Hybrid in vitro diffusion cell for simultaneous evaluation of hair and skin decontamination: temporal distribution of chemical contaminants

Most casualty or personnel decontamination studies have focused on removing contaminants from the skin. However, scalp hair and underlying skin are the most likely areas of contamination following airborne exposure to chemicals. The aim of this study was to investigate the interactions of contaminants with scalp hair and underlying skin using a hybrid in vitro diffusion cell model. The in vitro hybrid test system comprised “curtains” of human hair mounted onto sections of excised porcine skin within a modified diffusion cell. The results demonstrated that hair substantially reduced underlying scalp skin contamination and that hair may provide a limited decontamination effect by removing contaminants from the skin surface. This hybrid test system may have application in the development of improved chemical incident response processes through the evaluation of various hair and skin decontamination strategies.Peer reviewedFinal Published versio

Choice and judgement in developing models for health technology assessment; a qualitative study

Introduction: The role of models in supporting health policy decisions is reliant on model credibility. Credibility is fundamentally determined by the choices and judgements that people make in the process of developing a model. However, the method of uncovering choices and making judgements in model development is largely unreported and is not addressed by modelling methods guidance. Methods: This qualitative study was part of a project examining errors in health technology assessment models. In-depth interviews with academic and commercial modellers were used to obtain descriptions of the model development process. Data were analysed using framework analysis and interpreted in the context of the methodological literature. Results: The activities involved in developing models were characterised according to the themes; understanding the decision problem, conceptual modelling, model implementation, model checking, and engaging with the decision maker. Finding and using evidence was frequently mentioned across these themes. There was marked variation between practitioners in the extent to which conceptual modelling was recognised as an activity distinct from model implementation. Discussion: Methodological approaches to addressing model credibility described in the wider modelling literature highlight the necessity to disentangle the conceptual modelling and implementation activities. Whilst interviewees talked of judgements and choice making throughout model development, discussion indicated that these were based upon skills and experience with no discussion of formal approaches. Methods are required that provide for a systematic approach to uncovering choices, to generating a shared view of consensus and divergence, and for making judgements and choices in model development

Optimising Bowel Cancer Screening Phase 1: Optimising the cost effectiveness of repeated FIT screening and screening strategies combining bowel scope and FIT screening

ScHARR has been commissioned by the UK National Screening Committee (NSC) to consider the costeffectiveness and endoscopy capacity requirements of a variety of different screening options incorporating faecal immunochemical testing (FIT) and bowel scope (BS) within the Bowel Cancer Screening Programme (BCSP). An existing cost-effectiveness model was used. The model was refined considerably, new data included and model validation was undertaken. All FIT thresholds between 20 and 180 µg/ml were modelled. Analyses were undertaken to determine which screening strategies involving repeated FIT screening and/or bowel scope are most cost-effective given endoscopy constraints. Note that the conclusions reached are based on optimising cost-effectiveness where effectiveness is measured in terms of QALYs gained. If the aim was to optimise QALY gains or CRC incidence/mortality reduction then conclusions would be different. The analysis without endoscopy constraints indicates that the most cost effective screening strategy is the one which delivers the most intensive screening. Regardless of capacity constraints the current screening strategies (gFOBT 2-yearly 60-74 with or without bowel scope age 55) are dominated by a FIT screening strategy (i.e. a FIT strategy exists which is more effective and less expensive). For repeated FIT screening it is recommended that the screening interval is kept to 2-yearly screening. However, increased benefits may be obtained by re-inviting non-attenders after a 1 year interval. The optimal starting age for a repeated FIT screening strategy is 50 or 51 hence it is suggested that the screening start age is reduced compared to what is currently used in the BCSP. The optimal upper screening age varies between 65 and 74, depending on the capacity constraint used. The optimal FIT threshold depends on the available capacity for screening referral colonoscopies. With 50,000 screening referral colonoscopies (current capacity) then we recommend a strategy of 2-yearly, age 51-65, FIT161 (8 screens). With 70,000 screening referral colonoscopies (current capacity) then we recommend a strategy of: 2-yearly, age 50-70, FIT153 (11 screens). If 90,000 screening referral colonoscopies is considered feasible to achieve in the future then we recommend a strategy of 2-yearly, age 50-74, FIT124 (13 screens). In terms of bowel scope screening the model found uncertainty in whether it is cost effective to replace one FIT screen with a one-off bowel scope at age 58/59. However, a repeated FIT screening strategy requiring 125k screening referral colonoscopies annually would be far more effective and cost effective than a one-off bowel scope at age 59. Such strategies could be considered to have equivalent ‘endoscopy capacity’ (assuming that 10 bowel scopes and 4 screening referral colonoscopies are equivalent ).Hence, if bowel scope capacity could be used for undertaking screening referral colonoscopies this would result in higher effectiveness and cost-effectiveness

