Persistent hypertriglyceridemia in statin-treated patients with type 2 diabetes mellitus

Purpose: This paper reports the results of an audit that assessed the prevalence of residual hypertriglyceridemia and the potential need for intensified management among patients with statin-treated type 2 diabetes mellitus (T2DM) in primary care in the UK. Patients and methods: A cross-sectional, observational, systematic audit of patients with diagnosed diabetes from 40 primary care practices was undertaken. The audit collected basic demographic information and data on prescriptions issued during the preceding 4 months. T2DM patients were stratified according to the proportion that attained European Society of Cardiology treatment targets. Results: The audit collected data from 14,652 patients with diagnosed diabetes: 89.5% (n = 13,108) of the total cohort had T2DM. Of the people with T2DM, 22.2% (2916) were not currently receiving lipid-lowering therapy. Up to approximately 80% of these people showed evidence of dyslipidemia. Among the group that received lipid-lowering therapy, 94.7% (9647) were on statin monotherapy, which was usually simvastatin (69.5% of patients receiving statin monotherapy; 6707). The currently available statins were prescribed, with the most common dose being 40 mg simvastatin (44.2%; 4267). Irrespective of the statin used, around half of the patients receiving statin monotherapy did not attain the European Society of Cardiology treatment targets for triglycerides, low-density lipoprotein, high-density lipoprotein, and total cholesterol. Conclusion: T2DM patients managed in UK primary care commonly show persistent lipid abnormalities. Clinicians need to optimize compliance with lipid-lowering and other medications. Clinicians also need to consider intensifying statin regimens, prescribing additional lipid-modifying therapies, and specific treatments aimed at triglyceride lowering to improve dyslipidemia control in statin-treated patients with T2DM

A novel method of non-clinical dispatch is associated with a higher rate of critical Helicopter Emergency Medical Service intervention

Background - Helicopter Emergency Medical Services (HEMS) are a scarce resource that can provide advanced emergency medical care to unwell or injured patients. Accurate tasking of HEMS is required to incidents where advanced pre-hospital clinical care is needed. We sought to evaluate any association between non-clinically trained dispatchers, following a bespoke algorithm, compared with HEMS paramedic dispatchers with respect to incidents requiring a critical HEMS intervention. Methods - Retrospective analysis of prospectively collected data from two 12-month periods was performed (Period one: 1st April 2014 – 1st April 2015; Period two: 1st April 2016 – 1st April 2017). Period 1 was a Paramedic-led dispatch process. Period 2 was a non-clinical HEMS dispatcher assisted by a bespoke algorithm. Kent, Surrey & Sussex HEMS (KSS HEMS) is tasked to approximately 2500 cases annually and operates 24/7 across south-east England. The primary outcome measure was incidence of a HEMS intervention.Results - A total of 4703 incidents were included; 2510 in period one and 2184 in period two. Variation in tasking was reduced by introducing non-clinical dispatchers. There was no difference in median time from 999 call to HEMS activation between period one and two (period one; median 7 min (IQR 4–17) vs period two; median 7 min (IQR 4–18). Non-clinical dispatch improved accuracy of HEMS tasking to a mission where a critical care intervention was required (OR 1.25, 95% CI 1.04–1.51, p = 0.02).Conclusion - The introduction of non-clinical, HEMS-specific dispatch, aided by a bespoke algorithm improved accuracy of HEMS tasking. Further research is warranted to explore where this model could be effective in other HEMS services.Peer reviewedFinal Published versio

Wigner Functions for Arbitrary Quantum Systems

The possibility of constructing a complete, continuous Wigner function for any quantum system has been a subject of investigation for over 50 years. A key system that has served to illustrate the difficulties of this problem has been an ensemble of spins. Here we present a general and consistent framework for constructing Wigner functions exploiting the underlying symmetries in the physical system at hand. The Wigner function can be used to fully describe any quantum system of arbitrary dimension or ensemble size.Comment: 5 pages, 3 figure

