Medical interns' reflections on their training in use of personal protective equipment.

BACKGROUND:The current COVID-19 pandemic has demonstrated that personal protective equipment (PPE) is essential, to prevent the acquisition and transmission of infectious diseases, yet its use is often sub-optimal in the clinical setting. Training and education are important to ensure and sustain the safe and effective use of PPE by medical interns, but current methods are often inadequate in providing the relevant knowledge and skills. The purpose of this study was to explore medical graduates' experiences of the use of PPE and identify opportunities for improvement in education and training programmes, to improve occupational and patient safety. METHODS:This study was undertaken in 2018 in a large tertiary-care teaching hospital in Sydney, Australia, to explore medical interns' self-reported experiences of PPE use, at the beginning of their internship. Reflexive groups were conducted immediately after theoretical and practical PPE training, during hospital orientation. Transcripts of recorded discussions were analysed, using a thematic approach that drew on the COM-B (capability, opportunity, motivation - behaviour) framework for behaviour. RESULTS:80% of 90 eligible graduates participated. Many interns had not previously received formal training in the specific skills required for optimal PPE use and had developed potentially unsafe habits. Their experiences as medical students in clinical areas contrasted sharply with recommended practice taught at hospital orientation and impacted on their ability to cultivate correct PPE use. CONCLUSIONS:Undergraduate teaching should be consistent with best practice PPE use, and include practical training that embeds correct and safe practices

A New Approach toward Transition State Spectroscopy

Chirped-Pulse millimetre-Wave (CPmmW) rotational spectroscopy provides a new class of information about photolysis transition state(s). Measured intensities in rotational spectra determine species-isomer-vibrational populations, provided that rotational populations can be thermalized. The formation and detection of S0 vinylidene is discussed in the limits of low and high initial rotational excitation. CPmmW spectra of 193 nm photolysis of Vinyl Cyanide (Acrylonitrile) contain J=0-1 transitions in more than 20 vibrational levels of HCN, HNC, but no transitions in vinylidene or highly excited local-bender vibrational levels of acetylene. Reasons for the non-observation of the vinylidene co-product of HCN are discussed.Comment: Accepted by Faraday Discussion

C Wright Mills, power and the power elites ? a reappraisal

This paper revisits and presents a critical appraisal of Mills's analysis of power and the power elite. There are signs of a revival of interest in Mills, but recent commentators have shown little interest in the intellectual, social or political context of his analysis. Setting Mills's thesis in its historical context, we consider an element of his project that has been particularly neglected in recent discussion: Mills's search for possible ways of redistributing power and his attempt to forge an ethico-political stance. Reflecting on recent discussion of contemporary elite formations, we comment on what critics might take from Mills in our own time in relation to the analysis of elites and the politics of critical management studies

The challenge of overdiagnosis begins with its definition

Overdiagnosis means different things to different people. S M Carter and colleagues argue that we should use a broad term such as too much medicine for advocacy and develop precise, case by case definitions of overdiagnosis for research and clinical purposes The implicit social contract underpinning healthcare is that it will reduce illness and preventable death and improve quality of life. But sometimes these promises are not delivered. Sometimes health services take people who don’t need intervention, subject them to tests, label them as sick or at risk, provide unnecessary treatments, tell them to live differently, or insist on monitoring them regularly.1 These interventions don’t improve things for people; they produce complications or illness, reduce quality of life, or even cause premature death. Active health intervention is not always a good thing: it can be “too much medicine,” or produce what is often called overdiagnosis. Although the concept of overdiagnosis has been described in the literature for nearly 50 years in relation to cancer screening,2 3 it was Welch and colleagues’ 2011 book, Overdiagnosed: Making People Sick in the Pursuit of Health, that popularised the term.4 Overdiagnosis is now an acknowledged problem for patients, clinicians, researchers, and policymakers; it is discussed in journals5 6 7 and at specialist conferences8 and addressed through policy and practice initiatives.9 10 11 There is, however, no formal, agreed definition of overdiagnosis. Rather, the word has become a banner under which disparate people with similar general concerns can unite. This vagueness and breadth allows the appearance of unity but does not serve the more exacting demands of research and healthcare. Here we examine the meanings of overdiagnosis more closely and discuss related challenges for healthcare professionals, patients, and researchers. If overdiagnosis is to be understood and mitigated, the broad concept should be subdivided into different problems and its ethical dimensions better acknowledged.NHMR

Daytime CO2 urban surface fluxes from airborne measurements, eddy-covariance observations and emissions inventory in Greater London

Airborne measurements within the urban mixing layer (360 m) over Greater London are used to quantify CO2 emissions at the meso-scale. Daytime CO2 fluxes, calculated by the Integrative Mass Boundary Layer (IMBL) method, ranged from 46 to 104 μmol CO2 m−2 s−1 for four days in October 2011. The day-to-day variability of IMBL fluxes is at the same order of magnitude as for surface eddy-covariance fluxes observed in central London. Compared to fluxes derived from emissions inventory, the IMBL method gives both lower (by −37%) and higher (by 19%) estimates. The sources of uncertainty of applying the IMBL method in urban areas are discussed and guidance for future studies is given

Mesangial IgA1 in IgA nephropathy exhibits aberrant O-glycosylation: Observations in three patients

