The impact of the European Working Time Regulations on Ophthalmic Specialist Training – A national trainee survey

AbstractSummary and introductionTo assess ophthalmic trainees' perspective of the impact of the European Working Time Regulations (EWTR) on their training.MethodsAll trainees in ophthalmology in the UK were emailed a link to an electronic survey asking about their experiences of the EWTR.Results324 trainees (46% of those invited) responded to the survey. 44.4% of trainees reported that their posts were compliant with the EWTR. 40.7% felt that training had been adversely affected. 49.1% thought that ophthalmic trainees should opt out of the EWTR to work more than 48 h per week, with 57 the mean number of hours suggested appropriate.DiscussionMany ophthalmic trainees in the United Kingdom are working in rotas which are not compliant with the European Working Time Directive. Many trainees feel that implementation of the EWTD has had a negative effect on training and feel it would be acceptable to work a higher number of hours per week

A systematic approach to echocardiography in hypertrophic cardiomyopathy: a guideline protocol from the British Society of Echocardiography.

Hypertrophic cardiomyopathy (HCM) is a relatively common inherited cardiac condition with a prevalence of approximately one in 500. It results in otherwise unexplained hypertrophy of the myocardium and predisposes the patient to a variety of disease-related complications including sudden cardiac death. Echocardiography is of vital importance in the diagnosis, assessment and follow-up of patients with known or suspected HCM. The British Society of Echocardiography (BSE) has previously published a minimum dataset for transthoracic echocardiography, providing the core parameters necessary when performing a standard echocardiographic study. However, for patients with known or suspected HCM, additional views and measurements are necessary. These additional views allow more subtle abnormalities to be detected or may provide important information in order to identify patients with an adverse prognosis. The aim of this Guideline is to outline the additional images and measurements that should be obtained when performing a study on a patient with known or suspected HCM

Diagnosis and assessment of dilated cardiomyopathy: a guideline protocol from the British Society of Echocardiography.

Heart failure (HF) is a debilitating and life-threatening condition, with 5-year survival rate lower than breast or prostate cancer. It is the leading cause of hospital admission in over 65s, and these admissions are projected to rise by more than 50% over the next 25 years. Transthoracic echocardiography (TTE) is the first-line step in diagnosis in acute and chronic HF and provides immediate information on chamber volumes, ventricular systolic and diastolic function, wall thickness, valve function and the presence of pericardial effusion, while contributing to information on aetiology. Dilated cardiomyopathy (DCM) is the third most common cause of HF and is the most common cardiomyopathy. It is defined by the presence of left ventricular dilatation and left ventricular systolic dysfunction in the absence of abnormal loading conditions (hypertension and valve disease) or coronary artery disease sufficient to cause global systolic impairment. This document provides a practical approach to diagnosis and assessment of dilated cardiomyopathy that is aimed at the practising sonographer

A thermal-optical analysis of a compound parabolic concentrator for single and multiphase flows, including superheat

A thermal and optical analysis of the performance of a refrigerant charged Compound Parabolic Concentrator (CPC) for solar applications operating in non-boiling, boiling and super-heated regimes is presented. The performance of the CPC working under these single and multiphase conditions is governed by the axial fractional channel lengths of the non-boiling and the superheating regions. The overall thermal loss coefficient, the dimensionless capacitance rate and collector efficiency factors for various CPC operating regions are defined. A new “Generalized Heat Removal Factor“, ℱ s for solar collectors under any operation mode is developed. The thermal efficiency of a CPC and flat-plate collector, whether under non-boiling, boiling or superheated conditions, is evaluated using ℱ s which enables the selection of a suitable collector design and concentration ratio at some specified operational temperature. It is shown that, in general, a CPC has a greater thermal conversion efficiency than a flat-plate for a given operating condition. Es wird eine thermische und optische Analyse des Verhaltens eines Verbund-Parabol-Kollektors für die Anwendung der Sonnenenergie vorgestellt, der mit Kältemittel im nichtsiedenden, und übehitzten Bereich arbeitet. Das Verhalten dieses unter ein- und mehrphasigen Bedingungen arbeitenden Kollektors wird bestimmt durch den axialen Anteil der Kühl-kanallängen im nichtsiedenden und im überhitzten Zustand. Es werden der mittlere thermische Verlustkoeffizient, die dimensionslose Wärmekapazität sowie die Kollektorwirkungsgrade für verschiedene Zustandsbereiche dieses Parabolspiegels definiert. Ein neuer „verallgemeinerter Wärmeabflußfaktor“, ℱ s , für Sonnenkollektoren, die unter beliebigen Betriebsbedingungen arbeiten, wurde entwickelt. Mit diesem ℱ s Faktor werden der thermische Wirkungsgrad des Parabolkollektors und eines Platten-kollektors bei einphasiger flüssiger Strömung beim Sieden und für überhitzten Dampf berechnet, wodurch es möglich wird, eine geeignete Kollektorauslegung und das dazugehörige Konzentrationsverhältnis bei vorgegebenen Betriebstemperaturen zu wählen. Es wird gezeigt, daß im allgemeinen der parabolische Kollektor einen höheren thermischen Wirkungsgrad besitzt als der Platten-kollektor bei identischen Betriebsbedingungen.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/46656/1/231_2005_Article_BF01377577.pd

