Pulmonary hypertension in infants with congenital heart defects: are leukotrienes involved?

The circulating levels of leukotriene E4 in infants with congenital heart defects, increased pulmonary blood flow and pulmonary arterial hypertension, were determined and compared with infants with decreased pulmonary blood flow (Tetralogy of Fallot). There was no correlation (r=0.38) between the pulmonary arterial pressure (56 ± 4 mmHg) and the leukotriene E4 levels (1.37 ± 0.67 ng/ml blood) measured in peripheral blood samples from the hypertensive group prior to surgery. There was considerable variation in the detectable leukotriene E4 levels in blood samples from different patients. The levels detected in the blood samples between the two groups of patients was similar. These data suggest that neither the surgical repair during cardiopulmonary bypass nor the pulmonary hypertension appeared to modify the leukotriene E4 blood levels in the small number of patients studied

Cold-spray of aluminium with and without ceramic combined with plasma electrolytic oxidation

Cold spraying is developing rapidly and has a wide spectrum of applications: protection against corrosion, preparation of high conductivity coatings, repair of damaged metal components, metal additive manufacturing, thermal management. Plasma electrolytic oxidation (PEO) is widely used to improve the corrosion and wear resistance of lightweight metals such as aluminum alloys by the formation of a ceramic oxide layer. When applied on aluminium alloys, the PEO oxide layer is mainly composed with γ-Al2O3 (in major proportion) and corundum, α-Al2O3. Increasing the proportion of corundum is an objective in order to improve the corrosion and wear resistance properties. For this purpose, a duplex treatment combining cold spray and PEO is investigate [1]. Particularly it consists in firstly cold spraying an aluminium coating containing a certain amount of α-Al2O3 which is then PEO processed. Our results show that, while the projected alpha alumina particles are observable on cross sections of untreated samples and for short PEO treatment times (lower than 20 min), this is no longer the case for long PEO treatment times (over than 35 min) (see the figure). In fact, under these conditions, it is no longer possible to observe the alpha alumina particles in the PEO layer. More interesting still, the proportion of alpha alumina in the layers resulting from a duplex treatment is greater than that obtained in the layer resulting from a cold spray treatment by scanning electron microscope

Implementation of influenza point-of-care-testing and patient-cohorting during a high-incidence season: a retrospective analysis of impact on infection prevention and control and clinical outcomes.

BACKGROUND: During high-incidence influenza seasons, a robust infection prevention and control policy is imperative to reduce nosocomial transmission of influenza. AIM: To assess the impact of Emergency Department (ED) influenza point-of-care-testing (POCT) and influenza-ward patient-cohorting on infection prevention and control and clinical outcomes. METHODS: Influenza POCT was operational in our adult ED from 21st January 2018 and an influenza-ward from 25th January 2018. A retrospective 'before-after' analysis was performed with pre-intervention defined as 1st November 2017-20th January 2018 and post-intervention 21st January-30th April 2018. Primary outcome was rate of hospital-acquired influenza (HAI). Secondary outcomes included antiviral prescription and length of stay. The length of time inpatients remain influenza RNA detected by polymerase chain reaction (PCR) was also analysed

Developing a serocorrelate of protection against invasive group B streptococcus disease in pregnant women: a feasibility study.

