6-month Period Research Articles

Differences in heroin overdose risk associated with the unregulated drug market: Insights from a supervised injecting facility in Melbourne, Australia.

To determine the contribution that variation in the unregulated drug market has on the risk of heroin overdose across individuals with different levels of personal overdose risk. A retrospective cohort study of heroin injecting episodes and overdose cases were examined over a 12-month period between 30 June 2022 and 30 June 2023. The Medically Supervised Injecting Room in Melbourne, Australia. 1474 witnessed heroin overdose cases were examined amongst a cohort of 337 individuals who were predominantly male (n = 276, 81.7%) with a median age of 43.5years (interquartile range 37.25-49.00 years, range 20-75 years). The daily overdose rate was used to differentiate High and Low daily overdose risk categories. The number of overdose events that an individual experienced during the study period was used to differentiate people into Standard, Moderate and High personal overdose risk categories. Each overdose case was differentiated by the personal overdose risk of the individual who experienced the overdose, as well as the overdose risk of the day that overdose occurred. A stratified overdose risk profile was then derived across the nine different daily overdose risk and personal overdose risk categories. The rate of overdose approximately doubled on High overdose risk days compared with Standard overdose risk days, increasing by a factor of 2.11, 2.41 and 2.03 times for individuals in the Standard, Moderate and High personal overdose risk groups. Conversely, the rate of overdose was also substantially reduced on Low overdose risk days to a factor of 0.17, 0.28 and 0.20, respectively. Among heroin users in Melbourne, Australia, there is an approximately 10-times difference in the risk of overdose on some days compared with others, which appears to be attributable to the effects of the unregulated drug market and not the effects of variation in personal overdose risk of individuals.

An audit to evaluate the prescribing of antibiotics for acne against NICE guidelines in a digital setting

Abstract Introduction According to NICE guidelines, individuals with moderate to severe acne may be recommended a fixed combination of topical treatment along with either oral lymecycline or doxycycline for a 12-week regimen1. If improvement is observed in these patients, continuation of the oral antibiotic and non-antibiotic-topical treatment for an additional 12 weeks is advised. It's important to adhere to these guidelines and avoid prescribing monotherapy topical antibiotics, monotherapy oral antibiotics, or the combination of topical antibiotics with oral antibiotics2. This audit aims to verify our compliance with these guidelines and ensure the appropriate use of antibiotics in our prescribing within a digital setting where patients undergo photo assessment consultations. Aim The objective of this audit is to ascertain our adherence to the NICE acne guidelines regarding the duration of oral antibiotic therapy prescribed and the accurate prescribing of topical treatments in conjunction with the oral antibiotic1. The audit criteria entail ensuring that 100% of consultations result in prescriptions aligning with the following: oral antibiotic treatment not exceeding 6 months, a prescribed non-antibiotic topical treatment alongside oral antibiotics, and avoidance of prescribing a combination of topical antibiotics with oral antibiotics. Method A retrospective review was conducted on all consultations involving the prescribing of oral and topical antibiotics from 22.4.2023 to 18.4.2024. Each consultation was assessed for the quantity of oral antibiotics prescribed over a 12-month period and examined for the accompanying topical treatments. Additionally, checks were made to determine if the patient was currently taking any oral or topical antibiotics from other sources, ensuring that antibiotics were not overprescribed and that co-prescribing practices adhered to guidelines. Ethical approval was not required since this is a clinical audit. Results The data extraction identified 427 consultations in which patients were prescribed either oral antibiotics (361 cases) or topical antibiotics (Duac-66 cases). In 99% of the consultations, patients were not prescribed oral antibiotics for more than six months. The remaining 1% of patients had already been prescribed oral antibiotics from other sources. It is noted that additional queries should have been conducted to ascertain the duration of antibiotic use prescribed elsewhere. Furthermore, 99% of consultations adhered to the criteria of prescribing a non-antibiotic topical treatment alongside an oral antibiotic. The remaining 1% involved patients who were already using a topical antibiotic from another source, which should have been further investigated to ensure cessation upon initiation of the prescribed oral antibiotics. In all cases, patients were prescribed an appropriate topical treatment in conjunction with an oral antibiotic from our digital setting. Discussion This audit confirms high compliance with NICE guidelines for acne treatment within our digital consultation framework1. Specifically, 99% of consultations adhered to the duration regimen of oral antibiotics, ensuring prescriptions did not exceed six months. Additionally, the majority of cases, correctly included non-antibiotic topical treatments alongside oral antibiotics, minimising the risk of antibiotic resistance. However, slight differences were noted in cases where patients had existing prescriptions from other sources. These findings highlight the effectiveness of our prescribing practices and the importance of thorough patient medication history reviews.

