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2021 ◽  
Vol 6 ◽  
pp. 342
Author(s):  
Holger Engleitner ◽  
Ashwani Jha ◽  
Daniel Herron ◽  
Amy Nelson ◽  
Geraint Rees ◽  
...  

Healthcare should be judged by its equity as well as its quality. Both aspects depend not only on the characteristics of service delivery but also on the research and innovation that ultimately shape them. Conducting a fully-inclusive evaluation of the relationship between enrolment in primary research studies at University College London Hospitals NHS Trust and indices of deprivation, here we demonstrate a quantitative approach to evaluating equity in healthcare research and innovation. We surveyed the geographical locations, aggregated into Lower Layer Super Output Areas (LSOAs), of all England-resident UCLH patients registered as enrolled in primary clinical research studies. We compared the distributions of ten established indices of deprivation across enrolled and non-enrolled areas within Greater London and within a distance-matched subset across England. Bayesian Poisson regression models were used to examine the relation between deprivation and the volume of enrolment standardized by population density and local disease prevalence. A total of 54593 enrolments covered 4401 LSOAs in Greater London and 10150 in England, revealing wide geographical reach. The distributions of deprivation indices were similar between enrolled and non-enrolled areas, exhibiting median differences from 0.26% to 8.73%. Across Greater London, enrolled areas were significantly more deprived on most indices, including the Index of Multiple Deprivation; across England, a more balanced relationship to deprivation emerged. Regression analyses of enrolment volumes yielded weak biases, in favour of greater deprivation for most indices, with little modulation by local disease prevalence. Primary clinical research at UCLH has wide geographical reach. Areas with enrolled patients show similar distributions of established indices of deprivation to those without, both within Greater London, and across distance-matched areas of England. We illustrate a robust approach to quantifying an important aspect of equity in clinical research and provide a flexible set of tools for replicating it across other institutions.


Cancers ◽  
2021 ◽  
Vol 13 (23) ◽  
pp. 6085
Author(s):  
Yien Ning Sophia Wong ◽  
Christopher C. T. Sng ◽  
Diego Ottaviani ◽  
Grisma Patel ◽  
Amani Chowdhury ◽  
...  

An increased mortality risk was observed in patients with cancer during the first wave of COVID-19. Here, we describe determinants of mortality in patients with solid cancer comparing the first and second waves of COVID-19. A retrospective analysis encompassing two waves of COVID-19 (March–May 2020; December 2020–February 2021) was performed. 207 patients with cancer were matched to 452 patients without cancer. Patient demographics and oncological variables such as cancer subtype, staging and anti-cancer treatment were evaluated for association with COVID-19 mortality. Overall mortality was lower in wave two compared to wave one, HR 0.41 (95% CI: 0.30–0.56). In patients with cancer, mortality was 43.6% in wave one and 15.9% in wave two. In hospitalized patients, after adjusting for age, ethnicity and co-morbidities, a history of cancer was associated with increased mortality in wave one but not wave two. In summary, the second UK wave of COVID-19 is associated with lower mortality in hospitalized patients. A history of solid cancer was not associated with increased mortality despite the dominance of the more transmissible B.1.1.7 SARS-CoV-2 variant. In both waves, metastatic disease and systemic anti-cancer treatment appeared to be independent risk factors for death within the combined cancer cohort.


BMJ Open ◽  
2021 ◽  
Vol 11 (12) ◽  
pp. e055864
Author(s):  
Jeremy Fabes ◽  
Gareth Ambler ◽  
Bina Shah ◽  
Norman R Williams ◽  
Daniel Martin ◽  
...  

IntroductionLiver transplantation is a complex operation that can provide significant improvements in quality of life and survival to the recipients. However, serious complications are common and include major haemorrhage, hypotension and renal failure. Blood transfusion and the development of acute kidney injury lead to both short-term and long-term poor patient outcomes, including an increased risk of death, graft failure, length of stay and reduced quality of life. Octreotide may reduce the incidence of renal dysfunction, perioperative haemorrhage and enhance intraoperative blood pressure. However, octreotide does have risks, including resistant bradycardia, hyperglycaemia and hypoglycaemia and QT prolongation. Hence, a randomised controlled trial of octreotide during liver transplantation is needed to determine the cost-efficacy and safety of its use; this study represents a feasibility study prior to this trial.Methods and analysisWe describe a multicentre, double-blind, randomised, placebo-controlled feasibility study of continuous infusion of octreotide during liver transplantation surgery. We will recruit 30 adult patients at two liver transplant centres. A blinded infusion during surgery will be administered in a 2:1 ratio of octreotide:placebo. The primary outcomes will determine the feasibility of this study design. These include the recruitment ratio, correct administration of blinded study intervention, adverse event rates, patient and clinician enrolment refusal and completion of data collection. Secondary outcome measures of efficacy and safety will help shape future trials by assessing potential primary outcome measures and monitoring safety end points. No formal statistical tests are planned. This manuscript represents study protocol number 1.3, dated 2 June 2021.Ethics and disseminationThis study has received Research Ethics Committee approval. The main study outcomes will be submitted to an open-access journal.Trial sponsorThe Joint Research Office, University College London, UK.Neither the sponsor nor the funder have any role in study design, collection, management, analysis and interpretation of data, writing of the study report or the decision to submit the report for publication.Trial registrationThe study is registered with ClinicalTrials.gov (NCT04941911) with recruitment due to start in August 2021 with anticipated completion in July 2022.Clinical trials unitSurgical and Interventional Group, Division of Surgery & Interventional Science, University College London.


