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While ChatGPT has recently become very popular, AI has a long history and philosophy. This paper intends to explore the promises and pitfalls of the Generative Pre-trained Transformer (GPT) AI and potentially future technologies by adopting a speculative methodology. Speculative future narratives with a specific focus on educational contexts are provided in an attempt to identify emerging themes and discuss their implications for education in the 21st century. Affordances of (using) AI in Education (AIEd) and possible adverse effects are identified and discussed which emerge from the narratives. It is argued that now is the best of times to define human vs AI contribution to education because AI can accomplish more and more educational activities that used to be the prerogative of human educators. Therefore, it is imperative to rethink the respective roles of technology and human educators in education with a future-oriented mindset.

As Covid-19 circulated worldwide, lockdowns forced individuals to connect virtually in order to continue maintaining relationships. The current study sought to understand the impact of these online interactions on students' mental health and wellbeing. Semi structured interviews were conducted with 17 students. Two main themes were uncovered: control (1) and no control (2). Participants reported that having control over online interactions helped them to choose when, how often and with whom to connect as well as disconnect which benefited and enhanced their wellbeing during the lockdown period. On the other hand, lack of control over interactions online resulted in students feeling anxious, stressed and unable to maintain healthy boundaries. The concept of control and its link to wellbeing has previously been explored in literature and this study reinforces the idea that individuals experience an enhanced sense of wellbeing when able to control important areas of their lives. [ABSTRACT FROM AUTHOR]

This essay explores what the development of writing might look like and how it might take shape in a secondary English classroom. The study problematises current definitions of progress. In direct opposition to standards-driven models, I propose an alternative way of thinking about the development of writers through a series of narrative accounts that shed light on actual learning moments. The study explores the potential of gaining insight into a learner's writing history, their attitudes and feelings towards writing, the potential of fostering writing communities and finding alternative ways of responding to writing. I argue that current assessment regimes misrepresent how writers develop and thus tend to have a negative impact on learners' confidence and enjoyment of writing.

Background: It is not well understood the overall changes that multidisciplinary teams (MDTs) have had to make in response to the COVID‐19 pandemic, nor the impact that such changes, in addition to the other challenges faced by MDTs, have had on decision‐making, communication, or participation in the context of MDT meetings specifically. Methods: This was a mixed method, prospective cross‐sectional survey study taking place in the United Kingdom between September 2020 and August 2021. Results: The participants were 423 MDT members. Qualitative findings revealed hybrid working and possibility of virtual attendance as the change introduced because of COVID‐19 that MDTs would like to maintain. However, IT‐related issues, slower meetings, longer lists and delays were identified as common with improving of the IT infrastructure necessary going forward. In contrast, virtual meetings and increased attendance/availability of clinicians were highlighted as the positive outcomes resulting from the change. Quantitative findings showed significant improvement from before COVID‐19 for MDT meeting organisation and logistics (M = 45, SD = 20) compared to the access (M = 50, SD = 12, t(390) = 5.028, p = 0.001), case discussions (M = 50, SD = 14, t(373) = −5.104, p = 0.001), and patient representation (M = 50, SD = 12, t(382) = −4.537, p = 0.001) at MDT meetings. Discussion: Our study explored the perception of change since COVID‐19 among cancer MDTs using mixed methods. While hybrid working was preferred, challenges exist. Significant improvements in the meeting organisation and logistics were reported. Although we found no significant perceived worsening across the four domains investigated, there was an indication in this direction for the case discussions warranting further 'live' assessments of MDT meetings. [ABSTRACT FROM AUTHOR]

Our paper evaluates the relationship between radiologically abnormal cardiophrenic lymph nodes (CPLN) in advanced ovarian cancer and pattern of disease distribution, tumour burden, surgical complexity, rates of cytoreduction and same-site recurrence. Impact of suspicious CPLN and CPLN dissection on overall survival also determined. Retrospective review of index CT imaging for 151 consecutive patients treated for stage III/IV ovarian malignancy in a large UK cancer centre to identify radiologically abnormal CPLN. Corresponding surgical, histo-pathological and survival data analysed. 42.6% of patients had radiologically 'positive' CPLN on index CT. Radiological identification of CPLN involvement demonstrated a sensitivity of 82% within our centre. Patients with cardiophrenic lymphadenopathy on pre-operative CT had significantly more co-existing ascites (p = 0.003), omental (p = 0.01) and diaphragmatic disease (p < 0.0001). At primary debulking (PDS), suspicious CPLN were associated with significantly higher surgical complexity scores, without feasibility of complete cytoreduction being impacted. Cardiophrenic involvement at initial diagnosis was associated with same-site relapse at recurrence (p = 0.001). No significant difference in overall survival was demonstrated according to CPLN status following either PDS or delayed debulking (DDS). CPLN dissection did not improve patient outcomes. Radiological identification of abnormal CPLN is reliable. Suspicious CPLN appear to represent a surrogate marker of tumour volume – in particular, heralding upper abdominal disease – and should prompt anticipation of high complexity surgery and referral to an appropriate centre. Patients with prior CPLN involvement are more likely to develop same-site recurrence at relapse. Our survival data suggests cardiophrenic LN disease does not worsen patient prognosis and that the therapeutic benefit of CPLN dissection remains unclear. [ABSTRACT FROM AUTHOR]

