Repeat prescribing of medications: a system-centred risk management model for primary care organisations

Rationale, aims and objectives: Reducing preventable harm from repeat medication prescriptions is a patient safety priority worldwide. In the United Kingdom, repeat prescriptions items issued has doubled in the last 20 years from 5.8 to 13.3 items per patient per annum. This has significant resource implications and consequences for avoidable patient harms. Consequently, we aimed to test a risk management model to identify, measure, and reduce repeat prescribing system risks in primary care. Methods: All 48 general medical practices in National Health Service (NHS) Lambeth Clinical Commissioning Group (an inner city area of south London in England) were recruited. Multiple interventions were implemented, including educational workshops, a web-based risk monitoring system, and external reviews of repeat prescribing system risks by clinicians. Data were collected via documentation reviews and interviews and subject to basic thematic and descriptive statistical analyses. Results: Across the 48 participating general practices, 62 unique repeat prescribing risks were identified on 505 occasions (eg, practices frequently experiencing difficulty interpreting medication changes on hospital discharge summaries), equating to a mean of 8.1 risks per practice (range: 1-33; SD = 7.13). Seven hundred sixty-seven system improvement actions were recommended across 96 categories (eg, alerting hospitals to illegible writing and delays with discharge summaries) with a mean of 15.6 actions per practice (range: 0-34; SD = 8.0). Conclusions: The risk management model tested uncovered important safety concerns and facilitated the development and communication of related improvement recommendations. System-wide information on hazardous repeat prescribing and how this could be mitigated is very limited. The approach reported may have potential to close this gap and improve the reliability of general practice systems and patient safety, which should be of high interest to primary care organisations internationally

Photonic Bandgap Structures of Core-Shell Simple Cubic Crystals from Holographic Lithography

We report the investigation of photonic bandgap properties of a core-shell simple cubic structure (air core with a dielectric shell) using a two-parameter level-set approach. The proposed structure can be obtained by partially backfilling high refractive index materials into a polymeric template fabricated by multi-beam interference lithography. We find that the shell formation in the inverted simple cubic structure increases the complete photonic bandgap width by 10–20% in comparison to that of a completely filled structure. The bandgap between the 5th and 6th bands begins to appear at a refractive index contrast of 2.7. This study suggests the importance to investigate the core-shell formation in three-dimensional photonic crystals through backfilling, which may offer an additional control over their photonic bandgap properties

Variational Quantum Circuits Enhanced Generative Adversarial Network

Generative adversarial network (GAN) is one of the widely-adopted machine-learning frameworks for a wide range of applications such as generating high-quality images, video, and audio contents. However, training a GAN could become computationally expensive for large neural networks. In this work, we propose a hybrid quantum-classical architecture for improving GAN (denoted as QC-GAN). The performance was examed numerically by benchmarking with a classical GAN using MindSpore Quantum on the task of hand-written image generation. The generator of the QC-GAN consists of a quantum variational circuit together with a one-layer neural network, and the discriminator consists of a traditional neural network. Leveraging the entangling and expressive power of quantum circuits, our hybrid architecture achieved better performance (Frechet Inception Distance) than the classical GAN, with much fewer training parameters and number of iterations for convergence. We have also demonstrated the superiority of QC-GAN over an alternative quantum GAN, namely pathGAN, which could hardly generate 16$\times$16 or larger images. This work demonstrates the value of combining ideas from quantum computing with machine learning for both areas of Quantum-for-AI and AI-for-Quantum

Phylogeography of Southeast Asian flying foxes (Chiroptera: Pteropodidae: Pteropus)

