Can we Save the rectum by watchful waiting or TransAnal surgery following (chemo)Radiotherapy versus Total mesorectal excision for early REctal Cancer (STAR-TREC)? Protocol for the international, multicentre, rolling phase II/III partially randomized patient preference trial evaluating long-course concurrent chemoradiotherapy versus short-course radiotherapy organ preservation approaches

Aim Organ-saving treatment for early-stage rectal cancer can reduce patient-reported side effects compared to standard total mesorectal excision (TME) and preserve quality of life. An optimal strategy for achieving organ preservation and longer-term oncological outcomes are unknown; thus there is a need for high quality trials. Method Can we Save the rectum by watchful waiting or TransAnal surgery following (chemo)Radiotherapy versus Total mesorectal excision for early REctal Cancer (STAR-TREC) is an international three-arm multicentre, partially randomized controlled trial incorporating an external pilot. In phase III, patients with cT1-3b N0 tumours, ≤40 mm in diameter, who prefer organ preservation are randomized 1:1 between mesorectal long-course chemoradiation versus mesorectal short-course radiotherapy, with selective transanal microsurgery. Patients preferring radical surgery receive TME. STAR-TREC aims to recruit 380 patients to organ preservation and 120 to TME surgery. The primary outcome is the rate of organ preservation at 30 months. Secondary clinician-reported outcomes include acute treatment-related toxicity, rate of non-operative management, non-regrowth pelvic tumour control at 36 months, non-regrowth disease-free survival at 36 months and overall survival at 60 months, and patient-reported toxicity, health-related quality of life at baseline, 12 and 24 months. Exploratory biomarker research uses circulating tumour DNA to predict response and relapse. Discussion STAR-TREC will prospectively evaluate contrasting therapeutic strategies and implement new measures including a smaller mesorectal target volume, two-step response assessment and non-operative management for complete response. The trial will yield important information to guide routine management of patients with early-stage rectal cancer

Measures of Performance and Proficiency in Robotic-Assisted Surgery : A Systematic Review

The first author received a research grant from RCS England and Health Education England in November 2021 until present to complete the study.Peer reviewedPostprin

CN and HCN in Dense Interstellar Clouds

We present a theoretical investigation of CN and HCN molecule formation in dense interstellar clouds. We study the gas-phase CN and HCN production efficiencies from the outer photon-dominated regions (PDRs) into the opaque cosmic-ray dominated cores. We calculate the equilibrium densities of CN and HCN, and of the associated species C+, C, and CO, as functions of the far-ultraviolet (FUV) optical depth. We consider isothermal gas at 50 K, with hydrogen particle densities from 10^2 to 10^6 cm^-3. We study clouds that are exposed to FUV fields with intensities 20 to 2*10^5 times the mean interstellar FUV intensity. We assume cosmic-ray H2 ionization rates ranging from 5*10^-17 s^-1, to an enhanced value of 5*10^-16 s^-1. We also examine the sensitivity of the density profiles to the gas-phase sulfur abundance.Comment: Accepted for publication in ApJ, 33 pages, 8 figure

The predictive mirror: interactions of mirror and affordance processes during action observation

An important question for the study of social interactions is how the motor actions of others are represented. Research has demonstrated that simply watching someone perform an action activates a similar motor representation in oneself. Key issues include (1) the automaticity of such processes, and (2) the role object affordances play in establishing motor representations of others’ actions. Participants were asked to move a lever to the left or right to respond to the grip width of a hand moving across a workspace. Stimulus-response compatibility effects were modulated by two task-irrelevant aspects of the visual stimulus: the observed reach direction and the match between hand-grasp and the affordance evoked by an incidentally presented visual object. These findings demonstrate that the observation of another person’s actions automatically evokes sophisticated motor representations that reflect the relationship between actions and objects even when an action is not directed towards an object

The Ground States of Large Quantum Dots in Magnetic Fields

The quantum mechanical ground state of a 2D $N$-electron system in a confining potential $V(x)=Kv(x)$ ($K$ is a coupling constant) and a homogeneous magnetic field $B$ is studied in the high density limit $N\to\infty$, $K\to \infty$ with $K/N$ fixed. It is proved that the ground state energy and electronic density can be computed {\it exactly} in this limit by minimizing simple functionals of the density. There are three such functionals depending on the way $B/N$ varies as $N\to\infty$: A 2D Thomas-Fermi (TF) theory applies in the case $B/N\to 0$; if $B/N\to{\rm const.}\neq 0$ the correct limit theory is a modified $B$-dependent TF model, and the case $B/N\to\infty$ is described by a ``classical'' continuum electrostatic theory. For homogeneous potentials this last model describes also the weak coupling limit $K/N\to 0$ for arbitrary $B$. Important steps in the proof are the derivation of a new Lieb-Thirring inequality for the sum of eigenvalues of single particle Hamiltonians in 2D with magnetic fields, and an estimation of the exchange-correlation energy. For this last estimate we study a model of classical point charges with electrostatic interactions that provides a lower bound for the true quantum mechanical energy.Comment: 57 pages, Plain tex, 5 figures in separate uufil

