Integrating research with NHS clinical practice: Unwelcome intrusion or constructive triangulation?

When embarking on research into the effectiveness of psychoanalytic psychotherapy in the NHS or the application of psychoanalytic principles, researchers come up against a number of hurdles: many clinicians still see empirical research as antithetical or disruptive to the practice of psychoanalytic psychotherapy; psychoanalytic psychotherapy has previously fared poorly in evidence-based policy guidelines and this can discourage ambition, and there are technical problems of research design, measurement and standardization. Nevertheless, in a political climate which stresses service evaluation, measurable outcomes and empirical evidence, psychoanalytic psychotherapy must participate to survive. There may be gains from conducting research beyond simply meeting the requirement to provide evidence of effectiveness. Research may be viewed by some clinicians as an unwelcome intruder but it may have the potential to offer triangulation, the perspective of the 'third', and so strengthen the foundations of clinical practice and the development of psychoanalytic thought

A Theoretical Model for a Prescription Drug Public Key Cryptographic System

A critical component of a physician\u27s duties is prescribing medication to his or her patients. This process is handled by the physician writing a prescription for a medication and having the medication dispensed to the named patient. A review of federal law reveals no requirement that the prescription be issued on any type of specific written instrument such as safety paper, multi-part forms, or other standardized documents. Because of the lack of adequate controls, there is a serious problem with false and altered prescriptions being issued within the United States. A 1994 study by the White House Office of National Drug Control estimated that there was two billion dollars spent annually on illegal prescription drugs that would have otherwise been spent to support legitimate activities in the overall domestic economy. Hospital records show that from 1990 through 1995, there has been a steady and alarming increase in overdoses of prescription medication. The United States Drug Enforcement Administration has estimated that in 1993 approximately 25 billion dollars in prescription drugs were sold illegally, compared to a government estimate of 31 billion dollars spent that year on cocaine. A large percentage of these drugs originate from altered prescriptions. The mechanics of prescription fraud can take many forms. These include forgery of the physician\u27s signature, alteration of the dosage or quantity of medication found on a legitimate prescription, phone-in prescription fraud, and theft of prescription blanks. Recent developments in the computer field have resulted in computer assisted cryptographic methods that can authenticate users, signatures, and the contents of electronic messages. One such method is a public key cryptographic system (PKCS). This technology allows data to be encrypted over public networks and allows the recipient of the message to definitively authenticate and verify both the contents and the sender of the message. The goal of this investigation was to develop a theoretical schema that uses a public key cryptographic system to authenticate every prescription written by a licensed physician and prevent any alteration to its contents. The schema also addresses implementation, connectivity, security, privacy, and the economic issues that are associated with this type of system. The theoretical schema consists of a model that addresses specific hardware, operating software, general configuration, implementation, and technical requirements for both the users of the system and the peripheral equipment that is required by the physician and pharmacist in order to operate in an effective manner. It also addresses connectivity issues associated with the dynamic Internet or asynchronous communications link between the physician\u27s desktop computer and the pharmacist\u27s office computer. Security and privacy issues specifically address the encryption and decryption mechanisms that are in place in order to make sure that the prescription information is secure and authentic. It also consists of requirements for public-key encryption and software authentication, explores existing products that make use of this technology, incorporates the products into the theoretical schema, and addresses the configuration issues required in order to setup the software with an appropriate and functional level security. Finally, the theoretical schema addresses the issues of password and public-key maintenance. Economic issues focus on the costs required to implement and maintain the system and potential revenue streams that exist within the market-place if the captured prescription drug data is sold to interested third-parties such as pharmaceutical or healthcare marketing companies. The technical components of the schema were validated by creating a prototype system that provided the necessary encryption for a physician and pharmacist. The system demonstrated that public-key cryptography could be used to encrypt, transmit, decrypt, and authenticate prescriptions sent between pharmacists and physicians. The system also demonstrated that the prescriptions can be generated quickly and that the actual encryption and decryption process could be performed is less than one second. The economic issues were validated by computing the actual cost of implementing the system using existing products and comparing these costs against the estimated costs available from the federal government associated with prescription drug fraud. Finally, the potential acceptance of the system was evaluated by distributing and correlating the results of a survey that was distributed to both physicians and pharmacists. The results showed that a public-key cryptographic system will eliminate prescription fraud by providing positive authentication of every prescription received by the pharmacist, and that the contents of the prescription could not be altered between the time it was written by the physician and received by the pharmacist. The investigation showed that the system was not expensive to develop or use. It also showed that the majority of the users (physicians and pharmacists) will be reluctant to embrace the technology; however, younger and more computer-literate users, as well as those users who perceive that a significant problem with prescription drug fraud already exists, were more likely to accept and use the technology