Sensing RF fields with a distant stand-alone Rydberg-atomic receiver

We combine a rubidium vapour cell with a corner-cube prism reflector to form a passive RF receiver, allowing the detection of microwave signals at a location distant from the active components required for atomic sensing. This compact receiver has no electrical components and is optically linked to the active base station by a pair of free-space laser beams that establish an electromagnetically induced transparency scenario in the atomic vapour. Microwave signals at the receiver location are imprinted onto an optical signal which is detected at the base station. Our stand-alone receiver architecture adds important flexibility to Rydberg-atom based sensing technologies, which are currently subject to significant attention. We demonstrate a ~20 m link with no particular effort and foresee significant future prospects of achieving a much larger separation between receiver and base station

Genetic therapeutic advancements for Dravet Syndrome

Dravet Syndrome is a genetic epileptic syndrome characterized by severe and intractable seizures associated with cognitive, motor, and behavioral impairments. The disease is also linked with increased mortality mainly due to sudden unexpected death in epilepsy. Over 80% of cases are due to a de novo mutation in one allele of the SCN1A gene, which encodes the α-subunit of the voltage-gated ion channel NaV1.1. Dravet Syndrome is usually refractory to antiepileptic drugs, which only alleviate seizures to a small extent. Viral, non-viral genetic therapy, and gene editing tools are rapidly enhancing and providing new platforms for more effective, alternative medicinal treatments for Dravet syndrome. These strategies include gene supplementation, CRISPR-mediated transcriptional activation, and the use of antisense oligonucleotides. In this review, we summarize our current knowledge of novel genetic therapies that are currently under development for Dravet syndrome

Plastic Surgery After Gastric Bypass Improves Long-Term Quality of Life

Background: Excess skin after massive weight loss impairs patient's health-related quality of life (HRQoL). Therefore, body-contouring surgeries can be proposed. However, few data exist concerning the effect of body contouring after bariatric surgery on HRQoL, including control group with a long-term follow-up. Methods: In a prospective study, 98 consecutive patients who had body contouring after gastric bypass for obesity (BMI > 40) were included (group A). A matched control-group containing 102 patients who had only gastric bypass was selected (group B). HRQoL was measured by Moorehead-Ardelt questionnaire before (group A1) and after (A2) body contouring, and at different time points for group B until 8years post-gastric bypass. To evaluate the effect of body contouring by two parallel methods, HRQoL was compared between groups A1 and A2, and between A2 and B. Results: We found that body contouring procedures improved significantly patients' HRQoL, in comparison to those who had only gastric bypass. Of the patients who had body contouring (group A2), 57% evaluated their HRQoL "much better” in comparison to only 22% of patients before body contouring (group A1) or those who never had body contouring (group B) (p < 0.001). The improvement was significant in all sub-domains of HRQoL: self-esteem, social life, work ability, sexual activity and physical activity (p < 0.001), and remained stable over time. Conclusions: Our study confirms the important role of plastic surgery in treatment of patients after massive weight loss. We demonstrated that body contouring, despite important scars, significantly improves satisfaction and HRQoL of patients after gastric bypass. Therefore, the treatment of morbid obesity should not be deemed achieved unless plastic surgery has been considere