Factors Associated With Ocular Perfusion Measurements as Obtained With Laser Speckle Contrast Imaging.

To study the ocular and systemic factors affecting optic nerve head (ONH) perfusion data as obtained using a commercially available laser speckle flowgraphy (LSFG) device in a cohort of Caucasian subjects without ocular diseases. Also, to assess the intrasession repeatability and intersession reproducibility of ONH, macular, retinal, and choroidal perfusion. Seventy-five healthy eyes of 75 Caucasian participants underwent LSFG and spectral-domain optical coherence tomography (SD-OCT) on the same visit. Perfusion of the ONH was assessed with LSFG, and SD-OCT was used to measure peripapillary retinal nerve fiber layer thickness (RNFLT) and macular ganglion cell plus inner plexiform layer thickness (GCIPLT). The intrasession repeatability and intersession reproducibility of ONH and macular perfusion and retinal and choroidal relative flow volume (RFV) were evaluated in 20 participants measured on three different days over a 6-month period. Intrasession and intersession intraclass correlation coefficients of LSFG parameters ranged from 0.787 to 0.967 and from 0.776 to 0.935, respectively. Intersession 95% prediction intervals for the ratio of two measurements were wider for RFV indices than for ONH and macular perfusion parameters. The multiple regression analysis indicated that higher ONH perfusion was associated with younger age, female sex, smaller optic disc area, and higher RNFLT. RNFLT was an independent predictor of ONH perfusion, whereas GCIPLT was not. Each 1-µm increase in RNFLT was associated with a 0.272 arbitrary unit increase in ONH perfusion. LSFG measurements of optic disc perfusion are influenced by sex, age, and anatomical variations in optic disc area and RNFLT. Better evaluation of ocular blood flow will result in better diagnosis and treatment of various ocular diseases.

Evaluation of the ENIGMA mentoring pilot; an approach to tackle leadership inequalities for ethnically diverse female pharmacists in general practice

Abstract Introduction Diversity in leadership positively impacts teams and productivity yet remains limited in pharmacy leadership. The NHS Pharmacy Workforce Race Equality Standard (PWRES) report1 highlights significant underrepresentation of ethnically diverse pharmacists in senior NHS Trust roles (Agenda for Change band 8a and above) compared to their representation in the general pharmacist workforce. This disparity is particularly pronounced for female pharmacists from ethnically diverse backgrounds, who make up 31.9% of all pharmacists but only 24.2% of those in band 8a and above, with a steep decline from 27.6% at band 8a to just 5.9% at band 91,2. To begin addressing this, we piloted the ENhancing leadershIp amonGst ethnically diverse feMale phArmacists (ENIGMA) mentoring scheme in general practice within Leeds. Aim The aim was to determine whether ENIGMA mentoring relationships supported leadership skill development, fostered networking, and developed authentic allies. We assessed the success of the pilot by exploring the perspectives of mentors and mentees and identifying their satisfaction with the scheme. Methods We recruited 18 experienced female senior leaders as mentors for ENIGMA. Mentee recruitment was conducted through dissemination of a flyer via social media, Microsoft Teams, email, and citywide meetings, offering places to the first 18 pharmacists who expressed interest, with no selection process. Mentors and mentees were paired based on mentee goals and mentor expertise. Mentees met their mentor 3 times in a 6-month period. Evaluation was undertaken through Microsoft Forms questionnaires completed anonymously by both mentors and mentees exploring how they experienced ENIGMA, benefits of the scheme, if they felt the scheme had enabled leadership skill development and how it had (or anticipated it would) impact(ed) on career development for the mentee. Ethical approval was deemed unnecessary as this was a service evaluation. Neither author-affiliated organisation is associated with the project. Results Of 18 mentoring pairs, 13 successfully completed the 6-month program. For five pairs, mentees did not establish contact. 62% of mentors responded to the questionnaire. 88% felt a positive impact on their mentoring skills and described a noticeable increase in mentee confidence and career focus. 100% of mentors would recommend the scheme. For mentees, 62% responded. 88% were ‘most satisfied’ with the experience and 88% felt their leadership skills improved because of participating. 75% met specific goals and 88% commented particularly on positive impact of the scheme. 100% of mentees would recommend ENIGMA to others. Discussion/conclusion The pilot was a great success, impacting positively on mentors and mentees. All responding participants would recommend it to others. Mentors and mentees expressed some challenges: finding a mutual time for meetings, and support from employers to use work time for meetings. Questionnaires were not returned by 38% of participants, which is a potential limitation. An identified improvement is to offer mentors an alternative mentee if their original mentee does not make contact. Offer of an annual ENIGMA cohort will continue in Leeds. Additionally, a second pilot is planned in another Integrated Care Board (ICB) to establish how ENIGMA could work in a different area, and if successful, we intend to share this model nationally.

