Ferroelastic Twin Angles at the Surface of CaTiO_{3} Quantified by Photoemission Electron Microscopy

We use photoemission electron microscopy to measure the ferroelastic twin wall angles at the surface of CaTiO_{3} (001) and deduce the strain ordering. We analyze the angular dependence of the photoelectron emission from different domain surfaces, each with its own characteristic tilt angle in the factory rooflike topography. By considering the surface topography as a field perturbation, the offset in the photoemission threshold can be directly related to the tilt angles. With knowledge of the symmetry allowed twin walls we quantify the twin angles between 179.1° to 180.8°.

Electroconvulsive Therapy in Patients with Cardiac Pacemakers

There are few contraindications to electroconvulsive therapy and it is generally well tolerated. However, electroconvulsive therapy in elderly patients with cardiac pacemakers in situ theoretically presents an increased risk of complications. We undertook a retrospective audit of all patients who received anaesthesia for electroconvulsive therapy between January 1999 and September 2005. There were ten patients who had cardiac pacemakers in situ. They underwent a total of 147 electroconvulsive therapy treatments. In 146 out of the 147 treatments, the anaesthesia proceeded uneventfully. The findings suggest that provision of anaesthesia and electroconvulsive therapy in patients with cardiac pacemakers, including rate-responsive pacemakers, is a safe undertaking, with no extra precautions being needed except for routine ECG monitoring.

Chemistry of resistivity changes in TiTe/Al2O3 conductive-bridge memories

We report the chemical phenomena involved in the reverse forming (negative bias on top electrode) and reset of a TaN/TiTe/Al2O3/Ta memory stack. Hard X-ray photoelectron spectroscopy was used to conduct a non-destructive investigation of the critical interfaces between the electrolyte (Al2O3) and the TiTe top and Ta bottom electrodes. During reverse forming, Te accumulates at the TiTe/Al2O3 interface, the TiOx layer between the electrolyte and the electrode is reduced and the TaOx at the interface with Al2O3 is oxidized. These interfacial redox processes are related to an oxygen drift toward the bottom electrode under applied bias, which may favour Te transport into the electrolyte. Thus, the forming processes is related to both Te release and also to the probable migration of oxygen vacancies inside the alumina layer. The opposite phenomena are observed during the reset. TiOx is oxidized near Al2O3 and TaOx is reduced at the Al2O3/Ta interface, following the O2- drift towards the top electrode under positive bias while Te is driven back into the TiTe electrode.

Surface Proximity Effect, Imprint Memory of Ferroelectric Twins, and Tweed in the Paraelectric Phase of BaTiO3

We have used energy-filtered photoemission electron microscopy (PEEM) at the photoemission threshold to carry out a microscopic scale characterization of the surface charge and domain structure of the (001) surface in BaTiO₃. Signatures of ferroelectric and ferroelastic domains, and tweed, dominate the surface structure of BaTiO₃ at room temperature. The surface ferroic signatures are maintained on heating to temperature (~550 K), well above the transition temperature (393 K). This surface proximity effect provides the mechanism for memory of the bulk ferroelectric domain arrangement up to 150 K above T_C and thus can be considered as a robust fingerprint of the ferroelectric state near the surface. Self-reversal of polarization is observed for the tweed below T_C and for the surface domains above T_C. Annealing at higher temperature triggers the dynamic tweed which in turn allows a full reorganization of the ferroic domain configuration.

High Level Expression of Active Human Prothrombin in a Vaccina Virus Expression System

We have worked out an efficient and time saving procedure for the expression of recombinant human prothrombin. The glycoprotein was expressed in the vaccinia virus expression system in several mammalian cell lines. The kidney cell lines Vero and BHK and the human cell line Hela were found to efficiently secrete prothrombin. Expression levels of 3–4 µg of factor II per 106 cells per day corresponding to 18–23 mU per 106 cells per day were achieved. Since the expression levels obtained with the vaccinia virus/Vero cell system were comparable to those obtained in amplified transformed CHO cells it provides an alternative system for the efficient expression of human prothrombin and may allow to further elucidate structure-function relationships of (pro)thrombin and its various effectors.

