Risk Adjustment In Neurocritical care (RAIN)--prospective validation of risk prediction models for adult patients with acute traumatic brain injury to use to evaluate the optimum location and comparative costs of neurocritical care: a cohort study.

OBJECTIVES: To validate risk prediction models for acute traumatic brain injury (TBI) and to use the best model to evaluate the optimum location and comparative costs of neurocritical care in the NHS. DESIGN: Cohort study. SETTING: Sixty-seven adult critical care units. PARTICIPANTS: Adult patients admitted to critical care following actual/suspected TBI with a Glasgow Coma Scale (GCS) score of < 15. INTERVENTIONS: Critical care delivered in a dedicated neurocritical care unit, a combined neuro/general critical care unit within a neuroscience centre or a general critical care unit outside a neuroscience centre. MAIN OUTCOME MEASURES: Mortality, Glasgow Outcome Scale - Extended (GOSE) questionnaire and European Quality of Life-5 Dimensions, 3-level version (EQ-5D-3L) questionnaire at 6 months following TBI. RESULTS: The final Risk Adjustment In Neurocritical care (RAIN) study data set contained 3626 admissions. After exclusions, 3210 patients with acute TBI were included. Overall follow-up rate at 6 months was 81%. Of 3210 patients, 101 (3.1%) had no GCS score recorded and 134 (4.2%) had a last pre-sedation GCS score of 15, resulting in 2975 patients for analysis. The most common causes of TBI were road traffic accidents (RTAs) (33%), falls (47%) and assault (12%). Patients were predominantly young (mean age 45 years overall) and male (76% overall). Six-month mortality was 22% for RTAs, 32% for falls and 17% for assault. Of survivors at 6 months with a known GOSE category, 44% had severe disability, 30% moderate disability and 26% made a good recovery. Overall, 61% of patients with known outcome had an unfavourable outcome (death or severe disability) at 6 months. Between 35% and 70% of survivors reported problems across the five domains of the EQ-5D-3L. Of the 10 risk models selected for validation, the best discrimination overall was from the International Mission for Prognosis and Analysis of Clinical Trials in TBI Lab model (IMPACT) (c-index 0.779 for mortality, 0.713 for unfavourable outcome). The model was well calibrated for 6-month mortality but substantially underpredicted the risk of unfavourable outcome at 6 months. Baseline patient characteristics were similar between dedicated neurocritical care units and combined neuro/general critical care units. In lifetime cost-effectiveness analysis, dedicated neurocritical care units had higher mean lifetime quality-adjusted life-years (QALYs) at small additional mean costs with an incremental cost-effectiveness ratio (ICER) of £14,000 per QALY and incremental net monetary benefit (INB) of £17,000. The cost-effectiveness acceptability curve suggested that the probability that dedicated compared with combined neurocritical care units are cost-effective is around 60%. There were substantial differences in case mix between the 'early' (within 18 hours of presentation) and 'no or late' (after 24 hours) transfer groups. After adjustment, the 'early' transfer group reported higher lifetime QALYs at an additional cost with an ICER of £11,000 and INB of £17,000. CONCLUSIONS: The risk models demonstrated sufficient statistical performance to support their use in research but fell below the level required to guide individual patient decision-making. The results suggest that management in a dedicated neurocritical care unit may be cost-effective compared with a combined neuro/general critical care unit (although there is considerable statistical uncertainty) and support current recommendations that all patients with severe TBI would benefit from transfer to a neurosciences centre, regardless of the need for surgery. We recommend further research to improve risk prediction models; consider alternative approaches for handling unobserved confounding; better understand long-term outcomes and alternative pathways of care; and explore equity of access to postcritical care support for patients following acute TBI. FUNDING: The National Institute for Health Research Health Technology Assessment programme

A comparison of vegetable leaves and replicated biomimetic surfaces on the binding of Escherichia coli and Listeria monocytogenes

