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We consider the symmetric exclusion particle system on $\mathbb{Z}$ starting from an infinite particle step configuration in which there are no particles to the right of a maximal one. We show that the scaled position $X_t/(\sigma b_t) - a_t$ of the right-most particle at time $t$ converges to a Gumbel limit law, where $b_t = \sqrt{t/\log t}$, $a_t = \log(t/(\sqrt{2\pi}\log t))$, and $\sigma$ is the standard deviation of the random walk jump probabilities. This work solves a problem left open in Arratia (1983). Moreover, to investigate the influence of the mass of particles behind the leading one, we consider initial profiles consisting of a block of $L$ particles, where $L \to \infty$ as $t \to \infty$. Gumbel limit laws, under appropriate scaling, are obtained for $X_t$ when $L$ diverges in $t$. In particular, there is a transition when $L$ is of order $b_t$, above which the displacement of $X_t$ is similar to that under a infinite particle step profile, and below which it is of order $\sqrt{t\log L}$. Proofs are based on recently developed negative dependence properties of the symmetric exclusion system. Remarks are also made on the behavior of the right-most particle starting from a step profile in asymmetric nearest-neighbor exclusion, which complement known results., Comment: 36 Pages; updated intro, fixed minor typos, added references

Percutaneous endoscopic colostomy (PEC) represents an important intervention in specific patients. Limited data currently exist. We present the largest recorded study of patients undergoing PEC.Retrospective analysis of consultant logbooks highlighted all patients from 1997 to 2020. Two independent reviewers assessed records. Parameters measured were age, sex, indication, number of sites, complications, mortality and survival. Three subgroups were identified: recurrent sigmoid volvulus (RSV), pseudo-obstruction and neurogenic. ANOVA, chi-squared and Fischer's exact tests were utilized; Kaplan-Meier curves estimated survival and the log-rank test was applied. A p value of0.05 was considered statistically significant.Ninety-six PEC insertions were done on 91 patients (five reinsertions). There were 66 men (69%) and the mean age was 73.1 years (interquartile range 23). The indications were RSV n = 72, pseudo-obstruction n = 13, neurogenic n = 11. The 30-day complication rate was overall n = 27 (28%), RSV n = 23, pseudo-obstruction n = 4. Nine patients leaked (9.9%) (eight RSV, one pseudo-obstruction), of whom five died. 90-day mortality was 14.6% (14 patients), 18.5% (13/72) for RSV, 7.7% (1/13) for pseudo-obstruction. Overall recurrence following PEC was 10.4%. The median follow-up was 25 months (interquartile range 4.6-62.2 months). At 3, 5 and 10 years survival was 46%, 34% and 26% for RSV, 70%, 55% and 15% for pseudo-obstruction and 91%, 91% and 81% for neurogenic respectively.Recurrent sigmoid volvulus and pseudo-obstruction patients undergoing PEC compared to neurogenic patients have poorer outcomes with higher complication rates and shorter life expectancy. We advocate that high volume specialist units undertake PEC. The significant associated risks of PEC require careful consideration when determining patient suitability. Utilizing risk stratification scores may help guide shared decision making between patients, relatives and clinicians.

Consider a collection of particles whose state evolution is described through a system of interacting diffusions in which each particle is driven by an independent individual source of noise and also by a small amount of noise that is common to all particles. The interaction between the particles is due to the common noise and also through the drift and diffusion coefficients that depend on the state empirical measure. We study large deviation behavior of the empirical measure process which is governed by two types of scaling, one corresponding to mean field asymptotics and the other to the Freidlin–Wentzell small noise asymptotics. Different levels of intensity of the small common noise lead to different types of large deviation behavior, and we provide a precise characterization of the various regimes. The rate functions can be interpreted as the value functions of certain stochastic control problems in which there are two types of controls; one of the controls is random and nonanticipative and arises from the aggregated contributions of the individual Brownian noises, whereas the second control is nonrandom and corresponds to the small common Brownian noise that impacts all particles. We also study large deviation behavior of interacting particle systems approximating various types of Feynman–Kac functionals. Proofs are based on stochastic control representations for exponential functionals of Brownian motions and on uniqueness results for weak solutions of stochastic differential equations associated with controlled nonlinear Markov processes

