A service improvement project to review prescribing information provided by general practitioners for new referrals to a UK National Health Service hospital pain clinic: potential implications of CYP2D6 enzyme inhibition.

INTRODUCTION: Chronic pain is often managed using co-prescription of analgesics and adjuvants, with concomitant medication prescribed for comorbidities. Patients may have suboptimal response to some analgesics or be at risk of drug interactions or adverse drug reactions (ADRs) due to polypharmacy affecting CYP2D6 enzyme activity. The aim of the service improvement project was to determine the proportion of patients referred to a specialist pain service in the UK National Health Service (NHS) by general practitioners (GPs) who may be at risk of suboptimal analgesic response or ADRs due to CYP2D6 inhibition through polypharmacy. This was achieved by reviewing clinical prescribing information provided by GPs at time of referral. It was hoped that the findings could be used to aid clinical and prescribing decisions without conducting CYP2D6 genotyping or phenotyping. METHODS: A review of letters from 250 patients referred to an NHS hospital pain service from GPs over a 3-month period was undertaken. Information about current and concomitant medications was analysed to identify the potential for CYP2D6 inhibition and adverse events. RESULTS: Letters failed to provide information about current pain medication for 20 (8%) patients or non-pain concomitant medication for 54 (21.6%) patients. Of 176 patients, 52 (29.5%) patients with information about non-pain concomitant medication had been prescribed at least one known CYP2D6 inhibitor. A total of 35 (19.9%) patients were identified as being at risk of an adverse drug reaction and 33 (18.75%) patients at risk of suboptimal analgesic response due to co-administration of CYP2D6 inhibitors. CONCLUSION: The review revealed the need for improved detail in GP referral letters used to transfer care to UK NHS hospital pain clinics. There is a need to consider an individual's CYP2D6 phenotype when prescribing analgesic prodrugs to manage persistent pain. Caution is needed when patients are co-prescribed codeine or tramadol with selective serotonin reuptake inhibitors (SSRIs)

Heterodyne detection of the 752.033-GHz H2O rotational absorption line

A tunable high resolution two stage heterodyne radiometer was developed for the purpose of investigating the intensity and lineshape of the 752.033 GHz rotational transition of water vapor. Single-sideband system noise temperatures of approximately 45,000 K were obtained using a sensitive GaAs Schottky diode as the first stage mixer. First local oscillator power was supplied by a CO2 laser pumped formic acid laser (761.61 GHz), generating an X-band IF signal with theoretical line center at 9.5744 GHz. Second local oscillator power was provided by means of a 3 GHz waveguide cavity filter with only 9 dB insertion loss. In absorption measurements of the H2O taken from a laboratory simulation of a high altitude rocket plume, the center frequency of the 752 GHz line was determined to within 1 MHz of the reported value. A rotational temperature 75 K, a linewidth 5 MHz and a Doppler shift 3 MHz were measured with the line-of-sight intersecting the simulated-plume axis at a distance downstream of 30 nozzle diameters. These absorption data were obtained against continuum background radiation sources at temperatures of 1175 and 300 K

A comparison of single-cycle versus multiple-cycle proof testing strategies

An evaluation of single-cycle and multiple-cycle proof testing (MCPT) strategies for SSME components is described. Data for initial sizes and shapes of actual SSME hardware defects are analyzed statistically. Closed-form estimates of the J-integral for surface flaws are derived with a modified reference stress method. The results of load- and displacement-controlled stable crack growth tests on thin IN-718 plates with deep surface flaws are summarized. A J-resistance curve for the surface-cracked configuration is developed and compared with data from thick compact tension specimens. The potential for further crack growth during large unload/reload cycles is discussed, highlighting conflicting data in the literature. A simple model for ductile crack growth during MCPT based on the J-resistance curve is used to study the potential effects of key variables. The projected changes in the crack size distribution during MCPT depend on the interactions between several key parameters, including the number of proof cycles, the nature of the resistance curve, the initial crack size distribution, the component boundary conditions (load vs. displacement control), and the magnitude of the applied load or displacement. The relative advantages of single-cycle and multiple-cycle proof testing appear to be specific, therefore, to individual component geometry, material, and loading

Finite resolution measurement of the non-classical polarization statistics of entangled photon pairs

By limiting the resolution of quantum measurements, the measurement induced changes of the quantum state can be reduced, permitting subsequent measurements of variables that do not commute with the initially measured property. It is then possible to experimentally determine correlations between non-commuting variables. The application of this method to the polarization statistics of entangled photon pairs reveals that negative conditional probabilities between non-orthogonal polarization components are responsible for the violation of Bell's inequalities. Such negative probabilities can also be observed in finite resolution measurements of the polarization of a single photon. The violation of Bell's inequalities therefore originates from local properties of the quantum statistics of single photon polarization.Comment: 15 pages, 5 figures and 1 table, new figure to illustrate results, improved explanation of statistical analysi

Photometric and proper motion study of neglected open cluster NGC 2215

Optical UBVRI photometric measurements using the Faulkes Telescope North were taken in early 2011 and combined with 2MASS JHK$_s$ and WISE infrared photometry as well as UCAC4 proper motion data in order to estimate the main parameters of the galactic open cluster NGC 2215 of which large uncertainty exists in the current literature. Fitting a King model we estimate a core radius of 1.12$'\pm$0.04$'$ (0.24$\pm$0.01pc) and a limiting radius of $4.3'\pm$0.5$'$ (0.94$\pm$0.11pc) for the cluster. The results of isochrone fits indicates an age of $log(t)=8.85\pm0.10$ with a distance of $d=790\pm90$pc, a metallicity of $[Fe/H]=-0.40\pm0.10$ dex and a reddening of $E(B-V)=0.26\pm0.04$. A proportion of the work in this study was undertaken by Australian and Canadian upper secondary school students involved in the Space to Grow astronomy education project, and is the first scientific publication to have utilized our star cluster photometry curriculum materials.Comment: 10 pages, 9 Figures, 3 Table

2018 UK national guideline for the management of infection with Neisseria gonorrhoeae

This guideline offers recommendations for the diagnostic tests, treatment regimens and health promotion principles needed for the effective management of gonorrhoea in people aged 16 years and older. For individuals under the age of 16 years please see the British Association for Sexual Health and HIV (BASHH) guideline on STI and Related Conditions in Children and Young People. The guidelines are primarily aimed at level 3 sexual health services within the United Kingdom (UK) although the principles of the recommendations could be adopted at all levels

Confirmatory factor analysis of two self-efficacy scales for astronomy understanding and robotic telescope use

This paper presents the results of a confirmatory factor analysis on two self-efficacy scales designed to probe the self-efficacy of college-level introductory astronomy (Astro-101) students (n=15181) from 22 institutions across the United States of America and Canada. The students undertook a course based on similar curriculum materials, which involved students using robotic telescopes to support their learning of astronomical concepts covered in the traditional Astro-101 courses. Previous research by the authors using these self-efficacy scales within a pre-/post-test approach showed both high reliabilities and very high construct validities. However, the scale purporting to measure students\u27 self-efficacy in relation to their use of the astronomical instrumentation associated with online robotic telescopes was particularly skewed and required further investigation. This current study builds on the previous work and shows how a slight adjustment of the survey items presents an improved and robust scale for measuring self-efficacy