UK Heart Surgery: What Patients Can Expect from their Surgeons

This report presents selected findings from the National Adult Cardiac Surgery Audit for heart operations that took place between 2001/2 and 2010/11, alongside other information about cardiac surgery in the UK

Results from an online survey of adults with cystic fibrosis: Accessing and using life expectancy information

Cystic fibrosis (CF) is the one of the most common inherited diseases. It affects around 10,000 people in the UK, and the median survival age is 47. Recent developments making use of longitudinal patient registry data are producing more detailed and relevant information about predicted life expectancy in CF based on current age and clinical measurements. The objective of this study was to conduct an online survey of adults with CF living in the UK using a web-based questionnaire to investigate: (i) if and how they access information on life expectancy; (ii) what they use it for; (iii) if they want more personalised information on life expectancy or the time until other milestones. The survey was advertised through the Cystic Fibrosis Trust using social media. There were 85 respondents, covering men (39%) and women (61%) aged 16–65. 75% had received information on life expectancy either from their CF care team (34%) or other sources (71%), the most common being the Cystic Fibrosis Trust website and research literature. Most people who received information found it to be beneficial and reported using it in a variety of ways, including to plan strategies for maintaining as best health as possible and to psychologically manage current health status. 82% of respondents were interested in more personalised information about their life expectancy, and participants also noted interest in other outcomes, including time to needing transplant or reaching a low level of lung function. Themes arising in text responses included the importance of good communication of information, the difficulty of relating general information to one’s own circumstances, and a desire for increased information on factors that impact on survival in CF. As an outcome from this work, research is underway to establish how information on life expectancy can be presented to people with CF in an accessible way

Identifying children with Cystic Fibrosis in population-scale routinely collected data in Wales

IntroductionThe challenges in identifying a cohort of people with a rare condition can be addressed by routinely collected, population-scale electronic health record (EHR) data, which provide large volumes of data at a national level. This paper describes the challenges of accurately identifying a cohort of children with Cystic Fibrosis (CF) using EHR and their validation against the UK CF Registry.ObjectivesTo establish a proof of principle and provide insight into the merits of linked data in CF research; to identify the benefits of access to multiple data sources, in particular the UK CF Registry data, and to demonstrate the opportunity it represents as a resource for future CF research.MethodsThree EHR data sources were used to identify children with CF born in Wales between 1st January 1998 and 31st August 2015 within the Secure Anonymised Information Linkage (SAIL) Databank. The UK CF Registry was later acquired by SAIL and linked to the EHR cohort to validate the cases and explore the reasons for misclassifications.ResultsWe identified 352 children with CF in the three EHR data sources. This was greater than expected based on historical incidence rates in Wales. Subsequent validation using the UK CF Registry found that 257 (73%) of these were true cases. Approximately 98.7% (156/158) of individuals identified as CF cases in all three EHR data sources were confirmed as true cases; but this was only the case for 19.8% (20/101) of all those identified in just a single data source.ConclusionIdentifying health conditions in EHR data can be challenging, so data quality assurance and validation is important or the merit of the research is undermined. This retrospective review identifies some of the challenges in identifying CF cases and demonstrates the benefits of linking cases across multiple data sources to improve quality

Architectural Effects on Impact Resistance of Uncoated MI SiC/SiC Composites

Impact tests were conducted on uncoated 2D and 2.5D MI SiC/SiC composite specimens at room temperature and 1316 C in air. The specimens were analyzed before and after impact using optical microscopy, pulsed thermography (PT) and computed tomography (CT). Preliminary results indicate the following. Both 2-D and 2.5D composites show increase in surface and volumetric damages with increasing impact velocity. However, 2-D composites are prone to delamination cracks. In both 2D and 2.5D composites, the magnitude of impact damage at a fixed impact velocity is slightly greater at room temperature than at 1315 C. At a fixed projectile velocity and test temperature, the depth of penetration of the projectile into the substrate is significantly lower in 2.5D composites than in 2D composites. Fiber architecture plays a significant role controlling impact damage in MI SiC/SiC composites

