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Aim We aimed to identify enablers and barriers of using primary care routine data for healthcare research, to formulate recommendations for improving efficiency in knowledge discovery.Background Data recorded routinely in primary care can be used for estimating the impact of interventions provided within routine care for all people who are clinically eligible. Despite official promotion of ‘efficient trial designs’, anecdotally researchers in the Asthma UK Centre for Applied Research (AUKCAR) have encountered multiple barriers to accessing and using routine data.Methods Using studies within the AUKCAR portfolio as exemplars, we captured limitations, barriers, successes, and strengths through correspondence and discussions with the principal investigators and project managers of the case studies.Results We identified 14 studies (8 trials, 2 developmental studies and 4 observational studies). Investigators agreed that using routine primary care data potentially offered a convenient collection of data for effectiveness outcomes, health economic assessment and process evaluation in one data extraction. However, this advantage was overshadowed by time-consuming processes that were major barriers to conducting efficient research. Common themes were multiple layers of information governance approvals in addition to the ethics and local governance approvals required by all health service research; lack of standardisation so that local approvals required diverse paperwork and reached conflicting conclusions as to whether a study should be approved. Practical consequences included a trial that over-recruited by 20% in order to randomise 144 practices with all required permissions, and a 5-year delay in reporting a trial while retrospectively applied regulations were satisfied to allow data linkage.Conclusions Overcoming the substantial barriers of using routine primary care data will require a streamlined governance process, standardised understanding/application of regulations and adequate National Health Service IT (Information Technology) capability. Without policy-driven prioritisation of these changes, the potential of this valuable resource will not be leveraged.

Models are the coin of the realm in current philosophy of science, as they are in science itself, having replaced laws and theories as the primary strategy. Logical Positivism tried to erase the older neo-Kantian distinction between ideal constructions and reality. It returns in the case of models. Nowak’s concept of idealization provided an alternative account of this issue. It construed model application as concretizations of hypotheses which improve by accounting for exceptions. This appears to account for physical law. But it raises the problem of uniqueness: is the result unique, as physical law should be? Neo-Kantianism failed this test. Its solutions were circular justifications for claims of uniqueness. Nowak inherited the problem without resolving it.

From the surface of the sea to a sea of data as a canvas of affective inscription, the port emerges as a calling card, constituted by the aggregate image of logistical media and its ‘looks’ and ‘likes’. The surface of software infrastructure encompasses and extends the operation of the port. Cross-weaving documentary (Allan Sekula and Noël Burch’s The Forgotten Space [2010]), experimental and independent film (Jean Luc Godard’s Socialisme [2010], Philip Scheffner’s Havarie [2010]), reality television (Below Deck: Mediterranean, 2016-present), and Instagram, the port emerges as the para-site par excellence of floating capital, consumption, and waste.

Objectives To identify and prioritise interventions, from the perspectives of parents and health professionals, which may be alternatives to current unscheduled paediatric urgent care pathways.Design FLAMINGO (FLow of AdMissions in chIldren and youNG peOple) is a sequential mixed-methods study, with public and patient involvement (PPI) throughout. Data linkage for urgent admissions and three referral sources: emergency department, out of hours service and general practice, was followed by qualitative interviews with parents and professionals. Findings were presented and discussed at a stakeholder intervention prioritisation event.Setting National Health Service in Scotland, UK.Participants Quantitative data: children with urgent medical admission to hospital from 2015 to 2017. Qualitative interviews: parents and health professionals with experiences of urgent short stay hospital admissions of children. PPI engagement was conducted with nine parent–toddler groups and a university-based PPI advisory group. Stakeholder event: parents, health professionals and representatives from Scottish Government, academia, charities and PPI attended.Results Data for 171 039 admissions which included 92 229 short stay admissions were analysed and 48 health professionals and 21 parents were interviewed. The stakeholder event included 7 parents, 12 health professionals and 28 other stakeholders. Analysis and synthesis of all data identified seven interventions which were prioritised at the stakeholder event: (1) addressing gaps in acute paediatric skills of health professionals working in community settings; (2) assessment and observation of acutely unwell children in community settings; (3) creation of holistic children’s ‘hubs’; (4) adoption of ‘hospital at home’ models; and three specialised care pathways for subgroups of children; (5) convulsions; (6) being aged