On Higher Order Gravities, Their Analogy to GR, and Dimensional Dependent Version of Duff's Trace Anomaly Relation

An almost brief, though lengthy, review introduction about the long history of higher order gravities and their applications, as employed in the literature, is provided. We review the analogous procedure between higher order gravities and GR, as described in our previous works, in order to highlight its important achievements. Amongst which are presentation of an easy classification of higher order Lagrangians and its employment as a \emph{criteria} in order to distinguish correct metric theories of gravity. For example, it does not permit the inclusion of only one of the second order Lagrangians in \emph{isolation}. But, it does allow the inclusion of the cosmological term. We also discuss on the compatibility of our procedure and the Mach idea. We derive a dimensional dependent version of Duff's trace anomaly relation, which in \emph{four}-dimension is the same as the usual Duff relation. The Lanczos Lagrangian satisfies this new constraint in \emph{any} dimension. The square of the Weyl tensor identically satisfies it independent of dimension, however, this Lagrangian satisfies the previous relation only in three and four dimensions.Comment: 30 pages, added reference

An exploratory randomised controlled trial of a premises-level intervention to reduce alcohol-related harm including violence in the United Kingdom

<b>Background</b><p></p> To assess the feasibility of a randomised controlled trial of a licensed premises intervention to reduce severe intoxication and disorder; to establish effect sizes and identify appropriate approaches to the development and maintenance of a rigorous research design and intervention implementation.<p></p> <b>Methods</b><p></p> An exploratory two-armed parallel randomised controlled trial with a nested process evaluation. An audit of risk factors and a tailored action plan for high risk premises, with three month follow up audit and feedback. Thirty-two premises that had experienced at least one assault in the year prior to the intervention were recruited, match paired and randomly allocated to control or intervention group. Police violence data and data from a street survey of study premises’ customers, including measures of breath alcohol concentration and surveyor rated customer intoxication, were used to assess effect sizes for a future definitive trial. A nested process evaluation explored implementation barriers and the fidelity of the intervention with key stakeholders and senior staff in intervention premises using semi-structured interviews.<p></p> <b>Results</b><p></p> The process evaluation indicated implementation barriers and low fidelity, with a reluctance to implement the intervention and to submit to a formal risk audit. Power calculations suggest the intervention effect on violence and subjective intoxication would be raised to significance with a study size of 517 premises.<p></p> <b>Conclusions</b><p></p> It is methodologically feasible to conduct randomised controlled trials where licensed premises are the unit of allocation. However, lack of enthusiasm in senior premises staff indicates the need for intervention enforcement, rather than voluntary agreements, and on-going strategies to promote sustainability

The Things You Do:Internal Models of Others' Expected Behaviour Guide Action Observation

Predictions allow humans to manage uncertainties within social interactions. Here, we investigate how explicit and implicit person models-how different people behave in different situations-shape these predictions. In a novel action identification task, participants judged whether actors interacted with or withdrew from objects. In two experiments, we manipulated, unbeknownst to participants, the two actors action likelihoods across situations, such that one actor typically interacted with one object and withdrew from the other, while the other actor showed the opposite behaviour. In Experiment 2, participants additionally received explicit information about the two individuals that either matched or mismatched their actual behaviours. The data revealed direct but dissociable effects of both kinds of person information on action identification. Implicit action likelihoods affected response times, speeding up the identification of typical relative to atypical actions, irrespective of the explicit knowledge about the individual's behaviour. Explicit person knowledge, in contrast, affected error rates, causing participants to respond according to expectations instead of observed behaviour, even when they were aware that the explicit information might not be valid. Together, the data show that internal models of others' behaviour are routinely re-activated during action observation. They provide first evidence of a person-specific social anticipation system, which predicts forthcoming actions from both explicit information and an individuals' prior behaviour in a situation. These data link action observation to recent models of predictive coding in the non-social domain where similar dissociations between implicit effects on stimulus identification and explicit behavioural wagers have been reported