University College Birmingham

HemoPill is a commercially available ingestible electronic capsule that detects hematin and blood through photometric measurements. An examination with HemoPill requires no special preparation and can be done bedside. Its major advantage is noninvasive luminal blood detection, requiring only a small amount of blood or hematin (> 20 mL) for a positive result, making it especially suitable in multimorbid and/or geriatric patients not primarily fit for endoscopic diagnostic allowing rapid and uncomplicated bleeding detection. Recent clinical reports showed that HemoPill is useful in stratifying patients with anemia and bleeding in the setting of an Emergency Department. The second generation with an extended battery capacity of 9 hours opens the possibility of detecting blood in the middle and lower gastrointestinal tract. Herein we report another advantage of the extended battery capacity allowing noninvasive bleeding detection in the middle and lower gastrointestinal tract, leading to early endoscopic diagnosis of gastrointestinal malignancies with occult bleeding in comorbid patients with severe anemia.

The awareness of consumers regarding the pets they own, the pet health demand and the overall growth in the number of people owning pets has subsequently fuelled the demand for new ideas in the field of pet health care. This research majorly focuses on the creation and validation of a health Smart Paws collar that is capable of managing pet health and safety issues through technological innovation. The research used both quantitative and qualitative research method, with data obtained from monitoring the pet' daily activities with the Smart Paws collar and feedback from pet owners on the use of the collars. Users of the Smart Paws collar are randomly sourced and willing participants who allow researchers to record the data on them for six months. The findings reveal the positive impact of Smart Paws collar in terms of accuracy in monitoring pets health, owners satisfaction with nutritional information provided, recording of owner-pet interactions, and reduction of anxiety in regard to the pets safety. While the research also formalized the identified challenges that Smart Paws collars present, it still gives confidence to investors in Smart Paws and indicates the merits of the companys market breakthrough by addressing such issues.

Background and Aims There is emerging evidence that genes, lifestyles and environment play a prominent role in the development of non‐communicable diseases. Currently, there is not information on people's perception of inherited genetics vs. lifestyle on disease development. Knowing people's belief on disease etiology will better inform public health strategies for the adoption of a healthy lifestyle. Methods Individuals aged 18 years and over were recruited in 2019 among the UK population and 363 participants completed an anonymous questionnaire. The main outcomes assessed were perception of importance of inherited genes and lifestyle on the development of diseases. T‐tests and χ² were used. Results The score for the importance of inherited genes in disease development was significantly lower than the lifestyle score (7.5 ± 1.7 vs. 8.5 ± 1, p <0.001). Moreover, the majority of the respondents chose lifestyle over inherited genes as most important factor for cancer, cardiovascular disease and Type 2 Diabetes development (50.8% vs. 29.6%, 79% vs. 11.9%, 85.7% vs. 9.6%; respectively), while 60.6% of respondents selected inherited genes for rheumatoid arthritis (p < 0.05). Knowledge about genes or a healthy lifestyle did not influence the selection of lifestyle as the most important factor (p > 0.05). Conclusion Overall, participants were well aware of the importance of lifestyle as a determinant risk factor for chronic disease development. This is an important step toward adopting a healthy lifestyle.

Introduction Despite unprecedented pressures on urgent and emergency care services, there is no clear consensus on how to provide acute medical care delivery in the UK. These pressures can lead to significant delays in care for patients presenting with emergencies when admitted via traditional routes through the emergency department. Historically, a separate pathway has existed where patients are directly admitted to acute medicine services without attending the emergency department. It is suspected that there is a significant variation in how these patients are selected, triaged and managed in the UK. This systematic review will assess the methods and evidence base used for direct patient admissions to acute medicine services compared with traditional admission pathways through the emergency department. Methods and analysis A systematic review of the literature will be conducted and a total of six databases will be searched: MEDLINE (Ovid), The Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE in process, Web of Science, CINAHL and Embase. This will include studies from the period 01 January 1975 to 24 January 2024. Covidence software will be the platform for the extraction of data and paper screening with the selection process reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flow diagram. Both title and abstract screening and full-text screening will be done by two reviewers independently. The risk of bias of included studies will be assessed using the methods introduced in the Cochrane Handbook for Systematic Reviews of Interventions and the tool used will be dependent on the type of study. Where possible, outcomes will be dealt with as continuous variables. Change percentage will be assessed between any pathway characteristic or outcome. The χ ² test and I ² test will be used to evaluate the heterogeneity of included studies. Where appropriate, relevant meta-analysis techniques will be used to compare studies and forest plot produced. Ethics and dissemination This systematic review does not require ethical approval. Findings will be disseminated widely in peer-reviewed publication and media, including conferences. PROSPERO registration number CRD42023495786.