In a sea of endless stories of corporate ethical scandals, many of which are attributed to ‘failed leadership', this article examines how creative writing research is being used as a way of inspiring – or suggesting – new forms of leadership behaviour. In the processual nature of being in our lives, if experience is valued as primary to consciousness as a way of active belonging, then it will be argued that creative writing – here, scriptwriting specifically – is a powerful medium to examine organisational experiences. This research practice occurs through the lens of affect in embodied responses to such experience, as distinct from the singular, scientific mode of cognitive analysis that can cause us to habitually jump too quickly to conclusions about our experiences. By employing the affective methodology of creative practice research, which in this case forms the basis for a PhD currently in candidature, this article speculates how creative writing might disrupt habitual thinking through the elevation of emergent data from our physical senses. Creative writing can, we argue, provide a balance for science to work with art and craft, and in doing so encourage new thinking in the fields of organisational behaviour, relational leadership and creative practice research. Refereed/Peer-reviewed

Introduction Henri Albert Hartmann first described resection of the rectosigmoid colon and exteriorization of the bowel with a colostomy in 1921. As we approach the centenary anniversary of Hartmann’s procedure we feel it is the appropriate time to discuss this significant surgical advancement and its relevance in modern day surgery. Methods We provide a contemporary overview of the literature, highlighting various aspects of the Hartmann’s procedure applicable to both today’s clinical practice and that of tomorrow. Results Hartmann’s procedure was initially performed for colorectal carcinoma in 1921. One hundred years on, the Hartmann’s procedure remains a safe and effective option in select patients with colorectal cancer and at high risk of anastomotic failure. In recent years, the majority of Hartmann’s procedures have been performed for benign disease and the majority of these cases are in the emergency setting. As hospital admissions with acute diverticulitis continue to rise steeply, the importance of the Hartmann’s procedure in the field of surgery continues. Hartmann’s procedure has adapted as surgery has advanced. Hartmann’s is now performed both laparoscopically and robotically with good postoperative outcomes. Conclusions In 1921, few would have predicted how modern day medicine and surgery is today. Hartmann’s procedure has survived the surgical test of time, and its key principles remain the same. As we look to the future, it is unlikely that it’s role will be lost to surgical advances, but to alternative management modalities in disease prevention.

Introduction Gastrointestinal hamartomas are rarely encountered benign growths made of an abnormal mixture of tissues normally found in the body where the growth occurs. Most hamartomas are asymptomatic and diagnosed incidentally. Evidence regarding symptomatic hamartomas of the jejunum and ileum is limited and restricted to anecdotal case reports. We aim to provide a contemporary overview to clarify various aspects linked to symptomatic hamartomas, helping aide management and clinical decision-making. Methods The search terms ‘small bowel’, ‘small intestine’, ‘jejunum’ and ‘ileum’ were combined with ‘hamartoma’. Embase, Medline, PubMed searches and Google Scholar hand-searches were conducted. All English language papers from 1 January 2000 to 1 June 2020 were included. Results In total 39 cases were reviewed: 29 adults and 10 paediatric (0–16 years). Presenting symptoms included abdominal pain (87%), vomiting (56%), gastrointestinal bleeding (20.5%) and weight loss (5%); 36 of 39 cases (92%) presented as emergencies. Diagnostic investigations included: abdominal x-ray (49%), endoscopy (38%), computed tomography (56%), magnetic resonance imaging (5%), contrast study (15%) and video capsule endoscopy (5%). Initial management strategy was either open (30) or laparoscopic (7) surgery or endoscopy (2). All cases required surgery for definitive management. Twenty-five cases recorded hamartoma size, and mean maximum diameter was 3.56cm (1.2–8cm) with stricturing in seven cases. Nine of the 39 cases were associated with hamartomatous syndromes. Two mortalities were recorded. Conclusions This is the first published review addressing symptomatic hamartomas of the jejunum and ileum. New data relating to demographic cohort, symptom profile, investigations, management strategies, and morbidity and mortality provide greater insight to those encountering this challenging clinical finding in the future.