Objectives The aim of this sequential mixed-methods study was to describe and understand how paediatric short stay admission (SSA) rates vary across Health Board regions of Scotland.Design Exploratory sequential mixed-methods study. Routinely acquired data for the annual (per capita) SSA to hospital were compared across the 11 regions. Five diverse regions with different SSA per capita formed cases for qualitative interviews with health professionals and parents to explore how care pathways, service features and geography may influence decisions to admit.Setting Scotland.Participants All children admitted to hospital 2015–2017. Healthcare staff (n=48) and parents (n=15) were interviewed.Results Of 171 039 urgent hospital admissions, 92 229 were SSAs, with a fivefold variation between 14 and 69/1000 children/year across regions. SSAs were higher for children in the most deprived compared with the least deprived communities. When expressed as a ratio of highest to lowest SSA/1000 children/year for diagnosed conditions between regions, the ratio was highest (10.1) for upper respiratory tract infection and lowest (2.8) for convulsions. Readmissions varied between 0.80 and 2.52/1000/year, with regions reporting higher SSA rates more likely to report higher readmission rates (r=0.70, p=0.016, n=11). Proximity and ease of access to services, local differences in service structure and configuration, national policy directives and disparities in how an SSA is defined were recognised by interviewees as explaining the observed regional variations in SSAs. Socioeconomic deprivation was seldom spontaneously raised by professionals when reflecting on reasons to refer or admit a child. Instead, greater emphasis was placed on the wider social circumstances and parents’ capacity to cope with and manage their child’s illness at home.Conclusion SSA rates for children vary quantitatively by region, condition and area deprivation and our interviews identify reasons for this. These findings can usefully inform future care pathway interventions.

The authors present novel observations providing insights into the formation of extraordinary gold-rich veins. We discovered metal nanoparticles associated with amorphous silica and carbon indicating their essential contribution to efficient gold deposition.

A través de una serie de casos históricos y análisis cuantitativos, los trabajos presentados en este número de Estudios Sociológicos abordan cuestiones fundamentales sobre las consecuencias políticas del financiamiento extranjero de las ciencias sociales. En conjunto, estos trabajos ilustran la paradoja inherente a la financiación de la vida intelectual: el poder de los donantes depende de la legitimidad y, por lo tanto, de la independencia de los donatarios. La cuestión es compleja porque los beneficiarios, que pueden operar como “Estados tapón”, tienen objetivos distintos de los de los donantes. En este marco, los donantes que financiaron proyectos en América Latina tuvieron dificultades para encontrar socios que consideraran fiables, así como para cooptar instituciones influyentes. Asimismo, se toparon con variadas resistencias. Los donantes practicaron por ello dos estrategias básicas para adaptarse a las circunstancias locales: el apoyo a instituciones ya existentes preferido por la Fundación Rockefeller, por un lado, y el desarrollo de think tanks elegido por la Fundación Ford, por el otro. Aun cuando los objetivos de los donantes reflejaban, en parte, las preocupaciones de la Guerra Fría, el resultado de su accionar fue un cierto pluralismo intelectual.

Background Healthcare technologies are becoming more commonplace, however clinical and patient perspectives regarding the use of technology in the management of childhood asthma have yet to be investigated. Within a clinical trial of asthma management in children, we conducted a qualitative process evaluation that provided insights into the experiences and perspectives of healthcare staff and families on (i) the use of smart inhalers to monitor medication adherence and (ii) the use of algorithm generated treatment recommendations. Methods We interviewed trial staff (n = 15) and families (n = 6) who were involved in the trial to gauge perspectives around the use of smart inhalers to monitor adherence and the algorithm to guide clinical decision making. Findings Staff and families indicated that there were technical issues associated with the smart inhalers. While staff suggested that the smart inhalers were good for monitoring adherence and enabling communication regarding medication use, parents and children indicated that smart inhaler use increased motivation to adhere to medication and provided the patient (child) with a sense of responsibility for the management of their asthma. Staff were open-minded about the use of the algorithm to guide treatment recommendations, but some were not familiar with its’ use in clinical care. There were some concerns expressed regarding treatment step-down decisions generated by the algorithm, and some staff highlighted the importance of using clinical judgement. Families perceived the algorithm to be a useful technology, but indicated that they felt comforted by the clinicians’ own judgements. Conclusion The use of technology and individual data within appointments was considered useful to both staff and families: closer monitoring and the educational impacts were especially highlighted. Utilising an algorithm was broadly acceptable, with caveats around clinicians using the recommendations as a guide only and wariness around extreme step-ups/downs considering contextual factors not taken into account.

