RAFT dispersion polymerization of glycidyl methacrylate for the synthesis of epoxy-functional block copolymer nanoparticles in mineral oil

Epoxy-functional poly(stearyl methacrylate)-poly(glycidyl methacrylate) (PSMA-PGlyMA) diblock copolymer nanoparticles are synthesized via reversible addition–fragmentation chain transfer (RAFT) dispersion polymerization of glycidyl methacrylate (GlyMA) in mineral oil at 70 °C. This efficient polymerization-induced self-assembly (PISA) formulation yields well-defined spheres of tunable diameter as confirmed by dynamic light scattering (DLS) and transmission electron microscopy (TEM) studies. 1H NMR spectroscopy and gel permeation chromatography (GPC) studies indicate that such non-polar dispersions exhibit greater stability during their long-term storage at 20 °C compared to related epoxy-functional nanoparticles prepared via RAFT aqueous emulsion polymerization. Model epoxy-amine ring-opening reactions using N-methylaniline demonstrate the potential for post-polymerization functionalization of such spherical nanoparticles

Association studies of up to 1.2 million individuals yield new insights into the genetic etiology of tobacco and alcohol use.

Tobacco and alcohol use are leading causes of mortality that influence risk for many complex diseases and disorders1. They are heritable2,3 and etiologically related4,5 behaviors that have been resistant to gene discovery efforts6-11. In sample sizes up to 1.2 million individuals, we discovered 566 genetic variants in 406 loci associated with multiple stages of tobacco use (initiation, cessation, and heaviness) as well as alcohol use, with 150 loci evidencing pleiotropic association. Smoking phenotypes were positively genetically correlated with many health conditions, whereas alcohol use was negatively correlated with these conditions, such that increased genetic risk for alcohol use is associated with lower disease risk. We report evidence for the involvement of many systems in tobacco and alcohol use, including genes involved in nicotinic, dopaminergic, and glutamatergic neurotransmission. The results provide a solid starting point to evaluate the effects of these loci in model organisms and more precise substance use measures

A systematic review and meta-analysis of enhanced recovery for open abdominal aortic aneurysm surgery

Introduction: Open abdominal aortic aneurysm (AAA) surgery is associated with significant morbidity, mortality and high length of stay (LOS). Enhanced recovery is now commonplace and has been shown to decrease these in other non-vascular surgery settings. This systematic review and meta-analysis aimed to assess the benefits of enhanced recovery (ERAS) in aortic surgery. Method: Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines were used to undertake a systematic review via Ovid MEDLINE and Embase on 10.07.2021. The search terms were “aortic aneurysm” and “fast track” or “enhanced recovery”. Data was obtained on major complications, 30-day mortality and LOS. Results: 107 papers were identified and 10 papers included for meta-analysis. Complication rates were significantly reduced with ERAS compared to non-ERAS protocols (ERAS n = 709, non-ERAS n = 930) (odds ratio.38,.22 to.65: P =.0005). LOS was also significantly reduced with an ERAS protocol (ERAS n = 708, non-ERAS n = 956) with a mean reduction of 3.18 days (−5.01 to −1.35 days) (P =.0007: I2 = 97%). There was no significant difference however in 30-day mortality (P =.92). Conclusion: This meta-analysis demonstrates significant benefits to an enhanced recovery programme in open AAA surgery. There is a need for a multi-centre randomized controlled trial to assess this further

Biomechanical Effects of Manual Therapy in Patients with Acute Non-specific Low Back Pain - A Feasibility Study

The data set relates to the PhD entitled: Biomechanical Effects of Manual Therapy in Patients with Acute Non-specific Low Back Pain - A Feasibility Study. The data set explores the Quantitative Fluoroscopy data for a Randomised Controlled Trial (RCT) exploring the biomechanical effects of Manual Therapy. The two groups included in the trial were manual therapy (n=7) and non-manual therapy (n=7). NOTE: The trial numbers were reduced due to COVID-19 pandemic

Stakeholder involvement in the development of trial material for a clinical trial

Background: Stakeholder involvement includes not just patients and public, but also those delivering treatment e.g. clinicians and students. Each stakeholder brings unique experiences to the process. The aim of this stakeholder exercise was to explore readability and understanding of the trial material for the future trial to be conducted by the authors: Biomechanical Effects of Manual Therapy – A Feasibility Study. Design: Volunteers from identified stakeholder groups were provided with trial material which included the information sheet, consent form, questionnaires and home management booklet. They provided feedback on content (readability, understanding) and style (font, layout). An additional document was provided with genres of pictures to choose the most appropriate style to be used in the booklet. Readability formulas were used to calculate reading age before and after feedback to objectively measure ease of reading. Results: The public group provided a layperson’s perspective to clarify the information sheet for patients, whereas practitioner and intern groups indicated where information could be clarified. The reading age of all documentation decreased following feedback; however templated sections of the documentation did not. The majority (87%) of volunteers chose coloured classic cartoons for the booklet. Conclusion: This process highlighted the importance of involving different stakeholder groups in the development of research materials as each group made a unique contribution. Readability and understanding of the trial material were improved, feeding back into the consent process contributing towards fully informed consent. Patient or Public Contribution: Public helped develop materials for a future trial but not with manuscript preparation

A public and patient consultation process as an aid to design a person-centred randomized clinical trial.

