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

Judging Children\u27s Literature

This study is the outgrowth of the work being done by the Institute of Character Research at the State University under Professor Edwin D. Starbuck. The Institute is publishing a series of guides to literature: lists of books which have a definite character value in and of themselves. These books are ranked, graded, and assigned situations indicating the type of situation and attitude toward it which will probably impress the reader

A Narrative Review of Medication-Related Clinical Decision Support

Objectives: A key element of the implementation and on-going use of an electronic prescribing (ePrescribing) system is ensuring that users are, and remain, sufficiently trained to use the system. Studies have suggested that insufficient training is associated with suboptimal use. However, it is not clear from these studies how clinicians are trained to use ePrescribing systems or the effectiveness of different approaches. We sought to describe the various approaches used to train qualified prescribers on ePrescribing systems and to identify whether users were educated about the pitfalls and challenges of using these systems. Methods: We performed a literature review, using a systematic approach across three large databases: Cumulative Index Nursing and Allied Health Literature (CINAHL), Embase and Medline were searched for relevant English language articles. Articles that explored the training of qualified prescribers on ePrescribing systems in a hospital setting were included. Key Findings: Our search of ‘all training’ approaches returned 1,155 publications, of which seven were included. A separate search of ‘online’ training found three relevant publications. Training methods in the ‘all training’ category included clinical scenarios, demonstrations and assessments. Regarding ‘online’ training approaches; a team at the University of Victoria in Canada developed a portal containing simulated versions of electronic health records, where individuals could prescribe for fictitious patients. Educating prescribers about the challenges and pitfalls of electronic systems was rarely discussed. Conclusions: A number of methods are used to train prescribers; however the lack of papers retrieved suggests a need for additional studies to inform training methods

Impact of phosphate dosing on the microbial ecology of drinking water distribution systems: fieldwork studies in chlorinated networks

Phosphate is routinely dosed to ensure regulatory compliance for lead in drinking water distribution systems. Little is known about the impact of the phosphate dose on the microbial ecology in these systems and in particular the endemic biofilms. Disturbance of the biofilms and embedded material in distribution can cause regulatory failures for turbidity and metals. To investigate the impact of phosphate on developing biofilms, pipe wall material from four independent pipe sections was mobilised and collected using two twin-flushing operations a year apart in a chlorinated UK network pre- and post-phosphate dosing. Intensive monitoring was undertaken, including turbidity and water physico-chemistry, traditional microbial culture-based indicators, and microbial community structure via sequencing the 16S rRNA gene for bacteria and the ITS2 gene for fungi. Whole metagenome sequencing was used to study shifts in functional characteristics following the addition of phosphate. As an operational consequence, turbidity responses from the phosphate-enriched water were increased, particularly from cast iron pipes. Differences in the taxonomic composition of both bacteria and fungi were also observed, emphasising a community shift towards microorganisms able to use or metabolise phosphate. Phosphate increased the relative abundance of bacteria such as Pseudomonas, Paenibacillus, Massilia, Acinetobacter and the fungi Cadophora, Rhizophagus and Eupenicillium. Whole metagenome sequencing showed with phosphate a favouring of sequences related to Gram-negative bacterium type cell wall function, virions and thylakoids, but a reduction in the number of sequences associated to vitamin binding, methanogenesis and toxin biosynthesis. With current faecal indicator tests only providing risk detection in bulk water samples, this work improves understanding of how network changes effect microbial ecology and highlights the potential for new approaches to inform future monitoring or control strategies to protect drinking water quality

Examining fault behaviour of a superconducting DC network

A large body of research is currently being conducted into superconducting power system applications, targeting improved efficiency and reductions in system size and weight. In order to attain the required levels of safety and reliability of the superconducting power system, effective protection systems, tailored to the specific fault behaviour of the novel components must also be in place. This paper presents a review of relevant literature concerning the dynamic and transient characteristics of superconducting DC networks and key associated components (such as superconducting cables and machines). This first part of a two stage Failure Modes and Effects Analysis (FMEA) is presented, which provides a conceptual consideration of expected physical failure modes and mechanisms. The effects on the wider network are discussed from which various protection considerations are drawn. A number of key research questions are drawn from this study, which will form the starting point of the second stage of the FMEA. The outputs from the FMEA will shape the protection requirements for a superconducting DC network

Manipulating the fluorescence lifetime at the sub-cellular scale via photo-switchable barcoding

Fluorescent barcoding is a pivotal technique for the investigation of the microscale world, from information storage to the monitoring of dynamic biochemical processes. Using fluorescence lifetime as the readout modality offers more reproducible and quantitative outputs compared to conventional fluorescent barcoding, being independent of sample concentration and measurement methods. However, the use of fluorescence lifetime in this area has been limited by the lack of strategies that provide spatiotemporal manipulation of the coding process. In this study, we design a two-component photo-switchable nanogel that exhibits variable fluorescence lifetime upon photoisomerization-induced energy transfer processes through light irradiation. This remotely manipulated fluorescence lifetime property could be visually mapped using fluorescence lifetime imaging microscopy (FLIM), allowing selective storage and display of information at the microscale. Most importantly, the reversibility of this system further provides a strategy for minimizing the background influence in fluorescence lifetime imaging of live cells and sub-cellular organelles. Using fluorescence lifetime as the readout modality offers more reproducible and quantitative outputs compared to conventional fluorescent barcoding, being independent of sample concentration and measurement methods. Here, the authors design a photo-switchable nanogel exhibiting variable fluorescence lifetime, and demonstrate visual mapping by using fluorescence lifetime imaging microscopy on a sub-cellular scale.This work was supported by the ERC (grant number 615142), EPSRC, and the University of Birmingham, the Ministerio de Economia y Competitividad (MINECO) of Spain (project CTQ2016-80375-P) and the Basque Government (grant IT-324-07). The authors acknowledge the computational and technical and human support provided by DIPC. Y.X. acknowledges Chancellor's International Scholarship (University ofWarwick) for funding. All three reviewers are thanked for their time and contribution to the final version of this paper

