Search

Abstract: There has been an emphasis in the development and research literature on the participation of beneficiaries in the planning, implementation, and evaluation of projects. Initially, approaches were described as facilitating participation. However, in more recent years the term participatory has been used. As this trend has occurred there has been an increasing advocacy of the participatory approach as a prerequisite for projects. The analysis starts with an identification of the differences between participation and participatory approaches to planning and evaluation. The importance of recognizing when participation may be appropriate as opposed to more participatory approaches is outlined. Conditions for the success of participatory approaches are noted and a set of criteria are recommended. The analysis is illustrated with examples from diverse geographic and subject-matter backgrounds.

The oscillator strength sums S (2), S (1), and S (−1) calculated using analytical Hartree–Fock wavefunctions and the sums S (−2) and S (−3) from an approximate uncoupled Hartree–Fock calculation are given for the atoms He to Kr. Trends are discussed as well as the accuracy of the Hartree–Fock calculations. An extensive compilation of accurate sums is used to assess the relative usefulness and accuracy of recently proposed bounds and approximations to the spherically averaged dispersion coefficient C6. Values of C6 for the first three rows are presented.

Geometrical aspects relevant to discussion of deformable epithelial cell sheets are presented. The epithelium is pictured as consisting of cells joined at their lateral surfaces and having cell heights which vary with position over the middle surface, which bisects the cell heights. The Gauss and Mean curvatures are shown to be represented by simple functions of variablesSandh, whereSis an angular deformation of the sheet at each point andhis the local cell height. It is argued that the Gauss curvature can often be considered as a simple quadratic function ofSdivided byh2, while the Mean curvatureHis defined asS/h. These two variables are in turn to be considered as monotonic functions of the morphogen(s). A closed set of coupled morphogen and geometry equations are suggested, which, however, represent an open dynamical system in the sense that there is continuous external energy input. A growing, three dimensional entity of continuously changing shape and pattern is thus represented by this growth and form algorithm.

Some features of a recently proposed model of superfluid bosons are examined. The equation of motion of the condensate wave function is derived and an expression for the chemical potential is obtained. It is shown that the excitation spectrum exhibits a gap in the long-wavelength limit which is identical to that obtained by Girardeau and Arnowitt. The pair correlation function is likewise shown to be very similar. Si esaminano alcune caratteristiche di un modello di bosoni superfluidi, proposto di recente. Si deduce l’equazione di moto della funzione d’onda condensata e si ottiene un’espressione del potenziale chimico. Si dimostra che lo spettro d’eccitazione presenta una lacuna nel limite delle grandi lunghezze d’onda, identica a quella ottenuta da Girardeau e Arnowitt. Analogamente si dimostra che la funzione di correlazione delle coppie è molto simile. Исследуются некоторые особенности недавно предложенной модели сверхтекучих боэонов. Выводится уравнение движения для волновой функции конденсата, и получается выражение для химического потенциала. Покаэывается, что спектр воэбуждения имеет шель в пределе длинных волн, которая идентична шели, полученной Джирардеу и Арповиттом. Также покаэывается, что функция парных корреляций является очень похожей.

A simple closed expression for the complete time behavior of a two-level «atom» interacting with a classical stochastic electromagnetic field is given. The answer for the energy of the atom as a function of time is in terms of a contour integral involving the power spectrum of the perturbing radiation. The cases of Lorentzian, Gaussian and «square» spectral-line profiles are compared; no significant difference in the time behavior is found in these three cases. Si presenta una semplice espressione chiusa per il comportamento temporale completo di un «atomo» a due livelliche interagisce con un campo elettromagnetico stocastico classico. La risposta per l'energia dell'atomo in funzione del tempo è espressa in termini di un integrale di contorno che coinvolge lo spettro di potenza della radiazione perturbante. Si fa un confronto fra i casi di profili lorentziani, gaussiani e «quadrati»; non si trova alcuna differenza significativa nel comportamento temporale nei tre casi. Приводится простое замкнутое выражение для временного поведения двухуровневого «атома», взаимодействующего с классическими стохастическим электромагнитным полем. Выражение для энергии атома, как функции времени, записывается в виде контурного интеграла, включающего степенной спектр возмущающего излучения. Рассматриваются и сравниваются случаи лоренцева, гауссова и «прямоугольного» профилей спектральных линий. В этих трех случаях не обнаружено существенных различий во временном поведении.