INTRODUCTION Meckel's diverticulum (MD) is the most common congenital malformation in the gastrointestinal tract. Limited up-to-date evidence is available regarding MD in pregnancy. We aim to review the available pertinent literature to help support clinical decision making and patient management in the future. MATERIALS AND METHODS The search term 'Meckel's diverticulum' was combined with 'pregnant' or 'pregnancy'. Database searches of EMBASE, Medline and PubMed were conducted. All papers published in English from 01/01/1990 to 01/01/2021 were included. Simple statistical analysis (t-test) was performed. RESULTS Twenty-seven cases were included. Average age = 26.9 years. Average gestation = 25.1 weeks. Occurrence: first trimester = 3.7%; second trimester = 48.1% and third trimester = 48.1%. Presenting symptoms: abdominal pain 88.9%; nausea/vomiting 59.3%; fever 18.5%; abdominal distension 18.5%; haematochezia 11.1%; constipation 11.1%; haematemesis 3.7%, diarrhoea 3.7% and asymptomatic 3.7%. Mean duration of preceding symptoms = 3.4 days. Diagnostic imaging modalities utilised: ultrasound = 40.7%; CT = 25.9%; MRI = 14.8%; abdominal X-ray = 11.1% and endoscopy = 7.4%. All cases required definite surgical management: laparotomy = 65.4%; laparoscopy = 15.4%; C-section = 19.2% and unreported = 3.8%. Main intra-operative findings: perforated MD = 40.7%; intussusception with MD as a lead point = 11.1%; bleeding MD = 11.1%, inflamed MD = 11.1%; small bowel obstruction = 11.1%; gangrenous MD = 3.7%; volvulus = 3.7% and unspecified = 7.4%. Mean length from ileocolic junction = 51.7 cm. Average length of stay was 7.1 days. T-test (p-value = 0.12) when comparing management strategy. Three maternal complications and two foetal mortalities. CONCLUSION MD and associated pathology are difficult to diagnose in the pregnant cohort. Current imaging demonstrates low diagnostic accuracy and a deviation away from recognised nuclear medicine investigations. Surgery appears the definitive management with both open and laparoscopic approaches utilised. Significant maternal morbidity and foetal mortality are associated with this condition.

BACKGROUND Appendicitis is a common surgical emergency that can be a challenging entity to manage. In the elderly, it is associated with significant morbidity and mortality. Risk prediction is not routinely performed prior to surgery. METHODS All patients aged >65 years undergoing appendicectomy over 5 years from one NHS Trust were included. Age, American Society of Anesthesiologists physical status classification system (ASA grade), Rockwood score, type of surgery, length of stay, morbidity and 90-day mortality were recorded. ACS NSQIP was retrospectively calculated. Spearman's Rank correlation coefficient and linear regression analysis were conducted, assessing correlation between ASA, Age, Rockwood Score and ACS NSQIP with length of stay and post-operative complications. RESULTS A total of 225 patient cases were reviewed. A complication rate of 29.3% was recorded, with a 6.7% serious complication rate. Two mortalities occurred. ASA, Age, Rockwood and NSQIP scoring systems all showed low degree positive correlation with length of stay (+0.16-+0.34). As predictors of length of stay, ASA was superior. Rockwood and age showed low degree positive correlation (+0.25-+0.33) with post-operative complications. NSQIP and ASA demonstrated a greater degree of correlation (+0.38-+0.40). CONCLUSION Both ASA and ACS NSQIP appear superior indicators for outcomes compared to age and Rockwood score. However, caution is warranted when interpreting the superiority of ASA over validated risk stratification tools. Therefore, we advocate the use of pre-operative risk stratification for elderly patients undergoing low-risk surgery such as appendicectomy. Validated tools are not routinely applied in many centres currently. Utilisation of scores such as ACS NSQIP may help improve consent, patient selection, outcomes and expectations.

