Evaluating the effectiveness of digital communication within the National Medication Safety Network for England

Objectives: The medication safety officer (MSO) role was created following a patient safety alert, with an action for MSOs to be active participants in a national network in England, which included regular online webinar meetings and an online forum. The aim of the study was to assess the effectiveness of digital platforms in facilitating interaction and communication by the MSO network. The objectives were to establish the proportion of MSOs who interact through monthly webinars and the online forum. A secondary objective was to identify barriers and facilitators for engaging digitally within the MSO network. Methods: An online survey was used alongside semistructured interviews. The online survey was disseminated to all 400 MSOs registered with the UK Department of Health Central Alerting System from December 2018 to February 2019. Interviewees were identified purposively through snowball sampling and voluntarily through the survey. Results: 84 MSOs responded to the survey (21% response rate) and 10 participated in the semistructured interviews. The majority of the respondents were pharmacists (79/84, 94%) from NHS large healthcare providers (44/84, 52%). MSO respondents (61/84, 73%) joined the monthly webinar and 47/84 (56%) believed the webinar was useful for networking. Ten (12%) did not attend the webinars due to technical difficulties or lack of time. The online forum was used less frequently, with a third (27/84, 32%) that had never used it. Conclusions: Digital communications through webinars and online forums were perceived by respondents as a way to facilitate networking but require a robust information technology infrastructure that can be accessed without difficulty. User-friendly platforms can help the MSO network achieve critical mass and greater interaction, allowing timely access to information

Prolonged ventilation in thyroid storm

Thyroid storm (crisis) is uncommon but may be life threatening and is recognised by an exaggeration of the clinical features of thyrotoxicosis. Proximal myopathy is a well recognised presenting feature of Graves disease. Respiratory muscle weakness may also commonly occur in thyrotoxicosis but is often undiagnosed. We report a case of thyroid storm with rapid atrial fibrillation, severe agitation and extreme widespread muscle weakness. The respiratory muscles were so compromised that a respiratory arrest occurred. Ventilation was required for 7 weeks until full recovery occurred. </jats:p

HIV-Associated Cryptococcal Meningitis: Bridging the Gap Between Developed and Resource-Limited Settings.

Cryptococcal meningitis is a major cause of HIV-associated morbidity and mortality worldwide. Most cases occur in low-income countries, where over half of patients die within 10 weeks of diagnosis compared to as few as 10 % of patients from developed countries. A host of factors, spanning the HIV care continuum, are responsible for this gap in treatment outcomes between developed and resource-limited settings. We explore factors responsible for this outcomes gap and describe low-cost, highly effective measures that can be implemented immediately to improve outcomes in resource-limited settings. We also explore health-system challenges that must be addressed to reduce mortality further, recent research in disease prevention, and novel short-course treatment regimens that, if efficacious, could be implemented in resource-limited settings where the cost of standard treatment regimens is currently prohibitive

UBE2QL1 is Disrupted by a Constitutional Translocation Associated with Renal Tumor Predisposition and is a Novel Candidate Renal Tumor Suppressor Gene

Investigation of rare familial forms of renal cell carcinoma (RCC) has led to the identification of genes such as VHL and MET that are also implicated in the pathogenesis of sporadic RCC. In order to identify a novel candidate renal tumor suppressor gene, we characterized the breakpoints of a constitutional balanced translocation, t(5;19)(p15.3;q12), associated with familial RCC and found that a previously uncharacterized gene UBE2QL1 was disrupted by the chromosome 5 breakpoint. UBE2QL1 mRNA expression was downregulated in 78.6% of sporadic RCC and, although no intragenic mutations were detected, gene deletions and promoter region hypermethylation were detected in 17.3% and 20.3%, respectively, of sporadic RCC. Reexpression of UBE2QL1 in a deficient RCC cell line suppressed anchorage-independent growth. UBE2QL1 shows homology to the E2 class of ubiquitin conjugating enzymes and we found that (1) UBE2QL1 possesses an active-site cysteine (C88) that is monoubiquitinated in vivo, and (2) UBE2QL1 interacts with FBXW7 (an F box protein providing substrate recognition to the SCF E3 ubiquitin ligase) and facilitates the degradation of the known FBXW7 targets, CCNE1 and mTOR. These findings suggest UBE2QL1 as a novel candidate renal tumor suppressor gen

