324139 research outputs found
Sort by
Patients’ acceptance of a penicillin allergy de-labelling programme in primary care: a qualitative study
Get PDFBackground About 6% of the UK general practice population has a record of a penicillin allergy but fewer than 10% of these people are likely to be truly allergic. Consequently, a significant portion of the population is denied first-line antibiotics. The ALlergy AntiBiotics And Microbial resistAnce (ALABAMA) trial aimed to determine if a penicillin allergy assessment pathway (PAAP) was safe and effective in de-labelling patients as allergic and improving antibiotic prescribing and patient health outcomes.
Aim To investigate patients’ experiences of penicillin allergy testing (PAT) and their acceptance of de-labelling following a negative allergy test.
Design & setting This was a qualitative study using semi-structured interviews with patients who took part in the PAAP intervention arm of the ALABAMA trial.
Method As part of a mixed-methods process evaluation embedded in the ALABAMA trial, we conducted interviews with patients in the PAAP intervention arm. Data from interviews with patients were analysed using thematic analysis.
Results Of the 28 participants interviewed, two received a positive PAT result and 26 received a negative PAT result; of these, 24 accepted and two declined de-labelling. At point of trial recruitment, many patients already doubted that they were allergic to penicillin. Patients were happy to attend PAT and felt cared for and safe at the hospital. These factors led to most people trusting their negative test result and accepting de-labelling.
Conclusion The patients we interviewed engaged with the PAAP intervention and, when testing negative, were predominantly willing to have their allergy record changed and to take penicillin in future. We highlight factors that influenced patients’ acceptance of de-labelling to facilitate future adoption of PAAP. These factors, which should be considered when planning for penicillin allergy testing services, were as follows: patients identifying themselves as low risk before the test; PAT being perceived as trustworthy and safe; patients' previous experience of penicillin allergy and reactions; patients' understanding of penicillin reactions; and clear communication after de-labelling
Short-term variability of chronic musculoskeletal pain
Get PDFChronic musculoskeletal (MSK) pain can be characterized by its temporal variability and evolution, affecting both pain management and treatment outcomes. While pain variability is traditionally studied over long timescales (e.g. days or weeks), few studies have explored short-term fluctuations (e.g. minutes to seconds) and their clinical relevance. This study investigated the short-term variability of chronic musculoskeletal pain across consecutive days, examining whether these fluctuations are stable, exhibit consistent temporal patterns, and relate to clinical severity. We also explored whether individuals with chronic MSK pain could predict their pain intensity on the following day, suggesting an ability to learn about their pain’s levels. Eighty-one participants with chronic MSK pain to the back, neck, leg or arm (22–65 years, 72% females, 28% males) rated their pain continuously over two days, using a smartphone-based app. Results indicated that pain ratings were stable and exhibited consistent temporal patterns across days, with a temporally correlated structure. High mean pain levels were associated with lower variability, possibly reflecting a stabilized pain state. Short-term pain variability negatively correlated with clinical severity, indicating that greater variability is linked to milder pain. These findings highlight the importance of short-term variability as a distinct and clinically relevant feature of chronic MSK pain, with implications for personalized pain management strategies
Enucleation for insulinoma: consolidating evidence through systematic review and meta-analysis
Get PDFBackground: Pancreas-preserving procedures such as enucleation (EN) are indicated for select patients with insulinomas. Despite the increasing popularity of EN, no consensus has been reached on the preferred surgical approach for the management of insulinomas. The aim of this meta-analysis of proportions is to evaluate the safety and efficacy of EN for patients with pancreatic insulinoma. Methods: Cochrane, Embase, PubMed, Scopus, and Web of Science were searched from database inception to December 2023. The pooled mean and proportions were analyzed using a random-effects model. The review was registered prospectively with PROSPERO (CRD42024492786). Results: Twenty-one studies with 803 patients met the inclusion criteria. The pooled mean tumor diameter was 1.5 cm (95%CI: 1.3–1.6). The pooled mean operative time was 142 min (95%CI: 118–166), postoperative hospital stay was 9.5 days (95% CI: 7.2–11.7), and estimated blood loss (EBL) was 71.3 mL (95% CI: 47.3–95.3). The overall postoperative occurrence rate was 37.3% (95%CI: 0.264–0.481, I2 = 92%, n = 277), including 27% (95%CI: 0.179–0.360, I2 = 90%, n = 176) with any postoperative pancreatic fistula (POPF) and 1.5% (95%CI: 0.000–0.030, I2 = 0%, n = 4) with new-onset diabetes. Additionally, the pooled overall recurrence rate was 3.1% (95%CI: 0.016–0.045, I2 = 7%, n = 31), and the pooled rate of postoperative mortality was 1.1% (95%CI: 0.002–0.023, I2 = 0%, n = 6). Conclusion: EN appears safe and effective in managing pancreatic insulinoma for selected patients, with low rates of grade C POPF and recurrence. Despite the promising results, more selective criteria based on the location of insulinoma with a larger sample size and extended follow-up periods are necessary to ascertain the safety and efficacy of the treatment. Graphical Abstract
