Point-of-care C reactive protein for the diagnosis of lower respiratory tract infection in NHS primary care: a qualitative study of barriers and facilitators to adoption

OBJECTIVES: Point-of-care (POC) C reactive protein (CRP) is incorporated in National Institute of Health and Care Excellence (NICE) guidelines for the diagnosis of pneumonia, reduces antibiotic prescribing and is cost effective. AIM: To determine the barriers and facilitators to adoption of POC CRP testing in National Health Service (NHS) primary care for the diagnosis of lower respiratory tract infection. DESIGN: The study followed a qualitative methodology based on grounded theory. The study was undertaken in 2 stages. Stage 1 consisted of semistructured interviews with 8 clinicians from Europe and the UK who use the test in routine practice, and focused on their subjective experience in the challenges of implementing POC CRP testing. Stage 2 was a multidisciplinary-facilitated workshop with NHS stakeholders to discuss barriers to adoption, impact of adoption and potential adoption scenarios. Emergent theme analysis was undertaken. PARTICIPANTS: Participants included general practitioners (including those with commissioning experience), biochemists, pharmacists, clinical laboratory scientists and industry representatives from the UK and abroad. RESULTS: Barriers to the implementation of POC CRP exist, but successful adoption has been demonstrated abroad. Analysis highlighted 7 themes: reimbursement and incentivisation, quality control and training, laboratory services, practitioner attitudes and experiences, effects on clinic flow and workload, use in pharmacy and gaps in evidence. CONCLUSIONS: Successful adoption models from the UK and abroad demonstrate a distinctive pattern and involve collaboration with central laboratory services. Incorporating antimicrobial stewardship into quality improvement frameworks may incentivise adoption. Further research is needed to develop scaling-up strategies to address the resourcing, clinical governance and economic impact of widespread NHS implementation

A time-strain monitoring system fabricated via offset lithographic printing

This paper reports progress in the development of strain sensors fabricated using the Conductive Lithographic Film (CLF) printing process. Strain sensitive structures printed via an unmodified offset lithographic printing press using a silver loaded conductive ink have been deposited concurrently with circuit interconnect, to form an electronic smart packaging system. A system populated with SMT components has proven successful in interpreting and logging deformation incidences subjected to a package during testing. It is proposed that with further development such a system could be printed in sync with packaging graphics using a single printing process to form an integrated time – strain monitoring system

A research protocol for developing a Point-Of-Care Key Evidence Tool 'POCKET': a checklist for multidimensional evidence reporting on point-of-care in vitro diagnostics.

INTRODUCTION: Point-of-care in vitro diagnostics (POC-IVD) are increasingly becoming widespread as an acceptable means of providing rapid diagnostic results to facilitate decision-making in many clinical pathways. Evidence in utility, usability and cost-effectiveness is currently provided in a fragmented and detached manner that is fraught with methodological challenges given the disruptive nature these tests have on the clinical pathway. The Point-of-care Key Evidence Tool (POCKET) checklist aims to provide an integrated evidence-based framework that incorporates all required evidence to guide the evaluation of POC-IVD to meet the needs of policy and decisionmakers in the National Health Service (NHS). METHODS AND ANALYSIS: A multimethod approach will be applied in order to develop the POCKET. A thorough literature review has formed the basis of a robust Delphi process and validation study. Semistructured interviews are being undertaken with POC-IVD stakeholders, including industry, regulators, commissioners, clinicians and patients to understand what evidence is required to facilitate decision-making. Emergent themes will be translated into a series of statements to form a survey questionnaire that aims to reach a consensus in each stakeholder group to what needs to be included in the tool. Results will be presented to a workshop to discuss the statements brought forward and the optimal format for the tool. Once assembled, the tool will be field-tested through case studies to ensure validity and usability and inform refinement, if required. The final version will be published online with a call for comments. Limitations include unpredictable sample representation, development of compromise position rather than consensus, and absence of blinding in validation exercise. ETHICS AND DISSEMINATION: The Imperial College Joint Research Compliance Office and the Imperial College Hospitals NHS Trust R&D department have approved the protocol. The checklist tool will be disseminated through a PhD thesis, a website, peer-reviewed publication, academic conferences and formal presentations