BACKGROUND: Group B streptococcus is the leading cause of infection in infants. Currently, intrapartum antibiotic prophylaxis is the major strategy to prevent invasive group B streptococcus disease. However, intrapartum antibiotic prophylaxis does not prevent maternal sepsis, premature births, stillbirths or late-onset disease. Maternal vaccination may offer an alternative strategy. Multivalent polysaccharide protein conjugate vaccine development is under way and a serocorrelate of protection is needed to expedite vaccine licensure. OBJECTIVES: The ultimate aim of this work is to determine the correlate of protection against the major group B streptococcus disease-causing serotypes in infants in the UK. The aim of this feasibility study is to test key operational aspects of the study design. DESIGN: Prospective cohort study of pregnant women and their infants in a 6-month period (1 July to 31 December 2018). SETTING: Five secondary and tertiary hospitals from London and South England. National iGBS disease surveillance was conducted in all trusts in England and Wales. PARTICIPANTS: Pregnant women aged ≥ 18 years who were delivering at one of the selected hospitals and who provided consent during the study period. There were no exclusion criteria. INTERVENTIONS: No interventions were performed. MAIN OUTCOME MEASURES: (1) To test the feasibility of collecting serum at delivery from a large cohort of pregnant women. (2) To test the key operational aspects for a proposed large serocorrelates study. (3) To test the feasibility of collecting samples from those with invasive group B streptococcus. RESULTS: A total of 1823 women were recruited during the study period. Overall, 85% of serum samples were collected at three sites collecting only cord blood. At the two sites collecting maternal, cord and infant blood samples, the collection rate was 60%. A total of 614 women were screened for group B streptococcus with a colonisation rate of 22% (serotype distribution: 30% III, 25% Ia, 16% II, 14% Ib, 14% V and 1% IV). A blood sample was collected from 34 infants who were born to colonised women. Maternal and infant blood and the bacterial isolates for 15 newborns who developed invasive group B streptococcal disease during the study period were collected (serotype distribution: 29% III, 29% II, 21% Ia, 7% Ib, 7% IV and 7% V). LIMITATIONS: Recruitment and sample collection were dependent on the presence of research midwives rather than the whole clinical team. In addition, individualised consent limited the number of women who could be approached each day, and site set-up for the national surveillance study and the limited time period of this feasibility study limited recruitment of all eligible participants. CONCLUSIONS: We have verified the feasibility of collecting and processing rectovaginal swabs and blood samples in pregnant women, as well as samples from those with invasive group B streptococcal disease. We have made recommendations for the recruitment of cases within the proposed GBS3 study and for controls both within GBS3 and as an extension of this feasibility study. FUTURE WORK: A large case-control study comparing specific immunoglobulin G levels in mothers whose infants develop invasive group B streptococcal disease with those in colonised mothers whose infants do not develop invasive group B streptococcal disease is recommended. TRIAL REGISTRATION: Current Controlled Trials ISRCTN49326091; IRAS project identification number 246149/REC reference number 18/WM/0147. FUNDING: This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 23, No. 67. See the NIHR Journals Library website for further project information

Full-scale validation of bio-recycled asphalt mixtures for road pavements

Recycling of asphalt has become a well-established practice in many countries, however the road pavement industry remains a bulk consumer of extracted raw materials. Novel solutions that find root in circular economy concepts and life‐cycle approaches are needed in order to enable optimisation of infrastructure resource efficiency, starting from the design stage and spanning the whole value chain in the construction sector. Itis within this framework that the present study presents a full-scale validation of asphalt mixtures specifically designed to ensure durability of flexible road pavements and at the same time enabling the reuse of reclaimed asphalt pavement (RAP) through the incorporation of bio-materials as recycling agent. These bio-recycled asphalt mixtures have been first designed in laboratory and subsequently validated in a real scale experiment conducted at the accelerated pavement testing facilities at IFSTTAR. Four pavement sections were evaluated: three test sections with innovative bio-materials, and a reference section with a conventional, high modulus asphalt mix (EME2). Two tests were realized: a rutting test and a fatigue test and for each of them the evolution of bio-recycled asphalt mixtures properties as well as the pavement deteriorations were recorded and studied. Evolution of the bio-asphalt mixtures was monitored for a 5 months period after paving by a bespoke nondestructive micro-coring, extracting and recovering methodology developed at the Western Research Institute (WRI). The structural health of the pavement sections was monitored through periodic falling weight deflectometer (FWD) as well as with strain gages and temperature sensors. As a result the three tailored bio-asphalt mixtures performed similarly or better than the control mixture, both in terms of property evolutions and durability

An analysis of C.difficile Environmental Contamination During and Following Treatment for C.difficile Infection

