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In response to the COVID-19 pandemic, Health Education England (HEE) and the University of Birmingham provided National Health Service (NHS) staff free access to SCRIPT, a national eLearning programme for safer prescribing and therapeutics. The eLearning was particularly for those returning to work or being redeployed. In the year March 2020-21, 3412 users registered to access portfolios and opened an aggregate of 17 198 modules. Each user completed a median of 2 (range 1-50, interquartile range [IQR] 1-7) assessed learning modules. Marks improved from pre-test to post-test by a median of 2 (IQR 0-3) marks out of 10. The most frequently selected modules were Adherence and Concordance (1109 users), Fluids (981 users) and Diabetic Emergencies (818 users). A total of 878 users accessed the unassessed COVID-19 module. The SCRIPT modules provided standardised education in core principles relating to prescribing and therapeutics, and were used by professionals from many healthcare disciplines.

Background Atrial fibrillation (AF) affects up to 2% of the UK population. AF is a potentially long-term condition that needs management, and as such primary care pharmacists may have a substantial role in supporting the management of AF. Objectives This study aims to explore the role of primary care pharmacists, working in community pharmacies and general practices (GPs), in supporting the management of AF. Furthermore, this study investigates pharmacists’ confidence in their knowledge and their attitudes towards incorporating AF-associated mobile apps use into their current practice. Methods A qualitative study was conducted, using one-to-one semi-structured, audio-recorded interviews with primary care pharmacists. The topic guide was developed based on pharmacy visits and included the most relevant constructs from the ‘consolidated framework for implementation research (CFIR)’. All interviews were audio-recorded, transcribed verbatim and thematically analysed until saturation was achieved, guided by Braun and Clarke’s 6-step research method. This study was given a favourable opinion on 5 September 2019 by the University of Birmingham (UOB) Research Ethics Committee (Reference ERN_19-0908). Results Thematic saturation was achieved after 11 interviews with primary care pharmacists (seven community pharmacists, and four GP pharmacists). Three main themes emerged relating to (1) the clinical role of pharmacists in the management of AF; (2) knowledge and awareness; and (3) prioritisation of resources. The first highlighted that primary care pharmacists were an underutilised resource within AF management. The second demonstrated that pharmacists, especially those based in the community, felt a lack of confidence in their knowledge of AF and its management, mainly community pharmacists due to other roles taking precedence over clinical roles. Both community and GP pharmacists expressed the need to have further training in this therapeutic area to be able to effectively support patients with AF. The third shed light on the pharmacists’ views relating to the technological revolution in healthcare. Pharmacists expressed an interest in using apps to support their current practice. Conclusions Primary care pharmacists supported an extended care to AF management from screening to consultations, yet the provision of such services remains limited and inconsistent. Future research should focus on understanding the ways in which pharmacists’ role can be adapted toward greater involvement in clinical care.

Pharmacists deliver pharmaceutical care in many different healthcare settings and are well-placed to support the prevention of stroke. However, their role and impact in this area is ill-defined. This systematic review aims to explore the pharmacists’ role in stroke prevention. Nine databases were searched for studies reporting pharmacist interventions in the management of primary and secondary ischaemic stroke prevention. Study quality was evaluated through Cochrane Risk of Bias and Joanna Briggs Institute (JBI) appraisal tools where possible. A narrative review was conducted and meta-analysis performed for studies with comparable outcomes. Of the 834 initial articles, 31 met inclusion criteria. Study designs were varied and included controlled trials, observational studies, audit reports and conference abstracts. Seven studies addressed the pharmacists’ role in primary prevention and 24 in secondary prevention. Pharmacist interventions reported were diverse and often multifactorial. Overall, 20 studies reported significant improvement in outcomes. Meta-analysis showed pharmacist interventions in emergency care significantly improved the odds of achieving thrombolytic therapy door to needle (DTN) times ≤45 min, odds ratio: 2.69 (95% confidence interval (CI): 1.95–3.72); p < 0.001. The pharmacists’ role is varied and spans the stroke treatment pathway, with the potential for a positive impact on a range of health-related outcomes.

All dental practitioners will treat patients who take medicines. An ageing population, combined with improved management of patients with multiple long-term co-morbidities, has seen a rise in complex medication regimens. Healthcare specialization, a widening drug market and better access to medicines has also contributed to more patients taking multiple medicines for conditions, often managed by a variety of specialists. Whether these medicines are prescribed or bought over-the-counter, dental practitioners must understand the implications that these treatment regimens can have on dental care. CPD/Clinical Relevance: Prescribing medicines is a small but essential part of dental practice. This paper describes various aspects of prescribing, the potential implications of dental treatment to a patient's medication regimen, and important considerations to reduce the risk of medication errors and improve patient safety.

