The development and validation of a decision aid to enhance shared decision‐making for the management of actinic keratosis

Actinic keratoses (AKs) are common pre‐malignant lesions. There are numerous management options including active surveillance, multiple topical therapies, cryotherapy, curettage and cautery, and photodynamic therapy, each with their own risks, benefits and efficacy. Best practice currently involves shared decision‐making between patient and clinician, particularly in the setting of multiple management options. Patient decision aids have been shown to be beneficial in the shared decision‐making process. In view of this, we have developed and validated a decision aid for the management of AKs, in concordance with the International Patient Decision Aids Standards

The development and validation of a decision aid to facilitate patient choice of surgery versus radiotherapy for high-risk basal cell carcinoma.

Basal Cell Carcinomas (BCCs) are increasingly common. For high risk BCCs, there are several treatment options, with similar efficacies. Current best practice is for a patient centred approach in deciding upon treatment modality. At present, there are few resources for clinicians to give to patients to assist their choice. This reduces patient autonomy and increases the burden on clinicians within clinic. Patient decision aids (PDAs) have been shown to increase patient autonomy and facilitate shared decision making. Currently, there is no published PDA designed to facilitate the decision between surgical management or radiotherapy in high risk BCCs. Here, we propose a novel decision aid designed along the International Patient Decision Aid Standards to fill this clinical need and evaluate its acceptance by both patients and clinicians. We describe the challenges faced at initial alpha and subsequent beta testing and go on to validate our PDA with both the Decisional Conflict Scale (DCS) and the 9-item Shared Decision Making Questionnaire (SDMQ9). We encourage other units to modify the PDA for their own use and include an example

A Rapid, Cost-Effective Method of Assembly and Purification of Synthetic DNA Probes >100 bp

Here we introduce a rapid, cost-effective method of generating molecular DNA probes in just under 15 minutes without the need for expensive, time-consuming gel-extraction steps. As an example, we enzymatically concatenated six variable strands (50 bp) with a common strand sequence (51 bp) in a single pool using Fast-Link DNA ligase to produce 101 bp targets (10 min). Unincorporated species were then filtered out by passing the crude reaction through a size-exclusion column (<5 min). We then compared full-length product yield of crude and purified samples using HPLC analysis; the results of which clearly show our method yields three-quarters that of the crude sample (50% higher than by gel-extraction). And while we substantially reduced the amount of unligated product with our filtration process, higher purity and yield, with an increase in number of stands per reaction (>12) could be achieved with further optimization. Moreover, for large-scale assays, we envision this method to be fully automated with the use of robotics such as the Biomek FX; here, potentially thousands of samples could be pooled, ligated and purified in either a 96, 384 or 1536-well platform in just minutes

Cutaneous manifestations of myelodysplastic syndrome: A systematic review.

Myelodysplastic syndrome (MDS) may present with specific skin lesions, such as leukaemia cutis, which is a well known poor prognostic marker of leukaemia with a high risk of acute leukaemic transformation. However, less is known regarding non-specific cutaneous manifestations of MDS including the prevalence, types and their prognostic and therapeutic significance, which we aimed to determine through this systematic review. We searched electronic databases (PubMed, Medline and EMBASE) from inception up to 26 January 2023 for studies reporting cutaneous manifestations of MDS. Eighty eight articles (case reports n = 67, case series n = 21), consisting of 134 patients were identified. We identified 6 common cutaneous manifestations: neutrophilic dermatoses (n = 64), vasculitis (n = 21), granulomatous (n = 8), connective tissue disease (CTD) (n = 7; composed of dermatomyositis (n = 5), cutaneous lupus erythematosus (n = 1), and systemic sclerosis (n = 1)), panniculitis (n = 4), immunobullous (n = 1), and other (n = 29). Cutaneous features either occurred at time of MDS diagnosis in 25.3%, preceding the diagnosis in 34.7% (range 0.5-216 months), or after diagnosis in 40.0% (range 1-132 months). Prognosis was poor (40.2% death) with 34.1% progressing to acute myeloid leukaemia (AML). 50% of those with MDS who progressed to AML had neutrophilic dermatoses (p = 0.21). Myelodysplastic syndrome was fatal in 39.2% of neutrophilic dermatoses (median time from onset of cutaneous manifestation: 12 months), 50% of vasculitis (7.5 months), 62.5% of granulomatous (15.5 months) and 14.3% of CTD (7 months). Recognition of patterns of cutaneous features in MDS will improve early diagnosis and risk stratification according to subtype and associated prognosis

