Seven steps for improving influenza vaccination rates in risk-groups: findings from a national cross sectional survey in UK general practice

The problem: Seasonal influenza vaccination rates in at-risk population in the UK are below the national and international target of 75%. Of people aged over 65 years in England 72.8% received influenza (flu) vaccine in 2010/11, just below the target of 75%. However, flu vaccination rates during 2010/11 in the under 65 year old at-risk groups was just 50.4%, which fell far short of 75%; in pregnant women who were not otherwise at risk the vaccination rate was only 36.6%, despite increasing evidence showing the beneficial effects of protection against flu for both mothers and babies. Evidence-based guidance, to advise practices how to optimise all aspects of their flu vaccination campaigns and maximise their likelihood of protecting at-risk patients against flu and its serious sequelae is greatly needed. This study sought to identify which strategies and procedures were associated with higher rates of flu vaccine uptake. The approach: An online questionnaire survey was administered to general practitioners (GPs), nursing staff and practice managers in 795 practices across England. We used logistic regression to analyse data for factors independently associated with higher practice flu vaccination rates in at-risk groups. Findings: The survey was completed by 569 practice managers, 335 nursing staff and 107 GPs. We identified seven independent factors associated with higher flu vaccination rates. Having a lead staff member for planning the flu campaign and producing a written report of practice performance predicted an 8% higher vaccination rate for at-risk patients aged <65 years (OR 1.37; 95% CI 1.10 to 1.71). These strategies, plus sending a personal invitation to all eligible patients and only stopping vaccination when Quality and Outcomes framework (QOF) targets were reached, predicted a 7% higher vaccination rate (OR 1.45; 95% CI 1.10 to 1.92) in patients aged 65 years and over. Using a lead member of staff for identifying eligible patients, with either a modified manufacturer’s or in-house search program for interrogating the practice computer system, independently predicted a 4% higher vaccination rate in patients aged 65 years and over (OR 1.22; 95% CI 1.06 to 1.41 / OR 1.20; 95% CI 1.03 to 1.40). The provision of flu vaccine by midwives was associated with a 4% higher vaccination rate in pregnant women (OR 1.19; 1.02 to 1.40). Consequences: Clear leadership, effective communication with patients, and methods used to identify and contact eligible patients were independently associated with significantly higher rates of flu vaccination. Financial targets appear to incentivise practices to work harder to maximise seasonal influenza vaccine uptake. The strategies identified here could help primary care providers to substantially increase their seasonal flu vaccination rates to meet or even exceed national targets

Sustainability of Cold-climate Strawberry Production Systems

Three cold-climate strawberry (Fragaria xananassa Duch.) production systems, conventional matted row (CMR), advanced matted row (AMR), and cold-climate plasticulture (CCP) were compared for aspects of sustainability including environmental impacts, economic viability and public acceptance over a three year production cycle. As a result of higher total yields, CMR had the highest overall revenue and estimated net profit of any system. The CCP had the lowest observed yield but the largest fruit in year one. Reduced fruit size and yield in the second harvest season indicate the CCP system may not be suitable for perennial production. Both the CCP and AMR production systems were better than CMR in preventing soil, nitrogen and pesticide loss due to rain-induced runoff, and had higher N uptake than CMR. The CCP and AMR systems were preferred over CMR in a pick-your-own consumer preference evaluation. AMR and CCP represent potential sustainable alternatives to the CMR system

Tracing diagnosis trajectories over millions of patients reveal an unexpected risk in schizophrenia.