Biofouling in the food industry is a huge issue, and one possible way to reduce surface fouling is to understand how naturally cleaning surfaces based on biomimetic designs influence bacterial binding. Four self-cleaning leaves (Tenderheart cabbage, Cauliflower, White cabbage and Leek) were analysed for their surface properties and artificial re-plicates were produced. The leaves and surfaces were subjected to attachment, adhesion and retention assays using Escherichia coli and Listeria monocytogenes. For the attachment assays, the lowest cell numbers occurred on the least hydrophobic and smooth surfaces but were higher than the flat control surface, regardless of the strain. Following the ad-hesion assays, using L. monocytogenes, the Tenderheart and Cauliflower biomimetic re-plicated leaves resulted in significantly lowered cell adhesion. Following the retention assays, White cabbage demonstrated lower cell retention for both types of bacteria on the biomimetic replicated surface compared to the flat control surface. The biomimetic sur-faces were also more efficient at avoiding bacterial retention than natural leaves, with reductions of about 1 and 2 Log in L. monocytogenes and E. coli retention, respectively, on most of the produced surfaces. Although the surfaces were promising in reducing bac-terial binding, the results suggested that different experimental assays exerted different influences on the conclusions. This work demonstrated that consideration needs to be given to the environmental factors where the surface is to be used and that bacterial species influence the propensity of biofouling on a surface. (c) 2022 The Author(s). Published by Elsevier Ltd on behalf of Institution of Chemical Engineers. This is an open access article under the CC BY license (http://creative-commons.org/licenses/by/4.0/)

Drawing inspiration from nature to develop anti-fouling coatings: the development of biomimetic polymer surfaces and their effect on bacterial fouling

The development of self-cleaning biomimetic surfaces has the potential to be of great benefit to human health, in addition to reducing the economic burden on industries worldwide. Consequently, this study developed a biomimetic wax surface using a moulding technique which emulated the topography of the self-cleaning Gladiolus hybridus (Gladioli) leaf. A comparison of topographies was performed for unmodified wax surfaces (control), biomimetic wax surfaces, and Gladioli leaves using optical profilometry and scanning electron microscopy. The results demonstrated that the biomimetic wax surface and Gladioli leaf had extremely similar surface roughness parameters, but the water contact angle of the Gladioli leaf was significantly higher than the replicated biomimetic surface. The self-cleaning properties of the biomimetic and control surfaces were compared by measuring their propensity to repel Escherichia coli and Listeria monocytogenes attachment, adhesion, and retention in mono-and co-culture conditions. When the bacterial assays were carried out in monoculture, the biomimetic surfaces retained fewer bacteria than the control surfaces. However, when using co-cultures of the bacterial species, only following the retention assays were the bacterial numbers reduced on the biomimetic surfaces. The results demonstrate that such surfaces may be effective in reducing biofouling if used in the appropriate medical, marine, and industrial scenarios. This study provides valuable insight into the anti-fouling physical and chemical control mechanisms found in plants, which are particularly appealing for engineering purposes

Simultaneous determination of natural and synthetic steroid estrogens and their conjugates in aqueous matrices by liquid chromatography / mass spectrometry

An analytical method for the simultaneous determination of nine free and conjugated steroid estrogens was developed with application to environmental aqueous matrices. Solid phase extraction (SPE) was employed for isolation and concentration, with detection by liquid chromatography/mass spectrometry (LC/MS) using electrospray ionisation (ESI) in the negative mode. Method recoveries for various aqueous matrices (wastewater, lake and drinking water) were determined, recoveries proving to be sample dependent. When spiked at 50 ng/l concentrations in sewage influent, recoveries ranged from 62-89 % with relative standard deviations (RSD) < 8.1 %. In comparison, drinking water spiked at the same concentrations had recoveries between 82-100 % with an RSD < 5%. Ion suppression is a known phenomenon when using ESI; hence its impact on method recovery was elucidated for raw sewage. Both ion suppression from matrix interferences and the extraction procedure has bearing on the overall method recovery. Analysis of municipal raw sewage identified several of the analytes of interest at ng/l concentrations, estriol (E3) being the most abundant. Only one conjugate, estrone 3-sulphate (E1-3S) was observe

The use of biomimetic surfaces to reduce single- and dual-species biofilms of Escherichia coli and Pseudomonas putida

