Cathodoluminescence hyperspectral imaging on the nanometre scale

Extending cathodoluminescence microscopy into the hyperspectral imaging mode brings significant benefits to an already powerful nano-scale characterization tool. In this paper, we give an introduction to the technique, and illustrate its potential with examples of its application to both semiconducting and plasmonic nanostructures

Functional assessment for acute stroke trials: properties, analysis, and application

A measure of treatment effect is needed to assess the utility of any novel intervention in acute stroke. For a potentially disabling condition such as stroke, outcomes of interest should include some measure of functional recovery. There are many functional outcome assessments that can be used after stroke. In this narrative review, we discuss exemplars of assessments that describe impairment, activity, participation, and quality of life. We will consider the psychometric properties of assessment scales in the context of stroke trials, focusing on validity, reliability, responsiveness, and feasibility. We will consider approaches to the analysis of functional outcome measures, including novel statistical approaches. Finally, we will discuss how advances in audiovisual and information technology could further improve outcome assessment in trials

A systematic review and meta-analysis of the effectiveness of pharmacist-led medication reconciliation in the community after hospital discharge

BACKGROUND Pharmacists’ completion of medication reconciliation in the community after hospital discharge is intended to reduce harm due to prescribed or omitted medication and increase healthcare efficiency, but the effectiveness of this approach is not clear. We systematically review the literature to evaluate intervention effectiveness in terms of discrepancy identification and resolution, clinical relevance of resolved discrepancies and healthcare utilisation, including readmission rates, emergency department attendance and primary care workload. DESIGN Systematic literature review and meta-analysis of extracted data. METHODS Medline, CINHAL, EMBASE, AMED, ERIC, SCOPUS, NHS evidence and the Cochrane databases were searched using a combination of Medical Subject Heading (MeSH) terms and free text search terms. Controlled studies evaluating pharmacist-led medication reconciliation in the community after hospital discharge were included. Study quality was appraised using CASP. Evidence was assessed through meta-analysis of readmission rates. Discrepancy identification rates, emergency department attendance and primary care workload were assessed narratively. RESULTS Fourteen studies were included comprising five RCTs, six cohort studies and three pre-post intervention studies. Twelve studies had a moderate or high risk of bias. Increased identification and resolution of discrepancies was demonstrated in the four studies where this was evaluated. Reduction in clinically relevant discrepancies was reported in two studies. Meta-analysis did not demonstrate a significant reduction in readmission rate. There was no consistent evidence of reduction in emergency department attendance or primary care workload. CONCLUSIONS Pharmacists can identify and resolve discrepancies when completing medication reconciliation after hospital discharge but patient outcome or care workload improvements were not consistently seen. Future research should examine the clinical relevance of discrepancies and potential benefits on reducing healthcare team workload

Use of magnesium as a drug in chronic kidney disease

From chronic kidney disease (CKD) Stage 4 onwards, phosphate binders are needed in many patients to prevent the development of hyperphosphataemia, which can result in disturbed bone and mineral metabolism, cardiovascular disease and secondary hyperparathyroidism. In this review, we re-examine the use of magnesium-containing phosphate binders for patients with CKD, particularly as their use circumvents problems such as calcium loading, aluminum toxicity and the high costs associated with other agents of this class. The use of magnesium hydroxide in the 1980s has been superseded by magnesium carbonate, as the hydroxide salt was associated with poor gastrointestinal tolerability, whereas studies with magnesium carbonate show much better gastrointestinal profiles. The use of combined magnesium- and calcium-based phosphate binder regimens allows a reduction in the calcium load, and magnesium and calcium regimen comparisons show that magnesium may be as effective a phosphate binder as calcium. A large well-designed trial has recently shown that a drug combining calcium acetate and magnesium carbonate was non-inferior in terms of lowering serum phosphate to sevelamer-HCl and had an equally good tolerability profile. Because of the high cost of sevelamer and lanthanum carbonate, the use of magnesium carbonate could be advantageous and drug acquisition cost savings would compensate for the cost of introducing routine magnesium monitoring, if this is thought to be necessary and not performed anyway. Moreover, given the potential cost savings, it may be time to re-investigate magnesium-containing phosphate binders for CKD patients with further well-designed clinical research using vascular end points

Applying utilitarianism and deontology in managing Bisphenol-A risks in the United States

We examine Bisphenol-A (BPA) as a case that illustrates key challenges in addressing the public health risks of consumer products in the 21st century. First, we trace growing concerns about the effects of BPA on human health, showing how regulatory approaches can exacerbate the difficulty of dealing with the unforeseen risks of chemicals in consumer products. Second, we highlight the question of who should bear the responsibility – and the cost – of rectifying or preventing unforeseen chemical risks in consumer products. Third, we discuss the challenge of substituting out a potentially hazardous chemical from consumer products in the context of well established global production chains and consumption patterns. Utilitarian and deontological ethical frameworks have influenced societal debates surrounding each of these three challenges, creating moral dilemmas for actors with different forms of moral agency – both those implicated in the production of harmful chemicals and those pursuing remedies

A comparative study of teaching forensics at a university degree level

Computer forensics is a relatively young University discipline which has developed strongly in the United States and the United Kingdom but is still in its infancy in continental Europe. The national programmes and courses offered therefore differ in many ways. We report on two recently established degree programmes from two European countries: Great Britain and Germany. We present and compare the design of both programmes and conclude that they cover two complementary and orthogonal aspects of computer forensics education: (a) rigorous practical skills and (b) competence for fundamental research discoveries