Impact Resistance of EBC Coated SiC/SiC Composites

Impact performance of 2-D woven SiC/SiC composites coated with 225 and 525 m thick environmental barrier coating (EBC) was investigated. The composites were fabricated by melt infiltration and the EBC was deposited by plasma spray. Impact tests were conducted at room temperature and at 1316 C in air using 1.59-mm diameter steel-balls at projectile velocities ranging from 110 to 375 m/s. Both microscopy and nondestructive evaluation (NDE) methods were used to determine the extent of damage in the substrate and coating with increasing projectile velocity. The impacted specimens were tensile tested at room temperature to determine their residual mechanical properties. At projectile velocities less than 125 m/s, no detectable damage was noticed in the MI SiC/SiC composites coated with 525 m EBC. With increase in projectile velocity beyond this value, spallation of EBC layers, delamination of fiber plies, and fiber fracture were detected. At a fixed projectile velocity, the composites coated with 525 m EBC showed less damage than the composite coated with 225 m EBC. Both types of EBC coated composites retained a large fraction of the baseline properties of as-fabricated composites and exhibited non-brittle failure after impact testing at projectile velocities up to 375 m/s. Exposure of impact tested specimens in a moisture environment at 1316 C for 500 hr indicated that the through-the-thickness cracks in the EBC coating and delamination cracks in the substrate generated after impact testing acted as conduits for internal oxidation

Crop Updates 2005 Oilseeds

This session covers fifteen papers from different authors: 1. ACKNOWLEDGEMENTS, Douglas Hamilton, FARMING SYSTEMS DEVELOPMENT OFFICER CROP AGRONOMY AND NUTRITION 2. Canola workshop at Crop Updates 2005, Oilseeds WA, John Duff, EXECUTIVE OFFICER OILSEEDS WA 3. Comparison of IT and TT canola varieties in geographic zones of WA, 2003-4, Graham Walton and Hasan Zaheer, Department of Agriculture 4. Farmer scale canola variety trials in WA, 2004, Graham Walton, John Duff, Neil Harris and Heather Cosgriff, Oilseeds WA 5. Oilseed crops for industrial uses, Margaret C. Campbell, Centre for Legumes in Mediterranean Agriculture (CLIMA), Graham Walton,Department of Agriculture 6. Weed control opportunities with GM canola, Bill Crabtree, Independent Consultant, Northam 7. Soil and tissue tests for the sulfur requirements of canola, R.F. Brennan and M.D.A. Bolland, Department of Agriculture 8. Tests to predict the potassium requirements of canola, R.F. Brennan and M.D.A. Bolland, Department of Agriculture 9. Genotypic variation in potassium efficiency of canola, P.M. Damon and Z. Rengel, Faculty of Natural and Agricultural Sciences, UWA 10. Atrazine contamination of groundwater in the agricultural region of Western Australia, Russell Speed1, Neil Rothnie2, John Simons1, Ted Spadek2 and John Moore1;1Department of Agriculture, 2Chemistry Centre (WA) PESTS AND DISEASES 11. Controlling aphids and Beet western yellows virus in canola using imidacloprid seed dressing, Brenda Coutts and Roger Jones; Department of Agriculture 12. Managing sclerotinia in canola, Neil Harris, Dovuro Seeds Western Australia 13. Slugs, the trail of destruction in canola, Neil Harris, Dovuro Seeds Western Australia 14. Blackleg risk assessment and strategies for risk management in canola during 2005 and beyond, Moin Salam, Ravjit Khanguraand Art Diggle, Department of Agriculture 15. Modelling: BRAT – Blackleg Risk Appraisal Tool, Moin Salam, Ravjit KhanguraDepartment of Agricultur

Getting our ducks in a row:The need for data utility comparisons of healthcare systems data for clinical trials

BACKGROUND: Better use of healthcare systems data, collected as part of interactions between patients and the healthcare system, could transform planning and conduct of randomised controlled trials. Multiple challenges to widespread use include whether healthcare systems data captures sufficiently well the data traditionally captured on case report forms. "Data Utility Comparison Studies" (DUCkS) assess the utility of healthcare systems data for RCTs by comparison to data collected by the trial. Despite their importance, there are few published UK examples of DUCkS.METHODS-AND-RESULTS: Building from ongoing and selected recent examples of UK-led DUCkS in the literature, we set out experience-based considerations for the conduct of future DUCkS. Developed through informal iterative discussions in many forums, considerations are offered for planning, protocol development, data, analysis and reporting, with comparisons at "patient-level" or "trial-level", depending on the item of interest and trial status.DISCUSSION: DUCkS could be a valuable tool in assessing where healthcare systems data can be used for trials and in which trial teams can play a leading role. There is a pressing need for trials to be more efficient in their delivery and research waste must be reduced. Trials have been making inconsistent use of healthcare systems data, not least because of an absence of evidence of utility. DUCkS can also help to identify challenges in using healthcare systems data, such as linkage (access and timing) and data quality. We encourage trial teams to incorporate and report DUCkS in trials and funders and data providers to support them.</p