The ability of bacteria to adhere to and form biofilms on food contact surfaces poses serious challenges, as these may lead to the cross-contamination of food products. Biomimetic topographic surface modifications have been explored to enhance the antifouling performance of materials. In this study, the topography of two plant leaves, Brassica oleracea var. botrytis (cauliflower, CF) and Brassica oleracea capitate (white cabbage, WC), was replicated through wax moulding, and their antibiofilm potential was tested against single- and dual-species biofilms of Escherichia coli and Pseudomonas putida. Biomimetic surfaces exhibited higher roughness values (SaWC = 4.0 ± 1.0 μm and SaCF = 3.3 ± 1.0 μm) than the flat control (SaF = 0.6 ± 0.2 μm), whilst the CF surface demonstrated a lower interfacial free energy (ΔGiwi) than the WC surface (−100.08 mJ m−2 and −71.98 mJ m−2, respectively). The CF and WC surfaces had similar antibiofilm effects against single-species biofilms, achieving cell reductions of approximately 50% and 60% for E. coli and P. putida, respectively, compared to the control. Additionally, the biomimetic surfaces led to reductions of up to 60% in biovolume, 45% in thickness, and 60% in the surface coverage of single-species biofilms. For dual-species biofilms, only the E. coli strain growing on the WC surface exhibited a significant decrease in the cell count. However, confocal microscopy analysis revealed a 60% reduction in the total biovolume and surface coverage of mixed biofilms developed on both biomimetic surfaces. Furthermore, dual-species biofilms were mainly composed of P. putida, which reduced E. coli growth. Altogether, these results demonstrate that the surface properties of CF and WC biomimetic surfaces have the potential for reducing biofilm formation

How do Graphene Composite Surfaces Affect the Development and Structure of Marine Cyanobacterial Biofilms?

The progress of nanotechnology has prompted the development of novel marine antifouling coatings. In this study, the influence of a pristine graphene nanoplatelet (GNP)-modified surface in cyanobacterial biofilm formation was evaluated over a long-term assay using an in vitro platform which mimics the hydrodynamic conditions that prevail in real marine environments. Surface characterization by Optical Profilometry and Scanning Electron Microscopy has shown that the main difference between GNP incorporated into a commercially used epoxy resin (GNP composite) and both control surfaces (glass and epoxy resin) was related to roughness and topography, where the GNP composite had a roughness value about 1000 times higher than control surfaces. The results showed that, after 7 weeks, the GNP composite reduced the biofilm wet weight (by 44%), biofilm thickness (by 54%), biovolume (by 82%), and surface coverage (by 64%) of cyanobacterial biofilms compared to the epoxy resin. Likewise, the GNP-modified surface delayed cyanobacterial biofilm development, modulated biofilm structure to a less porous arrangement over time, and showed a higher antifouling effect at the biofilm maturation stage. Overall, this nanocomposite seems to have the potential to be used as a long-term antifouling material in marine applications. Moreover, this multifactorial study was crucial to understanding the interactions between surface properties and cyanobacterial biofilm development and architecture over time

Effect of surface conditioning with cellular extracts on Escherichia coli adhesion and initial biofilm formation

Bacterial adhesion and subsequent biofilm formation start with surface conditioning by molecules originating from the surrounding medium and from cell lysis. Different cell extracts e.g. total cell extract (TCE), cytoplasm with cellular debris (CCDE) and periplasmic extract (PE) were tested in agitated 96-well microtiter plates and in a flow cell. Crystal violet assay demonstrated that a polystyrene substratum conditioned with TCE or CCDE decreased initial biofilm formation, however cell adhesion generally increased when PE was used. These results were dependent on conditioning film concentration. Using a parallel plate flow chamber, the use of optimal conditioning film concentrations resulted in all the different cellular extracts reducing biofilm formation. Multifractal analysis was used to generate quantitative data on the number of cell clusters. Surface conditioning with cellular components affected the amount and clustering of bacteria on polystyrene surfaces and their propensity to induce biofilm formation. To the best of our knowledge, this is the first study addressing the effect of cellular surface conditioning of cellular compartments on E. coli adhesion and initial biofilm formation. This work leads to a greater understanding of the factors that influence biofilm formation under flow conditions which are prevalent in food industry

A comparison of vegetable leaves and replicated biomimetic surfaces on the binding of Escherichia coli and Listeria monocytogenes

