ETHICAL AND ORGANISATIONAL CONSIDERATIONS IN SCREENING FOR DEMENTIA

The United Kingdom National Screening Committee (UKNSC) defines screening as “the process of identifying individuals who may be at higher risk of a disease or condition amongst large populations of healthy people”. Building on foundations laid by Wilson and Jungner in the landmark paper in 1968, the UKNSC states that “Once identified, those individuals can consider further tests, and healthcare providers can offer them interventions of benefit. A screening programme needs to offer more benefit than harm, at a reasonable cost to the NHS” (gov.uk 2014). We will consider the ethical issues surrounding some of the UK’s screening programmes and other methods used to assess and communicate patients’ risk of disease. We will discuss the appropriateness of candidate dementia biomarkers in order to inform research into developing such a biomarker or series of biomarkers

ETHICAL AND ORGANISATIONAL CONSIDERATIONS IN SCREENING FOR DEMENTIA

The United Kingdom National Screening Committee (UKNSC) defines screening as “the process of identifying individuals who may be at higher risk of a disease or condition amongst large populations of healthy people”. Building on foundations laid by Wilson and Jungner in the landmark paper in 1968, the UKNSC states that “Once identified, those individuals can consider further tests, and healthcare providers can offer them interventions of benefit. A screening programme needs to offer more benefit than harm, at a reasonable cost to the NHS” (gov.uk 2014). We will consider the ethical issues surrounding some of the UK’s screening programmes and other methods used to assess and communicate patients’ risk of disease. We will discuss the appropriateness of candidate dementia biomarkers in order to inform research into developing such a biomarker or series of biomarkers

Resting toucher: a time and motion analysis of elite lawn bowls

Whilst numerous investigations have explored the physical demands placed upon competitive sportspeople from a wide array of sports little is known about the physical demands placed on lawn bowlers. The purpose of this study was to ascertain the movement activities of Australian representative singles and pairs players and to determine the frequency and duration of these activities. One match each of two male and two female players (one singles and one pairs player per gender) were videotaped during an international tournament. During playback of the videotaped matches (n = 4), a single observer coded the players’ activities into five distinct categories (waiting, walking forward, walking backward, jogging and bowling) using a computerised video editing system (Gamebreaker™ Digital Video Analysis System). Field calibration of players over 30m for forward motions and 15m for the backward motion was performed to allow for the estimation of total distance covered during the match. Heart rate was monitored during each match. The duration of a match was found to be (mean ± SD) 1hr 28 ± 15mins. The total distance covered during each match was 2093 ± 276m. The mean percentage of match time spent in each motion was: waiting, 61.8 ± 9.3%; walking forward, 22.3 ± 5.6%; walking backward, 2.0 ± 0.4%; jogging, 1.1 ± 0.5%; and bowling, 8.5 ± 4.2%. Average heart rate was found to be 57 ± 7% of age-predicted HRmax with a maximum of 78 ± 9% of age-predicted HRmax. The results of this study suggest that playing lawn bowls at an international level requires light-moderate intensity activity similar to that reported for golf

DEPRESSION AND DRY EYE DISEASE: A NEED FOR AN INTERDISCIPLINARY APPROACH?

A recent meta-analysis including data from 22 studies including 2.9 million patients found that anxiety and depression are more prevalent in patients with dry eye disease (DED) than in controls. DED is a common disorder of the tear film which can cause ocular irritation, foreign body sensation and visual disturbance. However there is often a great discrepancy between signs and symptoms of DED, which the symptoms often being more associated with non-ocular disorders such as depression and PTSD than to tear film parameters. In this way it could be considered as more of a psychiatric than ophthalmic complaint. DED and depression feedback on one another in a synergistic manner. Severity of DED is associated with symptoms of anxiety and depression. Treatment of DED could help reduce depression symptoms, but also effective management of depression could help alleviate symptoms of DED. Complicating this however is the evidence that SSRIs can exacerbate DED. This makes the management of these comorbidities more difficult, however there are putative therapeutic targets which may be a source of future treatments for DED-associated depression. In conclusion, it is clear that DED and depression are closely linked and influence one another in ways that drastically affect patients’ lives. Collaboration between psychiatrists and ophthalmologists could be beneficial in the management of those with DED

DEPRESSION AND DRY EYE DISEASE: A NEED FOR AN INTERDISCIPLINARY APPROACH?

