Are differences in travel time or distance to healthcare for adults in global north countries associated with an impact on health outcomes? A systematic review

Objectives: To investigate whether there is an association between differences in travel time/ travel distance to healthcare services and patients’ health outcomes and assimilate the methodologies used to measure this. Design: Systematic Review. We searched MEDLINE, Embase, Web of Science, Transport database, HMIC, and EBM-Reviews for studies up to 7th September 2016. Studies were excluded that included children (including maternity), emergency medical travel, or countries classed as being in the global south. Settings: A wide range of settings within primary and secondary care (these were not restricted in the search) Results: One hundred and eight studies met the inclusion criteria. The results were mixed. Seventy seven percent of the included studies identified evidence of a distance decay association, whereby patients living further away from healthcare facilities they needed to attend had worse health outcomes (e.g. survival rates, length of stay in hospital, non-attendance at follow-up) than those that lived closer. Six of the studies identified the reverse (a distance bias effect) whereby patients living at a greater distance had better health outcomes. The remaining 19 studies found no relationship. There was a large variation in the data available to the studies on the patients’ geographical locations and the healthcare facilities attended and the methods used to calculate travel times and distances were not consistent across studies. Conclusions: The review observed that a relationship between travelling further and having worse health outcomes cannot be ruled out and should be considered within the healthcare services location debate

The impact of simulated motion blur on lesion detection performance in full field digital mammography

Objective: Motion blur is a known phenomenon in full-field digital mammography, but the impact on lesion detection is unknown. This is the first study to investigate detection performance with varying magnitudes of simulated motion blur. Method: Seven observers (15±5 years’ reporting experience) evaluated 248 cases (62 containing malignant masses, 62 containing malignant microcalcifications and 124 normal cases) for three conditions: no blurring (0 mm) and two magnitudes of simulated blurring (0.7 mm and 1.5 mm). Abnormal cases were biopsy proven. Mathematical simulation was used to provide a pixel shift in order to simulate motion blur. A free-response observer study was conducted to compare lesion detection performance for the three conditions. The equally weighted jackknife alternative free-response receiver operating characteristic (wJAFROC) was used as the figure of merit. Test alpha was set at 0.05 to control probability of Type I error. Results: wJAFROC analysis found a statistically significant difference in lesion detection performance for both masses (F(2,22) = 6.01, P=0.0084) and microcalcifications (F(2,49) = 23.14, P<0.0001). The figures of merit reduced as the magnitude of simulated blurring increased. Statistical differences were found between some of the pairs investigated for the detection of masses (0.0mm v 0.7mm, and 0.0mm v 1.5mm) and all pairs for microcalcifications (0.0 mm v 0.7 mm, 0.0 mm v 1.5 mm, and 0.7 mm v 1.5 mm). No difference was detected between 0.7 mm and 1.5 mm for masses. Conclusion: Mathematical simulation of motion blur caused a statistically significant reduction in lesion detection performance. These false negative decisions could have implications for clinical practice. Advances in knowledge: This research demonstrates for the first time that motion blur has a negative and statistically significant impact on lesion detection performance digital mammography

In situ electrochemical characterisation of graphene and various carbon-based electrode materials: an internal standard approach

We employ an internal standard protocol to simultaneously characterise and utilise electrode materials during their electrochemical implementation. The proposed approach involves ‘spiking’ a solution containing the analyte of interest (namely, β-nicotinamide adenine dinucleotide (NADH)) with a common electrochemical redox probe (such as hexaammine-ruthenium(III) chloride), which consequently allows information on the electrochemical properties of the electrode being utilised to be obtained and monitored throughout its application. This approach is explored using a range of commonly encountered carbonaceous electrode materials, including various graphene configurations, such as monolayer, double- and few-layered graphene electrodes – the latter is reported for the first time. The variability in structural quality and stability of the graphene electrodes used (particularly between batches) highlights the necessity for implementation of such approaches within the literature. This work provides a simple, yet effective option for the in situ electrochemical characterisation of various electrode materials, essential where the quality and composition of a ‘reported’ electrode material can vary greatly depending on its fabrication (batch-to-batch quality) or during the course of experimental use

