Readability, presentation and quality of allergy-related patient information leaflets: a cross sectional and longitudinal study

Objective: Patient information leaflets (PILs) are widely used to reinforce or illustrate health information and to complement verbal consultation. The objectives of the study were to assess the readability and presentation of PILs published by Allergy UK, and to conduct a longitudinal assessment to evaluate the impact of leaflet amendment and revision on readability. Methods: Readability of Allergy UK leaflets available in 2013 was assessed using Simple Measure of Gobbledegook (SMOG) and Flesch-Kincaid Reading Grade Formula. Leaflet presentation was evaluated using the Clear Print Guidelines of the Royal National Institute of Blind People (RNIB) and the Patient Information Appraisal System developed by the British Medical Association (BMA). Changes in the leaflets’ readability scores over five years were investigated. Results: 108 leaflets, covering a wide range of allergic conditions and treatment options, were assessed. The leaflets had average SMOG and Flesch-Kincaid scores of 13.9 (range 11-18, SD 1.2) and 10.9 (range 5-17, SD 2.1) respectively. All leaflets met the RNIB Clear Print guidelines, with the exception of font size which was universally inadequate. The leaflets scored on average 10 (median 10, range 7-15) out of a maximum of 27 on the BMA checklist. The overall average SMOG score of 31 leaflets available in both 2008 and 2013 had not changed significantly. The process of leaflet revision resulted in 1% change in readability scores overall, with a predominantly upward trend with six leaflets increasing their readability score by >10% and only three decreasing by >10%. Conclusion: Allergy-related patient information leaflets are well presented but have readability levels that are higher than those recommended for health information. Involving service users in the process of leaflet design, together with systematic pre-publication screening of readability would enhance the accessibility and comprehensibility of written information for people with allergy and their careers

Presence and abundance of microplastics in the Thames River Basin, UK

The global increase in plastic production has led to growing concern about the environmental impacts of plastics and their degradation products. Microplastics have been extensively observed and studied in the marine environment but little is known about their presence and abundance in freshwater environments. Although rivers are recognised as a significant source of microplastics to the oceans, they are seldom considered in studies of the environmental presence of microplastics and there are no data reported to date on microplastics in UK rivers (or indeed any freshwater bodies). This study aimed to identify and quantify the abundance and types of plastics in the Thames Basin where population densities and sewage inputs are well described. Ten sampling sites on the River Thames and its tributaries were selected, ranging from densely populated, urban areas to sparsely populated, rural areas. Sites are all downstream of sewage treatment works (STWs) serving known populations, allowing correlation between population density with plastic types and abundances found. In addition samples were collected from sites at known distances downstream of STW outfalls, as well as the effluent itself, to try and establish the proportion of plastics directly entering from STWs, and its fate and transport pathways. River sediment and water samples were collected at all sites. Sediment samples were initially searched by eye, followed by flotation and overflowing using ZnCl2 solution. Plastics collected from the sediments were subsequently identified by Raman spectroscopy. Initial observations indicate that coloured and manmade particles are obviously visible in sediments from sites with high population densities compared to few evident manmade particles in sediments from areas with low population densities. Further analysis will allow for correlation of the plastic types and abundance with population density and sewage inputs to understand the distribution of plastics in river systems

The ALMA Early Science View of FUor/EXor objects. IV. Misaligned Outflows in the Complex Star-forming Environment of V1647 Ori and McNeil's Nebula

We present Atacama Large Millimeter/sub-millimeter Array (ALMA) observations of the star-forming environment surrounding V1647 Ori, an outbursting FUor/EXor pre-MS star. Dust continuum and the (J = 2 - 1) $^{12}$CO, $^{13}$CO, C$^{18}$O molecular emission lines were observed to characterize the V1647 Ori circumstellar disc and any large scale molecular features present. We detect continuum emission from the circumstellar disc and determine a radius r = 40 au, inclination i = 17$^{\circ}$$^{+6}_{-9}$ and total disc mass of M$_{\mathrm{disk}}$ of ~0.1 M$_{\odot}$. We do not identify any disc structures associated with nearby companions, massive planets or fragmentation. The molecular cloud environment surrounding V1647 Ori is both structured and complex. We confirm the presence of an excavated cavity north of V1647 Ori and have identified dense material at the base of the optical reflection nebula (McNeil's Nebula) that is actively shaping its surrounding environment. Two distinct outflows have been detected with dynamical ages of ~11,700 and 17,200 years. These outflows are misaligned suggesting disc precession over ~5500 years as a result of anisotropic accretion events is responsible. The collimated outflows exhibit velocities of ~2 km s$^{-1}$, similar in velocity to that of other FUor objects presented in this series but significantly slower than previous observations and model predictions. The V1647 Ori system is seemingly connected by an "arm" of material to a large unresolved structure located ~20$"$ to the west. The complex environment surrounding V1647 Ori suggests it is in the early stages of star formation which may relate to its classification as both an FUor and EXor type object.Comment: 18 pages, 14 figures, 4 tables; accepted for publication in MNRA