Raman signatures of ferroic domain walls captured by principal component analysis

Ferroic domain walls are currently investigated by several state-of-the art techniques in order to get a better understanding of their distinct, functional properties. Here, principal component analysis (PCA) of Raman maps is used to study ferroelectric domain walls (DWs) in LiNbO₃ and ferroelastic DWs in NdGaO₃. It is shown that PCA allows us to quickly and reliably identify small Raman peak variations at ferroelectric DWs and that the value of a peak shift can be deduced-accurately and without a priori-from a first order Taylor expansion of the spectra. The ability of PCA to separate the contribution of ferroelastic domains and DWs to Raman spectra is emphasized. More generally, our results provide a novel route for the statistical analysis of any property mapped across a DW.

Low energy electron imaging of domains and domain walls in magnesium-doped lithium niobate

The understanding of domain structures, specifically domain walls, currently attracts a significant attention in the field of (multi)-ferroic materials. In this article, we analyze contrast formation in full field electron microscopy applied to domains and domain walls in the uniaxial ferroelectric lithium niobate, which presents a large 3.8 eV band gap and for which conductive domain walls have been reported. We show that the transition from Mirror Electron Microscopy (MEM – electrons reflected) to Low Energy Electron Microscopy (LEEM – electrons backscattered) gives rise to a robust contrast between domains with upwards (P_up) and downwards (P_down) polarization, and provides a measure of the difference in surface potential between the domains. We demonstrate that out-of-focus conditions of imaging produce contrast inversion, due to image distortion induced by charged surfaces, and also carry information on the polarization direction in the domains. Finally, we show that the intensity profile at domain walls provides experimental evidence for a local stray, lateral electric field.

The use and effect of video game design theory in the creation of game-based systems for upper limb stroke rehabilitation

Upper limb exercise is often neglected during post-stroke rehabilitation. Video games have been shown to be useful in providing environments in which patients can practise repetitive, functionally meaningful movements, and in inducing neuroplasticity. The design of video games is often focused upon a number of fundamental principles, such as reward, goals, challenge and the concept of meaningful play, and these same principles are important in the design of games for rehabilitation. Further to this, there have been several attempts for the strengthening of the relationship between commercial game design and rehabilitative game design, the former providing insight into factors that can increase motivation and engagement with the latter. In this article, we present an overview of various game design principles and the theoretical grounding behind their presence, in addition to attempts made to utilise these principles in the creation of upper limb stroke rehabilitation systems and the outcomes of their use. We also present research aiming to move the collaborative efforts of designers and therapists towards a model for the structured design of these games and the various steps taken concerning the theoretical classification and mapping of game design concepts with intended cognitive and motor outcomes.

Operando x-ray photoelectron emission microscopy for studying forward and reverse biased silicon p-n junctions

Significant progress in the understanding of surfaces and interfaces of materials for new technologies requires operando studies, i.e., measurement of chemical, electronic, and magnetic properties under external stimulus (such as mechanical strain, optical illumination, or electric fields) applied in situ in order to approach real operating conditions. Electron microscopy attracts much interest, thanks to its ability to determine semiconductor doping at various scales in devices. Spectroscopic photoelectron emission microscopy (PEEM) is particularly powerful since it combines high spatial and energy resolution, allowing a comprehensive analysis of local work function, chemistry, and electronic structure using secondary, core level, and valence band electrons, respectively. Here we present the first operando spectroscopic PEEM study of a planar Si p-n junction under forward and reverse bias. The method can be used to characterize a vast range of materials at near device scales such as resistive oxides, conducting bridge memories and domain wall arrays in ferroelectrics photovoltaic devices.

The effects of acute fluoxetine administration on temporal discounting in youth with ADHD

BACKGROUND

Serotonin is under-researched in attention deficit hyperactivity disorder (ADHD), despite accumulating evidence for its involvement in impulsiveness and the disorder. Serotonin further modulates temporal discounting (TD), which is typically abnormal in ADHD relative to healthy subjects, underpinned by reduced fronto-striato-limbic activation. This study tested whether a single acute dose of the selective serotonin reuptake inhibitor (SSRI) fluoxetine up-regulates and normalizes reduced fronto-striato-limbic neurofunctional activation in ADHD during TD.

METHOD

Twelve boys with ADHD were scanned twice in a placebo-controlled randomized design under either fluoxetine (between 8 and 15 mg, titrated to weight) or placebo while performing an individually adjusted functional magnetic resonance imaging TD task. Twenty healthy controls were scanned once. Brain activation was compared in patients under either drug condition and compared to controls to test for normalization effects.

