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Background. Fecal microbiota transplantation (FMT) is an effective treatment of recurrent Clostridioides difficile infections (rCDI), but has more limited efficacy in treating either ulcerative colitis (UC) or Crohn’s disease (CD), two major forms of inflammatory bowel diseases (IBD). We hypothesize that FMT recipients with rCDI and/or IBD have baseline fecal bile acid (BA) compositions that differ significantly from that of their healthy donors and that FMT will normalize the BA compositions. Aim. To study the effect of single colonoscopic FMT on microbial composition and function in four recipient groups: 1.) rCDI patients without IBD (rCDI-IBD); 2.) rCDI with IBD (rCDI+IBD); 3.) UC patients without rCDI (UC-rCDI); 4.) CD patients without rCDI (CD-rCDI). Methods. We performed 16S rRNA gene sequence, shotgun DNA sequence and quantitative bile acid metabolomic analyses on stools collected from 55 pairs of subjects and donors enrolled in two prospective single arm FMT clinical trials (Clinical Trials.gov ID NCT03268213, 479696, UC no rCDI ≥ 2x IND 1564 and NCT03267238, IND 16795). Fitted linear mixed models were used to examine the effects of four recipient groups, FMT status (Donor, pre-FMT, 1-week post-FMT, 3-months post-FMT) and first order Group*FMT interactions on microbial diversity and composition, bile acid metabolites and bile acid metabolizing enzyme gene abundance. Results. The pre-FMT stools collected from rCDI ± IBD recipients had reduced α-diversity compared to the healthy donor stools and was restored post-FMT. The α-diversity in the pre-FMT stools collected from UC-rCDI or CD-rCDI recipients did not differ significantly from donor stools. FMT normalized some recipient/donor ratios of genus level taxa abundance in the four groups. Fecal secondary BA levels, including some of the secondary BA epimers that exhibit in vitro immunomodulatory activities, were lower in rCDI±IBD and CD–rCDI but not UC-rCDI recipients compared to donors. FMT restored secondary BA levels. Metagenomic baiE gene and some of the eight bile salt hydrolase (BSH) phylotype abundances were significantly correlated with fecal BA levels. Conclusion. Restoration of multiple secondary BA levels, including BA epimers implicated in immunoregulation, are associated with restoration of fecal baiE gene counts, suggesting that the 7-α-dehydroxylation step is rate-limiting.

Background: For the last 17 years, the UK has employed a routine influenza vaccination programme with the aim of reducing the spread of seasonal influenza. In mid-2000, the programme moved from a purely risk-based approach to a risk and age group targeted approach with all those aged 65+ years being included. To date, there has been no assessment of the population effectiveness of this age targeted policy in Scotland. Objectives: Statistical modelling techniques were used to determine what impact the routine vaccination of those aged 65+ years has had on influenza related morbidity and mortality in Scotland. Methods: Two Poisson regression models were developed using weekly counts of all-cause mortality, cause specific mortality and emergency hospitalisations for the period 1981 – 2012, one using week-in-year and the other using temperature to capture the seasonal variability in mortality/hospitalisations. These models were used to determine the number of excess deaths/hospitalisations associated with the introduction of the local risk and age-based vaccination programme in 2000. Results: Routinely vaccinating those aged 65+ years is associated with a reduction in excess allcause mortality, cardiovascular and COPD related mortality and COPD related hospitalisations. Our analysis suggests that using the week-in-year model, on average, 732 (95%CI 66 – 1,398) deaths from all-causes, 248 (95%CI 10 – 486) cardiovascular related deaths, 123 (95%CI 28 – 218) COPD related deaths, and 425 (95%CI 258 – 592) COPD related hospitalisations have been prevented each flu season among the those aged 65+. Similar results were found using the temperature model. There was no evidence to suggest that the change in policy was associated with reductions in influenza/pneumonia related mortality or influenza/cardiovascular related hospitalisations. Conclusions: Routinely vaccinating those aged 65+ years appears to have reduced influenza related morbidity and mortality in Scotland. With the childhood vaccination programme well underway, these data provide an importance benchmark which can be used to accurately assess the impact of this new seasonal influenza vaccination programme.