Physician perspectives on communication quality in pediatric care.

We aimed to explore physician perspectives on communication quality across pediatric contexts. We conducted semi-structured interviews over a 4-month period. Purposive sampling was conducted to ensure a broad sampling of pediatricians from multiple subspecialties and practice settings. Interviews were conducted until thematic saturation was reached. An interview guide was created based on existing literature. Interviews were transcribed and analyzed for key themes. Eleven pediatricians enrolled in our study. Following thematic analysis, results were organized into four primary themes: Communication Education, High Quality Communication; Low Quality Communication; and Communication Factors and Barriers. Participants prioritized information transfer as a key aspect of communication quality. They identified communication quality as having wellness implications for clinicians. Participants prioritize information transfer and state that clinicians often neglect bidirectional information exchange. Participants often lacked formal communication skills training which may make it difficult to navigate common barriers such as language and cultural differences, lack of time, and interprofessional dysfunction. Formal communication skills training may help overcome challenges and may enhance physician wellness while improving patient care. While the importance of clinician-parent communication in pediatric settings has been established, little is known about provider perceptions of communication quality. Participants identified information transfer as a key aspect of communication quality, often neglecting bidirectional information exchange. Participants often lacked formal communication skills training which may make it difficult to navigate common barriers such as language and cultural differences, lack of time, and interprofessional dysfunction. Formal communication skills training may help with these challenges and may enhance physician wellness while improving patient care. More work is needed to explore the impact of communication skills training on each of these factors.

Perinatal optimisation and predictive testing of in utero transfers and their outcome: A regional study.

To review in utero transfers (IUT), their antenatal optimisation strategies including predictive testing and outcomes in a large region in the UK. All IUT requests received by regional transport service in the UK, over a 12-month period, were reviewed gathering information on gestation at referral, antenatal corticosteroid use, tocolysis, magnesium sulphate, predictive test use (and result if applicable) and delivery outcome at 48 h. The reason for transfer was also collated to determine capacity issues. Only 22.9% of women transferred delivered within 48 h of transfer, with only 76% of eligible women receiving antenatal steroids. The overall use of predictive testing was low, in 23.5% of all referrals. Approximately 19.8% of women presenting at 30 weeks gestation or more received predictive testing while only 26.5% of women at risk of extreme preterm delivery had a predictive test, and 40.7% of all IUT requests were for capacity reasons. More predictive testing with accurate approaches to predicting imminent preterm labour and delivery needs to be incorporated into clinical care to reduce the number of inappropriate IUTs. Appropriate antenatal optimisation to improve outcomes should be offered to women undergoing an IUT. Capacity remains problematic leading to a significant number of transfers.

Phase IV adaptive randomised clinical trials evaluating efficacy and cost-efficacy of pre-emptive pharmacogenetic genotyping strategies in the Spanish National Health System: iPHARMGx Master Protocol and PREVESTATGx nested clinical trial

IntroductionGenetic variations impact drug response, driving the need for personalised medicine through pre-emptive pharmacogenetic testing. However, the adoption of pre-emptive pharmacogenetic testing for commonly prescribed drugs, such as statins, outside...

Association of daily physical activity with pulmonary artery pressure in HFpEF and HFmrEF NYHA class III patients: a pilot trial-feasibility and first results.

