A novel drug management system in the Febuxostat versus Allopurinol Streamlined Trial:A description of a pharmacy system designed to supply medications directly to patients within a prospective multicenter randomised clinical trial

Background: Trials of investigational medicinal products are required to adhere to strict guidelines with regard to the handling and supply of medication. Information technology offers opportunities to approach clinical trial methodology in new ways. This report summarises a novel pharmacy system designed to supply trial medications directly to patients by post in the Febuxostat versus Allopurinol Streamlined Trial.Method: A bespoke web-based software package was designed to facilitate the direct supply of trial medications to Febuxostat versus Allopurinol Streamlined Trial participants from a pharmacy based in the Medicines Monitoring Unit, University of Dundee.Results: To date, 65,467 packs of medication have been dispensed using the system to 3978 patients. Up to 238 packs per day have been dispensed.Conclusion: The Medicines Monitoring Unit Febuxostat versus Allopurinol Streamlined Trial drug management system is an effective method of administering the complex drug supply requirements of a large-scale clinical trial with advantages over existing arrangements. A low rate of loss to follow-up in the Febuxostat versus Allopurinol Streamlined Trial may be attributable to the drug management system.</p

A fault management oriented early-design framework for electrical propulsion aircraft

Electrical propulsion has been identified as a key enabler of greener, quieter, and more efficient aircraft. However, electrical propulsion aircraft (EPA) will need to demonstrate a level of safety and reliability at least equal to current aircraft to be a viable alternative. Therefore, a robust and reliable fault management (FM) system is needed to prevent electrical faults causing loss of propulsion and critical flight functions. To date, FM of the electrical propulsion system has not been considered in detail for future EPA, nor has it been effectively integrated into the electrical architecture design. This poses a risk that the proposed electrical architectures will be infeasible from an FM perspective, and key FM technologies may not be sufficiently developed. Therefore, a methodology to incorporate FM into the early stages of the design of electrical architectures is required to determine viable FM solutions for a given EPA concept. This paper describes a novel, system-level electrical architecture design framework for EPA, which incorporates FM from the outset. This methodology captures the significant assumptions in the design and acknowledges the novel interfaces that exist between the electrical, conceptual, and FM design of EPA

Manufacture of electrical and magnetic graded and anisotropic materials for novel manipulations of microwaves

Spatial transformations (ST) provide a design framework to generate a required spatial distribution of electrical and magnetic properties of materials to effect manipulations of electromagnetic waves. To obtain the electromagnetic properties required by these designs, the most common materials approach has involved periodic arrays of metal-containing subwavelength elements. While aspects of ST theory have been confirmed using these structures, they are often disadvantaged by narrowband operation, high losses and difficulties in implementation. An all-dielectric approach involves weaker interactions with applied fields, but may offer more flexibility for practical implementation. This paper investigates manufacturing approaches to produce composite materials that may be conveniently arranged spatially, according to ST-based designs. A key aim is to highlight the limitations and possibilities of various manufacturing approaches, to constrain designs to those that may be achievable. The article focuses on polymer-based nano- and microcomposites in which interactions with microwaves are achieved by loading the polymers with high-permittivity and high-permeability particles, and manufacturing approaches based on spray deposition, extrusion, casting and additive manufacture

Antiretroviral Adherence Following Prison Release in a Randomized Trial of the imPACT Intervention to Maintain Suppression of HIV Viremia

Many people living with HIV (PLWH) pass through correctional facilities each year, a large proportion of whom do not maintain viral suppression following release. We examined the effects of imPACT, an intervention designed to promote post-release viral suppression, on antiretroviral therapy (ART) adherence. PLWH awaiting release from prisons in two southern states were randomized to imPACT (consisting of motivational interviewing, care linkage coordination, and text message medication reminders) versus standard care (SC). ART adherence, measured by unannounced monthly telephone pill counts, was compared between study arms over 6 months post-release. Of 381 participants eligible for post-release follow-up, 302 (79%) completed ≥ 1 of 6 possible pill counts (median: 4; IQR 1–6). Average adherence over follow-up was 80.3% (95% CI 77.5, 83.1) and 81.0% (78.3, 83.6) of expected doses taken in the imPACT and SC arms, respectively. There was no difference between arms when accounting for missing data using multiple imputation (mean difference = − 0.2 percentage points [− 3.7, 3.3]), controlling for study site and week of follow-up. Of the 936 (40.9%) pill counts that were missed, 212 (22.7%) were due to re-incarceration. Those who missed pill counts for any reason were more likely to be unsuppressed, suggesting that they had lower adherence. However, missingness was balanced between arms. Among PLWH released from prison, ART adherence averaged > 80% in both study arms over 6 months—a level higher than seen with most other chronic diseases. However, missing data may have led to an overestimate of adherence. Factors independent of the intervention influence ART adherence in this population and should be identified to inform future targeted interventions

Innate and adaptive humoral responses coat distinct commensal bacteria with immunoglobulin A

Immunoglobulin A (IgA) is prominently secreted at mucosal surfaces and coats a fraction of the intestinal microbiota. However, the commensal bacteria bound by IgA are poorly characterized and the type of humoral immunity they elicit remains elusive. We used bacterial flow cytometry coupled with 16S rRNA gene sequencing (IgA-Seq) in murine models of immunodeficiency to identify IgA-bound bacteria and elucidate mechanisms of commensal IgA targeting. We found that residence in the small intestine, rather than bacterial identity, dictated induction of specific IgA. Most commensals elicited strong T-independent (TI) responses that originated from the orphan B1b lineage and from B2 cells, but excluded natural antibacterial B1a specificities. Atypical commensals including segmented filamentous bacteria and Mucispirillum evaded TI responses but elicited T-dependent IgA. These data demonstrate exquisite targeting of distinct commensal bacteria by multiple layers of humoral immunity and reveal a specialized function of the B1b lineage in TI mucosal IgA responses

Charm and Bottom Semileptonic Decays

We review the present status of theoretical attempts to calculate the semileptonic charm and bottom decays and then present a calculation of these decays in the light--front frame at the kinematic point $q^2=0$. This allows us to evaluate the form factors at the same value of $q^2$, even though the allowed kinematic ranges for charm and bottom decays are very different. Also, at this kinematic point the decay is given in terms of only one form factor $A_{0}(0)$. For the ratio of the decay rates given by the E653 collaboration we show that the determination of the ratio of the Cabibbo--Kobayashi--Maskawa (CKM) matrix elements is consistent with that obtained from the unitarity constraint. At present, though, the unitarity method still has greater accuracy. Since comparisons of the semileptonic decays into $\rho$ and either electrons or muons will be available soon from the E791 Fermilab experiment, we also look at the massive muon case. We show that for a range of $q^2$ the $SU(3)_F$ symmetry breaking is small even though the contributions of the various helicity amplitudes becomes more complicated. For $B$ decays, the decay $B \rightarrow K^{*} \ell \bar{\ell}$ at $q^2=0$ involves an extra form factor coming from the photon contribution and so is not amenable to the same kind of analysis, leaving only the decay $B \rightarrow K^{*}\nu \bar{\nu}$ as a possibility. As the mass of the decaying particle increases we note that the $SU(3)$ symmetry becomes badly broken at $q^2=0$.Comment: Latex, 19 pages, two figures are attached, a minor change in the manuscript related to thi

A Model for Rigorously Applying the Exploration, Preparation, Implementation, Sustainment (EPIS) Framework in the Design and Measurement of a Large Scale Collaborative Multi-Site Study

Background This paper describes the means by which a United States National Institute on Drug Abuse (NIDA)-funded cooperative, Juvenile Justice-Translational Research on Interventions for Adolescents in the Legal System (JJ-TRIALS), utilized an established implementation science framework in conducting a multi-site, multi-research center implementation intervention initiative. The initiative aimed to bolster the ability of juvenile justice agencies to address unmet client needs related to substance use while enhancing inter-organizational relationships between juvenile justice and local behavioral health partners. Methods The EPIS (Exploration, Preparation, Implementation, Sustainment) framework was selected and utilized as the guiding model from inception through project completion; including the mapping of implementation strategies to EPIS stages, articulation of research questions, and selection, content, and timing of measurement protocols. Among other key developments, the project led to a reconceptualization of its governing implementation science framework into cyclical form as the EPIS Wheel. The EPIS Wheel is more consistent with rapid-cycle testing principles and permits researchers to track both progressive and recursive movement through EPIS. Moreover, because this randomized controlled trial was predicated on a bundled strategy method, JJ-TRIALS was designed to rigorously test progress through the EPIS stages as promoted by facilitation of data-driven decision making principles. The project extended EPIS by (1) elucidating the role and nature of recursive activity in promoting change (yielding the circular EPIS Wheel), (2) by expanding the applicability of the EPIS framework beyond a single evidence-based practice (EBP) to address varying process improvement efforts (representing varying EBPs), and (3) by disentangling outcome measures of progression through EPIS stages from the a priori established study timeline. Discussion The utilization of EPIS in JJ-TRIALS provides a model for practical and applied use of implementation frameworks in real-world settings that span outer service system and inner organizational contexts in improving care for vulnerable populations. Trial registration NCT02672150. Retrospectively registered on 22 January 2016