Background: Lower Clostridium difficile spore counts in feces from C difficile infection (CDI) patients treated with fidaxomicin versus vancomycin have been observed. We aimed to determine whether environmental contamination is lower in patients treated with fidaxomicin compared with those treated with vancomycin/metronidazole. Methods: The CDI cases were recruited at 4 UK hospitals (Leeds, Bradford, and London [2 centers]). Environmental samples (5 room sites) were taken pretreatment and at 2–3, 4–5, 6–8, and 9–12 days of treatment, end of treatment (EOT), and post-EOT. Fecal samples were collected at diagnosis and as often as produced thereafter. Swabs/feces were cultured for C difficile; percentage of C difficile-positive samples and C difficile bioburden were compared between different treatment arms at each time point. Results: Pre-EOT (n = 244), there was a significant reduction in environmental contamination (≥1 site positive) around fidaxomicin versus vancomycin/metronidazole recipients at days 4–5 (30% vs 50% recipients, P = .04) and at days 9–12 (22% vs 49%, P = .005). This trend was consistently seen at all other timepoints, but it was not statistically significant. No differences were seen between treatment groups post-EOT (n = 76). Fidaxomicin-associated fecal positivity rates and colony counts were consistently lower than those for vancomycin/metronidazole from days 4 to 5 of treatment (including post-EOT); however, the only significant difference was in positivity rate at days 9–12 (15% vs 55%, P = .03). Conclusions: There were significant reductions in C difficile recovery from both feces and the environment around fidaxomicin versus vancomycin/metronidazole recipients. Therefore, fidaxomicin treatment may lower the C difficile transmission risk by reducing excretion and environmental contamination

Human papillomavirus (HPV) vaccination and oropharyngeal HPV in ethnically diverse, sexually active adolescents: community-based cross-sectional study.

OBJECTIVES: Oropharyngeal squamous cell carcinoma is the most common human papillomavirus (HPV)-associated cancer in the UK, but little is known about the prevalence of oropharyngeal HPV in sexually active teenagers. We investigated reported HPV vaccination coverage (in females) and prevalence of oropharyngeal HPV in sexually active students attending six technical colleges in London, UK. METHODS: In 2017, we obtained mouthwash samples and questionnaires from male and female students taking part in the 'Test n Treat' chlamydia screening trial. Samples were subjected to HPV genotyping. RESULTS: Of 232 participants approached, 202 (87%) provided a mouthwash sample and questionnaire. Participants' median age was 17 years and 47% were male. Most (73%) were from black and minority ethnic groups, 64% gave a history of oral sex, 52% reported having a new sexual partner in the past 6 months, 33% smoked cigarettes, 5.9% had concurrent genitourinary Chlamydia trachomatis infection and 1.5% Neisseria gonorrhoeae and 5.0% were gay or bisexual. Only 47% (50/107) of females reported being vaccinated against HPV 16/18, of whom 74% had received ≥2 injections. HPV genotyping showed three mouthwash samples (1.5%, 95% CI 0.3% to 4.3%) were positive for possible high-risk human papillomavirus (HR-HPV), one (0.5%, 0.0% to 2.7%) for low-risk HPV 6/11, but none (0.0%, 0.0% to 1.8%) for HR-HPV. Four samples (2.0%, 0.5% to 5.0%) were positive for HPV16 using a HPV16 type-specific quantitative PCR, but these were at a very low copy number and considered essentially negative. CONCLUSIONS: Despite the high prevalence of oral sex and genitourinary chlamydia and low prevalence of HPV vaccination, the prevalence of oropharyngeal HR-HPV in these adolescents was negligible

Performance of a sustainable asphalt mix incorporating high RAP content and novel bio-derived binder

The recent drive to find ways to increase sustainability and decrease costs in asphalt paving has led researchers to find innovative ways to incorporate more recycled materials and bio-derived binders into mixes with varying success. A new novel bio-derived binder made from refined pine chemistry stabilised with a polymer can increase the sustainability of asphalt mixes while maintaining pavement performance. Laboratory performance testing was conducted on asphalt mixes containing 50% Reclaimed Asphalt Pavement (RAP) by mix weight and the novel bio-derived binder. Results show that the bio-derived binder outperforms the conventional 50/70 pen grade binder mixes with respect to resistance to thermal cracking and adequately passes all requirements for pavements with 20-year design loadings of less than 30 million ESALs. This research shows that asphalt mixes containing 50% RAP and a bio-derived binder can be designed to pass performance criteria at low, intermediate, and high temperatures without the need of neat bitumen