Background Adherence rates of preventative medication for cardiovascular disease (CVD) have been reported as 57%, and approximately 9% of all CVD events in Europe are attributable to poor medication adherence. Mobile health technologies, particularly mobile apps, have the potential to improve medication adherence and clinical outcomes. Objective The objective of this study is to assess the effects of mobile health care apps on medication adherence and health-related outcomes in patients with CVD. This study also evaluates apps’ functionality and usability and the involvement of health care professionals in their use. Methods Electronic databases (MEDLINE [Ovid], PubMed Central, Cochrane Library, CINAHL Plus, PsycINFO [Ovid], Embase [Ovid], and Google Scholar) were searched for randomized controlled trials (RCTs) to investigate app-based interventions aimed at improving medication adherence in patients with CVD. RCTs published in English from inception to January 2020 were reviewed. The Cochrane risk of bias tool was used to assess the included studies. Meta-analysis was performed for clinical outcomes and medication adherence, with meta-regression analysis used to evaluate the impact of app intervention duration on medication adherence. Results This study included 16 RCTs published within the last 6 years. In total, 12 RCTs reported medication adherence as the primary outcome, which is the most commonly self-reported adherence. The duration of the interventions ranged from 1 to 12 months, and sample sizes ranged from 24 to 412. Medication adherence rates showed statistically significant improvements in 9 RCTs when compared with the control, and meta-analysis of the 6 RCTs reporting continuous data showed a significant overall effect in favor of the app intervention (mean difference 0.90, 95% CI 0.03-1.78) with a high statistical heterogeneity (I2=93.32%). Moreover, 9 RCTs assessed clinical outcomes and reported an improvement in systolic blood pressure, diastolic blood pressure, total cholesterol, and low-density lipoprotein cholesterol levels in the intervention arm. Meta-analysis of these clinical outcomes from 6 RCTs favored app interventions, but none were significant. In the 7 trials evaluating app usability, all were found to be acceptable. There was a great variation in the app characteristics. A total of 10 RCTs involved health care professionals, mainly physicians and nurses, in the app-based interventions. The apps had mixed functionality: 2 used education, 7 delivered reminders, and 7 provided reminders in combination with educational support. Conclusions Apps tended to increase medication adherence, but interventions varied widely in design, content, and delivery. Apps have an acceptable degree of usability; yet the app characteristics conferring usability and effectiveness are ill-defined. Future large-scale studies should focus on identifying the essential active components of successful apps. Trial Registration PROSPERO International Prospective Register of Systematic Reviews CRD42019121385; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=121385

The patient's sensory experience when taking an oral medicine is important in the assessment of its palatability, and acceptability. The aim of this study was to develop tools useful for standardisation of sensory assessment of coated tablets: a lexicon and a sensory wheel. Two randomised, double-blind sensory assessments were performed involving 83 and 52 heathy adult volunteers and two sets of coated tablets. By adapting the principles used by food sciences, a free-text description of conventional, bitter-tasting or tasteless, coated tablets was performed. In the first assessment, volunteers described the sensory attributes of the first set of tablets. The attributes collected were then validated using a second set of tablets in a separate study with different volunteers. The appropriateness and semantics of each sensory attribute was analysed. Twenty attributes most relevant for assessment of coated tablets were selected for the lexicon and associated with explicit definitions. A collection of all attributes that could possibly be triggered by coated tablets were organised in the form of a sensory wheel. This study provides a valuable insight into the sensory experience while taking a coated tablet and presents tools which can accelerate the development of palatable medicines.

Fundamental knowledge about the composition of intestinal fluids in paediatric populations is currently unavailable. This study aimed to characterise gastric and intestinal fluid from paediatric populations. Gastric and intestinal fluid samples were obtained during routine clinical endoscopy from paediatric patients at a large teaching hospital. These fluids were characterised to measure the pH; buffer capacity; osmolality; bile acid concentration and composition. A total of 55 children were recruited to the study aged from 11 months to 15 years of age where 53 gastric fluid samples and 40 intestinal fluid samples were obtained. pH values recorded ranged from pH 0.57 to 11.05 (median: 2.50) in gastric fluids and from 0.89 to 8.97 (median: 3.27) in intestinal fluids. The buffer capacity did not change significantly between gastric and intestinal fluids with median values of 12 mM/L/ΔpH for both fluids. Gastric fluid osmolality values ranged from 1 to 615 mOsm/kg, while intestinal fluid values ranged from 35 to 631 mOsm/kg. Gastric fluid bile acid concentrations ranged from 0.002 to 2.3 mM with a median value of 0.017 mM whilst intestinal fluid bile acid concentrations ranged from 0.0008 to 3.3 mM with a median value of 0.178 mM. Glycocholate; taurocholic acid; glycochenodeoxycholate and taurochenodeoxycholate were the most commonly identified bile acids within paediatric intestinal fluids. All compositional components were associated with large inter-individual variability. Further work is required to develop simulated paediatric media and to explore the impact of these media on drug solubility and dissolution.