Background: Multidisciplinary teams (MDTs) are widely used in cancer care. Recent research points to logistical challenges impeding MDT decision-making and dissatisfaction among members. This study sought to identify different types of logistical issues and how they impacted team processes. Methods: This was a secondary analysis of a cross-sectional observational study. Three cancer MDTs (breast, colorectal, and gynaecological) were recruited from UK hospitals. Validated observational instruments were used to measure decision-making (Metrics of Observational Decision-making, MDT-MODe), communication (Bales' Interaction Process Analysis, Bales' IPA), and case complexity (Measure of Case Discussion Complexity, MeDiC), including logistical challenges (Measure of Case Discussion Complexity, MeDiC), across 822 case discussions from 30 videoed meetings. Descriptive analysis and paired samples t tests were used to identify and compare frequency of different types of logistical challenges, along with partial correlations, controlling for clinical complexity of cases, to understand how such issues related to the MDT decision-making and communication. Results: A significantly higher frequency of administrative and process issues (affecting 30 per cent of cases) was seen compared with the frequency of equipment issues (affecting 5 per cent of cases; P < 0.001) and the frequency of the attendance issues (affecting 16 per cent of cases; P < 0.001). The frequency of the attendance issues was significantly higher than the frequency of equipment issues (P < 0.001). Partial correlation analysis revealed that administrative and process issues, including attendance, were negatively correlated with quality of information (r = -0.15, P < 0.001; r = -0.11, P < 0.001), and equipment issues with the quality of contribution to meeting discussion (r = -0.14, P < 0.001). More questioning and answering by MDT members was evident with the administrative and process issues (r = 0.21, P < 0.001; r = 0.19, P < 0.001). Some differences were observed in teams' socioemotional reactions to the administrative and process issues with the gynaecological MDT showing positive correlation with positive socioemotional reactions (r = 0.20, P < 0.001), and the breast cancer MDT with negative socioemotional reactions (r = 0.17, P < 0.001). Conclusion: Administrative and process issues were the most frequent logistical challenges for the studied teams. Where diagnostic results were unavailable, and inadequate patient details provided, the quality of decision-making was reduced. [ABSTRACT FROM AUTHOR]

Summary: Patients with acne are increasingly using sunbeds as a self treatment despite the harmful effects. Little is known about sunbed use in adult patients with acne under dermatology care. This questionnaire study explored prevalence and behaviours surrounding sunbed use in patients with acne at a UK dermatology centre. Over a quarter (26%) of respondents used sunbeds and of these, 72% used them at least weekly. Respondents using sunbeds were more likely to be older, to be female, to have a longer duration of acne diagnosis and to have previously been offered blue‐light therapy by their doctor (P < 0.05 for all) Reasons for use included recommendations from external sources (including the Internet), the perceived greater efficacy compared with physician‐prescribed treatments and that light therapy was not offered by their doctor. Nearly half (49%) of respondents were taking isotretinoin at the time of sunbed use, which carries an increased risk for photosensitivity and sunburn in this cohort. Dermatologists have a responsibility to address this gap in public awareness by directly counselling patients at risk of sunbed use, particularly for those concomitantly prescribed oral retinoid therapy. [ABSTRACT FROM AUTHOR]

Compare the surgical complexity and histological accuracy of visual inspection of disease in patients undergoing primary debulking (PDS) versus delayed debulking surgery (DDS) following neo-adjuvant chemotherapy (NACT) for advanced ovarian cancer (AOC). All patients undergoing PDS or DDS for stage III / IV AOC at a UK cancer centre between January 2014–October 2021 were included. Retrospective data was collected accessing an electronic gynaecological oncology database, operation and histology records. Comparative frequencies of surgical procedures performed were calculated for primary versus delayed cohorts; and correlation between intra-operative suspicion of disease and specimen histology at PDS and DDS compared. N=232. PDS was performed in 45.3% and DDS in 54.7% of patients; achieving complete cytoreduction in 77.2%. Appendicectomy, pelvic and para-aortic nodal dissection were undertaken significantly more often at primary surgery; whilst right diaphragm stripping, pelvic peritonectomy, splenectomy and cholecystectomy were more likely following NACT. We found no variation in bowel resection rates between cohorts. For the majority of specimens, there was no difference in correlation between intra-operative suspicion of disease and final histopathology – with a significantly lower positive predictive value for visual assessment demonstrated only for liver capsule and pelvic peritoneum at DDS. NACT does not appear to reduce the complexity of surgery, including rates of bowel resection; nor accuracy of intra-operative visual assessment of disease. We therefore caution against both deferring to NACT to facilitate less radical delayed debulking; and any presumption that macroscopically abnormal tissue at DDS may represent inert post-NACT 'burn-out', mitigating indication for excision. We instead suggest reservation of the neo-adjuvant pathway for patients with poor PS and radiologically-confirmed surgical stopping points; and advocate equivalent and maximal cytoreductive effort to remove all visibly abnormal tissue in both the upfront and delayed surgical settings. [ABSTRACT FROM AUTHOR]

