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The recruitment of neutrophils to the infected airway occurs early following respiratory syncytial virus (RSV) infection, and high numbers of activated neutrophils in the airway and blood are associated with the development of severe disease. The aim of this study was to investigate whether trans-epithelial migration is sufficient and necessary for neutrophil activation during RSV infection. Here, we used flow cytometry and novel live-cell fluorescent microscopy to track neutrophil movement during trans-epithelial migration and measure the expression of key activation markers in a human model of RSV infection. We found that when migration occurred, neutrophil expression of CD11b, CD62L, CD64, NE, and MPO increased. However, the same increase did not occur on basolateral neutrophils when neutrophils were prevented from migrating, suggesting that activated neutrophils reverse migrate from the airway to the bloodstream side, as has been suggested by clinical observations. We then combined our findings with the temporal and spatial profiling and suggest 3 initial phases of neutrophil recruitment and behavior in the airways during RSV infection; (1) initial chemotaxis; (2) neutrophil activation and reverse migration; and (3) amplified chemotaxis and clustering, all of which occur within 20 min. This work and the novel outputs could be used to develop therapeutics and provide new insight into how neutrophil activation and a dysregulated neutrophil response to RSV mediates disease severity.

Neomycin sulphate is official in IP 2018, USP 2004 and BP 2003; which includes Microbial assay (Cylinder Plate assay) for the estimation therefore chemical derivatization of Neomycin Sulphate is done using 1-Fluoro-2, 4-Dinitrobenzene (DNFB); also known as Sanger’s reagent, to make it detectable by UV with good accuracy and precision. A fixed dose combination of Neomycin Sulphate, Clobetasol Propionate and Chlorocresol (preservative) in cream formulation is used to treat different types of Skin infections. The literature review reveals that methods like UV, HPLC, HPTLC, GC-MS etc. have been reported for Neomycin Sulphate and Clobetasol Propionate individually and along with other drugs. But no reported method found in combination for Neomycin sulphate and Clobetasol propionate. A simple, accurate, precise and economical UV spectrophotometric i.e. Area Under Curve Method (AUC) was developed. All the dilutions of drugs were prepared in Methanol: Acetonitrile (50:50). Area under curve was integrated in the wavelength range of 235.0- 245.0 nm, 252.0-262.0 nm and 223.0-233.0 nm for CSP, NMS and CCS respectively. The AUC method for Clobetasol Propionate (CSP), Neomycin Sulphate (NMS) and Chlorocresol (CCS) was found to be linear over the range of 0.8-1.2 μg/ml, 8.0-12.0 μg/ml and 1.6-2.4 μg/ml respectively. The result of analysis was analysed and validated statistically and recovery study was found within range of 98-102%. The % RSD was not more than 2.0 % which indicates good precision. All the validation parameters were carried out according to ICH Q2 (R1) guidelines.

Isoniazid and Rifapentine are used in combination (ratio 1:1) as tablet dosage form for the treatment of Macrobacterium tuberculosis. Objective of present work was to develop simple, precise, accurate and rapid chromatographic method for simultaneous estimation of both drugs using RP-HPLC. Developed method was validated as per ICH Q2(R1) guideline for quantitative determination of Isoniazid and Rifapentine in Synthetic mixture. RP-HPLC was developed using the mobile phase [Acetonitrile: Phosphate buffer pH 4 (85:15) pH-6 adjusted with 1% TEA], Flow rate 1 ml/min and detected at 262 nm. The separation was carried out on shim-pack solar C18 (250mm × 4.6 mm, 5µm). The linearity for ISO and RFP were between 5-25µg/ml with co-relation co-efficient 0.9979 and 0.9975 respectively. Limit of detection for ISO and RFP were found to be 0.20110 and 0.18813 μg/ml and limit of quantification for ISO and RFP were found to be 0.60941 μg/ml and 0.57012 μg/ml respectively. Recovery of both drugs were found in range of 98-102%. Further % R.S.D. was found to be less than 2% for Repeatability, Intraday and Interday Precision study. The % assay was found to be 99.60 % and 99.50 % for ISO and RFP respectively. The developed RP-HPLC method was found to be accurate, precise and robust and can be applicable to marketed formulation.