BACKGROUND Adherence rates of preventative medication for cardiovascular disease (CVD) have been reported as 57%, and approximately 9% of all CVD events in Europe are attributable to poor medication adherence. Mobile health technologies, particularly mobile apps, have the potential to improve medication adherence and clinical outcomes. OBJECTIVE The objective of this study is to assess the effects of mobile health care apps on medication adherence and health-related outcomes in patients with CVD. This study also evaluates apps’ functionality and usability and the involvement of health care professionals in their use. METHODS Electronic databases (MEDLINE [Ovid], PubMed Central, Cochrane Library, CINAHL Plus, PsycINFO [Ovid], Embase [Ovid], and Google Scholar) were searched for randomized controlled trials (RCTs) to investigate app-based interventions aimed at improving medication adherence in patients with CVD. RCTs published in English from inception to January 2020 were reviewed. The Cochrane risk of bias tool was used to assess the included studies. Meta-analysis was performed for clinical outcomes and medication adherence, with meta-regression analysis used to evaluate the impact of app intervention duration on medication adherence. RESULTS This study included 16 RCTs published within the last 6 years. In total, 12 RCTs reported medication adherence as the primary outcome, which is the most commonly self-reported adherence. The duration of the interventions ranged from 1 to 12 months, and sample sizes ranged from 24 to 412. Medication adherence rates showed statistically significant improvements in 9 RCTs when compared with the control, and meta-analysis of the 6 RCTs reporting continuous data showed a significant overall effect in favor of the app intervention (mean difference 0.90, 95% CI 0.03-1.78) with a high statistical heterogeneity (I2=93.32%). Moreover, 9 RCTs assessed clinical outcomes and reported an improvement in systolic blood pressure, diastolic blood pressure, total cholesterol, and low-density lipoprotein cholesterol levels in the intervention arm. Meta-analysis of these clinical outcomes from 6 RCTs favored app interventions, but none were significant. In the 7 trials evaluating app usability, all were found to be acceptable. There was a great variation in the app characteristics. A total of 10 RCTs involved health care professionals, mainly physicians and nurses, in the app-based interventions. The apps had mixed functionality: 2 used education, 7 delivered reminders, and 7 provided reminders in combination with educational support. CONCLUSIONS Apps tended to increase medication adherence, but interventions varied widely in design, content, and delivery. Apps have an acceptable degree of usability; yet the app characteristics conferring usability and effectiveness are ill-defined. Future large-scale studies should focus on identifying the essential active components of successful apps. CLINICALTRIAL PROSPERO International Prospective Register of Systematic Reviews CRD42019121385; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=121385

There is great interest in demonstrating acceptability of solid oral formulations in paediatric populations. This study investigated the acceptability of small, 7.5 mm, bitter-flavoured, coated tablets in healthy children and adults. A randomised, double-blind acceptability test was performed involving 101 children (4–12 years) and 52 adults (18–75 years). Acceptability was measured by participants as sensory assessment of taste, mouthfeel and hedonic perception, and by researcher observations of ability to swallow the tablet and negative facial expressions. Additionally, the taste-masking effect of film coatings was assessed based on the intensity of bitterness perception. At least one tablet was voluntarily swallowed by 35.7% of 4–6-year olds, 74% of 7–12-year olds and 98% of adults. The bitterness of the tablet did not affect participants’ ability to swallow it. The sensory properties determined whether the tablet was acceptable. The following factors: low bitterness, high smoothness, high slipperiness and pleasant aftertaste had a positive impact on overall palatability in both populations. The paediatric scores during sensory evaluation of tablets differed from adults, showing lower acceptability. This study demonstrates the multifactorial nature of palatability of tablets and highlights that adults’ palatability evaluation cannot be directly translated to a paediatric population.

The volume and localization of fluid in the paediatric gastrointestinal tract is crucial to the design of in vitro and in silico models that predict the absorption of oral drugs administered to children. Previous studies have used magnetic resonance imaging (MRI) to quantify fluid volumes and localization in the intestines of adults; this study is the first to undertake similar analysis of pediatric participants. This study quantified the amount and distribution of fluid in fasted and fluid-fed children using MRI data captured during the routine clinical assessment. Data from 32 fasted children (aged 0-16 years) and 23 fluid-fed children (aged 8-16 years) were evaluated. The gastric volume ranged from 0 to 9 mL in the fasted and 19-423 mL in the fluid-fed state. The small intestinal volume was recorded to be 0-51 mL in the fasted and 6-91 mL in the fluid-fed state with an average number of 7.7 and 22.4 fluid pockets, respectively. The data showed significant differences in gastric volumes and the number of fluid pockets in the small intestine for age-matched fasted and fluid-fed children (p < 0.05). Both the number and the volume of pockets reported in children are much lower than those previously reported in adults. This study is the first to report intestinal volumes and localization in children and provides new information to achieve the design of biorelevant in vitro models and real values to update in silico models. The data available from both fluid-fed and fasted children show the extremes of fluid volumes that are present in the gastro-intestinal tract which is useful to understand the variability associated with drug absorption in children.

