Are we stripping the care out of care plans?

In 2013, NHS England specified that: "‘... every person with a long-term condition or disability has a personalised care plan supporting them to develop the knowledge, skills and confidence to manage their own health’.1" Around 40% of the UK population experience a long-term condition while 65% of people aged 65–84 years have two or more.2 This is an all-time high, with figures set to rise. This places significant personal, social, and economic burden on individuals, their families, and the community. The use of care plans to manage multiple long-term conditions — by assessing individual behaviour, setting joint goals, supporting self-management, and ensuring proactive follow-up — is based on Wagner’s Chronic Care Model.3 The model takes into account the need to provide support and structure to patients, and the fact that all long-term conditions have common challenges. Care planning has received extraordinary interest in the NHS. Policymakers endorse care planning as a way of containing high costs, encouraging a more person-centred approach, improving quality of life, and reducing mortality rates and emergency admissions to hospitals. But are care plans effective in this regard and what challenges do GP practices face in implementation

A 10-year Review of Surgical Management of Dermatofibrosarcoma Protuberans

Background: Dermatofibrosarcoma protuberans (DFSP) is a rare skin cancer. Standard treatment in the United Kingdom (UK) is either surgical wide local excision (WLE) or Mohs micrographic surgery (MMS). It is unclear which approach has the lower recurrence rate.Objectives: We undertook a retrospective comparative review of DFSP surgical management in the UK National Health Service (NHS) in order to define:1) current surgical practice for primary and recurrent DFSP2) local recurrence rates for primary DFSP3) survival outcomes for DFSP.Methods: Retrospective clinical case-note review of patients with histologically-confirmed DFSP (January 2004–2014) who have undergone surgical treatment.Results: Surgical management of 483 primary and 64 recurrent DFSP in 11 plastic surgery and 15 dermatology departments was analysed. Almost 75% of primary DFSP (n=362) were treated with WLE and 20.1% (n=97) with MMS. For recurrent DFSP, 68.7% (n=44) and 23.4% (n=15) underwent WLE and MMS, respectively. Recurrent primary DFSP occurred in 6 patients after WLE and none after MMS. Median follow-up was 4.8 years [IQR 3.5, 5.8] with 8 reported deaths during the follow-up analysis period; one confirmed to be DFSP-related.Conclusions: WLE was the commonest surgical modality used to treat DFSP across the UK. The local recurrence rate was very low, occurring only after WLE. Although a prospective RCT may provide more definitive outcomes, in the absence of a clearly superior surgical modality, treatment decisions should be based on patient preference, clinical expertise and cost

Validation of a Lysis Buffer Containing 4 M Guanidinium Thiocyanate (GITC)/ Triton X-100 for Extraction of SARS-CoV-2 RNA for COVID-19 Testing: Comparison of Formulated Lysis Buffers Containing 4 to 6 M GITC, Roche External Lysis Buffer and Qiagen RTL Lysis Buffer

The COVID-19 pandemic has resulted in increased need for diagnostic testing using reverse transcriptase real-time PCR (RT-PCR). An exponential increase in demand has resulted in a shortage of numerous reagents in particular those associated with the lysis buffer required to extract the viral RNA. Herein, we describe a rapid collective effort by hospital laboratory scientists, academic researchers and the biopharma industry to generate a validated lysis buffer. We have formulated a 4M Guanidinium thiocyanate (GITC)/ Triton X-100 Lysis buffer which provides comparable results with the recommended reagents. This buffer will ease the burden on hospital labs in their heroic efforts diagnose a large population of patients

Direct microscopic examination of imprints in patients undergoing cardiac valve replacement

BACKGROUND: Bacteriological analysis of cardiac valves might be indicated in patients with suspected endocarditis. METHODS: We report here a prospective study on fifty-three consecutive patients whose native valves were sent to the bacteriological and pathological laboratories, to investigate the performance of direct microscopic examination of imprints and valve culture. RESULTS: On the basis of a histopathological gold standard to classify the inflammatory valve process, the sensitivity, the specificity, the positive and the negative predictive values of direct microscopic examination of imprints and valve culture were 21%, 100%, 100%, 60%, and 21%, 72%, 38%, 52% respectively. This weak threshold of the direct microscopic examination of imprints could be due to antimicrobial therapy prescribed before cardiac surgery and the fact that the patients came from a tertiary hospital receiving patients with a prolonged history of endocarditis. CONCLUSION: Clinical context and histopathology are indispensable when analyzing the imprints and valve culture

Have greenhouse gases intensified the contrast between wet and dry regions?