A 6 year study of mammographic compression force : practitioner variability within and between screening sites

Background The application of compression force in mammography is more heavily influenced by the practitioner rather than the client. This can affect client experience, radiation dose and image quality. This research investigates practitioner compression force variation over a 6 year screening cycle in three different screening units. Methods: Recorded data included: practitioner code, applied compression force(N), breast thickness(mm), BI-RADS® density category. Exclusion criteria included: previous breast surgery, previous/ongoing assessment, breast implants. 975 clients (2925) client visits, 11,700 mammogram images) met inclusion criteria across three sites. Data analysis assessed practitioner variation of compression force and breast thickness. Results: Practitioners across three breast screening sites behave differently in the application of compression force. Two of the three sites demonstrate variability within themselves, though they demonstrated no significant difference in mean, first and third quartile compression force and breast thickness values CC(p>0.5), MLO(p>0.1) between themselves. However, the third site (where mandate dictates a minimum compression force is applied) greater consistency was demonstrated; a significant difference in mean, first and third quartile compression force and breast thickness values(p<0.001) was demonstrated between this site and the other two sites. Conclusion: Stabilisation of variations in compression force may have a positive impact on image quality, radiation dose reduction, re-attendance levels and potentially cancer detection. The large variation in compression forces could negatively impact on client experience between the units and within a unit. Further research is required to establish best practice guidelines for compression force within mammography. Keywords: Compression force, Breast compression, Compression variabilit

New graduate doctors' preparedness for practice: A multistakeholder, multicentre narrative study

This is the final version. Available on open access from BMJ Publishing Group via the link in this recordData sharing statement The raw data for this research consist of audio-recordings of narrative interviews and audio diaries. The principal investigator (Professor Lynn V Monrouxe) has access to this specific data set, including audio-recordings of interviews and interview transcripts, in addition to participant contact details and signed consent forms. All authors have access to anonymised data from this set. All data are stored securely on password-protected and encrypted computers. Participants have not given their permission for data sharing outside the research group. Thus, no additional data are available.Objective While previous studies have begun to explore newly graduated junior doctors' preparedness for practice, findings are largely based on simplistic survey data or perceptions of newly graduated junior doctors and their clinical supervisors alone. This study explores, in a deeper manner, multiple stakeholders' conceptualisations of what it means to be prepared for practice and their perceptions about newly graduated junior doctors' preparedness (or unpreparedness) using innovative qualitative methods. Design A multistakeholder, multicentre qualitative study including narrative interviews and longitudinal audio diaries. Setting Four UK settings: England, Northern Ireland, Scotland and Wales. Participants Eight stakeholder groups comprising n=185 participants engaged in 101 narrative interviews (27 group and 84 individual). Twenty-six junior doctors in their first year postgraduation also provided audio diaries over a 3-month period. Results We identified 2186 narratives across all participants (506 classified as 'prepared', 663 as 'unprepared', 951 as 'general'). Seven themes were identified; this paper focuses on two themes pertinent to our research questions: (1) explicit conceptualisations of preparedness for practice; and (2) newly graduated junior doctors' preparedness for the General Medical Council's (GMC) outcomes for graduates. Stakeholders' conceptualisations of preparedness for practice included short-term (hitting the ground running) and long-term preparedness, alongside being prepared for practical and emotional aspects. Stakeholders' perceptions of medical graduates' preparedness for practice varied across different GMC outcomes for graduates (eg, Doctor as Scholar and Scientist, as Practitioner, as Professional) and across stakeholders (eg, newly graduated doctors sometimes perceived themselves as prepared but others did not). Conclusion Our narrative findings highlight the complexities and nuances surrounding new medical graduates' preparedness for practice. We encourage stakeholders to develop a shared understanding (and realistic expectations) of new medical graduates' preparedness. We invite medical school leaders to increase the proportion of time that medical students spend participating meaningfully in multiprofessional teams during workplace learning.General Medical Counci

