Quantifying disease activity in fatty-infiltrated skeletal muscle by IDEAL-CPMG in Duchenne muscular dystrophy

The purpose of this study was to explore the use of iterative decomposition of water and fat with echo asymmetry and least-squares estimation Carr-Purcell-Meiboom-Gill (IDEAL-CPMG) to simultaneously measure skeletal muscle apparent fat fraction and water T2 (T2,w) in patients with Duchenne muscular dystrophy (DMD). In twenty healthy volunteer boys and thirteen subjects with DMD, thigh muscle apparent fat fraction was measured by Dixon and IDEAL-CPMG, with the IDEAL-CPMG also providing T2,w as a measure of muscle inflammatory activity. A subset of subjects with DMD was followed up during a 48-week clinical study. The study was in compliance with the Patient Privacy Act and approved by the Institutional Review Board. Apparent fat fraction in the thigh muscles of subjects with DMD was significantly increased compared to healthy volunteer boys (p <0.001). There was a strong correlation between Dixon and IDEAL-CPMG apparent fat fraction. Muscle T2,w measured by IDEAL-CPMG was independent of changes in apparent fat fraction. Muscle T2,w was higher in the biceps femoris and vastus lateralis muscles of subjects with DMD (p <0.05). There was a strong correlation (p <0.004) between apparent fat fraction in all thigh muscles and six-minute walk distance (6MWD) in subjects with DMD. IDEAL-CPMG allowed independent and simultaneous quantification of skeletal muscle fatty degeneration and disease activity in DMD. IDEAL-CPMG apparent fat fraction and T2,w may be useful as biomarkers in clinical trials of DMD as the technique disentangles two competing biological processes

Marginal Returns in Small and Large Companies

Previous studies of large versus small company performance, though frequent, have not produced a clear answer as to whether large companies outperform small companies or vice versa. This article highlights retentions - the fact that different companies have different dividend policies —as a problem in that retentions obscure accurate measurement of a company’s growth. Retentions obscure accurate measurement in that these funds are not costed, hence a high retentions company is getting cost free funds using conventional accounting and security analysis techniques, and, thus other things equal, will outperform a low retentions company. The retentions problem can be overcome by a technique that produces a company statistic called “cash equivalents per share” (CEPS). When CEPS is calculated for 771 companies, arrayed into 13 SIC industrial classifications, each containing a portfolio of large companies (over $1 billion in 1988/1989 sales) and a portfolio of small companies (under$200 million in 1988/1989 sales), then in every industry, the portfolio of large companies outperforms the portfolio of small companies. An additional feature of CEPS covered in the study is that in a competitive economy, the CEPS should show a benchmark growth of zero. The 13 portfolios of large companies all show a CEPS growth rate in excess of zero; only three of the 13 small company portfolios do this. As this is an introductory and relatively small scale study, there are research opportunities to confirm or refute these initial findings

Videoconferencing for Health Care Provision for Older Adults in Care Homes: A Review of the Research Evidence

A scoping review was conducted to map the research evidence on the use of videoconferencing for remote health care provision for older adults in care homes. The review aimed to identify the nature and extent of the existing evidence base. Databases used were Embase, Medline, Web of Science, and Cochrane Library Reviews. The review identified 26 articles for inclusion, of which 14 were case studies, making the most used study design. Papers described videoconferencing as being used for assessment, management of health care, clinical support, and diagnosis, with eight of the papers reporting the use of videoconferencing for more than one clinical purpose. A further eight papers reported the use of videoconferencing for assessment alone. The literature reported the collection of various types of data, with 12 papers describing the use of both qualitative and quantitative data. The outcomes mainly addressed staff satisfaction (n=9) and resident satisfaction (n=8). Current evidence supports the feasibility of videoconferencing in care homes. However, research needs to be undertaken to establish the contexts and mechanisms that underpin the successful implementation of videoconferencing in care homes and to define useful measures for success

Gothic piles and cynical follies revisited: A quizzical tour through country house literature of the long eighteenth century

The eighteenth century witnessed an expansion in domestic tourism that allowed increasingly diversified visitors to access the grand homes of those for whom more lavish types of travel had furnished their seats, in town and country alike. Numerous travel guides and literary texts engage with the ongoing 'country house' tradition of praising the home, gardens, and owner of such places. However, the shifting social contexts in which both these buildings and the ideologies they embodied often drew writers to satirise critically the great houses they ostensibly admired. This essay examines how the Gothic aesthetic infused the broader country house tradition with a novel way of assessing the uneasy tension between tradition and innovation catalysed by the changing circumstances of the eighteenth century by examining the links several key writers forged between Gothic architectural structures and literary texts. It examines Horace Walpole's Gothic projects in both The Castle of Otranto and Strawberry Hill; Mary Leapor's Crumble Hall; William Beckford's Vathek and Fonthill; Austen's Northanger Abbey and Peacock's Nightmare Abbey; before settling on a detailed discussion of Norman Abbey in Byron's Don Juan, the literary equivalent of his own seat at Mansfield which, in turn, became a key spot on the tourist trail

Community pharmacist led medication reviews in the UK: a scoping review of the medicines use review and the new medicine service literatures

