Utility of sarcoma-specific fusion gene analysis in paraffin-embedded material for routine diagnosis at a specialist centre.

AIMS: Diagnosis of soft tissue sarcomas can be difficult. It can be aided by detection of specific genetic aberrations in many cases. This study assessed the utility of a molecular genetics/cytogenetics service as part of the routine diagnostic service at the Royal Marsden Hospital. METHODS: A retrospective audit was performed over a 15-month period to evaluate the diagnostic usefulness for soft tissue sarcomas with translocations of fluorescence in situ hybridisation (FISH) and reverse-transcriptase PCR (RT-PCR) in paraffin-embedded (PE) material. Results were compared with histology, and evaluated. RESULTS: Molecular investigations were performed on PE material in 158 samples (total 194 RT-PCR and 174 FISH tests), of which 85 were referral cases. Synovial sarcoma, Ewing sarcoma and low-grade fibromyxoid sarcoma were the most commonly tested tumours. Myxoid liposarcoma showed the best histological and molecular concordance, and alveolar rhabdomyosarcoma showed the best agreement between methods. FISH had a higher sensitivity for detecting tumours (73%, compared with 59% for RT-PCR) with a better success rate than RT-PCR, although the latter was specific in identifying the partner gene for each fusion. In particular, referral blocks in which methods of tissue fixation and processing were not certain resulted in higher RT-PCR failure rates. CONCLUSIONS: FISH and RT-PCR on PE tissue are practical and effective ancillary tools in the diagnosis of soft tissue sarcomas. They are useful in confirming doubtful histological diagnoses and excluding malignant diagnoses. PCR is less sensitive than FISH, and the use of both techniques is optimal for maximising the detection rate of translocation-positive sarcomas.

Ethical reasoning through simulation: a phenomenological analysis of student experience

Background
Medical students transitioning into professional practice feel underprepared to deal with the emotional complexities of real-life ethical situations. Simulation-based learning (SBL) may provide a safe environment for students to probe the boundaries of ethical encounters. Published studies of ethics simulation have not generated sufficiently deep accounts of student experience to inform pedagogy. The aim of this study was to understand students’ lived experiences as they engaged with the emotional challenges of managing clinical ethical dilemmas within a SBL environment.

Methods
This qualitative study was underpinned by an interpretivist epistemology. Eight senior medical students participated in an interprofessional ward-based SBL activity incorporating a series of ethically challenging encounters. Each student wore digital video glasses to capture point-of-view (PoV) film footage. Students were interviewed immediately after the simulation and the PoV footage played back to them. Interviews were transcribed verbatim. An interpretative phenomenological approach, using an established template analysis approach, was used to iteratively analyse the data.

Results
Four main themes emerged from the analysis: (1) ‘Authentic on all levels?’, (2)‘Letting the emotions flow’, (3) ‘Ethical alarm bells’ and (4) ‘Voices of children and ghosts’. Students recognised many explicit ethical dilemmas during the SBL activity but had difficulty navigating more subtle ethical and professional boundaries. In emotionally complex situations, instances of moral compromise were observed (such as telling an untruth). Some participants felt unable to raise concerns or challenge unethical behaviour within the scenarios due to prior negative undergraduate experiences.

Conclusions
This study provided deep insights into medical students’ immersive and embodied experiences of ethical reasoning during an authentic SBL activity. By layering on the human dimensions of ethical decision-making, students can understand their personal responses to emotion, complexity and interprofessional working. This could assist them in framing and observing appropriate ethical and professional boundaries and help smooth the transition into clinical practice.

Joint Analysis of Multiple Algorithms and Performance Measures

There has been an increasing interest in the development of new methods using Pareto optimality to deal with multi-objective criteria (for example, accuracy and time complexity). Once one has developed an approach to a problem of interest, the problem is then how to compare it with the state of art. In machine learning, algorithms are typically evaluated by comparing their performance on different data sets by means of statistical tests. Standard tests used for this purpose are able to consider jointly neither performance measures nor multiple competitors at once. The aim of this paper is to resolve these issues by developing statistical procedures that are able to account for multiple competing measures at the same time and to compare multiple algorithms altogether. In particular, we develop two tests: a frequentist procedure based on the generalized likelihood-ratio test and a Bayesian procedure based on a multinomial-Dirichlet conjugate model. We further extend them by discovering conditional independences among measures to reduce the number of parameters of such models, as usually the number of studied cases is very reduced in such comparisons. Data from a comparison among general purpose classifiers is used to show a practical application of our tests.

Parametric Analysis of Concrete Solar Collectors

Concrete solar collectors offer a type of solar collector with structural, aesthetic and economic advantages over current populartechnologies. This study examines the influential parameters of concrete solar collectors. In addition to the external conditions,the performance of a concrete solar collector is influenced by the thermal properties of the concrete matrix, piping network andfluid. Geometric and fluid flow parameters also influence the performance of the concrete solar collector. A literature review ofconcrete solar collectors is conducted in order to define the benchmark parameters from which individual parameters are thencompared. The numerical model consists of a 1D pipe flow network coupled with the heat transfer in a 3D concrete domain. Thispaper is concerned with the physical parameters that define the concrete solar collector, thus a constant surface temperature isused as the exposed surface boundary condition with all other surfaces being insulated. Results show that, of the parametersinvestigated, the pipe spacing, ps, concrete conductivity, kc, and the pipe embedment depth, demb, are among those parameterswhich have greatest effect on the collector’s performance. The optimum balance between these parameters is presented withrespect to the thermal performance and discussed with reference to practical development issues.

What do people think about running barefoot/with minimalist footwear? A thematic analysis

Objectives

Barefoot running describes when individuals run without footwear. Minimalist running utilizes shoes aimed to mimic being barefoot. Although these forms of running have become increasingly popular, we still know little about how recreational runners perceive them.
Design

In-depth interviews with eight recreational runners were used to gather information about their running experiences with a focus on barefoot and minimalist running.
Methods

Interviews were analysed using a latent level thematic analysis to identify and interpret themes within the data.
Results

Although participants considered barefoot running to be ‘natural’, they also considered it to be extreme. Minimalist running did not produce such aversive reactions. ‘Support’ reassured against concerns and was seen as central in protecting vulnerable body parts and reducing impact forces, but lacked a common or clear definition. A preference for practical over academic knowledge was found. Anecdotal information was generally trusted, as were running stores with gait assessment, but not health professionals.
Conclusion

People often have inconsistent ideas about barefoot and minimalist running, which are often formed by potentially biased sources, which may lead people to make poor decisions about barefoot and minimalist running. It is important to provide high-quality information to enable better decisions to be made about barefoot and minimalist running.

Statement of contribution

What is already known on this subject?
There is no known work on the psychology behind barefoot and minimalist running. We believe our study is the first qualitative study to have investigated views of this increasingly popular form of running.
What does this study add?
The results suggest that although barefoot running is considered ‘natural’, it is also considered ‘extreme’. Minimalist running, however, did not receive such aversive reactions.
‘Support’ was a common concern among runners. Although ‘support’ reassured against concerns and was seen as central in protecting vulnerable body parts and reducing impact forces, it lacked a common or clear definition.
A preference for practical over academic knowledge was found. Anecdotal information was generally trusted, as were running stores with gait assessment, but not health professionals.