RETINA ON CORNEA IN CASE OF MECHANICAL OCULAR INJURY: A CASE REPORT case report, RETINA ON CORNEA IN CASE OF MECHANICAL OCULAR INJURY: A CASE REPORT

Purpose Discharge prescriptions represent an important aspect of care for patients seen in the emergency department (ED) setting and are used by providers to continue therapy for acute illness once patients leave the ED or to prevent future exacerbations of chronic conditions. The success of an ED discharge and the medications prescribed rely on patient compliance. Compliance depends on patients’ ability to obtain prescriptions, which can be hindered by limited access to pharmacies and cost. Summary In order to address issues traditionally associated with medication noncompliance, a discharge pharmacy was implemented within a busy urban ED. The pharmacy began processing prescriptions on December 18, 2019, using a formulary aimed towards providing commonly prescribed and high-risk medications. The pharmacy accepts insurance plans in addition to utilizing 340B Drug Pricing Program pricing to offer affordable medications to patients. During the first year of operation 10,230 prescriptions were filled for 5,703 patients, representing 13% of all patients discharged during that time. Of the prescriptions filled, 35.4% were for products considered high-risk medications, including epinephrine auto-injectors, insulin, and antibiotics. Over 50% of these high-risk medications were provided to patients through reduced cash pricing. Pharmacist interventions were made on 4.3% of prescriptions to address incorrect dosing, avoid use of inappropriate antibiotics, and recommend alternative therapies. Conclusion The implementation of a discharge pharmacy within the ED allowed over 5,700 patients to be discharged with medications and represents a potential solution to issues surrounding medication noncompliance. Similar initiatives have the opportunity to improve medication access for a larger ED population.

Purpose Opioid overdose education and naloxone distribution (OEND) for use by laypersons has been shown to be safe and effective, but implementation in the emergency department (ED) setting is challenging. Recent literature has shown a discouragingly low rate of obtainment of naloxone that is prescribed in the ED setting. We conducted a study to evaluate the feasibility of point-of-care (POC) distribution of naloxone in an ED, hypothesizing a rate of obtainment higher than prescription fill rates reported in previous studies. Summary A multidisciplinary team of experts, including pharmacists, physicians, nurses, and case management professionals used an iterative process to develop a protocol for POC OEND in the ED. The protocol includes 5 steps: (1) patient screening, (2) order placement in the electronic health record (EHR), (3) a patient training video, (4) dispensing of naloxone kit, and (5) written discharge instructions. The naloxone kits were assembled, labeled to meet requirements for a prescription, and stored in an automated dispensing cabinet. Two pharmacists, 30 attending physicians, 65 resident physicians, and 108 nurses were trained. In 8 months, 134 orders for take-home naloxone were entered and 117 naloxone kits were dispensed, resulting in an obtainment rate of 87.3%. The indication for take-home naloxone kit was heroin use for 61 patients (92.4%). Conclusion POC naloxone distribution is feasible and yielded a rate of obtainment significantly higher than previous studies in which naloxone was prescribed. POC distribution can be replicated at other hospitals with low rates of obtainment.