Flying foxes (Pteropus) are a genus of Old World fruit bats that are important seed dispersers and pollinators for plants native to the 200,000+ islands in Southeast Asia, yet they are some of the most poorly known bats in the world. They comprise some of the largest known bat species, and are morphologically relatively conserved on the genus level. Pteropus is the most species-rich genus within Pteropodidae, though the origin for this diversity remains incompletely understood. In Chapter 1, I discuss the importance of Pteropus to the ecosystem and as reservoir hosts. In Chapter 2, a molecular phylogeny is presented with Pteropus species organized into fewer species groups than recognized from previous research that better reflected the comprehensive dataset. An increase in relative divergence rate was detected within Pteropus during the Pliocene that led to rapid radiations in three species groups. Additionally, discordant signals from nuclear and mitochondrial genes suggested incomplete lineage sorting and hybridization were present, likely as a result of the young clade age, low genetic variability, and rapid diversification of the genus. In Chapter 3, using the species tree generated in Chapter 2, I tested biogeographic mechanisms and scenarios that resulted in current distributions of Pteropus species using several ancestral area reconstruction methods. Dispersal and founder-event speciation were both important mechanisms through which species expanded into new areas. Wallacea was an integral part of the evolutionary history of Pteropus, and likely the region of origin, a new result uncovered largely a product of the increased taxonomic and geographic sampling. I then used a combination of phylogenetics and population genetics to determine the population connectivity of two commonly studied Pteropus hosts that are of interest to the disease ecology community, P. vampyrus (Chapter 4) and P. alecto (Chapter 5). Host metapopulation dynamics are important for predictions of pathogen diversity, aggressiveness, and transmission. Pteropus vampyrus and P. alecto highlight differences in management strategies needed and pathogen model predictions. Chapter 6 presents a general discussion regarding these findings and future directions for research

Septic Pulmonary Embolism Requiring Critical Care: Clinicoradiological Spectrum, Causative Pathogens and Outcomes

OBJECTIVES: Septic pulmonary embolism is an uncommon but life-threatening disorder. However, data on patients with septic pulmonary embolism who require critical care have not been well reported. This study elucidated the clinicoradiological spectrum, causative pathogens and outcomes of septic pulmonary embolism in patients requiring critical care. METHODS: The electronic medical records of 20 patients with septic pulmonary embolism who required intensive care unit admission between January 2005 and December 2013 were reviewed. RESULTS: Multiple organ dysfunction syndrome developed in 85% of the patients, and acute respiratory failure was the most common organ failure (75%). The most common computed tomographic findings included a feeding vessel sign (90%), peripheral nodules without cavities (80%) or with cavities (65%), and peripheral wedge-shaped opacities (75%). The most common primary source of infection was liver abscess (40%), followed by pneumonia (25%). The two most frequent causative pathogens were Klebsiella pneumoniae (50%) and Staphylococcus aureus (35%). Compared with survivors, nonsurvivors had significantly higher serum creatinine, arterial partial pressure of carbon dioxide, and Acute Physiology and Chronic Health Evaluation II and Sequential Organ Failure Assessment scores, and they were significantly more likely to have acute kidney injury, disseminated intravascular coagulation and lung abscesses. The in-hospital mortality rate was 30%. Pneumonia was the most common cause of death, followed by liver abscess. CONCLUSIONS: Patients with septic pulmonary embolism who require critical care, especially those with pneumonia and liver abscess, are associated with high mortality. Early diagnosis, appropriate antibiotic therapy, surgical intervention and respiratory support are essential

HIV-1 encoded candidate micro-RNAs and their cellular targets

MicroRNAs (miRNAs) are small RNAs of 21–25 nucleotides that specifically regulate cellular gene expression at the post-transcriptional level. miRNAs are derived from the maturation by cellular RNases III of imperfect stem loop structures of ~ 70 nucleotides. Evidence for hundreds of miRNAs and their corresponding targets has been reported in the literature for plants, insects, invertebrate animals, and mammals. While not all of these miRNA/target pairs have been functionally verified, some clearly serve roles in regulating normal development and physiology. Recently, it has been queried whether the genome of human viruses like their cellular counterpart also encode miRNA. To date, there has been only one report pertaining to this question. The Epstein-Barr virus (EBV) has been shown to encode five miRNAs. Here, we extend the analysis of miRNA-encoding potential to the human immunodeficiency virus (HIV). Using computer-directed analyses, we found that HIV putatively encodes five candidate pre-miRNAs. We then matched deduced mature miRNA sequences from these 5 pre-miRNAs against a database of 3' untranslated sequences (UTR) from the human genome. These searches revealed a large number of cellular transcripts that could potentially be targeted by these viral miRNA (vmiRNA) sequences. We propose that HIV has evolved to use vmiRNAs as a means to regulate cellular milieu for its benefit