Background Understanding why children die is important for grieving parents and for informing system improvements aimed at prevention and future care. Many countries have child death review (CDR) process, but little is known about how best to engage parents. The aim of this study was to use experience-based co-design to create a toolkit to support parental involvement in CDR. Methods A survey of English paediatric intensive care units (PICUs) and palliative care services explored practices and identified a diverse sample of sites for professional interviews. Bereaved parents were recruited through charities, hospitals and social media. Semistructured interviews were held with parents and professionals followed by co-design workshops to develop the toolkit. Results There were 29 survey responses, 13 out of 21 from PICUs and 16 out of 34 from palliative care. 21 multidisciplinary healthcare professionals were interviewed. 23 bereaved parents of children who died aged 0–18 years in 2021–2022, either during hospital admission or under palliative care were, interviewed. 10 parents and 23 professionals participated in co-design meetings. Key emotional touchpoints identified from parents’ experiences were: becoming aware of CDR meetings, being asked for input, knowing the date and receiving feedback. All agreed on the importance of involving parents, with clear communication, and need for resources and training for key workers. The toolkit includes training videos, a standardised pathway including template letters, feedback form, easy-read leaflet and an animation explaining the importance of involving parents. Conclusions Co-design has successfully supported the development of a toolkit of resources in a sensitive area. It required considerable support from bereavement support organisations and researchers. Future evaluation is required. Trial registration number ISRCTN14790455 .

Purpose: To evaluate the survival benefit of chemotherapy intensification in older patients with AML who have not achieved a measurable residual disease (MRD)-negative remission. Methods: Five hundred twenty-three patients with AML (median age, 67 years; range, 51-79) without a flow cytometric MRD-negative remission response after a first course of daunorubicin and AraC (DA; including 165 not in remission) were randomly assigned between up to two further courses of DA or intensified chemotherapy-either fludarabine, cytarabine, granulocyte colony-stimulating factor and idarubicin (FLAG-Ida) or DA with cladribine (DAC). Results: Overall survival (OS) was not improved in the intensification arms (DAC v DA: hazard ratio [HR], 0.74 [95% CI, 0.55 to 1.01]; P = .054; FLAG-Ida v DA: HR, 0.86 [95% CI, 0.66 to 1.12]; P = .270); OS at 3 years was 34%, 46%, and 42% for DA, DAC, and FLAG-Ida, respectively. Early deaths and other adverse events were more frequent with FLAG-Ida (9% day 60 deaths v 4% after DA or DAC; P = .032). Of patients entering random assignment, 131 had MRD unknown status. In this subgroup of patients lacking evidence of residual leukemia by flow cytometry, there was no detectable survival advantage from intensification. A planned sensitivity analysis excluding these patients demonstrated a survival benefit for both DAC (HR, 0.66 [95% CI, 0.46 to 0.93]; P = .018) and FLAG-Ida (HR, 0.72 [95% CI, 0.53 to 0.98]; P = .035); OS at 3 years was 30%, 46%, and 46% for DA, DAC, and FLAG-Ida, respectively. There was a concordant reduction in relapse (DAC v DA: HR, 0.66 [95% CI, 0.45 to 0.98]; P = .039; FLAG-Ida v DA: HR, 0.70 [95% CI, 0.49 to 0.99]; P = .042). DAC benefit was maintained when survival was censored for transplant (P = .042). Conclusion: In this study of older patients with AML considered fit and with evidence of residual disease after first induction, chemotherapy intensification improved survival. DAC intensification was better tolerated than FLAG-Ida.