There have been repeated claims in the literature that hearing thresholds can be estimated by means of acoustic reflex threshold (ART) measurements. We have evaluated this thesis in depth by examining the statistical relationships between conventional puretone thresholds and ARTs for tonal and broadband stimuli in a large sample (1 207) of adult patients with sensorineural hearing loss; they were compensation claimants for noise-induced loss. All relevant data were stored in a computer database, and analysed using the Statistical Package for the Social Sciences (SPSS). The relationships were examined from two distinct standpoints; dependency of ARTs upon puretone thresholds, and prediction of audiogram features using ARTs. The average tonal ART is constant up to 70 dB average loss, and thereafter increases rapidly. The broadband noise ART increases steadily for average losses of 10 to 85 dB. The convergence principle is therefore valid up to 70 dB in this population. The predictor suggested by Niemeyer & Sesterhenn does not fit the data. The single ART which best predicts average loss is that for white noise, but a multiple regression predicition using the white noise and 500 Hz ARTs is preferable. Predictive accuracy is dependent upon audiogram slope, but the latter cannot be predicted usefully from the ART measures used. None of the predictors studied is adequate for medico-legal assessment and the method is probably not sufficiently accurate for clinical use in adults.

Clinical, pharmacologic, and immunologic effects of 2'-deoxycoformycin (dCF) were evaluated in 15 patients with advanced malignancies. Toxicity was less severe with a low dose (4 mg/m2) of dCF, but this dose still resulted in suppression of cellular adenosine deaminase activity, skin test reactivity, and lymphocyte responses to mitogens. Improvement in cutaneous T cell lymphoma plaques was seen after dCF. Further investigations of antitumor efficacy with the use of this low dosage schedule should continue in patients with hematologie neoplasms, and additional preliminary studies of the combination of an adenosine deaminase inhibitor with an adenosine analog should also be considered.

A method is proposed for an experimental determination of the equilibrium condensate fraction in He4II which relies only on measurement of the liquid structure factor as a function of temperature.

Abstract: The articles in this volume present a unique perspective on participatory evaluation of development programs and projects. The authors are all evaluators and researchers who reside in the South or have extensive Third World experience. They present a broad range of insight into the forms of participation that are feasible and desirable in the evaluation of development activities.

IntroductionMacrophages play a major role as effector cells of the innate immune system and are vital for intestinal tissue homeostasis. An altered function of intestinal macrophages may contribute to the development and propagation of intestinal inflammation in IBD. However, all data available come from mouse models, human whole tissue or in vitroderived macrophages from blood monocytes. We have isolated intestinal macrophages from patients and healthy subjects and analysed their transcriptome in order to study the intrinsic role that macrophages play in the pathogenesis of IBD.MethodFresh colonic mucosal tissue biopsies from 10 CD patients, 10 UC patients and 10 healthy controls were disaggregated to cell suspensions and sorted using fluorescence-activated cell sorting. RNA from intestinal macrophages, identified as CD163+CD14+CD3- population, was extracted and subjected to RNA sequencing. Differential Gene Expression analysis and pathway analysis were performed between the groups.ResultsThe transcriptomic analysis revealed that the gene expression profile of the intestinal macrophages from IBD is dramatically reprogrammed. Differential Gene Expression analysis revealed 1287 DEGs between macrophages from UC patients and healthy controls; 840 DEGs between macrophages from CD patients and healthy controls and 20 DEGs between macrophages from UC and CD patients (1.5 fold change and FDR<0.1).ConclusionThis is the first study to describe the transcriptome of intestinal macrophages from active lesions of patients with IBD by high throughput RNAseq. We show that the transcriptome of these macrophages is profoundly different from those taken from healthy subjects. These results suggest that macrophages play an important role in the propagation of inflammation and we have identified a number of molecules that should be investigated as potential therapeutic targets.Disclosure of InterestNone Declared[Figure]