RESULTS

Repeated-measures whole-brain analysis in patients revealed significant up-regulation with fluoxetine in a large cluster comprising right inferior frontal cortex, insula, premotor cortex and basal ganglia, which further correlated trend-wise with TD performance, which was impaired relative to controls under placebo, but normalized under fluoxetine. Fluoxetine further down-regulated default mode areas of posterior cingulate and precuneus. Comparisons between controls and patients under either drug condition revealed normalization with fluoxetine in right premotor-insular-parietal activation, which was reduced in patients under placebo.

CONCLUSIONS

The findings show that a serotonin agonist up-regulates activation in typical ADHD dysfunctional areas in right inferior frontal cortex, insula and striatum as well as down-regulating default mode network regions in the context of impulsivity and TD.

International survey on the management of mechanical ventilation during ECMO in adults with severe respiratory failure

BACKGROUND

No consensus exists on the optimal settings of mechanical ventilation during veno-venous extracorporeal membrane oxygenation (ECMO). Our aim was to describe how mechanical ventilation and related interventions are managed by adult ECMO centres.

METHODS

A cross-sectional, multi-centre, international survey of 173 adult respiratory ECMO centres. The survey was generated through an iterative process and assessed for clarity, content and face validity.

RESULTS

One hundred thirty-three centres responded (76.8%). Pressure control was the most commonly used mechanical ventilation mode (64.4%). Although the median PEEP was 10 cmH2O, 22.6% set PEEP <10 cmH2O and 15.5% used 15-20 cmH2O. In 63% of centres PEEP was fixed and not titrated. Recruitment maneuvres, were never used in 34.1% of centres, or used daily in 13.2%. Centres reported using either a "lung rest" (45.7%), or an "open lung" strategy (44.2%). Only 24.8% used chest CT to guide mechanical ventilation. Adjunctive treatments were never or occasionally used. Only 10% of centres extubated patients on ECMO, mainly in more experienced centres. 71.3% of centres performed tracheostomy on ECMO, with large variability in timing (most frequent on days 6-10). Only 27.1% of ECMO centres had a protocol for mechanical ventilation on ECMO.

CONCLUSION

We found large variability in ventilatory practices during ECMO. The clinicians' training background and the centres' experience had no influence on the approach to ventilation. This survey shows that well conducted studies are necessary to determine the best practice of mechanical ventilation during ECMO and its impact on patient outcome.

Mechanical ventilation in critically-ill pregnant women: a case series

BACKGROUND

Approximately 0.1-0.2% of pregnancies are complicated by respiratory failure requiring mechanical ventilatory support, but few data exist to inform clinical management. This study aimed to characterize current practice and the effect of delivery on respiratory function.

METHODS

A retrospective review was performed of pregnant women who received mechanical ventilation for more than 24h, from four intensive care units in institutions with large-volume obstetric units.

RESULTS

Data were collected from 29 patients with a mean gestation at intensive care unit admission of 25.3 ± 6 weeks. Tidal volumes were 7.7 ± 1.7 mL/kg predicted body weight. Estimated respiratory system compliance was reduced, but was higher in four patients ventilated for neurological conditions without lung disease. Three maternal and three neonatal deaths occurred. Ten patients delivered while on ventilatory support: one spontaneous delivery, four for obstetric indications and five for worsening maternal condition. Following delivery of these 10 patients, three demonstrated a greater than 50% decrease in oxygenation index and five a greater than 50% increase in compliance. No characteristics identified which patients may benefit from delivery.

CONCLUSIONS

Review of current practice in four centers suggests that mechanical ventilation in pregnant patients follows usual guidelines applicable to non-pregnant patients. Delivery was associated with modest improvement in maternal respiratory function in some patients. Any potential benefit of delivery in improving maternal physiology must be weighed against the stress of delivery. The risks of premature birth for the fetus must be weighed against continued exposure to maternal hypoxemia and hypotension.

Disorder-dissociated effects of fluoxetine on brain function of working memory in attention deficit hyperactivity disorder and autism spectrum disorder

BACKGROUND

Attention deficit hyperactivity disorder (ADHD) and autism spectrum disorder (ASD) are often co-morbid and share performance and brain dysfunctions during working memory (WM). Serotonin agonists modulate WM and there is evidence of positive behavioural effects in both disorders. We therefore used functional magnetic resonance imaging (fMRI) to investigate shared and disorder-specific brain dysfunctions of WM in these disorders, and the effects of a single dose of the selective serotonin reuptake inhibitor (SSRI) fluoxetine.

METHOD

Age-matched boys with ADHD (n = 17), ASD (n = 17) and controls (n = 22) were compared using fMRI during an N-back WM task. Patients were scanned twice, under either an acute dose of fluoxetine or placebo in a double-blind, placebo-controlled randomized design. Repeated-measures analyses within patients assessed drug effects on performance and brain function. To test for normalization effects of brain dysfunctions, patients under each drug condition were compared to controls.

RESULTS

Under placebo, relative to controls, both ADHD and ASD boys shared underactivation in the right dorsolateral prefrontal cortex (DLPFC). Fluoxetine significantly normalized the DLPFC underactivation in ASD relative to controls whereas it increased posterior cingulate cortex (PCC) deactivation in ADHD relative to control boys. Within-patient analyses showed inverse effects of fluoxetine on PCC deactivation, which it enhanced in ADHD and decreased in ASD.

CONCLUSIONS

The findings show that fluoxetine modulates brain activation during WM in a disorder-specific manner by normalizing task-positive DLPFC dysfunction in ASD boys and enhancing task-negative default mode network (DMN) deactivation in ADHD.

The bottom-up growth of edge specific graphene nanoribbons

The discovery of ballistic transport in graphene grown on SiC(0001) sidewall trenches has sparked an intense effort to uncover the origin of this exceptional conductivity. How a ribbon's edge termination, width, and topography influence its transport is not yet understood. This work presents the first structural and electronic comparison of sidewall graphene grown with different edge terminations. We show that armchair and zigzag terminated ribbons, grown from SiC, have very different topographies and interact differently with the substrate, properties that are critical to device architecture in sidewall ribbon electronics.

Reversible switching of in-plane polarized ferroelectric domains in BaTiO3(001) with very low energy electrons

The switchable bipolar ground state is at the heart of research into ferroelectrics for future, low-energy electronics. Polarization switching by an applied field is a complex phenomenon which depends on the initial domain ordering, defect concentration, electrical boundary conditions and charge screening. Injected free charge may also to be used to reversibly switch in-plane polarized domains. We show that the interaction between the initial domain order and the bulk screening provided by very low energy electrons switches the polarization without the collateral radiation damage which occurs when employing a beam of high energy electrons. Polarization switching during charge injection adds a new dimension to the multifunctionality of ferroelectric oxides.

Drug-specific laterality effects on frontal lobe activation of atomoxetine and methylphenidate in attention deficit hyperactivity disorder boys during working memory

BACKGROUND

The catecholamine reuptake inhibitors methylphenidate (MPH) and atomoxetine (ATX) are the most common treatments for attention deficit hyperactivity disorder (ADHD). This study compares the neurofunctional modulation and normalization effects of acute doses of MPH and ATX within medication-naive ADHD boys during working memory (WM).

METHOD

A total of 20 medication-naive ADHD boys underwent functional magnetic resonance imaging during a parametric WM n-back task three times, under a single clinical dose of either MPH, ATX or placebo in a randomized, double-blind, placebo-controlled, cross-over design. To test for normalization effects, brain activations in ADHD under each drug condition were compared with that of 20 age-matched healthy control boys.

RESULTS

Relative to healthy boys, ADHD boys under placebo showed impaired performance only under high WM load together with significant underactivation in the bilateral dorsolateral prefrontal cortex (DLPFC). Both drugs normalized the performance deficits relative to controls. ATX significantly enhanced right DLPFC activation relative to MPH within patients, and significantly normalized its underactivation relative to controls. MPH, by contrast, both relative to placebo and ATX, as well as relative to controls, upregulated the left inferior frontal cortex (IFC), but only during 2-back. Both drugs enhanced fronto-temporo-striatal activation in ADHD relative to control boys and deactivated the default-mode network, which were negatively associated with the reduced DLPFC activation and performance deficits, suggesting compensation effects.

CONCLUSIONS

The study shows both shared and drug-specific effects. ATX upregulated and normalized right DLPFC underactivation, while MPH upregulated left IFC activation, suggesting drug-specific laterality effects on prefrontal regions mediating WM.

Enhancement of photovoltaic efficiency by insertion of a polyoxometalate layer at the anode of an organic solar cell

Thick layers of the Wells–Dawson K₆[P₂W₁₈O₆₂] highly ordered were obtained and integrated at the anodic interface of organic solar cells to reach high power conversion efficiency.