Introduction Travel to resource-limited settings is a known risk for acquisition of extended-spectrum β-lactamase-producing Enterobacterales (ESBL-PE) and carbapenem-resistant Enterobacterales (CRE), which are both associated with increased morbidity and mortality. We investigated the ESBL-PE and CRE baseline prevalence in British service personnel (SP). Methods SP provided faecal samples for research projects in several different settings, between September 2021 and April 2022. Bacterial colonies from faecal isolates were recovered from incubated ChromID ESBL plates (bioMérieux, Marcy-l'Étoile, France) and DNA extracted using Qiagen DNeasy extraction kits (Qiagen, UK). PCR to identify β-lactamase and CRE encoding genes was performed using the Rotor-Gene Q (RGQ) (Qiagen, UK), with positivity detected by RGQ software. Phenotypic assessment of antimicrobial susceptibility was not performed. Results Out of 250 personnel approached, 239 (85.5% men, median (IQR) age 31 (26–37) years) provided faecal samples suitable for analysis. The ESBL prevalence was 40/239 (16.7%), with ESBL-producing Escherichia coli detected in 39 (16.3%) samples and ESBL-producing Klebsiella pneumoniae in 1 (0.4%) sample. Combinations including Temoniera, sulfhydryl reagent variable (SHV), cefotaxime hydrolysing β-lactamase (Munich) (CTX-M) 1 and CTX-M 9 genes were detected in 18 (7.5%), 33 (13.8%) 16 (6.7%) and 8 (3.3%) samples, respectively. E. coli samples had mixtures of all four genotypes with SHV predominating. One (0.4%) sample carried all four gene types and the only K. pneumoniae sample carried a single SHV gene. No CRE were detected. Conclusions The prevalence of ESBL-PE in cohorts of SP closely matches that of civilian populations in England; however, we noted differences in ESBL genotype distribution. Potential exposure risks for SP from international travel and occupational trauma emphasise the need for repeated surveillance to characterise and detect changes in acquisition epidemiology and carriage of ESBL. Such prospective data have important antimicrobial stewardship implications in optimising clinical outcomes, controlling resistance and guiding empirical antibiotic formulary policy recommendations.

Introduction Schizophrenia and attention deficit hyperactivity disorder (ADHD) are psychiatric disorders that have a profound impact on patients and healthcare systems globally. There is preliminary evidence suggesting a potential association between the two in terms of symptomatology and genetic underpinning. There is a paucity of guidance regarding pharmacological approaches for patients with comorbid ADHD and schizophrenia. There is a concern that psychostimulants may be more harmful than therapeutic. This scoping review protocol aims to systematically review the evidence for potential harm and benefit of psychostimulants among patients with comorbid ADHD and schizophrenia and identify research gaps. Methods and analysis This scoping review will employ a systematic and iterative approach to identify and synthesise the literature on the topic of psychostimulant use among patients with comorbid schizophrenia and ADHD, based on Arksey and O’Malley’s framework. A search will be conducted in relevant databases, including MEDLINE (Ovid), Embase (Ovid), PsycINFO and ISI Web of Science. Additionally, grey literature will be sought. The scoping review will involve two independent reviewers screening the search results. The initial screen will be of title and abstract, and the subsequent full-text review will determine eligibility. A descriptive overview of the eligible studies will be provided. This scoping review has been registered at https://osf.io/cmn5s . Ethics and dissemination There is a paucity of high-quality evidence available to clinicians when making decisions regarding the prescription of psychostimulants to patients with comorbid schizophrenia and ADHD. To the best of our knowledge, this will be the first scoping review to examine the evidence addressing this clinical scenario. This review, therefore, has the potential to contribute to decision-making processes for this patient group, thereby improving patient outcomes. Furthermore, as this review is designed to identify research gaps, we aim to contribute to the development of a research agenda that will benefit patients, clinicians and healthcare systems. The dissemination strategy will involve open access peer review publication and scientific presentations.