A minimum dataset for a standard adult transthoracic echocardiogram: a guideline protocol from the British Society of Echocardiography.

There have been significant advances in the field of echocardiography with the introduction of a number of new techniques into standard clinical practice. Consequently, a 'standard' echocardiographic examination has evolved to become a more detailed and time-consuming examination that requires a high level of expertise. This Guideline produced by the British Society of Echocardiography (BSE) Education Committee aims to provide a minimum dataset that should be obtained in a comprehensive standard echocardiogram. In addition, the layout proposes a recommended sequence in which to acquire the images. If abnormal pathology is detected, additional views and measurements should be obtained with reference to other BSE protocols when appropriate. Adherence to these recommendations will promote an increased quality of echocardiography and facilitate accurate comparison of studies performed either by different operators or at different departments

A safety checklist for transoesophageal echocardiography from the British Society of Echocardiography and the Association of Cardiothoracic Anaesthetists.

The World Health Organisation (WHO) launched the Surgical Safety Checklist in 2008. The introduction of this checklist resulted in a significant reduction in the incidence of complications and death in patients undergoing surgery. Consequently, the WHO Surgical Safety checklist is recommended for use by the National Patient Safety Agency for all patients undergoing surgery. However, many invasive or interventional procedures occur outside the theatre setting and there are increasing requirements for a safety checklist to be used prior to such procedures. Transoesophageal echocardiography (TOE) is an invasive procedure and although generally considered to be safe, it carries the risk of serious and potentially life-threatening complications. Strict adherence to a safety checklist may reduce the rate of significant complications during TOE. However, the standard WHO Surgical Safety Checklist is not designed for procedures outside the theatre environment and therefore this document is designed to be a procedure-specific safety checklist for TOE. It has been endorsed for use by the British Society of Echocardiography and the Association of Cardiothoracic Anaesthetists

The solar particle event of July 16–19, 1966 and its possible association with a flare on the invisible solar hemisphere

An energetic solar proton and electron event was observed by particle detectors aboard Explorer 33 (AIMP-1) and OGO-3 during the period July 16–19, 1966. Optical and radio observations of the sun suggest that these particles were produced by a flare which may have occurred on July 16 near the central meridian of the invisible hemisphere. The active region to which the flare is assigned is known to have produced the energetic particle events of July 7 and 28 , 1966. The propagation of the particles in the July 16–19 event over the ∼180° extent of solar longitude from the flare to the earth is discussed, and it is concluded that there must exist a means of rapidly distributing energetic particles over a large area of the sun. Several possible mechanisms are suggested.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/43748/1/11207_2004_Article_BF00150955.pd

The Relationship Between Cardiac Troponin in People Hospitalised for Exacerbation of COPD and Major Adverse Cardiac Events (MACE) and COPD Readmissions