Objective Diffuse chest wall invasion (DCWI) is a common finding in patients undergoing intended resection for malignant pleural mesothelioma. We sought to determine the incidence and preoperative predictors of this finding, and to test our anecdotal impression that contraction of the ipsilateral hemithorax is associated with DCWI. Methods This was a single-institution retrospective study of 170 patients undergoing intended macroscopic complete resection for malignant pleural mesothelioma from 2014-2018. A novel metric of thoracic cage volume was calculated by preoperative chest computed tomography. Univariable analyses were performed to determine associations of preoperative variables with DCWI. Results Macroscopic complete resection was achieved by pleurectomy/decortication in 104 patients (61%) and by extrapleural pneumonectomy in 39 patients (23%). Unresectable disease was discovered at thoracotomy in 27 (16%) of patients; 24 (14%) by DCWI and 3 (2%) by intrathoracic organ invasion. In univariable analysis, decreased ipsilateral thoracic cage volume demonstrated the strongest association with unresectability by DCWI (P = .009) with >5% decrease in thoracic cage volume representing the optimal cutoff (P = .014; area under the curve, 0.67). Other preoperative variables associated with DCWI included preoperative chest pain requiring opioids (P = .028), prior pleurodesis (P = .036), decreased forced vital capacity (P = .023), decreased ipsilateral lung perfusion by ventilation/perfusion lung scan (P = .007), and magnetic resonance imaging findings of chest wall invasion (P = .035). Conclusions Preoperative identification of DCWI will avoid unnecessary thoracotomy and accelerate initiation of nonsurgical therapy in malignant pleural mesothelioma. Our data suggest that contraction of thoracic cage volume has merit in predicting malignant pleural mesothelioma unresectability and should be validated in prospective studies.

Objective: The aim of this study was to investigate the provision of community pharmacy services to children and young people with a focus on advanced services such as medicines use review. Perceptions and experiences of community pharmacists, pharmacy staff, young people and their parents or carers on the provision of such services were also explored. Methods: Four different cross-sectional, self-administered questionnaires were distributed in parallel to pharmacists, pharmacy staff members, children and young people and parents in the United Kingdom. Results: An outline of pharmacist's current involvement with children and young people was provided by 92 pharmacists. A different group of 38 community pharmacists and 40 non-pharmacist members of pharmacy staff from a total of 46 pharmacies provided information and views on the conduct of Medicines use review with children and young people. Experiences of advanced pharmacy service provision were collected from 51 children and young people and 18 parents. Most pharmacists offered public health advice to children and young people (73/92; 79.3%) and even more (83/92; 90.2%) reported that they often interacted with children and young people with long-term condition. Despite their high levels of interaction, and a majority opinion that medicines use reviews could benefit children (35/38; 92.1%), the number of pharmacies reporting to have conducted medicines use reviews with children was low (5/41). Pharmacists perceived the main barriers to recruitment as consent (17/29; 58.6%), guideline ambiguity (14/29; 48.3%) and training (13/29; 44.8%). A considerable proportion pharmacists (12/29; 41.4%) and other personnel (14/33; 42.4%) working in community pharmacies were unaware that children were potentially eligible for medicines use reviews. Only 29.4% of the 51 children and young people participants had received advice about their long-term condition from a pharmacist and the majority (46/51; 90.2%) had not taken part in an advanced service focused on adherence. Conclusions: While general engagement with children and young people appears high from the pharmacist's perspective, advice specific to children and young people with long-term conditions and the provision of advanced services in this group remains a challenge.

Acceptability of medicines is critical for effective pharmacotherapy. The aim of this study was to investigate the oral sensory properties of tablet coatings to determine how mouthfeel can improve acceptability. A randomised double-blind study was performed in 84 adult volunteers (51% ≥55 years). Each participant received 4 placebo tablets (3 coated and 1 uncoated) to evaluate (i) ease of swallowing and (ii) palatability. Visual analogue scales (VAS) were used to capture sensory parameters. Acceptability was assessed using the following parameters: ease of swallowing; amount of water taken with the tablet; rank order of preference; roughness; adhesiveness and slipperiness. Ease of swallowing was determined to be the most sensitive measure of acceptance. The best coating was the one that was reported to be the most slippery and smooth. The presence of a coating improved ease of swallowing, mouthfeel and overall palatability. This study demonstrates that slippery coatings improve acceptability of tablets. The study also demonstrates the value of VAS to measure the sensory attributes of coated tablets.