The identification of novel disease associations using big-data for patient care has had limited success. In this study, we created a longitudinal disease network of traced readmissions (disease trajectories), merging data from over 10.4 million inpatients through the Healthcare Cost and Utilization Project, which allowed the representation of disease progression mapping over 300 diseases. From these disease trajectories, we discovered an interesting association between schizophrenia and rhabdomyolysis, a rare muscle disease (incidence &lt; 1E-04) (relative risk, 2.21 [1.80-2.71, confidence interval = 0.95], P-value 9.54E-15). We validated this association by using independent electronic medical records from over 830,000 patients at the University of California, San Francisco (UCSF) medical center. A case review of 29 rhabdomyolysis incidents in schizophrenia patients at UCSF demonstrated that 62% are idiopathic, without the use of any drug known to lead to this adverse event, suggesting a warning to physicians to watch for this unexpected risk of schizophrenia. Large-scale analysis of disease trajectories can help physicians understand potential sequential events in their patients

Learning to predict: exposure to temporal sequences facilitates prediction of future events.

Previous experience is thought to facilitate our ability to extract spatial and temporal regularities from cluttered scenes. However, little is known about how we may use this knowledge to predict future events. Here we test whether exposure to temporal sequences facilitates the visual recognition of upcoming stimuli. We presented observers with a sequence of leftwards and rightwards oriented gratings that was interrupted by a test stimulus. Observers were asked to indicate whether the orientation of the test stimulus matched their expectation based on the preceding sequence. Our results demonstrate that exposure to temporal sequences without feedback facilitates our ability to predict an upcoming stimulus. In particular, observers' performance improved following exposure to structured but not random sequences. Improved performance lasted for a prolonged period and generalized to untrained stimulus orientations rather than sequences of different global structure, suggesting that observers acquire knowledge of the sequence structure rather than its items. Further, this learning was compromised when observers performed a dual task resulting in increased attentional load. These findings suggest that exposure to temporal regularities in a scene allows us to accumulate knowledge about its global structure and predict future events

Open Design and medical products : An Open Medical Products methodology.

This research details the use of Open Design to enable participation in the conceptualisation, design and development of medical products for those who are excluded by their chronic health condition. The research was directed according to the Action Research methodology outlined by Checkland & Holwell (1998); Action Research being highlighted by Archer (1995) as a method compatible for practice-led design research. Open design directed the design practice, which consisted of a long case study spanning 18 months from February 2012, through to July 2013. This case study, dubbed AIR involved the creation of a bespoke online social network, recruitment of people living with cystic fibrosis, and the facilitation of collaborative design work resulting in prototype medical devices based on the lived experience of the participants.The work involves research into design within health as the context for this research. In order to place design in this wider context, it has been tempting to adopt the mantle Evidence Based Design (Evans, 2010) - however in this research the position of design as phronesis, in a similar manner to health practice (Montgomery, 2005) is adopted. This allows for an alignment of the work done in both fields, without the problematic associations with an evidence hierarchy (Gaver & Bowers, 2012; Holmes, Murray, Perron, & Rail, 2006).The contribution to knowledge is an Open Medical Products Methodology, consisting of the artefacts supporting the evidence of the methodology's ability to foster genuine participation amongst those who are excluded from traditional participatory design. The artefacts constituting this submission are this thesis, the reflective log kept during the research (Appendix A), the prototypes from the collaborative research (Appendix B), and the online social network that contained the work (AIR1). The Open Medical Products Methodology is expected to be of interest primarily to designers of medical products, design management and policymakers, although Open Design as a product methodology has appeal to other sectors and the future work into standardisation, regulation, distributed manufacture and recruitment detailed at the conclusion of this thesis has application broader than the medical field

Cyclic AMP signaling in Dictyostelium promotes the translocation of the copine family of calcium-binding proteins to the plasma membrane

