A cross-sectional evaluation of community pharmacists’ perceptions of intermediate care and medicines management across the healthcare interface

Background Despite the importance placed on the concept of the multidisciplinary team in relation to intermediate care (IC), little is known about community pharmacists’ (CPs) involvement. Objective To determine CPs’ awareness of and involvement with IC services, perceptions of the transfer of patients’ medication information between healthcare settings and views of the development of a CP–IC service. Setting Community pharmacies in Northern Ireland. Methods A postal questionnaire, informed by previous qualitative work was developed and piloted. Main outcome measure CPs’ awareness of and involvement with IC. Results The response rate was 35.3 % (190/539). Under half (47.4 %) of CPs ‘agreed/strongly agreed’ that they understood the term ‘intermediate care’. Three quarters of respondents were either not involved or unsure if they were involved with providing services to IC. A small minority (1.2 %) of CPs reported that they received communication regarding medication changes made in hospital or IC settings ‘all of the time’. Only 9.5 and 0.5 % of respondents ‘strongly agreed’ that communication from hospital and IC, respectively, was sufficiently detailed. In total, 155 (81.6 %) CPs indicated that they would like to have greater involvement with IC services. ‘Current workload’ was ranked as the most important barrier to service development. Conclusion It was revealed that CPs had little awareness of, or involvement with, IC. Communication of information relating to patients’ medicines between settings was perceived as insufficient, especially between IC and community pharmacy settings. CPs demonstrated willingness to be involved with IC and services aimed at bridging the communication gap between healthcare settings. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1007/s11096-016-0377-3) contains supplementary material, which is available to authorized users

Building a healthy mouse model ecosystem to interrogate cancer biology

In a recent study, Sargent et al. characterise several novel Rag1−/− mouse strains and demonstrate that genetic background strongly influences xenograft development and phenotype. Here, we discuss this work within the broader context of cancer mouse modelling. We argue that new technologies will enable insights into how specific models align with human disease states and that this knowledge can be used to develop a diverse ecosystem of complementary mouse models of cancer. By utilising these diverse, well-characterised models to provide multiple perspectives on specific cancers, it should be possible to reduce the inappropriate attrition of sound hypotheses while protecting against false positives. Furthermore, careful re-introduction of biological variation, be that through outbred populations, environmental diversity or including animals of both sexes, can ensure that results are more broadly applicable and are less impacted by particular traits of homogeneous experimental populations. Thus, careful characterisation and judicious use of an array of mouse models provides an opportunity to address some of the issues surrounding both the reproducibility and translatability crises often referenced in pre-clinical cancer research

In the name of history: (De)Legitimising street vendors in New York and Rome

Policy makers across the Global North tend to remove poor and non-white vendors as inappropriate users of public space. Scholars have amply demonstrated that such removals reflect dominant aspirations of the present and future image of the city. But how do ideas about a city’s past help shape these aspirations? We compare how heritage, the socially constructed meanings through which people experience history, helps forge consensus over the legitimacy of vendors in Rome and New York. Vending has long allowed oppressed people to survive in both cities. These similar histories translate today into diverging attitudes. In Rome, a city branded as a site of (white) glory, authorities banish both long-standing Jewish vendors and newly arrived immigrants. In New York, mythicised as a place of success for immigrants, policy makers cannot always displace vendors who claim historical legitimacy. We explain these different conditions through a regimes of heritage framework. Using archival and ethnographic data, we examine whose voices count more in constructing each city’s past, what stories are told, and how these stories imbricate with existing political structures. Regimes of heritage, we find, help spatialise neoliberalism, differentiated citizenship, and authenticity. These dynamics highlight heritage as a critical, if underexplored agent of urban oppression and resistance. </jats:p