Effective Building Modelling for Energy Performance Contracting

Energy Performance Contracts (EPC) are contractual agreements between beneficiaries and energy service providers, where budgets are established in relation to a determined level of energy performance. Hence, the problem of forecasting the energy performance of buildings in the EPC tendering phase becomes relevant for the reliability of the overall contract. Unfortunately, fuzziness and incompleteness often characterize the technical information supporting EPC call for tenders. Furthermore, buildings that are the subjects of EPCs are normally quite complex public buildings (hospitals, schools, etc.) usually relatively old and not technically well known. Gathering information about such buildings is a time consuming and expensive process within the usually short time frame of EPC call for tenders. This paper investigates the application of Grey-Box modelling to the energy performance forecast of complex buildings, in perfectly and poorly informed operational cases. The proposed methodology offers a potential solution to the EPC operational requirements since it requires a substantially reduced parameter set. Results show that the proposed Grey-Box modelling can be used to arrange a calibration set-up with good forecasting performance. Furthermore, Grey-Box modelling allows an effective management of the information uncertainty usually present in the EPC context

Iminodiacetic acid (IDA) cation-exchange nonwoven membranes for efficient capture of antibodies and antibody fragments

There is strong need to reduce the manufacturing costs and increase the downstream purification efficiency of high-value therapeutic monoclonal antibodies (mAbs). This paper explores the performance of a weak cation-exchange membrane based on the coupling of IDA to poly(butylene terephthalate) (PBT) nonwoven fabrics. Uniform and conformal layers of poly(glycidyl methacrylate) (GMA) were first grafted to the surface of the nonwovens. Then IDA was coupled to the polyGMA layers under optimized conditions, resulting in membranes with very high permeability and binding capacity. This resulted in IgG dynamic binding capacities at very short residence times (0.1–2.0 min) that are much higher than those achieved by the best cation-exchange resins. Similar results were obtained in the purification of a single-chain (scFv) antibody fragment. As is customary with membrane systems, the dynamic binding capacities did not change significantly over a wide range of residence times. Finally, the excellent separation efficiency and potential reusability of the membrane were confirmed by five consecutive cycles of mAb capture from its cell culture harvest. The present work provides significant evidence that this weak cation-exchange nonwoven fabric platform might be a suitable alternative to packed resin chromatography for low-cost, higher productivity manufacturing of therapeutic mAbs and antibody fragments

Superovulation Response and In vivo Embryo

 አህፅሮት የጥናቱ ዋና ዓሊማ ንፁህ የቦረና ሊሞችና የቦረና ዲቃሊ ሊሞች ተጨማሪ ዕንቁሊል የማኮረትና ፅንስ የመስጠት አቅማቸውን ሇማጥናት የተሰራነው፡፡ ሊሞች በሦስት ቡድን ተከፍሇው 300፣ 250 እና 200 አይ.ዩ. ኤፍ.ኤስ.ኤች. ሆርሞን ተሰጣቸው፤ ከዚያም የኮርማ ፍሊጎት እስከሚያሳዩበት የወሰደባቸው ጊዜ፣ የኮርማ ፍሊጎት እያሳዩ የሚቆዩት ጊዜ እና ጠቅሊሊ አኮርተው የሇቀቁት ዕንቁሊል ቁጥር በማየት ሇሆርሞኑ የነበራቸው ምሊሽ ተጠንቷል፡፡ ተጨማሪ ዕንቁሊል እንዲያኮርቱ ሇማድረግ ሆርሞን በተሰጣቸው በ16-17 ቀን ሊይ ፅንሶችን በመሰብሰብ የዕድገታቸው ሁኔታና ጥራት ግምገማ ተደርጓል፡፡ በመጨረሻው ጊዜ ሆርሞን ከተሰጠበት የኮርማ ፍሊጎት እስከሚያሳዩበት ጊዜ በአማካይ 20.4 ሰዓታ የወሰደባቸው ሲሆን በቦረና እና በዲቃሎቻቸው መካከል የጎሊ የሰዓታት ልዩነት አልታየም፡፡ ይሁን እንጂ ከተሰጣቸው ሦስት የተሇያየ የሆርሞን መጠን 250 አይ.ዩ የወሰዱት ቀደም ብሇው በ10 ሰዓታ ውስጥ የኮርማ ፍሊጎት አሳይተዋል፡፡ የተኮረቱት ዕንቁሊል ቁጥር ሲታይ ቦረናዎች (10.1 ዕንቁሊል) ከዲቃሎቻቸው የተሸሇ በዛ ያለ አዘጋጅተዋል፡፡ የፅንስ ብዛትም ሲታይ ቦረናዎች 4 ሲሰጡ ዲቃሎቻቸው 2.67 ሰጥተዋል፡፡ ከፅንስ ዕድገትና ጥራት ግምገማ ውጤት ቦረናዎች ሉተሊሇፉ የሚችለ ፅንስ 3.8 ሲሆን የዲቃሎቻቸው 2.67 ነበር፡፡ በመሆኑም በታዩት መስፈርቶች ቦረና ሊሞች ከዲቃሎቻቸው የተሸሇ ዕንቁሊ ማኮረት እንደሚችለና የተሻሇ የዕድገት ደረጃና ጥራት ያሇው ፅንስ መስጠት የሚችል አቅም እንዳሇቸው ታይቷል፡፡ AbstractBoran (n=25) and Boran*Holstein (n=11) cows were superovullatedFSH with three doses level (300, 250 and 200IU) divided in to morning and afternoon decreasing doses over 4 daysto study the superovulatory response and embryo production potential. Time to estrus, duration of estrus, and CL count were used to determine superovulatory response. Embryos were flushed on Day 16/17 by non-surgical gravitational method and evaluated for development stage, and quality grade. The mean (±SEM) time interval from CIDR withdrawal to onset of estrus was 20.4±1.8 hours, and breed difference was not significant.However, the interval from CIDR removal to onset of estrus was shorter (p=0.01) in cows treated with 250 IU FSH (10.75±3.3 hours) than in cows received 200 or 300 IU. The total CL count was significantly higher (p=0.01) in Boran (10.1CL/cow/cycle) than Boran x Holstein cows (7.2CL/cow/cycle). A mean number of 4.1 and 2.67embryos’/cow were flushed from Boran and Boran*Holstein, respectively. The average transferable embryos/cow were 3.8±0.57 and 2.67±0.99 in Boran and Boran*Holstein, respectively. And hence, Boran cows’ response to superovulation and yield of better quality and number of embryo than their Boran*Holstein counterparts showed the high potential of the breed for in-vivo and in-vitro embyo production

