Treatment with supplementary arginine, vitamin C and zinc in patients with pressure ulcers: A randomised controlled trial

Background &amp; AimsNutrients putatively implicated in pressure ulcer healing were evaluated in a clinical setting.MethodsSixteen inpatients with a stage 2, 3 or 4 pressure ulcer randomised to receive daily a standard hospital diet; a standard diet plus two high-protein/energy supplements; or a standard diet plus two high-protein/energy supplements containing additional arginine (9 g), vitamin C (500 mg) and zinc (30 mg). Nutritional status measurements (dietary, anthropometric and biochemical) and pressure ulcer size and severity (by PUSH tool; Pressure Ulcer Scale for Healing; 0=completely healed, 17=greatest severity) were measured weekly for 3 weeks.ResultsPatients&rsquo; age and BMI ranges were 37&ndash;92 years and 16.4&ndash;28.1 kg/m2, respectively. Baseline PUSH scores were similar between groups (8.7&plusmn;0.5). Only patients receiving additional arginine, vitamin C and zinc demonstrated a clinically significant improvement in pressure ulcer healing (9.4&plusmn;1.2 vs. 2.6&plusmn;0.6; baseline and week 3, respectively; P&lt;0.01). All patient groups presented with low serum albumin and zinc and elevated C-reactive protein. There were no significant changes in biochemical markers, oral dietary intake or weight in any group.ConclusionsIn this small set of patients, supplementary arginine, vitamin C and zinc significantly improved the rate of pressure ulcer healing. The results need to be confirmed in a larger study.<br /

Microstructural analysis of additively manufactured Ti–6Al–4V subjected to duplex surface treatment

In this research, the impact of an innovative duplex surface treatment on the surface characteristics of additively manufactured Ti–6Al–4V was investigated. This duplex approach encompasses two distinct stages; the material is initially subjected to mechanical shot peening, followed by the application of a ceramic multilayer coating (consisting of Ti, TiN, TiAlN and TiAlCuN) through physical vapor deposition. The comprehensive analysis delves into the influence of the shot peening procedure, employing advanced techniques such as X-ray diffraction stress measurements, profile hardness assessments, and electron backscatter diffraction. The mechanical shot peening treatment induced a hardened surface layer, approximately 150 μm thick. This transformation was accompanied by the generation of compressive residual stresses, detected up to depths of 150 μm from the surface. Notably, the most substantial compressive residual stress, measuring 770 MPa, is located at a depth of approximately 27 μm beneath the surface. The existence of these stresses is further substantiated by average misorientation measurements of the cross-sections. The duplex treatment led to a remarkable advancement in the material’s microhardness, exhibiting an increase of approximately 210% when compared to the untreated sample. Additionally, the ceramic coating itself demonstrates outstanding mechanical properties, with a nanohardness of 26 GPa, and an elasticity index (H/E) of 0.08. Furthermore, when subjected to scratch tests, the duplex-treated specimens exhibited enhanced durability attributed to the concurrent rise in surface roughness induced by the peening process.peer-reviewe

Sheltering megalithic temples in Malta – evaluating the process through data collection and modelling

Since their excavation, a number of the sites listed as part of "The Megalithic Temples of Malta" inscription on the UNESCO World Heritage list have been afflicted by material and structural problems, including collapses. Therefore, three of these sites, the Ħaġar Qim, Mnajdra and Tarxien Temples, were protected by open-sided shelters, to address some of the principal causes of deterioration (e.g. direct rainfall, surface weathering, thermal stress). Environmental monitoring, condition assessments and biological surveys of the three sites took place before and after sheltering and are still in progress. To understand how the shelters are affecting these structures, a research programme has started aimed at analysing, through Computational Fluid Dynamics (CFD), the environmental data collected over a period of more than ten years. The aim of using CFD on the Temples is to provide detailed information on how different environmental conditions can affect the sites. For the CFD, macro and meso scale approaches will be used. The macroscale model represents the regional environment, including the all-terrain features around the Temples. Mesoscale modelling represents the Temple structures in a more detailed way. The final goal is to find confident correlations between CFD, and representative areas selected within the Temples showing particular deterioration patterns. All this information will be integrated with the results of in situ analyses to identify the causes of material deterioration and possibly mitigate against them.peer-reviewe

The Role of Accidental and Therapeutic Hypothermia in Non-Fatal Drowning

A case of non-fatal drowning with a successful outcome despite a submersion time of 25 min is described. Our case report emphasizes the role of accidental hypothermia in the survival of drowning victims with hypoxic brain injury, and supports the use of therapeutic hypothermia in the resuscitation of these patients

The effect of a duplex surface treatment on the corrosion and tribocorrosion characteristics of additively manufactured Ti-6Al-4V

The use of additively manufactured components specifically utilizing titanium alloys has seen rapid growth particularly in aerospace applications; however, the propensity for retained porosity, high(er) roughness finish, and detrimental tensile surface residual stresses are still a limiting factor curbing its expansion to other sectors such as maritime. The main aim of this investigation is to determine the effect of a duplex treatment, consisting of shot peening (SP) and a coating deposited by physical vapor deposition (PVD), to mitigate these issues and improve the surface characteristics of this material. In this study, the additive manufactured Ti-6Al-4V material was observed to have a tensile and yield strength comparable to its wrought counterpart. It also exhibited good impact performance undergoing mixed mode fracture. It was also observed that the SP and duplex treatments resulted in a 13% and 210% increase in hardness, respectively. Whilst the untreated and SP treated samples exhibited a similar tribocorrosion behavior, the duplex-treated sample exhibited the greatest resistance to corrosion-wear observed by the lack of damage on the surface and the diminished material loss rates. On the other hand, the surface treatments did not improve the corrosion performance of the Ti-6Al-4V substrate.peer-reviewe

Pulse oximetry and oxygen services for the care of children with pneumonia attending frontline health facilities in Lagos, Nigeria (INSPIRING-Lagos): study protocol for a mixed-methods evaluation.

Introduction The aim of this evaluation is to understand whether introducing stabilisation rooms equipped with pulse oximetry and oxygen systems to frontline health facilities in Ikorodu, Lagos State, alongside healthcare worker (HCW) training improves the quality of care for children with pneumonia aged 0–59 months. We will explore to what extent, how, for whom and in what contexts the intervention works.Methods and analysis Quasi-experimental time-series impact evaluation with embedded mixed-methods process and economic evaluation. Setting: seven government primary care facilities, seven private health facilities, two government secondary care facilities. Target population: children aged 0–59 months with clinically diagnosed pneumonia and/or suspected or confirmed COVID-19. Intervention: ‘stabilisation rooms’ within participating primary care facilities in Ikorodu local government area, designed to allow for short-term oxygen delivery for children with hypoxaemia prior to transfer to hospital, alongside HCW training on integrated management of childhood illness, pulse oximetry and oxygen therapy, immunisation and nutrition. Secondary facilities will also receive training and equipment for oxygen and pulse oximetry to ensure minimum standard of care is available for referred children. Primary outcome: correct management of hypoxaemic pneumonia including administration of oxygen therapy, referral and presentation to hospital. Secondary outcome: 14-day pneumonia case fatality rate. Evaluation period: August 2020 to September 202

Pulse oximetry and oxygen services for the care of children with pneumonia attending frontline health facilities in Lagos, Nigeria (INSPIRING-Lagos): study protocol for a mixed-methods evaluation

