CODIFI (Concordance in Diabetic Foot Ulcer Infection) : a cross-sectional study of wound swab versus tissue sampling in infected diabetic foot ulcers in England

OBJECTIVE: To determine the extent of agreement and patterns of disagreement between wound swab and tissue samples in patients with an infected diabetic foot ulcer (DFU). DESIGN: Multicentre, prospective, cross-sectional study. SETTING: Primary and secondary care foot ulcer/diabetic outpatient clinics and hospital wards across England. PARTICIPANTS: Inclusion criteria: consenting patients aged ≥18 years; diabetes mellitus; suspected infected DFU. EXCLUSION CRITERIA: clinically inappropriate to take either sample. INTERVENTIONS: Wound swab obtained using Levine's technique; tissue samples collected using a sterile dermal curette or scalpel. OUTCOME MEASURES: Coprimary: reported presence, and number, of pathogens per sample; prevalence of resistance to antimicrobials among likely pathogens. Secondary: recommended change in antibiotic therapy based on blinded clinical review; adverse events; sampling costs. RESULTS: 400 consenting patients (79% male) from 25 centres.Most prevalent reported pathogens were Staphylococcus aureus (43.8%), Streptococcus (16.7%) and other aerobic Gram-positive cocci (70.6%). At least one potential pathogen was reported from 70.1% of wound swab and 86.1% of tissue samples. Pathogen results differed between sampling methods in 58% of patients, with more pathogens and fewer contaminants reported from tissue specimens.The majority of pathogens were reported significantly more frequently in tissue than wound swab samples (P<0.01), with equal disagreement for S. aureus and Pseudomonas aeruginosa. Blinded clinicians more often recommended a change in antibiotic regimen based on tissue compared with wound swab results (increase of 8.9%, 95% CI 2.65% to 15.3%). Ulcer pain and bleeding occurred more often after tissue collection versus wound swabs (pain: 9.3%, 1.3%; bleeding: 6.8%, 1.5%, respectively). CONCLUSION: Reports of tissue samples more frequently identified pathogens, and less frequently identified non-pathogens compared with wound swab samples. Blinded clinicians more often recommended changes in antibiotic therapy based on tissue compared with wound swab specimens. Further research is needed to determine the effect of the additional information provided by tissue samples. TRIAL REGISTRATION NUMBER: ISRCTN52608451

The Prevalence of Sexually Transmitted Infections in Papua New Guinea: A Systematic Review and Meta-Analysis

Patellofemoral osteoarthritis (PF OA) is more prevalent than previously thought and contributes to patient's suffering from knee OA. Synthesis of prevalence data can provide estimates of the burden of PF OA

Factors predicting the outcome of foot and ankle surgery in patients with rheumatoid arthritis

Rheumatoid arthritis (RA) is the most common autoimmune inflammatory arthropathy. Foot pathology is almost ubiquitous in RA, affecting around 90% of patients during the course of their disease. Many of these require surgery! although reports suggest outcomes are varied and often suboptimal. Research into foot surgery is on the whole limited, methodologically poor, and hampered by a lack of understanding of what patients with RA perceive to be important when determining the outcome of their surgery. The hypothesis for work undertaken in this thesis was that patient specific factors will predict the outcome of foot and ankle surgery in patients with RA. In order to fully explore this, a multi methodological approach was used in a series of coordinated studies. Firstly, a secondary analysis of a large inception cohort of patients with RA was undertaken to explore use of surgical and conservative footcare and identify factors which may differentiate between the two. Then a series of preliminary studies were undertaken to explore what was important to patients when considering the outcome of their operation, compile a list of candidate factors to be tested in the main study, and assess the accuracy of new activity monitors in patients with RA. These preliminary studies then informed the design of a final prospective multicentre cohort of patients undergoing surgery to enable the prognostic ability of candidate factors to be modelled. Results presented in this thesis indicate that patients interpret the outcome of their operation using a multitude of interrelated factors and that further work is required before activity levels can be recorded objectively in patients with RA. Furthermore, patient specific factors may predict both an individual's future need for surgery, and the likely outcome of any surgery. However further work is required to confirm these findings before the evidence can be considered strong enough to inform clinical practice.EThOS - Electronic Theses Online ServiceGBUnited Kingdo

The Superconducting Super Proton Synchrotron

In order to continue pushing the frontiers of high energy physics, a future circular hadron collider, FCC-$hh$ has been proposed. Using 16 T magnets the FCC-$hh$ will be able to collide two beams of hadrons with a centre-of-mass energy of order 100 TeV. In doing so it is hoped that FCC-$hh$ will shed light on some of the mysteries of modern particle physics, in particular the nature of the Higgs potential and the Standard Model of Particle Physics as well as what may lie beyond. An important consideration for the design of the FCC-$hh$ is the series of accelerators that will be used to inject the hadron beams into the collider. The FCC-$hh$ requires a high energy injector. One possible machine to be used for this purpose is the superconducting Super Proton Synchrotron, scSPS. The scSPS is a new superconducting accelerator that will be built in the same tunnel as the normal-conducting, Super Proton Synchrotron, SPS. The scSPS will be able to accelerate proton beams to an energy of 1.3 TeV, nearly three times as high as the SPS, for extraction to either the FCC-$hh$ or to fixed target experiments. This report details the results of a design study for such an upgrade with a focus on the lattice design, magnet design and RF cavity design. A recommended design for a dispersion suppressor is discussed and the cell dimensions optimised to fit in the existing SPS tunnel. Preliminary designs for the magnets are proposed. Three superconducting designs are proposed for both the dipole and quadrupole magnets. These designs provide the freedom to operate the scSPS at 4.2 K with double-layered magnets and 1.9 K with single layered magnets. The design of both superconducting and normal-conducting sextupole magnets for chromaticity corrections have also been produced. A superconducting RF cavity design is also presented, requiring state-of-the-art high bandwidth and fast tuners