Background Principles of pharmacology form the basis of many healthcare professional undergraduate curricula. They are essential for pharmacists who need this knowledge to inform their practice. Pharmacology has traditionally been taught using a didactic approach. High-fidelity simulation manikins are commonly used to train healthcare professionals but there are limited reports of use in pharmacy training or to reinforce principles of pharmacology. This feasibility study examined the use of a high-fidelity simulation manikin (SimMan3G) to support the teaching of pharmacology to pharmacy students. Summary of work The undergraduate pharmacy curriculum was reviewed alongside the SimMan3G capabilities in order to identify pharmacological concepts suitable for simulation. A scenario template was developed to deliver defined learning objectives. A total of 24 pharmacy students (years 2 and 3 of a four year programme) participated in a SimMan3G simulation centred on opioid analgesia and management of overdose with reference to the theories of receptor pharmacology. All students had received underpinning lecture-based introductions to these concepts as part of their existing curriculum. Student knowledge was determined with a 12 question pre- and post-session test based on the learning objectives. Pre- and post-test scores were analysed using a paired t-test. The session was evaluated by all participants. Summary of results Average scores for pre- and post-session tests were 52% and 90% respectively demonstrating a mean overall improvement of 38% (p Discussion and conclusions This study demonstrates the feasibility of using high-fidelity simulation manikins to reinforce the concepts of pharmacology to undergraduate healthcare professionals. Manikin-based simulation was well received and improved student’s short-term knowledge of pharmacotherapeutics. The practical application of knowledge and interactive learning improved understanding and stimulated student interest. Further scenarios will be developed and future work will look to confirm these pilot findings and assess long-term knowledge retention. Currently, healthcare professionals may encounter high-fidelity manikin-based simulation as part of a post-graduate multidisciplinary team to develop clinical decision making and communication. We recommend that it should be introduced earlier, in the undergraduate programmes, to demonstrate pharmacotherapeutic principles and reinforce traditional lecture-based learning.

Background Endovascular treatment (EVT) of brain arteriovenous malformations has evolved from cyanoacrylate derivatives such as N-butyl cyanoacrylate, an adhesive glue, to ethylene vinyl copolymer-based liquid embolics such as Onyx® and SQUID® dissolved in dimethyl sulfoxide. Although these agents offer several advantages, their rapidly decreasing radiopacity, as a result of the sedimentation of tantalum powder, compromises visual control during EVT. This study aims to quantify and compare tantalum sedimentation rates of several liquid embolic agents, and determine their effects on radiopacity. Methods The rate of sedimentation of liquid embolics Onyx 18®, SQUID 12®, and SQUID 18® was measured after preparation by single x-ray exposures for a period of 30 minutes. The signal-to-noise ratios (SNRs) of the suspension of each liquid embolic was calculated at various time points as tantalum settled out of the suspension. Precipitating Hydrophobic Injectable Liquid (PHIL®) was imaged as a control. Results Onyx 18® demonstrated the fastest sedimentation rate of the liquid embolics analyzed and demonstrated a threefold faster drop in SNR compared to SQUID 18® over 30 minutes. Onyx 18® demonstrated a one and a half times faster drop in SNR compared to SQUID 12®. Although PHIL 25® maintained constant SNR over the same time, it was lower at baseline immediately after preparation compared to tantalum-based liquids. Conclusion Caution during long injections using tantalum-based agents is advised. Onyx 18® has a significantly faster drop in radiopacity compared to SQUID 12® and SQUID 18®. Covalently bonded iodine-based embolics like PHIL® demonstrate constant radiopacity over time.