Seventeenth-century Thomists, with the exception of John of St Thomas, are today virtually unknown. Nevertheless, in their day they contributed to the Catholic reception of the thought of the Angelic Doctor not only by continuation of the commentarial tradition but also by engaging in the intramural Catholic debates in which the Holy See intervened. After introducing the reader to some of the more prominent Thomists of the century, this chapter outlines some Thomist responses to intramural Catholic debates concerning the formation of conscience in light of probable opinions, the nature of our desire for the beatific vision and its compatibility with love of God above self, and the role of the gifts of the Holy Spirit in the life of the believer.

Background The impact of poison information services on patient care in hospital, particularly decisions on whether to admit patients after initial attendance at an emergency department (ED), is unclear. In the United Kingdom, the vast majority of poisons information is provided by use of the online poisons information database, TOXBASE. We investigated the relationship between rates of hospital access to TOXBASE and rates of poisoning admissions from EDs in England and Wales to begin to address the interactions between use of poisons information and patient management as reflected by hospital activity. Methods Data were obtained on attendances and admissions due to poisoning for individual National Health Service (NHS) Trusts in both England and Wales, together with data on the overall number of accesses to TOXBASE for drugs (pharmaceuticals and drugs of abuse), from 2008 to 2015. Rates of TOXBASE access and admissions per poisoning attendance in London were clearly different to the rest of England and Wales; London was therefore analyzed separately. Negative binomial generalized additive models were fit, incorporating an interaction effect, for accesses, attendances and admissions to check for variability according to hospital size. Additional models were then fit to assess whether there was any variation in association of overall TOXBASE use with rates of admission for 6 key drug subgroups: antidepressants, paracetamol, antipsychotics, opioids (including all medicines, but excluding heroin), heroin and non‐opioid drugs of abuse. Results Rates of TOXBASE use per Trust increased across the study period by 39.3% (95% confidence interval [CI] = 34.1%, 44.8%) in England and 76.9% (24.7%, 151.0%) in Wales, showing an increase in TOXBASE use which was substantially greater than the increase in poisoning attendances. Admission rates exhibited seasonality, with lower rates in January and February, increasing by 2.0% (1.0%, 3.1%) in England and 5.8% (5.5%, 5.9%) in Wales toward the middle of the year. The initial model fit indicated that the average proportion of poisoning patients admitted increased with both increasing attendances and increasing TOXBASE use (England and Wales overall, P < 0.0001; England and Wales excluding London, P < 0.0001; London, P < 0.0001). In England and Wales overall, and in London alone, increased TOXBASE access to non‐opioid drugs of abuse advice was associated with a significant decrease in admissions (England and Wales, −0.15% [−0.29%, −0.01%] [P = 0.032]; London, −1.02% [−1.53%, −0.50%] [P < 0.0001]). In contrast, increased access to heroin advice was associated with a significant increase in admissions in London (+2.03% [+0.11%, +3.99%] [P = 0.034]). Increasing access to TOXBASE for paracetamol advice was associated with lower admissions in England and Wales (England and Wales, −0.11% [−0.23%, −0.01%] [P = 0.036]; England and Wales excluding London, −0.18% [−0.30%, −0.06%] [P = 0.001]) but higher admissions in London (+0.52% [+0.03%, +1.01%] [P = 0.035]). Conclusions We have shown that greater overall use of TOXBASE by hospitals is associated with a higher proportion of poisoning attendances being admitted. Interestingly, looking at particular drug groups, we found significant associations in both directions between overall TOXBASE use and rates of admission for some drug groups. The current methodology is unable to determine whether such decisions might be appropriate or not. Mixed‐methods research is now required to gain a better understanding of how provision of poisons information affects decisions within the ED.

Quality of life (QoL) was an important endpoint in the adjuvant breast cancer trials International Breast Cancer Study Group (IBCSG) Trial VI and VII. Here, QoL was considered as a time-dependent effect. The hypothesis explored is that poorer QoL throughout the trial is associated with poorer disease-free survival (DFS) and vice-versa. Potential bias in the parameter estimates is an important concern associated with missing observations. Standard simple and multiple imputation methods were applied to missing QoL assessments before analysis in a time-dependent Cox model. There was no evidence that the patient's QoL is related to the patient's DFS.