While changes in land precipitation during the last 50 years have been attributed in part to human influences, results vary by season, are affected by data uncertainty and do not account for changes over ocean. One of the more physically robust responses of the water cycle to warming is the expected amplification of existing patterns of precipitation minus evaporation. Here, precipitation changes in wet and dry regions are analyzed from satellite data for 1988–2010, covering land and ocean. We derive fingerprints for the expected change from climate model simulations that separately track changes in wet and dry regions. The simulations used are driven with anthropogenic and natural forcings combined, and greenhouse gas forcing or natural forcing only. Results of detection and attribution analysis show that the fingerprint of combined external forcing is detectable in observations and that this intensification of the water cycle is partly attributable to greenhouse gas forcing

Requirements for a global data infrastructure in support of CMIP6

The World Climate Research Programme (WCRP)’s Working Group on Climate Modelling (WGCM) Infrastructure Panel (WIP) was formed in 2014 in response to the explosive growth in size and complexity of Coupled Model Intercomparison Projects (CMIPs) between CMIP3 (2005–2006) and CMIP5 (2011–2012). This article presents the WIP recommendations for the global data infrastruc- ture needed to support CMIP design, future growth, and evolution. Developed in close coordination with those who build and run the existing infrastructure (the Earth System Grid Federation; ESGF), the recommendations are based on several principles beginning with the need to separate requirements, implementation, and operations. Other im- portant principles include the consideration of the diversity of community needs around data – a data ecosystem – the importance of provenance, the need for automation, and the obligation to measure costs and benefits. This paper concentrates on requirements, recognizing the diversity of communities involved (modelers, analysts, soft- ware developers, and downstream users). Such requirements include the need for scientific reproducibility and account- ability alongside the need to record and track data usage. One key element is to generate a dataset-centric rather than system-centric focus, with an aim to making the infrastruc- ture less prone to systemic failure. With these overarching principles and requirements, the WIP has produced a set of position papers, which are summa- rized in the latter pages of this document. They provide spec- ifications for managing and delivering model output, includ- ing strategies for replication and versioning, licensing, data quality assurance, citation, long-term archiving, and dataset tracking. They also describe a new and more formal approach for specifying what data, and associated metadata, should be saved, which enables future data volumes to be estimated, particularly for well-defined projects such as CMIP6. The paper concludes with a future facing consideration of the global data infrastructure evolution that follows from the blurring of boundaries between climate and weather, and the changing nature of published scientific results in the digital age

Freshwater transport in the coupled ocean-atmosphere system: a passive ocean

Conservation of water demands that meridional ocean and atmosphere freshwater transports (FWT) are of equal magnitude but opposite in direction. This suggests that the atmospheric FWT and its associated latent heat (LH) transport could be thought of as a \textquotedblleft coupled ocean/atmosphere mode\textquotedblright. But what is the true nature of this coupling? Is the ocean passive or active? Here we analyze a series of simulations with a coupled ocean-atmosphere-sea ice model employing highly idealized geometries but with markedly different coupled climates and patterns of ocean circulation. Exploiting streamfunctions in specific humidity coordinates for the atmosphere and salt coordinates for the ocean to represent FWT in their respective medium, we find that atmospheric FWT/LH transport is essentially independent of the ocean state. Ocean circulation and salinity distribution adjust to achieve a return freshwater pathway demanded of them by the atmosphere. So, although ocean and atmosphere FWTs are indeed coupled by mass conservation, the ocean is a passive component acting as a reservoir of freshwater