Analysis of intercomponent energy transfer in the interaction of oscillating-grid turbulence with an impermeable boundary

New experimental results are presented that investigate the nature of the intercomponent energy transfer that occurs in the interaction between oscillating-grid turbulence and a solid impermeable boundary, using instantaneous velocity measurements obtained from two-dimensional particle imaging velocimetry (PIV). Estimates of the pressure-strain correlation term of the transport equation of the Reynolds stress tensor, which represents intercomponent energy transfer, are obtained using the PIV data from a balance of the remaining terms of the transport equation. The influence of the pressure-strain correlation term on the flow is examined by computing the energy spectra and conditional turbulent statistics associated with events in which intercomponent energy transfer is thought to be concentrated. Data reported here is in support of viscous and `return-to-isotropy' mechanisms governing the intercomponent energy transfer previously proposed, respectively, by Perot & Moin [B. Perot and P. Moin, J. Fluid Mech., 295, 199-227 (1995).] and Walker et al. [D. T. Walker, R. I. Leighton and L. O. Garza-Rios, J. Fluid Mech., 320, 19-51 (1996)]. However, the data reported also indicate the presence of a weak net intercomponent energy transfer from the boundary-normal velocity component to the boundary-tangential velocity components over a thin region outside the viscous sublayer which is not captured within existing models of intercomponent energy transfer at the boundary

Fully integrated digital microfluidics platform for automated immunoassay; a versatile tool for rapid, specific detection of a wide range of pathogens

© 2018 Elsevier Ltd. All rights reserved. This manuscript is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International Licence http://creativecommons.org/licenses/by-nc-nd/4.0/.With the tangible threat posed by the release of chemical and biological warfare (CBW) agents, detection of airborne pathogens is a critical military and security concern. Recent air sampling techniques developed for biocollection take advantage of Electrowetting on Dielectric (EWOD) to recover material, producing highly concentrated droplet samples. Bespoke EWOD-based digital microfluidics platforms are very well suited to take full advantage of the microlitre concentrated droplet resulting from this recovery process. In this paper we present a free-standing, fully automated DMF platform for immunoassay. Using this system, we demonstrate the automated detection of four classes of CBW agent simulant biomolecules and organisms each representing credible threat agents. Taking advantage of the full magnetic separation process with antibody-bound microbeads, rapid and complete separation of specific target antigen can be achieved with minimal washing steps allowing for very rapid detection. Here, we report clear detection of four categories of antigens achieved with assay completion times of between six and ten minutes. Detection of HSA, Bacillus atrophaeus (BG spores), MS2 bacteriophage and Escherichia coli are demonstrated with estimated limit of detection of respectively 30 ng ml -1, 4 × 10 4 cfu ml -1, 10 6 pfu ml -1 and 2 × 10 7 cfu ml -1. The fully-integrated portable platform described in this paper is highly compatible with the next generation of electrowetting-coupled air samplers and thus shows strong potential toward future in-field deployable biodetection systems and could have key implication in life-changing sectors such as healthcare, environment or food security.Peer reviewe

Exploring information behaviour and meaningful experience amongst hikers on the West Highland Way

This paper discusses the information behaviour of hikers on the West Highland Way in Scotland by exploring meaningful experiences described by fifty participants walking the route.Methods. Using an ethnographic approach, participants were interviewed in the field at sites on the West Highland Way using semi-structured questions. Qualitative results are discussed and analysed using inductive thematic analysis and links to literature are established. Two types of meaningful experience were found in the interview data: connections with nature and social connections. Profound natural connections were found to feature embodied information from sensory interaction with the environment, resulting in a contemplative mindset and offering well-being benefits. Social connections with family, friends and fellow walkers were also described as meaningful, situating the activity as a ‘higher thing’ and demonstrating further well-being benefits. This initial study indicates that natural and social connections are key to meaningful experience in walking the West Highland Way. A broader information behaviour study based on this work will further explore the use of embodied information, contemplation in information science, serious leisure as a ‘higher thing’, and well-being benefits.Peer Reviewe