Background: Cardiopulmonary exercise testing (CPET) is an exercise stress test with concomitant expired gas analysis that provides an objective, non-invasive measure of functional capacity under stress. CPET-derived variables predict postoperative morbidity and mortality after major abdominal and thoracic surgery. Two previous surveys have reported increasing utilisation of CPET preoperatively in England. We aimed to evaluate current CPET practice in the UK, to identify who performs CPET, how it is performed, how the data generated are used and the funding models. Methods: All anaesthetic departments in trusts with adult elective surgery in the UK were contacted by telephone to obtain contacts for their pre-assessment and CPET service leads. An online survey was sent to all leads between November 2016 and March 2017. Results: The response rate to the online survey was 73.1% (144/197) with 68.1% (98/144) reporting an established clinical service and 3.5% (5/144) setting up a service. Approximately 30,000 tests are performed a year with 93.0% (80/86) using cycle ergometry. Colorectal surgical patients are the most frequently tested (89.5%, 77/86). The majority of tests are performed and interpreted by anaesthetists. There is variability in the methods of interpretation and reporting of CPET and limited external validation of results. Conclusions: This survey has identified the continued expansion of perioperative CPET services in the UK which have doubled since 2011. The vast majority of CPET tests are performed and reported by anaesthetists. It has highlighted variation in practice and a lack of standardised reporting implying a need for practice guidelines and standardised training to ensure high-quality data to inform perioperative decision making. [ABSTRACT FROM AUTHOR]

Objectives: Cardiophrenic lymph node (CPLN) involvement represents stage IVB ovarian cancer. Driven by the prognostic importance of complete cytoreduction, the surgical practice has evolved to increasingly incorporate CPLN dissection as a component of ultraradical debulking for advanced disease. We aimed to evaluate the reliability of preoperative imaging in accurately identifying positive CPLN - and hence those patients for whom removal may confer benefit. Methods: Preoperative CT imaging was retrospectively reviewed for all patients undergoing either primary (PDS) or delayed debulking surgery (DDS) for stage III or IV tubo-ovarian / primary peritoneal carcinoma in a UK cancer center between 2017-2020. CPLN measuring >5 millimeters - or those with abnormal morphology (irregular border / absent fatty hilum / heterogeneous internal attenuation) - were deemed radiologically suspicious. For patients within this 'node-positive' cohort, histology for those having undergone CPLN dissection was also reviewed, and the correlation between imaging and final pathology was analyzed. Results: A total of 141 patients undergoing either PDS or DDS for advanced tubo-ovarian or primary peritoneal cancer were identified. On review of preoperative CT, 60 patients (42.6%) were deemed to have radiologically involved CPLN. Of these, 13 patients had undergone CPLN dissection, with positive histopathology confirming CPLN metastases in 11/13 patients (84.6%). This equates to a positive predictive value (PPV) for CT in identifying this disease entity of 0.846, with no significant difference seen in the context of PDS versus DDS. Conclusions: While our patient numbers are limited, reflecting the introduction of this evolving surgical technique to our center during the timeframe reviewed, our data suggest that preoperative CT is an accurate predictor of CPLN disease in advanced tubo-ovarian / primary peritoneal malignancy in advance of both PDS and DDS and can be reliably used to guide patient selection for CPLN dissection. [ABSTRACT FROM AUTHOR]

Background: Ovarian cancer is the second most common cancer of the female genital tract in the United Kingdom (UK), accounting for 6% of female deaths due to cancer. This cancer is associated with poor survival and there is a need for new treatments in addition to existing chemotherapy to improve survival. Potassium (K+) channels have been shown to be overexpressed in various cancers where they appear to play a role in cell proliferation and progression. Objectives: To determine the expression of the potassium channels Eag and HERG in ovarian cancer tissue and to assess their role in cell proliferation. Methods: The expression of Eag and HERG potassium channels was examined in an ovarian cancer tissue microarray. Their role in cell proliferation was investigated by blocking voltage-gated potassium channels in an ovarian cancer cell line (SK-OV-3). Results: We show for the first time that high expression of Eag channels in ovarian cancer patients is significantly associated with poor survival (P = 0.016) unlike HERG channel expression where there was no correlation with survival. There was also a significant association of Eag staining with high tumour grade (P = 0.014) and presence of residual disease (P = 0.011). Proliferation of SK-OV-3 cells was significantly (P < 0.001) inhibited after treatment with voltage gated K+ channel blockers. Conclusion: This novel finding demonstrates a role for Eag as a prognostic marker for survival in patients with ovarian cancer. [ABSTRACT FROM AUTHOR]

