The effect of seasonality on the immune response of rainbow trout (Oncorhynchus mykiss)

The primary aim of the work carried out in this thesis was to determine if season influences the rainbow trout (Oncorhynchus mykiss) immune system. It is already well established that seasonality dominates the life history of fish for example in reproductive activity, food intake, locomotor activity, body weight and body condition. To accomplish this, a twelve month trial was carried out in which a variety of innate immune and haematological parameters were measured every month (Chapter 2). Several of the parameters studied exhibited seasonal patterns. Further trials were carried out to examine the proximate cues of temperature (Chapter 3) and photoperiod (Chapter 4) and their effect on a variety of innate immune responses. These studies concluded that temperature exerted a significant effect on several of the parameters studied whereas, photoperiod, was found to have little or no effect. Furthermore, winter was generally found to have an immunosuppressive effect on the immune system. A second twelve month trial was carried out, investigating possible methods of alleviating seasonal immunosuppression. The effect of melatonin on the immune system of O. mykiss was examine, firstly to determine if it acts as an immunostimulant and secondly to investigate if it improves vaccination protection. The results of this trial generally corroborated those of the Base Level Trial (Chapter 2) in that generally, parameters were suppressed in winter, with the exception of haematocrits which were suppressed in summer. To investigate if the immune system of rainbow trout exhibits a circadian rhythm a trial was carried out where a variety of innate immune and haematological parameters were measured every 6 hours over a 24 h period (Chapter 6). None of the innate immune parameters studied were observed to exhibit a circadian rhythm. It is anticipated that this research investigating the seasonal effects of natural and artificial photoperiods and temperatures on immune function will be of benefit to the aquaculture industry. It will provide information that will allow administration of commercial diets containing functional supplements to be timed effectively and will facilitate our understanding of the epidemiology of specific fish pathogens

Merging conservation with production in remnant bush

Exports of cutflowers and foliage from Western Australia are now worth about $17 million a year. A third of this is picked from the bush, either on Crown Land or areas of remnant bush on private property. While the industry\u27s future lies in cultivation, bush picking is likely to remain important for some years. This can provide both extra income for farmers and benefit the environment - as long as care is take

How timely is access to palliative care medicines in the community? A mixed methods study in a UK city

YesObjective: To investigate timely access to palliative medicines/drugs (PMs) from community pharmacies to inform palliative care service delivery. Design: Mixed methods in two sequential phases: (1) prospective audit of prescriptions and concurrent survey of patients/representatives collecting PMs from pharmacy and (2) interviews with community pharmacists (CPs) and other healthcare professionals (HCPs). Setting: Five community pharmacies in Sheffield, UK and HCPs that deliver palliative care in that community. Participants: Phase 1: five CPs: two providing access to PMs within a locally commissioned service (LCS) and three not in the LCS; 55 patients/representatives who completed the survey when accessing PMs and phase 2: 16 HCPs, including five phase 1 CPs, were interviewed. Results: The prescription audit collected information on 75 prescriptions (75 patients) with 271 individual PMs; 55 patients/representatives (73%) completed the survey. Patients/representatives reported 73% of PMs were needed urgently. In 80% of cases, patients/representatives received all PMs on the first pharmacy visit. One in five had to travel to more than one pharmacy to access PMs. The range of PMs stocked by pharmacies was the key facilitating factor. CPs reported practical issues causing difficulty keeping PMs in stock and playing a reactive role with palliative prescriptions. Confidentiality concerns were cited by other HCPs who were reluctant to share key patient information proactively with pharmacy teams. Inadequate information transfer, lack of CP integration into the care of palliative patients and poor HCP knowledge of which pharmacies stock PMs meant patients and their families were not always able to access PMs promptly. Conclusions: Consistent routine information transfer and integration of pharmacy teams in the care of palliative patients are needed to achieve timely access to PMs. Commissioners of PM access schemes should review and monitor access. HCPs need to be routinely made aware and reminded about the service and its locations.EJM received research funding from Pharmacy Research UK and Sheffield Teaching Hospitals NHS Foundation Trust as well as support from St Luke’s Hospice, Sheffield. AB and JDM report grants from Pharmacy Research UK during the conduct of the study

Risk versus regulation: an update on the state of e-cigarette control in Australia

