Core outcome set for three ophthalmic conditions: a healthcare professional and patient consensus on core outcome sets for amblyopia, ocular motility and strabismus (COSAMS Study)

ObjectivesAmblyopia, strabismus and ocular motility disorders are common conditions with significant impact on visual function, appearance and quality of life. We aimed to establish a core set of outcomes for each of the three conditions for use in clinical trials and routine clinical practice.DesignA comprehensive databank of outcomes was developed from a systematic review of the literature and a series of focus groups with healthcare professionals, researchers, patients and carers. The databank of outcomes was scored in a two-round Delphi Survey completed by two stakeholder groups: healthcare professionals/researchers and patients/carers. Results of the online Delphi were discussed at a face-to-face consensus meeting where the core outcome sets were finalised.SettingUK-wide consultation.ParticipantsResearchers, clinicians, patients and carers.Outcome measuresCore outcome sets.ResultsFor amblyopia, strabismus and ocular motility, 40/42/33 participants contributed to both rounds of the Delphi; six/nine/seven members attended consensus meetings, respectively. Consensus was reached on ten core outcomes for both amblyopia and ocular motility and nine for strabismus. All three conditions shared the core outcomes: adverse events, cost, vision-related quality of life and ocular alignment. The strabismus and ocular motility disorder core sets included, in addition, measuring the deviation, binocular vision, ocular movement, patient satisfaction and symptoms. The amblyopia set, distinct from the sets for the other two conditions, included best corrected distance and near visual acuity, spherical and cylindrical refraction, compliance and treatment-related and functionality/long-term impacts.ConclusionsThe study used robust consensus methods to develop a core outcome set for three ophthalmic conditions. Implementation of these core outcome sets in clinical trials and routine clinical practice will ensure that the outcomes being measured and reported are relevant to all stakeholders. This will enhance the relevance of study findings and enable comparison of results from different studies

Deep Learning Methods for Device Identification Using Symbols Trace Plot

Devices authentication is one crucial aspect of any communication system. Recently, the physical layer approach radio frequency (RF) fingerprinting has gained increased interest as it provides an extra layer of security without requiring additional components. In this work, we propose an RF fingerprinting based transmitter authentication approach density trace plot (DTP) to exploit device-identifiable fingerprints. By considering IQ imbalance solely as the feature source, DTP can efficiently extract device-identifiable fingerprints from symbol transition trajectories and density center drifts. In total, three DTP modalities based on constellation, eye and phase traces are respectively generated and tested against three deep learning classifiers: the 2D-CNN, 2D-CNN+biLSTM and 3D-CNN. The feasibility of these DTP and classifier pairs is verified using a practical dataset collected from the ADALM-PLUTO software-defined radios (SDRs)

CR1 Knops blood group alleles are not associated with severe malaria in the Gambia

The Knops blood group antigen erythrocyte polymorphisms have been associated with reduced falciparum malaria-based in vitro rosette formation (putative malaria virulence factor). Having previously identified single-nucleotide polymorphisms (SNPs) in the human complement receptor 1 (CR1/CD35) gene underlying the Knops antithetical antigens Sl1/Sl2 and McC(a)/McC(b), we have now performed genotype comparisons to test associations between these two molecular variants and severe malaria in West African children living in the Gambia. While SNPs associated with Sl:2 and McC(b+) were equally distributed among malaria-infected children with severe malaria and control children not infected with malaria parasites, high allele frequencies for Sl 2 (0.800, 1,365/1,706) and McC(b) (0.385, 658/1706) were observed. Further, when compared to the Sl 1/McC(a) allele observed in all populations, the African Sl 2/McC(b) allele appears to have evolved as a result of positive selection (modified Nei-Gojobori test Ka-Ks/s.e.=1.77, P-value <0.05). Given the role of CR1 in host defense, our findings suggest that Sl 2 and McC(b) have arisen to confer a selective advantage against infectious disease that, in view of these case-control study data, was not solely Plasmodium falciparum malaria. Factors underlying the lack of association between Sl 2 and McC(b) with severe malaria may involve variation in CR1 expression levels

The effect of residual food stain on Candida albicans colonisation of denture acrylics