Background: Medicines Use Reviews (MURs) and the New Medicine Service (NMS) are services delivered by UK community pharmacists to improve adherence, improve patient understanding of their medicines and reduce medicines wastage. Aim: In this scoping review we aim to identify, map and critically examine the nature of existing empirical evidence in peer reviewed journals relating to MUR and NMS consultations. Method: Systematic searches identified the available MUR and NMS empirical literature. We sought data on barriers and facilitators to conducting MUR or NMS consultations, the perceptions of pharmacists and patients, the conduct of consultations, and outcomes of consultations. Searches from 2005 (when MURs were introduced) to May 2018 were conducted in MEDLINE, PsycINFO, Embase and Scopus databases. Data were extracted into Excel for examination of study characteristics, participant characteristics, type of intervention/services delivered and key study quantitative and/or qualitative findings. Results: Forty-one papers from 37 studies met the inclusion criteria: 28 papers were of MURs, 10 of NMS and 3 for both services. Studies focused on the introduction and implementation of these services, with little attention to outcomes for patients; effectiveness was not evaluated beyond in a single NMS RCT. Observational data indicated that pharmacists and patients view MURs and the NMS positively, despite challenges implementing these services and apparent lack of communication between pharmacists and GPs. Consultations were reported to be short, typically 10-12 minutes, characterised by limited engagement with patients and their health problems. The extent and nature of advice on health behaviours during consultations or other content was rarely examined. Conclusion: The research literature on MURs and the NMS has developed slowly. There is much scope for further research attention to developing more patient-centred care

Living with Plenty: Meeting the Challenge of Diabetes. The Twenty First Century Role of Pharmacy and Pharmaceutical Innovation in the Prevention and Treatment of Diabetes Mellitus.

This report describes recent developments in bio-medical, behavioural and social understandings of diabetes and how it can be prevented and treated. Its most important objectives relate to the further development of pharmacy-based health care as a cost-effective part of the overall pattern of support available to people with diabetes. This should facilitate a combination of better medicines use and positive health related behaviour changes. This report also seeks to contribute to wider public and professional debate about the nature of diabetes and how individuals and communities should respond to the threat it represents. It seeks to promote a balanced awareness of the fact that although there is no such thing as a 'mild' case of diabetes – everyone who is diagnosed with any variant of the disorder is at raised risk of disability or death – appropriate management can significantly reduce the harm that it would otherwise caus

Qualitative study of patient views on a 'telephone-first' approach in general practice in England: speaking to the GP by telephone before making face-to-face appointments.

This is the final version. Available from BMJ Publishing Group via the DOI in this record.OBJECTIVE: To understand patients' views on a 'telephone-first' approach, in which all appointment requests in general practice are followed by a telephone call from the general practitioner (GP). DESIGN: Qualitative interviews with patients and carers. SETTING: Twelve general practices in England. PARTICIPANTS: 43 patients, including 30 women, nine aged over 75 years, four parents of young children, five carers, five patients with hearing impairment and two whose first language was not English. RESULTS: Patients expressed varied views, often strongly held, ranging from enthusiasm for to hostility towards the 'telephone-first' approach. The new system suited some patients, avoiding the need to come into the surgery but was problematic for others, for example, when it was difficult for someone working in an open plan office to take a call-back. A substantial proportion of negative comments were about the operation of the scheme itself rather than the principles behind it, for example, difficulty getting through on the phone or being unable to schedule when the GP would phone back. Some practices were able to operate the scheme in a way that met their patients' needs better than others and practices varied significantly in how they had implemented the approach. CONCLUSIONS: The 'telephone-first' approach appears to work well for some patients, but others find it much less acceptable. Some of the reported problems related to how the approach had been implemented rather than the 'telephone-first' approach in principle and suggests there may be potential for some of the challenges experienced by patients to be overcome.National Institute for Health Researc

Diffusion tensor imaging reveals changes in microstructural integrity along compressed nerve roots that correlate with chronic pain symptoms and motor deficiencies in elderly stenosis patients

Age-related degenerative changes in the lumbar spine frequently result in nerve root compression causing severe pain and disability. Given the increasing incidence of lumbar spinal disorders in the aging population and the discrepancies between the use of current diagnostic imaging tools and clinical symptoms, novel methods of nerve root assessment are needed. We investigated elderly patients with stenosis at L4-L5 or L5-S1 levels. Diffusion tensor imaging (DTI) was used to quantify microstructure in compressed L5 nerve roots and investigate relationships to clinical symptoms and motor neurophysiology. DTI metrics (i.e. FA, MD, AD and RD) were measured at proximal, mid and distal segments along compressed (i.e. L5) and intact (i.e. L4 or S1) nerve roots. FA was significantly reduced in compressed nerve roots and MD, AD and RD were significantly elevated in the most proximal segment of the nerve root studied. FA was significantly correlated with electrophysiological measures of root function: minimum F-wave latency and peripheral motor conduction time (PMCT). In addition, FA along the compressed root also correlated with leg pain and depression score. There was also a relationship between RD and anxiety, leg pain and disability score and AD correlated with depression score. Taken together, these data show that DTI metrics are sensitive to nerve root compression in patients with stenosis as a result of age-related lumbar degeneration. Critically, they show that the changes in microstructural integrity along compressed L5 nerve roots are closely related to a number of clinical symptoms associated with the development of chronic pain as well as neurophysiological assessments of motor function. These inherent relationships between nerve root damage and phenotype suggest that the use DTI is a promising method as a way to stratify treatment selection and predict outcomes