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Background A widely accepted set of imaging criteria or classification has not yet been adopted to evaluate response to treatment by percutaneous sclerotherapy for aneurysmal bone cyst (ABC). In this article, we described and illustrated the Royal Orthopaedic Hospital (ROH) scoring system which is a new, reproducible, and objective tool to evaluate the radiological response. We also reported our institutional experience in the efficacy of computed tomography (CT)-guided sclerotherapy for treating such lesions.

Variant calling is fundamental in bacterial genomics, underpinning the identification of disease transmission clusters, the construction of phylogenetic trees, and antimicrobial resistance detection. This study presents a comprehensive benchmarking of variant calling accuracy in bacterial genomes using Oxford Nanopore Technologies (ONT) sequencing data. We evaluated three ONT basecalling models and both simplex (single-strand) and duplex (dual-strand) read types across 14 diverse bacterial species. Our findings reveal that deep learning-based variant callers, particularly Clair3 and DeepVariant, significantly outperform traditional methods and even exceed the accuracy of Illumina sequencing, especially when applied to ONT’s super-high accuracy model. ONT’s superior performance is attributed to its ability to overcome Illumina’s errors, which often arise from difficulties in aligning reads in repetitive and variant-dense genomic regions. Moreover, the use of high-performing variant callers with ONT’s super-high accuracy data mitigates ONT’s traditional errors in homopolymers. We also investigated the impact of read depth on variant calling, demonstrating that 10× depth of ONT super-accuracy data can achieve precision and recall comparable to, or better than, full-depth Illumina sequencing. These results underscore the potential of ONT sequencing, combined with advanced variant calling algorithms, to replace traditional short-read sequencing methods in bacterial genomics, particularly in resource-limited settings.

ABSTRACTThis study explores the perceived influence of social media on psychological wellbeing in young people living with type 1 diabetes. Young people aged 13–20 years (N = 19) with type 1 diabetes and caregivers (diabetes healthcare providers and parents) (N = 8) took part in an online focus group or interview. Thematic analysis was used to analyse the data. Participants reflected on social media’s capacity to facilitate accessible peer learning and emotional support. Themes for young people centred on the emotional demand of perceiving diabetes products/diets, stigma, and ‘filtered’ peer profiles. Caregiver themes centred on the accuracy and trustworthiness of diabetes content. Caregivers perceive that young people find it difficult to be open about their condition online. Young people with type 1 diabetes reflected on how social media enables them to control their experience. Findings reflect the paradoxical nature of social media as a diabetes support aid, and practical implications of this are discussed.

As power systems adopt greater levels of asynchronous generation, operators increasingly need to accurately monitor and manage their systems. With inverter-based generation progressively displacing traditional synchronous generators, power systems generally experience increased rate of change of grid frequency and wider propagation of voltage disturbances after a network contingency event. Inverter-based resources are now being leveraged to mitigate larger frequency disturbances, by delivering fast frequency control ancillary services. For this to be effective, accurate and robust, fast and fault-tolerant grid frequency measurements are needed. Commonly deployed frequency measurement techniques are susceptible to significant measurement error when exposed to unbalanced faults and frequency deviations. More robust techniques for measuring frequency are thus needed. This paper describes in detail a measurement strategy that extracts the continuous phase angle of the positive phase sequence phasor, from voltage signals. The method is demonstrated to provide robust measurements in the presence of simultaneously and rapidly varying voltage and frequency. From real-world measurements, using the Tasmanian power system as a case-study, the method is shown to be equivalent to or outperform measurement devices currently deployed in power systems. This paper provides all necessary control block diagrams required for integration into various modelling packages and frequency measurement devices.

Background The purpose of this study is to explore the professional and personal experiences of multidisciplinary healthcare professionals during and following diabetes counselling and empowerment-based education. Methods Everyone who had participated in a diabetes counselling and empowerment course between 2008-2016 was invited to respond to an online survey and follow-up telephone interview if willing. Interviews were recorded and transcribed verbatim. The research team used interpretative phenomenology to identify core themes from both the survey and telephone interviews and which captured the impact of empowerment-based education. Results 22 doctors, nurses, dieticians, and psychologists completed an online questionnaire. 10 subsequently took part in telephone interviews. Empowerment-based education changed them from fixers to facilitators. Their transformation included a sense of becoming authentic, ‘being the way I want to be’ in clinical practice and becoming more self-reflective. This affected them personally as well as reinvigorating them professionally. Conclusions The participants described a personal and professional journey of transformation that included discovering their person-centred philosophy. They adopted a consultation structure that empowered people with diabetes to care for themselves. It can be speculated that participants’ experience of transformation may also guard against professional burnout.

