Diabetic retinopathy and socioeconomic deprivation in Gloucestershire

Objectives To investigate socioeconomic variations in diabetes prevalence, uptake of screening for diabetic retinopathy, and prevalence of diabetic retinopathy. Methods The County of Gloucestershire formed the setting of the study. A cross-sectional study of people with diabetes was done on a countywide retinopathy-screening database. Diabetes prevalence with odds ratios, uptake of screening, prevalence of any retinopathy and prevalence of sight-threatening retinopathy at screening were compared for different area deprivation quintiles. Logistic regression was used to adjust for confounding. Results With each increasing quintile of deprivation, diabetes prevalence increased (odds ratio 0.84), the probability of having been screened for diabetic retinopathy decreased (odds ratio 1.11), and the prevalence of sight-threatening diabetic retinopathy among screened patients increased (odds ratio of 0.98), while the prevalence of non-sight-threatening diabetic retinopathy remained unchanged with each increasing quintile of deprivation. Conclusion Sight-threatening diabetic retinopathy was associated with socioeconomic deprivation, but non-sight-threatening diabetic retinopathy was not. Uptake of screening was inversely related to socioeconomic deprivation

Understanding and Managing Discolouration Risk in Trunk Mains

There is currently no accepted concept or approach for understanding and controlling discolouration risk associated with trunk mains. This paper assesses the applicability of cohesive layer theories to manage discolouration and a modelling tool that describes the process of particulate material accumulation. Results are presented from independent field experiments across the UK and internationally that evidence hydraulically induced mobilisation, or effectively cleaning, once imposed system shear stress exceeds normal conditions. Model calibration to measured data validates the cohesive layer concept with transferability in empirically derived parameters demonstrating a viable operational planning tool. The experiments highlight the accumulation of material layers as a continuous and ubiquitous process, such that fully clean pipes can never exist and helping explain how discolouration risk changes over time. A major practical implication of the novel understanding demonstrated in this paper is that discolouration risk in trunk mains can be simply managed by pro-active strategies that regularly vary the hydraulic conditions. This avoids the need for disruptive and expensive out of service invasive interventions yet offers operators a cost-effective long-term strategy to safeguard water quality

Modelling and flow conditioning to manage discolouration in trunk mains

This paper presents predictive discolouration modelling and subsequent field trial results for a cast iron trunk main network. This enabled a UK water company to propose an ‘operational flow conditioning’ maintenance plan that reduces discolouration risk, improves network resilience and asset condition and yet does not require the trunk main to be decommissioned for invasive cleaning. This represents substantial time and cost benefits. Pre-and-post trial turbidity monitoring data is also presented which identified a daily flux of material, a factor in the regeneration of material layers that have been shown to cause discolouration when mobilised. Additional data detecting the occurrence of pressure transients is also presented, a possible cause of contaminant ingress and asset failure

Identifying clustering at high redshift through actively star-forming galaxies

Identifying galaxy clustering at high redshift (i.e. z > 1) is essential to our understanding of the current cosmological model. However, at increasing redshift, clusters evolve considerably in star-formation activity and so are less likely to be identified using the widely-used red sequence method. Here we assess the viability of instead identifying high redshift clustering using actively star-forming galaxies (SMGs associated with over-densities of BzKs/LBGs). We perform both a 2- and 3-D clustering analysis to determine whether or not true (3D) clustering can be identified where only 2D data are available. As expected, we find that 2D clustering signals are weak at best and inferred results are method dependant. In our 3D analysis, we identify 12 SMGs associated with an over-density of galaxies coincident both spatially and in redshift - just 8% of SMGs with known redshifts in our sample. Where an SMG in our target fields lacks a known redshift, their sightline is no more likely to display clustering than blank sky fields; prior redshift information for the SMG is required to identify a true clustering signal. We find that the strength of clustering in the volume around typical SMGs, while identifiable, is not exceptional. However, we identify a small number of highly clustered regions, all associated with an SMG. The most notable of these, surrounding LESSJ033336.8-274401, potentially contains an SMG, a QSO and 36 star-forming galaxies (a > 20sig over-density) all at z~1.8. This region is highly likely to represent an actively star-forming cluster and illustrates the success of using star-forming galaxies to select sites of early clustering. Given the increasing number of deep fields with large volumes of spectroscopy, or high quality and reliable photometric redshifts, this opens a new avenue for cluster identification in the young Universe.Comment: 24 pages, 14 figures, accepted MNRA

