Post-operative epiphora following the transcutaneous medial canthal incision

Purpose The safety profile of the transcutaneous medial canthal incision for access to the medial orbit is assessed with a focus on the risk of post-operative iatrogenic epiphora. Methods A retrospective chart review of patients undergoing medial orbitotomy via the transcutaneous medial canthal incision was performed. Patients with a minimum of 3 months of follow-up were included and post-operative complications were assessed and characterized. Results One-hundred-fifty patients were included in the study. A total of 4 complications were identified, including one each of the following: nasolacrimal duct obstruction, hypertrophic scar, suture granuloma and soft tissue infection. Only the nasolacrimal duct obstruction required surgical intervention. Discussion Access to the medial orbit has been achieved through a variety of approaches, each with their own benefits and risk profile. The transcaruncular approach has increased in usage as a means to avoid a visible cutaneous scar and decrease the risk of iatrogenic epiphora, however, there are specific patients who may have relative contraindications to this approach. The current study demonstrates the low risk profile of the transcutaneous medial canthal incision, specifically the minimal risk of iatrogenic damage to the nasolacrimal outflow system. This approach is another useful tool which orbit surgeons should be familiar with to offer as an option to patients requiring medial orbitotomy

Variation in the prices of oncology medicines across Europe and the implications for the future

Introduction/ Objectives: There are increasing concerns among health authorities regarding the sustainability of healthcare systems with growing expenditure on medicines including new high-priced oncology medicines. Medicine prices among European countries may be adversely affected by their population size and economic power to negotiate. There are also concerns that prices of patented medicines do not change once the prices of medicines used for negotiations substantially change. This needs to be investigated as part of the implications of low-cost generic oncology medicines. Methodology: Analysing principally reimbursed prices of patented oral oncology medicines (imatinib, erlotinib and fludarabine) between 2013 and 2017 across Europe and exploring correlations between GDP, population size, and prices. Comparing the findings with previous research regarding prices of oral generic oncology medicines. Results: The prices of imatinib, erlotinib and fludarabine did vary among European countries but showed limited price erosion over time in the absence of generics. There appeared to be no correlation between population size and prices. However, higher prices were seen among countries with higher GDP per capita which is a concern for lower income countries referencing these. Discussion and Conclusion: It is likely that the limited price erosion for patented oncology medicines will change across Europe with increased scrutiny over their prices and value as more medicines used for pricing decisions lose their patents combined with growing pressures on the oncology drug budget. In addition, discussions will continue regarding fair pricing for new oncology medicines and other approaches given ever rising prices with research showing substantial price reductions for oral oncology medicines (up to -97.8% for imatinib) once generics become available. We are also seeing appreciable price reductions for biosimilars further increasing the likelihood of these developments

The influence of socioeconomic deprivation on prescribing within primary care

Gradients in area-level socioeconomic deprivation have been associated with variations in the delivery of healthcare services and outcomes across geographical areas. This thesis assesses the impact of deprivation on prescribing rates for non-prescription medicines and prescription medicines indica. ted for the management ... of conditions affected by socioeconomic variables including cardiovascular disease and diabetes. Th~ research also examined the influence ofthe Quality and Outcomes Framework (QOF) in minimisfng . prescribing variations and outcomes in cardiovascular disease. Northern Ireland demographic, mapping, prescribing and area-level deprivation data were collected retrospectively from 2000 to 2005. The first stage ofthe investigation revealed that the levels of General Practitioner prescribing for non-prescription medicines were high (30%). These prescribing rates increased as proportions of practice populations living in areas of highest deprivation increased, particularly in urban locations, and were closely correlated to income and employment deprivation. Measures of deprivation developed for application in NI appeared to be better at predicting these variations in rural areas than other extant indices of deprivation. Prescribing rates for codeine-containing and non-steroidal anti-inflammatory drugs (NSAIDs) analgesics together with benzodiazepines and, most notably, antidepressants were positively associated with increased proportions of patients living in areas associated with highest levels of deprivation. Inconclusive findings in relation to trends in Hormone Replacement Therapy (HRT) and methylphenidate prescribing may have been accounted for by lower observed rates of prescribing volume. The final study observed cardiovascular and diabetes prescribing trends and demonstrated annual increases in growth of prescribed items which appeared to respond to the implementation ofthe QOF. A time series analysis, employing a refined methodology, confirmed that significant increases in statin doses were observed after the second quarter of2004 immediately post-QOF and that the increase responded positively to rising levels of practice deprivation. However, no impact on the reduction of Coronary Heart Disease admissions to hospital was observed over the course of this investigation. Overall the research has tested the consistent influence of deprivation on prescribing trends and has identified how the employment of area-based deprivation measures may be used to target prescribing resources. Policy and planning arrangements should take into account the impact of multiple deprivation in driving demand for healthcare services and associated prescribing resources. Healthcare strategies should consider how these demands can be equitably managed and met. Pharma.ceutical public health and medicines management interventions should be evaluated and commissioned.EThOS - Electronic Theses Online ServiceGBUnited Kingdo