E-cigarettes are increasingly common around the world, particularly among youth. Ingestion of nicotine-containing e-liquid, while relatively rare, is the major toxicological risk associated with their use. Current Australian regulation has nicotine for use in e-cigarettes listed as a dangerous poison in Schedule 7, with its supply or sale illegal in all states and territories, while regulation on the sale of e-cigarettes and accessories varies by state. However, with increasing evidence that e-cigarettes produce far fewer toxic by-products than their combustible counterparts perhaps it is time to review this regulation

Fifteen-year survival of endoscopic anterior cruciate ligament reconstruction in patients aged 18 years and younger

Background: The current body of literature surrounding anterior cruciate ligament (ACL) survival and the variables contributing to further ACL injuries after primary ACL reconstruction in children and adolescents is limited, with no long-term evidence examining the incidence and contributing factors of further ACL injuries in this younger patient population. Purpose: To determine the long-term survival of the ACL graft and the contralateral ACL (CACL) after primary reconstruction in patients aged 18 years and to identify the factors that increase the odds of subsequent ACL injuries. Study Design: Case series; Level of evidence, 4. Methods: Patients having undergone primary ACL reconstruction at age 18 years between 1993 and 1998 who were included in a prospective database by a single surgeon were considered for this study. Single-incision endoscopic ACL reconstruction was performed with either an autologous bone–patellar tendon–bone graft or a hamstring tendon graft. At a minimum of 15 years after ACL reconstruction, patients completed a subjective survey involving the International Knee Documentation Committee (IKDC) questionnaire in addition to questions regarding current symptoms, further ACL injuries, family history of ACL injury, and current level of activity. Results: A total of 288 adolescents (age range, 13-18 years) met the inclusion criteria, of whom 242 (84%) were reviewed at a mean of 16 years and 6 months after ACL reconstruction. Of these patients, 75 (31%) sustained a further ACL injury: 27 (11.2%) suffered an ACL graft rupture, 33 suffered a CACL injury (13.6%), and 15 sustained both an ACL graft rupture and a CACL injury (6.2%) over 15 years. Survival of the ACL graft was 95%, 92%, 88%, 85%, and 83% at 1, 2, 5, 10, and 15 years, respectively, and survival of the CACL was 99%, 98%, 90%, 83%, and 81%, respectively. Survival of the ACL graft was less favorable in those with a family history of ACL injury than in those without a family history (69% vs 90%, respectively; hazard ratio [HR], 3.6; P = .001). Survival of the CACL was less favorable in male patients than in female patients (75% vs 88%, respectively; HR, 2.1; P = .03) and in those who returned to competitive team ball sports than in those who did not (78% vs 89%, respectively; HR, 2.3; P = .05). Conclusion: After ACL reconstruction in patients aged 18 years, a further ACL injury occurred in 1 in 3 patients over 15 years. The 15-year survival rate of the ACL graft was 83%, and the 15-year survival rate of the CACL was 81%. The ACL graft and CACL were most vulnerable within the first 5 years after index surgery. A family history of ACL rupture significantly increased the risk for ACL graft ruptures, and a CACL injury was more common in male patients and those who returned to team ball sports. High IKDC scores and continued participation in sports were maintained over the long term after ACL reconstruction in the adolescent population

Free electron laser generation of X-ray Poincaré beams

An optics-free method is proposed to generate x-ray radiation with spatially variant states of polarization via an afterburner extension to a free electron laser. Control of the polarization in the transverse plane is obtained through the overlap of different coherent transverse light distributions radiated from a bunched electron beam in two consecutive orthogonally polarised undulators. Different transverse profiles are obtained by emitting at a higher harmonic in one or both of the undulators. This method enables the generation of beams structured in their intensity, phase, and polarization - so-called Poincaré beams - at high powers with tunable wavelengths. Simulations are used to demonstrate the generation of two different classes of light with spatially inhomogeneous polarization - cylindrical vector beams and full Poincaré beams

