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Health Education England has created seven endoscopy training academies across England. These will oversee the multidisciplinary training of all endoscopy staff on a regional basis to address the challenges of waiting times and recovery, which are often limited by human resources. This article outlines the North West vision for the future of endoscopy training and how it will impact on all staff, for the benefit of patients.

This paper brings into light all the new developmental work performed in the wide domain of high frequency PCBs for the realisation of innovative metasurfaces at 5GHz as well as compact highly integrated 5G antenna-in-modules at 40 GHz. There is a fast growing demand in high frequency market that justifies the intense R&D work also on microwave and especially mmWave technologies, comprising both “beyond the state-of-the-art high frequency PCBs” and advanced PCB integration concepts. In this context, this paper intends to highlight new knowledge in materials, processes as well as thermal dissipation concepts, that have been derived from various R&D projects, but especially in the framework of the FET-EU “Visorsurf” and the EU-Serena projects. In specific, R&D work will be shown on the emerging concepts of metamaterials that can be software programmable and adapt their properties. The Visorsurf main objective is the development of a hardware platform, the Hypersurface, whose electromagnetic behavior can be programmatically defined. The key enablers for this are the metasurfaces whose electromagnetic properties depend on their internal structure. The Hypersurface hardware platform will be a 4-layer build-up of high frequency PCB substrate materials with the metasurfaces on the top and custom electronic controller nodes at the bottom of the PCB hardware platform. This paper will elaborate on how innovative PCB processes have been tailored to high frequency substrates for the manufacturing of the first 4-layer Hypersurface PCB hardware platform with a size of 300mmx300mm. In a complimentary way, the paper will describe in detail new chip embedding concepts in the same family of high frequency PCB substrates toward the realization of highly miniaturized advanced packages for 5G mmWave applications at 40 GHz. These concepts show vividly the potential of PCB embedding technologies as the mean for heterogeneous integration in high frequency advanced packages/modules. The paper discusses in detail all process chain developments in high frequency PCBs for the embedding of GaN and SiGe chips in PCBs, their interconnection path concept, the embedding of passives, the fabrication of the antenna module and its stacking on a high power or low power PCB module for the final formation of a 6-layer antenna-in-module package which could be separately assembled on the system board. Furthermore, the paper will present for the first time innovative thermal dissipation concepts for the “Serena” antenna module, with the prevailing scenario of thermal vias to the bottom of the GaN and SiGe chips for direct heat removal. All processes for realization of high frequency substrates and embedded 5G 40 GHz antenna modules will be discussed in detail.

BACKGROUND: Anti-TNF drugs are effective treatments for the management of Crohn's disease but treatment failure is common. We aimed to identify clinical and pharmacokinetic factors that predict primary non-response at week 14 after starting treatment, non-remission at week 54, and adverse events leading to drug withdrawal. METHODS: The personalised anti-TNF therapy in Crohn's disease study (PANTS) is a prospective observational UK-wide study. We enrolled anti-TNF-naive patients (aged ≥6 years) with active luminal Crohn's disease at the time of first exposure to infliximab or adalimumab between March 7, 2013, and July 15, 2016. Patients were evaluated for 12 months or until drug withdrawal. Demographic data, smoking status, age at diagnosis, disease duration, location, and behaviour, previous medical and drug history, and previous Crohn's disease-related surgeries were recorded at baseline. At every visit, disease activity score, weight, therapy, and adverse events were recorded; drug and total anti-drug antibody concentrations were also measured. Treatment failure endpoints were primary non-response at week 14, non-remission at week 54, and adverse events leading to drug withdrawal. We used regression analyses to identify which factors were associated with treatment failure. FINDINGS:We enrolled 955 patients treated with infliximab (753 with originator; 202 with biosimilar) and 655 treated with adalimumab. Primary non-response occurred in 295 (23·8%, 95% CI 21·4-26·2) of 1241 patients who were assessable at week 14. Non-remission at week 54 occurred in 764 (63·1%, 60·3-65·8) of 1211 patients who were assessable, and adverse events curtailed treatment in 126 (7·8%, 6·6-9·2) of 1610 patients. In multivariable analysis, the only factor independently associated with primary non-response was low drug concentration at week 14 (infliximab: odds ratio 0·35 [95% CI 0·20-0·62], p=0·00038; adalimumab: 0·13 [0·06-0·28], p

In this paper, a multilayered integrated inductor in Fan-out Wafer Level Packaging (FoWLP) technology is investigated. The inductor is designed on polyimide for integration into the redistribution layer of the package. Excellent correlation is obtained between simulation and measurement results. The fabricated inductor has an inductance of approximately 480 pH and a quality factor of approximately 27 at 11 GHz.

Preclinical studies have shown that administration of Bacillus Calmette-Guerin (BCG) vaccine induces depression-like behaviors in mice; however, the effect of antidepressant drug treatment has not been reported earlier. In the present study, we induced depression-like behavior by administering BCG vaccine to BALB/c mice. BCG treatment produced robust serum sickness as shown by a decrease in body weight, reduced spontaneous locomotor activity and reduced voluntary wheel running activity. BCG treatment also elevated plasma IL6 and IFNγ levels and produced a marked activation of lung IDO activity. At a time point when serum sickness-related behaviors had fully recovered (i.e., day 14) BCG-treated mice showed a significant increase in immobility in the forced swim test (FST) and tail suspension test (TST) indicative of a pro-depressant phenotype. We observed significant increase in [(3)H]PK11195 binding in cortex and hippocampus regions of BGC-treated mice in comparison to saline-treated mice indicating prominent neuroinflammation. Pharmacological evaluation of FST behavior in BCG-treated mice demonstrated selective resistance to the selective serotonin reuptake inhibitors (SSRIs) fluoxetine and escitalopram. In contrast the tricyclic antidepressant imipramine, the dual serotonin/norepinephrine reuptake inhibitor (SNRI) duloxetine, and the dual dopamine/norepinephrine reuptake inhibitor (DNRI) nomifensine retained antidepressant efficacy in these mice. The lack of efficacy with acute treatment with SSRIs could not be explained either by differences in drug exposure or serotonin transporter (SERT) occupancy. Our results demonstrate that BCG-vaccine induced depression like behavior is selectively resistant to SSRIs and could potentially be employed to evaluate novel therapeutic agents being developed to treat SSRI-resistance in humans.

In this work, we present a novel packaging and system-integration platform with integrated antennas (antenna-in-package, AiP, platform) for 5G millimeter-wave (mmWave) systems. We illustrate the application of the platform for the development of miniaturized, scalable, low-cost and high-performance 5G mmWave systems for new radio (NR) base stations. RF characterization of the dielectric material of the platform and the integrated mmWave antennas as well as thermal investigations of the platform are presented. The process steps required for the fabrication of the platform are discussed, and an example of a mmWave chip embedded in the platform is shown.