Access to and experience of education for children and adolescents with cancer: a scoping review protocol

BACKGROUND: Cancer diagnosis in childhood or adolescence impacts significantly on school attendance, experience and educational outcomes. While there is longstanding recognition in clinical practice that these effects span the whole illness trajectory and continue beyond treatment completion, further clarity is required on the specific barriers and facilitators to education during cancer treatment and beyond, as well as on the experiences of children and adolescents across the full range of education settings (hospital, home, virtual, original school of enrolment), in order to determine which interventions are successful in improving access and experience from their perspective. The aim of this review is to identify what is known from the existing literature about access to and experience of education for children and adolescents with cancer during and post treatment. METHODS: We have planned a scoping literature review searching the following databases from inception onwards: MEDLINE (Ovid), Embase and Embase Classic, Web of Science Core Collection, Education Resources Index, Sociological Abstracts, APA PsycINFO, SCOPUS, CINAHL Plus, Emcare and The Cochrane Library. In addition, DARE, conference abstracts, key journals, and institutional websites will be searched. Arksey and O'Malley's six-step process will be followed, including a consultation exercise. Studies, reports and policies from any country providing care and treatment for children and adolescents with cancer published in English will be considered eligible for inclusion. Two reviewers will independently screen all citations, full-text articles and abstract data. A narrative summary of findings will be conducted. Data analysis will involve quantitative (e.g., frequencies) and qualitative (e.g., content and thematic analysis) methods. DISCUSSION: This is a timely examination given the increased incidence of childhood cancer, more intensive treatment regimens and improved survival rates for childhood cancer. The inclusion of a substantive consultation exercise with families and professionals will provide an important opportunity to examine the scoping review outputs. Findings will assist the childhood cancer community in developing a comprehensive evidence-based understanding of a significant associated bio-psychosocial impact of cancer diagnosis and treatment and will form the first step towards developing effective interventions and policies to mitigate identified detrimental effects. SYSTEMATIC REVIEW REGISTRATION: Open Science Framework (osf/io/yc4wt)

Influence of the metal/metal oxide redox cycle on the catalytic activity of methane oxidation over Pd and Ni doped hydroxyapatite

© 2018 Elsevier B.V. The methane oxidation reaction was investigated over Pd and Ni doped hydroxyapatite (HAP) catalysts. All catalysts were evaluated in both their reduced and oxidised forms, and the behaviour of the metals in the reaction was investigated. The obtained results demonstrated that the reaction proceeds through a redox cycle between metal oxide and reduced metal, however more stable catalysts with higher conversions were observed when the catalysts were pre-treated in oxygen. After CH 4 oxidation, all the samples were tested towards coke formation using TGA analysis; results showed that all the catalysts were resistant to the coking process under the conditions studied

The IL-33:ST2 axis is unlikely to play a central fibrogenic role in idiopathic pulmonary fibrosis

BACKGROUND: Idiopathic pulmonary fibrosis (IPF) is a devastating interstitial lung disease (ILD) with limited treatment options. Interleukin-33 (IL-33) is proposed to play a role in the development of IPF however the exclusive use of prophylactic dosing regimens means that the therapeutic benefit of targeting this cytokine in IPF is unclear. METHODS: IL-33 expression was assessed in ILD lung sections and human lung fibroblasts (HLFs) by immunohistochemistry and gene/protein expression and responses of HLFs to IL-33 stimulation measured by qPCR. In vivo, the fibrotic potential of IL-33:ST2 signalling was assessed using a murine model of bleomycin (BLM)-induced pulmonary fibrosis and therapeutic dosing with an ST2-Fc fusion protein. Lung and bronchoalveolar lavage fluid were collected for measurement of inflammatory and fibrotic endpoints. Human precision-cut lung slices (PCLS) were stimulated with transforming growth factor-β (TGFβ) or IL-33 and fibrotic readouts assessed. RESULTS: IL-33 was expressed by fibrotic fibroblasts in situ and was increased by TGFβ treatment in vitro. IL-33 treatment of HLFs did not induce IL6, CXCL8, ACTA2 and COL1A1 mRNA expression with these cells found to lack the IL-33 receptor ST2. Similarly, IL-33 stimulation had no effect on ACTA2, COL1A1, FN1 and fibronectin expression by PCLS. Despite having effects on inflammation suggestive of target engagement, therapeutic dosing with the ST2-Fc fusion protein failed to reduce BLM-induced fibrosis measured by hydroxyproline content or Ashcroft score. CONCLUSIONS: Together these findings suggest the IL-33:ST2 axis does not play a central fibrogenic role in the lungs with therapeutic blockade of this pathway unlikely to surpass the current standard of care for IPF

