Do Neutrophils Play a Role in Establishing Liver Abscesses and Distant Metastases Caused by Klebsiella pneumoniae?

Serotype K1 Klebsiella pneumoniae is a major cause of liver abscesses and endophthalmitis. This study was designed to identify the role of neutrophils in the development of distant metastatic complications that were caused by serotype K1 K. pneumoniae. An in vitro cellular model was used to assess serum resistance and neutrophil-mediated killing. BALB/c mice were injected with neutrophils containing phagocytosed K. pneumoniae. Serotype K1 K. pneumoniae was significantly more resistant to serum killing, neutrophil-mediated phagocytosis and intra-cellular killing than non-K1 isolates (p<0.01). Electron microscopic examination had similar findings as in the bioassay findings. Intraperitoneal injection of neutrophils containing phagocytosed serotype K1 K. pneumoniae led to abscess formation in multiple sites including the subcutaneous tissue, lung, and liver, whereas no abscess formation was observed in mice injected with non-K1 isolates. The resistance of serotype K1 K. pneumoniae to complement- and neutrophil-mediated intracellular killing results in the dissemination of K. pneumoniae via the bloodstream. Escape from neutrophil intracellular killing may contribute to the dissemination and establishment of distant metastases. Thus, neutrophils play a role as a vehicle for helping K. pneumoniae and contributing to the establishment of liver abscess and distant metastatic complications

Environmental performance of miscanthus-lime lightweight concrete using life cycle assessment:Application in external wall assemblies

This is the final version. Available from Elsevier via the DOI in this record. In the UK context, miscanthus is a potential alternative perennial crop for the development of bio-based building materials. This paper presents the environmental benefits of using miscanthus shives in lightweight blocks and their potential application in wall assemblies. A systemic life cycle assessment (LCA) is carried out for miscanthus-lime blocks, and the effects of binder type and binder content are discussed. The environmental performance-based analysis reveals that miscanthus blocks can capture 135 kg CO eq/m for an assumed 100-years life period. The impact analysis using the University of Leiden, institute of environmental science (CML) baseline (v4.4) method shows that 75% of the greenhouse gas emissions are attributable to the production of mineral binders. A reduction of binder to aggregate ratio from 2.0 to 1.5 reduces greenhouse gas emissions by 32.9%. The use of 10 wt% mineral additions can potentially stabilise blocks while having little effect on their overall environmental impacts. The environmental profiles of wall systems incorporating miscanthus-lime blocks have been evaluated in this this study. Combining miscanthus blocks with fired clay bricks enables a potential low carbon retrofitting technique for the current stock of residential buildings in the UK. Timber-framed system filled with miscanthus blocks enables a carbon storage of ~97.3 kg CO eq/m , which presents a potential carbon offsetting strategy in new-build dwellings. Consideration should be given to the potential negative impacts related to agricultural activities for the production of miscanthus shives. The largest negative environmental impact was ozone layer depletion, where a relative difference of 12.8% was recorded between miscanthus timber-framed wall and a typical solid wall insulated with mineral wool. It appears that miscanthus-lime composites can substantially improve the environmental profile of wall assemblies and sustainability be applied in existing uninsulated masonry walls or incorporated in timber- framed new-build houses.Engineering and Physical Sciences Research Council (EPSRC)Natural Environment Research Council (NERC)NERC GW4+ Doctoral Training Partnership studentshi

ELECtric Tibial nerve stimulation to Reduce Incontinence in Care homes: protocol for the ELECTRIC randomised trial

Background Urinary incontinence (UI) is highly prevalent in nursing and residential care homes (CH) and profoundly impacts on residents’ dignity and quality of life. Care homes predominantly use absorbent pads to contain UI rather than actively treat the condition. Transcutaneous posterior tibial nerve stimulation (TPTNS) is a non-invasive, safe, low-cost intervention with demonstrated effectiveness for reducing UI in adults. However, the effectiveness of TPTNS to treat UI in older adults living in care homes is not known. The ELECTRIC Trial aims to establish if a programme of TPTNS is a clinically effective treatment for UI in care home residents and investigate the associated costs and consequences. Methods This is a pragmatic, multicentre, placebo controlled randomised parallel group trial comparing effectiveness of TPTNS (target n=250) with sham stimulation (target n=250) in reducing volume of UI in CH residents. CH residents (men and women) with self- or staff- reported UI of more than once per week are eligible to take part, including those with cognitive impairment. Outcomes will be measured at 6, 12 and 18 weeks post randomisation using the following measures: 24-hour pad weight tests (PWT), post void residual urine (bladder scans), Patient Perception of Bladder Condition (PPBC), Minnesota Toileting Skills Questionnaire (MTSQ) and Dementia Quality of Life (DEMQOL). Economic evaluation based on a bespoke Resource Use Questionnaire will assess the costs of providing a programme of TPTNS. A concurrent process evaluation will investigate fidelity to the intervention and influencing factors and qualitative interviews will explore the experiences of TPTNS from the perspective of CH residents, family members, CH staff and managers. Discussion TPTNS is a non-invasive intervention that has demonstrated effectiveness in reducing UI in adults. The ELECTRIC Trial will involve CH staff delivering TPTNS to residents and establish whether TPTNS is more effective than sham stimulation for reducing the volume of UI in CH residents. Should TPTNS be shown to be an effective and acceptable treatment for UI in older adults in CHs, it will provide a safe, low-cost and dignified alternative to the current standard approach of containment and medication. Trial registration Clinical Trials.gov. NCT03248362. Registered on 14/08/2017. https://clinicaltrials.gov/ ISRCTN, ISRCTN 98415244. Registered on 25/04/2018. https://www.isrctn.com