The ALMA Early Science View of FUor/EXor Objects - V. Continuum Disc Masses and Sizes

Low-mass stars build a significant fraction of their total mass during short outbursts of enhanced accretion known as FUor and EXor outbursts. FUor objects are characterized by a sudden brightening of ∼5 mag at visible wavelengths within 1 yr and remain bright for decades. EXor objects have lower amplitude outbursts on shorter time-scales. Here we discuss a 1.3 mm Atacama Large Millimeter/submillimeter Array (ALMA) mini-survey of eight outbursting sources (three FUors, four EXors, and the borderline object V1647 Ori) in the Orion Molecular Cloud. While previous papers in this series discuss the remarkable molecular outflows observed in the three FUor objects and V1647 Ori, here we focus on the continuum data and the differences and similarities between the FUor and EXor populations. We find that FUor discs are significantly more massive (∼80–600 MJup) than the EXor objects (∼0.5–40 MJup). We also report that the EXor sources lack the prominent outflows seen in the FUor population. Even though our sample is small, the large differences in disc masses and outflow activity suggest that the two types of objects represent different evolutionary stages. The FUor sources seem to be rather compact (Rc \u3c 20–40 au) and to have a smaller characteristic radius for a given disc mass when compared to T Tauri stars. V1118 Ori, the only known close binary system in our sample, is shown to host a disc around each one of the stellar components. The disc around HBC 494 is asymmetric, hinting at a structure in the outer disc or the presence of a second disc

CHEMISTRY IN THE TIME OF COVID-19: REFLECTIONS ON A VERY UNUSUAL SEMESTER

Educators around the world have been challenged to adapt their teaching and pastoral care rapidly in response to the COVID-19 pandemic. The academic members of the Chemistry Education and Communication Theme (CECR) from the School of Chemistry, The University of Sydney have reflected on the challenges and successes during this most unusual semester. As many would no doubt agree, the transition was rapid, and overwhelming with the sheer volume of shared resources and recommendations from our colleagues around the world. In this talk, we will discuss some of the specific tools and techniques employed across a range of teaching modes including lectures, tutorials, and the laboratory. Of particular note, we will explore the importance of communication and pastoral care that we found central to many of our teaching successes. While we recognise each classroom holds a unique context, we believe that the sharing and discussion of our communities’ journeys in navigating this time will hold valuable lessons to inform both our immediate practice and the long-term impact on our teaching

Duke Activity Status Index and Liver Frailty Index predict mortality in ambulatory patients with advanced chronic liver disease:A prospective, observational study

BACKGROUND: There remains a lack of consensus on how to assess functional exercise capacity and physical frailty in patients with advanced chronic liver disease (CLD) being assessed for liver transplantation (LT). Aim To investigate prospectively the utility of the Duke Activity Status Index (DASI) and Liver Frailty Index (LFI) in ambulatory patients with CLD.AIM: To investigate prospectively the utility of the Duke Activity Status Index (DASI) and Liver Frailty Index (LFI) in ambulatory patients with CLD.METHODS: We recruited patients from outpatient clinics at University Hospitals Birmingham, UK (2018-2019). We prospectively collated the DASI and LFI to identify the prevalence of, respectively, functional capacity and physical frailty, and to evaluate their accuracy in predicting overall and pre-LT mortality.RESULTS: We studied 307 patients (57% male; median age 54 years; UKELD 52). Median DASI score was 28.7 (IQR 16.2-50.2), mean LFI was 3.82 (SD = 0.72), and 81% were defined either 'pre-frail' or 'frail'. Female sex and hyponatraemia were significant independent predictors of both DASI and LFI. Age and encephalopathy were significant independent predictors of LFI, while BMI significantly predicted DASI. DASI and LFI were significantly related to overall (HR 0.97, p = 0.001 [DASI], HR 2.04, p = 0.001 [LFI]) and pre-LT mortality (HR 0.96, p = 0.02 [DASI], HR 1.94, p = 0.04 [LFI]).CONCLUSIONS: Poor functional exercise capacity and physical frailty are highly prevalent among ambulatory patients with CLD who are being assessed for LT. The DASI and LFI are simple, low-cost tools that predict overall and pre-LT mortality. Implementation of both should be considered in all outpatients with CLD to highlight those who may benefit from targeted nutritional and exercise interventions.</p

