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Abstract This article explores the criteria used to ascertain whether or not, and how, ancient Chinese bronze bells might form sets of musical instruments, thus clarifying their original intended use by ancient musicians. The focus is on ten bells unearthed from Changsha city in Hunan province in China, which date to the twelfth century BCE. A range of diverse relationships between these bells provide valuable insights that can be explored. Debate is ongoing among music historians regarding the nature of the bells. Some argue that the ten bells do not constitute a set of musical instruments because their designs and acoustic properties lack sufficient similarity and correlation. Conversely, another group of historians suggests that nine of the ten bells could indeed be seen as a set, but with the tenth bell being an outlier due to its distinct design. The third group of historians contends that the ten bells should be considered a musical set because of their organized sequence of consecutive semi-tones, while the design differences of the bells are less significant and can be overlooked if we focus on their musical functions. In this study, we scrutinize the assumptions made by these music historians, including their definitions of design similarity and the sequence of progressive pitches. Further previously overlooked criteria, such as the geographical proximity of these ten bells and others found in neighboring areas, and the incremental changes in the bell sizes, are also considered. Through the use of these criteria we aim to explore a wide range of relationships between ancient Chinese bells and to reassess what other new evidence the bells may offer to the study of ancient Chinese musical concepts. The concept of the chromatic scale discovered by ancient Chinese musicians was embodied on the casting of bronze bells.

Introduction Digital surgical wound monitoring for patients at home is becoming an increasingly common method of wound follow-up. This regular monitoring improves patient outcomes by detecting wound complications early and enabling treatment to start before complications worsen. However, reviewing the digital data creates a new and additional workload for staff. The aim of this study is to assess a surgical wound monitoring platform that uses artificial intelligence to assist clinicians to review patients’ wound images by prioritising concerning images for urgent review. This will manage staff time more effectively.Methods and analysis This is a feasibility study for a new artificial intelligence module with 120 cardiac surgery patients at two centres serving a range of patient ethnicities and urban, rural and coastal locations. Each patient will be randomly allocated using a 1:1 ratio with mixed block sizes to receive the platform with the new detection and prioritising module (for up to 30 days after surgery) plus standard postoperative wound care or standard postoperative wound care only. Assessment is through surveys, interviews, phone calls and platform review at 30 days and through medical notes review and patient phone calls at 60 days. Outcomes will assess safety, acceptability, feasibility and health economic endpoints. The decision to proceed to a definitive trial will be based on prespecified progression criteria.Ethics and dissemination Permission to conduct the study was granted by the North of Scotland Research Ethics Committee 1 (24/NS0005) and the MHRA (CI/2024/0004/GB). The results of this Wound Imaging Software Digital platfOrM (WISDOM) study will be reported in peer-reviewed open-access journals and shared with participants and stakeholders.Trial registration numbers ISRCTN16900119 and NCT06475703.

IntroductionCOVID-19 has been associated with high morbidity and mortality in allogeneic hematopoietic stem cell transplant (allo-HCT) recipients.MethodsThis study reports on 986 patients reported to the EBMT registry during the first 29 months of the pandemic.ResultsThe median age was 50.3 years (min – max; 1.0 – 80.7). The median time from most recent HCT to diagnosis of COVID-19 was 20 months (min – max; 0.0 – 383.9). The median time was 19.3 (0.0 - 287.6) months during 2020, 21.2 (0.1 - 324.5) months during 2021, and 19.7 (0.1 – 383.9) months during 2022 (p = NS). 145/986 (14.7%) patients died; 124 (12.6%) due to COVID-19 and 21 of other causes. Only 2/204 (1%) fully vaccinated patients died from COVID-19. There was a successive improvement in overall survival over time. In multivariate analysis, increasing age (p

Fig rust, caused by Cerotelium fici, was first recorded in South Africa in 1927. Recent observations have revealed high incidence of rust and untimely defoliation of fig trees (Ficus carica) in residential gardens and commercial orchards. Using phylogenetic analysis, the causal organism of a fig rust isolate (PREM63073) collected in 2020 was confirmed as Phakopsora nishidana. Inoculation and microscope studies showed that mulberry plants were immune to P. nishidana isolate PREM63073. Infection of fig leaves occurred through stomata on the abaxial leaf surfaces. Very long germ tubes were observed for P. nishidana, often with no clear contact with the leaf surfaces and an apparent lack of directional growth towards stomata. Inoculated plants from 15 fig cultivars varied in their severity of leaf infection, whereas fruit of the cultivar Kadota developed reddish-brown blemishes without sporulation. Currently, C. fici and P. nishidana are recognised as occurring on F. carica in South Africa. This suggests a need to resolve the worldwide distribution and identity of the rust species involved.