Background The prevalences of obstructive and restrictive spirometric phenotypes, and their relation to early-life risk factors from childhood to young adulthood remain poorly understood. The aim was to explore these phenotypes and associations with well-known respiratory risk factors across ages and populations in European cohorts. Methods We studied 49 334 participants from 14 population-based cohorts in different age groups (≤10, >10–15, >15–20, >20–25 years, and overall, 5–25 years). The obstructive phenotype was defined as forced expiratory volume in 1 s (FEV1)/forced vital capacity (FVC) z-score less than the lower limit of normal (LLN), whereas the restrictive phenotype was defined as FEV1/FVC z-score ≥LLN, and FVC z-score

In “The Tyranny of Transparency,” Marilyn Strathern argues that, in the neoliberal university, “visibility as a conduit for knowledge is elided with visibility as an instrument for control.” It is, but we would go further. After Deleuze, we would describe the apparatus of the university as an “optical machine”: it is “made of lines of light … distributing the visible and the invisible.” The drive to transparency, or panoptics, dominates the university today – from audit to architecture – and serves what Levien de Cauter calls “transcendental capitalism.” But it obscures a shadow discourse, or scotoptics, which hides invisible “lines of flight” and “fracture” that are transversal to transparency and transcendental capitalism. What this shadow discourse discloses about our university is that it is a transcendental-colonial-Maori place, a place that is palimpsestic and contested, a whenua tautohetohe (contested territory). We need to know that our university is more than it seems to be able to conceive of it as a “pluriversity,” a place of possibilities, upbuilding and practical wisdom: a wānanga (place of learning).

From education to expertise: sociology as a "profession"

Introduction Clinical recommendations for childhood asthma are often based on data extrapolated from studies conducted in adults, despite significant differences in mechanisms and response to treatments. The Paediatric Asthma in Real Life (PeARL) Think Tank aspires to develop recommendations based on the best available evidence from studies in children. An overview of systematic reviews (SRs) on paediatric asthma maintenance management and an SR of treatments for acute asthma attacks in children, requiring an emergency presentation with/without hospital admission will be conducted.Methods and analysis Standard methodology recommended by Cochrane will be followed. Maintenance pharmacotherapy of childhood asthma will be evaluated in an overview of SRs published after 2005 and including clinical trials or real-life studies. For evaluating pharmacotherapy of acute asthma attacks leading to an emergency presentation with/without hospital admission, we opted to conduct de novo synthesis in the absence of adequate up-to-date published SRs. For the SR of acute asthma pharmacotherapy, we will consider eligible SRs, clinical trials or real-life studies without time restrictions. Our evidence updates will be based on broad searches of Pubmed/Medline and the Cochrane Library. We will use A MeaSurement Tool to Assess systematic Reviews, V.2, Cochrane risk of bias 2 and REal Life EVidence AssessmeNt Tool to evaluate the methodological quality of SRs, controlled clinical trials and real-life studies, respectively.Next, we will further assess interventions for acute severe asthma attacks with positive clinical results in meta-analyses. We will include both controlled clinical trials and observational studies and will assess their quality using the previously mentioned tools. We will employ random effect models for conducting meta-analyses, and Grading of Recommendations Assessment, Development and Evaluation methodology to assess certainty in the body of evidence.Ethics and dissemination Ethics approval is not required for SRs. Our findings will be published in peer reviewed journals and will inform clinical recommendations being developed by the PeARL Think Tank.PROSPERO registration numbers CRD42020132990, CRD42020171624.

Introduction Asthma affects millions of children worldwide—1.1 million children in the UK. Asthma symptoms cannot be cured but can be controlled with low-dose inhaled corticosteroids (ICSs) in the majority of individuals. Treatment with a low-dose ICS, however, fails to control asthma symptoms in around 10%–15% of children and this places the individual at increased risk for an asthma attack. At present, there is no clear preferred treatment option for a child whose asthma is not controlled by low-dose ICS and international guidelines currently recommend at least three treatment options. Herein, we propose a systematic review and individual participant data network meta-analysis (IPD-NMA) aiming to synthesise all available published and unpublished evidence from randomised controlled trials (RCTs) to establish the clinical effectiveness of pharmacological treatments in children and adolescents with uncontrolled asthma on ICS and help to make evidence-informed treatment choices. This will be used to parameterise a Markov-based economic model to assess the cost-effectiveness of alternative treatment options in order to inform decisions in the context of drug formularies and clinical guidelines.Methods and analysis We will search in MEDLINE, the Cochrane Library, the Cochrane Central Register of Controlled Trials (CENTRAL), Embase, NICE Technology Appraisals and the National Institute for Health Research (NIHR) Health Technology Assessment series for RCTs of interventions in patients with uncontrolled asthma on ICS. All studies where children and adolescents were eligible for inclusion will be considered, and authors or sponsors will be contacted to request IPD on patients aged