AimTo explore the role of primary care pharmacists in the management of chronic illnesses in young people aged 10–24 years.MethodsSystematic search of four databases: MEDLINE, EMBASE, Cochrane Library and CINAHL using MeSH (Medical Subject Heading) and Emtree terms covering three main themes, namely, pharmacist, young people and chronic illnesses. Inclusion criteria: articles identifying the role of primary care pharmacists in the management of chronic illness and its acute manifestations in young people aged 10–24 years. Exclusion criteria: articles referring to the hospital, secondary care setting. Chronic conditions such as disability. Acute disease. Conference abstracts, letters and case studies.ResultsEight relevant articles were identified from different countries UK(3), USA(3), Netherlands(1) and Chile(1). All of the articles made reference to community pharmacists only and did not include information on pharmacists working in any other area of primary care (e.g. general practice). Seven of the articles identified included original research studies (1 observational, 2 survey, 2 qualitative interview, 2 intervention). The remaining article was a literature review. The interventional studies utilised pharmacists to manage specific chronic illnesses (i.e. asthma and metabolic disease). Both showed significant results in terms of improvement of a young person’s quality of life and improvement in their knowledge about their disease and its treatment. The research studies gathered the opinions of pharmacists (3) and young people (1) based on their experiences. The most prominent issue arising from the research into pharmacist opinion was the lack of direct communication with the young person because of parents collecting prescription items. In one study,1 around half of participants stated this to be the main cause of medication-related problems, which in the main were non-adherence, in young people. Community pharmacists identified many roles that they felt were of high priority to their practice when dealing with young people. These included supporting young people to develop generic health care skills, build trusting relationships directly with young people, counselling with affirmation on the necessity and benefits of adhering to their medicine regimens, helping young people to find credible online health information and use digital media for educational or reminder purposes, transferring information effectively across care interfaces and provision of specialist services.1 2ConclusionThere is a lack of published literature regarding the role of pharmacists in the management of chronic illness in young people. Where primary care pharmacists have managed chronic illnesses in this patient population, they have been community-based and have had a positive impact on patient outcomes. Pharmacists feel that they have a role to play in supporting young people with chronic illness and have identified many areas where they can provide additional services and support. However, many pharmacists perceive a fundamental communication barrier which hinders provision of this support i.e. lack of access to the patient. This suggests that given the appropriate training and access to these patients pharmacists could have a positive impact on patient outcomes. Further research is necessary to provide more evidence that primary care pharmacists could be further utilised in supporting young people with their medications.ReferencesKoster E, Philbert D, Winters N, et al. Medication adherence in adolescents in current practice: community pharmacy staff’s opinions. International Journal of Pharmacy Practice, 2015;23(3):221–224.Gray N, Shaw K, Smith F, et al. The Role of Pharmacists in Caring for Young People With Chronic Illness. Journal of Adolescent Health, 2017;60(2):219–225.

Offenders with mental health problems often have complex and interrelated needs which separately challenge the criminal justice system (CJS) and National Health Service (NHS) in the United Kingdom (U.K.). Consequently, interagency collaboration and timely information sharing are essential. This study focused on the sharing of information about people with mental health problems in contact with the CJS. Questionnaires were distributed to a range of health and criminal justice personnel. The results showed that there was a mismatch between what service user information criminal justice agencies felt they needed and what was routinely received. Prison Service staff received more information (between 15% and 37%) from health agencies than the police (between 6% and 22%). Health professionals received most of the information they needed from criminal justice agencies (between 55% and 85%). Sharing service user information was impeded by incompatible computer systems and restrictions due to data protection/confidentiality requirements. In the U.K., recent governmental publications have highlighted the importance of information sharing; however there remains a clear mismatch between what health related information about service users criminal justice agencies need, and what is actually received. Better guidance is required to encourage and empower people to share.

Background Clarity and accuracy of the pharmacy aspects of cancer clinical trial protocols is essential. Inconsistencies and ambiguities in such protocols have the potential to delay research and jeopardise both patient safety and collection of credible data. The Chemotherapy and Pharmacy Advisory Service was established by the UK National Cancer Research Network, currently known as National Institute for Health Research Clinical Research Network, to improve the quality of pharmacy-related content in cancer clinical research protocols. This article reports the scope of Chemotherapy and Pharmacy Advisory Service, its methodology of mandated protocol review and pharmacy-related guidance initiatives and its current impact. Methods Over a 6-year period (2008–2013) since the inception of Chemotherapy and Pharmacy Advisory Service, cancer clinical trial protocols were reviewed by the service, prior to implementation at clinical trial sites. A customised Review Checklist was developed and used by a panel of experts to standardise the review process and report back queries and inconsistencies to chief investigators. Based on common queries, a Standard Protocol Template comprising specific guidance on drug-related content and a Pharmacy Manual Template were developed. In addition, a guidance framework was established to address ‘ad hoc’ pharmacy-related queries. The most common remarks made at protocol review have been summarised and categorised through retrospective analysis. In order to evaluate the impact of the service, chief investigators were asked to respond to queries made at protocol review and make appropriate changes to their protocols. Responses from chief investigators have been collated and acceptance rates determined. Results A total of 176 protocols were reviewed. The median number of remarks per protocol was 26, of which 20 were deemed clinically relevant and mainly concerned the drug regimen, support medication, frequency and type of monitoring and drug supply aspects. Further analysis revealed that 62% of chief investigators responded to the review. All responses were positive with an overall acceptance rate of 89% of the proposed protocol changes. Conclusion Review of pharmacy content of cancer clinical trial protocols is feasible and exposes many undetected clinically relevant issues that could hinder efficient trial conduct. Our service audit revealed that the majority of suggestions were effectively incorporated in the final protocols. The refinement of existing and development of new pharmacy-related guidance documents by Chemotherapy and Pharmacy Advisory Service might aid in better and safer clinical research.

The following describes a number of technologies and exemplary service designs that foster better Internet finding tools in libraries and more cooperative and efficient effort in Internet resource collection building. Our library and partner institutions have been involved in this work for over a decade. The open source software and projects discussed represent appropriate technologies and sustainable strategies that will help Internet portals, digital libraries, virtual libraries and library catalogs‐with‐portal‐like‐capabilities (IPDVLCs) to scale better and to anticipate and meet the needs of scholarly and educational users.