Community pharmacy interventions for public health priorities: protocol for a systematic review of community pharmacy-delivered smoking, alcohol and weight management interventions

Background: Community pharmacists can deliver health care advice at an opportunistic level, related to prescription or non-prescription medicines and as part of focused services designed to reduce specific risks to health. Obesity, smoking and excessive alcohol intake are three of the most significant modifiable risk factors for morbidity and mortality in the UK, and interventions led by community pharmacists, aimed at these three risk factors, have been identified by the government as public health priorities. In 2008, the Department of Health for England stated that ‘a sound evidence base that demonstrates how pharmacy delivers effective, high quality and value for money services is needed’; this systematic review aims to respond to this requirement. Methods/design: We will search the databases MEDLINE, Embase, CINAHL, PsycINFO, Social Sciences Citation Index, ASSIA, IBSS, Sociological Abstracts, Scopus and NHS Economic Evaluation Database for studies that have evaluated interventions based on community pharmacies that aim to target weight management, smoking cessation and alcohol misuse. We will include all randomised controlled trials (RCTs), non-randomised controlled trials (NRCTs), controlled before-after studies (CBAs) and interrupted time series (ITS) and repeated measures studies. Data from included studies will be extracted by two independent reviewers and will include study details methods, results, intervention implementation/costs and methodological quality. Meta-analysis will be conducted if appropriate; if not, the synthesis will be restricted to a narrative overview of individual studies looking at the same question. Discussion: The review aims to summarise the evidence base on the effectiveness of community pharmacy interventions on health and health behaviours in relation to weight management, smoking cessation and alcohol misuse. It will also explore if, and how, socio-economic status, gender, ethnicity and age moderate the effect of the interventions and will describe how the interventions included in the review have been organised, implemented and delivered, since context is an important factor governing the success of public health interventions. The findings from this review will have an impact on the commissioning of public health services aiming to promote healthy weight, smoking cessation and prevent excessive alcohol consumption. Systematic review registration: The review has been registered with PROSPERO (registration no. CRD42013005943)

C-5A/orbiter wind tunnel testing and analysis: Piggyback ferry

Wind tunnel testing and analytical studies of the feasibility of ferrying the NASA Shuttle Orbiter on the C-5A in a piggyback mode have been accomplished. Testing was conducted in the 8x12 foot low speed wind tunnel using an existing 0.0399 scale C-5A model in conjunction with a NASA 0.0405 scale Orbiter model. Six component force and moment data were measured over a range of pitch and yaw angles to determine lift and drag characteristics, lateral/directional stability characteristics and longitudinal and directional control powers. A description of the wind tunnel test program with a run schedule and the complete plotted data for all the test runs are presented. Initial emphasis was given to determining the effects of the Orbiter above the C-5A and the optimum location for minimum interference on C-5A characteristics. A comprehensive series of cruise configurations were tested including a range of Orbiter longitudinal and vertical locations, incidences, and afterbody fairings. Subsequently, a series of configurations were devised during the test program to determine means of recovering directional stability degradation due to Orbiter interference

A literature review of the training offered to qualified prescribers to use electronic prescribing systems: why is it so important?

Objectives A key element of the implementation and ongoing use of an electronic prescribing (ePrescribing) system is ensuring that users are, and remain, sufficiently trained to use the system. Studies have suggested that insufficient training is associated with suboptimal use. However, it is not clear from these studies how clinicians are trained to use ePrescribing systems or the effectiveness of different approaches. We sought to describe the various approaches used to train qualified prescribers on ePrescribing systems and to identify whether users were educated about the pitfalls and challenges of using these systems. Methods We performed a literature review, using a systematic approach across three large databases: Cumulative Index Nursing and Allied Health Literature, Embase and Medline were searched for relevant English language articles. Articles that explored the training of qualified prescribers on ePrescribing systems in a hospital setting were included. Key findings Our search of ‘all training’ approaches returned 1155 publications, of which seven were included. A separate search of ‘online’ training found three relevant publications. Training methods in the ‘all training’ category included clinical scenarios, demonstrations and assessments. Regarding ‘online’ training approaches; a team at the University of Victoria in Canada developed a portal containing simulated versions of electronic health records, where individuals could prescribe for fictitious patients. Educating prescribers about the challenges and pitfalls of electronic systems was rarely discussed. Conclusions A number of methods are used to train prescribers; however, the lack of papers retrieved suggests a need for additional studies to inform training methods