Published: NA Keywords: Candida albicans dentures food stains denture-induced stomatitis A B S T R A C T Objectives: In the UK, 19% of adults wear dentures. Failure to keep a denture clean can lead to staining from foods, along with subsequent colonisation of the denture and associated mucosa by microorganisms, particularly Candida albicans. This colonisation can potentially lead to chronic erythematous candidosis and other oral infections. This study investigated the association between staining of denture acrylics by different food types and subsequent C. albicans colonisation. Materials and Methods: Chemically polymerised acrylic specimens were produced and stained for 14 days with six different combinations of food stains. The level of acrylic staining was determined spectrophotometrically. Specimens were then incubated in Sabouraud-dextrose broth (SAB) or SAB inoculated with Candida albicans. Confocal laser scanning microscopy coupled with propidium iodide staining of C. albicans was used to determine the extent of C. albicans colonisation to these acrylics. Results analysed descriptively and by one-way analysis of variance (ANOVA), one sample student t-test, and Dunnett's test. Results: Acrylics in Group 4 (stained with spices, tomato puree, acai berry juice and sunflower oil) exhibited highest staining but had low C. albicans colonisation. Highest C. albicans colonisation occurred with Group 5 (sunflower oil) stained acrylics. The unstained control acrylic group had lowest colonisation. Conclusion: This study demonstrated that staining acrylics with certain foods promoted C. albicans colonisation, but this was not associated with level of visual staining. Further research is required to determine the precise mechanism(s) by which residual food stains promote candidal colonisation on denture acrylics. This knowledge may then be used by dental professionals to advise patients on improving denture hygiene to improve not only denture aesthetics but also minimise Candida biofilms

The effect of Liver Transplantation on the quality of life of the recipient's main caregiver - a systematic review

Introduction: Liver transplantation (LT) is a transformative, life-saving procedure with life-long sequale for patients and their caregivers. The impact of LT on the patient's main caregiver can be underestimated. We carried out a systematic review of the impact of LT on the Health Related Quality of Life (HRQL) of LT patients’ main caregivers. Methods: We searched 13 medical databases from 1996 to 2015. We included studies with HRQL data on caregivers of patients following LT then quality assessed and narratively synthesized the findings from these studies. Results: Of 7076 initial hits, only five studies fell within the scope of this study. In general, they showed caregiver burden persisted in the early period following LT. One study showed improvements, however the other four showed caregiver's levels of stress, anxiety and depression, remained similar or got worse post-LT and remained above that of the normal population. It was suggested that HRQL of the patient impacted on the caregiver and vice versa and may be linked to patient outcomes. No data was available investigating which groups were at particular risk of low HRQL following LT or if any interventions could improve this. Conclusion: The current information about LT caregivers’ needs and factors that impact on their HRQL are not adequately defined. Large studies are needed to examine the effects of LT on the patients’ family and caregivers in order to understand the importance of caregiver support to maximise outcomes of LT for the patient and their caregivers

The Effect of Basal Diet on Lactate-Producing Bacteria and the Susceptibility of Sheep to Lactic Acidosis

The influence of a diet of either pasture or hay on the development of lactic acidosis in sheep was investigated using a grain challenge approach. Twenty-four Merino wethers with a mean live weight of 36.7 (s.e. 3.6) kg were used; 12 were adapted to grass pasture and 12 to hay (lucerne and oaten hay, 60 : 40) for 4 weeks before being given 1 kg of crushed barley via stomach tube. Six sheep in each group were also given virginiamycin (VM; 50 mg/kg barley) with the grain to test the efficacy of this antibiotic in controlling the bacteria responsible for the development of acidosis. Changes in volatile fatty acid (VFA), pH, lactate and bacterial count in the rumen and faecal pH and dry matter (DM) were measured for a 24-h period following administration of the barley. Daily intakes of hay were measured for a 10-day period following grain engorgement. Total ruminal VFA increased (P < 0.01) over time and tended (P = 0.08) to be higher in sheep adapted to hay than in those adapted to pasture (67.5 v. 59.8 mmol/l). The molar proportions of VFA changed (P< 0.01) over time in favour of propionate in both groups. Ruminal pH was higher (P< 0.001) in pasture-adapted sheep, but declined (P< 0.001) in both groups over time following the introduction of barley. This decline in pH was associated with increases in ruminal concentration of VFA in pasture-adapted sheep and VFA and lactate in hay-adapted sheep. The addition of VM resulted in a higher (P < 0.001) proportion of propionate and a trend towards higher (P = 0.24) faecal pH and DM content. Faecal pH and DM content declined (P < 0.001) over time and was lower for the pasture-adapted sheep. The introduction of either barley alone or barley with VM from both hay and pasture diets increased (P < 0.05) the viable counts of total bacteria, Streptococcus bovis and lactic acid bacteria. Bacterial isolates were purified and identified by complete sequencing of the 16S rRNA gene to determine the predominant bacteria during the overfeeding of grain. Isolates from medium selective for S. bovis were all identified as this species when VM was not given. VM had no effect on counts of viable bacteria, but inhibited the growth of S. bovis