MCL-1 is essential for survival but dispensable for metabolic fitness of FOXP3+ regulatory T cells

FOXP3+ regulatory T (Treg) cells are essential for maintaining immunological tolerance. Given their importance in immune-related diseases, cancer and obesity, there is increasing interest in targeting the Treg cell compartment therapeutically. New pharmacological inhibitors that specifically target the prosurvival protein MCL-1 may provide this opportunity, as Treg cells are particularly reliant upon this protein. However, there are two distinct isoforms of MCL-1; one located at the outer mitochondrial membrane (OMM) that is required to antagonize apoptosis, and another at the inner mitochondrial membrane (IMM) that is reported to maintain IMM structure and metabolism via ATP production during oxidative phosphorylation. We set out to elucidate the relative importance of these distinct biological functions of MCL-1 in Treg cells to assess whether MCL-1 inhibition might impact upon the metabolism of cells able to resist apoptosis. Conditional deletion of Mcl1 in FOXP3+ Treg cells resulted in a lethal multiorgan autoimmunity due to the depletion of the Treg cell compartment. This striking phenotype was completely rescued by concomitant deletion of the apoptotic effector proteins BAK and BAX, indicating that apoptosis plays a pivotal role in the homeostasis of Treg cells. Notably, MCL-1-deficient Treg cells rescued from apoptosis displayed normal metabolic capacity. Moreover, pharmacological inhibition of MCL-1 in Treg cells resistant to apoptosis did not perturb their metabolic function. We conclude that Treg cells require MCL-1 only to antagonize apoptosis and not for metabolism. Therefore, MCL-1 inhibition could be used to manipulate Treg cell survival for clinical benefit without affecting the metabolic fitness of cells resisting apoptosis

The effect of TiO2 coatings on the formation of ozone and nitrogen oxides in non-thermal atmospheric pressure plasma

The use of photocatalytic materials in plasma systems has the potential to enhance the selectivity and yield of desired products. However, the surface interaction between the photocatalyst and plasma is a complex process that is not well understood. This work presents a comprehensive study of the effects of combining titanium dioxide (TiO2) photocatalysts with non-thermal atmospheric pressure nitrogen-oxygen plasmas, which increases the production of ozone and dinitrogen pentoxide (N2O5) while limiting the formation of harmful nitrogen dioxide (NO2) and nitrous oxide (N2O) by products. TiO2 coatings were deposited by magnetron sputtering onto barium titanate (BaTiO3) particulates for use within a packed bed dielectric barrier discharge reactor (DBD). The presence of titanium dioxide can affect the plasma chemistry in the DBD by acting as a sink for atomic oxygen, through photocatalytic formation of superoxide anion radical (O2-), and alteration of the dielectric constant of the BaTiO3 particulates. This work explains the complex interaction of these effects on oxygen and nitrogen plasma chemistry. The effect of the photocatalyst surface properties, gas composition and residence time on the reaction pathways for the formation of ozone and nitrogen oxides (NxOy) were investigated. The photocatalytic activity of titanium dioxide was improved by annealing the coated surface, and was subsequently found to enable the formation of ozone, increase the formation of N2O5 while significantly decreasing the formation of harmful NO2 and N2O with a residence time of 0.011