Supervised physical exercise has been shown to benefit patients with heart failure with preserved/mildly reduced ejection fraction (HFpEF/HfmrEF) by improving symptoms and diastolic function. This study aimed to investigate the correlation between unsupervised daily physical activity and changes in daily pulmonary artery pressure (PAP) in patients with stable NYHA class III heart failure (HF) and left ventricular ejection fraction (LVEF) of 45% or higher. Daily physical activity was monitored over a 3-month period using a Holter-ECG with an accelerometer that calculated an activity-associated, heart rate-derived metabolic equivalent of task (MET) score. PAP was measured using an implanted sensor in 17 patients. During 3months of PAP monitoring in parallel with Holter ECG in our HF patients (median age 77 [IQR 72-79.5] years, LVEF 55 [49-56] %, mean cardiac index 1.9 ± 0.3), mean, diastolic, and systolic PAP remained unchanged. Patients engaged in unsupervised daily activity with a mean MET score of 5.0 ± 1.2 and a median daily duration of 41 [13-123] minutes. Intensity of daily activity was associated with a higher diastolic PAP on the following day (R2 = 0.017, p = 0.003), particularly in female patients and those with pulmonary hypertension (PH) (female: R2 = 0.044, p = 0.002; PH: R2 = 0.024, p = 0.004). Patients with longer daily activity durations had lower systolic and mean PAP (p = 0.038 and p = 0.048) and a similar diastolic PAP (p = 0.053) after 3months. Tracking changes in daily PAP based on intensity and duration of unsupervised daily activity using implanted sensors and a PocketECG® is feasible. While daily activity duration was not directly linked to diastolic PAP on the first day after daily activity, intensity, especially in female and PH patients, was associated with increased diastolic PAP. In addition, longer daily activity, rather than higher intensity, might be more important for lowering PAP in the long term. Further research in larger trials is warranted to confirm these findings.

Pre-Exposure Prophylaxis for the Prevention of HIV-1: An Assessment of Oral Pre-Exposure Prophylaxis Usage Patterns, First Evidence of HIV-1, and HIV-1 Risk Factors in the United States.

In clinical trials, once-daily oral tenofovir-based pre-exposure prophylaxis (PrEP) significantly reduced HIV-1 acquisition risk; however, this was highly dependent on medication adherence and persistence. We report clinical characteristics, PrEP usage patterns, first evidence of HIV-1, and associated risk factors among adults with commercial insurance using oral PrEP in the United States using health plan claims from the IQVIA PharMetrics® Plus database between January 1, 2015, and March 31, 2020, from individuals who newly initiated emtricitabine/tenofovir disoproxil fumarate (FTC/TDF) or FTC/tenofovir alafenamide (TAF) for daily PrEP. Overall, 25,419 individuals were included (FTC/TDF, n = 24,232; FTC/TAF, n = 1187), with generally similar characteristics reported during the 6-month baseline period across cohorts. Mean follow-up length was 504 and 77 days for FTC/TDF and FTC/TAF, respectively, corresponding with the 2019 approval of FTC/TAF for PrEP. Similarly, mean PrEP use duration was 354 and 68 days for FTC/TDF and FTC/TAF, respectively. PrEP breaks (>90-day gap) were observed in 11.1% of individuals using FTC/TDF, with a mean break duration of 249 days; 20.0% of individuals using FTC/TDF and 7.3% using FTC/TAF had ≥1 sexually transmitted infection diagnosis during follow-up. From 6 to 12 months of follow-up, mean FTC/TDF proportion of days covered (PDC; 0.74 vs. 0.67) and persistence (70.2% vs. 57.4%) decreased; real-world PDC and persistence were lower than reported in globally conducted clinical trials. First evidence of HIV-1 was infrequent among individuals using FTC/TDF (0.6%), though 60.3% had PrEP on hand when HIV-1 definition was met; high-risk sexual behavior, syphilis, and gonorrhea were the most important risk factors.

