Clinical Utility of the Cryptococcal Antigen Lateral Flow Assay in a Diagnostic Mycology Laboratory

Abstract Background: Cryptococcus neoformans causes life-threatening meningitis. A recently introduced lateral flow immunoassay (LFA) to detect cryptococcal antigen (CRAG) is reportedly more rapid and convenient than standard latex agglutination (LA), but has not yet been evaluated in a diagnostic laboratory setting

Epidural analgesia in labour and severe maternal morbidity: a population-based study

Objectives: Epidural analgesia in labour may reduce the risk of severe maternal morbidity (SMM), a potentially life-threatening complication, though evidence is limited. We aimed to determine the effect of labour epidural on SMM and explore whether this was greater in women with a medical indication for epidural in labour, or in preterm labour.Design: Population-based study using Scottish National Health Service administrative linked data of all mothers in labour in Scotland between 1st January 2007 and 31st December 2019. Setting: All Scottish National Health Service hospitals.Participants: 567,216 mothers in labour between 24+0 and 42+6 weeks gestation, delivering vaginally or via unplanned caesarean section. Intervention: Epidural analgesia in labour.Main outcome measures: The primary outcome was SMM, defined as having one or more of 21 conditions used by the US Centers for Disease Control and Prevention (CDC) as criteria for SMM, or a critical care admission, with either occurring at any point from date of delivery to 42-days postpartum (described as SMM). Secondary outcomes included (i) a composite outcome of one or more of the 21 CDC conditions and critical care admission (described as SMM plus critical care), and (ii) respiratory morbidity.Results: Of the 567,216 women, 125,024 (22.0%) had epidural analgesia in labour. SMM occurred in 2,412 women (4.3 per 1000 births, 95%CI 4.2 to 4.3). Epidural was associated with reduction in SMM (adjusted relative risk 0.65, 95% CI 0.50 to 0.85), SMM plus critical care admission (0.46, 0.29 to 0.73), and respiratory morbidity (0.42, 0.16 to 1.15), though the latter was underpowered with wide confidence intervals. Greater risk reductions in SMM were detected among women with a medical 4indication for epidural (0.50, 0.34 to 0.72) compared to those with no indication (0.67, 0.43 to 1.03); p-value for difference <0.001. More marked reductions in SMM were also seen in women delivering preterm (0.53, 0.37 to 0.76), compared to term or post-term (1.09, 0.98 to 1.21; p-value for difference <0.001). The reduced risk of SMM with epidural analgesia was increasingly profound as gestational age at birth decreased in the whole cohort, and in women with a medical indication for epidural.Conclusion: Labour epidural analgesia was associated with a 35% reduction in SMM, with an even more pronounced effect in women with medical indications for an epidural and those experiencing preterm births. Broadening access to epidural analgesia for all women, and particularly for those at greatest risk could improve maternal health

Viscoelastic properties of high pressure and heat induced tofu gels

Tofu gels were rheologically examined to determine their storage or elastic (G′) and loss or viscous (G″) moduli as a function of frequency within their linear viscoelastic limits. The tofu gels were made using either glucono-δ-lactone (GDL) or calcium sulphate (CaSO4·2H2O), followed by either heat treatment (heated soymilk at 97 °C prior to coagulation and subsequently held at 70 °C for 60 min, HT) or high pressure treatment (400 MPa at 20 °C for 10 min, HP). The overall moduli values of the GDL gels and CaSO4·2H2O gels of both physical treatments were similar, each gave frequency profiles expected for weak viscoelastic materials. However, although both temperature and high pressure treatments could be used to produce tofu gels, the final products were not the same. Pressure formed gels, despite having a higher overall “consistency” (increasing values of their moduli), had a proportionately higher contribution from the loss modulus (increased tan δ). Differences could also be observed using confocal scanning laser microscopy. While such treatment may give rise to differing systems/structures, with new or modified organoleptic properties, the more “open” structures obtained by pressure treatment may well cause processing difficulties if subsequent reworking or moulding is required

Economic evaluation of specialist cancer and palliative nursing : a literature review.

Little progress has been made in economic evaluation of specialist cancer and palliative care nursing. A literature review of economic studies of clinical nurse specialists (CNSs) was undertaken to assess how the measurement of economic outcomes has been tackled in the literature to date. The initial search found 400studies. Abstracts from all the studies were reviewed but only 17studies met the basic criteria for inclusion, reporting primary cost and outcomes data, and clearly specifying the role of a CNS. All of the studies but one focused on direct patient care rather than other CNS roles and were undertaken alongside effectiveness studies. The economic evaluations considered only a narrow range of costs, but a wide range of outcomes. Specific nursing outcomes were only reported in a minority of studies. None of the studies reported cost-effectiveness ratios. However, CNS interventions were reported to be both less costly and more effective than alternative forms of care, negating the need for further cost-effectiveness analysis. Overall, the papers were not of good quality, reducing the validity of the findings. Robust economic evaluations of the CNS role need to be undertaken. These should involve nursing researchers and practitioners so that evaluations reflect the complex and multidimensional nature of CNS care and meet the required standard of evidence to influence practice

NHS cadet schemes: student experience, commitment, job satisfaction and job stress

In the context of various policy initiatives concerning widening access to and strengthening recruitment and retention in the health services, cadet schemes--predominantly in nursing--have proliferated over the last few years. As part of a larger national evaluation of National Health Service (NHS) cadet schemes, this paper reports on a survey of senior cadet students across 62 cadet schemes in England and examines their experience of being a cadet on such a scheme. Cadets forming the most senior cohort from each of the 62 schemes (n = 596) were surveyed using a questionnaire. The questionnaire included self-rated measures of job satisfaction, job stress and commitment. A 5% sample of these cadets participated in follow-up telephone interviews. Cadets reported high satisfaction with their courses. One of the most positive aspects of the schemes was the first-hand experience of working in the NHS they provided, whilst also giving cadets the opportunity to gain recognisable skills and qualifications. Cadets scored highly on the job satisfaction scale and, on the job stress scale, showed low stress overall. A significant positive correlation was found between satisfaction and stress, indicating that the cadets who are most satisfied are also more highly stressed. A negative correlation was found between stress and the dimensions of commitment indicating that those cadets who are stressed are less committed to the NHS. A negative correlation was also found between satisfaction and the dimensions of commitment, suggesting that commitment to the NHS is not contingent on high satisfaction. The implications for the findings of the survey are discussed

Characteristics of patients and samples.

*<p>Three patients had had fungemia and one each had laryngitis and osteomyelitis.</p>†<p>Two patients had encapsulated yeast seen on Periodic acid-Schiff/mucicarmine staining. One patient had granulomatous inflammation seen on fine-needle aspirate but fungal stains were not performed, both lateral flow assay and latex agglutination were positive for this patient.</p