Introduction Gastrointestinal hamartomas are rarely encountered benign growths made of an abnormal mixture of tissues normally found in the body where the growth occurs. Most hamartomas are asymptomatic and diagnosed incidentally. Evidence regarding symptomatic hamartomas of the jejunum and ileum is limited. Method The search terms ‘small bowel,’ ‘small intestine,’ ‘jejunum’ and ‘ileum’ were combined with ‘hamartoma.’ EMBASE, Medline, PubMed searches and Google Scholar hand searches were conducted. All English language papers from 01/01/2000-01/06/2020 were included. Results A total of 39 cases were reviewed, 29 adults and 10 paediatric (0-16 years). Presenting symptoms included: abdominal pain (87%), vomiting (56%), gastrointestinal bleeding (20.5%) and weight loss (5%). Stricturing was noted in 7 cases. 36/39 (92%) presented as emergencies. Diagnostic investigations included: Abdominal X-ray (49%), endoscopy (38%) and CT (56%). Initial management strategy was either open (30) or laparoscopic (7) surgery or endoscopy (2). All cases required surgery for definitive management. 9/39 cases were associated with hamartomatous syndromes. 2 mortalities were recorded. Conclusions This is the first review addressing symptomatic hamartomas of the jejunum and ileum. New data relating to demographic cohort, symptom profile, investigations, management strategies and morbidity and mortality provide greater insight to those encountering this challenging clinical finding in the future.

BackgroundNatural killer (NK) cells provide important immune protection from cancer and are a key requirement for particular immunotherapies. There is accumulating evidence that NK cells become dysfunctional during cancer. Overcoming NK cell exhaustion would be an important step to allow them to function optimally in a range of NK cell therapies, including those that depend on autologos circulating NK cells. We have previously demonstrated that NK cells undergo a normal metabolic reprogramming in response to cytokine activation and that this is required for optimal function. The objective of this work was to investigate if cellular metabolism of circulating NK cells is dysregulated in patients with metastatic breast cancer and if so, to gain insights into potential mechanisms underpinning this. Such discoveries would provide important insights into how to unleash the full activity of NK cells for maximum immunotherapy output.MethodsSingle-cell analysis, metabolic flux and confocal analysis of NK cells from patients with metastatic breast cancer and healthy controlsResultsIn addition to reduced interferon-γ production and cytotoxicity, peripheral blood NK cells from patients had clear metabolic deficits including reduced glycolysis and oxidative phosphorylation. There were also distinct morphologically alterations in the mitochondria with increased mitochondrial fragmentation observed. Transforminggrowth factor-β (TGFβ) was identified as a key driver of this phenotype as blocking its activity reversed many metabolic and functional readouts. Expression of glycoprotein-A repetitions predominant (GARP) and latency associated peptide (LAP), which are involved with a novel TGFβ processing pathway, was increased on NK cells from some patients. Blocking the GARP–TGFβ axis recapitulated the effects of TGFβ neutralization, highlighting GARP as a novel NK cell immunotherapy target for the first time.ConclusionsTGFβ contributes to metabolic dysfunction of circulating NK cells in patients with metastatic breast cancer. Blocking TGFβ and/or GARP can restore NK cell metabolism and function and is an important target for improving NK cell-based immunotherapies.

RAS oncogenes are the most commonly mutated oncogenes in human cancer, and RAS-mutant cancers represent a major burden of human disease. Though these oncogenes were discovered decades ago, recent years have seen major advances in understanding of their structure and function, including the therapeutic and prognostic significance of diverse isoforms. Targeting of these mutations has proven difficult, despite some successes with inhibition of RAS effector signalling. More recently, direct RAS inhibition has been achieved in a trial setting. While this has yet to be translated to everyday clinical practice, this development carries much promise. This review summarizes the diverse approaches that have been taken to RAS inhibition and then focuses on the most recent developments in direct inhibition of KRAS(G12C).

A 74-year-old man presented with acute small bowel obstruction secondary to recurrence of a caecal tumour. The patient underwent laparotomy and formation of loop ileostomy and had a nasogastric tube (NGT) inserted in the theatre. A decision was made to remove the patient’s NGT postoperatively, which was found to be stuck. High-quality imaging demonstrated a knot in the tube within the nasopharynx; so, subsequent removal via the oral route necessitated sedation. This case highlights the importance of considering rare or unusual complications of NGT insertion when a patient describes more pain or discomfort than would otherwise be expected. The clarity of imaging highlights clearly the underlying findings when compared with the few other documented cases. We offer a number of learning points specific to this complication.