Purpose Digital photoplethysmography (PPG) has been proposed as an alternative to Doppler technology for measuring ankle pressures and ankle-brachial indices (ABIs). However, in patients with critical-limb ischemia (CLI), digital waveforms may not be detectable, which would negate digital pressure measurement and ABI calculation. In this study we evaluated the presence of digital PPG waveforms in patients with lower-extremity CLI (ABI < 0.40). Methods From January through December 2007, vascular laboratory patients who had a lower-extremity physiological study, including an ankle waveform, PPG waveform analysis of their great toe, and an ABI of =0.40, were prospectively entered into a database. ABIs and waveforms were obtained in the standard fashion. Patients with incomplete waveform data and CLI follow-up examinations were excluded from the analysis. Subjects were separated into 2 groups: those with digital PPG waveforms (group 1) and those with flatline digital waveforms (group 2). Each group was evaluated for audible posterior tibial (PT) and dorsalis pedis (DP) Doppler signals. Results A total of 160 extremities (140 patients) with CLI were identified during the study period; 45 patients and 53 extremities were excluded. There were 41% (44/107) group 1 and 59% (63/107) group 2 extremities. In group 2 extremities, 67% (42/63) had flatline ankle waveforms, 40% (25/63) had absent PT and DP Doppler signals, and 60% (38/63) had one or more audible PT or DP signals. Conclusions Less than one half of the extremities with CLI had digital PPG waveforms. However, 60% of those limbs with flatline digital waveforms had one or more audible pedal Doppler signal, requiring a more detailed noninvasive evaluation with a Doppler ABI endpoint. Automated digital PPG devices may be inadequate for ABI evaluation of patients with CLI.

Preventing and removing the build-up of regolith on an astronaut’s space suit is a major issue facing future manned exploration missions. The dust poses a health threat to astronauts; it also adversely affects their equipment. The Field Integrated Regolith Cleaning Experiment (FIRCE) was designed to study different techniques for removing regolith as well as reviewing what commercial off-the-shelf products were best suited for cleaning space suit orthofabric and polycarbonate (used on the astronaut’s visor). All of the commercial products worked well in both the 1-g environment as well as the 0-g environment. All were ranked above a 7.0/10 for ease of use and above 7.6/10 for cleaning effectiveness. A custom made magnetic brush, designed to attract the regolith’s static charge was not effective at removing dust because the humidity in the air prevented the build-up of static charge on the regolith.Â

The crew would like to thank the Wisconsin Space Grant Consortium (WSGC), the UW- Madison Dean of Engineering, their faculty advisor Dr. Frederick Elder, and the Mars Society Mission Support for their knowledge, guidance, and support of the mission. We could not have accomplished our goals without you. Crew 110A consisted of a team of engineers, undergraduates and graduate students, from the University of Wisconsin-Madison. During our stay, we celebrated the New Year with an inaugural midnight EVA and red Martian cool-aid, we anxiously listened to the UW-Madison Badger Football Team play in the Rose Bowl, and we completed 15 EVA’s within a seven day period. The crew set out with a mission to conduct habitability, atmospheric, geologic imaging, and space suit ergonomic studies and a vision to advance the space industry’s exploration capabilities.

Aims To engage with high risk groups to identify knowledge and awareness of oral cancer signs and symptoms and the factors likely to contribute to improved screening uptake. Methods Focus group discussions were undertaken with 18 males; 40+ years of age; smokers and/or drinkers (15+ cigarettes per day and/or 15+ units of alcohol per week), irregular dental attenders living in economically deprived areas of Teesside. Results There was a striking reported lack of knowledge and awareness of oral cancer and its signs and symptoms among the participants. When oral/mouth cancer leaflets produced by Cancer Research UK were presented to the participants, they claimed that they would seek help on noticing such a condition. There was a preference to seek help from their general practitioner rather than their dentist due to perceptions that a dentist is ‘inaccessible’ on a physical and psychological level, costly, a ‘tooth specialist’ not a ‘mouth specialist’, and also not able to prescribe medication and make referrals to specialists. Interestingly, none of the 18 participants who were offered a free oral cancer examination at a dental practice took up this offer. Conclusions The uptake of oral cancer screening may be improved by increasing knowledge of the existence and signs and symptoms of oral cancer. Other factors that may increase uptake are increased awareness of the role of dentists in diagnosing oral cancer, promotion of oral cancer screening by health professionals during routine health checks, and the use of a “health” screening setting as opposed to a “dental” setting for such checks.