This essay responds to an article by Elizabeth Bothamley Rex titled “The Magisterial Liceity of Embryo Adoption” (NCBQ, Winter 2015), specifically to Rex’s critique that his objections to the liceity of embryo transfer distort magisterial documents. He then draws out the implications of the differences between his view and Rex’s on the relation between maternity and pregnancy. The essay concludes by pointing out that, if they are to change their minds, opponents of embryo adoption need to be convinced that it is morally licit to impregnate, or “introduce an order to birth,” in a woman by means other than the marriage act.

BackgroundGlobally, seasonal influenza is responsible for an estimated 3 to 5 million cases of severe illness and 250,000 to 500,000 deaths per year. It is uncertain to what extent national vaccination programmes can prevent this morbidity and mortality.ObjectiveTo determine the effectiveness of the seasonal trivalent inactivated influenza vaccine.DesignWe undertook a retrospective observational cohort study. A propensity score model was constructed and adjusted odds ratios (ORs) were calculated to assess differences in vaccine uptake according to a number of patient characteristics. Adjusted illness and mortality hazard ratios (HRs) were estimated from a Cox proportional hazards model adjusted for sex, age, socioeconomic status, smoking status, urban/rural location, clinical at-risk groups (i.e. patients with chronic respiratory, heart, kidney, liver or neurological disease, immunosuppression and diabetes), Charlson comorbidity index, previous pneumococcal and influenza vaccination, and number of previous primary care consultations, prescribed drugs and hospital admissions. We also included nursing home residence and social care support. Vaccine effectiveness (VE) was expressed as a percentage, and represents a reduction in risk provided by the vaccine for a given outcome (e.g. laboratory-confirmed influenza). This was calculated as 1 − HR, where HR is that of the measured clinical outcome in vaccinated compared with unvaccinated individuals. For estimates of VE derived from linked virological swab data, we carried out a nested case–control study design.SettingA national linkage of patient-level primary care, hospital, death certification and virological swab-linked data across nine influenza seasons (2000–9).ParticipantsA nationally representative sample of the Scottish population during 1,767,919 person-seasons of observation. Cases of influenza were confirmed using reverse transcription-polymerase chain reaction (RT-PCR) in a subset of the population (n = 3323).InterventionsTrivalent inactivated seasonal influenza vaccination (n = 274,071).Main outcome measuresVE, pooled across seasons and adjusting for confounders, was estimated by determining laboratory-confirmed influenza, influenza-related morbidity and mortality including primary care influenza-like illnesses, hospitalisation and death from influenza and pneumonia.ResultsMost vaccines (93.6%;n = 256,474 vaccines) were administered to at-risk patients targeted for vaccination, with a 69.3% uptake among those aged ≥ 65 years (178,754 vaccinations during 258,100 person-seasons). For at-risk patients aged ConclusionsFew countries' health systems allow for the integrated and accessible data recording that made this study possible and made it feasible to collate centrally almost all hospitalisations and deaths attributed to influenza, thereby allowing completeness of reporting. Using these data, we found most influenza vaccines were administered to those at risk of serious complications from influenza. In a nationally representative cohort we found that the vaccine was associated with a significant decrease in the risk of RT-PCR-confirmed influenza (the decrease was substantial particularly for at-risk patients aged FundingThe National Institute for Health Research Health Services and Delivery Research programme.

The LivePaper system augments ordinary pieces of paper with projected information. Pages, cards and books are placed on an instrumented tabletop to activate their enhancement. To the user, it appears as if the paper gains new visual and auditory features. Projected annotations track the orientation and location of pages as the user moves them on the desktop. A piece of paper that is removed, but then returned to the desk, regains the same features that it previously exhibited. The LivePaper system accomplishes this by using features extracted from written material on the page, not from glyphs or other artificial marks. The paper describes both the system as a whole, and a number of sample applications we have developed to illustrate the feasibility of the LivePaper system. These applications include an architectural visualization tool, which projects a 3D hidden-line rendering of walls onto a page. The user may rotate and move the page to view the rendering from different angles. Another application is an audio player, which begins playing when a page (such as a business card) is laid on the desk. The user may control playback with his or her finger via projected buttons. Other applications include page-sharing, remote collaboration, and World Wide Web page viewing. From the user's perspective, all of these applications are attributes of the particular page, not features of the tabletop. Particular attention is given to the design of interaction: LivePaper is object-oriented, because the individual sheets are treated as computational units, but it also provides functions that involve several objects. The design principles applied to handle the different kinds of functionality are explained and illustrated in the LivePaper system, but are also proposed for wider use in augmented reality.

