Clinical outcomes and response to treatment of patients receiving topical treatments for pyoderma gangrenosum: a prospective cohort study

Background: pyoderma gangrenosum (PG) is an uncommon dermatosis with a limited evidence base for treatment. Objective: to estimate the effectiveness of topical therapies in the treatment of PG. Methods: prospective cohort study of UK secondary care patients with a clinical diagnosis of PG suitable for topical treatment (recruited July 2009 to June 2012). Participants received topical therapy following normal clinical practice (mainly Class I-III topical corticosteroids, tacrolimus 0.03% or 0.1%). Primary outcome: speed of healing at 6 weeks. Secondary outcomes: proportion healed by 6 months; time to healing; global assessment; inflammation; pain; quality-of-life; treatment failure and recurrence. Results: Sixty-six patients (22 to 85 years) were enrolled. Clobetasol propionate 0.05% was the most commonly prescribed therapy. Overall, 28/66 (43.8%) of ulcers healed by 6 months. Median time-to-healing was 145 days (95% CI: 96 days, ∞). Initial ulcer size was a significant predictor of time-to-healing (hazard ratio 0.94 (0.88;80 1.00); p = 0.043). Four patients (15%) had a recurrence. Limitations: No randomised comparator Conclusion: Topical therapy is potentially an effective first-line treatment for PG that avoids possible side effects associated with systemic therapy. It remains unclear whether more severe disease will respond adequately to topical therapy alone

The Craft at Work: An Interview with Stefan Laszczuk

Novelist Stefan Laszczuk was a PhD student in creative writing at the University of Adelaide when he penned 'I Dream of Magda'. A beautiful rumination on family and loss, in 2007 the novel won The Australian/Vogel Literary Award, Australia’s grand literary prize for unpublished manuscripts by writers under 35. Although the award carried with it prestige, prize-money and publication with Allen & Unwin, it was also reward for many years dedicated to the craft of writing. No stranger to literary success with his acclaimed previous works 'The New Cage' (2002) and 'The Goddamn Bus of Happiness' (2004), the Melbourne-based Laszczuk spoke to Brooke Dunnell and Annie Morgan about tapping into his creative potential, shaping and nurturing the creative drive in a university environment, and his broader concerns about supporting Australia’s emerging writers

New Qing Imperial History.: The making of Inner Asian Empire at Qing Chengde

International audienceNew Qing Imperial History uses the Manchu summer capital of Chengde and associated architecture, art and ritual activity as the focus for an exploration of the importance of Inner Asia and Tibet to the Qing Empire (1636-1911). Well-known contributors argue that the Qing was not simply another Chinese dynasty, but was deeply engaged in Inner Asia not only militarily, but culturally, politically and ideologically.Emphasizing the diverse range of peoples in the Qing empire, this book analyzes the importance to Chinese history of Manchu relations with Tibetan prelates, Mongolian chieftains, and the Turkic elites of Xinjiang. In offering a new appreciation of a culturally and politically complex period, the authors discuss the nature and representation of emperorship, especially under Qianlong (r. 1736-1795), and examine the role of ritual in relations with Inner Asia, including the vaunted (but overrated) tribute system.By using a specific artifact or text as a starting point for analysis in each chapter, the contributors not only include material previously unavailable in English but allow the reader an intimate knowledge of life at Chengde and its significance to the Qing period as a whole

Impact of persistent substance misuse on 1-year outcome in first-episode psychosis

Background: Substance misuse is a common comorbid problem in people presenting with first-episode psychosis and is associated with a poor short-term outcome. Aims: The aim of this study is to examine differences in baseline characteristics and 1-year outcome between individuals with first-episode psychosis who have never misused substances, those who stop misusing substances after initial presentation and those who persistently misuse substances over the 1-year assessment period. Method: Patients were recruited to the Northern Ireland First Episode Psychosis Study (n = 272). Clinical assessments were performed at baseline and at 1 year (n = 194) and data were collected from the case notes. Results: Individuals with persistent substance misuse had more severe depression, more positive symptoms, poorer functional outcome and greater rates of relapse at 1 year than those who stopped and those who had never misused substances. There were no differences in outcome between people who had never misused substances and those who stopped misusing after presentation. Conclusions: These results support assertive intervention targeted at comorbid substance misuse in individual