British Thoracic Society Guideline for oxygen use in adults in healthcare and emergency settings

The full Guideline for oxygen use in adults in healthcare and emergency settings, published in Thorax1 provides an update to the 2008 BTS Emergency oxygen guideline.2 The following is a summary of the recommendations and good practice points. The sections noted to within this summary refer to the full guideline sections

Pervasive speleogenetic modification of cave passages by nitrification of biogenic ammonia

It has long been known that guano deposits from animals in caves can cause localised biogenic modification through a combination of acidity and altered environmental conditions, such as increased humidity and CO2. Geomorphological and geochemical evidence from the caves in the Gunung Mulu National Park, Sarawak, suggest this biogenic overprint may be far more widespread than previously thought due to microbial metabolic activity. Based on our observations, we propose a novel method of secondary cave enlargement by the conversion of highly soluble ammonia gas released by bat and swiftlet guano to NOx on surfaces by microbial ammonia oxidation. Our data suggest this activity produces aggressive nitric acid solutions on moist cave walls, accelerating limestone dissolution. This previously undescribed cave enlargement process has potentially profound geomorphological implications, as the original passage morphologies (which are used to interpret speleogenesis and landscape evolution) are erased and replaced with a distinctive suite of biogenic corrosion features. Such findings significantly alter our understanding of post-speleogenetic modification and secondary enlargement of caves in tropic environments

The Oxford Royal College of General Practitioners Clinical Informatics Digital Hub: Protocol to Develop Extended COVID-19 Surveillance and Trial Platforms

Background Routinely recorded primary care data have been used for many years by sentinel networks for surveillance. More recently, real world data have been used for a wider range of research projects to support rapid, inexpensive clinical trials. Because the partial national lockdown in the United Kingdom due to the coronavirus disease (COVID-19) pandemic has resulted in decreasing community disease incidence, much larger numbers of general practices are needed to deliver effective COVID-19 surveillance and contribute to in-pandemic clinical trials. Objective The aim of this protocol is to describe the rapid design and development of the Oxford Royal College of General Practitioners Clinical Informatics Digital Hub (ORCHID) and its first two platforms. The Surveillance Platform will provide extended primary care surveillance, while the Trials Platform is a streamlined clinical trials platform that will be integrated into routine primary care practice. Methods We will apply the FAIR (Findable, Accessible, Interoperable, and Reusable) metadata principles to a new, integrated digital health hub that will extract routinely collected general practice electronic health data for use in clinical trials and provide enhanced communicable disease surveillance. The hub will be findable through membership in Health Data Research UK and European metadata repositories. Accessibility through an online application system will provide access to study-ready data sets or developed custom data sets. Interoperability will be facilitated by fixed linkage to other key sources such as Hospital Episodes Statistics and the Office of National Statistics using pseudonymized data. All semantic descriptors (ie, ontologies) and code used for analysis will be made available to accelerate analyses. We will also make data available using common data models, starting with the US Food and Drug Administration Sentinel and Observational Medical Outcomes Partnership approaches, to facilitate international studies. The Surveillance Platform will provide access to data for health protection and promotion work as authorized through agreements between Oxford, the Royal College of General Practitioners, and Public Health England. All studies using the Trials Platform will go through appropriate ethical and other regulatory approval processes. Results The hub will be a bottom-up, professionally led network that will provide benefits for member practices, our health service, and the population served. Data will only be used for SQUIRE (surveillance, quality improvement, research, and education) purposes. We have already received positive responses from practices, and the number of practices in the network has doubled to over 1150 since February 2020. COVID-19 surveillance has resulted in tripling of the number of virology sites to 293 (target 300), which has aided the collection of the largest ever weekly total of surveillance swabs in the United Kingdom as well as over 3000 severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) serology samples. Practices are recruiting to the PRINCIPLE (Platform Randomised trial of INterventions against COVID-19 In older PeopLE) trial, and these participants will be followed up through ORCHID. These initial outputs demonstrate the feasibility of ORCHID to provide an extended national digital health hub. Conclusions ORCHID will provide equitable and innovative use of big data through a professionally led national primary care network and the application of FAIR principles. The secure data hub will host routinely collected general practice data linked to other key health care repositories for clinical trials and support enhanced in situ surveillance without always requiring large volume data extracts. ORCHID will support rapid data extraction, analysis, and dissemination with the aim of improving future research and development in general practice to positively impact patient care. International Registered Report Identifier (IRRID) DERR1-10.2196/19773 </jats:sec

