The use of synchrotron edge topography to study polytype nearest neighbour relationships in SiC

A brief review of the phenomenon of polytypism is presented and its prolific abundance in Silicon Carbide discussed. An attempt has been made to emphasise modern developments in understanding this unique behaviour. The properties of Synchrotron Radiation are shown to be ideally suited to studies of polytypes in various materials and in particular the coalescence of polytypes in SiC. It is shown that with complex multipolytypic crystals the technique of edge topography allows the spatial extent of disorder to be determined and, from the superposition of Laue type reflections, neighbourhood relationships between polytypes can be deduced. Finer features have now been observed with the advent of second generation synchrotrons, the resolution available enabling the regions between adjoining polytypes to be examined more closely. It is shown that Long Period Polytypes and One Dimensionally Disordered layers often found in association with regions of high defect density are common features at polytype boundaries. An idealised configuration termed a "polytype sandwich" is presented as a model for the structure of SiC grown by the modified Lely technique. The frequency of common sandwich edge profiles are classified and some general trends of polytype neighbourism are summarised

Does patient-reported outcome measures use at new foot and ankle patient clinic visits improve patient activation, experience, and satisfaction?

Background: Patient-reported outcome measures (PROMs) can help predict clinical outcomes and improve shared clinical decision-making discussions. There remains a paucity of research assessing how the use of PROMs may drive improved patient experience and patient activation. Methods: New foot and ankle patients completed PROMIS physical function (PF), pain interference (PI), and depression assessments. Patients were then randomized to viewing and discussing their PROMIS scores with their surgeon or not. Following the clinic visit, patients completed a series of Clinician & Group Survey-Consumer Assessment of Healthcare Providers and Systems (CG-CAHPS) questions and the Patient Activation Measure (PAM). Responses to the CG-CAHPS questions and PAM were compared between the 2 groups and after clustering on surgeon. Potential interaction effects by social deprivation were also explored. Results: After enrolling patients but removing those lost to follow-up or with missing data, 97 and 116 patients remained in the intervention control cohorts, respectively. No difference was found in CG-CAHPS responses nor PAM scores between the 2 groups (P > .05). All surgeons were highly rated by all patients. When clustered by surgeon, intervention subjects were less likely to indicate "top box" scores for the understanding domain of the CG-CAHPS question (OR 0.51, P < .001) and had decreased odds of high patient activation compared to control subjects (OR 0.67; P = .005). Among the most socially disadvantaged patients, there was no difference in control and intervention subjects in their likelihood of having high patient activation (P = .09). Conclusion: Highly rated foot and ankle surgeons who show and discuss PROM results may not improve patient experience or activation and may, in fact, decrease understanding or patient activation in select populations. Future work is needed to determine when PROM discussions are most beneficial and how best to present PROMs data, as we suspect that how the information was presented-and not the use of PROMs-resulted in our findings. Health literacy tools and/or communication training may better engage different patient groups regarding PROMs.Orthopaedics, Trauma Surgery and Rehabilitatio