Duke Activity Status Index and Liver Frailty Index predict mortality in ambulatory patients with advanced chronic liver disease:A prospective, observational study

BACKGROUND: There remains a lack of consensus on how to assess functional exercise capacity and physical frailty in patients with advanced chronic liver disease (CLD) being assessed for liver transplantation (LT). Aim To investigate prospectively the utility of the Duke Activity Status Index (DASI) and Liver Frailty Index (LFI) in ambulatory patients with CLD.AIM: To investigate prospectively the utility of the Duke Activity Status Index (DASI) and Liver Frailty Index (LFI) in ambulatory patients with CLD.METHODS: We recruited patients from outpatient clinics at University Hospitals Birmingham, UK (2018-2019). We prospectively collated the DASI and LFI to identify the prevalence of, respectively, functional capacity and physical frailty, and to evaluate their accuracy in predicting overall and pre-LT mortality.RESULTS: We studied 307 patients (57% male; median age 54 years; UKELD 52). Median DASI score was 28.7 (IQR 16.2-50.2), mean LFI was 3.82 (SD = 0.72), and 81% were defined either 'pre-frail' or 'frail'. Female sex and hyponatraemia were significant independent predictors of both DASI and LFI. Age and encephalopathy were significant independent predictors of LFI, while BMI significantly predicted DASI. DASI and LFI were significantly related to overall (HR 0.97, p = 0.001 [DASI], HR 2.04, p = 0.001 [LFI]) and pre-LT mortality (HR 0.96, p = 0.02 [DASI], HR 1.94, p = 0.04 [LFI]).CONCLUSIONS: Poor functional exercise capacity and physical frailty are highly prevalent among ambulatory patients with CLD who are being assessed for LT. The DASI and LFI are simple, low-cost tools that predict overall and pre-LT mortality. Implementation of both should be considered in all outpatients with CLD to highlight those who may benefit from targeted nutritional and exercise interventions.</p

Large microplastic particles in sediments of tributaries of the River Thames, UK – abundance, sources and methods for effective quantification

Sewage effluent input and population were chosen as predictors of microplastic presence in sediments at four sites in the River Thames basin (UK). Large microplastic particles (1mm–4mm)were extracted using a stepwise approach to include visual extraction, flotation and identification using Raman spectroscopy. Microplastics were found at all four sites. One site had significantly higher numbers of microplastics than other sites, average 66 particles 100 g−1, 91% of which were fragments. This site was downstream of a storm drain outfall receiving urban runoff; many of the fragments at this site were determined to be derived of thermoplastic road-surface marking paints. At the remaining three sites, fibres were the dominant particle type. The most common polymers identified included polypropylene, polyester and polyarylsulphone. This study describes two major new findings: presence of microplastic particles in a UK freshwater system and identification of road marking paints as a source of microplastics

The structural basis for high affinity binding of α1-acid glycoprotein to the potent antitumor compound UCN-01

The α1-acid glycoprotein (AGP) is an abundant blood plasma protein with important immunomodulatory functions coupled to endogenous and exogenous ligand-binding properties. Its affinity for many drug-like structures, however, means AGP can have a significant effect on the pharmokinetics and pharmacodynamics of numerous small molecule therapeutics. Staurosporine, and its hydroxylated forms UCN-01 and UCN-02, are kinase inhibitors that have been investigated at length as antitumour compounds. Despite their potency, these compounds display poor pharmokinetics due to binding to both AGP variants, AGP1 and AGP2. The recent renewed interest in UCN-01 as a cytostatic protective agent prompted us to solve the structure of the AGP2–UCN-01 complex by X-ray crystallography, revealing for the first time the precise binding mode of UCN-01. The solution NMR suggests AGP2 undergoes a significant conformational change upon ligand binding, but also that it uses a common set of sidechains with which it captures key groups of UCN-01 and other small molecule ligands. We anticipate that this structure and the supporting NMR data will facilitate rational redesign of small molecules that could evade AGP and therefore improve tissue distribution