Silver Dreams Fund Learning and Evaluation Contract: Final report June 2014

This is a summary of the Final Report which presents the findings of the evaluation of the Big Lottery Fund's Silver Dreams Fund conducted by Ecorys.The Silver Dreams Fund was a £10 million programme which sought to address the gaps in provision by challenging organisations to come up with an innovative idea for a project that would "pioneer ways to help vulnerable older people deal more effectively with life-changing events".Our approach involved both formative and summative elements and was based upon a robust and evidence-based outcome evaluation framework. In addition, we have also undertaken an evaluation of the new programme management processes employed by the Big Lottery Fund which has been reported separately.In summary, the evaluation involved:- development of an evaluation framework and common indicators to measure outcomes;- provision of a package of self-evaluation support to projects;- programme level work to provide independent primary qualitative research and to validate findings from self-evaluations;- a range of learning activities; and- analysis and reporting

Chemical Mechanical Planarization for Ta-based Superconducting Quantum Devices

We report on the development of a chemical mechanical planarization (CMP) process for thick damascene Ta structures with pattern feature sizes down to 100 nm. This CMP process is the core of the fabrication sequence for scalable superconducting integrated circuits at 300 mm wafer scale. This work has established the elements of the various CMP-related design rules that can be followed by a designer for the layout of circuits that include Ta-based coplanar waveguide resonators, capacitors, and interconnects for tantalum-based qubits and single flux quantum (SFQ) circuits. The fabrication of these structures utilizes 193 nm optical lithography, along with 300 mm process tools for dielectric deposition, reactive ion etch, wet-clean, CMP and in-line metrology, all tools typical for a 300 mm wafer CMOS foundry. Process development was guided by measurements of physical and electrical characteristics of the planarized structures. Physical characterization such as atomic force microscopy across the 300 mm wafer surface showed local topography was less than 5 nm. Electrical characterization confirmed low leakage at room temperature, and less than 12% within wafer sheet resistance variation, for damascene Ta line-widths ranging from 100 nm to 3 {\mu}m. Run-to-run reproducibility was also evaluated. Effects of process integration choices including deposited thickness of Ta are discussed.Comment: 31 pages, 16 figure

Implementation of the national antimicrobial stewardship competencies for UK undergraduate healthcare professional education within undergraduate pharmacy programmes: a survey of UK schools of pharmacy.

Pharmacists play a key role in antimicrobial stewardship (AMS). Consensus-based national AMS competencies for undergraduate healthcare professionals in the UK reflect the increasing emphasis on competency-based healthcare professional education. However, the extent to which these are included within undergraduate pharmacy education programmes in the UK is unknown. To explore which of the AMS competencies are delivered, including when and at which level, within UK undergraduate MPharm programmes. A cross-sectional online questionnaire captured the level of study of the MPharm programme in which each competency was taught, the method of delivery and assessment of AMS education, and examples of student feedback. Ten institutions completed the survey (33% response rate). No institution reported covering all 54 AMS competencies and 5 of these were taught at half or fewer of the institutions. Key gaps were identified around taking samples, communication, outpatient parenteral antimicrobial therapy and surgical prophylaxis. The minimum time dedicated to AMS teaching differed between institutions (range 9–119 h), teaching was generally through didactic methods, and assessment was generally through knowledge recall and objective structured clinical examinations. Feedback from students suggests they find AMS and antimicrobial resistance (AMR) to be complex yet important topics. UK schools of pharmacy should utilize the competency framework to identify gaps in their AMS, AMR and infection teaching. To prepare newly qualified pharmacists to be effective at delivering AMS and prescribing antimicrobials, schools of pharmacy should utilize more simulated environments and clinical placements for education and assessment of AMS

Developing a competency-based approach to facilitate teaching and learning of antimicrobial stewardship as part of environmental sustainability in higher education.

