The clinical application of recombinant human bone morphogenetic protein 7 for reconstruction of alveolar cleft; 10 years follow up

Purpose: The purpose of this study was to report on a 10-year assessment after the application of recombinant human bone morphogenetic protein 7 (rhBMP-7) for the reconstruction of alveolar clefts. Patients and Methods: This study was conducted as a prospective phase II clinical trial on 9 unilateral and 2 bilateral alveolar clefts that received rhBMP-7 (Osigraft; Stryker Biotech, UK). The mean age of the patients at surgery was 10.4 years. At 6 months postoperatively, occlusal radiographs were taken to evaluate bone formation at the cleft site. Patients were followed within the routine cleft care pathway for 10 years to monitor the impact of bone morphogenetic protein 7 on orthodontic treatments and maxillary growth. Radiographs were taken according to the standard cleft care protocol. Results: The radiographic assessment of the unilateral cleft lip and palate cases suggested good bone formation with a Kindelan score of grade 1 or 2. The bilateral alveolar cleft cases had a score of grade 3 or 4, indicating failure or partial failure. The children with successful grafts underwent a routine orthodontic follow-up without incident. The maxillary growth appeared to be similar to that in cases grafted with autogenous bone. No long-term complications and no abnormal pattern of bone formation were detected. Conclusions: The study provides unique evidence on the long-term safety of rhBMP-7 when applied at the area of skeletal immaturity for the reconstruction of alveolar clefts in children

A review of the use of technology for pedagogical purposes by students in clinical placement

Purpose: Technology is now ubiquitous and with a wide range of clinical and pedagogical applications. This study sought to assess students’ use of technology on clinical placement to facilitate supporting its use. Method: A questionnaire based review asking questions of medical, and physician associate, students at the University of Sheffield. Results: All responding students had smartphones and utilised technology. The sites and apps used were a wider range than we were aware of raising questions of how we support students if we are ignorant of their preferred sources. There were both positive and negative perceptions of the use of mobile technology by supervisors despite the known widespread use of technology by healthcare professionals. Conclusion: Barriers still exist to the use of the available technologies, in particular supervisor and patient perceptions, which need to be overcome to realise the full potential of technology with some key steps that can be taken to help do this

Requirements and access needs of patients with chronic disease to their hospital electronic health record: results of a cross-sectional questionnaire survey

Objectives: To identify patient’s views on the functionality required for personalised access to the secondary care EHR and their priorities for development. Design: Quantitative analysis of a cross-sectional self-complete survey of patient views on required EHR functionality from a secondary care EHR, including a patient ranking of functionality. Setting: Secondary care patients attending a regional cystic fibrosis unit in the north of England Participants: 201 adults [106 (52.7%) male], median age 29 years (range 17-58 years) entered and completed the study. Inclusion criteria; a confirmed diagnosis of CF, aged 16 years and over, at a time of clinical stability Outcome measures: Quantitative responses within 4 themes; 1) value placed on aspects of the EHR; 2) access requirements to functions of the EHR; 3) views on information sent to the EHR 4) patient feedback entered into the EHR. A ranked score for 15 functions of the EHR was obtained Results: Highest ratings (% reporting item as very important/important) were reported for access to clinical measures [lung function (94%), CRP (84%), sputum microbiology (81%) and blood results (80%)], medication changes (82%) and lists (83%) and sending repeat prescription (83%) and treatment requests (80%), whilst sending symptom diaries was less so (62%). Email contact with clinicians was the most valuable communication element of the EHR (84% very important/important). Of 15 features of the EHR [1=most desirable to 15=least desirable) patients identified ‘clinical measures’ [2.62 (CI 2.07-3.06)], and ‘access to medication lists’ [4.91 (CI 4.47-5.44)], as highest priority for development and the ability to comment on errors/ommissions [11.0 (CI 10.6-11.5)] or experience of care [11.8 (CI 11.4-12.2)] as lowest. Conclusions: Patients want extensive personal access to their hospital EHR, placing high importance on the viewing of practical clinical measures and medication management. These influence routine day to day care and are priorities for developmen