A Regularized Discrete Laminate Parametrization Technique with Applications to Wing-Box Design Optimization

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/97055/1/AIAA2012-1519.pd

Integrating organizational, social, and individual perspectives in Web 2.0-based workplace e-learning

From the issue entitled 'Special Issue: Emerging Social and Legal Aspect'E-learning is emerging as a popular approach of education in the workplace by virtue of its flexibility to access, just-in-time delivery, and cost-effectiveness. To improve social interaction and knowledge sharing in e-learning, Web 2.0 is increasingly utilized and integrated with e-learning applications. However, existing social learning systems fail to align learning with organizational goals and individual needs in a systemic way. The dominance of technology-oriented approaches makes elearning applications less goal-effective and poor in quality and design. To solve the problem, we address the requirement of integrating organizational, social, and individual perspectives in the development of Web 2.0 elearning systems. To fulfill the requirement, a key performance indicator (KPI)-oriented approach is presented in this study. By integrating a KPI model with Web 2.0 technologies, our approach is able to: 1) set up organizational goals and link the goals with expertise required for individuals; 2) build a knowledge network by linking learning resources to a set of competences to be developed and a group of people who learn and contribute to the knowledge network through knowledge creation, sharing, and peer evaluation; and 3) improve social networking and knowledge sharing by identifying each individual's work context, expertise, learning need, performance, and contribution. The mechanism of the approach is explored and elaborated with conceptual frameworks and implementation technologies. A prototype system for Web 2.0 e-learning has been developed to demonstrate the effectiveness of the approach. © Springer Science + Business Media, LLC 2009.postprin

Doxycycline versus prednisolone as an initial treatment strategy for bullous pemphigoid: a pragmatic non-inferiority randomised controlled trial

Background: Bullous pemphigoid (BP) is a blistering skin disorder with increased mortality. We tested whether a strategy of starting treatment with doxycycline conveys acceptable short-term blister control whilst conferring long-term safety advantages over starting treatment with oral corticosteroids. Methods: Pragmatic multi-centre parallel-group randomised controlled trial of adults with BP (≥3 blisters ≥2 sites and linear basement membrane IgG/C3) plus economic evaluation. Participants were randomised to doxycycline (200 mg/day) or prednisolone (0·5 mg/kg/day). Localised adjuvant potent topical corticosteroids (<30 g/week) was permitted weeks 1-3. The non-inferiority primary effectiveness outcome was the proportion of participants with ≤3 blisters at 6 weeks. We assumed that doxycycline would be 25% less effective than corticosteroids with a 37% acceptable margin of noninferiority. The primary safety outcome was the proportion with severe, life-threatening or fatal treatment-related adverse events by 52 weeks. Analysis used a regression model adjusting for baseline disease severity, age and Karnofsky score, with missing data imputed. Results: 132 patients were randomised to doxycycline and 121 to prednisolone from 54 UK and 7 German dermatology centres. Mean age was 77·7 years and 68.4% had moderate to severe baseline disease. For those starting doxycycline, 83/112 (74·1%) had ≤3 blisters at 6 weeks compared with 92/101 (91·1%) for prednisolone, a difference of 18·6% favouring prednisolone (upper limit of 90% CI, 26·1%, within the predefined 37% margin). Related severe, life-threatening and fatal events at 52 weeks were 18·5% for those starting doxycycline and 36·6% for prednisolone (mITT analysis), an adjusted difference of 19·0% (95% CI, 7·9%, 30·1%, p=0·001). Conclusions: A strategy of starting BP patients on doxycycline is non-inferior to standard treatment with oral prednisolone for short-term blister control and significantly safer long-term