Workshop Report: Improving Resilience to Climate Impacts in Ethiopia Through Improved Availability, Access and Use of Climate Information: Dialogue With Users

Ethiopia's National Meteorological Agency (NMA) is transforming its climate information services in a way that is unprecedented in Africa, and in many parts of the world. NMA's new innovative products include a 30-year time series of ten-daily rainfall and temperature data for every 10 km grid across Ethiopia, created by combining station measurements and satellite proxies; and an online mapping service providing user-friendly tools for visualization, querying, and accessing informatioff. The workshop presented these tools to a range of users and potential users in order . to: • provide an overview of the themes of climate risk management; • make participants aware of the information and products that already exist • train them in the use of the tool • solicit feedback regarding improvements and/or other climate information products that could assist in risk management practices within the country Workshops participants represented agriculture, water, food security, and disaster risk management, and provided feedback regarding how the tool could be improved

Response of the Pacific Sector of the Southern Ocean to wind stress variability from 1995 to 2017

AbstractDrifter, satellite, expendable bathythermograph (XBT), and Argo float data are used to study the response of the Pacific Sector of the Southern Ocean (PSSO) to the wind stress field in the period 1995–2017, in terms of eddy field, water mass transport, and heat fluxes at large and regional scales. Increasing wind stress over the PSSO in those two decades led to a growth of the Eddy Kinetic Energy (EKE) in the region of the Antarctic Circumpolar Current (ACC). Increases of the EKE occur with delays of 1–4 years with respect to peaks in the zonal component of the wind stress. The persistent ACC meander located south of New Zealand (between 150°E and 180°W and 50°S to 66°S) responds to the interannual wind variations earlier than the entire ACC branch in the PSSO. In the same area, an estimate of the ACC transport based on in situ data shows interannual variability but no significant decadal trend over the study period. The effects of the EKE variability on the meridional eddy heat fluxes are significant on interannual scales. The strengthening of the EKE field leads to a local increase in the poleward meridional eddy heat fluxes in the PSSO, especially in the ACC band. The weakening of the EKE field defines an area of equatorward meridional eddy heat fluxes in the middle of the PSSO (south of 40°S, between 130°W and 160°W) and prevalent poleward fluxes in the further western and eastern regions

Visceral leishmaniasis patients display altered composition and maturity of neutrophils as well as impaired neutrophil effector functions

Immunologically, active visceral leishmaniasis (VL) is characterised by profound immunosuppression, severe systemic inflammatory responses and an impaired capacity to control parasite replication. Neutrophils are highly versatile cells, which play a crucial role in the induction as well as the resolution of inflammation, the control of pathogen replication and the regulation of immune responses. Neutrophil functions have been investigated in human cutaneous leishmaniasis, however, their role in human visceral leishmaniasis is poorly understood. In the present study we evaluated the activation status and effector functions of neutrophils in patients with active VL and after successful anti-leishmanial treatment. Our results show that neutrophils are highly activated and have degranulated; high levels of arginase, myeloperoxidase and elastase, all contained in neutrophils’ granules, were found in the plasma of VL patients. In addition, we show that a large proportion of these cells are immature. We also analysed effector functions of neutrophils that are essential for pathogen clearance and show that neutrophils have an impaired capacity to release neutrophil extracellular traps, produce reactive oxygen species and phagocytose bacterial particles, but not Leishmania parasites. Our results suggest that impaired effector functions, increased activation and immaturity of neutrophils play a key role in the pathogenesis of VL