Managing risk in cancer presentation, detection and referral: a qualitative study of primary care staff views

Objectives In the UK, there have been a number of national initiatives to promote earlier detection and prompt referral of patients presenting to primary care with signs and symptoms of cancer. The aim of the study was to explore the experiences of a range of primary care staff in promoting earlier presentation, detection and referral of patients with symptoms suggestive of cancer. Setting Six primary care practices in northwest England. Participants: 39 primary care staff from a variety of disciplines took part in five group and four individual interviews. Results The global theme to emerge from the interviews was ‘managing risk’, which had three underpinning organising themes: ‘complexity’, relating to uncertainty of cancer diagnoses, service fragmentation and plethora of guidelines; ‘continuity’, relating to relationships between practice staff and their patients and between primary and secondary care; ‘conflict’ relating to policy drivers and staff role boundaries. A key concern of staff was that policymakers and those implementing cancer initiatives did not fully understand how risk was managed within primary care. Conclusions Primary care staff expressed a range of views and opinions on the benefits of cancer initiatives. National initiatives did not appear to wholly resolve issues in managing risk for all practitioners. Staff were concerned about the number of guidelines and priorities they were expected to implement. These issues need to be considered by policymakers when developing and implementing new initiatives

Persistence of chlorpropham (CIPC) in the concrete flooring of potato stores

The loss of the sprout suppressant, chlorpropham (CIPC), to the fabric of potato stores is currently of concern due to the risk of potential cross contamination of other crops subsequently housed in these stores. HPLC UV/VIS and GCMS methods were successfully employed to detect CIPC in the concrete flooring of research and commercial potato stores with histories of between 1 and 26 years of use. The concentrations in identical research stores, with different numbers of applications, were in the range 0.58–5.7 and 3.4–112 μg g−1, suggesting the magnitude of contamination was influenced by the number of applications. Commercial store A, with a history of 18 seasons of applications (estimate of total CIPC applied 2040 kg), had concentrations varying between 6 and 48 μg g−1 in the top three centimetres, with more than 92% within the top centimetre. In contrast, commercial store B, with a history of less than five seasons of applications (estimate of total CIPC applied 319 kg), had concentrations varying between 0.58 and 304 μg g−1 in the top four centimetres, with less than 47% within the top centimetre. The difference in depth distributions between A and B may be due to the structural integrity of the concrete, which was much poorer in B. CIPC was persistent in all stores irrespective of the total quantities of CIPC applied and date of the final application

The team as a secure base: Promoting resilience and competence in child and family social work

This paper outlines research findings on the relevance of the Secure Base model (Schofield & Beek, 2014) for developing supportive teams in child and family social work. When the social work team functions as a secure base, this can help workers cope with the emotional demands of the role. The concept of the secure base comes from attachment theory (Bowlby, 1969) in which our relationships with significant others, who are available, sensitive to our needs and reliable, provide us with a secure base to return to when life is stressful and provide us with comforting internal mental models when we are physically away from them. This ‘secure base for exploration’ reduces anxiety and enables us to engage with the world, consider the internal world of others (empathy) and remain resilient when life is stressful. Using data from 52 phone interviews with child and family social workers across eight local authorities in the UK, we show how the Secure Base model has relevance for emotion regulation and resilience for child and family social workers. Data were analysed using Theoretical Thematic Analysis (Braun & Clarke, 2006). In the context of the emotional demands of social work, our data indicate that the supervisors and teams provide a work related secure base across five dimensions by behaving in ways which instil these beliefs: Availability -‘People are there for me’; Sensitivity - ‘My feelings are manageable’; Acceptance - I don't always have to be strong’; Cooperation - ‘I can work with others to find a solution’; Team belonging - ‘I am valued and I belong’. Implications for practice are proposed to help supervisors and team members reflect on beliefs and behaviours which can help provide a secure base for their teams

Accumulation of Sellafield-derived radiocarbon (14C) in Irish Sea and West of Scotland intertidal shells and sediments