Background Immunogenicity of cancer vaccines is impacted by adjuvants and schedule, but systematic assessments of their effects have not been performed. Montanide ISA-51, an incomplete Freund’s adjuvant (IFA), is used in many vaccine trials, but concerns have been raised about negative effects in murine studies. We found in humans that IFA enhances systemic immune responses and that repeat vaccination at one site (same site vaccination (SSV)) creates tertiary lymphoid structures (TLS) in the vaccine site microenvironment (VSME). We hypothesized that vaccination with peptides+IFA+pICLC or SSV×3 with peptides in IFA would create an immunogenic milieu locally at the VSME, with activated dendritic cells (DC), TLS-associated chemokines and a Th1-dominant VSME.Methods Biopsies of the VSME were obtained from participants on two clinical trials who were immunized with multiple melanoma peptides (MELITAC 12.1) in adjuvants comprising IFA and/or the TLR3-agonist pICLC. Biopsies were obtained either a week after one vaccine or a week after SSV×3. Controls included normal skin and skin injected with IFA without peptides. Gene expression analysis was performed by RNAseq.Results VSME samples were evaluated from 27 patients. One vaccine with peptides in pICLC+IFA enhanced expression of CD80, CD83, CD86 (p

Background Optimal feeding of very low birthweight (VLBW

Objective: To determine if low-cost air-quality monitors providing personalised feedback of household second-hand smoke (SHS) concentrations plus standard health service advice on SHS were more effective than standard advice in helping parents protect their child from SHS. Design: A randomised controlled trial of a personalised intervention delivered to disadvantaged mothers who were exposed to SHS at home. Changes in household concentrations of fine Particulate Matter (PM2.5) were the primary outcome. Methods: Air-quality monitors measured household PM2.5 concentrations over approximately 6 days at baseline and at one-month and six-months post-intervention. Data on smoking and smoking-rules were gathered. Participants were randomised to either Group A (standard health service advice on SHS) or Group B (standard advice plus personalised air-quality feedback). Group B participants received personalised air-quality feedback after the baseline measurement and at 1-month. Both groups received air-quality feedback at 6-months. Results: 120 mothers were recruited of whom 117 were randomised. Follow up was completed after 1-month in 102 and at 6-months in 78 participants. There was no statistically significant reduction in PM2.5 concentrations by either intervention type at 1-month or 6-months, nor significant differences between the two groups at 1-month (p = 0.76) and 6-month follow-up (p = 0.16). Conclusions: Neither standard advice nor standard advice plus personalised air-quality feedback were effective in reducing PM2.5 concentrations in deprived households where smoking occurred. Finding ways of identifying homes where air-quality feedback can be a useful tool to change household smoking behaviour is important to ensure resources are targeted successfully. Keywords: Environmental Tobacco Smoke, Second-hand Smoke, Children, PM2.5, Education, Intervention

Two high resolution, 3D imaging techniques were applied to visualize and characterize sterilizing grade dual-layer filtration of liposomes, enabling membrane structure to be related with function and performance. Two polyethersulfone membranes with nominal retention ratings of 650 nm and 200 nm were used to filter liposomes of an average diameter of 143 nm and a polydispersity index of 0.1. Operating conditions including differential pressure were evaluated. X-ray computed tomography at a pixel size of 63 nm was capable of resolving the internal geometry of each membrane. The respective asymmetry and symmetry of the upstream and downstream membranes could be measured, with pore network modeling used to identify pore sizes as a function of distance through the imaged volume. Reconstructed 3D digital datasets were the basis of tortuous flow simulation through each porous structure. Confocal microscopy visualized liposome retention within each membrane using fluorescent dyes, with bacterial challenges also performed. It was found that increasing pressure drop from 0.07 MPa to 0.21 MPa resulted in differing fluorescent retention profiles in the upstream membrane. These results highlighted the capability for complementary imaging approaches to deepen understanding of liposome sterilizing grade filtration.