Invasive Aspergillosis (IA), typically caused by the fungus Aspergillus fumigatus, is a leading cause of morbidity and mortality in immunocompromised patients. IA remains a significant burden in haematology patients, despite improvements in the diagnosis and treatment of Aspergillus infection. Diagnosing IA is challenging, requiring multiple factors to classify patients into possible, probable and proven IA cohorts. Given the low incidence of IA, using negative results as exclusion criteria is optimal. However, frequent false positives and severe IA mortality rates in haematology patients have led to the empirical use of toxic, drug-interactive and often ineffective anti-fungal therapeutics. Improvements in IA diagnosis are needed to reduce unnecessary anti-fungal therapy. Early IA diagnosis is vital for positive patient outcomes; therefore, a pre-emptive approach is required. In this study, we examined the sequence and expression of four C-type Lectin-like receptors (Dectin-1, Dectin-2, Mincle, Mcl) from 42 haematology patients and investigated each patient’s anti-Aspergillus immune response (IL-6, TNF). Correlation analysis revealed novel IA disease risk factors which we used to develop a pre-emptive patient stratification protocol to identify haematopoietic stem cell transplant patients at high and low risk of developing IA. This stratification protocol has the potential to enhance the identification of high-risk patients whilst reducing unnecessary treatment, minimizing the development of anti-fungal resistance, and prioritising primary disease treatment for low-risk patients.

Objective To examine the effects of a consultant-led, community-based chronic obstructive pulmonary disease (COPD) service, based in a highly deprived area on emergency hospital admissions.Design A longitudinal matched controlled study using difference-in-differences analysis to compare the change in outcomes in the intervention population to a matched comparison population, 5 years before and after implementation.Setting A deprived district in the North West of England between 2005 and 2016.Intervention A community-based, consultant-led COPD service providing diagnostics, treatment and rehabilitation from 2011 to 2016.Main outcome measures Emergency hospital admissions, length of stay per emergency admission and emergency readmissions for COPD.Results The intervention was associated with 24 fewer emergency COPD admissions per 100 000 population per year (95% CI −10.6 to 58.8, p=0.17) in the postintervention period, relative to the control group. There were significantly fewer emergency admissions in populations with medium levels of deprivation (64 per 100 000 per year; 95% CI 1.8 to 126.9) and among men (60 per 100 000 per year; 95% CI 12.3 to 107.3).Conclusion We found limited evidence that the service reduced emergency hospital admissions, after an initial decline the effect was not sustained. The service, however, may have been more effective in some subgroups.

Head and neck cancer (HNC) remains the sixth most common malignancy worldwide and survival upon recurrence and/or metastasis remains poor. HNSCC has traditionally been associated with alcohol and nicotine use, but more recently the Human Papilloma Virus (HPV) has emerged as a favorable prognostic risk factor for oropharyngeal HNSCC. However, further stratification with additional biomarkers to predict patient outcome continues to be essential. One candidate biomarker is the DEK oncogenic protein, which was previously detected in the urine of patients with bladder cancer and is known to be secreted by immune cells such as macrophages. Here, we investigated if DEK could be detected in human plasma and if DEK levels correlated with clinical and pathological variables of HNSCC. Plasma was separated from the peripheral blood of newly diagnosed, untreated HNSCC patients or age-matched normal healthy controls and analyzed for DEK protein using ELISA. Plasma concentrations of DEK protein were lower in p16-negative tumors compared to both normal controls and patients with p16-positive tumors. Patients with lower plasma concentrations of DEK were also more likely to have late stage tumors and a lower white blood cell count. Contrary to previously published work demonstrating a poor prognosis with high intratumoral DEK levels, we show for the first time that decreased concentrations of DEK in patient plasma correlates with poor prognostic factors, including HPV-negative status as determined by negative p16 expression and advanced tumor stage.

