Point-of-care C reactive protein for the diagnosis of lower respiratory tract infection in NHS primary care: a qualitative study of barriers and facilitators to adoption

OBJECTIVES: Point-of-care (POC) C reactive protein (CRP) is incorporated in National Institute of Health and Care Excellence (NICE) guidelines for the diagnosis of pneumonia, reduces antibiotic prescribing and is cost effective. AIM: To determine the barriers and facilitators to adoption of POC CRP testing in National Health Service (NHS) primary care for the diagnosis of lower respiratory tract infection. DESIGN: The study followed a qualitative methodology based on grounded theory. The study was undertaken in 2 stages. Stage 1 consisted of semistructured interviews with 8 clinicians from Europe and the UK who use the test in routine practice, and focused on their subjective experience in the challenges of implementing POC CRP testing. Stage 2 was a multidisciplinary-facilitated workshop with NHS stakeholders to discuss barriers to adoption, impact of adoption and potential adoption scenarios. Emergent theme analysis was undertaken. PARTICIPANTS: Participants included general practitioners (including those with commissioning experience), biochemists, pharmacists, clinical laboratory scientists and industry representatives from the UK and abroad. RESULTS: Barriers to the implementation of POC CRP exist, but successful adoption has been demonstrated abroad. Analysis highlighted 7 themes: reimbursement and incentivisation, quality control and training, laboratory services, practitioner attitudes and experiences, effects on clinic flow and workload, use in pharmacy and gaps in evidence. CONCLUSIONS: Successful adoption models from the UK and abroad demonstrate a distinctive pattern and involve collaboration with central laboratory services. Incorporating antimicrobial stewardship into quality improvement frameworks may incentivise adoption. Further research is needed to develop scaling-up strategies to address the resourcing, clinical governance and economic impact of widespread NHS implementation

A research protocol for developing a Point-Of-Care Key Evidence Tool 'POCKET': a checklist for multidimensional evidence reporting on point-of-care in vitro diagnostics.

INTRODUCTION: Point-of-care in vitro diagnostics (POC-IVD) are increasingly becoming widespread as an acceptable means of providing rapid diagnostic results to facilitate decision-making in many clinical pathways. Evidence in utility, usability and cost-effectiveness is currently provided in a fragmented and detached manner that is fraught with methodological challenges given the disruptive nature these tests have on the clinical pathway. The Point-of-care Key Evidence Tool (POCKET) checklist aims to provide an integrated evidence-based framework that incorporates all required evidence to guide the evaluation of POC-IVD to meet the needs of policy and decisionmakers in the National Health Service (NHS). METHODS AND ANALYSIS: A multimethod approach will be applied in order to develop the POCKET. A thorough literature review has formed the basis of a robust Delphi process and validation study. Semistructured interviews are being undertaken with POC-IVD stakeholders, including industry, regulators, commissioners, clinicians and patients to understand what evidence is required to facilitate decision-making. Emergent themes will be translated into a series of statements to form a survey questionnaire that aims to reach a consensus in each stakeholder group to what needs to be included in the tool. Results will be presented to a workshop to discuss the statements brought forward and the optimal format for the tool. Once assembled, the tool will be field-tested through case studies to ensure validity and usability and inform refinement, if required. The final version will be published online with a call for comments. Limitations include unpredictable sample representation, development of compromise position rather than consensus, and absence of blinding in validation exercise. ETHICS AND DISSEMINATION: The Imperial College Joint Research Compliance Office and the Imperial College Hospitals NHS Trust R&D department have approved the protocol. The checklist tool will be disseminated through a PhD thesis, a website, peer-reviewed publication, academic conferences and formal presentations

Growth to early adulthood following extremely preterm birth: the EPICure study.

OBJECTIVE: To investigate growth trajectories from age 2.5 to 19 years in individuals born before 26 weeks of gestation (extremely preterm; EP) compared with term-born controls. METHODS: Multilevel modelling of growth data from the EPICure study, a prospective 1995 birth cohort of 315 EP participants born in the UK and Ireland and 160 term-born controls recruited at school age. Height, weight, head circumference and body mass index (BMI) z-scores were derived from UK standards at ages 2.5, 6, 11 and 19 years. RESULTS: 129 (42%) EP children were assessed at 19 years. EP individuals were on average 4.0 cm shorter and 6.8 kg lighter with a 1.5 cm smaller head circumference relative to controls at 19 years. Relative to controls, EP participants grew faster in weight by 0.06 SD per year (95% CI 0.05 to 0.07), in head circumference by 0.04 SD (95% CI 0.03 to 0.05), but with no catch-up in height. For the EP group, because of weight catch-up between 6 and 19 years, BMI was significantly elevated at 19 years to +0.32 SD; 23.4% had BMI >25 kg/m2 and 6.3% >30 kg/m2 but these proportions were similar to those in control subjects. EP and control participants showed similar pubertal development in early adolescence, which was not associated with height at 19 years in either study group. Growth through childhood was related to birth characteristics and to neonatal feeding practices. CONCLUSIONS: EP participants remained shorter and lighter and had smaller head circumferences than reference data or controls in adulthood but had elevated BMI

