Improving Together: A National Framework for Quality and GP Clusters in Scotland

Improving together will complement the development of the Scottish national GP contract that sets out the role of GPs and their important contribution as clinical leaders and expert medical generalists working in a community setting. This framework will be reviewed by the Scottish Government and the Scottish General Practitioners Committee of the BMA on a periodic basis, attentive to feedback from those involved in delivering its intent. As such, it is a framework that will develop to its full potential over time, as elements of the transformation of primary care in Scotland create the capacity to do so

Development of solution phase hybridisation PCR-ELISA for the detection and quantification of Enterococcus faecalis and Pediococcus pentosaceus in Nurmi-type cultures

Nurmi-type cultures (NTCs), derived from the fermentation of caecal contents of specifically pathogen-free (SPF) birds, have been used successfully to control salmonella colonisation in chicks. These cultures are undefined in nature and, consequently, it is difficult to obtain approval from regulatory agencies for their use as direct fed microbials (DFMs) for poultry. Progress towards the generation of effective defined probiotics requires further knowledge of the composition of these cultures. As such, species-specific, culture-independent quantification methodologies need to be developed to elucidate the concentration of specific bacterial constituents of NTCs. Quantification of specific bacterial species in such ill-defined complex cultures using conventional culturing methods is inaccurate due to low levels of sensitivity and reproducibility, in addition to slow turnaround times. Furthermore, these methods lack selectivity due to the nature of the accompanying microflora. This study describes the development of a rapid, sensitive, reliable, reproducible, and species-specific culture-independent, solution phase hybridisation PCR-ELISA procedure for the detection and quantification of Enterococcus faecalis and Pediococcus pentosaceus in NTCs. In this technique, biotin-labelled primers were designed to amplify a species-specific fragment of a marker gene of known copy number, in both species. Resulting amplicons were hybridised with a dinitrophenol (DNP)-labelled oligonucleotide probe in solution and were subsequently captured on a streptavidin-coated microtitre plate. The degree of binding was determined by the addition of IgG (anti-DNP)–horseradish peroxidase conjugate, which was subsequently visualised using a chromogenic substrate, tetramethylbenzidine. This novel quantitative method was capable of detecting E. faecalis and P. pentosaceus at levels as low as 5 CFU per PCR reaction

Social sustainability and urban form: evidence from five British cities

Planning and urban policies emphasise ‘sustainability’, but claims that ‘compact cities’ are more socially sustainable and acceptable have been controversial and subject to limited empirical testing. After a brief review of the concepts and debate, we set out new empirical evidence based on household surveys linked to neighbourhood physical, map-based, and sociodemographic data for five British cities. Statistical models are developed to account for systematic variations in the main social sustainability outcomes. The results are considered both in terms of the role of particular urban form and locational measures, but also in terms of the broader patterns of effects of packages of measures. Outcomes relating to residential satisfaction, stability, neighbourhood environment, and safety are all shown to be lower in higher density/central places, but it is also shown that a good deal of this apparent effect is due to social and demographic factors. Interaction with neighbours and participation in groups is better at medium densities, controlling for other factors, while use of local services is, as expected, greater in denser, more central locations. These findings indicate that compact cities are not ‘win – win’ on all dimensions of sustainability but, rather, that reductions in transport emissions will have to be weighed against social criteria. In addition, urban form has different aspects, which have differing social effects, and this knowledge could inform the future design of ‘smarter’ urban environments.

Haemagglutinin-neuraminidase from HPIV3 mediates human NK regulation of T cell proliferation via NKp44 and NKp46

HPIV3 is a respiratory virus causing airway diseases, including pneumonia, croup, and bronchiolitis, during infancy and childhood. Currently there is no effective vaccine or anti-viral therapy for this virus. Studies have suggested that poor T cell proliferation following HPIV3 infection is responsible for impaired immunological memory associated with this virus. We have previously demonstrated that NK cells mediate regulation of T cell proliferation during HPIV3 infection. Here we add to these studies by demonstrating that the regulation of T cell proliferation during HPIV3 infection is mediated via NK receptors NKp44 and NKp46 and involves the surface glycoprotein haemagglutinin-neuraminidase but not the fusion protein of the virus. These studies extend our knowledge of the regulatory repertoire of NK cells and provide mechanistic insights which may explain reoccurring failures of vaccines against this virus

What\u27s in this Drink? Classification and Adulterant Detection in Irish Whiskey Samples Using Near Infrared Spectroscopy Combined with Chemometrics