Introduction Litigation in healthcare is a large financial burden to the NHS and can be a cause of great stress to clinicians. The overall number of claims across specialities, from the years 1995–2017 have increased. Despite being one of the smaller surgical specialities, litigation costs are still significant within Otolaryngology. In this piece we sought to analyse the available data to identify trends within litigation and therefore which areas of practise could be improved. Methods A freedom of information request was submitted to NHS Resolution for summarised data on claims coded under ‘Otolaryngology’ or ‘ENT’ between 1996 and 2017. Information was collected on the total number of claims, the number of successful claims and details on the reasons for making claims. Results The total number of claims made against Otolaryngology departments from 1996/97 to 2016/17 was 1952. The overall number of claims have increased during this time period. The total amount of money paid out between 1996 and 2017 was £108, 240, 323. The top causes of claim by injury were unnecessary pain and unnecessary operations. The highest number of claims by cause were for failure or delay in diagnosis and intraoperative problems. Conclusion These results highlight areas that local units can focus on to reduce their litigation burden. Targeted initiatives aimed at improving patient-clinician communication, the consent process and improving local organisational efficiency will address a significant proportion of claims. Re-examination of this data on a regular basis can serve as a useful adjunct in assessing the impact of quality improvement initiatives and implementation of best practiseswithin the speciality.

A simple, rapid, precise, and accurate high-performance liquid chromatography method was developed for simultaneous estimation of Clobetasol propionate and Fusidic acid in cream. The separation was obtained using a mobile phase consisting of Acetonitrile and Water in the ratio of 90:10 and adjusting pH 5.0 with Glacial acetic acid (10%) using Shim-pack solar C18 (250 × 4.6 mm, 5 µm) column. The flow rate of 1.0 mL/min and UV detection at 240 nm was employed. The retention time for Clobetasol propionate and Fusidic acid was 4.787 min and 6.006 min respectively. Linearity for Clobetasol propionate and Fusidic acid was found to be in the range of 3-7 µg/mL and 120-280 µg/mL, respectively. The method was validated as per the ICH guidelines and the results were within the acceptance criteria for precision, linearity, specificity, and robustness.

AimsAcute Inpatient Psychiatric Wards present the challenge of a high turnover of patients who have multiple physical health comorbidities that both contribute to patients’ overall morbidity and may exacerbate any mental illness. Furthermore, there are a number of physical health parameters which must be checked and monitored in the initiation of psychiatric treatments. It is therefore important that patients receive physical examination, blood tests and Electrocardiograms (ECGs). The busy environment of inpatient units and the acute presentation of patients, who often decline interventions, lack capacity or cannot communicate their physical health problems, mean these assessments are often missed when offered in an ad hoc fashion. This Quality Improvement Project looked at implementing a Physical Health Clinic to look at whether this structured environment would provide better coverage of these physical health assessments.MethodsThe number of physical examinations, blood tests and ECGs both offered but declined and successfully obtained was measured on an Inpatient Ward with 20 patients and 2 junior doctors over 2 weeks with assessments being offered in an ad hoc fashion. Following this, a structured clinic run by a doctor and nurse with three 20 minute appointments three times a week was implemented and the same data collected over 2 weeks. A paired T-test was used to evaluate the results.ResultsThere was a statistically significant increase in the number of successfully obtained physical examinations, bloods tests and ECGs when the Physical Health Clinic was implemented (Mean difference = 7.33, Two tailed P value = 0.0480,95% confidence interval 0.16–14.50, t = 4.4, df = 2, standard error of difference = 1.667). However, there was no difference between the number of bloods, examinations and ECGs offered but declined (Mean difference = 4.83, Two tailed P value = 0.2495, 95% confidence interval −3.92–8.58, t = 1.6059, df = 2, standard error of difference = 1.453).ConclusionThe clinic led to a statistically significant increase in the number of examinations, blood tests and ECGs successfully obtained. The reasons for this are hypothesized that having a structured clinic prepares the patient to have a physical assessment and ensures their availability, provides motivation for staff and increases the efficiency of assessments with appropriate teamwork between doctors and nurses. Issues with the Clinic are limited availability of junior doctor and nursing staff and emergencies disrupting the functioning of the clinic. Implementing the clinic on a wider scale is required to assess its effectiveness.

The COVID-19 pandemic had forced schools and school-based partnerships in the US to re-imagine extracurricular activities while schools were closed for in-person learning. We highlight lessons learned from implementing the Supplemental Nutrition Assistance Education Program (SNAP-Ed) virtually, a nutrition education program to improve nutrition literacy and skills among children, in a Maryland School of Nursing/K-8 Partnership school amid in-person school closures.