Microparticle surface layering through dry coating: impact of moisture content and process parameters on the properties of orally disintegrating tablets

Objectives: The aim of this study was to investigate the influence of process parameters during dry coating on particle and dosage form properties upon varying the surface adsorbed moisture of microcrystalline cellulose (MCC), a model filler/binder for orally disintegrating tablets (ODTs). Methods: The moisture content of MCC was optimised using the spray water method and analysed using thermogravimetric analysis. Microproperty/macro-property assessment was investigated using atomic force microscopy, nano-indentation, scanning electron microscopy, tablet hardness and disintegration testing. Key findings: The results showed that MCC demonstrated its best flowability at a moisture content of 11.2% w/w when compared to control, comprising of3.9% w/w moisture. The use of the composite powder coating process (without air) resulted in up to 80% increase in tablet hardness, when compared to the control. The study also demonstrated that surface adsorbed moisture can be displaced upon addition of excipients during dry processing circumventing the need for particle drying before tabletting. Conclusions: It was concluded that MCC with a moisture content of 11% w/w provides a good balance between powder flowability and favourable ODT characteristics

Assessment of the effect of Cellets’ particle size on the flow in a Wurster fluid-bed coater via powder rheology

© 2019 Elsevier B.V. This manuscript is made available under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International licence (CC BY-NC-ND 4.0). For further details please see: https://creativecommons.org/licenses/by-nc-nd/4.0/The main objective of this study was to investigate the effect of microcrystalline cellulose (MCC) spheres (Cellets) size effect on the powder properties to assess the possible impact of the Cellets’ size on the powder behaviour in the down-flow bed and horizontal transport zone when a Wurster fluid-bed coater is used. The particle size distribution of Cellets was determined using optical digital microscopy. Standard pharmacopoeia methods as bulk/tapped density and flow rate measured with gravitational funnel method as well as investigation of dynamic angle of repose and dynamic cohesivity index with a rotating drum tester (GranuDrum) and conditioned bulk density, basic flowability energy, specific energy, pressure drop, permeability and compressibility by powder rheometer (FT4 Powder Rheometer®), were employed to characterise the powder's properties of Cellets 90, 100, 200 and 350 (D 50-size from 94 to 424 μm) alone or premixed with 0.5% w/w magnesium stearate. Specific powder rheology methods were proposed for characterisation of Cellets’ behaviour in down-flow bed, the horizontal transport and coating zone. The level of Cellets’ processability decreasing in the Wurster fluid-bed coater with decreasing of Cellets size (D 50) from 425 to 94 μm was established with different powder rheology methods.Peer reviewedFinal Accepted Versio

Interprofessional, student-led intervention to improve insulin prescribing to patients in an Acute Surgical Receiving Unit

Our aim was to test the feasibility of interprofessional, workplace-based learning about improvement through a 4-week placement for one medical and two pharmacy final year students in an Acute Surgical Receiving Unit (ASRU). The target was insulin because this is a common, high-risk medicine in this ASRU and the intervention was medicines reconciliation. Baseline data were collected from 10 patients and used to construct a cause and effect diagram and a process map through feedback and discussions with staff. Hypoglycaemia occurred in four patients but hyperglycaemia occurred in eight patients, of whom six were placed on intravenous insulin infusion (IVII). We estimated that £2454 could be saved by preventing one patient from going on IVII. The students designed and tested a sticker to improve medicines reconciliation for insulin patients. An online form was created to capture clinician feedback on the layout and usability of the sticker. The intervention was associated with improvements in the reliability of medicines reconciliation. The students’ work contributed to a larger project to reduce the risk of hypoglycaemia in the ASRU. This proved beneficial in enabling the students to engage with the clinical team. Nonetheless, it was challenging for students from two Universities to get a shared understanding of improvement methods and work effectively with the clinical team. The students said that they learnt more about quality improvement in a working healthcare environment than they would ever learn in a classroom and they valued the opportunity to work with students from other healthcare backgrounds in practice. Despite the additional staff time required to support students from two Universities, both have supported continuation of this work