Influência da compactação do solo em subsuperfície sobre o crescimento aéreo e radicular de plantas de adubação verde de inverno

Soil compaction has been a very common problem on the fields, affecting growth and yield of the crops as well as soil and water conservation. In order to study this problem, five winter green manure species (Vicia sativa; Raphanus sativus; Lupinus albus; Avena strigosa and Avena sativa) were cultivated in four soil profiles with increasing levels of subsurface compaction (soil bulk densities: 1.31, 1.43, 1.58 and 1.70 Mg m-3). The experiment was carried out in pots under greenhouse conditions at FCA/UNESP in Botucatu, São Paulo in 1998, using a sandy loam Dark Red Latosol (Acrudox). As soil compaction increased, root length and dry matter increased above the compacted layer decreasing below it, concentrating the root system of the plants close to the surface. Root mean diameter of L. albus, A. strigosa and A. sativa increased in the compacted layer with increasing soil density, decreased for V. sativa and was not altered for R. sativus. Raphanus sativus and A. strigosa showed the best performances on root growth, with higher values of root length density in both compacted and inferior soil layers, and in the pot as a whole, even with increasing soil compaction. This study shows that R. sativus and A. strigosa came out as good materials for ameliorating the characteristics of soils with subsurface compaction, showing vigorous root growth inside and below the compacted laye. These results, however, should be validated in the field, under different soil and climate conditions.A compactação do solo é um problema comum nas lavouras e que influi tanto no crescimento e na produtividade das culturas, como na conservação do solo e da água. A fim de estudar esse problema, cinco espécies de plantas de adubação verde de inverno (ervilhaca, nabo forrageiro, tremoço branco, aveia preta e aveia branca) foram cultivadas em quatro perfis de solo com crescentes níveis de compactação em subsuperfície (Ds: 1,31, 1,43, 1,58 e 1,70 Mg m-3). O experimento foi realizado em vaso e sob condição de casa de vegetação na FCA/UNESP, em Botucatu (SP), em 1998, utilizando um LE de textura média. Com o aumento da compactação do solo, o comprimento e a matéria seca das raízes aumentaram acima da camada compactada e diminuíram abaixo dela, concentrando o sistema radicular das plantas próximo à superfície. O diâmetro radicular médio do tremoço e das duas aveias aumentou na camada compactada com o aumento da densidade do solo, diminuiu para o caso da ervilhaca e não se alterou para o caso do nabo. O nabo forrageiro e a aveia preta sobressaíram-se com maiores valores de densidade de comprimento radicular na camada compactada e inferior e no vaso como um todo, mesmo com o aumento da compactação. Concluiu-se, neste estudo, que o nabo forrageiro e a aveia preta apresentaram-se como bons materiais, para melhorar as características de solos com compactação subsuperficial, mostrando vigor no crescimento de raízes dentro e abaixo da camada compactada do solo, devendo-se, entretanto, validar estes resultados no campo, em condições diferentes de clima e solo.Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)Universidade Estadual Paulista - UNESP Faculdade de Ciências Agroveterinárias - FCAUNESP FCA Departamento de Agricultura e Melhoramento VegetalUniversidade Estadual Paulista - UNESP Faculdade de Ciências Agroveterinárias - FCAUNESP FCA Departamento de Agricultura e Melhoramento Vegeta