IntroductionIron deficiency anaemia (IDA) is a common complication of Crohn’s disease (CD) and Ulcerative Colitis (UC), with estimated prevalence between 36%–76%. Both IDA and its treatment can be associated with significant disease morbidity, particularly fatigue. This 12 month pilot investigation, preceding a wider UK audit, aims to utilise the IBD Registry Web Tool to capture the prevalence of IDA in an outpatient setting and the consistency and quality of treatment patients receive, which are currently uncertain.MethodIn a Joint Working project between the IBD Registry and Pharmacosmos, patients were recruited at 5 hospitals: UCLH, Southampton, UHSM, James Cook, and Luton and Dunstable. At each site, 20 consecutive patients were recruited until 10 patients with CD and 10 with UC were enrolled, giving a total of 100 patients for the study. Patients gave permission for their data including demographics, disease activity scores, IBD Control Questionnaire, and blood parameters relating to IDA to be used by the Anaemia Service Evaluation and IBD Registry.ResultsWe report baseline data for patients at enrolment. Average age was 44 years 11mos (19–90 years). Mean HBI score was 3.7 based on 57 recorded scores and UCDAI was 2.4 from 13 patients. Using the Physician’s Global Assessment, 3.7% had severe, 13.4% moderate, 26.8% mildly active and 56.1% quiescent disease. 18 patients were anaemic; 9 men and 9 women, with mean Hb114.4±13.7 g/L and 110.9±4.2 g/L respectively. 9 additional patients were iron deficient without anaemia. In anaemic patients, mean ferritin and CRP were 100.3 µg/L and 12.1 mg/L respectively. Ferritin and CRP were 69.9 µg/L and 7.7 mg/L in non-anaemic patients. Mean patient-reported IBD control-8 scores (range 0–16) were 11.47 (anaemic) and 11.45 (non-anaemic). 52 patients reported fatigue while 26 missed activities due to their disease.ConclusionIn this pilot study, once patients were consented and entered on the IBD Registry Web Tool, adding blood results and disease scores was straightforward. This could easily be done in an outpatient clinic setting once the clinician is familiar with the process. This initial data set confirms the feasibility of effectively monitoring anaemia with the IBD Registry to enhance detection of under-recognised symptoms such as fatigue and help improve patient care. Our initial experience suggests that the IBD Registry serves as a reliable and meaningful way of capturing quality improvement data regarding IDA and its treatment in IBD.Disclosure of InterestNone Declared

IntroductionHypothesis:Over the last decade, therapy advances and a national audit programme should have improved outcomes for UC patients admitted as emergencies (Em).MethodTo support IBD Registry analytics, we have developed metrics from routine NHS data to allow reporting of trends in national-level indicators of IBD care.Design:Retrospective analysis of 10 years of HES data for England. Target population:54,533 Em. admissions with UC as primary diagnosis (April ‘05 to March ‘13; n=37 170 patients). Binary Outcome Measures: Surgery (colectomy) during index admission (Sx-Index) or within 1 year (Sx-1-Year); Em. readmission within 30 days of discharge (Readmit-30d); Inpatient death during index admission (Death-Index). Case-mix Variables: Age, Gender, Co-morbidities (0, 1 or 2+, Charlson), Deprivation Status (IMD Quintiles), Any Cancer, Em. bed bays (all-cause) in preceding year (EmBedDaysLastYr). Predictor Variable:Year of Admission (Yr-Adm). Analyses:Uni- and multivariable logistic regression (stepwise), reporting adjusted odds ratios (OR) for retained variables. Adjusted for repeat admissions in same patient (clustered standard errors).ResultsMultivariable Models: OR for Sx-Indexwas reducedwith increased age (0.98 per yr), 2+ co-morbidities (0.81 vs. none), females (0.74 vs. male) and for >28 EmBedDaysLastYr. OR for Death-Indexwas increasedwith increased age (1.10 per yr), co-morbidities (1.87 for one, 3.2 for two or more, vs none) and colectomy during admission (6.99 vs. no surgery) but reducedfor >28 EmBedDaysLastYr (0.88 vs. none). Models for Sx-1-Yearshowed a similar pattern with respect to reduced OR for age, co-morbidity and females. For Readmit-30d, the most significant factor associated with reducedOR was colectomy during admission (0.43), whereas >28 EmBedDaysLastYr was associated with increasedOR (2.0 vs. none). Deprivation status was not independently associated with any outcome. After adjusting for these co-variates, Yr-Adm was associated with a significant reduction in OR for both Sx-Index and Death-Index, with OR of 0.98(0.976–0.998) and 0.91(0.88, 0.94) per yr relative to base year. Models for all-cause admissions did not show these trends, suggesting condition-specific findings.ConclusionRisk of colectomy and inpatient death for UC patients admitted as emergencies to English hospitals has reduced over the last 10 years. Many factors may explain these trends, but cycles of UK-wide IBD audit are likely contributors. We found no signal for social inequality, but a reduced odds of surgery for females requires further study.Funding: Crohn’s and Colitis UKDisclosure of InterestM. Shawihdi: None Declared, S Dodd: None Declared, R Grainger: None Declared, S Bloom: None Declared, F Cummings: None Declared, R Driscoll: None Declared, M Pearson: None Declared, P Williamson: None Declared, K Bodger Conflict with: AbbVie, Conflict with: Boston Scientific | Takeda