Spatially Extended Low Ionization Emission Regions (LIERs) at z∼0.9z\sim0.9

We present spatially resolved emission diagnostics for eight $z\sim0.9$ galaxies that demonstrate extended low ionization emission-line regions (LIERs) over kpc scales. Eight candidates are selected based on their spatial extent and emission line fluxes from slitless spectroscopic observations with the HST/WFC3 G141 and G800L grisms in the well-studied GOODS survey fields. Five of the candidates (62.5%) are matched to X-ray counterparts in the \textit{Chandra X-Ray Observatory} Deep Fields. We modify the traditional Baldwin-Philips-Terlevich (BPT) emission line diagnostic diagram to use [SII]/(H$\alpha$+[NII]) instead of [NII]/H$\alpha$ to overcome the blending of [NII] and H$\alpha$+[NII] in the low resolution slitless grism spectra. We construct emission line ratio maps and place the individual pixels in the modified BPT. The extended LINER-like emission present in all of our candidates, coupled with X-Ray properties consistent with star-forming galaxies and weak [OIII]$\lambda$5007\AA\ detections, is inconsistent with purely nuclear sources (LINERs) driven by active galactic nuclei. While recent ground-based integral field unit spectroscopic surveys have revealed significant evidence for diffuse LINER-like emission in galaxies within the local universe $(z\sim0.04)$, this work provides the first evidence for the non-AGN origin of LINER-like emission out to high redshifts.Comment: 11 pages, 1 table, 6 figures, accepted for publication in the Astrophysics Journal (ApJ

Mothers' beliefs about infant teething in Enugu, South-east Nigeria: a cross sectional study

<p>Abstract</p> <p>Background</p> <p>Parents and Health Care Workers have traditionally attributed a variety of symptoms to teething in young children. Some of these symptoms may however connote underlying serious medical condition in a child. There is little evidence to support these beliefs despite their implications on management of a symptomatic teething child. This study therefore seeks determine the beliefs and problems mothers associate with teething in Enugu, South-east Nigeria.</p> <p>Findings</p> <p>A cross-sectional survey involving sixty mothers presenting at a Children's clinic in Enugu metropolis using questionnaire. More than 90% of the respondents thought that babies can experience medical problems as a result of teething. The commonest medical problems perceived to be associated with teething were fever (71.7%), loose stools (58.3%) and vomiting (35%).</p> <p>Conclusion</p> <p>Mothers still associate a variety of symptoms of childhood illnesses to teething and this association is not evidence based and could lead to delayed interventions, increased morbidity and mortality of children. It is important therefore that mothers and health workers caring for young children are educated on the need to seek prompt medical attentions in a symptomatic child.</p

Dark energy constraints from cosmic shear power spectra: impact of intrinsic alignments on photometric redshift requirements

Cosmic shear constrains cosmology by exploiting the apparent alignments of pairs of galaxies due to gravitational lensing by intervening mass clumps. However galaxies may become (intrinsically) aligned with each other, and with nearby mass clumps, during their formation. This effect needs to be disentangled from the cosmic shear signal to place constraints on cosmology. We use the linear intrinsic alignment model as a base and compare it to an alternative model and data. If intrinsic alignments are ignored then the dark energy equation of state is biased by ~50 per cent. We examine how the number of tomographic redshift bins affects uncertainties on cosmological parameters and find that when intrinsic alignments are included two or more times as many bins are required to obtain 80 per cent of the available information. We investigate how the degradation in the dark energy figure of merit depends on the photometric redshift scatter. Previous studies have shown that lensing does not place stringent requirements on the photometric redshift uncertainty, so long as the uncertainty is well known. However, if intrinsic alignments are included the requirements become a factor of three tighter. These results are quite insensitive to the fraction of catastrophic outliers, assuming that this fraction is well known. We show the effect of uncertainties in photometric redshift bias and scatter. Finally we quantify how priors on the intrinsic alignment model would improve dark energy constraints.Comment: 14 pages and 9 figures. Replaced with final version accepted in "Gravitational Lensing" Focus Issue of the New Journal of Physics at http://www.iop.org/EJ/abstract/1367-2630/9/12/E0