There has been considerable investment in efforts to improve postoperative pain management, including the introduction of acute pain teams. There have also been a number of guidelines published on postoperative pain management and there is widespread agreement on how pain should be practically managed. Despite these advances, there is no apparent improvement in the number of patients experiencing moderately severe or extreme pain after surgery. This highlights significant scope for improvement in acute postoperative pain management. In January 2009, a multidisciplinary UK expert panel met to define and agree a practical framework to encourage implementation of the numerous guidelines and fundamentals of pain management at a local level. The panel recognised that to do this, there was a need to organise the information and guidelines into a simplified, accessible and easy-to-implement system based on their practical clinical experience. Given the volume of literature in this area, the Chair recommended that key international guidelines from professional bodies should be distributed and then reviewed during the meeting to form the basis of the framework. Consensus was reached by unanimous agreement of all ten participants. This report provides a framework for the key themes, including consensus recommendations based upon practical experience agreed during the meeting, with the aim of consolidating the key guidelines to provide a fundamental framework which is simple to teach and implement in all areas. Key priorities that emerged were: Responsibility, Anticipation, Discussion, Assessment and Response. This formed the basis of RADAR, a novel framework to help pain specialists educate the wider care team on understanding and prioritising the management of acute pain. Acute postoperative pain can be more effectively managed if it is prioritised and anticipated by a well-informed care team who are educated with regard to appropriate analgesic options and understand what the long-term benefits of pain relief are. The principles of RADAR provide structure to help with training and implementation of good practice, to achieve effective postoperative pain management. [ABSTRACT FROM AUTHOR]

Any analysis of money in late nineteenth-century Britain has been handicapped to some extent by deficiencies in the available data. We believe we have now remedied many of the deficiencies and can therefore proceed with greater confidence to an investigation of the monetary sector. In this paper we explore the money adjustment process, drawing on the monetary data base that we have built and using recently developed econometric techniques.
This paper is organized as follows. In the first brief section an outline of the data used is provided. That is followed by a section on the money adjustment process, which gives the estimation technique used and subjects the obtained specification to a variety of diagnostic tests. We then present our results on interest and income elasticities and our thoughts on the unsettled issue of the stability of the demand for money. [ABSTRACT FROM AUTHOR]

• The duration of follow-up for conservatively treated microinvasive surgical cancer is varied. • 98 patients with microinvasive cervical cancer who underwent conservative surgery were follow-up with 510 smears over approximately 11 years. • There were no recurrent cancers detected and only 2 smears showing high grade dyskaryosis. • Reducing the intensity of follow-up should be considered. To assess the follow-up smears and their outcomes of patients with conservatively managed early-stage cervical cancer as per UK guidelines within our service. To evaluate whether intensive follow-up can detect pre-cancer early compared to the standard 3 yearly follow-up. Retrospective review. All patients treated for early stage (stage 1A1 and 1A2) with cervical cancer from 01/2002 to 01/2020 at University Hospitals of Derby and Burton were included. Patients who had initial hysterectomy were excluded from our analysis. Review conducted using electronic patient records for treatment, histology, and follow-up smears. Number of abnormal follow-up smears and number of recurrent cervical cancers were considered the main outcome measures. 98 cases were identified. 81 (82.65 %) were stage 1A1 and 17 (17.35 %) were stage 1A2. 74 (75.51 %) patients had squamous histology and 24 (24.49 %) had adenocarcinomas. Median follow-up was 11.08 years (4043 days). 510 follow-up smears were performed, of which 33 (6.47 %) were abnormal. 5 of these abnormal smears showed low grade dyskaryosis (0.98 %) and 2 smears showed high grade dyskaryosis (0.39 %). The positive predictive value of follow-up smears to detect pre-cancerous changes was 5.71 %. There were no recurrent cancers detected. Microinvasive cervical cancer is effectively managed with conservative surgery. There were no recurrent cancers detected in our cohort during follow-up and there were only 2 high grade dyskaryoses detected (n = 2/510, 0.39 %). We therefore believe that reducing the intensity of follow up of these patients should be considered. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented about the plight of doctors in taking a series of examinations to prove themselves to practice in Great Britain.