BACKGROUND: No single biomarker currently risk stratifies chronic obstructive pulmonary disease (COPD) patients at the time of an exacerbation, though previous studies have suggested that patients with elevated troponin at exacerbation have worse outcomes. This study evaluated the relationship between peak cardiac troponin and subsequent major adverse cardiac events (MACE) including all-cause mortality and COPD hospital readmission, among patients admitted with COPD exacerbation. METHODS: Data from five cross-regional hospitals in England were analysed using the National Institute of Health Research Health Informatics Collaborative (NIHR-HIC) acute coronary syndrome database (2008-2017). People hospitalised with a COPD exacerbation were included, and peak troponin levels were standardised relative to the 99th percentile (upper limit of normal). We used Cox Proportional Hazard models adjusting for age, sex, laboratory results and clinical risk factors, and implemented logarithmic transformation (base-10 logarithm). The primary outcome was risk of MACE within 90 days from peak troponin measurement. Secondary outcome was risk of COPD readmission within 90 days from peak troponin measurement. RESULTS: There were 2487 patients included. Of these, 377 (15.2%) patients had a MACE event and 203 (8.2%) were readmitted within 90 days from peak troponin measurement. A total of 1107 (44.5%) patients had an elevated troponin level. Of 1107 patients with elevated troponin at exacerbation, 256 (22.8%) had a MACE event and 101 (9.0%) a COPD readmission within 90 days from peak troponin measurement. Patients with troponin above the upper limit of normal had a higher risk of MACE (adjusted HR 2.20, 95% CI 1.75-2.77) and COPD hospital readmission (adjusted HR 1.37, 95% CI 1.02-1.83) when compared with patients without elevated troponin. CONCLUSION: An elevated troponin level at the time of COPD exacerbation may be a useful tool for predicting MACE in COPD patients. The relationship between degree of troponin elevation and risk of future events is complex and requires further investigation

A case-control and cohort study to determine the relationship between ethnic background and severe COVID-19.

BACKGROUND: People of minority ethnic backgrounds may be disproportionately affected by severe COVID-19. Whether this relates to increased infection risk, more severe disease progression, or worse in-hospital survival is unknown. The contribution of comorbidities or socioeconomic deprivation to ethnic patterning of outcomes is also unclear. METHODS: We conducted a case-control and a cohort study in an inner city primary and secondary care setting to examine whether ethnic background affects the risk of hospital admission with severe COVID-19 and/or in-hospital mortality. Inner city adult residents admitted to hospital with confirmed COVID-19 (n = 872 cases) were compared with 3,488 matched controls randomly sampled from a primary healthcare database comprising 344,083 people residing in the same region. For the cohort study, we studied 1827 adults consecutively admitted with COVID-19. The primary exposure variable was self-defined ethnicity. Analyses were adjusted for socio-demographic and clinical variables. FINDINGS: The 872 cases comprised 48.1% Black, 33.7% White, 12.6% Mixed/Other and 5.6% Asian patients. In conditional logistic regression analyses, Black and Mixed/Other ethnicity were associated with higher admission risk than white (OR 3.12 [95% CI 2.63–3.71] and 2.97 [2.30–3.85] respectively). Adjustment for comorbidities and deprivation modestly attenuated the association (OR 2.24 [1.83–2.74] for Black, 2.70 [2.03–3.59] for Mixed/Other). Asian ethnicity was not associated with higher admission risk (adjusted OR 1.01 [0.70–1.46]). In the cohort study of 1827 patients, 455 (28.9%) died over a median (IQR) of 8 (4–16) days. Age and male sex, but not Black (adjusted HR 1.06 [0.82–1.37]) or Mixed/Other ethnicity (adjusted HR 0.72 [0.47–1.10]), were associated with in-hospital mortality. Asian ethnicity was associated with higher in-hospital mortality but with a large confidence interval (adjusted HR 1.71 [1.15–2.56]). INTERPRETATION: Black and Mixed ethnicity are independently associated with greater admission risk with COVID-19 and may be risk factors for development of severe disease, but do not affect in-hospital mortality risk. Comorbidities and socioeconomic factors only partly account for this and additional ethnicity-related factors may play a large role. The impact of COVID-19 may be different in Asians. FUNDING: British Heart Foundation; the National Institute for Health Research; Health Data Research UK