BHPR research: qualitative1. Complex reasoning determines patients' perception of outcome following foot surgery in rheumatoid arhtritis

Background: Foot surgery is common in patients with RA but research into surgical outcomes is limited and conceptually flawed as current outcome measures lack face validity: to date no one has asked patients what is important to them. This study aimed to determine which factors are important to patients when evaluating the success of foot surgery in RA Methods: Semi structured interviews of RA patients who had undergone foot surgery were conducted and transcribed verbatim. Thematic analysis of interviews was conducted to explore issues that were important to patients. Results: 11 RA patients (9 ♂, mean age 59, dis dur = 22yrs, mean of 3 yrs post op) with mixed experiences of foot surgery were interviewed. Patients interpreted outcome in respect to a multitude of factors, frequently positive change in one aspect contrasted with negative opinions about another. Overall, four major themes emerged. Function: Functional ability & participation in valued activities were very important to patients. Walking ability was a key concern but patients interpreted levels of activity in light of other aspects of their disease, reflecting on change in functional ability more than overall level. Positive feelings of improved mobility were often moderated by negative self perception ("I mean, I still walk like a waddling duck”). Appearance: Appearance was important to almost all patients but perhaps the most complex theme of all. Physical appearance, foot shape, and footwear were closely interlinked, yet patients saw these as distinct separate concepts. Patients need to legitimize these feelings was clear and they frequently entered into a defensive repertoire ("it's not cosmetic surgery; it's something that's more important than that, you know?”). Clinician opinion: Surgeons' post operative evaluation of the procedure was very influential. The impact of this appraisal continued to affect patients' lasting impression irrespective of how the outcome compared to their initial goals ("when he'd done it ... he said that hasn't worked as good as he'd wanted to ... but the pain has gone”). Pain: Whilst pain was important to almost all patients, it appeared to be less important than the other themes. Pain was predominately raised when it influenced other themes, such as function; many still felt the need to legitimize their foot pain in order for health professionals to take it seriously ("in the end I went to my GP because it had happened a few times and I went to an orthopaedic surgeon who was quite dismissive of it, it was like what are you complaining about”). Conclusions: Patients interpret the outcome of foot surgery using a multitude of interrelated factors, particularly functional ability, appearance and surgeons' appraisal of the procedure. While pain was often noted, this appeared less important than other factors in the overall outcome of the surgery. Future research into foot surgery should incorporate the complexity of how patients determine their outcome Disclosure statement: All authors have declared no conflicts of interes

Performances of a Research CFR Octane Rating Unit Engine and Dacia Single Cylinder SI Engine Ignited by a LASER System

At this time, the severe legislation regarding the level limits of the waste and exhaust gases released by thermal engines and also the necessity of engines efficiency improvement boost the engine research domain to bring in front the use of new technologies that can be used to control the in-cylinder combustion process. Now, the new technologies is represented by LASER spark plug systems which can be successfully used at petrol engines. LASER spark plug technology can have many advantages for engine operation control, an ignition system that could provide improved combustion is the one using plasma generation and a Q-switched LASER that results in pulses with high MW power. The LASER spark plug device used in the current research was a LASER medium Nd:YAG/Cr4+:YAG ceramic structure made up of a 8.0-mm long, 1.0-at.% Nd:YAG ceramic, optically-bonded to a Cr4+:YAG c. It was developed and constructed similar to classical spark plug and could be assembled on a CFR Octane Rating Unit Engine as well as on a Dacia Single Cylinder SI Engine which led to several results among which: influences on in-cylinder pressure, combustion and pollutant emissions