Outreach marketing may be a successful strategy for NHS libraries.

This dissertation study investigates the ways that NHS libraries are currently marketing their services within their organisation and was submitted as part of the MA Library and Information Management at the University of Sheffield in 2019. This paper presents the findings from twelve semi-structured interviews carried out with NHS library managers in the East of England to identify the most and least successful methods, and in comparison with that which is currently in the general marketing literature. The study found that outreach marketing was the most effective and that librarians are currently conducting marketing to the best of their ability, but they lack time and funding to be able to make the most of their promotional campaigns. F.J.

Identifying Patient-Specific Epstein-Barr Nuclear Antigen-1 Genetic Variation and Potential Autoreactive Targets Relevant to Multiple Sclerosis Pathogenesis.

BACKGROUND: Epstein-Barr virus (EBV) infection represents a major environmental risk factor for multiple sclerosis (MS), with evidence of selective expansion of Epstein-Barr Nuclear Antigen-1 (EBNA1)-specific CD4+ T cells that cross-recognize MS-associated myelin antigens in MS patients. HLA-DRB1*15-restricted antigen presentation also appears to determine susceptibility given its role as a dominant risk allele. In this study, we have utilised standard and next-generation sequencing techniques to investigate EBNA-1 sequence variation and its relationship to HLA-DR15 binding affinity, as well as examining potential cross-reactive immune targets within the central nervous system proteome. METHODS: Sanger sequencing was performed on DNA isolated from peripheral blood samples from 73 Western Australian MS cases, without requirement for primary culture, with additional FLX 454 Roche sequencing in 23 samples to identify low-frequency variants. Patient-derived viral sequences were used to predict HLA-DRB1*1501 epitopes (NetMHCII, NetMHCIIpan) and candidates were evaluated for cross recognition with human brain proteins. RESULTS: EBNA-1 sequence variation was limited, with no evidence of multiple viral strains and only low levels of variation identified by FLX technology (8.3% nucleotide positions at a 1% cut-off). In silico epitope mapping revealed two known HLA-DRB1*1501-restricted epitopes ('AEG': aa 481-496 and 'MVF': aa 562-577), and two putative epitopes between positions 502-543. We identified potential cross-reactive targets involving a number of major myelin antigens including experimentally confirmed HLA-DRB1*15-restricted epitopes as well as novel candidate antigens within myelin and paranodal assembly proteins that may be relevant to MS pathogenesis. CONCLUSIONS: This study demonstrates the feasibility of obtaining autologous EBNA-1 sequences directly from buffy coat samples, and confirms divergence of these sequences from standard laboratory strains. This approach has identified a number of immunogenic regions of EBNA-1 as well as known and novel targets for autoreactive HLA-DRB1*15-restricted T cells within the central nervous system that could arise as a result of cross-reactivity with EBNA-1-specific immune responses.

Field Placement Correction Using MV IGRT. Is Postintervention Imaging Necessary?

PURPOSE: Online image-guided radiation therapy (IGRT) is used for all radical pelvic patients at Radiation Oncology Queensland. One linear accelerator is equipped with megavoltage electronic portal imaging. Daily imaging on this linear accelerator introduces a dose burden that must be accounted for in the planning process. This dose burden is further complicated by postintervention images taken to verify field placement corrections. Analysis of setup errors and number and management of isocenter shifts was also used to identify an appropriate dose burden to be applied. METHOD: The IGRT data of 50 radical pelvic patients were retrospectively collected and analysed, and the number of isocenter moves made was assessed. Statistical analysis of systematic and random errors, both preintervention and postintervention, was undertaken. Inclusive in this analysis was the number of times postintervention images revealed an error in manually entered isocenter shifts. The imaging dose used was also investigated. RESULTS: Online IGRT was able to reduce the setup error to <2 mm for all orthogonal planes. Postintervention imaging was shown to be necessary to assess field placement, because manual errors in field placement were found to occur. The generic dose burden in use was found to be excessive. CONCLUSION: Daily IGRT is now considered an essential tool in modern radiation therapy. Postintervention imaging is required to ensure correct isocenter placement on linear accelerators where the process is manual. The current estimate of the worst-case scenario dose burden may be reduced to either incorporate a "population" dose or a more realistic absolute maximum dose. Any removal of a quality assurance process such as this requires evidence, consultation, and careful consideration.