Provision of foot and ankle care services for people with rheumatic and musculoskeletal disease across Europe

Background: The aim of the present study was to explore the variation in theprovision of care for people with rheumatic and musculoskeletal diseases (RMDs),and foot and ankle problems between European healthcare systems.Methods: An electronic questionnaire was developed and piloted in seven countriesprior to being distributed to the presidents of all 22 national health professionals inrheumatology associations within the European League Against Rheumatism(EULAR). Summary data were obtained using SPSS V22. Ethical approval was soughtfrom the Medical Research Ethics Committee of University of Malaga (CEUMA-91-2015-H).Results: Sixteen questionnaires (73% response rate) were completed (Austria,Belgium, Czech Republic, Denmark, France, Hungary, Ireland, Italy, Malta, theNetherlands, Norway, Portugal, Spain, Sweden, Switzerland and the UK). All16 respondents indicated that foot and ankle healthcare services were providedin their country, but only three countries had services specializing in RMD-relatedfoot and ankle problems (the Netherlands, the UK and Malta). The professionsproviding care varied, depending on the pathology and the country. Foot andankle pain was mostly treated by rheumatologists and physiotherapists; foot andankle deformities by orthopaedic surgeons and orthotist/prosthetists; and footand ankle ulcers by nurses. Services were predominantly delivered through thepublic sector, and in secondary care (hospital) settings.Conclusions: Only three countries reported having specialist foot and ankle servicesaddressing the needs of people with RMDs. Variation was seen in the professionswhich provided care between countries, and also between the foot and ankle pathol-ogies cared for. There is a lack of clinical pathways and guidelines for the manage-ment of patients with RMD-related foot and ankle problems

Lateral compression type 1 fracture fixation in the elderly (L1FE): study protocol for a randomised controlled trial (with internal pilot) comparing the effects of INFIX surgery and non-surgical management for treating patients with lateral compression type 1 (LC-1) fragility fractures.

BACKGROUND: Lateral compression type1 (LC-1) fragility fractures are a common, painful injury in older adults resulting in reduced mobility. The incidence of these fractures is increasing with the growing older adult population. The current standard of care is non-surgical management; however, patients with this injury are at risk of long-term immobility and related complications. INFIX is a pelvic fixation device used in younger patients with high-energy fractures. The device is fitted via a percutaneous technique with no external pin sites and has good purchase even in osteoporotic bone. It therefore has the potential to be well tolerated in patients with LC-1 fragility fractures. INFIX could improve patients' ability to mobilise and reduce the risk of immobility-related complications. However, there is a risk of complications related to surgery, and robust evidence is required on patient outcomes. This study will investigate the clinical and cost-effectiveness of surgical fixation with INFIX compared to non-surgical management of LC-1 fragility fractures in older adults. METHODS: A multi-centre randomised controlled trial of 600 patients allocated 1:1 to non-surgical management or INFIX surgery. The study will have a 12-month internal pilot to assess recruitment and trial feasibility. The primary outcome will be the patient quality of life over 6 months, measured by the patient-reported EQ-5D-5L. The secondary outcomes will include physical function, mental health, pain, delirium, imaging assessment, resource use, and complications. DISCUSSION: The L1FE study aims to compare the clinical and cost-effectiveness of surgical and non-surgical management of people aged 60 years and older with LC-1 fragility fractures. The trial is sufficiently powered and rigorously designed to inform future clinical and patient decision-making and allocation of NHS resources. TRIAL REGISTRATION: International Standard Randomised Controlled Trial Number Registry ISRCTN16478561. Registered on 8 April 2019

Stripers, bailarinas exóticas, eróticas: identidad e inmigración en la construcción del Estado canadiense Stripers, erotic and exotic dancers: immigration and identity in the construction of the canadian nation-State

Este artículo presenta una discusión sobre la migración de mujeres Latinoamericanas para trabajar en la industria del sexo en Canadá, como bailarinas exóticas, a través de visas temporales de trabajo. El objetivo es demostrar que esa migración se encuentra determinada en un contexto de relaciones desiguales de poder enmarcadas por las políticas migratorias canadienses, relaciones de explotación económica de Norte América hacia Latinoamérica, construcciones raciales y racistas, y relaciones patriarcales de género, en el que el trabajo sexual es una de las pocas opciones laborales que tienen las mujeres.<br>This article discusses how the migration of Latin American women to work in the sex trade, specifically as exotic dancers, as temporary workers is framed within a specific context of Canadian immigration policies, uneven economic relationships between North America and Latin America, racial and racist constructions and sexist gender relations where sex work is one of the few working possibilities that women have