The recruitment of neutrophils to the infected airway occurs early following respiratory syncytial virus (RSV) infection and high numbers of activated neutrophils in airway and blood is associated with the development of severe disease. Here, we investigated whether trans-epithelial migration across primary human airway epithelial cells (AECs) is sufficient and necessary for neutrophil activation during RSV infection. Using flow cytometry, we identified three populations of neutrophils in our in vitro model; those in suspension in basolateral and apical compartments and those that migrated and adhered to AECs. After 1h incubation, the number of adherent neutrophils was significantly greater following RSV infection compared to mock infected. We found that, when migration occurred, neutrophil expression of CD11b, CD62L, CD64, NE and MPO increased in all compartments. However, this did not occur when neutrophils were prevented from migrating. This suggests that the heightened neutrophil activation we detected in the basolateral compartment may be due to reverse migrating neutrophils, as has been suggested by clinical observations. Using live-cell fluorescent microscopy, we then profiled the early temporal and spatial movement and adherence of human neutrophils during migration. Our findings suggest three main phases of early neutrophil recruitment and behaviour in the airways during RSV infection, with neutrophil recruitment, activation and adherence to RSV infected AECs, with clustering, occurring within the first 20 minutes. This work and the model we developed could provide new insight into how neutrophil activation and a dysregulated neutrophil response to RSV mediates disease severity.Graphical AbstractBuilding on previous work of neutrophil function we propose 3 main phases of early neutrophil recruitment and behaviour in the airways during RSV infection. Phase 1. Initial chemotaxis and adherence: Here unstimulated circulating neutrophils expressing baseline levels of CD11b migrate across infected AECs in response to chemotactic signals in the apical supernatant. Some neutrophils remain adherent to the infected AECs. Phase 2: Activation and reverse migration: once on the apical side of the epithelium, neutrophils increase expression of CD11b and other activation associated markers, and some ‘activated’ neutrophils undergo reverse migration. Neutrophils with greater expression of CD11b are detected on the basolateral side Phase 3: Amplified chemotaxis and clustering: after 20 minutes, adherent neutrophils begin to rapidly cluster on RSV infected primary airway epithelial cells cultures, mediated by signalling from a dying neutrophil. Drawing created using BioRender.com.

Pesticides have played a serious role in achieving the utmost crop production but maximum usage and accumulation of pesticide residues is very detrimental to aquatic and other ecosystem. Pesticide residues in water have become a major challenge over the last few decades and has been monitored in public water supply resources in national capital territory. Results shows that continuous consumption of contaminated water can pose severe health threats to local parts of this area. Central Pollution Control Board (CPCB), Delhi, shows that ? and ? isomers of endosulphan residues within the Yamuna river. High concentration levels of ?-HCH (0.259 ?g/l) and malathion (2.618 ?g/l) were detected within the surface water samples collected from the river Ganga in Kanpur, Uttar Pradesh (UP). High concentration levels of methyl parathion, endosulfan, and DDT were observed in water samples collected from the river at Bhagalpur, Bihar. The Industrial Toxicology Research Centre (ITRC), Lucknow (UP) study shows the result 0.5671 ppb concentrations of endosulfan in the river at Allahabad, UP. Same results were found in other water samples in India.

Mineral oils which consists mineral oil saturated hydrocarbons (MOSH) and mineral oil aromatic hydrocarbons (MOAH), which are largely applied in various consumer products like medicines cosmetics etc. MOAH which is potential public health hazard because it include carcinogenic polycyclic compounds. There is a rapid method for quantifying MOAH by proton nuclear magnetic resonance spectroscopy (1H qNMR) in anhydrous cosmetics. The 1H qNMR method is a good complement to the LC-GC-FID method. Another method is a simple and fast developed that uses columns packed with silver-modified silica in supercritical fluid chromatography with flame ionization and UV detection (SFC-FID/UV) for the determination of mineral oil saturated hydrocarbons (MOSH) and also mineral oil aromatic hydrocarbons (MOAH) in purified mineral oil samples. Another method which is based on gas chromatography with vacuum ultraviolet detection (GC-VUV) and relies on the spectral differences between the aliphatic and aromatic compounds in the sample. The detector provides a good selectivity for aromatics, direct quantification of the MOAH content is possible without the need for a laborious pre-separation of the mineral oil. GC-VUV method good sensitive for the analysis of all but gives highest purity mineral oils.