IntroductionThe UK IBD Registry (UK-IBD-R) is developing analyses of Hospital Episode Statistics (HES) with linkage to locally-recorded registry data to generate aggregated reports and indicators to support IBD services. We have created methods to categorise relevant hospital events and track outcomes in HES. For this project, we produced metrics of unplanned care and surgical events before and after initiation of biologics, generating a national scale analysis from HES alone and a proof-of-concept study with linkage to UK-IBD-R.MethodDatasets:HES for England (04/05 to 13/14); UK-IBD-R dataset (to June 2016). Patientcohorts: (1) HES cohortidentified using HES only. We flagged all admissions (incl. daycases) with a diagnosis of CD and procedure code X921 (biologic infusion; assumed to be infliximab), locating 1 st infusion for each case; (2) Registry cohortwas based on anonymized linkage (undertaken by NHS Digital), identifying cases with a registry-recorded diagnosis of CD, a medication entry for anti-TNF drug (infliximab, inflectra or adalimumab) and a valid start date. Hospital events in HES:All-cause episodes were extracted for 1 year before (Yr-Pre) and after (Yr-Post) start of treatment, categorising each inpatient and daycase event based on admission method, diagnoses (IBD-specific, IBD-related and Other) and procedures.[Figure]ResultsHES cohort:n=15 399 (Age: 35 [16]; 47% male); Registry cohort:n=217 (Age: 26 [13.5]; 56% male). Unplanned care activity for Yr-Pre versus Yr-Post are shown in Abstract PTH090 Figure 1, confirming substantial reductions in all-cause and CD-specific emergency care following initiation of biologics in routine UK practice (p<0.05). Of HES cohort, 10 877 (71%) continued infusion visits beyond induction phase (’Maintenance’), and 4522 (29%) did not (’Stopped’). Surgical resections at 1 year:Total, 944 (6.2%); Maintenance versus Stopped: 395 (3.6%) v. 549 (12%), p<0.05. Emergency admissions with ‘infections’ at 1 year: Total, 222 (1.4%); Maintenance versus Stopped: 146 (1.3%) v. 76 (1.7%), p=0.11.ConclusionThese national scale data provide new insights into activity, costs and outcomes associated with routine use of biologics for CD in England. Linkage between UK-IBD-R and HES provides a potentially powerful tool for monitoring of activity, process and outcome of IBD care. The use of existing datasets reduces the burden of local point-of-care data collection, allowing focus on collecting items to enhance accuracy and clinical depth of analyses. [Funding: Crohn’s and Colitis UK]Disclosure of InterestNone Declared

IntroductionNICE recommend faecal calprotectin (FC) testing to help differentiate between irritable bowel syndrome and other pathologies including inflammatory bowel disease (IBD) in adults for whom specialist assessment is being considered. We aimed to explore the impact of introducing GP FC testing on referrals to secondary care.MethodGPs within Southampton City and West Hampshire CCGs were invited to request FC in adults under 45 with symptoms that could initiate referral. Before requesting electronically, GPs answered questions on patient history and if they planned to refer the patient. GP/hospital data was collected electronically from April 2015-June 2016 and reviewed according to FC (<50: negative, 50–99: indeterminate, ≥100: positive) as a service evaluation.Results59/64 (92%) of GP surgeries used FC testing. 410/435 samples received were processed: 66 (16%) positive, 33 (8%) indeterminate, 311 (76%) negative. 85/410 (21%) patients were referred to secondary care (60% positive/indeterminate FC). Mean monthly gastroenterology (including non-IBD) referral rates were unchanged from 2014/15 to 2015/16 (187 vs. 186/mth). 16/410 were diagnosed with IBD (19% of FC referrals, all positive/indeterminate FC). Of 66 patients with positive FC, only 43 (65%) were referred, with no referral/appointment on record for the remaining 23.When asked ‘would you refer even if FC was negative?’ in 55/410 cases GPs responded ‘yes’, but only referred 22 (40%). Of 176/410 cases where the response was ‘no’, 13 (7%) were referred. When asked ‘would you refer if FC was not available?’ in 205/410 cases GPs responded ‘yes’ but only referred 52 (25%). Of 34/410 cases where the response was ‘no’, 4 (12%) were referred. GPs were twice as likely to report planning to refer patients who ultimately had a positive FC than those with a negative FC (24% vs. 11%), suggesting these patients may have symptoms of greater concern.56/85 (66%) of referred patients (14 with negative FC) underwent lower GI endoscopy (30/56 (53%) normal, 16/56 (29%) IBD, 4/56 (7%) microscopic colitis, 1/56 (2%) cancer, 5/56 (9%) other). Mean times from referral to outpatient clinic and endoscopy: 69 and 93 days. Despite being at higher risk of IBD, the mean time from referral to clinic for patients with positive FC was only slightly less than for negative FC (64 vs. 78 days).ConclusionFC testing was requested by most GP practices but in low numbers and a significant number of patients with positive FC were not referred. FC did appear to influence GP decision-making regarding referral. Local pathways will be developed to introduce a Positive FC clinic to streamline referrals and aim to improve time to IBD diagnosis.Disclosure of InterestNone Declared

Without Abstract: