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Pharmacy Homeless Outreach Engagement Non-medical Independent Prescribing Rx (PHOENIx) community pharmacy-based pilot randomized controlled trial
Get PDFRandomized controlled trials (RCTs) aiming to address the multiple health and social challenges of people experiencing homelessness (PEH) are lacking. Here we report the findings from a multicenter, open, pilot RCT. The intervention involved independent prescriber pharmacist from the National Health Service working on outreach in partnership with dedicated workers from Homeless Voluntary Charity or Social Enterprises (HVCSEs) (Pharmacist and third sector charity worker integrated Homeless Outreach Engagement Non-medical Independent prescriber Rx’-PHOENIx) in low threshold HVCSE venues or temporary accommodation addressing PEH participants’ health and wider needs through repeated outreach. The trial aimed to investigate whether sufficient numbers of participants could be recruited, retained, the intervention delivered as planned, and sufficient data collected to inform a subsequent definitive RCT. Clinical outcomes were also collected at follow-up (6 months). Participants were recruited from five community pharmacies and nearby venues in urban centers of Glasgow-Scotland and Birmingham-England, then randomized one-to-one into PHOENIx intervention in addition to usual care (UC) or UC only. A priori progression criteria were achieved: 55% of those assessed as eligible were recruited; at 6 months, 72% remained in the study, 91% had emergency department and mortality data available, and 72% completed questionnaire booklets. Fifty-three percent of participants received at least 50% of the planned PHOENIx intervention consultations (in-person or phone) at 6 months. Signs of improvement in clinical outcomes in the PHOENIx group included fewer ambulance call-outs, ED visits, and hospitalizations; higher outpatient attendances; and higher scores on self-reported health-related quality of life. A definitive RCT is merited
Watching one more episode and reading one more chapter: what entertainment contexts lead to retrospective imaginative involvement?
Get PDFResearch on retrospective-imaginative-involvement (RII) suggests individuals reflect on and play around with favorite narratives long after the story ends. We investigated different factors of entertainment consumption that could impact stories' memorability and audiences' RII. Findings provide evidence that TV shows and books consumed consecutively for longer durations were more memorable and more likely to be targets of RII. Audience members who tend to binge-watch and use narratives to escape were more likely to engage in RII. Likewise, leisure time increased RII whereas stress decreased RII. Overall, this study highlights how one's memory of a story (and the factors that shape memorability) impacts imagination and fantasy. Results suggest that the formation of robust mental models about narratives could be facilitated through binge-watching which might help people recover from daily stressors through retrospective imagination
Iatrogenic injustice: an institutional ethnography of Fitness to Practise hearings
Get PDFThe public has an important role to play in the regulation of health and social care, including raising concerns about harms caused by health and social care professionals to improve the safety and quality of services. There is little evidence about the experiences of members of the public who engage in regulatory processes and raise concerns with regulators. We conducted an institutional ethnography of the experiences of public witnesses (patients, service-users or family members of patients and service-users) in Fitness to Practise hearings held in the UK 2021–2023. We found public witnesses' experiences of these processes were onerous and, often, disappointing. We argue that these negative experiences arose from the ruling relations of the regulatory powers. Witnesses were required to perform certain kinds of work to fulfil their role. The adversarial form of justice exercised by regulatory bodies entailed the systematic doubting of witnesses' testimonies; producing epistemic injustice. Witnesses were at risk of being made more vulnerable, in the sense of being exposed to further harm, through and by the Fitness to Practise processes. Troubling tensions were evident between witnesses’ experiences of Fitness to Practise and what they expected from institutions ostensibly concerned with upholding professional standards of practice and conduct to protect the public. We interpret the exercise of power observed by the regulators over public witnesses as iatrogenic injustice; harm caused by interactions between the public and institutions of health and social care. There are important implications for reduced public trust in health and social care systems and regulatory processes
Anopheles mosquito survival and pharmacokinetic modeling show the mosquitocidal activity of nitisinone