Investigation of the degradation behaviour of poly-L-lactic acid braided stents under real-time and accelerated conditions

Degradation tests are a key step in the development of a bioresorbable stent. The present study focused on the degradation of bioresorbable stents made from PLLA filaments, and examined the variation of the physical, thermal, and mechanical properties of the material and the devices under both real-time and accelerated degradation conditions. Results showed that the undegraded filaments were highly crystalline and composed by both α and α′ crystalline phases, induced by both the melt spinning and heat treatment processes. The latter was shown to have an important influence on the further formation of α crystalline phase and therefore crystalline structure perfectioning. Real-time degradation tests showed that the devices maintained structural stability for up to a year, meeting the required 6-month degradation period for vascular stents. Degradation was shown to primarily affect the crystalline regions, and to cause a gradual loss of material ductility before any mass loss or decrease in crystallinity. In turn, a constant decrease of molecular weight was observed, with stent failure occurring around day 389 due to a drop in molecular weight below 10,000 g/mol. Accelerated degradation tests mirrored real-time results until mass loss began. Subsequently a slower molecular weight decrease was observed, with an increase and subsequent decrease of material crystallinity. The consistency of the data obtained between real-time and accelerated degradation before mass loss confirmed the possibility to gain insights into real-time degradation through an accelerated protocol. However, attention must be paid to the initial molecular weight of the material, which has been shown to highly influence the acceleration rate. This study provides a wide range of experimental data both on the real-time and thermally accelerated degradation behaviour of PLLA braided stents that can be used as benchmark for further studies in the field.

High immunity and low mortality after Omicron and mass event in Cameroon despite low vaccination

Background: Little is known about the evolution of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) immunity in African communities.Aim: We evaluated changes in anti-SARS-CoV-2 antibodies, mortality and vaccination status in Cameroon between August 2021 and September 2022 to begin describing the evolution of the pandemic in Africa.Setting: The study was conducted across Cameroon’s 10 regional capitals, between 2021 and 2022 as the country hosted a mass gathering.Methods: We conducted a cross-sectional population-based survey in 2022, including SARS-CoV-2 seroprevalence testing and retrospective mortality estimation using two-stage cluster sampling. We estimated and compared seroprevalence and crude mortality rates (CMR) to a survey conducted in 2021 using the same methodology.Results: We performed serologic testing on 8400 individuals and collected mortality data from 22 314 individuals. Approximately 5% in each survey reported SARS-CoV-2-vaccination. Rapid diagnostic test-based seroprevalence increased from 11.2% (95% confidence interval [CI]: 10–12.5) to 59.8% (95% CI: 58.3–61.2) between 2021 and 2022, despite no increase in the proportion vaccinated. The CMR decreased from 0.17 to 0.06 deaths per 10 000 persons per day between 2021 and 2022. In 2022, no deaths were reportedly attributable to COVID-19 as compared to 17 deaths in 2021.Conclusion: Over a 12-month period encompassing two waves of omicron variant SARS-CoV-2 and a mass gathering, SARS-CoV-2 seropositivity in Cameroon approached 60%, and deaths declined despite low vaccination coverage.Contribution: This study challenges the assumption that high immunisation coverage is the sole determinant of epidemic control in the African context and encourages policymakers to increasingly rely on local research when designing response strategies for more effective outbreak management.

Efficacy of Sutureless Scleral Fixation of One-Piece T-Shaped Haptic Intraocular Lens in Maintaining Anterior Chamber Stability During Descemet Membrane Endothelial Keratoplasty in Vitrectomized Eyes: Leak Test and Iris Diaphragm Reconstruction

Objectives: This study aimed to describe the outcomes of a staged procedure combining Descemet membrane endothelial keratoplasty (DMEK) and sutureless scleral fixation (SSF) of a one-piece intraocular lens (IOL) in a case series. Co-performing endothelial keratoplasty (EK) and SSF is associated with intraoperative and postoperative complications such as graft deployment difficulties, air migration, graft detachment, and IOL opacification or tilt, all of which are evaluated in this study. Methods: This is a retrospective observational case series. Clinical data were collected from eight eyes of eight patients who underwent DMEK for endothelial failure and had previously received an SSF with one-piece IOL following complete vitrectomy. During DMEK surgery, an air leak test was conducted to check for air migration into the posterior chamber. If instability was detected, pupilloplasty was performed. Intraoperative and postoperative data, including DMEK graft unfolding time, were collected. Corrected Distance Visual Acuity (CDVA), refraction, endothelial cell density (ECD), central corneal thickness (CCT), intraocular pressure (IOP), and complications were recorded over a 12-month follow-up period. Results: We performed pupilloplasty in four patients (50%). The median CDVA improved from preoperative 0.85 logMAR (range: 0.60 to 1.00) at baseline to 0.18 logMAR (range: 0.10 to 0.70, p = 0.012) at 12 months. The median refraction value changed significantly from −1.00 to −0.50 at 12 months. The median percentage reduction in ECD after 12 months was 33.4% (range 30 to 40). The median baseline CCT was 689 μm (range: 651 to 701) at baseline visit and 541.5 μm (range: 525 to 591, p = 0.008) at 12 months. The median IOP was reduced significantly during follow-up. The median graft unfolding time was 6 min (5 to 9). One patient required rebubbling for partial detachment on postoperative day one. No complications occurred within 12 months. Conclusions: The effective compartmentalization of the anterior and posterior chambers in vitrectomized eyes with an SSF one-piece IOL and pupilloplasty can facilitate critical steps of DMEK surgery in complex eyes. Additionally, the air leak test could prove useful in identifying the need for iris-lens diaphragm reconstruction.