Polarization sensitive surface band structure of doped BaTiO3(001)

We present a spatial and wave-vector resolved study of the electronic structure of micron sized ferroelectric domains at the surface of a BaTiO(3)(001) single crystal. The n-type doping of the BaTiO(3) is controlled by in situ vacuum and oxygen annealing, providing experimental evidence of a surface paraelectric-ferroelectric transition below a critical doping level. Real space imaging of photoemission threshold, core level and valence band spectra show contrast due to domain polarization. Reciprocal space imaging of the electronic structure using linearly polarized light provides unambiguous evidence for the presence of both in- and out-of-plane polarization with two- and fourfold symmetry, respectively. The results agree well with first principles calculations.

Thickness-dependent polarization of strained BiFeO3 films with constant tetragonality

We measure the ferroelectric polarization of BiFeO3 films down to 3.6 nm using low energy electron and photoelectron emission microscopy. The measured polarization decays strongly below a critical thickness of 5-7 nm predicted by continuous medium theory whereas the tetragonal distortion does not change. We resolve this apparent contradiction using first-principles-based effective Hamiltonian calculations. In ultrathin films, the energetics of near open circuit electrical boundary conditions, i.e., an unscreened depolarizing field, drive the system through a phase transition from single out-of-plane polarization to nanoscale stripe domains. It gives rise to an average polarization close to zero as measured by the electron microscopy while maintaining the relatively large tetragonal distortion imposed by the nonzero polarization state of each individual domain.

Dark field photoelectron emission microscopy of micron scale few layer graphene

We demonstrate dark field imaging in photoelectron emission microscopy (PEEM) of heterogeneous few layer graphene (FLG) furnace grown on SiC(000-1). Energy-filtered, threshold PEEM is used to locate distinct zones of FLG graphene. In each region, selected by a field aperture, the k-space information is imaged using appropriate transfer optics. By selecting the photoelectron intensity at a given wave vector and using the inverse transfer optics, dark field PEEM gives a spatial distribution of the angular photoelectron emission. In the results presented here, the wave vector coordinates of the Dirac cones characteristic of commensurate rotations of FLG on SiC(000-1) are selected providing a map of the commensurate rotations across the surface. This special type of contrast is therefore a method to map the spatial distribution of the local band structure and offers a new laboratory tool for the characterisation of technically relevant, microscopically structured matter.

Normal urine output after elective caesarean section: an observational study

BACKGROUND

When monitoring postoperative urine output there is no guidance specific to obstetrics. Factors such as peri-operative oxytocin infusions add further complexity. Our aim was to determine a normal range for urine output after elective caesarean section under neuraxial anaesthesia.

METHODS

Sixty women were recruited and for 24h from the time of urethral catheterisation, we recorded urine output and fluid input. We also measured intra-operative blood loss, use of prophylactic oxytocin infusion and markers of renal function. Data were compared with Mann-Whitney U-tests or paired t tests.

RESULTS

Oxytocin infusions were used in 45 women (75%). Median (95% CI) urine output in the first 6h was 0.8 (0.4-1.9) mL kg(-1)h(-1) in women receiving oxytocin compared to 1.4 (0.7-2.2)mL kg(-1)h(-1) in those who did not (P=0.02). Urine output for all women at 12 and 18 h was 2.0 (0.7-5.7) and 1.9 (0.5-4.5)mL kg(-1)h(-1). Blood loss was 0.4 (0.2-0.8)L in women with oxytocin infusions and 0.3 (0.1-0.4)L in those without (P=0.003). Mean (SD) pre- and postoperative urine osmolality was 622.5 (185.7) and 293.0 (135.1) mosm/kg, respectively (P<0.0001).

CONCLUSIONS

Urine output varied widely between subjects, especially after the first 6h and was further reduced by the use of oxytocin infusion. This may have been a direct effect or related to increased blood loss in this group. Oxytocin use should be accounted for when setting a minimum postoperative urine output. We also found high pre-operative urine osmolalities suggesting significant dehydration.

Carcinoma of the breast wire localisation post nuclear medicine sentinel lymph node imaging. Are radiologists receiving a significant dose?

OBJECTIVE

To assess the radiation dose received by the radiologist when performing wire localisation for axillary radio-isotope sentinel node imaging-guided biopsy in patients with impalpable breast cancers treated with breast-preserving excision. When wire placement follows radio-isotope sentinel node imaging (RSNI) the radiologist is exposed to a radiation risk that has never been previously assessed.