Summary The New Macmillan Reading Analysis (1985) was administered to 14 integrated hearing‐impaired children, with a mean hearing loss of 58.8 dB, and to 14 age‐matched hearing controls. Both groups read equally well in terms of accuracy, but the hearing had superior comprehension. The hearing‐impaired and the hearing controls were retarded in terms of the published norms. Their speech intelligibility was rated and compared with that in other studies. All of the hearing‐impaired were educated orally with the support of the Salford Education Service for the Hearing‐Impaired.

Hybridomas secreting monoclonal antibodies (MABs) specific for a soil Flavobacterium species (P25) were isolated. The MAB (D10) was used to target P25 using an enzyme-linked immunosorbant assay (ELISA) and indirect immunofluorescence. Cross-reactivity of the MAB with other Gram-negative bacteria (including Flavobacterium spp.) and a number of Gram-positive bacteria was investigated but none were found. Cross-reactivity with other orange/yellow pigmented Gram-negative rods (Pseudomonas/Flavobacterium type) isolated from the soil into which P25 has been introduced in field experiments was also assessed using a modified colony blotting procedure. None of the indigenous species tested were recognised by the monoclonal antibody, thereby allowing unambiguous identification of P25 in soil. The MAB D10 was shown to recognise P25 growth under low-nutrient or stored under starvation conditions, suggesting that the antigen is a constitutive component of the cell and that the microorganism should be detected in oligotrophic environments such as soil. The pattern of fluorescence of P25 gave a clear indication of the localisation of the antigen in the outer membrane/cell wall region, and this was confirmed by immunogold labelling. Preliminary studies on the limits of detection of P25 using immunofluorescence suggest that densities as low as 20 bacteria g−1 soil can be enumerated.

efforts to begin the creation of a cooperative VL content building program, together with open software development in the area of machine-learning based hybrid systems. Such a system will feature the best of VL, expert-based content selection, and description effort as augmented by machine-assisted resource collection, classification, and collection maintenance software.

Objective. —To assess the potential availability and utility of fetal tissues obtained from spontaneous abortions and from ectopic pregnancies for human transplantation therapy. Design. —Tissue collection and analysis by personnel skilled in tissue banking. Setting. —Procurement programs in five tissue banks located in diverse geographical areas that are funded by the National Institutes of Health. Patients. —All women entering obstetric clinics during 1993 who consented to participate in the study. Interventions. —None. Main Outcome Measures. —Evaluation of the products of conception by standard developmental, histological, microbiological, and cytogenetic criteria. Results. —From 22235 obstetric admissions, 1250 spontaneously aborted embryos and 247 products of ectopic pregnancies were obtained. Of these, seven embryos (0.5%) were potentially useful for human transplantation therapy. Conclusion. —Fetal tissues from spontaneous abortions and from ectopic pregnancies are quite limited as feasible sources for human transplantation therapy. ( JAMA . 1995;273:66-68)

SUMMARY: Several thiobacilli and Thermothrix thiopara were grown in chemostat culture with inorganic sulphur compounds as growth-limiting energy substrates for autotrophic growth. Thiobacillus neapolitanus, Thiobacillus thiooxidans and Thiobacillus acidophilus were all able to use thiosulphate, trithionate or tetrathionate as sole energy substrates, as was Thx. thiopara grown at 72 °C. “True growth yields” (Y max) were estimated for the organisms and showed yields of T. neapolitanus to be the same on trithionate and thiosulphate, thereby suggesting that only oxidative, and not substrate-level, phosphorylation is involved in energy conservation in this organism. The yield data suggested that substrate-level phosphorylation could, however, be significant in T. acidophilus. Thiobacillus versutus only grew with thiosulphate, with which it gave yield values similar to those of T. neapolitanus and T. thiooxidans. Thx. thiopara exhibited maximum specific growth rates on thiosulphate, trithionate and tetrathionate of 0·55, 0·23-0·25 and

All-night polygraphic recordings of 25 normal infants were carried out to describe the early development of sleep-waking-state sequencing. Each minute of the 12-h recordings was coded into quiet sleep, active sleep, or waking states. These data were then transformed into a binary series and subjected to spectral analysis using the fast Fourier transform for determination of periodicity of each state. Spectral estimates of sleep- and waking-state periodicities displayed a high variance early in life, but by 3 to 4 months of age, there was a principal rhythm approximating 1 cycle/h in the active and quiet sleep states. The average frequency for the quiet and active sleep states increased significantly from 0.87 to 1.07 cycles/h during this 6-month period. These data offer evidence that the establishment of the periodic organization of sleep states requires 4 months to develop in the normal infant.

The chemolithotrophic bacteria obtain energy from the oxidation of inorganic substrates. The best known are those which oxidize hydrogen, ammonia, nitrite, ferrous iron, and sulphur and its reduced compounds. Other oxidations probably yielding metabolic energy to some bacteria include U(IV) to U(VI), Cu(I) to Cu(II) and those of some selenium and antimony compounds.