Evaluation and Analysis of the Clinical Effects of Laparoscopic Surgery for Pediatric Direct Inguinal Hernia.

Objective: To assess both the clinical effectiveness and practical experience of utilizing laparoscopic methods for addressing direct inguinal hernia in the pediatric population. Method: The study collected clinical data from 10 pediatric patients with direct inguinal hernia treated at the Children's Hospital of Anhui Province from July 2014 to July 2023. Among them, there were 8 males and 2 females, with an average age of 43.4 ± 22.0 months. All were initially diagnosed with indirect inguinal hernia before surgery. During the laparoscopic procedures, direct hernia was confirmed. Two cases had undergone open hernial sac high ligation surgery due to misdiagnosis as indirect hernia, resulting in recurrent groin bulges postoperatively. For these cases, laparoscopic direct hernia neck ligation with reinforcement and repair using the inner side of the umbilical ligament was performed. Results: All 10 cases of pediatric patients underwent surgeries smoothly without any need for open conversion. The average surgical duration was 29.8 ± 15.0 minutes, with minimal intraoperative bleeding. Patients were discharged on the first day postoperatively, and no significant surgery-related complications were observed. During the 12-month follow-up period, it was noted that the scar at the umbilical ring was superficial and inconspicuous. There were no occurrences of hernia recurrence, testicular retraction, or atrophy. Conclusion: Laparoscopic treatment for pediatric direct inguinal hernia has demonstrated favorable therapeutic outcomes, ensuring a safe surgical process, rapid recovery, and a low postoperative recurrence rate. The laparoscopic approach, specifically utilizing direct hernia neck ligation with reinforcement and repair using the inner side of the umbilical ligament, proves to be a secure and effective treatment for pediatric direct inguinal hernia. It can be considered as a conventional treatment method.

Behavioural and neuronal substrates of serious game-based computerised cognitive training in cognitive decline: randomised controlled trial.

Investigations of computerised cognitive training (CCT) show heterogeneous results in slowing age-related cognitive decline. To comprehensively evaluate the effectiveness of serious games-based CCT, integrating control conditions, neurophysiological and blood-based biomarkers, and subjective measures. In this bi-centric randomised controlled trial with parallel groups, 160 participants (mean age 71.3 years) with cognitive impairment ranging from subjective decline to mild cognitive impairment, were pseudo-randomised to three arms: an intervention group receiving CCT immediately, an active control (watching documentaries) and a waitlist condition, which both started the CCT intervention after the control period. Both active arms entailed a 3-month intervention period comprising a total of 60 at-home sessions (five per week) and weekly on-site group meetings. In the intervention group, this was followed by additional 6 months of CCT, with monthly booster sessions to assess long-term training effects. Behavioural and subjective changes were assessed in 3-month intervals. Biological effects were measured by amyloid blood markers and magnetic resonance imaging obtained before and after training. Adherence to the training protocol was consistently high across groups and time points (4.87 sessions per week). Domain-specific cognitive scores showed no significant interaction between groups and time points. Significant cognitive and subjective improvements were observed after long-term training. Voxel-based morphometry revealed no significant changes in grey matter volume following CCT, nor did amyloid levels moderate its effectiveness. Our study demonstrates no benefits of 3 months of CCT on cognitive or biological outcomes. However, positive effects were observed subjectively and after long-term CCT, warranting the inclusion of CCT in multicomponent interventions.