METHODS

Radiation doses to radiologists performing ultrasound-guided localisation following nuclear medicine sentinel node imaging were measured for procedures on the day of surgery (20 MBq) and also on the day before surgery (40 MBq). These measurements were compared with theoretically calculated doses.

RESULTS

Twelve patients showed comparable results between measurements and estimated doses. The mean measured dose was 1.8 muSv (estimated 1.8 muSv) for same-day and 4.8 muSv (estimated 3.4 muSv) for next-day surgery cases. At worst, radiologists who perform 36 wire localisations per year immediately following RSNI receive a radiation dose of 0.17 mSv.

CONCLUSIONS

This study highlights the need to inform radiologists of the relative risk when performing pre-surgical localisation after RSNI. This risk should be justified locally in accordance with the total dose received by the localising radiologist. Particular consideration should be given to pregnant staff and the possibility of performing wire localisations before radio-isotope injection.

Spatially resolved, energy-filtered imaging of core level and valence band photoemission of highly p and n doped silicon patterns

An accurate description of spatial variations in the energy levels of patterned semiconductor substrates on the micron and sub-micron scale as a function of local doping is an important technological challenge for the microelectronics industry. Spatially resolved surface analysis by photoelectron spectromicroscopy can provide an invaluable contribution thanks to the relatively non-destructive, quantitative analysis. We present results on highly doped n and p type patterns on, respectively, p and n type silicon substrates. Using synchrotron radiation and spherical aberration-corrected energy filtering, we have obtained a spectroscopic image series at the Si 2p core level and across the valence band. Local band alignments are extracted, accounting for doping, band bending and surface photovoltage.

Aspects of lateral resolution in energy-filtered core level photoelectron emission microscopy

Lateral resolution is a major issue in photoelectron emission microscopy (PEEM) and received much attention in the past; however a reliable practical methodology allowing for inter-laboratory comparisons is still lacking. In modern, energy-filtered instruments, core level or valence electrons give much lower signal levels than secondary electrons used in still most of the present experiments. A quantitative measurement of the practical resolution obtained with core level electrons is needed. Here, we report on critical measurements of the practical lateral resolution measured for certified semiconducting test patterns using core level photoelectrons imaged with synchrotron radiation and an x-ray PEEM instrument with an aberration-corrected energy filter. The resolution is 250 ± 20 nm and the sensitivity, 38 nm. The different contributions to the effective lateral resolution (electron optics, sample surface imperfections, counting statistics) are presented and quantitatively discussed.

Orientation-dependent work function of in situ annealed strontium titanate

We have used energy-filtered x-ray photoelectron emission microscopy (XPEEM) and synchrotron radiation to measure the grain orientation dependence of the work function of a sintered niobium-doped strontium titanate ceramic. A significant spread in work function values is found. Grain orientation and surface reducing/oxidizing conditions are the main factors in determining the work function. Energy-filtered XPEEM looks ideally suited for analysis of other technologically interesting polycrystalline samples.

Direct quantification of gold along a single Si nanowire

The presence of gold on the sidewall of a tapered, single silicon nanowire is directly quantified from core-level nanospectra using energy-filtered photoelectron emission microscopy. The uniform island-type partial coverage of gold determined as 0.42+/-0.06 (approximately 1.8 ML) is in quantitative agreement with the diameter reduction of the gold catalyst observed by scanning electron microscopy and is confirmed by a splitting of the photothresholds collected from the sidewall, from which characteristic local work functions are extracted using a model of the full secondary electron distributions.

Correlation of serum CA125 with stage, grade and survival of patients with epithelial ovarian cancer at a single centre

To evaluate the relationship between serum CA125 tumour marker level before and after surgery of epithelial ovarian carcinoma and assess its potential role as a prognostic factor. A retrospective review of 87 patients with epithelial ovarian carcinoma at a single centre between January 2001 and December 2005 was performed. Serum CA125 levels were assessed for their relationship to pathological stage, tumour grade, tumour volume and age as well as overall survival. A total of 75 patients, mean age 58.94 years and median follow-up of 24 months were included in the analysis. While the preoperative CA125 level did not correlate significantly with stage, tumour grade or survival, the postoperative CA125 correlated to FIGO stage (p<0.0001), tumour grade (p<0.0001) and overall survival (p=0.01). Reduced survival was noted with increasing age at the time of surgery (p=0.009) and bulk of the residual disease postoperatively (p=0.011).