No full textOne approach to interrupting the transmission of insect-borne diseases that is successfully used in veterinary medicine is exploiting the ability of antiparasitic drugs to make vertebrate blood toxic for blood-feeding insects. Recent studies have identified 4-hydroxyphenylpyruvate dioxygenase (HPPD), an enzyme of the tyrosine detoxification pathway, as essential for hematophagous arthropods to digest their blood meals. Such blood-feeding insects include anopheline mosquitoes, which transmit malaria-causing Plasmodium parasites. A US Food and Drug Administration–approved HPPD enzyme inhibitor called nitisinone is a drug used to treat rare human-inherited disorders of the tyrosine pathway. Here, we demonstrate that feeding human blood containing nitisinone to insectary-reared female Anopheles gambiae mosquitoes was mosquitocidal to both young and old mosquitoes as well as insecticide-resistant Anopheles strains. Pharmacokinetic-pharmacodynamic (PK/PD) modeling of nitisinone’s dose-response relationship (when administered at the highest recommended doses for adults and children) demonstrated improved efficacy against mosquitoes compared with the gold standard endectocidal drug, ivermectin. Furthermore, blood samples from individuals with alkaptonuria (a rare genetic metabolic disorder in the tyrosine degradation pathway), who were taking a daily low dose of 2 milligrams of nitisinone, were shown to be lethal to mosquitoes. Thus, inhibiting the Anopheles HPPD enzyme with nitisinone warrants further investigation as a complementary intervention for vector control and the prevention of malaria transmission
The Double-Edged Impact of User Customisation on QoE in Personalised Media Experiences
No full textUser-driven experience customisation can potentially enhance the Quality of Experience (QoE) in personalised multimedia. Such experiences could be, for example, delivered using HTTP Adaptive Streaming - the most prominent way of consuming media over the Internet. In this paper, we present a subjective study designed to investigate the QoE impact of user-driven customisation in personalised media experiences. We offered participants the option to customise their video layout, after which we asked them to score a range of quality impairments found in HTTP Adaptive Streaming. Based on our analysis of the collected Mean Opinion Scores (MOS), we found that experience customisation impacts the QoE in a surprising way. We found that experience personalisation caused participants’ expectations to increase when it comes to QoE, as they perceived the most severe quality impairments worse than the control. This establishes the need for specialised QoE models that take into account different levels of user expectations
Risk factors for development of diabetic foot ulcer disease in two large contemporary UK cohorts
Get PDFAims:
Diabetic foot ulcer disease ( DFUD ) is common, life‐changing and associated with a lower 5‐Year survival rate than many cancers. However, the risk factors for DFUD have generally been identified in small, single‐centre, clinic‐based studies, many of which are cross‐sectional. This study aims to assess the incidence of DFUD and its related risk factors in two large, contemporary UK cohorts.
Materials and Methods:
We investigated common sociodemographic and clinical factors affecting the incidence rates of DFUD in two large representative independent cohorts of people with diabetes in England ( CPRD , n = 131 042) and Scotland (Scottish Diabetes Research Network‐National Diabetes Dataset [ SDRN ‐ NDS ] n = 260 748). The methods of case ascertainment differed between the two cohorts: in England, both primary and secondary care data were used, whereas in Scotland, secondary care and foot clinic data were used.
Results and Conclusions:
In the English cohort, 4.7% developed DFUD over a median of 4.3years (incidence rate 9.0[95%CI: 8.8–9.2] per 1000 person‐years) follow‐up; in the Scottish cohort, the equivalent figure was 2.9% over a median of 6.3 years (incidence rate 4.4 [95% CI: 4.3–4.5] per 1000 person‐years). Despite different methods of case ascertainment, multivariable analysis in both populations indicated that those who developed DFUD were more likely to be older, male, smokers, of White ethnicity, with higher systolic blood pressure and baseline HbA1c. These findings provide a robust evidence base for identifying people with diabetes at risk of DFUD for targeted efforts for prevention
Model-free estimation of the Cramér–Rao bound for deep learning microscopy in complex media
Get PDFArtificial neural networks have become important tools to harness the complexity of disordered or random photonic systems. Recent applications include the recovery of information from light that has been scrambled during propagation through a complex scattering medium, especially in the challenging case in which the deterministic input–output transmission matrix cannot be measured. This naturally raises the question of what the limit is that information theory imposes on this recovery process, and whether neural networks can actually reach this limit. To answer these questions, we introduce a model-free approach to calculate the Cramér–Rao bound, which sets the ultimate precision limit at which artificial neural networks can operate. As an example, we apply this approach in a proof-of-principle experiment using laser light propagating through a disordered medium, evidencing that a convolutional network approaches the ultimate precision limit in the challenging task of localizing a reflective target hidden behind a dynamically fluctuating scattering medium. The model-free method introduced here is generally applicable to benchmark the performance of any deep learning microscope, to drive algorithmic developments and to push the precision of metrology and imaging techniques to their ultimate limit
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