Legislation, Policy and Equality: Evaluating deaf people’s access to the National Health Service

The Equality Act 2010 imposes a duty on healthcare providers to make an adjustment for people who are disabled to enable them to access the service in such a way that is equal to a person who is not disabled. Existing research shows that many deaf people have had poor experiences when accessing the National Health Service (NHS), which has resulted in negative outcomes when reasonable adjustments have not been made. Although medical settings have a duty to make adjustments for deaf people, it is unclear what the ‘reasonable adjustment’ should be. Therefore, this thesis aims to investigate what the ‘reasonable adjustment’ duty implies, as outlined in the Equality Act 2010, in the specific context of paramedic practice, as no official definition has been given within the legislation. This qualitative study uses an Interpretative Phenomenological Analysis (IPA) framework which investigates the lived experiences of both deaf people and paramedics when communicating in medical emergency encounters. Analysis of the interviews with these two participant groups are drawn together into common themes to gain an understanding of the issues experienced by both groups, what they were concerned about, and how interaction was facilitated with each other. This research also draws upon NHS hospital policies across England to understand how hospitals intend to make the ‘reasonable adjustment’ duty that is placed on them through the Equality Act 2010. The policies are then reviewed alongside the identified themes from both participant groups to explore similarity or discrepancy between policy aims and outcomes, including whether the adjustments that need to be made for deaf BSL users are understood. The findings in this thesis demonstrate that qualified British Sign Language interpreters are essential to facilitating deaf people’s access to healthcare, and NHS policies struggle to meet the anticipatory duty outlined in the Equality Act. This study concludes that medical settings and personnel must be prepared for when emergency situations arise, and must have clear policies and expectations about how to obtain a qualified interpreter within a reasonable timeframe, and the communication methods that are acceptable until a qualified interpreter arrives

Acute Complication Due to Impella 2.5 Device (Superficial Femoral Artery Thrombosis): Managed Successfully with Novel Aspiration Thrombectomy Catheter (Pronto V3)

The Impella recover LP 2.5 is a percutaneous left ventricular assist device (LVAD) recently approved for use in patients undergoing high risk percutaneous coronary intervention (PCI) and also in cases of cardiogenic shock. There is limited evidence available in literature about its safety, especially with regards to the incidence of local vascular complications, their management and long-term implications. We report here the first case of a serious local vascular complication—superficial femoral artery thrombus formation during Impella recover LP 2.5 use in a high risk PCI which was managed successfully with novel aspiration thrombectomy catheter (Pronto V3), which in itself is the first reported use of Pronto V3 in such a vascular complication

A novel powder-epoxy towpregging line for wind and tidal turbine blades

A novel material and process was developed using fibre-reinforced powder-epoxy to produce unidirectional towpreg with a pilot-scale towpregging line, for cost-effective production of large composite structures for the renewable energy market, specifically for wind and tidal turbine blades. Electrostatic attraction was used to coat fibre tows with powder epoxy and either joule or radiant heating employed to heat and melt the polymer, followed by consolidation between rollers. Unidirectional carbon-fibre and basalt-fibre reinforced polymer laminates (UD-CFRP and UD-BFRP, respectively) were manufactured from the towpreg. Tensile test results showed that the towpregging process could be employed to achieve high performance UD-CFRP with 0° tensile properties that are similar or better than commercially-available UD-CFRP systems. The competitive advantages of the powder-epoxy towpreg system include lower cost, better overall manufacturing control for vacuum-bag-only manufacturing and the ability to co-cure parts together at a later stage. Mechanical test results showed some variation between two types of UD-BFRP, but the results compared well with published data on UD-BFRP and equivalent glass-fibre reinforced polymer (GFRP) systems. Finally, the influence of hygrothermal ageing due to water immersion on the tensile properties of the materials was investigated, with tests revealing that the water ageing effect was more severe in the case of UD-BFRP than for UD-CFRP

Isolated Left Ventricular Noncompaction Cardiomyopathy diagnosed by Transesophageal Echocardiography

Isolated noncompaction of the ventricular myocardium has often been misdiagnosed as other cardiomyopathies because it is a relatively recently described cardiomyopathy with literature limited to case reports and case series and little awareness among physicians. We are reporting a case of isolated left ventricular noncompaction cardiomyopathy that was misdiagnosed for over two decades

The Interaction of Photoactivators with Proteins during Microfabrication

Micron-scale protein cross-linking or microfabrication has been carried out using an Nd3+–YAG laser as the excitation source. Fabrication is carried out by the excitation of photoactivators (Rose Bengal, methylene blue and 9-fluorenone-2-carboxylic acid) with the ultimate goal of creating stable structures that will serve as models for various applications (drug delivery and tissue engineering). Experimental parameters have been adjusted to minimize photodamage and maximize cross-linking efficiency. The higher than ideal photon flux and peak power necessitates the use of high protein concentrations to minimize photodamage. Rose Bengal and methylene blue are binding to proteins with high association constants (Ka ≈ 106 M−1) and both Rose Bengal and both 9-fluorenone-2-carboxylic acid are showing changes to their excited states in presence of proteins at cross-linking concentrations. Molecular docking studies show that Rose Bengal binds close to the tryptophan with ΔG = −6.15 kcal/mol

Complete Recovery of Ischemic Cardiomyopathy from Thrombotic Thrombocytopenic Purpura

A 50 year old male HIV patient on antiretroviral therapy was admitted for chest pain. Upon admission, the patient was found to have elevated cardiac enzymes, acute thrombocytopenia, hemolytic anemia, acute pancreatitis and acute renal failure. The patient was diagnosed with thrombotic thrombocytopenic purpura/haemolytic uremic syndrome and emergency plasma exchange therapy was initiated along with aspirin, beta-blockers, steroids, and antiretroviral therapy. Patient responded well and demonstrated complete resolution of ischemic cardiomyopathy with left ventricular ejection fraction improving from 35% to 55% by the time of discharge. Essentially, prompt diagnosis and treatment can reverse cardiac damage induced by thrombotic thrombocytopenic purpura