Safety profile of lamotrigine in overdose

Background: Lamotrigine is an anticonvulsant as well as a mood stabilizer. Apart from its established use in the treatment of epilepsy, there has been an expansion of its use in the treatment of mental disorders. Patients with epilepsy as well as those with mental disorders are at increased risk of deliberate drug overdoses. An evidence base for the safety profile of lamotrigine in overdose is an essential tool for prescribers. The objective of this study was to carry out a narrative synthesis of the existing evidence for the safety profile of lamotrigine in overdose. Methods: A systematic search was conducted of EMBASE (1974 to December 2015), MEDLINE (1946 to December 2015), PsycINFO (1806 to December 2015) and CINAHL (1981 to December 2015) databases. Studies were included in which there was a deliberate or accidental single drug overdose of lamotrigine, with its toxic effects described. Studies that did not involve an overdose were excluded. A narrative synthesis of the described toxic effects was carried out. Results: Out of 562 articles identified, 26 studies were included, mainly in the form of case reports and series. The most commonly described toxic effects of lamotrigine were on the central nervous system, specifically seizures, movement disorders and reduced consciousness. Other toxic effects included QTc interval and QRS complex prolongations, hypersensitivity reactions, serotonin syndrome as well as rhabdomyolysis possibly due to seizures and/or agitation. Deaths were recorded in two studies, with cardiovascular and neurological toxic effects described. Conclusions: Even though lamotrigine has been reported to be well tolerated, there is a risk of toxic effects which can be life threatening in overdose. This needs to be borne in mind when prescribing to patients at an increased risk of deliberate drug overdose

Widening the scope for early cancer detection: identification of alarm symptoms by community pharmacies

Background Cancers are one of the leading causes of death in the world and, due to the aging population, incidence rates are set to rise. As such, considerable effort has been placed on initiatives that aid the early detection of cancer, as this may improve patient survival outcome. One such initiative is the development of guidelines that explain how and when patient reported alarm symptoms suggestive of an underlying malignancy should be referred to a specialist. However, despite being conveniently placed to deliver interventions to promote the early detection of cancer, it is not clear what role community pharmacists could have in the development and implementation of these guidelines. Objective To: (1) assess the frequency and mean of patient reported alarm symptoms in a community pharmacy setting; (2) determine the demographics of patients presenting with the alarm symptom; and (3) explore the relationship between deprivation index of the community pharmacy and average frequency of alarm symptoms per pharmacy. Setting Thirty-three community pharmacies in the North of England. Method A prospective study from September 2013 to February 2014. Each community pharmacy team was provided training in relation to alarm symptoms to ensure there was consistency in reporting. Deprivation tertiles for each community pharmacy were calculated using the IMD 2010 deprivation index. The data were analysed using a Kruskal-Wallis test in order to determine whether there were any statistically significant associations between average frequency of alarm symptoms presented per pharmacy and the deprivation tertile. Main outcome measure Frequency of patient reported alarm symptoms

Uncharted waters: the unintended impacts of residual chlorine on water quality and biofilms

Disinfection residuals in drinking water protect water quality and public heath by limiting planktonic microbial regrowth during distribution. However, we do not consider the consequences and selective pressures of such residuals on the ubiquitous biofilms that persist on the vast internal surface area of drinking water distribution systems. Using a full scale experimental facility, integrated analyses were applied to determine the physical, chemical and biological impacts of different free chlorine regimes on biofilm characteristics (composition, structure and microbiome) and water quality. Unexpectedly, higher free chlorine concentrations resulted in greater water quality degredation, observable as elevated inorganic loading and greater discolouration (a major cause of water quality complaints and a mask for other failures). High-chlorine concentrations also reduced biofilm cell concentrations but selected for a distinct biofilm bacterial community and inorganic composition, presenting unique risks. The results challenge the assumption that a measurable free chlorine residual necessarily assures drinking water safety

Climate change and cattle farming

Issues raised by cattle farming in relation to climate change extend beyond discussion of greenhouse gas emissions and global warming. There are profound consequences for water availability, soil degradation, biodiversity and local ecology, as well as in terms of conflict for energy supplies. Although climate change impacts on cattle farming (through effects on water availability, heat stress and flooding, for example), this article focuses on how cattle farming impacts on climate change. It explores the issues in terms of the impact of cattle farming on the environment, and how to measure and reduce climate change impacts at farm level. Managing the complex and conflicting balance of factors required for sustainable food production offers an important role for the veterinary surgeon

Brexit and the Implications of Food Safety Cultural Compliance in the Food Manufacturing Sector

In theory food safety is a critical measurement, not just for economic and legal reasons but also for the moral integrity of the organisation. However, in reality, the number of accidents or incidents particularly in the food manufacturing sector is a serious cause for concern. The problem is further compounded with the onset of Brexit. Given the UK government’s floundering negotiation talks and the pending conservative leadership challenge, it has resulted in a climate of uncertainty, a devaluation of currency and economic instability. Food manufacturers along with other commercial businesses are reluctant to further invest until the economic future is more transparent. In consequence, food manufacturers are seeking efficiency savings, whilst aiming not to compromise food safety compliance. Whilst there are areas of best practice, sadly there are an increasing number of examples in which failure to comply to food safety is resulting in lost of business, serious injury and in certain cases fatalities. This paper addresses Food Safety Cultural Compliance within UK Food Manufacturers and identifies core issues that hinder the establishment of a proactive food safety culture. The research study adopts a mixed methods approach in which five UK food manufacturers were consulted via 15 semi-structured interviews with management and three focused groups. The data collected clearly indicates a commitment to food safety compliance. However, the majority of organisations struggled to maintain consistent levels of food safety compliance despite implementing costly training and development initiatives. Their strategic and operational drive to both enhance and maintain a positive food safety culture was also undermined with the uncertainty of economic pressures and the quagmire of Brexit. The paper concludes with a series of commercially viable recommendations within the context of the Brexit divorce and provides a clear contribution to the community of practice