The phase behavior of gels of E40B10 in 0.2 mol dm-3 aqueous K2SO4 was studied as a function of temperature and concentration. E40B10 is a diblock copolymer of poly(oxyethylene) (E) and poly(oxybutylene) (B), where the subscripts denote the number of repeats. The phase of the material was characterized by both simultaneous rheology and small-angle X-ray scattering, (SAXS). Depending on polymer volume fraction in the range 23−38% a body-centered cubic (bcc) structure or a face-centered cubic (fcc) structure was observed at low temperature, and at high temperature a hexagonally packed rod structure was formed. The phase transitions were shown to be characterized by discontinuous changes in the values of the dynamic shear moduli. A bcc−fcc transition was observed at high concentration, the corresponding transition temperature increasing with increasing polymer concentration. The effects of reciprocating shear were shown to increase the degree of order, manifested as a sharpening of the diffraction peaks in the SAXS pattern. The dynamic moduli decreased rapidly on the application of oscillatory shear and recovered equally rapidly when the deformation ceased. The decrease in moduli was shown, via the SAXS patterns acquired simultaneously, to be correlated to structural changes within the gel.

In myelodysplastic syndromes (MDS), health-related quality of life (HRQoL) represents a relevant patient-reported outcome, which is essential in individualized therapy planning. Prospective data on HRQoL in lower-risk MDS remain rare. We assessed HRQOL by EQ-5D questionnaire at initial diagnosis in 1690 consecutive IPSS-Low/Int-1 MDS patients from the European LeukemiaNet Registry. Impairments were compared with age- and sex-matched EuroQol Group norms. A significant proportion of MDS patients reported moderate/severe problems in the dimensions pain/discomfort (49.5%), mobility (41.0%), anxiety/depression (37.9%), and usual activities (36.1%). Limitations in mobility, self-care, usual activities, pain/discomfort, and EQ-VAS were significantly more frequent in the old, in females, and in those with high co-morbidity burden, low haemoglobin levels, or red blood cells transfusion need (p < 0.001). In comparison to age- and sex-matched peers, the proportion of problems in usual activities and anxiety/depression was significantly higher in MDS patients (p < 0.001). MDS-related restrictions in the dimension mobility were most prominent in males, and in older people (p < 0.001); in anxiety/depression in females and in younger people (p < 0.001); and in EQ-VAS in women and in persons older than 75 years (p < 0.05). Patients newly diagnosed with IPSS lower-risk MDS experience a pronounced reduction in HRQoL and a clustering of restrictions in distinct dimensions of HRQoL as compared with reference populations.

BackgroundIn the UK, women are recommended to engage with maternity services and establish a plan of care prior to the 12th completed week of pregnancy. The aim of this study was to identify predictors for late initiation of antenatal care within an ethnically diverse cohort in East London.MethodsCross-sectional analysis of routinely collected electronic patient record data from Newham University Hospital NHS Trust (NUHT). All women who attended their antenatal booking appointment within NUHT between 1st January 2008 and 24th January 2011 were included in this study. The main outcome measure was late antenatal booking, defined as attendance at the antenatal booking appointment after 12 weeks (+6 days) gestation. Data were analysed using multivariable logistic regression with robust standard errors.ResultsLate initiation of antenatal care was independently associated with non-British (White) ethnicity, inability to speak English, and non-UK maternal birthplace in the multivariable model. However, among those women who both spoke English and were born in the UK, the only ethnic group at increased risk of late booking were women who identified as African/Caribbean (aOR: 1.40: 95% CI: 1.11, 1.76) relative to British (White). Other predictors identified include maternal age younger than 20 years (aOR: 1.32; 95% CI: 1.13-1.54), high parity (aOR: 2.09; 95% CI: 1.77-2.46) and living in temporary accommodation (aOR: 1.71; 95% CI: 1.35-2.16).ConclusionsSocio-cultural factors in addition to poor English ability or assimilation may play an important role in determining early initiation of antenatal care. Future research should focus on effective interventions to encourage and enable these minority groups to engage with the maternity services.

BackgroundIn high-income countries, 6% of all women will have sustained a fracture of the wrist (distal radius) by the age of 80 years and 9% by the age of 90 years. Advances in orthopaedic surgery have improved the outcome for patients: many such fractures can be treated in a plaster cast alone, but others require surgical fixation to hold the bone in place while they heal. The existing evidence suggests that modern locking-plate fixation provides improved functional outcomes, but costs more than traditional wire fixation.MethodsIn this multicentre trial, we randomly assigned 461 adult patients having surgery for an acute dorsally displaced fracture of the distal radius to either percutaneous Kirschner-wire fixation or locking-plate fixation. The primary outcome measure was the Patient-Rated Wrist Evaluation©(PRWE) questionnaire at 12 months after the fracture. In this surgical trial, neither the patients nor the surgeons could be blind to the intervention. We also collected information on complications and combined costs and quality-adjusted life-years (QALYs) to assess cost-effectiveness.ResultsThe baseline characteristics of the two groups were well balanced and over 90% of patients completed follow-up. Both groups of patients recovered wrist function by 12 months. There was no clinically relevant difference in the PRWE questionnaire score at 3 months, 6 months or 12 months [difference at 12 months: –1.3; 95% confidence interval (CI) –4.5 to 1.8;p = 0.398]. There was no difference in the number of complications in each group and small differences in QALY gains (0.008; 95% CI –0.001 to 0.018); Kirschner-wire fixation represents a cost-saving intervention (–£727; 95% CI –£588 to –£865), particularly in younger patients.ConclusionsContrary to the existing literature, and against the increasing use of locking-plate fixation, this trial shows that there is no difference between Kirschner wires and volar locking plates for patients with dorsally displaced fractures of the distal radius. A Kirschner-wire fixation is less expensive and quicker to perform.Trial registrationCurrent Controlled Trials ISRCTN31379280.FundingThis project was funded by the NIHR Health Technology Assessment programme and will be published in full inHealth Technology Assessment; Vol. 19, No. 17. See the NIHR Journals Library website for further project information.

The effect of shear on the orientation of cubic micellar phases formed by a poly(oxyethylene)–poly(oxybutylene) diblock copolymer in aqueous solution has been investigated using small-angle x-ray scattering (SAXS) and small-angle neutron scattering (SANS). SAXS was performed on samples oriented in a Couette cell using steady shear, and SANS was performed on samples subject to oscillatory shear in situ in a rheometer with a shear sandwich configuration. A body-centered-cubic (bcc) phase observed for gels with concentrations greater than 30 wt % copolymer was found to orient into a polydomain structure, with the close-packed {110} planes both parallel and perpendicular to the shear plane. For gels with 30 wt % copolymer or less, a face-centered-cubic (fcc) phase was observed, and this was also observed on heating the more concentrated gels that formed a bcc phase at room temperature. The fcc phase could be oriented to form a highly twinned structure, with a significant deviation from the ABCABC… stacking sequence of the ideal structure due to random sequences resulting from slip of {111} hexagonal-close-packed planes. For the lower concentration gels, a transition from hard to soft gel on increasing temperature was found to be characterized by a change in the susceptibility of the sample to macroscopic shear orientation, as probed using SAXS. The hard gel could be oriented by shear into a twinned fcc structure, whereas the soft gel comprised a fcc phase with a small grain size, which could not be sheared to form a macroscopically oriented domain. Shear only homogenized the sample, producing a powder SAXS pattern from a fcc structure.