ObjectivesTo explore patient characteristics recorded at the initial consultation associated with a poor response to non-surgical multidisciplinary management of knee osteoarthritis (KOA) in tertiary care.DesignProspective multisite longitudinal study.SettingAdvanced practice physiotherapist-led multidisciplinary orthopaedic service within eight tertiary hospitals.Participants238 patients with KOA.Primary and secondary outcome measuresStandardised measures were recorded in all patients prior to them receiving non-surgical multidisciplinary management in a tertiary hospital service across multiple sites. These measures were examined for their relationship with a poor response to management 6 months after the initial consultation using a 15-point Global Rating of Change measure (poor response (scores −7 to +1)/positive response (scores+2 to+7)). Generalised linear models with binomial family and logit link were used to examine which patient characteristics yielded the strongest relationship with a poor response to management as estimated by the OR (95% CI).ResultsOverall, 114 out of 238 (47.9%) participants recorded a poor response. The odds of a poor response decreased with higher patient expectations of benefit (OR 0.74 (0.63 to 0.87) per 1/10 point score increase) and higher self-reported knee function (OR 0.67 (0.51 to 0.89) per 10/100 point score increase) (pConclusionsThese characteristics may need to be considered in patients presenting for non-surgical multidisciplinary management of KOA in tertiary care. Measurement of these patient characteristics may potentially better inform patient-centred management and flag the need for judicious monitoring of outcome for some patients to avoid unproductive care.

We consider the distributional fixed-point equation: $$R \stackrel{\mathcal{D}}{=} Q \vee \left( \bigvee_{i=1}^N C_i R_i \right),$$ where the $\{R_i\}$ are i.i.d.~copies of $R$, independent of the vector $(Q, N, \{C_i\})$, where $N \in \mathbb{N}$, $Q, \{C_i\} \geq 0$ and $P(Q > 0) > 0$. By setting $W = \log R$, $X_i = \log C_i$, $Y = \log Q$ it is equivalent to the high-order Lindley equation $$W \stackrel{\mathcal{D}}{=} \max\left\{ Y, \, \max_{1 \leq i \leq N} (X_i + W_i) \right\}.$$ It is known that under Kesten assumptions, $$P(W > t) \sim H e^{-\alpha t}, \qquad t \to \infty,$$ where $\alpha>0$ solves the Cram\'er-Lundberg equation $E \left[ \sum_{j=1}^N C_i ^\alpha \right] = E\left[ \sum_{i=1}^N e^{\alpha X_i} \right] = 1$. The main goal of this paper is to provide an explicit representation for $P(W > t)$, which can be directly connected to the underlying weighted branching process where $W$ is constructed and that can be used to construct unbiased and strongly efficient estimators for all $t$. Furthermore, we show how this new representation can be directly analyzed using Alsmeyer's Markov renewal theorem, yielding an alternative representation for the constant $H$. We provide numerical examples illustrating the use of this new algorithm.

Radiological investigations are central to cancer screening, diagnosis and follow up. This chapter aims to familiarise students with the role of imaging in oncology. It is important for students to understand when imaging is appropriate and what studies are most helpful for different cancer types and at different stages in the patient’s journey. We will highlight the most relevant radiological investigations for the most common cancers, specifically colorectal, lung, breast, prostate and pancreatic cancer. After completion of this tutorial, students should be able to choose the preferred imaging investigations for these malignancies, identify basic imaging features and understand the principles of cancer screening, staging and surveillance.