The environmental impact of the inappropriate use of antimicrobials and antimicrobial resistance (AMR) is recognised by global organisations, such as the World Health Organisation and the European Union. Antimicrobial stewardship (AMS) is one strategy to promote appropriate use of antimicrobials to minimise AMR and is a priority for the NHS to ensure sustainable prescribing. It is therefore imperative to support and empower future health care professionals by providing them with the knowledge to be leaders in the field of AMS. National consensus-based competencies for teaching AMS to undergraduate healthcare professionals in the UK were launched in 2018. This generic framework includes competencies relating to specific aspects of antimicrobial prescribing and infection control, and also emphasizes the importance of collaborative interprofessional working. The aim of this project is to determine which AMS competencies are required to be met by student pharmacists. This pedagogic approach will provide a guiding tool for curricula development, and will allow identification of gaps and strengths within the undergraduate pharmacy curriculum. To enable the development of a UK-wide national AMS competency framework specifically for student pharmacists, a working group of academics and pharmacy practitioners with expertise in AMS was set up in September 2022. The diverse backgrounds of group members provide a healthy mix of ideas, with academics informing the group of what may be achievable within the constraints and professional requirements of the pharmacy curriculum, and pharmacy practitioners providing input into essential AMS competencies for early-career pharmacists. Student pharmacists from a national organisation are being invited to join the group to encourage co-designing of this curriculum. Considering the UN commitment to act on global antimicrobial resistance and the NHS Sustainable Development management plan, this project is timely and of great importance to support development of future pharmacists as leaders in environmental sustainability

Probable Transmission of Coxsackie B3 Virus from Human to Chimpanzee, Denmark

In 2010, a chimpanzee died at Copenhagen Zoo following an outbreak of respiratory disease among chimpanzees in the zoo. Identification of coxsackie B3 virus, a common human pathogen, as the causative agent, and its severe manifestation, raise questions about pathogenicity and transmissibility among humans and other primates

Technology-assisted stroke rehabilitation in Mexico: a pilot randomized trial comparing traditional therapy to circuit training in a Robot/technology-assisted therapy gym

Background Stroke rehabilitation in low- and middle-income countries, such as Mexico, is often hampered by lack of clinical resources and funding. To provide a cost-effective solution for comprehensive post-stroke rehabilitation that can alleviate the need for one-on-one physical or occupational therapy, in lower and upper extremities, we proposed and implemented a technology-assisted rehabilitation gymnasium in Chihuahua, Mexico. The Gymnasium for Robotic Rehabilitation (Robot Gym) consisted of low- and high-tech systems for upper and lower limb rehabilitation. Our hypothesis is that the Robot Gym can provide a cost- and labor-efficient alternative for post-stroke rehabilitation, while being more or as effective as traditional physical and occupational therapy approaches. Methods A typical group of stroke patients was randomly allocated to an intervention (n = 10) or a control group (n = 10). The intervention group received rehabilitation using the devices in the Robot Gym, whereas the control group (n = 10) received time-matched standard care. All of the study subjects were subjected to 24 two-hour therapy sessions over a period of 6 to 8 weeks. Several clinical assessments tests for upper and lower extremities were used to evaluate motor function pre- and post-intervention. A cost analysis was done to compare the cost effectiveness for both therapies. Results No significant differences were observed when comparing the results of the pre-intervention Mini-mental, Brunnstrom Test, and Geriatric Depression Scale Test, showing that both groups were functionally similar prior to the intervention. Although, both training groups were functionally equivalent, they had a significant age difference. The results of all of the upper extremity tests showed an improvement in function in both groups with no statistically significant differences between the groups. The Fugl-Meyer and the 10 Meters Walk lower extremity tests showed greater improvement in the intervention group compared to the control group. On the Time Up and Go Test, no statistically significant differences were observed pre- and post-intervention when comparing the control and the intervention groups. For the 6 Minute Walk Test, both groups presented a statistically significant difference pre- and post-intervention, showing progress in their performance. The robot gym therapy was more cost-effective than the traditional one-to-one therapy used during this study in that it enabled therapist to train up to 1.5 to 6 times more patients for the approximately same cost in the long term. Conclusions The results of this study showed that the patients that received therapy using the Robot Gym had enhanced functionality in the upper extremity tests similar to patients in the control group. In the lower extremity tests, the intervention patients showed more improvement than those subjected to traditional therapy. These results support that the Robot Gym can be as effective as traditional therapy for stroke patients, presenting a more cost- and labor-efficient option for countries with scarce clinical resources and funding. Trial registration ISRCTN98578807

Metabolic Profiling of Children Undergoing Surgery for Congenital Heart Disease.