BACKGROUND: Involving patients and members of the public, together with researchers, in decisions about how studies are designed and conducted can create a study that is more person-centred. The aim of this consultation process was to explore ways of designing a study which takes the person into consideration for the randomized clinical study entitled 'Biomechanical Effects of Manual Therapy-A Feasibility Study' using the novel approach of usability testing. DESIGN: Patient and public volunteers were sought with experience of low back pain. Volunteers were invited to participate in usability testing (a physical walkthrough) of the proposed study method. This was followed by a discussion of areas where usability testing could not be used, such as recruitment strategies, continuity of participant care and dissemination of results. Resulting feedback was considered by the research team and alterations to the original study method were incorporated, provided the research questions could be answered and were practical within the resources available. RESULTS: Additional recruitment strategies were proposed. Alterations to the study included reduction in study time burden; completion of study paperwork in a quieter location; continuity of participant care after the study; and methods of dissemination of overall study results to participants. CONCLUSION: The consultation process used the unique method of usability testing, together with a post-usability discussion, and resulted in alterations to the future study which may facilitate making it more person-centred. PATIENT AND PUBLIC CONTRIBUTION: Patients and public developed the future study design but did not participate in manuscript preparation

Epoxy-functional diblock copolymer spheres, worms and vesicles via polymerization-induced self-assembly in mineral oil

Epoxy-functional diblock copolymer spheres, worms and vesicles are synthesized at 30% w/w solids via reversible addition–fragmentation chain transfer (RAFT) dispersion polymerization of glycidyl methacrylate (GlyMA) in mineral oil at 70 °C. This is achieved by using a relatively short oil-soluble poly(stearyl methacrylate) (PSMA) macromolecular chain transfer agent (macro-CTA) with a mean degree of polymerization of 9. Gel permeation chromatography (GPC) studies indicate that good control over the molecular weight distribution can be obtained and the resulting PSMA9-PGlyMAx nano-objects are characterized by dynamic light scattering (DLS), transmission electron microscopy (TEM) and small-angle X-ray scattering (SAXS). Oscillatory rheology studies of a 30% w/w PSMA9-PGlyMA75 worm gel indicate that thermally-triggered degelation occurs on heating to 100 °C. TEM studies indicate that a partial worm-to-vesicle transition occurs under such conditions

A Scalable Home Care System Infrastructure Supporting Domiciliary Care

Technology-mediated home care is attractive for older people living at home and also for their carers. It provides the information necessary to give confidence and assurance to everyone interested in the wellbeing of the older person. From a care delivery perspective, however, widespread deployment of home care technologies presents system developers with a set of challenges. These challenges arise from the issues associated with scaling from individual installations to providing a community-wide service, particularly when each installation is to be fitted to the particular but changing needs of the residents, their in-home carers and the larger healthcare community. This paper presents a home care software architecture and services that seek to address these challenges. The approach aims to generate the information needed in a timely and appropriate form to inform older residents and their carers about changing life style that may indicate a loss of well-being. It unites sensor-based services, home care policy management, resource discovery, multimodal interaction and dynamic configuration services. In this way, the approach offers the integration of a variety of home care services with adaptation to the context of use

VIEWER:an extensible visual analytics framework for enhancing mental healthcare

ObjectiveA proof-of-concept study aimed at designing and implementing Visual & Interactive Engagement With Electronic Records (VIEWER), a versatile toolkit for visual analytics of clinical data, and systematically evaluating its effectiveness across various clinical applications while gathering feedback for iterative improvements.Materials and MethodsVIEWER is an open-source and extensible toolkit that employs natural language processing and interactive visualization techniques to facilitate the rapid design, development, and deployment of clinical information retrieval, analysis, and visualization at the point of care. Through an iterative and collaborative participatory design approach, VIEWER was designed and implemented in one of the United Kingdom’s largest National Health Services mental health Trusts, where its clinical utility and effectiveness were assessed using both quantitative and qualitative methods.ResultsVIEWER provides interactive, problem-focused, and comprehensive views of longitudinal patient data (n = 409 870) from a combination of structured clinical data and unstructured clinical notes. Despite a relatively short adoption period and users’ initial unfamiliarity, VIEWER significantly improved performance and task completion speed compared to the standard clinical information system. More than 1000 users and partners in the hospital tested and used VIEWER, reporting high satisfaction and expressed strong interest in incorporating VIEWER into their daily practice.DiscussionVIEWER provides a cost-effective enhancement to the functionalities of standard clinical information systems, with evaluation offering valuable feedback for future improvements.ConclusionVIEWER was developed to improve data accessibility and representation across various aspects of healthcare delivery, including population health management and patient monitoring. The deployment of VIEWER highlights the benefits of collaborative refinement in optimizing health informatics solutions for enhanced patient care

Developing clinical informatics to support direct care and population health management:the VIEWER story

Electronic health records (EHRs) provide comprehensive patient data which could be better used to enhance informed decision-making, resource allocation, and coordinated care, thereby optimising healthcare delivery. However, in mental healthcare, critical information, such as on risk factors, precipitants, and treatment responses, is often embedded in unstructured text, limiting the ability to automate at scale measures to identify and prioritise local populationsand patients, which potentially hinders timely prevention and intervention. We describe the development and proof-of-concept implementation of VIEWER, a clinical informatics platform designed to enhance direct patient care and population health management by improving the accessibility and usability of EHR data. We further outline strategies that were employed in this work to foster informatics innovation through interdisciplinary and cross-organisational collaboration to support integrated, personalised care, and detail howthese advancements were piloted and implemented within a large UK mental health National Health Service Foundation Trust to improve patient outcomes at an individual patient, clinician, clinical team, and organisational level