The nuclear energy industry produces radioactive waste at various stages of the fuel cycle. In the United Kingdom, spent fuel is reprocessed at the Sellafield facility in Cumbria on the north west coast of England. Waste generated at the site comprises a wide range of radionuclides including radiocarbon (14C) which is disposed of in various forms including highly soluble inorganic carbon within the low level liquid radioactive effluent, via pipelines into the Irish Sea. This 14C is rapidly incorporated into the dissolved inorganic carbon (DIC) reservoir and marine calcifying organisms, e.g. molluscs, readily utilise DIC for shell formation. This study investigated a number of sites located in Irish Sea and West of Scotland intertidal zones. Results indicate 14C enrichment above ambient background levels in shell material at least as far as Port Appin, 265 km north of Sellafield. Of the commonly found species (blue mussel (Mytilus edulis), common cockle (Cerastoderma edule) and common periwinkle (Littorina littorea)), mussels were found to be the most highly enriched in 14C due to the surface environment they inhabit and their feeding behaviour. Whole mussel shell activities appear to have been decreasing in response to reduced discharge activities since the early 2000s but in contrast, there is evidence of continuing enrichment of the carbonate sediment component due to in-situ shell erosion, as well as indications of particle transport of fine 14C-enriched material close to Sellafield

Is it time to talk? interpreter services use in general practice within Canterbury

INTRODUCTION: Effective communication is fundamental to successful health care service delivery, and has a positive impact on access, quality of care, health outcomes, and patient satisfaction. Although there are a growing number of New Zealanders who do not speak English proficiently, underutilisation of trained interpreter services appears to be common in primary health care settings. AIMS: To describe the pattern of interpreter service need and utilisation by general practice services, and to identify key barriers and enabling factors to the use of trained interpreters. METHODS: A mixed methods study was employed. Census and Partnership Health Canterbury Te Kei o Te Waka (PHC) databases were combined, and quantitative analysis used to derive interpreter service need and utilisation patterns. Transcripts of focus groups and interviews from general practitioners, practice nurses and practice administration staff within the PHC were analysed, using qualitative methods to identify barriers and enablers to interpreter service use. RESULTS: For the years 2008-2010, approximately 10742 consultations per year involved a non-English-speaking patient, yet in only approximately 74.8 (0.7%) consultations per year were interpreter services utilised. Analysis of focus groups and interviews identified four global themes that represented barriers for interpreter service utilisation; namely, practicalities, expectations, knowledge of service, and systems. DISCUSSION: The current use of interpreter services in PHC general practice appears to be significantly less than the need. In order to maximise health outcomes and reduce risk, strategies must be initiated to counter the barriers currently inhibiting interpreter service use, including adopting best practice policies

Ecosystem uptake and transfer of Sellafield-derived radiocarbon (14C). Part 1. The Irish Sea

Ecosystem uptake and transfer processes of Sellafield-derived radiocarbon (14C) within the Irish Sea were examined. Highly variable activities in sediment, seawater and biota indicate complex 14C dispersal and uptake dynamics. All east basin biota exhibited 14C enrichments above ambient background while most west basin biota had 14C activities close to background, although four organisms including two slow-moving species were significantly enriched. The western Irish Sea gyre is a suggested pathway for transfer of 14C to the west basin and retention therein. Despite ongoing Sellafield 14C discharges, organic sediments near Sellafield were significantly less enriched than associated benthic organisms. Rapid scavenging of labile, 14C-enriched organic material by organisms and mixing to depth of 14C-enriched detritus arriving at the sediment/water interface are proposed mechanisms to explain this. All commercially important fish, crustaceans and molluscs showed 14C enrichments above background; however, the radiation dose from their consumption is extremely low and radiologically insignificant

Quantifying Plasmodium falciparum infections clustering within households to inform household-based intervention strategies for malaria control programs: An observational study and meta-analysis from 41 malaria-endemic countries.