In search of a working notion of lex sportiva

The emergence of a lex specialis regime and its interaction with the established, governing lex generalis in their overlapping spheres of application is always an intriguing legal relationship to explore. In this article, the focus will be on the development of legal principles and rules that have been/can be collectively described as lex sportiva. However, it is notable that those involved in the consideration, usage and application of this notion have not agreed as to the scope and delimitation of the concept. It is debated whether lex sportiva exists in the first place, its legal sources and its purpose. The risk is for the concept becoming redundant when not vilified as a hidden strategy to exclude non-sports-related law from the ambit of sport. Through an examination of the different propositions to the framework of the term, this article will shed light on the existence, utility and limits of the development of this conceptualisation

Reionization and Cosmology with 21 cm Fluctuations

Measurement of the spatial distribution of neutral hydrogen via the redshifted 21 cm line promises to revolutionize our knowledge of the epoch of reionization and the first galaxies, and may provide a powerful new tool for observational cosmology from redshifts 1<z<4 . In this review we discuss recent advances in our theoretical understanding of the epoch of reionization (EoR), the application of 21 cm tomography to cosmology and measurements of the dark energy equation of state after reionization, and the instrumentation and observational techniques shared by 21 cm EoR and post reionization cosmology machines. We place particular emphasis on the expected signal and observational capabilities of first generation 21 cm fluctuation instruments.Comment: Invited review for Annual Review of Astronomy and Astrophysics (2010 volume

Stability effects on results of diffusion tensor imaging analysis by reduction of the number of gradient directions due to motion artifacts: an application to presymptomatic Huntington's disease.

In diffusion tensor imaging (DTI), an improvement in the signal-to-noise ratio (SNR) of the fractional anisotropy (FA) maps can be obtained when the number of recorded gradient directions (GD) is increased. Vice versa, elimination of motion-corrupted or noisy GD leads to a more accurate characterization of the diffusion tensor. We previously suggest a slice-wise method for artifact detection in FA maps. This current study applies this approach to a cohort of 18 premanifest Huntington's disease (pHD) subjects and 23 controls. By 2-D voxelwise statistical comparison of original FA-maps and FA-maps with a reduced number of GD, the effect of eliminating GD that were affected by motion was demonstrated.We present an evaluation metric that allows to test if the computed FA-maps (with a reduced number of GD) still reflect a "true" FA-map, as defined by simulations in the control sample. Furthermore, we investigated if omitting data volumes affected by motion in the pHD cohort could lead to an increased SNR in the resulting FA-maps.A high agreement between original FA maps (with all GD) and corrected FA maps (i.e. without GD corrupted by motion) were observed even for numbers of eliminated GD up to 13. Even in one data set in which 46 GD had to be eliminated, the results showed a moderate agreement

A Technique for Optimal Selection of Segmentation Scale Parameters for Object-oriented Classification of Urban Scenes

Multi-scale image segmentation produces high level object features at more than one level, compared to single scale segmentation. Objects generated from this type of segmentation hold additional attributes such as mean values per spectral band, distances to neighbouring objects, size, and texture, as well as shape characteristics. However, the accuracy of these high level features depends on the choice of segmentation scale parameters. Several studies have investigated techniques for scale parameter selection. These proposed approaches do not consider the different objects’ size variability found in complex scenes such as urban scene as they rely upon arbitrary object size measures, introducing instability errors when computing image variances. A technique to select optimal segmentation scale parameters based on image variance and spatial autocorrelation is presented in this paper. Optimal scales satisfy simultaneously the conditions of low object internal variance and high inter-segments spatial autocorrelation. Applied on three Cape Town urban scenes, the technique produced visually promising results that would  improve object extraction over urban areas.Key words: segmentation, object oriented classification, object’s variance, spatial autocorrelation, objective function, Moran’s index

Current status of NLTE analysis of stellar atmospheres

Various available codes for NLTE modeling and analysis of hot star spectra are reviewed. Generalizations of standard equations of kinetic equilibrium and their consequences are discussed.Comment: in Determination of Atmospheric Parameters of B-, A-, F- and G-Type Stars, E. Niemczura et al. eds., Springer, in pres