OBJECTIVE: Inflammation and metabolism are closely interlinked. Both undergo significant dysregulation following surgery for congenital heart disease, contributing to organ failure and morbidity. In this study, we combined cytokine and metabolic profiling to examine the effect of postoperative tight glycemic control compared with conventional blood glucose management on metabolic and inflammatory outcomes in children undergoing congenital heart surgery. The aim was to evaluate changes in key metabolites following congenital heart surgery and to examine the potential of metabolic profiling for stratifying patients in terms of expected clinical outcomes. DESIGN: Laboratory and clinical study. SETTING: University Hospital and Laboratory. PATIENTS: Of 28 children undergoing surgery for congenital heart disease, 15 underwent tight glycemic control postoperatively and 13 were treated conventionally. INTERVENTIONS: Metabolic profiling of blood plasma was undertaken using proton nuclear magnetic resonance spectroscopy. A panel of metabolites was measured using a curve-fitting algorithm. Inflammatory cytokines were measured by enzyme-linked immunosorbent assay. The data were assessed with respect to clinical markers of disease severity (Risk Adjusted Congenital heart surgery score-1, Pediatric Logistic Organ Dysfunction, inotrope score, duration of ventilation and pediatric ICU-free days). MEASUREMENTS AND MAIN RESULTS: Changes in metabolic and inflammatory profiles were seen over the time course from surgery to recovery, compared with the preoperative state. Tight glycemic control did not significantly alter the response profile. We identified eight metabolites (3-D-hydroxybutyrate, acetone, acetoacetate, citrate, lactate, creatine, creatinine, and alanine) associated with surgical and disease severity. The strength of proinflammatory response, particularly interleukin-8 and interleukin-6 concentrations, inversely correlated with PICU-free days at 28 days. The interleukin-6/interleukin-10 ratio directly correlated with plasma lactate. CONCLUSIONS: This is the first report on the metabolic response to cardiac surgery in children. Using nuclear magnetic resonance to monitor the patient journey, we identified metabolites whose concentrations and trajectory appeared to be associated with clinical outcome. Metabolic profiling could be useful for patient stratification and directing investigations of clinical interventions.Mr. Correia is supported by the Imperial College Stratified Medicine Graduate Training Programme in Systems Medicine and Spectroscopic Profiling (STRATiGRAD). Dr. Pathan’s institution received grant support from the British Heart Foundation (research grant) and a Higher Education Funding Council for England clinical senior lecturer award. Dr. Ng received grant support from the British Heart Foundation (Researcher salary) and received support for article research from the British Heart Foundation. Dr. Jimenez consulted for Metabometrix is employed by the Imperial College London, and received support for article research from the National Institutes of Health (NIH). Her institution received grant support from the Cardiovascular Biomedical Research Institute. Dr. Macrae is employed by Royal Brompton and Harefield NHS Foundation Trust. Dr. Holmes is employed by the Imperial College London and received support for article research. Her institution received grant support from the Imperial College London (unrelated research grants in the field of metabolic medicine). The remaining authors have disclosed that they do not have any potential conflicts of interest.This is the final published version. It first appeared at http://journals.lww.com/ccmjournal/pages/articleviewer.aspx?year=9000&issue=00000&article=97295&type=abstract

In vitro fermentation of juçara pulp (Euterpe edulis) by human colonic microbiota

This study was carried out to investigate the potential fermentation properties of juçara pulp, using pH-controlled anaerobic batch cultures reflective of the distal region of the human large intestine. Effects upon major groups of the microbiota were monitored over 24 h incubations by fluorescence in situ hybridisation (FISH). Short-chain fatty acids (SCFA) were measured by HPLC. Phenolic compounds, during an in vitro simulated digestion and fermentation, were also analysed. Juçara pulp can modulate the intestinal microbiota in vitro, promoting changes in the relevant microbial populations and shifts in the production of SCFA. Fermentation of juçara pulp resulted in a significant increase in numbers of bifidobacteria after a 24 h fermentation compared to a negative control. After in vitro digestion, 46% of total phenolic content still remained. This is the first study reporting the potential prebiotic effect of juçara pulp; however, human studies are necessary to prove its efficacy

Consumer Bankruptcy Update

Materials from the Consumer Bankruptcy Update presentations held by UK/CLE in December 2000