Treatment satisfaction and effectiveness of Lurasidone on quality of life and functioning in adult patients with schizophrenia in the real-world Italian clinical practice: a prospective 3-month observational study.

Although second-generation antipsychotics (SGAs) have proven to be effective therapeutic options for patients with schizophrenia, there is a notable lack of evidence on patients' subjective perspectives regarding their well-being, quality of life, and satisfaction with these medications. This study aimed to evaluate the treatment satisfaction and effectiveness of lurasidone on quality of life and functioning in adult patients with schizophrenia in real-world Italian clinical practice. This was a multicentre, national, non-interventional, single-arm, 3-month prospective study. Patients who were naive to lurasidone treatment and whose treating physician had decided to start them on this medication were enrolled and evaluated over a 3-month period. Eligible patients were adults (≥ 18 years of age) with a primary diagnosis of schizophrenia who were being treated with lurasidone (for the first time [i.e., they were lurasidone naive]) as part of routine clinical practice. Efficacy endpoints were changes in patient/caregiver treatment satisfaction (seven-point Likert scale from the Treatment Satisfaction Questionnaire for Medication), patient quality of life and functioning (QLS), investigator-rated global assessment of functioning (CGI-S, IAQ) after 6 weeks and 3 months of lurasidone, and number of relapses and hospitalizations. Sixty-one patients were enrolled and 59 completed the study. The median dosage of lurasidone at baseline was 37.00mg/day. The median duration of titration was 86.0 days (Min 28; Max 115 days); the median number of dosage changes was 1.0. At the end of 3-month observation period, the median dose of lurasidone was 74.00mg/day. QoL and Functioning Score showed a trend of improvement over time, reaching a mean change from baseline of 9.8 at the end of the study. According to the CGI-S, the percentage of patients who were "markedly or severely ill" showed a continuous decrease from baseline to 3 months, from 62.29% to 8.20%. Patient satisfaction increased over time, with 80.32% of patients reporting that they were somewhat, fairly, or very satisfied (including 63.93% who were completely or very satisfied) at the end of the study. No relapses/hospitalizations for psychiatric reasons were reported. Lurasidone was well tolerated with no safety concerns or discontinuations due to AEs. Lurasidone represents a valid option for the treatment of schizophrenia and positively affects subjective well-being, quality of life and satisfaction. NCT06527885 retrospectively registered (01/08/2024).

A Study on 128 Slice MDCT unit in a Tertiary Care Teaching Hospital with Special Emphasis on Work Flow and Break-Even Analysis

Purpose: To study the Cost Analysis of 128 Slice MDCT unit in a tertiary care teaching hospital Materials and methods: The study followed a biphasic design, comprising both retrospective and prospective components. The retrospective phase involved a record-based analysis conducted over a 3-month period, while the prospective phase included record review, observational methods, interviews, and material evaluation relevant to the study, carried out over the course of 1 month. Results: The cost of running the 128 Slice MDCT unit, including manpower, was calculated for a 3-month period, with an average of 28 cases per day. The unit handles a total workload of 54 TR (15 TR + 35 TR + 4 TR). Power is supplied by a 120KVA UPS located in the unit's UPS room. Depreciation for the building, with a lifespan of 100 years, is set at 1% of the capital cost. For an area of 51.2 sqm, the construction cost totals Rs 19,18,208/-, with a depreciation cost of Rs 47,955/- over 3 months. According to the CPWD manual, the annual maintenance cost is Rs 5104/- per sq.m., resulting in a maintenance expense of Rs 65,331/-. Additional costs for electricity, water, and linen over the 3-month period were also factored in. The breakeven point for the unit is estimated to be 744 days (approximately 2 years and 14 days). Conclusion: Getting each patient into and out of the procedure room in a timely manner can add minutes and maybe even hours to the daily schedules, allowing for the accommodation of a greater number of cases. Increasing the number of procedures performed per day or week can add to overall income.

