University of Wales

Abstract Introduction Minimally invasive techniques have transformed early rectal cancer treatment; yet the optimal approach is unclear. ESD, EMR, and TAMIS are increasingly being used, however, most studies only compare two of these techniques. This meta-analysis directly compares all three in efficacy, safety, and oncological performance. Methods PubMed, Scopus, and Medline were searched to identify relevant studies as of September 2024. Criteria included studies in adults with early rectal cancer treated by ESD, EMR, or TAMIS, reporting at least one outcome and specifying treatment type and cancer stage. Comprehensive Meta-Analysis v4 was used for analysis with heterogeneity assessed via I². Results A total of 127 studies encompassing 8915 patients were included (EMR = 3979, ESD = 4470, and TAMIS = 466). Mean procedural times were: overall 8.3 min (7.7–8.8), I² = 99%; EMR 7.5 (6.9–8.1), I² = 98%; ESD 32.6 (29.3–36), I² = 99%; TAMIS 101.6 (83.9–119.9), I² = 95%. En bloc resection: overall 87.1% (85.6–88.5), I² = 81%; EMR 86.5% (84.4–88.4), I² = 82%; ESD 87.2% (84.4–89.5), I² = 80%; TAMIS 94.1% (88.9–97), I² = 0%. R0 resection: overall 79.7% (78.6–80.8), I² = 80%—EMR 79.9% (78.3–81.5), I² = 85%; ESD 78.7% (77.1–80.3), I² = 76%; TAMIS 87.1% (82.8–90.4), I² = 42%. Conclusions Although EMR appears efficient, it demonstrated less favourable outcomes regarding en bloc resection. ESD showed favourable oncological outcomes while maintaining moderate procedural time. TAMIS is most time-intensive but yields the highest resection quality.

Experimental and computational studies on the mechanism of a well-known procedure for the oxidation of alcohols to carbonyl compounds using TEMPO and the hypervalent iodine(III) reagent (diacetoxyiodo)benzene (PIDA) are reported. Kinetic data show that the assumed classical oxoammonium-hydroxylamine mechanism requires modification due to zero-order behavior observed in TEMPO. Instead, a dual catalytic system is proposed featuring two rate-determining steps involving a combination of alcohol, hypervalent iodine species, and water, which is typically present in adventitious quantities and is necessary for the reaction to proceed. The use of different alcohols implies the mechanism to be general. Intramolecular radical trap probes rule out a radical mechanism, while an investigation of TEMPO derivatives suggests that TEMPO is involved prior to the rate-determining step. Kinetic isotope effect studies demonstrate that TEMPO is also involved after the rate-determining step. Electrochemical studies find that the oxoammonium form of TEMPO is reduced by PIDA, likely oxidizing iodine(III) to an iodine(V) species. Theoretical investigations support the feasibility of a pathway involving an iodine(V) species, demonstrate good agreement with the experimentally derived kinetics, and support an updated mechanism. Finally, the demonstration of oxidative kinetic resolution of a secondary alcohol using a chiral iodine(III) reagent rationally extends the reactivity of this system to new chemistry and lends further support toward our mechanistic proposals.

Over the past quarter-century, pediatric dentistry has shifted from an expert-opinion-driven craft-often extrapolated from adult dental care, to become a discipline anchored in rigorous, child-specific evidence. This transformation reflects the maturation of evidence-based dentistry (EBD): integrating the best available research with clinical expertise and the values and preferences of children and their families. As we celebrate the Journal of Evidence-Based Dental Practice at 25 years of age, this article charts some milestones in pediatric EBD that show how clinical practice has led to scientific enquiry, research investigations and widespread changes in practice. The examples used are the Hall Technique, Atraumatic Restorative Treatment and pulp canal obliteration in dental trauma management. A pathway to improve research impact is proposed, stretching from ensuring research relevance and methodological rigor through to talking and listening to those who are stakeholders, planning implementation of findings, using core- and patient relevant- outcome sets, public communication and open science. Change does not have to be global to be important: locally tailored, context-aware research and its implementation can improve children's oral healthcare, reduce inequalities and deliver value.

Mental imagery vividness varies between individuals. Low levels of mental imagery have been associated with high levels of autistic traits, whilst autistic traits are known to positively correlate with sensory sensitivities. This would predict a negative correlation between sensory sensitivity and imagery. However, one recent study has suggested that mental imagery vividness may be positively associated with sensory sensitivities, possibly through the shared mechanism of hyperexcitability of the sensory cortices. The aim of this paper was to explore this contradictory set of associations across two modalities (visual and tactile). We used standardised questionnaires to measure autistic traits, sensory sensitivities, and mental imagery vividness in a sample evenly comprised of autistic and non-autistic adults (n = 595). Higher autistic traits were significantly associated with lower mental imagery (r = - 0.20 and r = - 0.17 for visual and tactile imagery respectively), and a higher incidence of aphantasia was observed in the autistic group compared to the non-autistic group. In addition, higher autistic traits were significantly associated with increased sensory sensitivities (r = 0.76). Importantly, we found negligible evidence of an association between mental imagery and sensory sensitivity, even when controlling for autistic traits. In the first study to directly explore autistic traits, sensory sensitivities and mental imagery, we conclude that there is no clear evidence to suggest that mental imagery and sensory sensitivity are related, challenging the idea of shared mechanisms of hyperexcitability of sensory cortex.