Coated fuel particles, most commonly tri-structural isotropic (TRISO), are intended for application in several designs of advanced nuclear reactors. A complete understanding of the residual stresses and local properties of these particles through their entire lifecycle is required to inform fuel element manufacturing, reactor operation, accident scenarios, and reprocessing. However, there is very little experimental data available in the literature on the magnitude of residual stresses in the individual coating layers of these particles. This work applies ring-core focussed ion beam milling combined with digital image correlation analysis (FIB-DIC) to cross-sections of TRISO and pyrolytic carbon coatings in surrogate coated fuel particles to evaluate the residual stresses. Tensile residual hoop stresses are identified in both pyrolytic carbon layers, while silicon carbide experiences a compressive residual hoop stress. Note that these residual stresses, which were not accounted for in the models reported in open literature, have magnitudes comparable to the stresses predicted to arise in real fuel particles during service. A 2D linear-elastic continuum-based finite element analysis has been conducted to investigate the stress relaxation phenomena caused by sectioning stressed coatings on spherical particles. The FIB-DIC method established here is independent of radiation defects and can be applied to irradiated TRISO particles to retrieve first-hand information regarding the residual stress evolution during service.

Objectives: A Rapid Realist Review of social prescribing in Higher Education (HE) was undertaken to determine what works, for whom, how, why, and within what circumstances. The review resulted in the development of a Realist Programme Theory articulating the way in which social prescribing can be implemented within the HE environment.Methods: Searches of 12 electronic databases were supplemented by citation chaining and grey literature surfaced by the Project Advisory Group. The RAMESES Quality Standards for Realist Review were followed, and the retrieved articles were systematically screened and iteratively analysed to develop Context-Mechanism-Outcome Configurations (CMOCs) and an overarching Realist Programme Theory.Results: A total of 57 documents were included. The overarching programme theory was developed from the analysis of these documents and comprised of a social prescribing pathway with the following components: (1) An Accessible Gateway, (2) A Skilled Peer, (3) Trusted-Safe-Credible Resources, and (4) A Healthy Setting.Conclusion: A Realist Programme Theory was developed—this model and associated principles will provide a theoretical basis for the implementation of social prescribing pathways within higher education. Whilst the direct project outputs are of particular significance to the UK HE audience, the underpinning principles can support practice within the global arena.

Introduction. Labral tears (LT) can present with hip or groin pain. Investigation of LT is typically with Magnetic Resonance Arthrography (MRA). The injection of contrast for MRA can lead to fluid signal intensity/oedema on fluid sensitive sequences within the iliopsoas muscle and tendon complex masking the diagnosis of iliopsoas tendinopathy, which may present with similar symptoms. The aim of this study was to identify the presence of iliopsoas oedema in young adult patients being investigated for LT. Material and methods. We performed a retrospective search of our radiology system for the word ‘labral tear’ in the reports of patients who had MRI between 2012 to 2018. Patients under the age of 40 years who underwent high resolution dedicated hip MRI were included in our study. From this database, we then used a keyword search ‘strain and (o)edema’ to identify cases of iliopsoas pathology and analysed the results. Results. We identified 1151 consecutive cases of high resolution hip MRI with a suspected labral tear. 503 patients under the age of 40 years were included in our study with the average age of 27 years. Of the 503 patients within our cohort, searching for the word ‘strain’ identified 48 (9.5%) cases. Of these, 26 (5.3%) patients had iliopsoas oedema with a labral tear. 22 (4.4%) patients had iliopsoas oedema without a labral tear. Conclusion. Our study shows that 4.4% of patients undergoing MRA have no labral tears but iliopsoas oedema. Patients should undergo MRI to exclude iliopsoas strains before MRA.