A case study on the effect of contaminated inlet tubes on the accuracy of mid-cost optical particle counters for the ambient air monitoring of fine particles

This study investigates the impact of the long-term use of inlet-heated tubes on the performance of mid-cost optical particle counters (OPCs) for ambient air monitoring of fine particles (PM2.5). Two OPCs, equipped with inlet-heated tubes, were deployed over a 6-month period, with a beta attenuation monitor (BAM) serving as the reference device. The performance of the OPCs using the same inlet tubes for the first 3 months was compared to their performance after the frequent replacement of clean tubes during the final 3 months. The correlation coefficients (r2) for the 1 h and 24 h average PM2.5 concentrations between the OPCs and the BAM were lower with long-term contaminated tubes (0.82 < r2 < 0.93) compared to clean tubes (r2 > 0.93). The relative mean errors and biases significantly increased over time with contaminated tubes. Temperature, humidity, precipitation, and wind speed were found to have an insignificant effect (r2 < 0.1) on the performance of the two OPCs with inlet-heated tubes over the 6-month period. The relative average PM2.5 error when using clean tubes was less than 4%. These findings highlight the importance of inlet-heated tubes in improving OPC performance, particularly for mitigating humidity effects.Graphical

A hip and knee orthopaedic specialist triage service evaluation: comparing physiotherapists and chiropractors in an NHS pathway

Background: The burden of musculoskeletal pain and disability is a global problem; reducing waiting times and improving access to care is part of the solution. The need to widen the workforce to improve access is well documented. A possible solution could be chiropractors and allied health professionals working together in a multidisciplinary environment where workforce demands are high. Aims: This service evaluation sought to assess the outcomes of two groups of healthcare professionals in managing a hip and knee orthopaedic interface caseload. The two groups were physiotherapists and chiropractors. Methods: The two groups of healthcare professionals completed an internal competency programme based on national standards. They were evaluated based on outcomes from an interface service as part of a commissioned NHS pathway in a university setting for hip and knee complaints. A total of 810 contacts were achieved over a 7-month period in 2023. Findings: The two groups were comparable in the rate of imaging ordered (MRI, ultrasound and X-ray); while chiropractors ordered less Magnetic resonance imaging (MRI) and offered more self-management advice, the overall results were similar. NHS friends and family tests were also comparable and positive. Conclusions: Physiotherapists working with chiropractors produce similar outcomes within a musculoskeletal lower limb triage service.

Encapsulated Predatory Bacteria Efficiently Protect Potato Tubers from Soft Rot Disease.

Soft rot Pectobacteriaceae (SRP) are a group of destructive Gram-negative phytopathogens that can infect a wide range of plant hosts, including potatoes. There are no effective control agents available against SRP, making their management challenging. We have developed a novel approach to protect potato tubers against SRP. It makes use of encapsulated predatory Bdellovibrio bacteriovorus bacteria that, upon release from a polymeric carrier, prey upon SRP. We applied a carrageenan-trehalose-based formulation containing a B. bacteriovorus HD100 predator to prevent soft rot disease development in potato tubers, under various conditions. The dried formulation exhibited very high stability over an 18-month period at room temperature (∼25°C), in contrast to unencapsulated suspensions of the predator, in which viability decreased rapidly below detection level. The rehydrated formulation was as efficient as freshly grown unencapsulated predators and provided high protection in potted potato tubers, displaying an average of 50% reduction in disease parameters (e.g., tissue decay and disease index) under controlled conditions at 7 days postinoculation and planting. The protective effect provided by this formulation was maintained in longer-term trials (28 days) conducted in larger vessels within a net house under natural climate conditions, highlighting its potential for practical application in the field.

Predicting Performance of Call Center Staff: The Role of Cognitive Ability and Emotional Intelligence

This study examined the relationship between cognitive ability (IQ) and emotional intelligence (EQ) in predicting a range of different performance metrics from a call centre environment. In all, 303 call centre staff completed multi-dimensional measures of both EQ and IQ. We also had recorded nine performance data measures for each individual over a 12-month period. There were a few significant correlations with IQ (4/35) and a few more with EQ (4/28), though all EQ measures were related to “Errors Made over the year”. The performance metric that had most correlates was Average Handling Time (AHT) relating to speed of working. The number of errors an employee made was significantly positively correlated with all four EQ factors. Correlational and Structural Equation Model (SEM) analysis highlighted the importance of analysing performance metrics as distinct variables, finding contradictory evidence in the sense that some individual difference factors correlated positively with some and negatively with other outcome measures. The results are discussed in relation to the theoretical implications for researchers interested in analysing call centre performance, and also practical implications for organisations with call centres.