INTRODUCTION: The aim of this evaluation is to understand whether introducing stabilisation rooms equipped with pulse oximetry and oxygen systems to frontline health facilities in Ikorodu, Lagos State, alongside healthcare worker (HCW) training improves the quality of care for children with pneumonia aged 0-59 months. We will explore to what extent, how, for whom and in what contexts the intervention works. METHODS AND ANALYSIS: Quasi-experimental time-series impact evaluation with embedded mixed-methods process and economic evaluation. SETTING: seven government primary care facilities, seven private health facilities, two government secondary care facilities. TARGET POPULATION: children aged 0-59 months with clinically diagnosed pneumonia and/or suspected or confirmed COVID-19. INTERVENTION: 'stabilisation rooms' within participating primary care facilities in Ikorodu local government area, designed to allow for short-term oxygen delivery for children with hypoxaemia prior to transfer to hospital, alongside HCW training on integrated management of childhood illness, pulse oximetry and oxygen therapy, immunisation and nutrition. Secondary facilities will also receive training and equipment for oxygen and pulse oximetry to ensure minimum standard of care is available for referred children. PRIMARY OUTCOME: correct management of hypoxaemic pneumonia including administration of oxygen therapy, referral and presentation to hospital. SECONDARY OUTCOME: 14-day pneumonia case fatality rate. Evaluation period: August 2020 to September 2022. ETHICS AND DISSEMINATION: Ethical approval from University of Ibadan, Lagos State and University College London. Ongoing engagement with government and other key stakeholders during the project. Local dissemination events will be held with the State Ministry of Health at the end of the project (December 2022). We will publish the main impact results, process evaluation and economic evaluation results as open-access academic publications in international journals. TRIAL REGISTRATION NUMBER: ACTRN12621001071819; Registered on the Australian and New Zealand Clinical Trials Registry

Integrated Sustainable childhood Pneumonia and Infectious disease Reduction in Nigeria (INSPIRING) through whole system strengthening in Jigawa, Nigeria: study protocol for a cluster randomised controlled trial

BACKGROUND: Child mortality remains unacceptably high, with Northern Nigeria reporting some of the highest rates globally (e.g. 192/1000 live births in Jigawa State). Coverage of key protect and prevent interventions, such as vaccination and clean cooking fuel use, is low. Additionally, knowledge, care-seeking and health system factors are poor. Therefore, a whole systems approach is needed for sustainable reductions in child mortality. METHODS: This is a cluster randomised controlled trial, with integrated process and economic evaluations, conducted from January 2021 to September 2022. The trial will be conducted in Kiyawa Local Government Area, Jigawa State, Nigeria, with an estimated population of 230,000. Clusters are defined as primary government health facility catchment areas (n = 33). The 33 clusters will be randomly allocated (1:1) in a public ceremony, and 32 clusters included in the impact evaluation. The trial will evaluate a locally adapted 'whole systems strengthening' package of three evidence-based methods: community men's and women's groups, Partnership Defined Quality Scorecard and healthcare worker training, mentorship and provision of basic essential equipment and commodities. The primary outcome is mortality of children aged 7 days to 59 months. Mortality will be recorded prospectively using a cohort design, and secondary outcomes measured through baseline and endline cross-sectional surveys. Assuming the following, we will have a minimum detectable effect size of 30%: (a) baseline mortality of 100 per 1000 livebirths, (b) 4480 compounds with 3 eligible children per compound, (c) 80% power, (d) 5% significance, (e) intra-cluster correlation of 0.007 and (f) coefficient of variance of cluster size of 0.74. Analysis will be by intention-to-treat, comparing intervention and control clusters, adjusting for compound and trial clustering. DISCUSSION: This study will provide robust evidence of the effectiveness and cost-effectiveness of community-based participatory learning and action, with integrated health system strengthening and accountability mechanisms, to reduce child mortality. The ethnographic process evaluation will allow for a rich understanding of how the intervention works in this context. However, we encountered a key challenge in calculating the sample size, given the lack of timely and reliable mortality data and the uncertain impacts of the COVID-19 pandemic. TRIAL REGISTRATION: ISRCTN 39213655 . Registered on 11 December 2019

Cultural Heritage and Climate Change: New challenges and perspectives for research

JPI Cultural Heritage & JPI ClimateCollaboration between the two Joint Programming Initiatives “Cultural Heritage and Global Change” (JPI CH), and “Connecting Climate Knowledge for Europe” (JPI Climate) began in 2019 and led to the organisation of a joint workshop a year later. Following the recommendations in the workshop report, an expert working group was set up to scope research gaps and opportunities at the interface of cultural heritage and climate change, culminating in the publication of this White Paper. This strategic document is expected to support the two JPIs to generate policy-relevant research outcomes.Peer reviewe

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London