Correlation of serum CA125 levels with stage, grade and survival of patients with epithelial ovarian cancer

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Background: Serum levels of the tumor marker CA125 and its relation to disease stage, grade, tumor volume, survival and prognosis have been studied with conflicting results. This study was conducted in a single center serving a population of 340,000. Methods: Newly diagnosed patients referred between Jan 1 2001 and Dec 31 2005 were included. Serum CA125 levels were recorded before and after optimal debulking surgery and before each cycle of chemotherapy. Patients received standard adjuvant or palliative chemotherapy. Disease was staged using the FIGO staging system. Tumors were graded by the Broders Classification. CT scan within 6 weeks of surgery was used to quantify residual disease. Disease status as of Dec 2006 was used for measurements of overall survival (OS). The relationships between preoperative CA125 and stage, grade and OS were retrospectively evaluated. Post surgical levels of CA125 were also analysed and correlated to the same parameters. The influence of age and bulk of residual disease on OS were also examined. Kaplan- Meier (univariate) analysis was applied for survival analysis and Spearman's method was used to study the correlation of CA125 and the multiple variables. Results: 91 newly diagnosed ovarian cancer referrals were received in the study period. This report is based on the 75 patients of this total group for whom full data was available. Length of follow up ranged from 2 to 71 months (median of 24, mean of 28.2 months). Preoperative CA125 level did not correlate significantly with stage, tumor grade or OS (p=0.08. p=0.113 and p=0.847 respectively). A strong correlation was seen however between postoperative CA125 level (recorded prior to commencement of chemotherapy) and stage, tumor grade and OS (p<0.0001, p<0.0001 and p<0.01respectively) OS for the total group was 37%, and OS for those with stage III and IV disease (n=43) was 17%. The mean age of the patients was 59.6 years. Older age at time of surgery (p=0.009) followed by bulk of residual disease (p=0.011) correlated strongly with shortened OS. Kaplan-Meier curves will be available for presentation. Conclusion: In our study, CA125 levels after optimal surgery correlated well with FIGO stage, tumor grade and overall survival. No correlation was seen with preoperative CA125 levels.

No significant financial relationships to disclose.

Exchange and correlation effects in electronic excitations of Cu(2)O

State-of-the-art theoretical methods fail in describing the optical absorption spectrum, band gap, and optical onset of Cu(2)O. We have extended a recently proposed self-consistent quasiparticle approach, based on the GW approximation, to the calculation of optical spectra, including excitonic effects. The band structure compares favorably with our present angle-resolved photoemission measurements. The excitonic effects based on these realistic band structure and screening provide a reliable optical absorption spectrum, which allows for a revised interpretation of its main structures.

Predictors of outcome of mammography in the National Health Service Breast Screening Programme

BACKGROUND

Little is known about the factors influencing the risk of recall for assessment, invasive diagnostic procedures, and early rescreening after screening mammography.

METHODS

From June 1996 to March 1998 women attending screening at 10 National Health Service Breast Screening Programme (NHSBSP) centres completed a self administered questionnaire and were followed up for their screening outcome.

RESULTS

1969 (3.3%) out of 60 443 women aged 50-64 who had never used hormone replacement therapy (HRT) were recalled for assessment but were not diagnosed with breast cancer (defined here as false positive recall). After adjustment for the variation between centres, false positive recall was decreased significantly among women who were likely to have had a previous NHSBSP mammogram (odds ratio (OR) 0.49, 95% confidence interval (95% CI) 0.38 to 0.63 for likely versus unlikely), who were postmenopausal (OR 0.65, 95% CI 0.56 to 0.76 for postmenopausal v premenopausal) and increased significantly for women reporting previous breast surgery (OR 1.64, 95% CI 1.42 to 1.89). Although false positive recall decreased significantly with parity and increasing body mass index, these effects were not large and no significant variation was found with age, education, family history of breast cancer, oral contraceptive use, sterilisation, exercise, smoking, or alcohol consumption. Altogether 655 (1.1%) women had an invasive diagnostic procedure; no personal characteristics were predictive of this outcome, 286(0.5%) were referred for early rescreening, and this was increased significantly by nulliparity and a family history of breast cancer.

INTERPRETATION

Premenopausal women, those without a previous NHSBSP mammogram, and women with previous breast surgery have an increased risk of false positive recall by the NHSBSP.