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We lead multidisciplinary applied research and training to rethink the way health care is delivered in general practice and across the community.
Advanced algorithms for fast and scalable deep packet inspection
Modern deep packet inspection systems use regular expressions to define various patterns of interest in network data streams. Deterministic Finite Automata (DFA) are commonly used to parse regular expressions. DFAs are fast, but can require prohibitively large amounts of memory for patterns arising in network applications. Traditional DFA table compression only slightly reduces the memory required and requires an additional memory access per input character. Alternative representations of regular expressions, such as NFAs and Delayed Input DFAs (D 2FA) require less memory but sacrifice throughput. In this paper we introduce the Content Addressed Delayed Input DFA (CD 2FA), which provides a compact representation of regular expressions that match the throughput of traditional uncompressed DFAs. A CD 2FA addresses successive states of a D 2FA using their content, rather than a "content-less" identifier. This makes selected information available earlier in the state traversal process, which makes it possible to avoid unnecessary memory accesses. We demonstrate that such content-addressing can be effectively used to obtain automata that are very compact and can achieve high throughput. Specifically, we show that for an application using thousands of patterns defined by regular expressions, CD 2FAs use as little as 10% of the space required by a conventional compressed DFA, and match the throughput of an uncompressed DFA. Copyright 2006 ACM.
Increased statin prescribing in patients with diabetes after the introduction of the NSF for Coronary Heart Disease
Cardiovascular disease accounts for 70% of deaths in people with diabetes. This is partly due to their abnormal lipoprotein profiles. Several studies have shown that the prescription of statins to this group of people can greatly reduce the risk of death. The National Service Framework for Coronary Heart Disease (NSF for CHD), introduced in March 2000, set targets for treating people at high risk of death from CHD. Our study looked at 14 practices in Surrey to see whether the NSF has had an impact on statin prescribing in people with diabetes over the age of 40. There has been a 21 % increase in the prevalence of diabetes between 1999 and 2002. We have also shown a 74% increase in the prescribing of statins to people with diabetes following the introduction of the NSF for CHD. The increase in the number of people receiving statins has cost implications for primary care trusts. Copyright © 2003 John Wiley & Sons, Ltd.
Upper airways abnormalities and tracheal problems in Morquio's disease
Morquio's disease is a metabolic disorder that can cause various respiratory abnormalities. Patients who live into adulthood are likely to develop upper airway problems and respiratory failure. With advances in home ventilation, these patients are increasingly likely to be referred to specialist respiratory units. We describe our experiences with two such patients.
Measuring the Completeness and Currency of Codified Clinical Information
Objectives: The paper describes how an objective score (CCscore) of the 'completeness' and 'currency' of codified clinical information relevant to the management of diabetes mellitus may be derived for individual practices. Methods: A questionnaire was developed and administered to 35 practices and statistical methods were used: to test for correlation between the prevalence for diabetes mellitus and the relevant CCscores Results: No significant correlation could be found. Conclusions: The 'quality' of computer-stored information varies widely across English General practices for reasons that are incompletely understood. We demonstrated how CCscores may be calibrated for different 'views' of 'relevance', 'completeness', and 'currency' and yet be consistent across practices for a given 'view'. The potential value of this score and how it may contribute to our understanding of variation in 'information quality' are discussed.
Rapid respiratory response team - The first two years' experience
Our hospital based rapid respiratory response team has previously reported its early experience of community respiratory care and its success in preventing some hospital admissions for exacerbations of chronic obstructive pulmonary disease (Thorax 1998; 53:Supp 4:A70) We wish to present our data from two years' experience which also includes data on patients with malignant disease. 341 referrals were received for 314 patients from 1.12.97 to 1.12.99. 210(61%) were from general practitioners. GP Referrals Inpatient Referrals Non- Malignant Non- Malignant Malignant Disease Malignant Disease Disease Disease Number of Referrals 175 35 98 5 Mean Age (years±SD) 72±11 66±11 70±13 69.6±10 Gender (M:F) 82:93 19:17 50:48 2:3 Median number of Visits (Range) 7 (4-121) 4 (3-42) 7 (3-56) 8 (4-38) Median number of telephone calls (Range) 3 (2-80) 3 3 (0-25) 3 (2-10) Chest readmissions while in scheme 10 (5.7%) 2 (5.6%) 0 1 (20%) Only 62 (18%) patients with non-malignant disease were readmitted with respiratory disorders after discharge from the team of which 30 patients (48%) were admitted within the first three months. The readmission rates for respiratory disease while within the scheme and post discharge compare favourably with the results of others. The popularity of the scheme with primary care teams and patients alike increases. There is a local desire to include non acute respiratory care in team's remit.
A hospital based rapid respiratory response team
An audit of admissions due to respiratory disease to our hospital cited insufficient home support as the precipitating reason for 30% of cases. A hospital based respiratory team consisting of a specialist nurse, physiotherapist and two nurses was established to see if these admissions could be reduced by providing support in the home. Referrals were taken from general practitioners and hospital firms. 130 referrals deemed suitable for home based care by stringent criteria were made between 1.12.97 and 31.5.98, 70 from G.P.'s and 60 from the hospital. Only 7/70 of the G.P. referrals had to be admitted. 12/60 hospital referred patients had to be readmitted for their respiratory disease. The number of patients kept out of hospital represented 10% of the all acute admissions during the study period. By 31.5.98, 49 patients were still being seen at home, 63 had been discharged and 4 were in hospital. 14 patients had died primarily due to their underlying lung disorder.
Occupational asthma in fruit salad processing
Background: Three subjects employed in the preparation of fruit for fruit salads reported work-related respiratory symptoms. Their work entailed removing the peel from citrus fruits, primarily oranges, following soaking of the fruits in a bath of enzymes including fungal derived pectinase and glucanase. Objectives: To investigate the respiratory symptoms reported by these workers and determine their causes. Methods The three workers were investigated by a respiratory physician, including spirometry and serial peak flow measurements. Blood was taken for the measurement of IgE and IgG antibody responses against the enzyme solution. Results: Predominant symptoms in these workers were shortness of breath, chest tightness and wheezing which were all alleviated at weekends and holidays only to occur when returning to work. Serial peak flow measurements showed a clear work-related pattern. All three had strong IgE responses to the enzyme solution used at the workplace and showed distinct patterns of binding in immunoblots. All three improved immensely following withdrawal from the workplace environment. Conclusion: Enzymes appear to be widely used in the preparation of fruit and although they are used in liquid form, exposure can occur to induce immunological sensitization and asthma.
Inhalation of chlorine gas
The clinical features of acute chlorine gas inhalation, and its management are reviewed. Current medical views on the chronic effects of an acute overwhelming exposure on lung function (reactive airways dysfunction syndrome), and the more controversial field of lung disease secondary to repeated inhalations of lower concentrations of chlorine gas are discussed.