Crystal Structure of the ZrO Phase at Zirconium/Zirconium Oxide Interfaces

Zirconium-based alloys are used in water-cooled nuclear reactors for both nuclear fuel cladding and structural components. Under this harsh environment, the main factor limiting the service life of zirconium cladding, and hence fuel burn-up efficiency, is water corrosion. This oxidation process has recently been linked to the presence of a sub-oxide phase with well-defined composition but unknown structure at the metal–oxide interface. In this paper, the combination of first-principles materials modeling and high-resolution electron microscopy is used to identify the structure of this sub-oxide phase, bringing us a step closer to developing strategies to mitigate aqueous oxidation in Zr alloys and prolong the operational lifetime of commercial fuel cladding alloys

A combined wavelet-element free Galerkin method for numerical calculations of electromagnetic fields

Author name used in this publication: S. L. HoAuthor name used in this publication: J. M. Machado2002-2003 > Academic research: refereed > Publication in refereed journalVersion of RecordPublishe

Spectro-microscopy of single and multi-layer graphene supported by a weakly interacting substrate

We report measurements of the electronic structure and surface morphology of exfoliated graphene on an insulating substrate using angle-resolved photoemission and low energy electron diffraction. Our results show that although exfoliated graphene is microscopically corrugated, the valence band retains a massless fermionic dispersion, with a Fermi velocity of ~10^6 m/s. We observe a close relationship between the morphology and electronic structure, which suggests that controlling the interaction between graphene and the supporting substrate is essential for graphene device applications.Comment: 10 pages of text, 4 JPEG figure

An improved tabu-based vector optimal algorithm for design optimizations of electromagnetic devices

Author name used in this publication: S. Y. YangAuthor name used in this publication: S. L. HoAuthor name used in this publication: J. M. MachadoAuthor name used in this publication: Edward W. C. Lo2003-2004 > Academic research: refereed > Publication in refereed journalVersion of RecordPublishe

Ullemar's formula for the Jacobian of the complex moment mapping

The complex moment sequence m(P) is assigned to a univalent polynomial P by the Cauchy transform of the P(D), where D is the unit disk. We establish the representation of the Jacobian det dm(P) in terms of roots of the derivative P'. Combining this result with the special decomposition for the Hurwitz determinants, we prove a formula for the Jacobian which was previously conjectured by C. Ullemar. As a consequence, we show that the boundary of the class of all locally univalent polynomials in $U$ is contained in the union of three irreducible algebraic surfaces.Comment: 14 pages, submitted for "Complex Variables. Theory and Application

Critical change in the Fermi surface of iron arsenic superconductors at the onset of superconductivity

The phase diagram of a correlated material is the result of a complex interplay between several degrees of freedom, providing a map of the material's behavior. One can understand (and ultimately control) the material's ground state by associating features and regions of the phase diagram, with specific physical events or underlying quantum mechanical properties. The phase diagram of the newly discovered iron arsenic high temperature superconductors is particularly rich and interesting. In the AE(Fe1-xTx)2As2 class (AE being Ca, Sr, Ba, T being transition metals), the simultaneous structural/magnetic phase transition that occurs at elevated temperature in the undoped material, splits and is suppressed by carrier doping, the suppression being complete around optimal doping. A dome of superconductivity exists with apparent equal ease in the orthorhombic / antiferromagnetic (AFM) state as well as in the tetragonal state with no long range magnetic order. The question then is what determines the critical doping at which superconductivity emerges, if the AFM order is fully suppressed only at higher doping values. Here we report evidence from angle resolved photoemission spectroscopy (ARPES) that critical changes in the Fermi surface (FS) occur at the doping level that marks the onset of superconductivity. The presence of the AFM order leads to a reconstruction of the electronic structure, most significantly the appearance of the small hole pockets at the Fermi level. These hole pockets vanish, i. e. undergo a Lifshitz transition, at the onset of superconductivity. Superconductivity and magnetism are competing states in the iron arsenic superconductors. In the presence of the hole pockets superconductivity is fully suppressed, while in their absence the two states can coexist.Comment: Updated version accepted in Nature Physic

MANAGEMENT OF DEFENSE HERITAGE BASED TOURISM TO ENHANCE YOUTH NATIONALISM AND PATRIOTISM

Some countries have proven to be advanced by managing their historical and cultural heritage and promoting it internationally. Japan and South Korea are living examples, who transform the war site not only into national defense heritage but also bring it to the international level.  The management of historical heritage is crucial to enhance people's awareness of the importance of national defense. However, many of Indonesia's historical relics are still neglected or poorly managed, even though many historical and cultural heritages have the potential to become tourist attractions. This article aims to discuss how to manage Indonesian historical and cultural heritage to enhance nationalism and patriotism. Proper management of historical and cultural heritage will increase the love of the motherland. The research method is done by a qualitative research method as well as literature studies. This study proves that the management of culture and historical heritage of Indonesia, especially those related to the national struggle, is still largely ignored. Moreover, Indonesia even lacks in managing its historical and cultural heritage. Therefore, Indonesia has to improve the management of its cultural and historical heritage so that it can be promoted to the global world as an object of tourism to increase the nationalism of the younger generation