Alcohol misuse in patients with alcohol-related liver disease: How can we do better? A narrative review of the literature.

BACKGROUND: Ongoing alcohol use is strongly associated with progressive liver damage and higher mortality in patients with alcohol-related liver disease (ArLD). Reduction in alcohol use is therefore the cornerstone of treatment to improve the long-term outcome of these patients. However, a large proportion of patients continue to use alcohol and do not access or engage with alcohol treatment services after a diagnosis of ArLD. We reviewed the literature on factors associated with ongoing alcohol consumption among patients with ArLD to identify barriers or facilitators to their accessing alcohol treatment. METHODS: A search of MEDLINE and EMBASE was conducted using search strategies relating to ArLD and the psychosocial factors hypothesized to influence alcohol reduction and/or abstinence. RESULTS: There were few relevant studies pertinent to this population group. Several studies reported a high prevalence of mental health diagnoses associated with the severity of alcohol dependence. Social and environmental factors were shown to be important determinants of alcohol use. Common themes perceived as barriers to treatment from qualitative interviews with ArLD patients across studies included poor communication between the clinical team and patient, lack of symptoms recognized by patients themselves, and perceived loss of control over their condition. CONCLUSIONS: We recommend that future clinical studies of patient cohorts with ArLD include detailed psychosocial assessments to capture information on mental health and social factors. Qualitative studies are required to explore the patient journey pre and post hospital admission, which should focus on identifying facilitators and barriers to accessing treatment. Well-designed, controlled studies are needed to identify patient, social, and environmental factors associated with relapse to alcohol use after a diagnosis of ArLD. These data will enable us to adapt our support for patients to enhance engagement with services and improve long-term outcomes

Diagnostic accuracy of intraoperative margin assessment techniques in surgery for head and neck squamous cell carcinoma: a meta-analysis

BACKGROUND: Positive margins following head and neck squamous cell carcinoma (HNSCC) surgery lead to significant morbidity and mortality. Existing Intraoperative Margin Assessment (IMA) techniques are not widely used due to limitations in sampling technique, time constraints and resource requirements. We performed a meta-analysis of the diagnostic performance of existing IMA techniques in HNSCC, providing a benchmark against which emerging techniques may be judged. METHODS: The study was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guidelines. Studies were included if they reported diagnostic metrics of techniques used during HNSCC surgery, compared with permanent histopathology. Screening, manuscript review and data extraction was performed by multiple independent observers. Pooled sensitivity and specificity were estimated using the bivariate random effects model. RESULTS: From an initial 2344 references, 35 studies were included for meta-analysis. Sensitivity (Sens), specificity (Spec), diagnostic odds ratio (DOR) and area under the receiver operating characteristic curve (AUROC) were calculated for each group (n, Sens, Spec, DOR, AUROC): frozen section = 13, 0.798, 0.991, 309.8, 0.976; tumour-targeted fluorescence (TTF) = 5, 0.957, 0.827, 66.4, 0.944; optical techniques = 10, 0.919, 0.855, 58.9, 0.925; touch imprint cytology = 3, 0.925, 0.988, 51.1, 0.919; topical staining = 4, 0.918, 0.759, 16.4, 0.833. CONCLUSIONS: Frozen section and TTF had the best diagnostic performance. Frozen section is limited by sampling error. TTF shows promise but involves administration of a systemic agent. Neither is currently in widespread clinical use. Emerging techniques must demonstrate competitive diagnostic accuracy whilst allowing rapid, reliable, cost-effective results

Academic training in oral and maxillofacial surgery - when and how to enter the pathway

Entering into surgical academia can seem a daunting prospect for an oral and maxillofacial surgery (OMFS) trainee. However, the streamlining of academic training by the NIHR to create the integrated academic training (IAT) pathway has simplified academic training and more clearly defined academic positions and entry points for trainees. In this article we review the current NIHR IAT pathway and the various grades and entry points available to OMF surgeons, both pre- and post-doctoral. We highlight the unique challenges facing OMF trainees and provide advice and insight from both junior and senior OMFS academics. Finally, we focus on the planning and application for a doctoral research fellowship - discussing funding streams available to OMF surgeons