Antibiotic resistance is driven by selection, but the degree to which a bacterial strain’s evolutionary history shapes the mechanism and strength of resistance remains an open question. Here, we reconstruct the genetic and evolutionary mechanisms of carbapenem resistance in a clinical isolate of Klebsiella quasipneumoniae. A combination of short- and long-read sequencing, machine learning, and genetic and enzymatic analyses established that this carbapenem-resistant strain carries no carbapenemase-encoding genes. Genetic reconstruction of the resistance phenotype confirmed that two distinct genetic loci are necessary in order for the strain to acquire carbapenem resistance. Experimental evolution of the carbapenem-resistant strains in growth conditions without the antibiotic revealed that both loci confer a significant cost and are readily lost by de novo mutations resulting in the rapid evolution of a carbapenem-sensitive phenotype. To explain how carbapenem resistance evolves via multiple, low-fitness single-locus intermediates, we hypothesised that one of these loci had previously conferred adaptation to another antibiotic. Fitness assays in a range of drug concentrations show how selection in the antibiotic ceftazidime can select for one gene (blaDHA-1) potentiating the evolution of carbapenem resistance by a single mutation in a second gene (ompK36). These results show how a patient’s treatment history might shape the evolution of antibiotic resistance and could explain the genetic basis of carbapenem-resistance found in many enteric-pathogens.

Background: Total talus replacements are a surgical treatment for talar avascular necrosis (AVN) replacing the entire talus. The potential for total talus replacements has increased with the advent of patient-specific implants using 3D printing based on computed tomographic scanning of the ipsilateral or contralateral talus. The primary aim of this review is to summarize the literature on total talus replacements, providing a historical survey, indications, controversies, complications, survival, and functional outcomes. Methods: A systematic review was performed. Articles with survival of total talus replacements were included. Basic percentages and a critical review of the literature was performed. Results: Nine articles with 115 patients were included. The mean age ranged from 27.6 to 72 years, but with 5 studies having a mean age of

Background: Breast cancer incidence increases with age and real-world data is essential to guide prescribing practices in the older population. The aim of this study was to collect large scale real-world data on tolerability and efficacy of palbociclib + AI in the first line treatment of ER+/HER2-advanced breast cancer in those aged ≥75 years. Methods: 14 cancer centres participated in this national UK retrospective study. Patients aged ≥75 years treated with palbociclib + AI in the first line setting were identified. Data included baseline demographics, disease characteristics, toxicities, dose reductions and delays, treatment response and survival data. Multivariable Cox regression was used to assess independent predictors of PFS, OS and toxicities. Results: 276 patients met the eligibility criteria. The incidence of febrile neutropenia was low (2.2%). The clinical benefit rate was 87%. 50.7% of patients had dose reductions and 59.3% had dose delays. The 12- and 24- month PFS rates were 75.9% and 64.9%, respectively. The 12- and 24- month OS rates were 85.1% and 74.0%, respectively. Multivariable analysis identified PS, Age-adjusted Charlson Comorbidity Index (ACCI) and number of metastatic sites to be independent predictors of PFS. Dose reductions and delays were not associated with adverse survival outcomes. Baseline ACCI was an independent predictor of development and severity of neutropenia. Conclusion: Palbociclib is an effective therapy in the real-world older population and is well-tolerated with low levels of clinically significant toxicities. The use of geriatric and frailty assessments can help guide decision making in these patients.