Data associated with "A patchy-particle 3-dimensional octagonal quasicrystal"
No full textConfiguration files (.xyz format) for an ideal octagonal quasicrystal and its approximants, and for octagonal quasicrystals assembled in the simulations. Also included are vmd scripts for viewing the configurations
Evaluating dynamic norm messages and alternative interventions to reduce meat consumption in cafeterias
No full textTo meet UK Net-Zero emissions targets, meat consumption must decrease. We present results from two studies evaluating interventions to reduce purchasing of meat-containing meals across university cafeterias in Oxford, UK. Study 1 tested whether two dynamic descriptive norm messages changed meal purchasing. Over eight weeks, four cafeterias displayed a norm message incorporating a socially ‘close’ referent group and three cafeterias displayed a message incorporating a socially ‘distant’ referent group. Two cafeterias were assigned a no-message control condition. A generalised linear mixed effect model suggested both messages decreased odds of cafeteria diners purchasing vegetarian meals, in comparison to control, 'Close' Message: Ratio of Odds Ratios (ORs)=0.79, 95% 95% CI [0.72, 0.86]; 'Remote' Message: Ratio of ORs=0.84, 95% CI [0.76,0.92]. Study 2 involved three pre-post experiments testing whether different interventions changed meal purchasing: re-positioning vegetarian products, increasing vegetarian availability, and introducing vegetarian defaults. Generalised linear models suggested each intervention was associated with significant increases in odds of diners purchasing vegetarian meals, Positioning: OR=1.33, 95% CI [1.24,1.44]; Availability: OR=1.60, 95% CI [1.45, 1.75]; Defaults: OR=1.77, 95% CI [1.61, 1.95]. These study results could be due to norm messaging being less effective at promoting vegetarian meals than interventions in availability, defaults, and positioning. But, given the study designs, they could instead be due to self-selection effects, or regression to the mean
Gene Therapy Strategies for the Treatment of Bestrophinopathies
Get PDFThe BEST1 gene encodes a transmembrane protein in the retinal pigment epithelium (RPE) in the eye, that functions as a calcium-dependent chloride channel (CaCC). Pathogenic variants in BEST1 are the underlying cause for bestrophinopathies, a group of inherited retinal disorders that vary in their pattern of inheritance, clinical appearance, and underlying molecular disease mechanisms. Currently, there are no treatments available for any of the bestrophinopathies, and gene therapy represents an attractive strategy due to the accessibility of the eye and slow disease progression. While gene augmentation may be effective for a subset of bestrophinopathies, others require allele-specific silencing or correction of the disease-causing variant to reconstitute expression of the BEST1 protein. This review aims to give an overview of the clinical diversity of bestrophinopathies and proposes the molecular disease mechanism of the pathogenic BEST1 variant as an important parameter for the choice of treatment strategy. Furthermore, we discuss the potential of different mutation-specific and mutation-independent CRISPR/Cas9-based gene editing strategies as a future treatment approach for bestrophinopathies
Annotation of digital music notation documents: surveying needs for a generalised implementation
Get PDFThe ability to annotate music notation documents offers a powerful affordance to musicologists using digital libraries, and in the organisation and discovery of annotated sources within a music digital library. In this paper we first assess the current state of the art for annotating digital scores, then report on a survey conducted into existing uses and future needs elicited from the music library community. Analysing the survey results, we distinguish between extensions which might provide generalised annotation services for music notation software, versus application-specific interfaces and visualisations using such annotation services. Drawing upon the Web Annotation Data Model, we frame this distinction in terms of annotation targets and bodies, whereby specialist or customised bodies might utilise common shared mechanisms to address targets. We demonstrate the value of the latter by, for the first time, implementing support for annotation targets in the popular and widely used Verovio open source music engraving software, adding visual indications for enumerations and ranges encoded using the MEI element, and which can be manipulated in the resultant SVG image. We conclude that common mechanisms for specifying and implementing annotation targets are not only possible, but a practical and useful foundation for music digital library tools and infrastructure