Fall-Planted Cover Crops for Weed Suppression in Western Kansas

The widespread evolution of herbicide-resistant (HR) kochia and Palmer amaranth warrants the use of alternative ecological-based strategies for weed management in no-tillage (NT) dryland cropping systems in western Kansas. A field study was established in the fall of 2020 at Kansas State University Agricultural Research Center near Hays, KS, to determine the impact of fall-planted cover crop (CC) mixture on 1) kochia and Palmer amaranth suppression (density and biomass reduction), and 2) Palmer amaranth emergence dynamics in subsequent grain sorghum. A CC mixture of winter triticale, winter pea, radish, and rapeseed was planted in wheat stubble in the fall of 2020. The CC mixture was terminated at triticale heading stage on May 26, 2021 by using 1) Roundup PowerMax (glyphosate) at 32 fl oz/a, and 2) Roundup PowerMax at 32 fl oz/a + Degree Xtra (premix of acetochlor + atrazine) at 2.2 quart/a. A chemical fallow treatment (without CC) was included for comparison. The study site was planted with grain sorghum hybrid ‘DKS 38-16’ on June 10, 2021. The CC mixture produced an average of 1360 lb/a aboveground biomass at the time of termination. The CC terminated with Roundup PowerMax + Degree Xtra had 98 and 95% less total weed density at 0 and 30 days after termination (DAT), respectively, compared to chemical fallow. No difference in weed density was observed at later evaluations. At grain sorghum harvest, CC terminated with Roundup PowerMax and Roundup PowerMax + Degree Xtra reduced total weed biomass by 61% and 73%, respectively, compared to chemical fallow. The time taken to reach 10, 50, and 90% cumulative emergence of Palmer amaranth was delayed by 9, 15, and 21 days, respectively, in CC terminated with Roundup PowerMax and 11, 39, and 128 days, respectively, in CC terminated with Roundup PowerMax + Degree Xtra when compared with chemical fallow. Grain sorghum yield did not differ between CC and chemical fallow treatments. These results suggest that a fall-planted CC mixture can play an important role for kochia and Palmer amaranth suppression in NT dryland crop production in western Kansas

A REVIEW OF RECORDING TECHNOLOGIES FOR DIGITAL FABRICATION IN HERITAGE CONSERVATION

Digital tools have brought new techniques for recording and fabrication allowing for the augmentation of traditional processes in repairs and restorations. Traditional mechanical and chemical techniques require physical contact to the artefacts of interest, while LiDAR Scanning, photogrammetry and structured light scanning provide non-invasive solutions. Analog recording technologies have always informed fabrication processes, but contemporary digital recording can produce complete geometry for fabrication. In this paper, we discuss recording and fabrication technologies and how they have been applied for heritage conservation

The epigenetic landscape of oral squamous cell carcinoma

BACKGROUND: There is relatively little methylation array data available specifically for oral squamous cell carcinoma (OSCC). This study aims to compare the DNA methylome across a large cohort of tumour/normal pairs. METHODS: DNA was extracted from 44 OSCCs and paired normal mucosa. DNA methylation analysis employed the Illumina GoldenGate high-throughput array comprising 1505 CpG loci selected from 807 epigenetically regulated genes. This data was correlated with extracapsular spread (ECS), human papilloma virus (HPV) status, recurrence and 5-year survival. RESULTS: Differential methylation levels of a number of genes distinguished the tumour tissue sample from the matched normal. Putative methylation signatures for ECS and recurrence were identified. The concept of concordant methylation or CpG island methylator phenotype (CIMP) in OSCC is supported by our data, with an association between ‘CIMP-high' and worse prognosis. Epigenetic deregulation of NOTCH4 signalling in OSCC was also observed, as part of a possible methylation signature for recurrence, with parallels to recently discovered NOTCH mutations in HNSCC. Differences in methylation in HPV-driven cases were seen, but are less significant than that has been recently proposed in other series. CONCLUSION: Although OSCC seems as much an ‘epigenetic' as a genetic disease, the translational potential of cancer epigenetics has yet to be fully exploited. This data points to the application of epigenetic biomarkers and targets available to further the development of therapy in OSCC