To examine the effect of an inpatient pulmonary rehabilitation program on functional outcome, supplemental oxygen use, quality of life (QOL), and rehospitalization.A prospective study.Inpatient pulmonary rehabilitation unit.One hundred fifty-seven patients with moderate to severe chronic obstructive pulmonary disease (COPD) admitted to an inpatient pulmonary rehabilitation program over a 3-year period.Comprehensive interdisciplinary inpatient pulmonary rehabilitation program with an average length of stay of 21 days.Improvements in QOL questionnaire scores, COPD knowledge questionnaire scores, 6-minute walking test (with 3 ambulation categories: bed-bound, household ambulators, community ambulators), and supplemental oxygen use. Rehospitalization 1 year after completion of the program was also assessed and compared with hospital days for the year before the program.On discharge from the program, 88% of individuals walked farther (p.0001), and community ambulators doubled their walking distance, whereas bed-bound patients decreased 10-fold; supplemental oxygen use dropped 33% during the day (p.0001) and 57% during the night (p.0001); 82% showed improved QOL (p.0001); 67% showed improved knowledge of COPD (p.0001); and 67% of the sample spent less time in the hospital during the 12 months after program completion compared with the 12 months before admission (p.001).An inpatient pulmonary rehabilitation program leads to improved endurance and functional ambulation, decreased supplemental oxygen use, and fewer hospitalizations 1 year after discharge for patients with COPD.

Sinka, Katy Kavanagh, Kimberley Gordon, Ruth Love, John Potts, Alison Donaghy, Martin Robertson, Chris eng England 2013/08/30 06:00 J Epidemiol Community Health. 2014 Jan;68(1):57-63. doi: 10.1136/jech-2013-202620. Epub 2013 Aug 28.; International audience; BACKGROUND AND METHODS: The national immunisation records of over 220,000 girls offered vaccine in the routine or catch-up programme of the Human papillomavirus (HPV) programme in Scotland were analysed. Descriptive statistics and multilevel modelling were used to determine individual and organisational factors associated with uptake. Age, school year, school denomination, deprivation and, for school-leavers, mode of delivery were explored. Additional aggregate data were used to examine the effect of late uptake of missed doses in the routine vaccination programme. RESULTS: School-based delivery initially achieved over 80% uptake of complete courses in routine and catch-up age groups. Within this context of generally high coverage, there was an association between individual level deprivation and lower uptake, and a decline in in-year course completion over time. However, later uptake of missed doses in the following year substantially decreased these effects. There was no influence on uptake of the type of school (non-denominational/denominational). Vaccination of school-leavers in the catch-up campaign had lower coverage, with 50% starting and 30% completing the course in-year. There was no clear advantage of vaccination through general practice or through Board-run clinics in reaching this group. CONCLUSIONS: School-based vaccination can achieve high and equitable uptake of a multidose vaccine in a routine immunisation programme. Sustained high coverage with HPV vaccine across Scotland provides a stable platform for planning future strategies for cervical screening and understanding the impact of the vaccination at a population level.

Aim This study examines estimation of seasonal influenza vaccine effectiveness (VE) for a cohort of patients attending general practice in Scotland in 2010/11. The study focuses on the variation in estimation of VE for both virological and clinical consultation outcomes and understanding the dependency on date of analysis during the season, methodological approach and the effect of use of a propensity score model. Methods For the clinical outcomes, three methodological approaches were considered; adjusted Poisson multi-level modelling splitting consultations in vaccinated individuals into those before and after vaccination, adjusted Cox proportional hazards modelling and finally the screening method. For the virological outcome, the test-negative case–control study design was employed. Results VE was highest for the most specific outcomes of ILI (Poisson end-of-season VE = 47% (95% CI: −69%, 83%); Cox VE = 34% (95% CI: −64%, 73.2%); Screening VE = 52.8% (95% CI: 3.8%, 76.8%)) and a virological diagnosis (VE = 54% (95% CI: −37%, 85%)). Using the Cox approach, adjusted for propensity score only gave VE = 46.5% (95% CI: −30.4%, 78.0%). Conclusion Our approach illustrated the ability to achieve relatively consistent estimates of seasonal influenza VE using both specific and less specific outcomes. Construction of a propensity score and use for bias adjustment increased the estimate of ILI VE estimated from the Cox model and made estimates more similar to the Poisson approach, which models differences in consultation behaviour of vaccinated individuals more inherently in its structure. VE estimation for the same data was found to vary by methodology which should be noted when comparing results from different studies and countries.