Background Elderly patients are frequently considered poor candidates for continuous renal replacement therapy in intensive care units, but with little evidence base. Methods We gathered data regarding patients requiring continuous renal replacement therapy at our institution’s intensive care unit during 2012–2014, and compared outcomes between patients of 75 years or older, and younger patients. Results Older patients had similar intensive care unit mortality to younger patients (41.5% vs. 36.1%, p = 0.21), but higher hospital mortality (54.2% vs. 44.0%, p = 0.02), and one-year mortality (63.6% vs. 50.6%, p = 0.005). There were no significant differences in dialysis-dependence rates between older and younger patients at intensive care unit discharge (31.9% vs. 35.8%, p = 0.50), and hospital discharge (18.5% vs. 24.2%, 0.32). Rates of new dialysis-dependence between older and younger patients at time of hospital discharge were similar (10.2% vs. 6.0%, p = 0.20). Conclusions Intensivists should not withhold continuous renal replacement therapy based on age alone. Other factors should be considered in triage of patients for intensive care unit and continuous renal replacement therapy.

We consider a family of resource sharing networks that were introduced in the work of Massoulie and Roberts (2000) as models for Internet flows and study an optimal stochastic control problem associated with the dynamic allocation of resource capacities to jobs in the system. Since these stochastic control problems are in general intractable, we analyze the system in a heavy traffic regime where one can formally approximate these control problems by certain Brownian control problems (BCP). It is shown that, both for a discounted cost and an ergodic cost criterion, an appropriate BCP gives a lower bound on the best achievable asymptotic cost under any sequence of admissible policies. The lower bounds established in this work show that the threshold control policies constructed in Budhiraja and Johnson (2017), which achieve the Hierarchical Greedy Ideal (HGI) performance (cf. Harrison et al. (2014)) in the heavy traffic limit, are in fact asymptotically optimal when certain monotonicity conditions on the cost function are satisfied.

This symposium brings together scholars who are taking individual perspectives to norm-making or diffusion in MNCs to engage in a conversation on this frontier of IM and HRM research. We seek to en...

OBJECTIVES: The Vulnerable Elders Survey (VES), a re-cently developed screening tool for at-risk older people inthecommunity,hasbeenvalidatedintheUnitedStates.Thisstudy evaluated its profile in older Irish people. It assessedwhether those categorized as vulnerable according to theVES were likely to use health services more frequently thanothers.DESIGN: Nationally representative cross-sectional inter-views.SETTING: Private homes in the community.PARTICIPANTS: Randomly selected older people (aged 65) (N52,033; 68% response).MEASUREMENTS: Interviews included the 13-item VESand questions on health service use.RESULTS: The proportion scoring as vulnerable was iden-tical to the U.S. sample (32.1% vs 32.3%). At the commu-nity healthcare level, participants categorized as vulnerablevisited their primary care physician more frequently (meanvisits 6.7 vs 4.0, Po.001), had more home-based publichealth nurse visits (29% vs 5%, Po.001), and were morelikely to have had preventive influenza vaccinations (81%vs 72%, Po.001) in the previous year. More-vulnerableolder adults did not differ on assessment of blood pressure(97% vs 96%), cholesterol (82% vs 85%), or receipt ofsmoking advice (66% vs 52%). Vulnerable participantswere more likely to have used emergency department (17%vs 8%, Po.05), inpatient (21% vs 12%, Po.05), and out-patient (28% vs 21%, Po.05) hospital services. Fourteenpercent of those categorized as vulnerable had zero or onevisit to their family physician in the previous year.CONCLUSION: This study provides further evidence,from a different healthcare system, of the potential of theVES to differentiate more-vulnerable older people. Pro-spective studies are needed to assess use of the VES as aclinical decision aid for community professionals such asfamily physicians and public health nurses. J Am GeriatrSoc 56:8–15, 2008.Key words: vulnerability; frailty; Vulnerable EldersSurvey; health service use

