The management of acne vulgaris in primary care: a cohort study of consulting and prescribing patterns using CPRD

Background Effective management of acne vulgaris in primary care involves support (usually provided over a number of consultations) and prescribing effective treatments. However, consulting and prescribing patterns for acne in primary care are not well described. Objective To describe the rate of primary care consultations and follow-up consultations; prescribing patterns, including overall use of acne related medications (ARM) and initial and follow-up prescribing, for acne vulgaris in the UK. Methods UK primary care acne consultations and prescriptions for ARMs were identified in the Clinical Practice Research Datalink (CPRD). Annual consultation rates (between 2004 and 2013) by age and gender, new consultations and consultations in the subsequent year; prescribing trends, prescribing during a new consultation and over the subsequent 90 days and year were calculated, using number of registered patients as the denominator. Results 65.9% of patients who had a new acne consultation had no further acne consultations in the subsequent year. 26.6%, 25.2%, 23.5% and 2.8% of patients were prescribed no ARM, an oral antibiotic, a topical antibiotic, or an oral plus topical antibiotic respectively during a new acne consultation. 59.9% and 38.5% of patients prescribed an ARM received no further ARM prescriptions in the following 90 days and one year respectively, despite most prescriptions being for 2 months or less. Prescribing rates for lymecycline and topical combined clindamycin/benzoyl peroxide increased substantially between 2004 and 2013. There were no important changes in consultation rates between 2004 and 2013. Conclusion These data suggest that patients with acne are receiving sub-optimal initial choice of ARMs, longitudinal care and prescribing

Let the Dead and Beautiful Rest

[Verse 1]Let the dead and the beautiful rest,Make her grave \u27neath the willow by the stream,Where the wind harps will whisper o\u27er the blest,Like the song of some angel in our dream.Oh, so young and fair,With her bright golden hair.Let her sleep, let her sleepLet her sleep \u27neath the willow by the stream,Let her sleep,Let her sleep \u27neath the willow by the stream. [Verse 2]Let the dead and the beautiful rest, Make her grave \u27neath the willow by the stream, Where the wind harps will whisper o\u27er the blest, Like the song of some angel in our dream. Oh, so young and fair, With her bright golden hair. Let her sleep, let her sleep Let her sleep \u27neath the willow by the stream, Let her sleep, Let her sleep \u27neath the willow by the stream. Let the dead and the beautiful rest,For the spring time is coming with its flow\u27rs,When the wild rose will blossom o\u27er her breast,As the song birds will while away the hours. [Verse 3]Let the dead and the beautiful rest, Make her grave \u27neath the willow by the stream, Where the wind harps will whisper o\u27er the blest, Like the song of some angel in our dream. Oh, so young and fair, With her bright golden hair. Let her sleep, let her sleep Let her sleep \u27neath the willow by the stream, Let her sleep, Let her sleep \u27neath the willow by the stream. Let the dead and the beautiful rest,Where the long drooping willow branches wave,While the moon, slowly sinking in the west,Leaves the stars keeping vigils o\u27er her grave

A Pair of Disjoint 3-GDDs of type g^t u^1

Pairwise disjoint 3-GDDs can be used to construct some optimal constant-weight codes. We study the existence of a pair of disjoint 3-GDDs of type $g^t u^1$ and establish that its necessary conditions are also sufficient.Comment: Designs, Codes and Cryptography (to appear

Developmental contexts and features of elite academy football players: Coach and player perspectives

Player profiling can reap many benefits; through reflective coach-athlete dialogue that produces a profile the athlete has a raised awareness of their own development, while the coach has an opportunity to understand the athlete's viewpoint. In this study, we explored how coaches and players perceived the development features of an elite academy footballer and the contexts in which these features are revealed, in order to develop a player profile to be used for mentoring players. Using a Delphi polling technique, coaches and players experienced a number of 'rounds' of expressing their opinions regarding player development contexts and features, ultimately reduced into a consensus. Players and coaches had differing priorities on the key contexts of player development. These contexts, when they reflect the consensus between players and coaches were heavily dominated by ability within the game and training. Personal, social, school, and lifestyle contexts featured less prominently. Although 'discipline' was frequently mentioned as an important player development feature, coaches and players disagreed on the importance of 'training'

Perspicuity and Granularity in Refinement

This paper reconsiders refinements which introduce actions on the concrete level which were not present at the abstract level. It draws a distinction between concrete actions which are "perspicuous" at the abstract level, and changes of granularity of actions between different levels of abstraction. The main contribution of this paper is in exploring the relation between these different methods of "action refinement", and the basic refinement relation that is used. In particular, it shows how the "refining skip" method is incompatible with failures-based refinement relations, and consequently some decisions in designing Event-B refinement are entangled.Comment: In Proceedings Refine 2011, arXiv:1106.348