2021 ◽  
Vol 21 (68) ◽  
Author(s):  
Jesús Moreno León ◽  
Marcos Román González ◽  
Ramón García Perales ◽  
Gregorio Robles

Este artículo presenta los resultados de la investigación que ha medido el impacto causal de la intervención realizada en el marco del proyecto Escuela de Pensamiento Computacional, que el Ministerio de Educación y Formación Profesional de España puso en marcha en el curso académico 2018-2019. En concreto, el trabajo estudia si es posible mejorar el desarrollo de la competencia matemática del alumnado a través de actividades de programación usando el lenguaje Scratch en 5º de Educación Primaria. El diseño de la investigación consiste en un estudio empírico de intervención basado en las lecciones aprendidas del proyecto ScratchMaths, desarrollado por la University College London en Reino Unido. Se han usado dos grupos de estudiantes no equivalentes, grupo experimental y grupo de control, sin asignación aleatoria, con medición pre-test y post-test sobre la variable competencia matemática. Para ello, se ha contado con la participación de más de 3.700 estudiantes, que fueron asignados bien al grupo experimental -que trabajó la competencia matemática a través de actividades de programación informática- o al grupo de control -que lo hizo con otras actividades y recursos habituales en el área de Matemáticas. Los resultados muestran que el alumnado del grupo experimental desarrolló en mayor medida esta competencia que el alumnado del grupo de control, apreciándose un impacto significativo y positivo sobre la misma. Con un tamaño del efecto de la intervención d=0,449 puede afirmarse que el proyecto logró el efecto pretendido sobre la competencia matemática de los estudiantes. La generalización de experiencias de pensamiento computacional en el currículum podrá garantizar la mejora de la calidad de los procesos de enseñanza y aprendizaje. This article presents the results of an investigation that has measured the causal impact of the intervention carried out within the framework of the School of Computational Thinking project, launched by the Ministry of Education and Vocational Training of Spain in the 2018-2019 academic year. Specifically, the work studies whether it is possible to improve the development of students’ mathematical competence through programming activities using the Scratch language in 5th grade of Primary Education. The research design consists of an empirical intervention study based on the lessons learned from the ScratchMaths project, developed by University College London in the United Kingdom. Two groups of non-equivalent students have been used, the experimental group and the control group, without random assignment, with pre-test and post-test measurement on the mathematical competence variable. More than 3,700 students participated in the investigation, who were assigned either to the experimental group -which worked on the mathematical competence through computer programming activities- or to the control group -which did so with other common activities and resources in the area of ​​Mathematics. The results show that the students in the experimental group developed this competence to a greater extent than the students in the control group, with a significant and positive impact on it. Being the intervention effect size d=0.449, it can be stated that the project achieved the intended effect on the students’ mathematical competence. The generalization of computational thinking experiences in the curriculum can guarantee the improvement of the quality of the teaching and learning processes.


2021 ◽  
Vol 1 (2) ◽  
pp. 76-80
Author(s):  
Matea Bulić ◽  
Catherine Tuleu

Despite its unpopularity, the rectal route of paediatric drug administration remains of interest especially in pre-school children as it can overcome some drug delivery challenges with oral and parenteral routes. Few studies have been conducted on the use and acceptability of traditional rectal dosage forms (i.e., suppositories, enemas and gels) in different parts of the world. It showed that barrier to adoption could be linked with poor knowledge, little information and understanding of this administration modality. Reformulation for the rectal delivery of drugs intended for oral and/or parenteral administration that do not reach their full potential, was explored by a study at University College London. The top 3 candidates were Azithromycin, Amodiaquine and Raltegravir. Little rectal delivery innovation has occurred but topics such as acceptability and use of rectal drug delivery; types of rectal dosage forms and reformulation considerations are discussed presently in order to raise awareness around the need to modernise rectal dosage forms this to achieve the full potential for successful reformulation.