Laser haemocytometer

This thesis describes the work carried out to provide a proof of principle coupled-cavity laser measurement for blood cell analysis, using an integrated device with capillary fill microfluidics. The development of both light source and microfluidics on the same sensing platform provides complete integration and removes the dependence on external systems. In principle, InAsP quantum dot lasers, cover a wavelength range extending into the near infrared, where the response of biological matter can provide useful diagnostic information. The suitability and limitations, of both an InAsP quantum dot and GaInP quantum well active medium, are con-sidered for the coupled-cavity structure. A InAsP quantum dot structure with an 8 nm AlGaInP barrier between each dot layer was seen to have a slight improvement in device performance, but optical gain measurements indicated that this structure would not provide sufficient gain to over-come the high losses expected in the integrated device. Consequently, a GaInP quantum well was considered a sensible choice for a proof of principle coupled-cavity measurement. The efficiency of an etched facet is key to overall performance in the coupled-cavity device and has been quantified using the gain characteristics of the quantum well structure. A value of facet efficiency was found to be ηf = 0.37 ± 0.04, which is valid for all angles of etched facet. A very low facet reflectivity of 4.9x10−9 was measured for a laser with a 14.1o etched facet. Perturbation of the optical coupling between two laser/detector sections causes a change in the measured photo-voltage signal from the device. This effect has been employed to demonstrate detection of both 10 and 6 µm microbeads. In a coupled-cavity regime, a 22.6o angled facet coupled-cavity laser pair has been shown to have a lower threshold current density than either of its individual sections, indicating its potential for sensing applications

The Validation of an Innovative Method for 3D Capture and Analysis of the Nasolabial Region in Cleft Cases

Objective: To validate a newly developed method for capturing three-dimensional (3D) images of the nasolabial region for assessing upper lip scarring and asymmetry in surgically managed unilateral cleft lip and palate (UCLP) cases. Design: Validation study, single cohort. Materials and Methods: Eighteen surgically managed UCLP cases were recruited, the nasolabial region of each face was scanned using an intraoral scanner (IOS) to produce 3D images. The images were manually segmented to allow the calculation of surface area of the scar and upper lip asymmetry. Five professionals and five lay assessors subjectively evaluated the same images and graded the upper lip scarring and asymmetry at two separate occasions. The relationship between the subjective and objective assessments was evaluated. Results: Moderate correlation was found between subjective and objective evaluations of the upper lip scarring and total asymmetry. The captured 3D images were of good quality for the objective measurements of lip asymmetry and residual scarring. Moderate to strong correlations were detected between the two panels (T ranging between 0.5 and 0.9) with no significant difference (p > 0.05) in the mean score of the subjectively evaluated parameters. Conclusion: The IOS is a useful tool for the capture of the nasolabial morphology. The captured 3D images are a reliable source for measuring lip asymmetry and scar surface area. The method has sufficient validity for routine clinical use and for objective outcome measures of the surgical repair of cleft lip

Outcome measures of the surgery first approach for orthognathic correction of dentofacial deformities

Background: In the surgery-first approach (SFA) the orthognathic surgery is performed without the need for presurgical orthodontic treatment. Aim: This study was aimed at assessing the treatment durations and occlusal outcomes for a consecutive cohort of patients, with a range of dentofacial deformities, who have completed orthognathic treatment using the SFA. Methodology: The duration of orthognathic treatment was measured. The overall change in occlusion, and the quality of the final occlusion, were evaluated using the patients’ study casts. A single independent, calibrated, operator carried out the occlusal scores, using the validated Peer Assessment Rating (PAR) index. This was repeated to test intra-operator reliability. Results: A total of 51 patients completed surgery-first treatment during the study period. The mean age at surgery was 23.3 years. The pre-treatment skeletal jaw relationship was Class III in 39 cases, and Class II in 12 cases. The mean overall treatment duration was 11.7 months (SD = 5.7). The intra-examiner reliability of assessing the occlusion was high. The PAR scores confirmed a significant improvement in the quality of occlusion at the completion of treatment, which compares favourably with previous studies on the conventional orthodontics-first approach. Conclusion: The SFA can be effective at correcting both Class 2 and Class 3 malocclusion types with reduced treatment times

1.3-μm InAs Quantum Dot Lasers with P-type modulation and direct N-type co-doping

O-band quantum dot lasers with co-doping reduce threshold current density relative to the undoped case, for 1mm long uncoated lasers from 245Acm-2 to 132Acm-2 at 27°C and 731Acm-2 to 312Acm-2 at 97°C. Improvements are also significant compared to lasers employing any one doping strategy

Co-doped 1.3μm InAs Quantum Dot Lasers with high gain and low threshold current

The mechanism by which co-doping reduces threshold current in O-band Quantum dot lasers is examined, with n-type direct doping of the dots reducing threshold current and p-type modulation doping improving the temperature dependence of threshold current density, relative to undoped samples

Urinary bicarbonate and metabolic alkalosis during exacerbations in cystic fibrosis

The aetiology of increased serum bicarbonate and metabolic alkalosis in CF is complex and appears to be driven, at least in part, by renal tubular CFTR dysfunction https://bit.ly/3NFPkU