Antibodies directed against the beta chain of the T cell receptor (anti-Vbeta antibodies) are useful to identify the Vbeta repertoire of T cells in various diseases and to quantify numbers of Vbeta-bearing T cells. The goals of this study were to identify Vbeta+ cases of leukemic phase cutaneous T cell lymphoma (CTCL) and to compare the percentage of positive calls with other measures of blood tumor burden, i.e., lymphocyte subsets with a CD4+CD7- and CD4+CD26- phenotype and Sezary cell counts. Thirty-three of 49 (67%) cases of leukemic CTCL reacted with an anti-Vbeta antibody. When combined with reports from the literature, the frequency of Vbeta5 (probably Vbeta5.1) usage was relatively high when compared with Vbeta2 that is also frequently expressed by normal CD4+ T cells. The percentage of Vbeta+ cells correlated to the percentage of CD4+CD7- and CD4+CD26- cells for cases in which the neoplastic cells were deficient in expression of CD7 and CD26, respectively, but not the Sezary cell count. We hypothesize that the increased Vbeta5.1 usage in CTCL may be the result of depletion of Vbeta2 and other Vbeta-bearing T cells by staphylococcal superantigens prior to neoplastic transformation, resulting in a relative increase in the frequency of Vbeta5.1 usage in CTCL.

e13013 Background: Diagnostic criteria for BRCA1/2 genetic testing vary worldwide. Different eligibility thresholds for testing are used in different healthcare systems. In the public system in Ireland, this threshold is based on the Manchester Score (MS), with a score of ≥16 (approximately 10% likelihood of BRCA1/2 mutation) required for testing. Individuals unaffected by cancer are not eligible for diagnostic testing. Testing is also available privately by self-paying. We reviewed all self-pay patients in Ireland who were unrestricted by national guidelines. Methods: We performed a retrospective chart review of results from BRCA1/2 genetic testing in the Mater Private Hospital genetics clinic. Outcomes were recorded as ‘positive’, ‘wild type’ or ‘variant of uncertain significance’ (VUS). Results: 276 patients underwent testing between 2011 and 2016. 203 were affected with a median age of diagnosis of 48 (range 14-76), and 73 were unaffected individuals with a median age of 45 (range 30-74) at testing. 103 affected patients had a MS of ≥ 16: 7(6.8%) tested positive for BRCA1 mutation and 11(10.7%) tested positive for a BRCA2 mutation. Seven (6.8%) had a VUS characterised. 100 affected patients had an MS of

The current state of development of micro-thermal analysis (micro-TA) and related techniques are briefly reviewed. Results for a PET/epoxy resin composite and a bilayer polymer film are given as illustrations. Details are given of a new interface that enables the micro-TA unit to be placed inside a conventional FTIR spectrometer to carry out photothermal IR microscopy. New results are presented for a micro-pyrolysis-mass spectroscopy technique. The limitations of the current instrumentation are discussed in terms of the overriding problem being one of spatial resolution. Images obtained using pulsed force mode AFM with a high-resolution heated tip indicate the scope for future development of this technique. The possibility of even higher spatial resolution with other forms of probe are discussed along with the potential for imaging micro-pyrolysis time of flight mass spectroscopy and even tomography. It is concluded that these methods offer excellent prospects for characterising a wide range of polymer systems.

This paper examines an excerpt from a larger (televised) interview, wherein various married couples are asked to characterize their living situations in the aftermath of job loss and on the work of description and assessment by interview parties. It thus focuses on features of affiliation and disaffiliation and analyzes how both procedures work, particularly within an environment in which affiliated parties are engaged in attempting to figure out an "unpredictable" outcome of some (mutually experienced or experienceable) situation. In the excerpt, there are instances of both affiliation and disaffiliation. Using such conversation analytic structures as topic organization, story organization, preference structures, and distinguishing between content and structural affiliations, the interview excerpt is shown to contain a series of story stages, each of which is an element of the overall work of collaborative assessment. Within this assessment, parties make use of "content affiliations," wherein they reference their lived affiliation with one another, while at the same time, structuring their talk so as to disagree and disaffiliate with one another's stance. In contrast to such classical theorists as Durkheim, Simmel, Toennies and Cooley, who viewed affiliation as resulting from internal, emotive sources, or as Durkheim put it, saw this as being a non-directly measurable condition of "primary group" relationships, this report argues for the possibility of seeing affiliation as a performed, or achieved, activity. In this latter conception, one made evident through ethnomethodology and conversation analysis, affiliation - along with its counterpart, disaffiliation, are indeed external and measurable actions.