The need for and provision of intrathecal baclofen therapy for the management of spasticity in England : an assessment of the Hospital Episode Statistics database

OBJECTIVES: The aim of this study was to evaluate changes in the uptake of intrathecal baclofen (ITB) following commissioning of this therapy by the National Health Service (NHS) England in April 2013. The specific objectives of this study were: (i) to explore the gap between the need for and the actual provision of ITB services; and (ii) to compare England figures with other European countries with comparable data available. SETTING: Data for ITB -related procedures were obtained from the Hospital Episode Statistics (HES) database from 2009/2010 to 2013/2014. PARTICIPANTS: Patients receiving ITB for the management of spasticity. RESULTS: The available data for implantation of ITB from 2009/2010 to 2013/2014 for the treatment of spasticity due to varied aetiologies show that there has not been an increase in uptake of this therapy. The estimated need for this treatment based on the incidence and prevalence of conditions susceptible to ITB therapy is between 4.6 and 5.7 per million population. Our analysis of the data available from the HES database showed that the actual number of implants is around 3.0 per million population. The same period 2009–2014 has seen an increase in the delivery of other neuromodulation techniques including spinal cord stimulation, deep brain stimulation and sacral nerve stimulation. CONCLUSIONS: There is a considerable gap between the need for and provision of ITB figures nationally. Additionally, within the same area, we have observed important differences in the ITB service delivery between the various trusts. The reasons for this can be multifactorial, including individual experience and opinions, organisational structures, resource and financial limitations. Further research analysing the efficacy and cost-effectiveness of this treatment in the UK might inform the development of Technology Appraisal Guidance for ITB, potentially leading to an improvement in service provision

Rotational imaging optical coherence tomography for full-body mouse embryonic imaging

Optical coherence tomography (OCT) has been widely used to study mammalian embryonic development with the advantages of high spatial and temporal resolutions and without the need for any contrast enhancement probes. However, the limited imaging depth of traditional OCT might prohibit visualization of the full embryonic body. To overcome this limitation, we have developed a new methodology to enhance the imaging range of OCT in embryonic day (E) 9.5 and 10.5 mouse embryos using rotational imaging. Rotational imaging OCT (RI-OCT) enables full-body imaging of mouse embryos by performing multiangle imaging. A series of postprocessing procedures was performed on each cross-section image, resulting in the final composited image. The results demonstrate that RI-OCT is able to improve the visualization of internal mouse embryo structures as compared to conventional OCT

Optimization of Job Shop Scheduling Problem using Tabu Search Optimization Technique

ABSTRACT-The Job shop scheduling (JSS) problem consists of "n" jobs and "m" operations on each of the jobs and it is hardest combinatorial optimization problems for which it is extremely difficult to find optimal solutions. Past two decades, much attention has been made to general heuristics such as Genetic algorithm, Ant Colony Optimization, Tabu Search and Simulated Annealing to solve this type of combinatorial optimization problems. In this paper we present how the adaptive search algorithms namely Tabu search is applied to solve Job shop scheduling (JSS) problem. The method uses dispatching rules to obtain an initial solution and searches for new solutions in a neighborhood based on the critical paths of the jobs. Several benchmark problems are tested using this algorithm for the best makespan and the obtained results are encouraging when compared with benchmark values

Steady-state pharmacokinetics of Nevirapine in HIV-1 infected adults in India

Background and Objectives: A variety of demographic factors, sex, and degree of immunosuppression can influence antiretroviral drug concentratians. The authors studied the influence of immune status, sex, and body mass index (BMI) on the steady-state pharmacokinetics of nevirapine delivered as a fixed-dose combination in HIV-1-infected patients in India. Methods: Twenty-six HIV-l-infected adult patients undergoing treatment with nevirapine-based highly active antiretroviral therapy regimens participated in the study. Pharmacokinetic variables were compared between patients divided based an CD4 cell counts, sex, and BMI. Results: Patients with higher BMI had lower peak and trough concentration and exposure of nevirapine than those with lower BMI; none of the differences in the pharmacokinetic variables of nevirapine between the various patient groups was statistically significant. Conclusions: Patients' immune status, sex, or BMI had no impact on the pharmacokinetics of nevirapine. Plasma nevirapine concentrations were maintained within the therapeutic range of the drug in the majority of the patients

Geodesic rewriting systems and pregroups

In this paper we study rewriting systems for groups and monoids, focusing on situations where finite convergent systems may be difficult to find or do not exist. We consider systems which have no length increasing rules and are confluent and then systems in which the length reducing rules lead to geodesics. Combining these properties we arrive at our main object of study which we call geodesically perfect rewriting systems. We show that these are well-behaved and convenient to use, and give several examples of classes of groups for which they can be constructed from natural presentations. We describe a Knuth-Bendix completion process to construct such systems, show how they may be found with the help of Stallings' pregroups and conversely may be used to construct such pregroups.Comment: 44 pages, to appear in "Combinatorial and Geometric Group Theory, Dortmund and Carleton Conferences". Series: Trends in Mathematics. Bogopolski, O.; Bumagin, I.; Kharlampovich, O.; Ventura, E. (Eds.) 2009, Approx. 350 p., Hardcover. ISBN: 978-3-7643-9910-8 Birkhause

Hypoglycemia in Non-Diabetic In-Patients: Clinical or Criminal?

BACKGROUND AND AIM: We wished to establish the frequency of unexpected hypoglycemia observed in non diabetic patients outside the intensive care unit and to determine if they have a plausible clinical explanation. METHODS: We analysed data for 2010 from three distinct sources to identify non diabetic hypoglycaemic patients: bedside and laboratory blood glucose measurements; medication records for those treatments (high-strength glucose solution and glucagon) commonly given to reverse hypoglycemia; and diagnostic codes for hypoglycemia. We excluded from the denominator admissions of patients with a diagnosis of diabetes or prescribed diabetic medication. Case notes of patients identified were reviewed. We used capture-recapture methods to establish the likely frequency of hypoglycemia in non-diabetic in-patients outside intensive care unit at different cut-off points for hypoglycemia. We also recorded co-morbidities that might have given rise to hypoglycemia. RESULTS: Among the 37,898 admissions, the triggers identified 71 hypoglycaemic episodes at a cut-off of 3.3 mmol/l. Estimated frequency at 3.3 mmol/l was 50(CI 33-93), at 3.0 mmol/l, 36(CI 24-64), at 2.7 mmol/l, 13(CI 11-19), at 2.5 mmol/l, 11(CI 9-15) and at 2.2 mmol/l, 8(CI 7-11) per 10,000 admissions. Admissions of patients aged above 65 years were approximately 50% more likely to have an episode of hypoglycemia. Most were associated with important co-morbidities. CONCLUSION: Significant non-diabetic hypoglycemia in hospital in-patients (at or below 2.7 mmol/l) outside critical care is rare. It is sufficiently rare for occurrences to merit case-note review and diagnostic blood tests, unless an obvious explanation is found