<h3>Introduction</h3> Validated grief tools help assess and support bereaved populations, but there are currently no suitable tools for use with young children and children with Special Educational Needs (SEN). <h3>Aim</h3> To develop a pictorial version of the Children’s Attitude to Grief (CAG) Scale for use with young children and children with SEN. <h3>Methods</h3> We conducted a scoping review of grief and mental health tools which use non-verbal methods, followed by an online workshop with child bereavement and SEN practitioners, academic/researchers, an illustrator and public representative. Review findings were discussed in relation to the main CAG scale and associated Range of Response to Loss (RRL) model, with changes suggested to improve accessibility, alongside ideas for visual representations. Through an iterative design and review process involving the research team, practitioners and illustrator, alongside child feedback on draft illustrations, we created a pictorial version of the scale which is now being piloted. <h3>Results</h3> A number of modifications were made to the main CAG scale. Structurally, the order of the nine questions was changed to give flow to the grief ‘story’, based on three subgroups of questions: thinking; feeling, and a changed world. Narrative explanations precede each question, with focus directed towards pictures depicting the overwhelmed, controlled and resilient RRL concepts. Direct (do you..?) questions are used to assess each concept, and a reduced three-point scale captures responses, with beakers used to visualise the options ‘yes-a lot’, ‘yes-a bit’, ‘no-not at all.’ To aid identification, gender neutral images have been used centring around a child named ‘Sam’, who experienced the same type of (modifiable) loss as the child receiving support. <h3>Conclusion/Impact</h3> The CAG-P is the first pictorial grief scale designed for use with bereaved young children and older children with SEN. We anticipate widespread Impact on these populations and those working with them.

Ammonia is increasingly seen as a promising fuel for combustion applications, including gas turbines, due to its hydrogen content and ease of storage, making it a potential method for storing renewable energy. However, using ammonia directly poses challenges in controlling NO x emissions, especially for retrofitting existing gas turbines. Cracking ammonia to produce hydrogen and nitrogen could mitigate this issue, although uncracked ammonia traces may remain due to inefficiencies. Therefore, this paper evaluates the impacts on swirling flames, representative of gas turbine combustors, when highly cracked ammonia (17.5% H2, 1.0% NH3, and 81.5% N2) is used. Experiments were conducted at pressures ranging from 1.1 to 6 bar absolute, with air preheated to 500 K and a constant power output of 22.7 kW maintained under lean conditions (equivalence ratio ∼ 0.545) throughout the tests. NH2 chemiluminescence intensity increased monotonically with pressure from 1.1 to 6 bar, with a peak intensity observed at 6 bar due to enhanced radical formation at higher collision frequencies. NO x emissions rose from 90 ppmv at 1.1 bar to 189 ppmv at 4 bar before stabilizing, indicating a balance between thermal NO x formation and ammonia-mediated reduction pathways at higher pressures. NH* intensity decreased with increasing pressure, while OH* radicals remained relatively constant, providing insights into flame structure and reaction zone characteristics. A chemical reactor network model complemented the experimental findings, capturing flame zone dynamics and revealing consistent NO formation pathways through NH3, NH2, and NNH dissociation across different pressures. These findings demonstrate that pressure significantly influences radical distribution and NO x formation mechanisms in highly cracked ammonia combustion, with implications for gas turbine combustor design and emission control strategies. To the authors' knowledge, this is the first systematic study of pressure-dependent chemiluminescence behavior in highly cracked ammonia swirl flames, providing critical insights for the development of low-emission gas turbine combustors using ammonia-derived fuels.

In most countries, a criminal conviction requires evidence that the individual committed the act and that they had the mental capacity to understand what they were doing and that it was wrong. Youth, as an indicator of brain development, is one factor affecting criminal capacity. Worldwide, this has commonly been managed in part by setting in law an age below which criminal incapacity is presumed, so no prosecution is possible. Considerable variation in the MACR was confirmed across 195 countries. Some countries have no MACR. Otherwise, the MACR ranges from 7years (some African and South Asian countries) to 18 (some South American countries); many North Asian, European and a few African countries set theirs at 14 which is the most frequently found level, and also the minimum age recommended by the United Nations Convention on the Rights of the Child. Therefore, how do countries set or change their MACR? To explore change, efforts to change and impact of change in MACR internationally. Between February 1st 2022 and December 31st 2023, members of an international research group (GIRAF-Group of International Researchers in Adolescent Forensics) were asked to complete an emailed questionnaire about changes in the MACR, or efforts to change it, in their country since 2000. Reports were then collated, circulated and discussed within the group. Among the 14 countries responding in detail about the MACR, efforts to raise the MACR had been successful in three, but in nine such efforts had been unsuccessful; in at least two countries pressures were to lower their MACR, but in only one, Denmark, did that happen (from 15 to 14) in the data collection period (though this change was subsequently reversed). Factors most influencing retention of a lower age were exceptional individual cases, which triggered press and political interest in retaining a higher age, and well-evidenced and developed arguments from legal, social and medical or other clinical bodies. The wide differences in the MACR between countries suggest under-use of evidence in deciding it. We need more governmental willingness to bring the MACR at least to the UN-recommended level-but accompanied by research into the impact of this. Efforts targeted exclusively on child and adolescent welfare may have less effect if they also force children through the criminal justice system, with consequent impact on self-identity and sense of citizenship. A low MACR is also likely to be more directly and indirectly costly than a higher one.