Do variations in the theatre team have an impact on the incidence of complications?

BACKGROUND: To examine whether variations in non-medical personnel influence the incidence of complications in a cataract theatre. METHODS: A retrospective Case-Control study was undertaken in a single-site, designated cataract theatre. Staffing variations within theatre were examined and the incidence of cataract complications was assessed. RESULTS: 100 complicated lists and 200 uncomplicated control lists were chosen. At least 7 nurses were present for every list. Mean experience of the nurses was 6.4 years for case lists and 6.5 years for control lists. Average scrub nurse experience in years was 7.6 years for complicated lists and 8.0 years for controls. 26% of complicated case lists were affected by unplanned leave and 17% in control lists. Odds ratio 1.7 (1.0 to 3.1) 95% CI. CONCLUSION: Unplanned leave can have a detrimental effect on the operating list. The impact of this may be modifiable with careful planning

Pathophysiological lessons from rare associations of immunological disorders

Rare associations of immunological disorders can often tell more than mice and rats about the pathogenesis of immunologically mediated human kidney disease. Cases of glomerular disease with thyroiditis and Graves’ disease and of minimal change disease with lymphoepithelioma-like thymic carcinoma and lymphomatoid papulosis were recently reported in Pediatric Nephrology. These rare associations can contribute to the unraveling of the pathogenesis of membranous nephropathy (MN) and minimal change disease (MCD) and lead to the testing of novel research hypotheses. In MN, the target antigen may be thyroglobulin or another thyroid-released antigen that becomes planted in the glomerulus, but other scenarios can be envisaged, including epitope spreading, polyreactivity of pathogenic antibodies, and dysregulation of T regulatory cells, leading to the production of a variety of auto-antibodies with different specificities [immune dysregulation, polyendocrinopathy, enteropathy, X-linked (IPEX syndrome)]. The occurrence of MCD with hemopathies supports the role of T cells in the pathogenesis of proteinuria, although the characteristics of those T cells remain to be established and the glomerular permeability factor(s) identified

Assessing the transition of municipal solid waste management using combined material flow analysis and life cycle assessment

Faced with the challenges to deal with increasingly growing and ever diversified municipal solid waste (MSW), a series of waste directives have been published by European Commission to divert MSW from landfills to more sustainable management options. The presented study assessed the transition of MSW man-agement in Nottingham, UK, since the enforcement of the EU Landfill Directive using a tool of combined materials flow analysis (MFA) and life cycle assess-ment (LCA). The results show that the MSW management system in Nottingham changed from a relatively simple landfill & energy from waste (EfW) mode to a complex, multi-technology mode. Improvements in waste reduction, material re-cycling, energy recovery, and landfill prevention have been made. As a positive result, the global warming potential (GWP) of the MSW management system re-duced from 1,076.0 kg CO2–eq./t of MSW in 2001/02 to 211.3 kg CO2–eq./t of MSW in 2016/17. Based on the results of MFA and LCA, recommendations on separating food waste and textile at source and updating treatment technologies are made for future improvement

Progress towards early detection services for infants with hearing loss in developing countries

BACKGROUND: Early detection of infants with permanent hearing loss through infant hearing screening is recognised and routinely offered as a vital component of early childhood care in developed countries. This article investigates the initiatives and progress towards early detection of infants with hearing loss in developing countries against the backdrop of the dearth of epidemiological data from this region. METHODS: A cross-sectional, descriptive study based on responses to a structured questionnaire eliciting information on the nature and scope of early hearing detection services; strategies for financing services; parental and professional attitudes towards screening; and the performance of screening programmes. Responses were complemented with relevant data from the internet and PubMed/Medline. RESULTS: Pilot projects using objective screening tests are on-going in a growing number of countries. Screening services are provided at public/private hospitals and/or community health centres and at no charge only in a few countries. Attitudes amongst parents and health care workers are typically positive towards such programmes. Screening efficiency, as measured by referral rate at discharge, was generally found to be lower than desired but several programmes achieved other international benchmarks. Coverage is generally above 90% but poor follow-up rates remain a challenge in some countries. The mean age of diagnosis is usually less than six months, even for community-based programmes. CONCLUSION: Lack of adequate resources by many governments may limit rapid nationwide introduction of services for early hearing detection and intervention, but may not deter such services altogether. Parents may be required to pay for services in some settings in line with the existing practice where healthcare services are predominantly financed by out-of-pocket spending rather than public funding. However, governments and their international development partners need to complement current voluntary initiatives through systematic scaling-up of public awareness and requisite manpower development towards sustainable service capacities at all levels of healthcare delivery

Dynamic Tunneling of Ultra-Cold Atoms

The divergence of quantum and classical descriptions of particle motion is clearly apparent in quantum tunnelling1, 2 between two regions of classically stable motion. An archetype of such non-classical motion is tunnelling through an energy barrier. In the 1980s, a new process, 'dynamical' tunnelling1, 2, 3, was predicted, involving no potential energy barrier; however, a constant of the motion (other than energy) still forbids classically the quantum-allowed motion. This process should occur, for example, in periodically driven, nonlinear hamiltonian systems with one degree of freedom4, 5, 6. Such systems may be chaotic, consisting of regions in phase space of stable, regular motion embedded in a sea of chaos. Previous studies predicted4 dynamical tunnelling between these stable regions. Here we observe dynamical tunnelling of ultracold atoms from a Bose-Einstein condensate in an amplitude-modulated optical standing wave. Atoms coherently tunnel back and forth between their initial state of oscillatory motion (corresponding to an island of regular motion) and the state oscillating 180° out of phase with the initial state