Background: Modern general practice is characterised by increased demand and growing multi-disciplinarity, including ring-fenced funding for additional non-clinical roles. However, for practice receptionists training has remained unchanged for decades, yet primary care is under greater pressure than ever with receptionists becoming a growing focal point of abuse and unprecedented numbers leaving the role. Aim: To present the evidence of the range of tasks that receptionists continue to perform, describing their impact on primary care delivery and how the role might be better supported. Method: We conducted a systematic review of evidence contained in the major medical databases (Medline/PubMed, CINAHL, ASSIA, Cochrane Library, and EMBASE) up until July 2023, including hand searches of the bibliographies of included studies. Results: We identified 28 studies which we grouped into three themes: Service delivery, confirming the continuing role of receptionists in providing administrative support alongside clinical tasks of prioritising patients for consultations, facilitating repeat prescriptions, and communicating blood test results; Patient attitudes describing how patient’s lacked trust in receptionists viewed as unqualified and unnecessarily obstructive; Finally, in considering Receptionist experience, the contrast between their confidence in performing administrative roles and the anxiety induced from the clinically related tasks was described, particularly the mounting pressure from patients to meet their preferences for clinician appointments. Conclusion: Though confident performing administrative tasks, receptionists described the uncertainty and anxiety when providing clinically oriented support or managing patients when their requests for appointments could not be met. More appropriate training or professionalisation might improve staff retainment.

Objectives: To investigate the utility and effectiveness of a school outreach programme in areas of lower socioeconomic status to improve understanding of common endocrine topics and the medical profession. Methods: Two secondary school outreach sessions were conducted in July 2022. Students were invited to attend lectures delivered by medical professionals and engage in poster-making sessions using the knowledge they had gained throughout the day. Participants completed anonymised pre- and post-session surveys. Outcomes were identified using Kirkpatrick’s training evaluation model. Self-reported perceptions and beliefs (Kirkpatrick’s Level 2a) were compared using chi-square tests. Thematic analysis of team-led poster presentations was performed. Results: Of the 254 participants included, the response rates of pre- and post-session questionnaires were 75.6% and 56.2%, respectively. The outreach day increased students’ understanding of Obesity and Diabetes, PCOS, and Health Technology. The most well-received activities from the outreach day were voted to be the poster challenge (43.4%) and poster presentation (14.7%). Following the session, there was a trend towards an increased understanding of medical careers and interest in pursuing a medical career, although these did not reach statistical significance. Conclusions: Outreach programmes could be a practical and effective approach to engaging prospective medical applicants from areas of lower socioeconomic status. Further studies are required to expand outreach programmes to investigate the efficacy of school engagement programmes.

The current study tested a mediational model accounting for the hypothesized sequence of relationships between the perceived peer-created learning climate, academic motivation, and indices of student functioning across two cohorts in a Higher Education setting. Utilizing a total of 373 undergraduate psychology students from two independent samples (cohort 1: n = 172; cohort 2: n = 201), our findings revealed that a perceived peer-autonomy supportive climate significantly and positively related to both types of academic motivation, albeit more strongly for autonomous relative to controlled regulation, and was inversely associated with amotivation. In turn, higher levels of autonomous motivation were strongly related with higher levels of engagement, and lower levels of burnout symptoms among the participants, whereas the inverse was observed for controlled and amotivation. Indirect effects were also found concerning the mediational role of academic motivation, and our findings were replicated across samples ruling out the possibility of a potential cohort effect. Overall, our findings point towards the theoretical and practical significance of peer influence for fostering academic motivation and healthy functioning among students in Higher Education. However, they also highlight the potential of peers to create climates which may, on the face of it, appear autonomy-supportive, but promote more introjected and external reasons for student motivation which, in turn, undermines their psychological functioning. Future research unpacking the complex influence of peer climates on student motivation in Higher Education is needed.

Systemic glucocorticoid excess causes several adverse metabolic conditions, most notably Cushing’s syndrome. These effects are amplified by the intracellular enzyme 11β-hydroxysteroid dehydrogenase type 1 (11β-HSD1). Here we determined the less well characterised effects of glucocorticoid excess, and the contribution of 11β-HSD1 amplification, on metabolic rate in mice. Male and female C57BL/6J (wild type, WT) and 11β-HSD1 knock out (11β-HSD1KO) mice were treated with high-dose corticosterone or a vehicle control for 3 weeks. Indirect calorimetry was conducted during the final week of treatment, with or without fasting, to determine the impact on metabolic rate. We found that corticosterone treatment elevated metabolic rate and promoted carbohydrate utilisation primarily in female WT mice, with effects more pronounced during the light phase. Corticosterone treatment also resulted in greater fat accumulation in female WT mice. Corticosterone induced hyperphagia was identified as a likely causal factor altering the respiratory exchange ratio (RER) but not energy expenditure (EE). Male and female 11β-HSD1KO mice were protected against these effects. We identify novel metabolic consequences of sustained glucocorticoid excess, identify a key mechanism of hyperphagia and demonstrate that 11β-HSD1 is required to manifest the full metabolic derangement.