The influence of socioeconomic deprivation on prescribing within primary care

Gradients in area-level socioeconomic deprivation have been associated with variations in the delivery of healthcare services and outcomes across geographical areas. This thesis assesses the impact of deprivation on prescribing rates for non-prescription medicines and prescription medicines indica. ted for the management ... of conditions affected by socioeconomic variables including cardiovascular disease and diabetes. Th~ research also examined the influence ofthe Quality and Outcomes Framework (QOF) in minimisfng . prescribing variations and outcomes in cardiovascular disease. Northern Ireland demographic, mapping, prescribing and area-level deprivation data were collected retrospectively from 2000 to 2005. The first stage ofthe investigation revealed that the levels of General Practitioner prescribing for non-prescription medicines were high (30%). These prescribing rates increased as proportions of practice populations living in areas of highest deprivation increased, particularly in urban locations, and were closely correlated to income and employment deprivation. Measures of deprivation developed for application in NI appeared to be better at predicting these variations in rural areas than other extant indices of deprivation. Prescribing rates for codeine-containing and non-steroidal anti-inflammatory drugs (NSAIDs) analgesics together with benzodiazepines and, most notably, antidepressants were positively associated with increased proportions of patients living in areas associated with highest levels of deprivation. Inconclusive findings in relation to trends in Hormone Replacement Therapy (HRT) and methylphenidate prescribing may have been accounted for by lower observed rates of prescribing volume. The final study observed cardiovascular and diabetes prescribing trends and demonstrated annual increases in growth of prescribed items which appeared to respond to the implementation ofthe QOF. A time series analysis, employing a refined methodology, confirmed that significant increases in statin doses were observed after the second quarter of2004 immediately post-QOF and that the increase responded positively to rising levels of practice deprivation. However, no impact on the reduction of Coronary Heart Disease admissions to hospital was observed over the course of this investigation. Overall the research has tested the consistent influence of deprivation on prescribing trends and has identified how the employment of area-based deprivation measures may be used to target prescribing resources. Policy and planning arrangements should take into account the impact of multiple deprivation in driving demand for healthcare services and associated prescribing resources. Healthcare strategies should consider how these demands can be equitably managed and met. Pharma.ceutical public health and medicines management interventions should be evaluated and commissioned.EThOS - Electronic Theses Online ServiceGBUnited Kingdo

Genomic evidence for the evolution of Streptococcus equi : host restriction, increased virulence, and genetic exchange with human pathogens

The continued evolution of bacterial pathogens has major implications for both human and animal disease, but the exchange of genetic material between host-restricted pathogens is rarely considered. Streptococcus equi subspecies equi (S. equi) is a host-restricted pathogen of horses that has evolved from the zoonotic pathogen Streptococcus equi subspecies zooepidemicus (S. zooepidemicus). These pathogens share approximately 80% genome sequence identity with the important human pathogen Streptococcus pyogenes. We sequenced and compared the genomes of S. equi 4047 and S. zooepidemicus H70 and screened S. equi and S. zooepidemicus strains from around the world to uncover evidence of the genetic events that have shaped the evolution of the S. equi genome and led to its emergence as a host-restricted pathogen. Our analysis provides evidence of functional loss due to mutation and deletion, coupled with pathogenic specialization through the acquisition of bacteriophage encoding a phospholipase A(2) toxin, and four superantigens, and an integrative conjugative element carrying a novel iron acquisition system with similarity to the high pathogenicity island of Yersinia pestis. We also highlight that S. equi, S. zooepidemicus, and S. pyogenes share a common phage pool that enhances cross-species pathogen evolution. We conclude that the complex interplay of functional loss, pathogenic specialization, and genetic exchange between S. equi, S. zooepidemicus, and S. pyogenes continues to influence the evolution of these important streptococci.Publisher PDFPeer reviewe

Haptic Touchscreens

Background. The development of haptic touchscreens, that is touchscreens with the ability to mimic the feel of a real keyboard, would be a significant advance in the mobile phone and tablet market. This report investigates one possible route to developing such touchscreens using piezoelectric actuators placed at the edge of the screen and driven at a range of frequencies. Scope. The report addresses the following questions: Can an array of piezoelectric transducers placed round the edge of the screen create localised vibrations in the right physiological range to produce the sensation of a keyboard? If so how many transducers are needed? Where should they be placed? How should they be driven? We consider both the excitation of longitudinal and transverse waves but do not discuss surface waves. Methods. We first consider the full inverse problem in which a key shaped vibration is to be constructed by driving a touchscreen embedded in a phone. We argue that a useful subproblem is to construct a localised vibration in a one dimensional beam driven at one end. If such solutions do exist, that would (1) provide strong evidence that solutions to the full inverse problem do exist, (2) act as good initial starting points towards solutions of the full inverse problem. Results. We show that in the case of longitudinal waves the mathematical formalism set up for sonar can be exploited. In the case of transverse waves the system is highly dispersive and so a ready-made formalism does not exist. However we show that localised solutions can likewise be constructed. Conclusions and Recommendations. Our results suggest that it is indeed possible to construct virtual keyboards by driving the edges of a touchscreen. The minimum number of transducers needed is two although we expect that using more would increase resolution. However, before a practical implementation can be made there is still a great deal of work to be done both on the simplified models and on the full problem