PHAR-QA, funded by the European Commission, is producing a framework of competences for pharmacy practice. The framework is in line with the EU directive on sectoral professions and takes into account the diversity of the pharmacy profession and the on-going changes in healthcare systems (with an increasingly important role for pharmacists), and in the pharmaceutical industry. PHAR-QA is asking academia, students and practicing pharmacists to rank competences required for practice. The results show that competences in the areas of “drug interactions”, “need for drug treatment” and “provision of information and service” were ranked highest whereas those in the areas of “ability to design and conduct research” and “development and production of medicines” were ranked lower. For the latter two categories, industrial pharmacists ranked them higher than did the other five groups.

Do community pharmacists coming from different educational backgrounds rank the importance of competences for practice differently—or is the way in which they see their profession more influenced by practice than university education? A survey was carried out on 68 competences for pharmacy practice in seven countries with different pharmacy education systems in terms of the relative importance of the subject areas chemical and medicinal sciences. Community pharmacists were asked to rank the competences in terms of relative importance for practice; competences were divided into personal and patient-care competences. The ranking was very similar in the seven countries suggesting that evaluation of competences for practice is based more on professional experience than on prior university education. There were some differences for instance in research-related competences and these may be influenced, by education.

The PHAR-IN (“Competences for industrial pharmacy practice in biotechnology”) looked at whether there is a difference in how industrial employees and academics rank competences for practice in the biotechnological industry. A small expert panel consisting of the authors of this paper produced a biotechnology competence framework by drawing up an initial list of competences then ranking them in importance using a three-stage Delphi process. The framework was next evaluated and validated by a large expert panel of academics (n = 37) and industrial employees (n = 154). Results show that priorities for industrial employees and academics were similar. The competences for biotechnology practice that received the highest scores were mainly in: “Research and Development”, ‘“Upstream” and “Downstream” Processing’, “Product development and formulation”, “Aseptic processing”, “Analytical methodology”, “Product stability”, and “Regulation”. The main area of disagreement was in the category “Ethics and drug safety” where academics ranked competences higher than did industrial employees.

The goal of the PHAR-QA (quality assurance in European pharmacy education and training) project is the production of a European framework for a quality assurance system based on competences for pharmacy practice. The PHAR-QA framework will be European, consultative and will encompass the various aspects of pharmacy practice. In this review, we describe the methodology to be used in the project and the first stage in the development of this framework. Using the proposals for competences produced by our previous PHARMINE (Pharmacy education in Europe) project, together with those of other sources, three university professors of pharmacy (Authors 2 through 4) produced a list of three major competency domains that reflect the activities of practitioners: Patient Care Competences, Personal Competences and Management and Organizational Structure Competences. Each domain was subdivided into nine, nine and eight competencies, respectively, for a total of 27 major competencies that were further subdivided into an average of five supporting competences per major competence, giving a total of 140 proposals for competences for pharmacy practice. The 27 and 140 proposals were ranked by an expert panel of seven university professors of pharmacy (Authors 5 through 11). The panel also commented on the proposed competences. On the basis of the ranks and comments, a list of 68 proposals for competences was produced. This list was then examined by the expert panel and a new version based on their comments produced. The latter process was repeated twice based on Delphi methodology. This review presents this process and the 68 proposals. We invite the pharmacy community to participate in the second stage of the elaboration of the PHAR-QA competence framework for pharmacy practice by ranking the proposals and adding comments. It is anticipated that this survey will stimulate a productive discussion on pharmacy education and practice by the various stakeholders (department staff and students, community, hospital and industrial pharmacists, as well as pharmacists working in clinical biology and other branches, together with representatives of chambers and associations).

With the changes in the Bologna process and the European directive on sectoral professions, the education and training of the pharmacists in the European Higher Education Area is moving towards a quality system based on competences. In this paper we analyze the existing quality assurance and accreditation systems in 10 countries and examine how far these systems have evolved from a resources and curriculum basis towards a competences basis. This is the first step towards the goal of the PHAR-QA project: establishment of a European quality assurance system based on competences. Existing systems of quality assurance for pharmacy education and teaching are based mainly on resources and management not competences. Furthermore, they are national, obligatory, and do not recognize all the current activities of the pharmacists. The PHAR-QA system that will be developed by the consortium of the same name will be based on competences; it will be European, consultative, and will encompass pharmacy practice in a wide sense.