Aims Patients with refractory respiratory symptoms related to gastro-oesophageal reflux disease (GORD) such as asthma and cough are being referred for laparoscopic fundoplication (LFP), as recommended by the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES). However there are limited data regarding symptomatic response to fundoplication in this group of patients. Method A 7 year retrospective review was performed to study the efficacy of LFP in the treatment of patients with respiratory manifestations of GORD. Patients were followed up from 4 to 6 weeks (short-term) to 6–12 months (long-term) post-operatively. Results Of 208 patients who underwent LFP, 73 (35%) patients were eligible for inclusion into the study. 55 (75%) patients had improved respiratory symptoms at short-term follow-up. At long-term follow-up, 7 of these patients had recurrence of respiratory symptoms, while 4 patients had improvement not initially apparent. No significant predictive factor for the success or failure of surgery was identified. 190 (91%) of 208 patients had symptomatic improvement in GORD at short-term follow-up. Conclusion LFP is effective with the response rates over 75% in the control of respiratory manifestation of GORD, compared to over 91% response rate in the control GOR symptoms alone. More research is needed to identify factors to aid patient selection to improve response rate.

This study compared three spatio-temporal models for estimation of exposure to air pollution throughout the central part of Scotland during 1970–79 for approximately 21,600 individuals in 2 closely-related prospective cohort studies. Although 181 black smoke (BS) monitoring sites operated in this region at some point during 1970–79, a substantial amount of BS exposure data was missing at many sites. The three exposure estimation methods were: (i) area-based regression models to impute missing data followed by assignment of exposure by inverse distance weighting of observed BS at nearby monitoring sites (IDWBS); (ii) area-based regression models to impute missing data followed by a spatial regression additive model using four local air quality predictors (LAQP): altitude; distance to the nearest major road; household density within a 250 m buffer zone; and distance to the edge of urban boundary (AMBS); (iii) a multilevel spatio-temporal model using LAQP (MultiBS). The three methods were evaluated using maps of predicted BS, and cross validation using monitored and imputed BS at sites with ≥80% data. The use of LAQP in the AMBS and MultiBS exposure models provided spatial patterns in BS consistent with known sources of BS associated with major roads and the centre of urban areas. Cross-validation analyses demonstrated that the MultiBS model provided more precise predictions (R2 = 60%) of decadal geometric mean BS concentrations at monitoring sites compared with the IDWBS and AMBS models (R2 of 19% and 20%, respectively).

The VideoWriter is an investigation into applying a natural user interface to telewriting. It employs a computer-controlled video camera to capture images of the user's writing space: a desk with various pieces of paper. The images are processed to extract the written marks on the current page from the clutter of objects in the scene, including the user's moving hand and pen. The system compresses the extracted marks for transmission. The system is successful at extracting the marks as the user is writing and avoids digitizing most false marks. It incorporates update mechanisms that deal with false marks that do occur.

The VideoWriter is a real-time system that uses digitized images from a computer-controlled video camera to find the location of pages on a desktop. Once an image of a page is extracted, the system must determine if the page has been previously stored. We investigate the use of the Hausdorff distance metric to compare two-level versions of page images. The Hausdorff distance metric does not require exact correspondence between pels in images. We compare the accuracy of the original metric with several modifications.

We describe extensions to the traditional techniques for anomaly detection, as well as new anomaly detection techniques based on alternate models of what distinguishes normal from abnormal behavior. Some of these techniques are designed to capture anomalies at individual sensors; some detect anomalies across collections of sensors. To assist in reasoning about complex global behaviors, we construct and simulate a causal model of the physical system being monitored. These techniques have been tested on data from the ECLSS of Space Station Freedom (SSF) and are being applied in advanced monitoring prototypes for the SSF External Active Thermal Control System of SSF and the Environmental Emergency and Consumables Management subsystem of the Space Shuttle.