Design and Fabrication of an Ultra-Low Capacitive Pressure Transducer

The goal of the Capacitive Pressure Sensor project is to redesign the Alpha Instruments 168 series capacitive pressure sensor sold by Dwyer Instruments. The primary objectives of the new design will be to eliminate the use of welding in the assembly of the sensor components and to eliminate stray capacitance in the system measurements through the use of dielectric boundaries. Additionally, the sensor housing will be a stamped design in order to avoid expensive machining steps. The electrical components of the system will be tailored to accept a capacitive signal and transfer it to a voltage reading. This voltage will be used to obtain a proportional loop current that can then be calibrated as a pressure differential and displayed onto a digital read-out device. The project is set to be completed by the end of spring semester 2013

Reputation Agent: Prompting Fair Reviews in Gig Markets

Our study presents a new tool, Reputation Agent, to promote fairer reviews from requesters (employers or customers) on gig markets. Unfair reviews, created when requesters consider factors outside of a worker's control, are known to plague gig workers and can result in lost job opportunities and even termination from the marketplace. Our tool leverages machine learning to implement an intelligent interface that: (1) uses deep learning to automatically detect when an individual has included unfair factors into her review (factors outside the worker's control per the policies of the market); and (2) prompts the individual to reconsider her review if she has incorporated unfair factors. To study the effectiveness of Reputation Agent, we conducted a controlled experiment over different gig markets. Our experiment illustrates that across markets, Reputation Agent, in contrast with traditional approaches, motivates requesters to review gig workers' performance more fairly. We discuss how tools that bring more transparency to employers about the policies of a gig market can help build empathy thus resulting in reasoned discussions around potential injustices towards workers generated by these interfaces. Our vision is that with tools that promote truth and transparency we can bring fairer treatment to gig workers.Comment: 12 pages, 5 figures, The Web Conference 2020, ACM WWW 202

Valuing Health-Related Quality of Life: An EQ-5D-5L Value Set for England

Objectives: Measures of patient-reported health are increasingly used in clinical and health system decisions, and the EQ-5D is one of the most widely used questionnaires. It is recommended by NICE and is widely used in clinical trials, as well as in population health surveys and the NHS PROMs programme. A new version, the EQ-5D-5L, is now available. The objective of this study is to establish how important different sorts of health problems are to overall quality of life, and to produce the set of scores (‘value set’) required to use EQ-5D-5L data in decision-making and priority setting in the English NHS. Design: The study design followed an international research protocol. Each participant valued 10 health states using a time trade-off approach and completed seven discrete choice tasks. The data are used to model values for all 3,125 states described by the EQ-5D-5L. Setting: England general population. Participants: Data were collected in face-to-face interviews with 996 adult members of the general public, selected at random from residential postcodes. The sample is broadly representative of the general population. Results: The data obtained from participants had good face validity. Problems with pain/discomfort and anxiety/depression were the most important factor in overall quality of life. Values ranged from -0.281 (for extreme problems on all dimensions) to 0.951. Conclusions: The value set reported here will have important implications for public decisions made using EQ-5D-5L data. There are considerably fewer states judged to be ‘worse than dead’ compared to the current EQ-5D value set (4.93%, compared with over one-third) and the minimum value is higher (-0.281 compared to -0.594). The results imply that QALY gains for interventions seeking to improve very poor health will be smaller using the EQ-5D-5L tariff, and may previously have been overestimated

Widespread perturbation of ETS factor binding sites in cancer.

Although \u3e90% of somatic mutations reside in non-coding regions, few have been reported as cancer drivers. To predict driver non-coding variants (NCVs), we present a transcription factor (TF)-aware burden test based on a model of coherent TF function in promoters. We apply this test to NCVs from the Pan-Cancer Analysis of Whole Genomes cohort and predict 2555 driver NCVs in the promoters of 813 genes across 20 cancer types. These genes are enriched in cancer-related gene ontologies, essential genes, and genes associated with cancer prognosis. We find that 765 candidate driver NCVs alter transcriptional activity, 510 lead to differential binding of TF-cofactor regulatory complexes, and that they primarily impact the binding of ETS factors. Finally, we show that different NCVs within a promoter often affect transcriptional activity through shared mechanisms. Our integrated computational and experimental approach shows that cancer NCVs are widespread and that ETS factors are commonly disrupted

PO-140 Physiological and Molecular Adaptations to Concurrent Training in Combination with High Protein Availability

