SummaryWe undertook a randomised, controlled trial to compare the analgesic efficacy and opioid sparing effect of nerve stimulator-guided femoral nerve block with fascia iliaca compartment block in patients awaiting surgery for fractured neck of femur. Ten-centimetre visual analogue pain scores were measured before and 2 h after the block and opioid consumption was recorded in the 12-h period after the block. One hundred and ten patients were randomly assigned. Femoral nerve block provided superior pre-operative analgesia for fractured neck of femur compared with fascia iliaca compartment block. The difference in the mean reduction of pain score after the block was 0.9 (95% CI 0-1.8); p = 0.047. Patients receiving a femoral nerve block required less morphine after the block than those receiving fascia iliaca compartment block (p = 0.041). In the UK, the target for maximum delay from diagnosis to surgery for patients with femoral neck fracture is 36 h, during which time they require adequate analgesia. Both femoral nerve block [1] and the fascia iliaca compartment block [2] are commonly used peri-operatively for analgesia in patients with a fractured neck of femur. These two techniques are used in our institution and we have equipoise as to their relative efficacy. They are either performed with a nerve stimulator to place local anaesthetic solution close to the femoral nerve or as a fascia iliaca compartment block using surface landmarks and the tactile feedback technique. All blocks are undertaken by four specialist acute pain nurses with training and extensive experience in performing these blocks. To date, over 1600 blocks have been undertaken by this team with no significant complications recorded. The two blocks have not been compared for relative efficacy when administered pre-operatively. This study was designed to resolve the question as to which technique provides superior analgesic efficacy. MethodsThe study was approved by the Local Research Ethics Committee and written informed consent was obtained from all patients. Inclusion criteria were patients presenting with isolated femoral neck fracture who had a mini-mental score [3] of ≥ 8/10 and fulfilled the requirements for full mental capacity for

Critical illness in COVID-19 is an extreme and clinically homogeneous disease phenotype that we have previously shown1 to be highly efficient for discovery of genetic associations2. Despite the advanced stage of illness at presentation, we have shown that host genetics in patients who are critically ill with COVID-19 can identify immunomodulatory therapies with strong beneficial effects in this group3. Here we analyse 24,202 cases of COVID-19 with critical illness comprising a combination of microarray genotype and whole-genome sequencing data from cases of critical illness in the international GenOMICC (11,440 cases) study, combined with other studies recruiting hospitalized patients with a strong focus on severe and critical disease: ISARIC4C (676 cases) and the SCOURGE consortium (5,934 cases). To put these results in the context of existing work, we conduct a meta-analysis of the new GenOMICC genome-wide association study (GWAS) results with previously published data. We find 49 genome-wide significant associations, of which 16 have not been reported previously. To investigate the therapeutic implications of these findings, we infer the structural consequences of protein-coding variants, and combine our GWAS results with gene expression data using a monocyte transcriptome-wide association study (TWAS) model, as well as gene and protein expression using Mendelian randomization. We identify potentially druggable targets in multiple systems, including inflammatory signalling (JAK1), monocyte–macrophage activation and endothelial permeability (PDE4A), immunometabolism (SLC2A5 and AK5), and host factors required for viral entry and replication (TMPRSS2 and RAB2A).

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Interest in the environmental factors that affect biometric image quality is increasing as biometric technologies are currently being implemented in various business applications. This study aims to determine, through repeated trials, the effects of various external factors on the image quality and usability of prints collected by an electronic reader. These factors include age and gender but also the absence or presence of immediate feedback. A key factor in biometric systems that will be used daily or routinely is habituation. The user's behavior could potentially change as a result of acclimatization; one's input might increase in quality as one learns how to use the system better, or decrease in quality since comfort with the system could translate into carelessness.

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