Frequency analysis of two subsystems coupled by a spring-inerter-damper device and its application to continuous system for vibration control
Get PDFTwo continuous subsystems interconnected by a spring-inerter-damper device are common engineering configurations for vibration control. To address the problem of designing device parameters for optimal vibration control, comprehensive and systematic mathematical analyses are carried out for the minimum 2-degrees-of-freedom (DOF) system which includes two subsystems interconnected by a spring-inerter-damper device. Then, the equivalence between the 2DOF system and the full-scale continuous system is established, which allows the results of the 2DOF system to be directly transferrable to the original full-scale system. Results show that there is an optimal tuning condition in which two roots coalesce and both damping ratios reach equally high value at the first bifurcation. The device parameters at this point are derived mathematically, and used for optimal vibration control. The subcritical and supercritical conditions are also defined and the associated properties are derived. When applied to a continuous rotating beam-tendon system as a case study, the device parameters derived based on the equivalent 2DOF system are shown to be close to the optimal parameters with errors less than 6 %, and the performance of the resulting full-scale continuous system is almost identical to the optimal performance
Automatic assessment of spinal deformities in 2D and 3D
Get PDFScoliosis assessment still relies on 2D radiographs and manual measurements by expert clinicians. This thesis proposes deep learning pipelines that automate 2D measurements on dual energy X-ray absorptiometry (DXA) and 3D measurements on Magnetic Resonance Imaging (MRI), unifying 2D and 3D information. We start by the development of an end-to-end pipeline for 2D scoliosis assessment using DXA scans from the UK Biobank. This foundational work introduces a U-Net style network that segments six body parts including the spine, coupled with an iterative label refinement loop that effectively suppresses segmentation failures. Through cubic spline fitting, we derive precise spine curvature metrics, establishing the spinal geometric framework that underpins the following work in this thesis. We then shift to a 3D perspective by leveraging volumetric spine MRIs from the UK Biobank. Here, we develop a custom 3D U-Net-like model capable of accurately extracting spine meshes given limited annotation of the spine. This advancement enables comprehensive 3D shape analysis of the spine, capturing critical elements invisible in two dimensions, such as axial rotation and lordosis. The result is a richer set of biomarkers that enhance classification of spine deformity and scoliosis severity. Building on these advancements, we bridge the gap between imaging modalities by pioneering a technique to predict 3D spine shape directly from a single DXA scan. Our approach employs a vision transformer with a regression head that outputs spine curves from a cropped DXA image, allowing us to reconstruct the full 3D vertebral stack with sub-millimeter accuracy. This image-to-shape model creates opportunities for 3D insights in clinical settings using only low-dose DXA systems. We also develop an Automated DXA Scoliosis Method (DSM) that directly outputs the maximum angle of the spine, enabling fair comparison with human annotation. This automated approach is validated on manually annotated DXA scans by expert clinicians with strong agreement against expert annotations. The final stage of our research focuses on enhancing 3D segmentation of the spine to achieve vertebrae-level prediction. We address the challenge of generalizing segmentation to out-of-domain datasets by implementing test-time-adaptation techniques, further improving the robustness and clinical applicability of our methods
Distribution of bank offices in fascist Italy: a historical accident? New evidence from provincial data (1927–1936)
Get PDFAbstract
This paper examines the geographical distribution of bank offices in fascist Italy between 1927 and 1936, a period of critical banking consolidation, marked by the Great Depression and culminating in the 1936 banking law. We contribute to the ongoing debate between the Italian banking history literature—which emphasizes the complex interplay of economic, technical, and political factors—and the empirical economics literature, claiming the distribution of banks in 1936 as quasi-random: a “historical accident.” We fit into this debate by constructing a novel, detailed dataset of provincial-level economic and banking indicators for late 1920s Italy. With OLS regression and Principal Component Analysis, we rigorously assess the relationship between pre-Depression economic fundamentals and banks’ spatial organization. We document a strong and persistent correlation between the 1928 and the 1936 branch networks, and that local economic conditions are good predictors of both the 1928 and the 1936 spatial distributions. Our findings challenge the “historical accident” narrative by showing that market forces fundamentally shaped Italy’s banking geography through the consolidation period. This research re-contextualizes the 1936 banking law not as an arbitrary political imposition, but as a codification of market-driven evolutions