Mesangial IgA1 in IgA nephropathy exhibits aberrant O-glycosylation: Observations in three patients.BackgroundIn IgA nephropathy (IgAN), circulating IgA1 molecules display an abnormal pattern of O-glycosylation. This abnormality may potentially contribute to mesangial IgA1 deposition, but this is unproven because the O-glycosylation of mesangial IgA1 has not been analyzed.MethodsIgA1 was eluted from glomeruli isolated from the kidneys of three IgAN patients obtained after nephrectomy or at postmortem. Serum from these patients, other patients with IgAN, and controls was subjected to the same treatment as the glomerular eluates. The O-glycosylation of eluted and serum IgA1 was measured by lectin binding using an enzyme-linked immunosorbent assay-based system.ResultsIn all three cases, the lectin binding of IgA1 eluted from the glomeruli of IgAN patients was markedly higher than that of the serum IgA1 of the same individual, and also all but one of a series of serum IgA1 samples from other patients and controls.ConclusionsThe higher lectin binding of glomerular compared with serum IgA1 suggests that O-glycosylated IgA1 molecules abnormally and selectively deposit in the kidney. These results provide the first evidence that mesangial IgA1 is abnormally O-glycosylated, and support a direct role for abnormal IgA1 O-glycosylation in the mechanism of mesangial IgA deposition in IgAN

Can Waterlow score predict 30-day mortality and length of stay in acutely admitted medical patients (aged ≥65 years)? Evidence from a single centre prospective cohort study

OBJECTIVE: This study aimed to explore the potential for the Waterlow score (WS) to be used as a predictor of 30-day mortality and length of hospital stay (LHS) in acutely admitted medical patients aged 65 years and older. DESIGN: Prospective observational cohort study. SETTING: UK District General Hospital. SUBJECTS: 834 consecutive patients aged 65 years and older admitted acutely to medical specialties between 30 May and 22 July 2014. METHODS ADMISSION: WS (range 4–64) assessment paired with the patient’s status at 30 days in terms of mortality and their LHS. PRIMARY OUTCOMES: 30-day mortality and length of inpatient stay. RESULTS: 834 consecutive acute medical admissions had their WS recorded. 30-day mortality was 13.1% (109 deaths). A significant difference in the distribution of WS (p<0.001) was seen between those who survived (median 12) and those who died (median 16) within 30 days, particularly within respiratory (p<0.001), stroke (p<0.001), cardiology (p<0.016), non-respiratory infections (p<0.018) and trauma (p<0.044) subgroups. Odds of dying within 30 days increased threefold for every 10-unit increase in the WS (p<0.001, 95% CI 2.1 to 4.3). LHS was also positively linearly associated with the WS in those who survived 30 days (median=5, IQR=10; r=0.32, p<0.01). A five-unit increase in WS was associated with approximately 5 days increase in LHS. On the other hand, quadratic regression showed this relationship was curvilinear and negative (concave) for those who died within 30 days where a five-unit increase in WS was associated with an approximately 10 days decrease in LHS. CONCLUSION: This study demonstrates an association between a high WS and both 30-day mortality and LHS. This is particularly significant for mortality in patients in the respiratory, stroke and cardiac subcategories. The WS, a nursing-led screening tool that is carried out on virtually all admissions to UK hospitals, could have additional use at the time of patient admission as a risk assessment tool for 30-day mortality as well as a predictor of LHS

A framework for estimating society’s economic welfare following the introduction of an animal disease: the case of Johne’s disease

Animal diseases are global issues affecting the productivity and financial profitability of affected farms. Johne’s disease is distributed on farms worldwide and is an endemic contagious bacterial infection in ruminants caused by Mycobacterium avium subspecies paratuberculosis. In cattle, the clinical disease manifests itself as chronic enteritis resulting in reduced production, weight loss, and eventually death. Johne’s disease is prevalent in the UK, including Scotland. Direct costs and losses associated with Johne’s disease have been estimated in previous research, confirming an important economic impact of the disease in UK herds. Despite this, the distributional impact of Johne’s disease among milk consumers and producers in Scotland has not been estimated. In this paper, we evaluate the change in society’s economic welfare, namely to dairy producers (i.e. infected and uninfected herds) and milk consumers in Scotland induced by the introduction of Johne’s disease in the national Scottish dairy herd. At the national-level, we conclude that the economic burden falls mainly on producers of infected herds and, to a lesser extent, milk consumers, while producers of uninfected herds benefit from the presence of Johne’s. An infected producer’s loss per cow is approximately two times larger in magnitude than that of an uninfected producer’s gain. Such economic welfare estimates are an important comparison of the relative costs of national herd prevalence and the wider economic welfare implications for both producers and consumers. This is particularly important from a policy, public good, cost sharing, and human health perspective. The economic welfare framework presented in this paper can be applied to other diseases to examine the relative burden of society’s economic welfare of alternative livestock disease scenarios. In addition, the sensitivity analysis evaluates uncertainty in economic welfare given limited data and uncertainty in the national herd prevalence, and other input parameters, associated with Johne’s disease in Scotland. Therefore, until the prevalence of Johne’s is better understood, the full economic cost to Scottish dairy herds remains uncertain but in the meantime the sensitivity analysis evaluates the robustness of economic welfare to such uncertainties