BACKGROUND: Reactive malaria strategies are predicated on the assumption that individuals infected with malaria are clustered within households or neighbourhoods. Despite the widespread programmatic implementation of reactive strategies, little empirical evidence exists as to whether such strategies are appropriate and, if so, how they should be most effectively implemented. METHODS AND FINDINGS: We collated 2 different datasets to assess clustering of malaria infections within households: (i) demographic health survey (DHS) data, integrating household information and patent malaria infection, recent fever, and recent treatment status in children; and (ii) data from cross-sectional and reactive detection studies containing information on the household and malaria infection status (patent and subpatent) of all-aged individuals. Both datasets were used to assess the odds of infections clustering within index households, where index households were defined based on whether they contained infections detectable through one of 3 programmatic strategies: (a) Reactive Case Detection (RACD) classifed by confirmed clinical cases, (b) Mass Screen and Treat (MSAT) classifed by febrile, symptomatic infections, and (c) Mass Test and Treat (MTAT) classifed by infections detectable using routine diagnostics. Data included 59,050 infections in 208,140 children under 7 years old (median age = 2 years, minimum = 2, maximum = 7) by microscopy/rapid diagnostic test (RDT) from 57 DHSs conducted between November 2006 and December 2018 from 23 African countries. Data representing 11,349 infections across all ages (median age = 22 years, minimum = 0.5, maximum = 100) detected by molecular tools in 132,590 individuals in 43 studies published between April 2006 and May 2019 in 20 African, American, Asian, and Middle Eastern countries were obtained from the published literature. Extensive clustering was observed-overall, there was a 20.40 greater (95% credible interval [CrI] 0.35-20.45; P < 0.001) odds of patent infections (according to the DHS data) and 5.13 greater odds (95% CI 3.85-6.84; P < 0.001) of molecularly detected infections (from the published literature) detected within households in which a programmatically detectable infection resides. The strongest degree of clustering identified by polymerase chain reaction (PCR)/ loop mediated isothermal amplification (LAMP) was observed using the MTAT strategy (odds ratio [OR] = 6.79, 95% CI 4.42-10.43) but was not significantly different when compared to MSAT (OR = 5.2, 95% CI 3.22-8.37; P-difference = 0.883) and RACD (OR = 4.08, 95% CI 2.55-6.53; P-difference = 0.29). Across both datasets, clustering became more prominent when transmission was low. However, limitations to our analysis include not accounting for any malaria control interventions in place, malaria seasonality, or the likely heterogeneity of transmission within study sites. Clustering may thus have been underestimated. CONCLUSIONS: In areas where malaria transmission is peri-domestic, there are programmatic options for identifying households where residual infections are likely to be found. Combining these detection strategies with presumptively treating residents of index households over a sustained time period could contribute to malaria elimination efforts

Determination of Chlorpropham (CIPC) residues, in the concrete flooring of potato stores, using quantitative (HPLC UV/VIS) and qualitative (GCMS) methods

Isopropyl-N-(3-chlorophenyl) carbamate (CIPC, common name Chlorpropham) is commonly used for post-harvest sprout inhibition in stored potatoes. It is applied as a thermal fog which results in loss to the fabric of the store and the atmosphere. Recently, there have been concerns in the United Kingdom because of cross contamination of other crop commodities that were stored in buildings with a history of CIPC usage. This cross contamination may have occurred because of retained residues in the fabric of the stores. The retention of CIPC in concrete is poorly understood; therefore the requirement for a robust analytical method for the detection and quantification of CIPC in concrete is a critical first step in tackling this problem. A method using High-Performance Liquid Chromatography with ultraviolet detection (HPLC UV/VIS) was validated. CIPC recoveries at three concentration levels (0.4, 4.0 and 40.0 µg g-1) were in the range of 90.7-97.0 % with relative standard deviations between 2.14-3.01 %. The limits of detection and quantification were 0.03 and 0.1 µg g-1 , respectively. This study confirmed that CIPC was persistent in concrete to a depth of 4 cm, with &gt; 90 % within the top 1 cm of the flooring

Malaria Hotspots: Is There Epidemiological Evidence for Fine-Scale Spatial Targeting of Interventions?

As data at progressively granular spatial scales become available, the temptation is to target interventions to areas with higher malaria transmission - so-called hotspots - with the aim of reducing transmission in the wider community. This paper reviews literature to determine if hotspots are an intrinsic feature of malaria epidemiology and whether current evidence supports hotspot-targeted interventions. Hotspots are a consistent feature of malaria transmission at all endemicities. The smallest spatial unit capable of supporting transmission is the household, where peri-domestic transmission occurs. Whilst the value of focusing interventions to high-burden areas is evident, there is currently limited evidence that local-scale hotspots fuel transmission. As boundaries are often uncertain, there is no conclusive evidence that hotspot-targeted interventions accelerate malaria elimination