Abstract Background Copines are calcium-dependent phospholipid-binding proteins found in many eukaryotic organisms and are thought to be involved in signaling pathways that regulate a wide variety of cellular processes. Copines are characterized by having two C2 domains at the N-terminus accompanied by an A domain at the C-terminus. Six copine genes have been identified in the Dictyostelium genome, cpnA – cpnF. Results Independent cell lines expressing CpnA, CpnB, CpnC, CpnE, or CpnF tagged with green fluorescent protein (GFP) were created as tools to study copine protein membrane-binding and localization. In general, the GFP-tagged copine proteins appeared to localize to the cytoplasm in live cells. GFP-tagged CpnB, CpnC, and CpnF were also found in the nucleus. When cells were fixed or when live cells were treated with calcium ionophore, the GFP-tagged copine proteins were found associated with the plasma membrane and vesicular organelles. When starved Dictyostelium cells were stimulated with cAMP, which causes a transitory increase in calcium concentration, all of the copines translocated to the plasma membrane, but with varying magnitudes and on and off times, suggesting each of the copines has distinct calcium-sensitivities and/or membrane-binding properties. In vitro membrane binding assays showed that all of the GFP-tagged copines pelleted with cellular membranes in the presence of calcium; yet, each copine displayed distinct calcium-independent membrane-binding in the absence of calcium. A lipid overlay assay with purified GFP-tagged copine proteins was used to screen for specific phospholipid-binding targets. Similar to other proteins that contain C2 domains, GFP-tagged copines bound to a variety of acidic phospholipids. CpnA, CpnB, and CpnE bound strongly to PS, PI(4)P, and PI(4,5)P2, while CpnC and CpnF bound strongly to PI(4)P. Conclusions Our studies show that the Dictyostelium copines are soluble cytoplasmic and nuclear proteins that have the ability to bind intracellular membranes. Moreover, copines display different membrane-binding properties suggesting they play distinct roles in the cell. The transient translocation of copines to the plasma membrane in response to cAMP suggests copines may play a specific role in chemotaxis signaling.https://deepblue.lib.umich.edu/bitstream/2027.42/145158/1/12860_2018_Article_160.pd

Cyclic AMP signaling in Dictyostelium promotes the translocation of the copine family of calcium-binding proteins to the plasma membrane

Abstract Background Copines are calcium-dependent phospholipid-binding proteins found in many eukaryotic organisms and are thought to be involved in signaling pathways that regulate a wide variety of cellular processes. Copines are characterized by having two C2 domains at the N-terminus accompanied by an A domain at the C-terminus. Six copine genes have been identified in the Dictyostelium genome, cpnA – cpnF. Results Independent cell lines expressing CpnA, CpnB, CpnC, CpnE, or CpnF tagged with green fluorescent protein (GFP) were created as tools to study copine protein membrane-binding and localization. In general, the GFP-tagged copine proteins appeared to localize to the cytoplasm in live cells. GFP-tagged CpnB, CpnC, and CpnF were also found in the nucleus. When cells were fixed or when live cells were treated with calcium ionophore, the GFP-tagged copine proteins were found associated with the plasma membrane and vesicular organelles. When starved Dictyostelium cells were stimulated with cAMP, which causes a transitory increase in calcium concentration, all of the copines translocated to the plasma membrane, but with varying magnitudes and on and off times, suggesting each of the copines has distinct calcium-sensitivities and/or membrane-binding properties. In vitro membrane binding assays showed that all of the GFP-tagged copines pelleted with cellular membranes in the presence of calcium; yet, each copine displayed distinct calcium-independent membrane-binding in the absence of calcium. A lipid overlay assay with purified GFP-tagged copine proteins was used to screen for specific phospholipid-binding targets. Similar to other proteins that contain C2 domains, GFP-tagged copines bound to a variety of acidic phospholipids. CpnA, CpnB, and CpnE bound strongly to PS, PI(4)P, and PI(4,5)P2, while CpnC and CpnF bound strongly to PI(4)P. Conclusions Our studies show that the Dictyostelium copines are soluble cytoplasmic and nuclear proteins that have the ability to bind intracellular membranes. Moreover, copines display different membrane-binding properties suggesting they play distinct roles in the cell. The transient translocation of copines to the plasma membrane in response to cAMP suggests copines may play a specific role in chemotaxis signaling.https://deepblue.lib.umich.edu/bitstream/2027.42/145158/1/12860_2018_Article_160.pd