What proportion of adult allergy referrals to secondary care could be dealt with in primary care by a GP with special interest?

Background: The concept of a General Practitioner with Special Interest (GPwSI) was first proposed in the 2000 National Health Service Plan, as a way of providing specialised treatment closer to the patient’s home and reducing hospital waiting times. Given the patchy and inadequate provision of allergy services in the UK the introduction of GPwSIs might reduce the pressure on existing specialist services. Objectives: This study assessed what proportion of referrals to a specialist allergy clinic could be managed in a GPwSI allergy service with a predefined range of facilities and expertise (accurate diagnosis and management of allergy; skin prick testing; provision of advice on allergen avoidance; ability to assess suitability for desensitisation). Methods: 100 consecutive GP referrals to a hospital allergy clinic were reviewed to determine whether patients could be seen in a community-based clinic led by a general practitioner with special interest (GPwSI) allergy. The documentation relating to each referral was independently assessed by three allergy specialists. The referrals were judged initially on the referral letter alone and then re-assessed with the benefit of information summarised in the clinic letter, to determine whether appropriate triage decisions could be made prospectively. The proportion of referrals suitable for a GPwSI was calculated and their referral characteristics identified. Results: 29 % referrals were judged unanimously appropriate for management by a GPwSI and an additional 30 % by 2 of the 3 reviewers. 18 % referrals were unsuitable for a GPwSI service because of the complexity of the presenting problem, patient co-morbidity or the need for specialist knowledge or facilities. Conclusions and clinical relevance: At least a quarter, and possibly half, of allergy referrals to our hospital-based service could be dealt with in a GPwSI clinic, thereby diversifying the patient pathway, allowing specialist services to focus on more complex cases and reducing the waiting time for first appointments

Enhancing radial distribution system performance by optimal placement of DSTATCOM

In this paper, A novel modified optimization method was used to find the optimal location and size for placing distribution Static Compensator in the radial distribution test feeder in order to improve its performance by minimizing the total power losses of the test feeder, enhancing the voltage profile and reducing the costs. The modified grey wolf optimization algorithm is used for the first time to solve this kind of optimization problem. An objective function was developed to study the radial distribution system included total power loss of the system and costs due to power loss in system. The proposed method is applied to two different test distribution feeders (33 bus and 69 bus test systems) using different Dstatcom sizes and the acquired results were analyzed and compared to other recent optimization methods applied to the same test feeders to ensure the effectiveness of the used method and its superiority over other recent optimization mehods. The major findings from obtained results that the applied technique found the most minimized total power loss in system ,the best improved voltage profile and most reduction in costs due power loss compared to other methods

Annotator-dependent uncertainty-aware estimation of gait relative attributes

In this paper, we describe an uncertainty-aware estimation framework for gait relative attributes. We specifically design a two-stream network model that takes a pair of gait videos as input. It then outputs a corresponding pair of Gaussian distributions of gait absolute attribute scores and annotator-dependent gait relative attribute label distributions. Moreover, we propose a differentiable annotator-independent uncertainty layer to estimate the gait relative attribute score distribution from the absolute distributions then map it to a relative attribute label distribution using the computation of cumulative distribution functions. Furthermore, we propose another annotator-dependent uncertainty layer to estimate the uncertainty on the gait relative attribute labels in terms of a set of trainable transition matrices. Finally, we design a joint loss function on the relative attribute label distribution to learn the model parameters. Experiments on two gait relative attribute datasets demonstrated the effectiveness of the proposed method against baselines in quantitative and qualitative evaluations

Clinical audit of neonatal care in Assiut Women's Health Hospital, Egypt

Background: The current study aims to auditing the current care of healthy full term newborns in the delivery room and identify the gap between the current practice and ideal practice in Assiut Women's Health Hospital, Egypt.Methods: The current study was a clinical audit carried out in Assiut Woman Health Hospital, in the period from 1 September 2016 to 28 February 2017.The study included all newborns delivered in the delivery word of gestational age after 37 week. We excluded all Preterm babies, those with congenital anomalies, pregnant women with medical disorders and multiple pregnancies. In the present work all data was collected prospectively through direct personal patient contact, direct observation of care givers, patient interactions and attitudes, from the clinical records and then recording the data in special check sheet. All basic criteria of the study participants as age, parity, gestational age at delivery and type of delivery were obtained. The neonatal gender, weight, heart rate and respiratory rate were checked. Audit criteria were selected according to the WHO 2015 and AAP 2010-2015 guidelines.Results: The study included 800 women; the mean age of the women was 26.52±5.70 years. The mean parity was 1.78±1.85. The mean gestational age at delivery was 38.81±0.96 weeks. As regard the type of delivery, 54.1% of women were delivered by cesarean section. Calling neonatologists occurred in 67.9% of deliveries. The mean birth weight was 3.17±0.39 kilograms. Nearly half of them (52%) were males.Conclusions: Application of the guidelines of the neonatal handling is important for optimum care to the neonates. Re-audit the steps of the handling is important to discuss whether practice has improved or not in our tertiary hospital

Biocompatibility and application of carbon fibres in heart valve tissue engineering

The success of tissue engineered heart valves relies on a balance between polymer degradation, appropriate cell repopulation and ECM deposition, in order for the valves to continue their vital function. However, the process of remodelling is highly dynamic and species dependent. Carbon fibres have been well used in the construction industry for their high tensile strength and flexibility, and therefore might be relevant to support tissue engineered hearts valve during this transition in the mechanically demanding environment of the circulation. The aim of this study was to assess the suitability of carbon fibres to be incorporated into tissue engineered heart valves, with respect to optimising their cellular interaction and mechanical flexibility during valve opening and closure. The morphology and surface oxidation of the carbon fibres was characterised by scanning electron microscopy (SEM). Their ability to interact with human adipose derived stem cells (hADSCs) was assessed with respect to cell attachment and phenotypic changes. hADSCs attached and maintained their expression of stem cell markers with negligible differentiation to other lineages. Incorporation of carbon fibres into a stand-alone tissue engineered aortic root, comprised of jet-sprayed poly-caprolactone aligned fibres had no negative effects on the opening and closure characteristics of the valve when simulated in a pulsatile bioreactor. In conclusion, carbon fibres were found to be conducive to hADSC attachment and maintaining their phenotype. Carbon fibres were sufficiently flexible for full motion of valvular opening and closure. This study provides a proof of concept for the incorporation of carbon fibres into tissue engineered heart valves to continue their vital function during scaffold degradation

Effects of Foliar Nutrition on Onion Seed Storage under Modified Atmosphere Packages

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Foliar Nutrition and Post-Harvest of Onion Seed: effects of storage temperatures, storage period and foliar nutrition

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Effects of Foliar Nutrition on Onion Seed Storage under Controlled Atmosphere

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Role of the IRS-1 and/or -2 in the pathogenesis of insulin resistance in Dahl salt-sensitive (S) rats

Insulin resistance is a common finding in hypertensive humans and animal models. The Dahl salt-sensitive (S) rat is an ideal model of genetically predetermined insulin resistance and salt-sensitive hypertension. Along the insulin signaling pathway, the insulin receptor substrates 1 and 2 (IRS-1 and -2) are important mediators of insulin signaling. IRS-1 and/or IRS-2 genetic variant(s) and/or enhanced serine phosphorylation correlate with insulin resistance. The present commentary was designed to highlight the significance of IRS-1 and/or -2 in the pathogenesis of insulin resistance. An emphasis will be given to the putative role of IRS-1 and/or -2 genetic variant(s) and serine phosphorylation in precipitating insulin resistance