Gastrointestinal symptoms and association with medication use patterns, adherence, treatment satisfaction, quality of life, and resource use in osteoporosis: baseline results of the MUSIC-OS study

Summary: The Medication Use Patterns, Treatment Satisfaction, and Inadequate Control of Osteoporosis Study (MUSIC-OS) is a prospective, observational study of women with osteoporosis in Europe and Canada. At baseline, patients with gastrointestinal symptoms reported lower adherence to osteoporosis treatment, treatment satisfaction, and health-related quality of life, than those without gastrointestinal symptoms. Introduction: The aim of the study was to examine gastrointestinal (GI) symptoms and the association between GI symptoms and treatment adherence, treatment satisfaction, and health-related quality of life (HRQoL) among osteoporotic women in Europe and Canada. Methods: Baseline results are reported here for a prospective study which enrolled postmenopausal, osteoporotic women who were initiating (new users) or continuing (experienced users) osteoporosis treatment at study entry (baseline). A patient survey was administered at baseline and included the occurrence of GI symptoms during 6-month pre-enrolment, treatment adherence (adherence evaluation of osteoporosis (ADEOS), score 0–22), treatment satisfaction (Osteoporosis Treatment Satisfaction Questionnaire for Medications (OPSAT-Q), score 0–100) and HRQoL (EuroQol-5 dimension (EQ-5D) utility, score 0–1; OPAQ-SV, score 0–100). The association between GI symptoms and ADEOS (experienced users), OPSAT-Q (experienced users), and HRQoL (new and experienced users) was assessed by general linear models adjusted for patient characteristics. Results: A total of 2959 patients (2275 experienced and 684 new users) were included. Overall, 68.1 % of patients experienced GI symptoms in the past 6 months. Compared with patients without GI symptoms, patients with GI symptoms had lower mean baseline scores on most measures. The mean adjusted differences were ADEOS, −0.43; OPSAT-Q, −5.68; EQ-5D, −0.04 (new users) and −0.06 (experienced users), all P < 0.01. GI symptoms were also associated with lower OPAQ-SV domain scores: physical function, −4.17 (experienced users); emotional status, −4.28 (new users) and −5.68 (experienced users); back pain, −5.82 (new users) and −11.33 (experienced users), all P < 0.01. Conclusions: Patients with GI symptoms have lower treatment adherence and treatment satisfaction and worse HRQoL than patients without GI symptoms

Outpatient hospital attendances in people with rheumatoid arthritis during the COVID-19 pandemic and beyond: a cohort study in three nations of the UK

Objectives We aimed to estimate how rheumatology outpatient hospital attendances have changed since the COVID-19 pandemic and determine demographic characteristics associated with observed changes. Methods Using three primary and secondary care electronic health record datasets in England (with the approval of NHS England), Scotland and Wales, we identified people with a diagnosis of RA before 1 April 2019. We determined the proportion of people with rheumatology hospital outpatient appointments each month [April 2019 to December 2022 (Wales and Scotland), November 2023 (England)] and quantified changes using interrupted time-series analysis. We used logistic regression to determine characteristics associated with having fewer appointments compared with 2019. Results We identified 145 065, 3813 and 13 637 people coded with RA in England, Scotland and Wales, respectively. At the start of the COVID-19 pandemic the number of rheumatology outpatient appointments dropped sharply across all nations. In England and Scotland, the percentage of monthly appointments has continued to decline. In Wales, while there was a gradual recovery, rheumatology services have not returned to pre-pandemic levels. In contrast, the number of appointments for other specialties has recovered in all nations. People with no rheumatology outpatient appointments were more often aged over 80, male and living in rural areas. Ethnic minorities, those living in more deprived and urban areas had fewer appointments after the start of the pandemic compared with 2019. Conclusion For the first time, we compared healthcare use across three UK nations and found rheumatology outpatient appointments had not recovered to pre-COVID-19 pandemic levels, particularly in Scotland and England