Search For Trapped Antihydrogen

We present the results of an experiment to search for trapped antihydrogen atoms with the ALPHA antihydrogen trap at the CERN Antiproton Decelerator. Sensitive diagnostics of the temperatures, sizes, and densities of the trapped antiproton and positron plasmas have been developed, which in turn permitted development of techniques to precisely and reproducibly control the initial experimental parameters. The use of a position-sensitive annihilation vertex detector, together with the capability of controllably quenching the superconducting magnetic minimum trap, enabled us to carry out a high-sensitivity and low-background search for trapped synthesised antihydrogen atoms. We aim to identify the annihilations of antihydrogen atoms held for at least 130 ms in the trap before being released over ~30 ms. After a three-week experimental run in 2009 involving mixing of 10^7 antiprotons with 1.3 10^9 positrons to produce 6 10^5 antihydrogen atoms, we have identified six antiproton annihilation events that are consistent with the release of trapped antihydrogen. The cosmic ray background, estimated to contribute 0.14 counts, is incompatible with this observation at a significance of 5.6 sigma. Extensive simulations predict that an alternative source of annihilations, the escape of mirror-trapped antiprotons, is highly unlikely, though this possibility has not yet been ruled out experimentally.Comment: 12 pages, 7 figure

What the public think about participation in medical research during an influenza pandemic: an international cross-sectional survey

Objectives The public and patients are primary contributors and beneficiaries of pandemic-relevant clinical research. However, their views on research participation during a pandemic have not been systematically studied. We aimed to understand public views regarding participation in clinical research during a hypothetical influenza pandemic. Study design This is an international cross-sectional survey. Methods We surveyed the views of nationally representative samples of people in Belgium, Poland, Spain, Ireland, the United Kingdom, Canada, Australia and New Zealand, using a scenario-based instrument during the 2017 regional influenza season. Descriptive and regression analyses were conducted. Results Of the 6804 respondents, 5572 (81.8%) thought pandemic-relevant research was important, and 5089 (74.8%) thought ‘special rules’ should be applied to make this research feasible. The respondents indicated willingness to take part in lower risk (4715, 69.3%) and higher risk (3585, 52.7%) primary care and lower risk (4780, 70.3%) and higher risk (4113, 60.4%) intensive care unit (ICU) study scenarios. For primary care studies, most (3972, 58.4%) participants preferred standard enrolment procedures such as prospective written informed consent, but 2327 (34.2%) thought simplified procedures would be acceptable. For ICU studies, 2800 (41.2%) preferred deferred consent, and 2623 (38.6%) preferred prospective third-party consent. Greater knowledge about pandemics, trust in a health professional, trust in the government, therapeutic misconception and having had ICU experience as a patient or carer predicted increased willingness to participate in pandemic-relevant research. Conclusions Our study indicates current public support for pandemic-relevant clinical research. Tailored information and initiatives to advance research literacy and maintain trust are required to support pandemic-relevant research participation and engagement

Advances in Antisense Oligonucleotide Development for Target Identification, Validation, and as Novel Therapeutics

Antisense oligonucleotides (As-ODNs) are single stranded, synthetically prepared strands of deoxynucleotide sequences, usually 18–21 nucleotides in length, complementary to the mRNA sequence of the target gene. As-ODNs are able to selectively bind cognate mRNA sequences by sequence-specific hybridization. This results in cleavage or disablement of the mRNA and, thus, inhibits the expression of the target gene. The specificity of the As approach is based on the probability that, in the human genome, any sequence longer than a minimal number of nucleotides (nt), 13 for RNA and 17 for DNA, normally occurs only once. The potential applications of As-ODNs are numerous because mRNA is ubiquitous and is more accessible to manipulation than DNA. With the publication of the human genome sequence, it has become theoretically possible to inhibit mRNA of almost any gene by As-ODNs, in order to get a better understanding of gene function, investigate its role in disease pathology and to study novel therapeutic targets for the diseases caused by dysregulated gene expression. The conceptual simplicity, the availability of gene sequence information from the human genome, the inexpensive availability of synthetic oligonucleotides and the possibility of rational drug design makes As-ODNs powerful tools for target identification, validation and therapeutic intervention. In this review we discuss the latest developments in antisense oligonucleotide design, delivery, pharmacokinetics and potential side effects, as well as its uses in target identification and validation, and finally focus on the current developments of antisense oligonucleotides in therapeutic intervention in various diseases