Item does not contain fulltext BACKGROUND: The behavior of desmoid tumors is unpredictable and varies from spontaneous remission to symptomatic and radiologic progression. This study aimed to evaluate the radiologic and symptomatic course of the disease in patients initially managed with active surveillance. METHODS: Patients with a primary desmoid tumor at any anatomic location diagnosed between 1998 and 2016 were identified in a prospectively maintained database from a single sarcoma reference center in the United Kingdom. Inverse univariate Cox proportional hazard regression analyses were conducted to evaluate the course of the disease and indications for initiating treatment. RESULTS: The study identified 168 patients with a primary desmoid tumor initially managed with active surveillance. The tumors were located in the abdominal wall (n = 61, 36%), an extremity (n = 51, 30%), chest wall (n = 30, 18%), intra-abdominal site (n = 15, 9%), or elsewhere (n = 11, 6%). Of all the patients, 36% experienced radiologic progressive disease, 36% had stable disease, and 27% regressed. The patients younger than 50 years were more likely to progress (p = 0.046), whereas the patients with chest wall or upper-extremity tumors reported significantly more pain (p = 0.01). Eventually, 46% of the patients proceeded to treatment. The median time to start of treatment after initial surveillance was 31 months, whereas the median follow-up time for the patients not receiving any treatment was 40.5 months. The indications for initiation of treatment were pain (32%), progression (31%), or both (13%). CONCLUSIONS: Patients with desmoid tumors can be managed with initial active surveillance, although almost half of patients may eventually need treatment. Pain, tumor progression, or both are the most common indications for the initiation of treatment.

AimTo assess the effects of a social prescribing service development on healthcare use and the subsequent economic and environmental costs.BackgroundSocial prescribing services for mental healthcare create links with support in the community for people using primary care. Social prescribing services may reduce future healthcare use, and therefore reduce the financial and environmental costs of healthcare, by providing structured psychosocial support. The National Health Service (NHS) is required to reduce its carbon footprint by 80% by 2050 according to the Climate Change Act (2008). This study is the first of its kind to analyse both the financial and environmental impacts associated with healthcare use following social prescribing. The value of this observational study lies in its novel methodology of analysing the carbon footprint of a service at the primary-care level.MethodAn observational study was carried out to assess the impact of the service on the financial and environmental impacts of healthcare use. GP appointments, psychotropic medications and secondary-care referrals were measured.FindingsResults demonstrate no statistical difference in the financial and carbon costs of healthcare use between groups. Social prescribing showed a trend towards reduced healthcare use, mainly due to a reduction in secondary-care referrals compared with controls. The associations found did not achieve significance due to the small sample size leading to a large degree of uncertainty regarding differences. This study demonstrates that these services are potentially able to pay for themselves through reducing future healthcare costs and are effective, low-carbon interventions, when compared with cognitive behavioral therapy or antidepressants. This is an important finding in light of Government targets for the NHS to reduce its carbon footprint by 80% by 2050. Larger studies are required to investigate the potentials of social prescribing services further.