Objective Attenuated muscle strength, hypertrophy and power adaptations with combined resistance and endurance (‘concurrent’) training may result from blunted cell signalling. Protein intake potentiates anabolic signalling pathways to facilitate adaptation. We hypothesized that 12 wk concurrent training with a high protein diet would elicit similar adaptations to a) strength, hypertrophy and power compared to resistance training alone, and b) aerobic capacity compared to endurance training. Methods Thirty-two recreationally active males (age 25±5y; BMI 24±3kg•m-2; mean±SD) performed 12 wk of either resistance (RES; n=10) or endurance (END; n=10) training (3x•w-1), or concurrent training (CET; n=12; 6x•w-1) with a high-protein (2g•kg-1•d-1) diet. Strength (1RM), aerobic capacity (VO2peak) and anaerobic power (Wingate) were assessed PRE and POST. Vastus lateralis biopsies (immunoblotting) and thickness (ultrasound) were assessed PRE, after week 4 (WK4) and 8 (WK8), and POST. Changes were analyzed by two-way ANOVA with repeated measures. Results Muscle thickness increased PRE to POST by 18% in CET, 14% in RES and 10% in END (P&lt;0.001) and was greater in CET and RES compared to END (P&lt;0.05). Leg press 1RM increased PRE to POST by 24% in CET and 33% in RES (P&lt;0.01) but was not different between CET and RES. VO2peak (L•min-1) increased PRE to POST by 7% in CET and 12% in END (P&lt;0.05) but was not different between CET and END. Wingate peak power (N•kg-1) increased PRE to POST by 10% in RES (P&lt;0.01) and was greater compared to CET and END (P&lt;0.05). Total mTORC1 increased PRE to POST in CET (P&lt;0.001) and was greater in CET compared to RES and END (P&lt;0.01) and RES compared to END (P&lt;0.05). Conclusions Despite a high protein intake, concurrent training selectively attenuates developments to anaerobic power compared to resistance training. High protein availability may be effective for curtailing interferences to strength and hypertrophy with concurrent training

Inborn Errors of Immunity on the Island of Ireland - a Cross-Jurisdictional UKPID/ESID Registry Report

The epidemiology of inborn errors of immunity (IEI) in the Republic of Ireland was first published in 2005 but has not been updated since. IEI prevalence data from Northern Ireland was last published in 2018. Using data from the United Kingdom Primary Immune Deficiency (UKPID) and European Society for Immunodeficiencies (ESID) registries, we reviewed all registered cases of IEI affecting adult patients ≥ 18 years of age from the two largest immunology specialist centres in Northern Ireland and the Republic of Ireland, respectively and calculated the combined minimum adult prevalence of IEI on the island of Ireland for the first time. We also recorded data pertaining to presenting symptoms of IEI, diagnostic delay, immunoglobulin data, and genetic testing, as well as briefly reporting data pertaining to secondary immunodeficiency in both countries. As of 1 May 2020, we identified a minimum adult IEI prevalence in Ireland of 8.85/100,000 population

Inborn Errors of Immunity on the Island of Ireland - a Cross-Jurisdictional UKPID/ESID Registry Report

Correction; Early Access:The epidemiology of inborn errors of immunity (IEI) in the Republic of Ireland was first published in 2005 but has not been updated since. IEI prevalence data from Northern Ireland was last published in 2018. Using data from the United Kingdom Primary Immune Deficiency (UKPID) and European Society for Immunodeficiencies (ESID) registries, we reviewed all registered cases of IEI affecting adult patients >= 18 years of age from the two largest immunology specialist centres in Northern Ireland and the Republic of Ireland, respectively and calculated the combined minimum adult prevalence of IEI on the island of Ireland for the first time. We also recorded data pertaining to presenting symptoms of IEI, diagnostic delay, immunoglobulin data, and genetic testing, as well as briefly reporting data pertaining to secondary immunodeficiency in both countries. As of 1 May 2020, we identified a minimum adult IEI prevalence in Ireland of 8.85/100,000 population.Peer reviewe