Getting our ducks in a row:The need for data utility comparisons of healthcare systems data for clinical trials

BACKGROUND: Better use of healthcare systems data, collected as part of interactions between patients and the healthcare system, could transform planning and conduct of randomised controlled trials. Multiple challenges to widespread use include whether healthcare systems data captures sufficiently well the data traditionally captured on case report forms. "Data Utility Comparison Studies" (DUCkS) assess the utility of healthcare systems data for RCTs by comparison to data collected by the trial. Despite their importance, there are few published UK examples of DUCkS.METHODS-AND-RESULTS: Building from ongoing and selected recent examples of UK-led DUCkS in the literature, we set out experience-based considerations for the conduct of future DUCkS. Developed through informal iterative discussions in many forums, considerations are offered for planning, protocol development, data, analysis and reporting, with comparisons at "patient-level" or "trial-level", depending on the item of interest and trial status.DISCUSSION: DUCkS could be a valuable tool in assessing where healthcare systems data can be used for trials and in which trial teams can play a leading role. There is a pressing need for trials to be more efficient in their delivery and research waste must be reduced. Trials have been making inconsistent use of healthcare systems data, not least because of an absence of evidence of utility. DUCkS can also help to identify challenges in using healthcare systems data, such as linkage (access and timing) and data quality. We encourage trial teams to incorporate and report DUCkS in trials and funders and data providers to support them.</p

Current concepts of the management of dental extractions for patients taking warfarin

The document attached has been archived with permission from the Australian Dental Association. An external link to the publisher’s copy is included.Background: Controversy has surrounded the correct management of patients therapeutically anticoagulated with warfarin who require dental extractions. The risk of bleeding must be weighed up against the risk of thromboembolism when deciding whether to interfere with a patient's warfarin regimen. An improved understanding of the importance of fibrinolytic mechanisms in the oral cavity has resulted in the development of various local measures to enable these patients to be treated on an outpatient basis. Methods: A review of the literature was undertaken. This was supplemented by the authors' clinical trials and extensive clinical experience with anticoagulated patients. Results: Various protocols for treating patients taking warfarin have been reviewed and summarized and an overview of the haemostatic and fibrinolytic systems is presented. A protocol for management of warfarinized patients requiring dental extractions in the outpatient setting is proposed. Conclusions: Patients therapeutically anticoagulated with warfarin can be treated on an ambulatory basis, without interruption of their warfarin regimen provided appropriate local measures are used.G Carter, AN Goss, JV Lloyd, R Tocchett

Chemotactic and Inflammatory Responses in the Liver and Brain Are Associated with Pathogenesis of Rift Valley Fever Virus Infection in the Mouse

Rift Valley fever virus (RVFV) is a major human and animal pathogen associated with severe disease including hemorrhagic fever or encephalitis. RVFV is endemic to parts of Africa and the Arabian Peninsula, but there is significant concern regarding its introduction into non-endemic regions and the potentially devastating effect to livestock populations with concurrent infections of humans. To date, there is little detailed data directly comparing the host response to infection with wild-type or vaccine strains of RVFV and correlation with viral pathogenesis. Here we characterized clinical and systemic immune responses to infection with wild-type strain ZH501 or IND vaccine strain MP-12 in the C57BL/6 mouse. Animals infected with live-attenuated MP-12 survived productive viral infection with little evidence of clinical disease and minimal cytokine response in evaluated tissues. In contrast, ZH501 infection was lethal, caused depletion of lymphocytes and platelets and elicited a strong, systemic cytokine response which correlated with high virus titers and significant tissue pathology. Lymphopenia and platelet depletion were indicators of disease onset with indications of lymphocyte recovery correlating with increases in G-CSF production. RVFV is hepatotropic and in these studies significant clinical and histological data supported these findings; however, significant evidence of a pro-inflammatory response in the liver was not apparent. Rather, viral infection resulted in a chemokine response indicating infiltration of immunoreactive cells, such as neutrophils, which was supported by histological data. In brains of ZH501 infected mice, a significant chemokine and pro-inflammatory cytokine response was evident, but with little pathology indicating meningoencephalitis. These data suggest that RVFV pathogenesis in mice is associated with a loss of liver function due to liver necrosis and hepatitis yet the long-term course of disease for those that might survive the initial hepatitis is neurologic in nature which is supported by observations of human disease and the BALB/c mouse model