Biofouling in the food industry is a huge issue, and one possible way to reduce surface fouling is to understand how naturally cleaning surfaces based on biomimetic designs influence bacterial binding. Four self-cleaning leaves (Tenderheart cabbage, Cauliflower, White cabbage and Leek) were analysed for their surface properties and artificial replicates were produced. The leaves and surfaces were subjected to attachment, adhesion and retention assays using Escherichia coli and Listeria monocytogenes. For the attachment assays, the lowest cell numbers occurred on the least hydrophobic and smooth surfaces but were higher than the flat control surface, regardless of the strain. Following the adhesion assays, using L. monocytogenes, the Tenderheart and Cauliflower biomimetic replicated leaves resulted in significantly lowered cell adhesion. Following the retention assays, White cabbage demonstrated lower cell retention for both types of bacteria on the biomimetic replicated surface compared to the flat control surface. The biomimetic surfaces were also more efficient at avoiding bacterial retention than natural leaves, with reductions of about 1 and 2 Log in L. monocytogenes and E. coli retention, respectively, on most of the produced surfaces. Although the surfaces were promising in reducing bacterial binding, the results suggested that different experimental assays exerted different influences on the conclusions. This work demonstrated that consideration needs to be given to the environmental factors where the surface is to be used and that bacterial species influence the propensity of biofouling on a surface

A reassuring presence: An evaluation of Bradford District Hospice at Home service

Within the United Kingdom, a developing role for primary care services in cancer and palliative care has resulted in an increase in palliative home care teams. The provision of professional care in the home setting seeks to provide necessary services and enhanced choice for patients whose preference is to die at home. A mismatch between patient preference for home death and the actual number of people who died at home was identified within Bradford, the locality of this study. In response to this mismatch, and reflecting the policy environment of wishing to enhance community service provision, the four Primary Care Trusts (PCTs) in the city sought to offer support to patients who wished to remain in their own homes through the final stages of a terminal illness. To offer this support they set up a dedicated hospice at home team. This would provide services and support for patients in achieving a dignified, symptom free and peaceful death, allowing families to maximise time spent together. The aim of the study was to evaluate the Bradford hospice at home service from the perspective of carers, nurses and General Practitioners. Postal questionnaires were sent to carers (n = 289), district nurses (n = 508) and GP's (n = 444) using Bradford's hospice at home service. Resulting quantitative data was analysed using the Statical Package for Social Sciences (SPSS) and qualitative data was analysed using grounded theory techniques. The data from carers, district nurses and GPs provide general support for the Bradford hospice at home service. Carers valued highly the opportunity to 'fulfil a promise' to the individual who wished to be cared for at home. District nurses and GPs cited the positive impact of access to specialist expertise. This was a 'reassuring presence' for primary healthcare teams and offered 'relief of carer anxiety' by providing prompt, accessible and sensitive care. Carers and health professionals welcomed the increased possibility of patients being cared for at home. The study identified the need to focus on improving skill levels of staff and on ensuring continuity of care

Celebrating the centenary in polymer science: Drawing inspiration from nature to develop anti-fouling coatings: the development of biomimetic polymer surfaces and their effect on bacterial fouling

The development of self-cleaning biomimetic surfaces has the potential to be of great benefit to human health, in addition to reducing the economic burden on industries worldwide. Consequently, this study developed a biomimetic wax surface using a moulding technique which emulated the topography of the self-cleaning Gladiolus hybridus (Gladioli) leaf. A comparison of topographies was performed for unmodified wax surfaces (control), biomimetic wax surfaces, and Gladioli leaves using optical profilometry and scanning electron microscopy. The results demonstrated that the biomimetic wax surface and Gladioli leaf had extremely similar surface roughness parameters, but the water contact angle of the Gladioli leaf was significantly higher than the replicated biomimetic surface. The self-cleaning properties of the biomimetic and control surfaces were compared by measuring their propensity to repel Escherichia coli and Listeria monocytogenes attachment, adhesion, and retention in mono- and co-culture conditions. When the bacterial assays were carried out in monoculture, the biomimetic surfaces retained fewer bacteria than the control surfaces. However, when using co-cultures of the bacterial species, only following the retention assays were the bacterial numbers reduced on the biomimetic surfaces. The results demonstrate that such surfaces may be effective in reducing biofouling if used in the appropriate medical, marine, and industrial scenarios. This study provides valuable insight into the antifouling physical and chemical control mechanisms found in plants, which are particularly appealing for engineering purposes