In current missiological discussions, economy is the operant lens with its focus on action, often to the neglect of being. Part of the reason for a neglect of ontology appears to be the inattention of Creation theology for theological conceptions of Christian mission. In this article, we argue that the practice of rest is a key element in the missional connection between being and doing. We ground our discussion in biblical texts marked by Creation theology, showing that God's rhythms of work and rest are the foundation of Christian missional practice. This is drawn out by close attention to Genesis 1–2, as well as key Synoptic Gospel texts on Jesus’ relationship to the Sabbath. Since these texts integrate mission with the Sabbath rhythms of rest and reflection, we argue that rest allows for greater integration of human ontology and economy into a life of participation in the Missio Dei. This has implications for shaping a richer participation of God's missional rhythms, measuring fruitfulness in mission, and contemplating longevity in ministry.

Purpose The calliper function is used for manual measurements of full thickness macular holes (FTMHs). We aimed to investigate whether a reproducible difference could be detected beyond interobserver variability between two commonly used manufacturers in their manual calliper facility in spectral domain optical coherence tomography (OCT) for metrics related to FTMH. Methods This is a non-interventional, retrospective, observational study. Two independent observers examined 8 eyes (16 OCT) scans and 128 measurements (minimal linear diameter (MLD), basal diameter and hole height on both sides) of FTMHs, taken on Heidelberg Spectralis and Topcon Triton (OCT machines). The interobserver agreement and OCT machine agreement of measurements were analysed by Bland-Altman plots and intraclass correlation coefficient (ICC) analysis. Spectralis and Triton had 125 µm and 50 µm horizontal b-scan spacing, respectively. Results Overall, we report high absolute agreement in interobserver (ICC 0.991 (95% CI 0.985 to 0.995, p<0.001)) and OCT machine (ICC 0.993 (95% CI 0.987 to 0.996, p<0.001)) variability. Lower horizontal resolution in Triton compared with Spectralis leads to interobserver variability, in smaller horizontal measurements. Lower horizontal scanning density in Spectralis lead to relatively large interobserver variation if different reference scans were chosen, and consistently smaller MLD measurements than Triton. Vertical measurements without 1:1 scaling lead to inaccurate exaggerated oblique vertical measurements. Calliper function appears otherwise identically calibrated. Conclusions We report excellent interobserver and OCT machine agreement in measurements. However, the paper shows several factors that could influence the reliability of measurements acquired in eyes with FTMHs, such as the dimension of the hole as well as different image resolution, density scanning protocols or vertical scaling of the OCT machines viewing platform.

Background There is a need to empower parents and carers of young infants to recognise signs of serious illness and to act on these appropriately. Compiling the signs and symptoms of serious illness in infants found in clinical guidelines will support the evidence-based update of the 30+-year-old content of the Baby Check App to empower parents and carers. Objective To systematically review clinical guidelines for signs and symptoms related to serious illness in infants aged 6 months and below. Methods A rapid review was carried out by searching PubMed, CINAHL, NICE, Cochrane and Embase for clinical guidelines reporting signs and symptoms of serious illness in young infants. The time period was restricted from 2018 to 2023. Only guidelines published in English were included. Results Fourteen clinical guidelines from 2307 retrieved articles were reviewed. Sixty signs and symptoms indicative of serious illness in infants were identified from the clinical guidelines. The guidelines originated from the UK (n=9, 65%), Italy (n=1, 7%), South Africa (n=1, 7%), Switzerland (n=1, 7%), USA (n=1, 7%), UK and USA (n=1, 7%). The 10 most frequent signs and symptoms were decreased consciousness, tachypnoea, looks seriously unwell to a health professional, high fever, central cyanosis, apnoea, seizures, frequent vomiting, non-blanching rash and noisy breathing. Conclusions Knowledge of the most frequently occurring signs and symptoms that were found in the reviewed guidelines will contribute to the update of the content of the Baby Check App. This will ensure that guidance for parents and carers is consistent with the current evidence base.