Author(s):  
Michela Massimi ◽  
Vinicius Carvallho Da Silva ◽  
Ivã Gurgel ◽  
Ronaldo Moraca

Michela Massimi é professora de Filosofia da Ciência no Departamento de Filosofia da Universidade de Edimburgo, onde também é afiliada ao  Higgs Centre for Theoretical Physics. Membro de importantes sociedades filosóficas e científicas, como a Royal Society of Edinburgh, a Royal Astronomical Society, e a Académie Internationale de Philosophie des Sciences (membro correspondente) é presidente eleita da PSA, Philosophy of Science Association, para o biênio 2023-2024. Massimi, com dupla nacionalidade, italiana e britânica, estudou na Sapienza Università di Roma, na London School of Economics, e lecionou História e Filosofia da Ciência na University College London antes de mudar-se para Edimburgo. Massimi trabalha com Filosofia da Ciência em uma abordagem marcada pelo recurso à pesquisa histórica. Seus interesses amplos abarcam a Filosofia da Cosmologia, o realismo científico, os estudos de ciências, as relações entre ciência e sociedade, entre outros tópicos. Tem se destacado por defender o que chama de Perspectival Realism, se afastando tanto do realismo tradicional, quanto do pragmatismo e do relativismo. Nessa entrevista dialogamos com Massimi sobre temas como o valor da ciência, a defesa da ciência em épocas de negacionismo e obscurantismo e as características de sua posição filosófica. 


2021 ◽  
Vol 9 (11) ◽  
pp. 460-462
Author(s):  
Dave Hancock

Based on data collected through Freedom of Information requests, researchers at University College London generated a detailed picture of the effects of the pandemic on health visiting services in England. Dave Hancock reveals some highlights


2021 ◽  
Vol 8 (1) ◽  
pp. e001041
Author(s):  
Melissa Heightman ◽  
Jai Prashar ◽  
Toby E Hillman ◽  
Michael Marks ◽  
Rebecca Livingston ◽  
...  

IntroductionPost-COVID-19 complications require simultaneous characterisation and management to plan policy and health system responses. We describe the 12-month experience of the first UK dedicated post-COVID-19 clinical service to include hospitalised and non-hospitalised patients.MethodsIn a single-centre, observational analysis, we report the demographics, symptoms, comorbidities, investigations, treatments, functional recovery, specialist referral and rehabilitation of 1325 individuals assessed at the University College London Hospitals post-COVID-19 service between April 2020 and April 2021, comparing by referral route: posthospitalised (PH), non-hospitalised (NH) and post emergency department (PED). Symptoms associated with poor recovery or inability to return to work full time were assessed using multivariable logistic regression.Results1325 individuals were assessed (PH: 547, 41.3%; PED: 212, 16%; NH: 566, 42.7%). Compared with the PH and PED groups, the NH group were younger (median 44.6 (35.6–52.8) years vs 58.3 (47.0–67.7) years and 48.5 (39.4–55.7) years), more likely to be female (68.2%, 43.0% and 59.9%), less likely to be of ethnic minority (30.9%, 52.7% and 41.0%) or seen later after symptom onset (median (IQR): 194 (118–298) days, 69 (51–111) days and 76 (55–128) days; all p<0.0001). All groups had similar rates of onward specialist referral (NH 18.7%, PH 16.1% and PED 18.9%, p=0.452) and were more likely to require support for breathlessness (23.7%, 5.5% and 15.1%, p<0.001) and fatigue (17.8%, 4.8% and 8.0%, p<0.001). Hospitalised patients had higher rates of pulmonary emboli, persistent lung interstitial abnormalities and other organ impairment. 716 (54.0%) individuals reported <75% optimal health (median 70%, IQR 55%–85%). Less than half of employed individuals could return to work full time at first assessment.ConclusionPost-COVID-19 symptoms were significant in PH and NH patients, with significant ongoing healthcare needs and utilisation. Trials of interventions and patient-centred pathways for diagnostic and treatment approaches are urgently required.


2021 ◽  
Author(s):  
Hestetraeet Johannessen

This paper addresses the propeller singing mitigation strategy of implementing an anti-singing edge so that the vortex shedding mechanism causing the excitation at the trailing edge of the propeller blade can be reduced. A Reynolds-Averaged Navier Stokes model with a k-ε turbulence formulation in 2D-flow was used to investigate the problem numerically. Simulations on a NACA 0009 hydrofoil with varying inflow velocity, angle of attack, and bevel angle were done. The content in this paper is a summary of the work done by the author during his MSc Individual Project at University College London (Johannessen, MSc thesis, 2020).


2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Lucinda Zahrah Motie ◽  
Shahil Kaini

AbstractBoyle et al. discuss the development and implementation of a Virtual Objective Structured Clinical Examination due to the COVID-19 pandemic lockdown precluding face-to-face Objective Structured Clinical Examinations, something we too as clinical medical students studying at University College London have experienced. We commend Boyle et al. for promptly creating and delivering this assessment. However, we believe this style of assessment has the potential to exacerbate the ethnic and social inequalities that currently exist within medical education. Going forward, it is imperative that the home environment is considered in an attempt to level the playing field.


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