot study was conducted to determine whether 3-monthly groin ultrasonography could eliminate groin dissection after a negative bilateral groin ultrasound in three groups of patients: (i) Those with a unifocal stage 1B squamous cell carcinoma of up to 20 mm in diameter. (ii) Those with an ipsilateral squamous cell carcinoma of any size which extended to within 1 cm either side of the midline. These patients underwent ipsilateral inguinofemoral lymphadenectomy and ultrasonic surveillance of the contralateral groin. (iii) Patients with multifocal invasive lesions with the largest individual focus 20 mm or less in diameter. Three additional patients were added because they either refused groin dissection or were considered unfit for surgery. All ultrasonically positive nodes were confirmed histologically. Thirty-two patients were entered, and no patients were lost to follow-up. Forty-three groins were followed. With a median follow-up of 37 months, three positive nodes (9.4%) were detected. One patient died of her recurrence (3.1%), and 39 groins (90.7%) were preserved. The overall sensitivity of ultrasonic surveillance was 100% (95% CI: 44-100%), with a specificity of 97% (95% CI: 83-99%) and a negative predictive value of 100% (95% CI: 88-100%). This pilot justifies a larger study on serial ultrasonography in lieu of groin dissection in selected patients with vulvar cancer.