BackgroundNHS mental health services are under pressure due to chronic underfunding and constrained resources. The Health & Social Care Act implemented an extensive restructure of the NHS and introduced three new legal duties: duty to arrange, promote competition, and integrate services.AimTo establish how the Health and Social Care Act 2012 affected commissioning of mental health services in England and how the duties are being fulfilled.MethodFreedom of Information (FOI) requests were sent to all 211 clinical commissioning groups in England. The number, value, and length of all contracts for mental health services were requested from 2013 to 2016 by type and name of provider; as well as a range of quality and performance data.ResultsThe FOI received a 93% response rate. CCGs commissioned between 1–127 contracts each: 65.3% of all contracts were awarded to the third sector (private for profit, not for profit, and voluntary organisations), amounting to 6% of the total value of contracts commissioned. NHS foundation trusts were awarded 25% of contracts, worth 70% of the total value of contracts. 71% of contracts had no evidence of quality monitoring.ConclusionThe high volume and low value of contracts commissioned to third sector organisations fulfils the new duty to arrange but not to integrate; showing considerable fragmentation of mental health provision. The emerging external market is a result of the Health & Social Care Act promoting diversification of the provider market. Finally, the lack of quality and performance data raises concerns over the transparency and accountability of an NHS that is increasingly being provided by companies.

In today’s society, mass media surround us, inform us, and sometimes confound us. Even if we tried, most of us could not escape the reach of the video screens (in restaurants, bars, grocery checkouts, sports venues, even gas pumps), audio messages (from radios, soundtracks, Muzak in elevators, and accompanying those myriad video screens), and billboards and other outdoor advertising that bombard us every time we step outside our homes. And most of us willingly invite the mass media into our homes, via television, radios, newspapers, and Internet content. We further seek it out via our smartphones, tablets, and laptops, which creates two-way or ‘social media’ options via Facebook, blogs, and email blasts. We are almost never beyond the reach of the mass media. (There are even radios you can take in the shower with you!)The effects of such constant bombardment by the mass media are farreaching, including our increased consumerism in response to the barrage of advertisements to which we are exposed, our reduced personal connection as two people eating dinner together are increasingly each glued to his or her own smartphone, and our lack of privacy as social networking sites increasingly provide our location and information about our activities to friends, advertisers, and even strangers. But perhaps one of the most problematic aspects of our constant media exposure is that the media become an ever more powerful shaper of our views of the world. What is important? What is real? What is the world really like?

Quality of documentation is harder to quantify and incentivise, but it has a significant impact on patient care. Good discharge summaries facilitate continuity between secondary and primary care. The junior doctors9 forum led this project to improve the quality of electronic discharge summaries (eDS). Baseline measurement revealed significant room for improvement. We measured the quality of 10 summaries per month (across all inpatient specialties), against 23 indicators from the revised Academy of Medical Royal Colleges (AoMRC) standards (2013) that were prioritised by GPs as a “minimum dataset”. Junior doctors felt that the Trust’s dual eDS systems were responsible for great variation in quality. This was confirmed by the results of a comparison audit of the systems in April 2014: one system greatly outperformed the other (57% mean compliance with iSoft clinical management (iCM) based system vs. 77% with InfoPath-based system). We recommended that the Trust move to a single eDS system, decommissioning the iCM-based system, and this proposal was approved by several Trust committees. We worked with information services, junior doctors, general practitioners and hospital physicians to develop and implement a generic template to further improve compliance with AoMRC standards. In August 2014, the iCM-based system was withdrawn, the new template went live, and training was delivered, coinciding with the changeover of junior doctors to minimise disruption. Median compliance increased from 66.7% to 77.8%. Quality of discharge summaries had improved across the specialties. There was a reduction in the number of complaints and positive qualitative feedback from general practitioners and junior doctors. Completion of discharge summaries within 24 hours was not affected by this change. There is still more to be done to improve quality; average compliance with the full AoMRC standards (39 indicators) is 59.5%. With the approval of the Trust executive committee further plan, do, study, act (PDSA) cycles are underway, working to improve the remaining specialty-specific templates.

The working paper reflects on the critical opportunities and limits of collecting people’s voices in Africa, with a particular emphasis on Ethiopia, a country where formal public opinion research is largely novel, despite government efforts to emphasize the need to develop a participatory approach to development.