Objectives Early recognition of chronic kidney disease (CKD) should be achieved by every modern healthcare system. The objective of this study was to investigate CKD risk factor trends in England using general practice level data.Design Observational analysis of data at practice level for all general practices in England. Practice characteristics identified as potential CKD risk factors included comorbidities and local demography. Data were analysed using both univariate and multivariate analysis to identify significant factors that were associated with CKD diagnosis for the period 1 April 2019 to 31 March 2020.Setting Publicly available data from UK primary care sources including Primary Care Quality and Outcomes Framework database, practice-level prescribing data from the British National Formulary and Public Health England health outcome data.Participants All data submitted from 6471 medium to large practices in England were included (over 46 million patients).Risk factor analysis Potential risk factors were grouped into four classes based on existing literature: demographic factors, comorbidities, service and practice outcome factors, and prescribing data effects.Results The original model’s prediction of CKD improved from r2 0.38 to an r2 of 0.66 when updated factors were included. Positive associations included known risk factors with higher relative risk such as hypertension and diabetes, along with less recognised factors such as depression and use of opiates. Negative associations included NSAIDs which are traditionally associated with increased CKD risk, and prescribing of antibiotics, along with more northerly locations.Conclusions CKD is a preventable disease with high costs and consequences. These data and novel analysis give clearer relative risk values for different patient characteristics with some unexpected findings such as potential harmful association between CKD and opiates, and a more benign association with NSAIDs. A deeper understanding of CKD risk factors is important to update and implement local and national management strategies. Further research is required to establish the causal nature of these associations and to refine location appropriate actions to minimise harm from CKD on regional and local levels.

Osteoid osteomas are mostly solitary. We report a case of metachronous osteoid osteoma of mid-diaphysis of fibula followed by distal humeral osteoid osteoma after a 7-year interval.

Category: Ankle Arthritis Introduction/Purpose: Total talus replacements have been proposed as a method to treat talar AVN replacing the entire talus. The potential for total talar replacements has increased with the advent of patient specific implants utilising 3D printing based on CT scanning of the ipsilateral or contralateral talus. The primary aim of this systematic review is to analyse the current literature on total talus replacements. It specifically aims to look at the indications, complications, survival and functional outcomes. Methods: A systematic review was undertaken including all levels of evidence and following PRISMA guidelines. Basic percentages and a weighted pooled proportion for failures using the Freeman Tukey double arscine transformation were performed. Results: 9 papers with 151 patients were included. The mean age ranged from 27.6 to 72, with 5 papers having a mean age of less than 50. Mean follow-up ranged from 12.8 to 58 months. The most common indication was avascular necrosis in 103 patients.4 studies used 3D printing and 5 customised implants. 3 studies undertook a talus replacement with an ankle replacement. 4 studies used ceramic prostheses, 3 cobalt chromium 1 stainless steel and 1 titanium with ceramic surface. Post-operative complications ranged from 0 to 33%. 69.6% of 23 functional outcomes scores demonstrated significant improvement in functional scores with the others demonstrating a non-significant improvement.3 of 151 implants failed requiring further surgery with 2 revisions and 1 amputation. 6 of the 8 studies did not report any operations for failure. The cumulative incidence of failure was 0.1 % (95% CI 0.0- 4.9%). Conclusion: Total talus replacements are a potential alternative to tibiotalocalcaneal fusion for patients with avascular necrosis of the talus. Further studies are required to ensure good outcomes prior to an increase in use of this prosthesis.

Magnetic resonance imaging has continued to evolve over the recent decades, in part, due to the evolution of gadolinium-based contrast agents and their use. These were initially thought to have a relatively low-risk profile. However, there is mounting evidence that trace amounts of gadolinium are retained within the body. To ascertain the current use of gadolinium in medical practice, we performed a survey of musculoskeletal radiologists, within the United Kingdom, Europe and India. The survey demonstrated varied practices amongst all radiologists with relatively indiscriminate use of gadolinium. In this review, we discuss the current evidence for and against the use of gadolinium in musculoskeletal magnetic resonance imaging.

Osteoid osteoma (OO) is a benign bone forming tumor characterized by small size and a disproportionate amount of pain. They are most commonly seen between the ages of 5 and 30 years; however, they can be seen in the older patient albeit infrequently. The hands and feet are the least common site of OO among the extremity bones. We present a case of an OO in the hand of a 77-year-old man who underwent successful treatment with computed tomography–guided percutaneous radiofrequency ablation. We believe this is the oldest recorded patient in the medical literature with a histologically confirmed OO. The condition should therefore be considered in the differential diagnosis of a painful sclerotic bone lesion in this age group to avoid a delay in diagnosis and subsequent treatment.

Objective The evidence base for social prescribing is inconclusive, and evaluations have been criticised for lacking rigour. This realist review sought to understand how and why social prescribing evaluations work or do not work. Findings from this review will contribute to the development of an evidence-based evaluation framework and reporting standards for social prescribing.Design A realist review.Data sources ASSIA, CINAHL, Embase, Medline, PsycINFO, PubMed, Scopus Online, Social Care Online, Web of Science and grey literature.Eligibility criteria Documents reporting on social prescribing evaluations using any methods, published between 1998 and 2020 were included. Documents not reporting findings or lacking detail on methods for data collection and outcomes were excluded.Analysis Included documents were segregated into subcases based on methodology. Data relating to context, mechanisms and outcomes and the programme theory were extracted and context-mechanism-outcome configurations were developed. Meta-inferences were drawn from all subcases to refine the programme theory.Results 83 documents contributed to analysis. Generally, studies lacked in-depth descriptions of the methods and evaluation processes employed. A cyclical process of social prescribing evaluation was identified, involving preparation, conducting the study and interpretation. The analysis found that coproduction, alignment, research agency, sequential mixed-methods design and integration of findings all contributed to the development of an acceptable, high-quality social prescribing evaluation design. Context-mechanism-outcome configurations relating to these themes are reported.Conclusions To develop the social prescribing evidence base and address gaps in our knowledge about the impact of social prescribing and how it works, evaluations must be high quality and acceptable to stakeholders. Development of an evaluation framework and reporting standards drawing on the findings of this realist review will support this aim.PROSPERO registration number CRD42020183065.

Introduction UK higher education (HE) student numbers are increasing and students report higher levels of mental health and well-being issues. Social prescribing links individuals to community-based, non-medical support. It is widely implemented throughout the UK, and is supported by the Welsh Government. This protocol presents an evaluation of a new social prescribing service to enhance student well-being, a first for UK HE students.Methods and analysis A realist evaluation to articulate why, how and to what extent and circumstances social prescribing works for students, using a mixed-methods sequential design of four cycles. Cycle 1 informs the model and programme theory development of how the model works; activities include a Realist Review, Group Concept Mapping and producing bilingual short films about the evaluation and model. Cycle 2 involves secondary analysis of routine service data, and outcome measurements from students receiving a social prescription. Cycle 3 uses reflective diaries and qualitative realist interviews with stakeholders to understand the process and outcome of the model. Cycle 4 concludes with a world café workshop with stakeholders to agree and finalise the framework specification of ‘how, why, when and to what extent’ the model works. A meta-matrix construction will determine convergence, complementarity or discrepancy across the cycles. An advisory group of key stakeholders informs each cycle.Ethics and dissemination University of South Wales Life Sciences and Education Ethics Committee and Wrexham Glyndwr University (WGU) Research Ethics Sub-Committee approved secondary data analysis of participant demographics (200 805LRL:USW, id441:WGU), outcome measurement tools (200 902LR:USW, id441:WGU) and qualitative data collection (200 804LR:USW, id449:WGU). The authors will publish findings in peer-reviewed journals, produce an evaluation report to the funder and a short film for dissemination via stakeholders, university networks, United Nations Regional Centre of Expertise in Wales, PRIME Centre Wales, Wales School for Social Prescribing Research, conferences and social media.

Introduction: Weber A ankle fractures are isolated fibula fractures distal to the level of the ankle joint line. They are regarded as stable injuries that usually heal successfully without intervention. We have identified several patients that have developed symptomatic atrophic non-union of transverse Weber A fractures that are not simple avulsion fractures of the anterior talo-fibular ligament. We explored variations to the blood supply of the distal fibula as a potential cause of this rare complication. Cases: Five patients presented with ongoing ankle pain following a period of non-operative management. All shared a similar transverse atrophic non-union fracture pattern.Surgical management with open reduction and internal fixation with or without the use of bone graft achieved successful union and resolution of symptoms in all cases. Conclusions: Atrophic fracture non-unions usually result from a disruption to the blood supply at the site of injury. The arterial supply to the distal fibula consists of a complex of arterial loops which usually enable fracture healing. However, there are anatomical variations to the blood supply that potentially could account for the rare outcome of non-union of Weber A fracture patterns. Weber A fractures are generally benign ankle fractures that heal well with non-operative treatment. No alterations should be made to the management of such injuries, but patients should be counselled about the risk of a symptomatic non-union outcome.

Background Lithium is viewed as the first-line long-term treatment for prevention of relapse in people with bipolar disorder. Aims This study examined factors associated with the likelihood of maintaining serum lithium levels within the recommended range and explored whether the monitoring interval could be extended in some cases. Method We included 46 555 lithium rest requests in 3371 individuals over 7 years from three UK centres. Using lithium results in four categories (

Objectives Post-traumatic stress disorder (PTSD) is commonly experienced in the aftermath of major incidents such as terrorism and pandemics. Well-established principles of response include effective and scalable treatment for individuals affected by PTSD. In England, such responses have combined proactive outreach, screening and evidence-based interventions (a ‘screen-and-treat’ approach), but little is known about its cost-effectiveness. The objective of this paper is to report the first systematic attempt to assess the cost-effectiveness of this approach.Methods A decision modelling analysis was undertaken to estimate the costs per quality-adjusted life-year (QALY) gained from a screen-and-treat approach compared with treatment-as-usual, the latter involving identification of PTSD by general practitioners and referral to psychological therapy services. Model input variables were drawn from relevant empirical studies in the context of terrorism and the unit costs of health and social care in England. The model was run over a 5-year time horizon for a hypothetical cohort of 1000 exposed adults from the perspective of the National Health Service and Personal Social Services in England.Results The incremental cost per QALY gained was £7931. This would be considered cost-effective 88% of the time at a willingness-to-pay threshold of £20 000 per QALY gained, the threshold associated with the National Institute for Health and Care Excellence in England. Sensitivity analysis confirmed this result was robust.Conclusions A screen-and-treat approach for identifying and treating PTSD in adults following terrorist attacks appears cost-effective in England compared with treatment-as-usual through conventional primary care routes. Although this finding was in the context of terrorism, the implications might be translatable into other major incident-related scenarios including the current COVID-19 pandemic.

The recently-established Goldsmiths Prize, rewards ‘creative daring [and] fiction that breaks the mould or extends the possibilities of the novel form’. The prize’s existence suggests a resurgence in the interest in questions of formal novelty, the prestige of which has historically fluctuated in the U.K. Several recently shortlisted novels have broached the topic of contemporary communications technologies and their relationship to narrative and self-definition, while deploying stylistic devices which encourage readers to associate formal experimentation with these themes. In a societal context in which human individuality is seemingly being undermined by technology, it seems pertinent to investigate the ways in which the ‘experimental’ novel can represent character and thought while possibly providing answers to the question of their potentially frightening uniformization.

Two types of dedicated Tristructural isotropic (TRISO) nuclear fuel particles, PyC-1 (Kernel/Buffer/PyC) and PyC-2 (Kernel/Buffer/SiC/PyC) from PYCASSO (Pyrocarbon irradiation for creep and swelling/shrinkage of objects) neutron irradiation experiments, were studied. For unirradiated particles, crushing experiments using a unique hot cell, combined with in situ X-ray computed micro-tomography (XCT) imaging, were conducted at room temperature (RT) and at 1000 °C. Although the SiC layer on the particles is presumed to provide ‘mechanical stability’ to the TRISO particles, results showed a remarkable reduction (~45%) in the crushing strength of the PyC-2 particles at 1000 °C compared to RT. The fracture patterns of the two types of particles, both at the contact zone and on subsequent propagation, differ significantly at RT and 1000 °C. Further, irradiated particles (irradiation temperature: 1000 ± 20 °C; irradiation doses: 1.08–1.23 dpa and 1.49–1.51 dpa) were imaged by XCT; 250 PyC-1 particles and 223 PyC-2 particles were studied in total and the change in radius/layer thickness in each type was examined. It was found that the buffer densification was lower in PyC-1 particles compared to PyC-2 particles, and the PyC layer shrank in the PyC-I particles, whereas it expanded in PyC-2. Results are discussed in terms of how the residual stresses can impact the high-temperature and post-irradiation behavior of these particles. Keywords: TRISO, PYCASSO, High-temperature X-ray computed micro-tomography, Irradiation induced dimensional change, Uniaxial compression, Contact crushing

Objective Evaluate relative clinical effectiveness of treatment options for type 2 diabetes mellitus (T2DM) using a statistical model of real-world evidence within UK general practitioner practices (GPP), to quantify the opportunities for diabetes care performance improvement.Method From the National Diabetes Audit in 2015–2016 and 2016–2017, GPP target glycaemic control (TGC—%HbA1c ≤58 mmol/mol) and higher glycaemic risk (HGR —%HbA1c results >86 mmol/mol) outcomes were linked using multivariate linear regression to prescribing, demographics and practice service indicators. This was carried out both cross-sectionally (XS) (within year) and longitudinally (Lo) (across years) on 35 indicators. Standardised β coefficients were used to show relative level of impact of each factor. Improvement opportunity was calculated as impact on TGC & HGR numbers.Results Values from 6525 GPP with 2.7 million T2DM individuals were included. The cross-sectional model accounted for up to 28% TGC variance and 35% HGR variance, and the longitudinal model accounted for up to 9% TGC and 17% HGR variance. Practice service indicators including % achieving routine checks/blood pressure/cholesterol control targets were positively correlated, while demographic indicators including % younger age/social deprivation/white ethnicity were negatively correlated. The β values for selected molecules are shown as (increased TGC; decreased HGR), canagliflozin (XS 0.07;0.145/Lo 0.04;0.07), metformin (XS 0.12;0.04/Lo –;–), sitagliptin (XS 0.06;0.02/Lo 0.10;0.06), empagliflozin (XS–;0.07/Lo 0.09;0.07), dapagliflozin (XS –;0.04/Lo –;0.4), sulphonylurea (XS −0.18;−0.12/Lo–;–) and insulin (XS−0.14;0.02/ Lo−0.09;–). Moving all GPP prescribing and interventions to the equivalent of the top performing decile of GPP could result in total patients in TGC increasing from 1.90 million to 2.14 million, and total HGR falling from 191 000 to 123 000.Conclusions GPP using more legacy therapies such as sulphonylurea/insulin demonstrate poorer outcomes, while those applying holistic patient management/use of newer molecules demonstrate improved glycaemic outcomes. If all GPP moved service levels/prescribing to those of the top decile, both TGC/HGR could be substantially improved.

It is known that in many cases a combination of drugs is more effective than single-drug treatments both for reducing toxicity and increasing efficacy. With the advent of organoid screens, personalised medicine has become possible for many diseases. Automated pipetting to well plates is the pharmaceutical industry standard for drug screening, but this is relatively expensive and slow. Here, a rotary microfluidic system is presented that can test all possible drug combinations at speed with the use of droplets. For large numbers of combinations, it is shown how the experimental scale is reduced by considering drug dilutions and machine learning. As an example, two cases are considered; the first is a three-ring and three radii configuration and the second is a four ring and forty-eight radii configuration. Between these two, all other cases are shown to be possible. The proposed commercial instrument is shown to be flexible, the user choosing which wells to fill and which driver-computational sub-routine to select. The major issues addressed here are the programming theory of the instrument and the reduction of droplets to be generated by drug dilutions and machine learning.

Wyndham Lewis’s 1928 novel The Childermass stages an apocalyptic voyage through an overtly fake landscape inhabited by animated simulacra and constructs a problematic narrative investigating the world-space the characters inhabit. Its questioning of suspension of disbelief is echoed in Will Self’s generically unstable Walking to Hollywood, as it interrogates the viability of narrative and representation. Both texts also contain a challenging approach towards selfhood that suggests complementary reactions to the modern technologies of the time. Lewis requires his reader to question the self’s viability, and Self engages in a burlesque reworking of Hollywood tropes whose starting point is the fracturing of this self/Self. Walking to Hollywood returns to many of Lewis’s preoccupations with multiple levels of irony and yet engages readerly interest, suggesting Lewis’s automata characters in The Childermass are open to a renewed interpretation in the context of new media forms.

ChEMBL Beaker is an open source web framework, exposing a versatile chemistry-focused API (Application Programming Interface) to support the development of new cheminformatics applications. This paper describes the current functionality offered by Beaker and outlines the future technology roadmap.

MyChEMBL is an open virtual platform which provides a free, secure, standardised and easy to use chemoinformatics environment for bioactivity data mining, machine learning, application development, learning and teaching. The main technical features of myChEMBL along with its applications and future plans are discussed here.

This study reports on the evaluation, using a phenomenological approach, of a hybrid model of PBL, implemented with a cohort of fifteen students. Semi-structured interviewing provided an interpretive basis for the lived experience of teaching and learning in the context of a Masters Degree programme designed specifically for multidisciplinary postgraduate healthcare education. The findings point towards a differentiation of attitude from behaviour and are grouped into three themes of ââ¬ËProfessionalism and the Value of Characterââ¬â¢, ââ¬ËPerceived Cognitive Development and Meaningful Learningââ¬Ë and the ââ¬ËSituatedness of Learning and Knowledge Transferââ¬â¢. àIt was perceived by students that professionalism could be learned through the process of PBL, although they did not necessarily feel familiar or comfortable when this process was new to them. They perceived the major benefit of using a hybrid PBL as a teaching strategy was that it afforded all students in the cohort a means of being valued in their contribution to the sessions and in their wider contribution to a multi-disciplinary workforce. The significant degrees to which both interprofessional learning and the adoption of a multidisciplinary approach had impacted upon student engagement were the two most salient outcomes of the study

There are over 14,000 newly diagnosed rectal cancers per year in the United Kingdom of which between 50 and 64 percent are locally advanced (T3/T4) at presentation. Pelvic exenterative surgery was first described by Brunschwig in 1948 for advanced cervical cancer, but early series reported high morbidity and mortality. This approach was later applied to advanced primary rectal carcinomas with contemporary series reporting 5-year survival rates between 32 and 66 percent and to recurrent rectal carcinoma with survival rates of 22–42%. The Swansea Pelvic Oncology Group was established in 1999 and is involved in the assessment and management of advanced pelvic malignancies referred both regionally and UK wide. This paper will set out the selection, assessment, preparation, surgery, and outcomes from pelvic exenterative surgery for locally advanced primary rectal carcinomas.

Background The purpose of this study is to explore the professional and personal experiences of multidisciplinary healthcare professionals during and following diabetes counselling and empowerment-based education. Methods Everyone who had participated in a diabetes counselling and empowerment course between 2008-2016 was invited to respond to an online survey and follow-up telephone interview if willing. Interviews were recorded and transcribed verbatim. The research team used interpretative phenomenology to identify core themes from both the survey and telephone interviews and which captured the impact of empowerment-based education. Results 22 doctors, nurses, dieticians, and psychologists completed an online questionnaire. 10 subsequently took part in telephone interviews. Empowerment-based education changed them from fixers to facilitators. Their transformation included a sense of becoming authentic, ‘being the way I want to be’ in clinical practice and becoming more self-reflective. This affected them personally as well as reinvigorating them professionally. Conclusions The participants described a personal and professional journey of transformation that included discovering their person-centred philosophy. They adopted a consultation structure that empowered people with diabetes to care for themselves. It can be speculated that participants’ experience of transformation may also guard against professional burnout.

Background: The purpose of this study is to explore the professional and personal experiences of multidisciplinary healthcare professionals during and following diabetes counselling and empowerment education. Methods: Everyone who had participated in a diabetes counselling and empowerment course between 2008-2016 was invited to respond to an online survey and follow-up telephone interview if willing. Interviews were recorded and transcribed verbatim. The research team used interpretative phenomenology to identify core themes from both the survey and telephone interviews and which captured the impact of empowerment education. Results: 22 doctors, nurses, dieticians, and psychologists completed an online questionnaire. 10 subsequently took part in telephone interviews. Empowerment education changed them from fixers to facilitators. Their transformation included a sense of becoming authentic, ‘being the way I want to be’ in clinical practice and becoming more self-reflective. This affected them personally as well as reinvigorating them professionally. Conclusions: The participants described a personal and professional journey of transformation that included discovering their person-centred philosophy. They adopted a consultation structure that empowered people with diabetes to care for themselves. It can be speculated that participants’ experience of transformation may also guard against professional burnout.