Musculoskeletal care pathways for adults

Background: Musculoskeletal (MSK) conditions are the most frequently reported chronic conditions and one of the biggest causes of disability in the UK. Given the ageing population and the impact of these problems, the demand for MSK treatment will rise. Despite reduced waiting times, MSK pathways have remained variable and inconsistent and need to be improved to meet patient needs. The aim of this systematic review is to understand the evidence for the effectiveness of current models of service delivery and care pathways for adult hip/knee pain patients accessing secondary care for specialist opinions. Methods: MEDLINE, MEDLINE In-Process, CINAHL, Embase, PEDro, PubMed, Web of Science, Cochrane Central and HMIC databases will be searched without language restrictions for papers published from 1990 onward. Websites will be reviewed for grey literature including care pathways, policy documents and unpublished MSK research. Additionally, reference lists will be checked and citations tracked for included studies. Discussion: The following evidence will be included: research considering care pathways at the intersection between primary and secondary care for adults with hip and/or knee pain in countries with an established clinical pathway. Studies considering generalised inflammatory arthropathy and post-surgical care pathways will be excluded. Screening for included data will be conducted independently by two reviewers. After benchmarking, quality assessment and data extraction will be conducted by one reviewer and checked by a second. A mixed method analysis will be conducted. This systematic review will be used as part of a programme of research to identify best practice for MSK hip and knee pain care pathways. It will provide recommendations for pathway re-design to meet patient needs and ensure efficient streamlining of the patient journey. The review will combine a wide range of information sources including patient and clinician opinion, clinical guidelines, health service delivery research and stakeholder requirements. This should result in a pathway that provides better patient experience and outcomes, whilst meeting the demands placed on the NHS for high-quality evidence-based interventions with efficient use of resources

Using text messaging in long-term arthroplasty follow-up: A pilot study

Background: Patient-reported outcome measures (PROMs) and mobile technology have the potential to change the way patients are monitored following joint replacement surgery. Objective: The aim of this study was to determine the feasibility of text messaging to record PROMs in long-term follow-up of hip and knee arthroplasty. Our participants were 17 patients 2-years-plus post hip or knee arthroplasty attending clinic with a mobile telephone number on record. Methods: A simple PROM (Oswestry Very Short Form) was texted to the patient. Responses were compared to clinical, radiographic, and existing PROM findings. Patients were interviewed to discover their opinions on this use of texting. Results: A total of 11 patients engaged with the text messaging. Reasons for not engaging included wrong numbers, physical barriers, and lack of understanding. A total of 8 patients attending clinic allowed comparison of text messaging with clinical findings. The average age was 70 years. A total of 4 patient text messaging responses matched clinical and radiographic findings; 3 also matched PROM scores collected in clinic. The 3 patients with mixed responses had abnormal clinical, radiographic, or PROM findings. One patient’s text responses conflicted with clinical outcome. Analysis of patients’ views showed a generally positive opinion: patients were happy to communicate with surgeons by text. Practical problems, PROM limitations, and trustworthiness of texting were highlighted. Conclusions: Engaging with changing technology creates challenges for patients and health care professionals. Despite this, our results suggest text messaging is a promising way to communicate with arthroplasty patients. Earlier integration of text communication in the patient pathway may be important and needs further research

Falling Through the Cracks? An Exploration of the Conditions of Care Experienced by Younger Residents Living in Long-Term Care Facilities

This dissertation examines the situation of younger residents living in long-term care facilities (LTCFs) in Ontario in the decades leading up to the COVID-19 pandemic. Adults under the age of 65 with disabilities and chronic health conditions were impacted by neoliberal processes of long-term care (LTC) reform and the closure of provincial residential institutions for people with disabilities. Gaps in public health and social care associated with these changes led some non-senior adults to turn to LTCFs when their needs were not being met. Very little is known about the situation of younger residents, who comprise less than eight percent of the total resident population in Ontario’s LTCFs. I address this gap by exploring non-senior residents’ “conditions of care”—the practices, interactions, relationships, and structures that make up their everyday experiences living in a LTCF. My study asks: What are the conditions of care for younger residents, do they align with their needs and preferences, and what factors account for the value of and problems with these conditions? Guided by a relational feminist disability perspective, I address these questions by drawing on data from semi-structured interviews with younger residents, direct care workers, and administrators, as well as from a focus group with family members, field notes, and facility-specific documents. I analyze the data as informed by intersecting relations of difference and inequality associated with gender, disability and age, and as situated within a particular set of contexts. My findings demonstrate that for non-senior residents, the promise of LTCFs lies in relational care—the presence of favourable interpersonal care relationships and the practice of care in relational ways. However, relational care is often prevented by the structures of LTC, particularly those associated with public funding inadequacies and the application of strategies associated with new public management (NPM). Addressing these barriers is key to transforming LTCFs into places that are better for younger residents. But LTCFs will not be appropriate until a range of accessible, high quality, public LTC and social services are also made available