A recent meta-analysis including data from 22 studies including 2.9 million patients found that anxiety and depression are more prevalent in patients with dry eye disease (DED) than in controls. DED is a common disorder of the tear film which can cause ocular irritation, foreign body sensation and visual disturbance. However there is often a great discrepancy between signs and symptoms of DED, which the symptoms often being more associated with non-ocular disorders such as depression and PTSD than to tear film parameters. In this way it could be considered as more of a psychiatric than ophthalmic complaint. DED and depression feedback on one another in a synergistic manner. Severity of DED is associated with symptoms of anxiety and depression. Treatment of DED could help reduce depression symptoms, but also effective management of depression could help alleviate symptoms of DED. Complicating this however is the evidence that SSRIs can exacerbate DED. This makes the management of these comorbidities more difficult, however there are putative therapeutic targets which may be a source of future treatments for DED-associated depression. In conclusion, it is clear that DED and depression are closely linked and influence one another in ways that drastically affect patients’ lives. Collaboration between psychiatrists and ophthalmologists could be beneficial in the management of those with DED

Efficient and reliable transportation of consignments (ERTOC)

This paper describes a new initiative to drive business improvement and sustainability throughout the supply chain from factory to point of sale. The effort, called Efficient and Reliable Transportation of Consignments (ERTOC), aims to develop a standards based open architecture data hub to deliver accurate information for transport operators and their customers to use and improve business efficiency and effectiveness. Only by understanding the true environmental costs involved, users will be able to compare and assess different transport options to make better informed choices. Such a need drives this effort to demonstrate how a standardised data hub can track the carbon costs of transport at consignment level. The paper presents the underlying architecture of the proposed system, which servesto integrate (diverse and third party)resources, involving collection of data, storage and provision of it for further processing

The Profiling Potential of Computer Vision and the Challenge of Computational Empiricism

Computer vision and other biometrics data science applications have commenced a new project of profiling people. Rather than using 'transaction generated information', these systems measure the 'real world' and produce an assessment of the 'world state' - in this case an assessment of some individual trait. Instead of using proxies or scores to evaluate people, they increasingly deploy a logic of revealing the truth about reality and the people within it. While these profiling knowledge claims are sometimes tentative, they increasingly suggest that only through computation can these excesses of reality be captured and understood. This article explores the bases of those claims in the systems of measurement, representation, and classification deployed in computer vision. It asks if there is something new in this type of knowledge claim, sketches an account of a new form of computational empiricism being operationalised, and questions what kind of human subject is being constructed by these technological systems and practices. Finally, the article explores legal mechanisms for contesting the emergence of computational empiricism as the dominant knowledge platform for understanding the world and the people within it

Improvements in pain, medication use and quality of life in onabotulinumtoxinA-resistant chronic migraine patients following erenumab treatment – real world outcomes

Abstract Background The CGRP antagonists offer a novel therapeutic approach in migraine. Their utility in patients with severe forms of chronic migraine is a subject of particular interest. We present outcomes of 9 months of erenumab treatment in a cohort of patients with difficult-to-control chronic migraine, all of whom had prior unsatisfactory response to onabotulinumtoxinA. Methods We offered erenumab to 98 patients with a prior unsatisfactory response to onabotulinumtoxinA. Eighty of 98 had trialled greater occipital nerve injections (82%), 32/98 peripheral neurostimulation (33%) and 18/98 intravenous dihydroergotamine (18%). Thirty eight of 98 (39%) met the definition of triptan overuse and 43/98 (44%) analgesic overuse. All patients met the EHF criteria for ‘resistant migraine’. Outcome measures (recorded monthly) included days with headache limiting activities of daily living (“red”), not limiting (“amber”), headache free (“green”), and requiring triptans or other analgesics. Quality of life scores - headache impact test 6 (HIT-6), patient health questionnaire 9 (PHQ-9) and pain disability index (PDI) - were also measured. Results Mean number of red days improved by − 6.4 days (SE 0.67, 95%CI − 7.7 to − 5.1, p=0.001) at 3 months; − 6.8 days (SE 0.96, 95%CI − 8.80 to − 4.9, p=0.001) at 6 months and − 6.5 days (SE 0.86, 95%CI − 8.3 to − 4.8, p=0.001) at 9 months. Repeated measures ANOVA confirmed improvements in the number of red (p=0.001), green (p=0.001), triptan (p=0.001) and painkiller days (p=0.001) as well as scores of the HIT-6 (p=0.001), PHQ-9 (p=0.001), and PDI (p=0.001) across the duration of study. Conclusion We observed improvements in pain, medication use and quality of life in onabotulinumtoxinA-resistant chronic migraine patients following erenumab treatment. </jats:sec

Controlled dehydration of a ruthenium complex-DNA crystal induces reversible DNA kinking

Hydration-dependent DNA deformation has been known since Rosalind Franklin recognised that the relative humidity of the sample had to be maintained to observe a single conformation in DNA fibre diffraction. We now report for the first time the crystal structure, at the atomic level, of a dehydrated form of a DNA duplex and demonstrate the reversible interconversion to the hydrated form at room temperature. This system, containing d(TCGGCGCCGA) in the presence of Λ-[Ru(TAP)2(dppz)]2+ (TAP = 1,4,5,8-tetraazaphenanthrene, dppz = dipyridophenazine), undergoes a partial transition from an A/B hybrid to the A-DNA conformation, at 84-79% relative humidity. This is accompanied by an increase in kink at the central step from 22° to 51°, with a large movement of the terminal bases forming the intercalation site. This transition is reversible on rehydration. Seven datasets, collected from one crystal at room temperature, show the consequences of dehydration at near-atomic resolution. This result highlights that crystals, traditionally thought of as static systems, are still dynamic and therefore can be the subject of further experimentation