Structural colour generation by nanoscale plasmonic structures is of major interest for non-bleaching colour printing, anti-counterfeit measures and decoration applications. We explore the physics of a two-metal plasmonic nanostructure consisting of metallic nanodiscs separated from a metallic back-reflector by a uniform thin polymer film and investigate the potential for vibrant structural colour in reflection. We demonstrate that light trapping within the nanostructures is the primary mechanism for colour generation. The use of planar back-reflector and polymer layers allows for less complex fabrication requirements and robust structures, but most significantly allows for the easy incorporation of two different metals for the back-reflector and the nanodiscs. The simplicity of the structure is also suitable for scalability. Combinations of gold, silver, aluminium and copper are considered, with wide colour gamuts observed as a function of the polymer layer thickness. The structural colours are also shown to be insensitive to the viewing angle. Structures of copper nanodiscs with an aluminium back-reflector produce the widest colour gamut.

This paper presents the results of the second European Delphi round on the ranking of competences for pharmacy practice and compares these data to those of the first round already published. A comparison of the numbers of respondents, distribution by age group, country of residence, etc., shows that whilst the student population of respondents changed from Round 1 to 2, the populations of the professional groups (community, hospital and industrial pharmacists, pharmacists in other occupations and academics) were more stable. Results are given for the consensus of ranking and the scores of ranking of 50 competences for pharmacy practice. This two-stage, large-scale Delphi process harmonized and validated the Quality Assurance in European Pharmacy Education and Training (PHAR-QA) framework and ensured the adoption by the pharmacy profession of a framework proposed by the academic pharmacy community. The process of evaluation and validation of ranking of competences by the pharmacy profession is now complete, and the PHAR-QA consortium will now put forward a definitive PHAR-QA framework of competences for pharmacy practice.

This paper looks at the opinions of 241 European academics (who provide pharmacy education), and of 258 European community pharmacists (who apply it), on competences for pharmacy practice. A proposal for competences was generated by a panel of experts using Delphi methodology. Once finalized, the proposal was then submitted to a large, European-wide community of academics and practicing pharmacists in an additional Delphi round. Academics and community pharmacy practitioners recognized the importance of the notion of patient care competences, underlining the nature of the pharmacist as a specialist of medicines. The survey revealed certain discrepancies. Academics placed substantial emphasis on research, pharmaceutical technology, regulatory aspects of quality, etc., but these were ranked much lower by community pharmacists who concentrated more on patient care competences. In a sub-analysis of the data, we evaluated how perceptions may have changed since the 1980s and the introduction of the notions of competence and pharmaceutical care. This was done by splitting both groups into respondents < 40 and > 40 years old. Results for the subgroups were essentially statistically the same but with some different qualitative tendencies. The results are discussed in the light of the different conceptions of the professional identity of the pharmacist.

This paper looks at the way in which industrial pharmacists rank the fundamental competences for pharmacy practice. European industrial pharmacists (n = 135) ranked 68 competences for practice, arranged into 13 clusters of two types (personal and patient care). Results show that, compared to community pharmacists (n = 258), industrial pharmacists rank competences centering on research, development and production of drugs higher, and those centering on patient care lower. Competences centering on values, communication skills, etc. were ranked similarly by the two groups of pharmacists. These results are discussed in the light of the existence or not of an “industrial pharmacy” specialization.

European students (n = 370), academics (n = 241) and community pharmacists (n = 258) ranked 13 clusters of 68 personal and patient care competences for pharmacy practice. The results show that ranking profiles for all three groups as a rule were similar. This was especially true of the comparison between students and community pharmacists concerning patient care competences suggesting that students have a good idea of their future profession. A comparison of first and fifth (final) year students shows more awareness of patient care competences in the final year students. Differences do exist, however, between students and community pharmacists. Students—like academics—ranked competences concerned with industrial pharmacy and the quality aspects of preparing drugs, as well as scientific fundamentals of pharmacy practice, well above the rankings of community pharmacists. There were no substantial differences amongst rankings of students from different countries although some countries have more “medicinal” courses than others. This is to our knowledge the first paper to look at how, within a healthcare sectoral profession such as pharmacy, the views on the relative importance of different competences for practice of those educating the future professionals and their students, are compared to the views of working professionals.