BACKGROUND: Near-infrared (NIR) spectroscopy coupled with principal component analysis (PCA) and partial least squares (PLS) regression was used to analyse a series of different Irish Whiskey samples in order to dene their spectral prole and to assess the capability of the NIR method to identify samples based on their origin and storage (e.g. distiller, method of mat- uration). The ability of NIR spectroscopy to quantify the level of potential chemical adulterants was also investigated. Samples were spiked with 0.1%, 0.5%, 1.0%, 1.5% and 2.0% v/v of each adulterant (e.g. methanol, ethyl acetate, etc.) prior to NIR analysis. RESULTS: The results of this study demonstrated the capability of NIR spectroscopy combined with PLS regression to classify the whiskey samples and to determine the level of adulteration. Moreover, the potential of NIR coupled with chemometric anal- ysis as a rapid, portable, and non-destructive screening tool for quality control, traceability, and food/beverage adulteration for customs and other regulatory agencies, to mitigate beverage fraud was illustrated. CONCLUSION: Given the non-specicity of the NIR technique, these positive preliminary results indicated that this method of analysis has the potential to be applied to identify the level of adulteration in distilled spirits. The rapid nature of the technique and lack of consumables or sample preparation required allows for a far more time and cost-effective analysis per sample

Outcomes in gastric and junctional cancer using neoadjuvant and adjuvant chemotherapy (epirubicin, oxaliplatin, and capecitabine) and radical surgery

Background The MAGIC/UK Medical Research Council (MRC) trial set the standard of care for treatment of resectable gastric and junctional adenocarcinoma, demonstrating that perioperative chemotherapy with epirubicin, cisplatin and 5-fluorouracil (ECF) confers a survival benefit over surgery alone. The randomized ECF for advanced and locally advanced esophagogastric cancer (REAL-2) trial showed that, in the metastatic setting, the EOX regimen (epirubicin, oxaliplatin and capecitabine) is as effective as ECF, with a favourable toxicity profile. Methods Consecutive patients with resectable gastric or junctional adenocarcinoma treated with perioperative EOX, between 2007 and 2012, were retrospectively analysed. Results Fifty-nine patients (12 female, 47 male), commenced EOX therapy; 47 underwent surgery. A good pathological response was seen in 34 %, (16/47). Disease recurrence occurred in 19 patients (19/47, 40 %). Median overall survival was 22 months, with 4-year survival of 47 %. Chemotoxicities were consistent with those previously reported for this regimen. Conclusion This study in a high-volume centre demonstrates that EOX in resectable gastric and junctional adenocarcinoma is associated with a reasonable safety profile, and efficacy consistent with that reported for ECF

The impact of a novel digital sun protection campaign on sun‐related attitudes and behaviours of healthcare workers: A prospective observational study

Background: 13 000 cases of skin cancer are diagnosed annually in Ireland, with ultraviolet (UV) radiation exposure the strongest risk factor. Public health primary prevention campaigns focus on encouraging safe sun protective measures and skin cancer awareness. We designed a novel, digitally‐animated hospital‐based campaign targeting all aspects of sun‐ protective behaviour. Objectives: To explore the sun‐protective attitudes and behaviours of healthcare workers, and the effect of a digital hospital‐based campaign on these findings. Methods: This was a cross‐sectional prospective observational study involving hospital staff across the six hospitals that form the University of Limerick Hospital Group (ULHG). A two‐phase online survey, the first taking place before campaign launch, and the second upon campaign completion. The digital campaign was displayed across all hospital sites from June to September 2021. Surveys comprised questions on sun‐related attitudes and behaviours, including the internationally validated Sun Exposure Pro?tection Index (SEPI) questionnaire. Results: Eight hundred fifty‐seven staff members completed survey 1 and 704 completed survey 2; 90% in each were female; 79% were aged 25–54; 71% reported skin types I–III. Best sun‐protective habits pre‐campaign included sunscreen use and avoiding sunburn, while wearing hats, pro?tective clothing and seeking shade were least adopted. For 177 matched participants, there were small improvements in SEPI scores. SEPI Part 1 scores, reflecting improved risk behaviour, pre‐campaign had a median of 11 (IQR 7), and 11 (IQR 6) post campaign. SEPI Part 2 scores, reflecting readiness to adopt sun‐protective behaviours, improved from median 7 (IQR 8) to 6 (IQR 6). Post‐campaign, small improvements were seen across some individual sun‐protective behaviours and attitudes, particularly reducing time spent in the midday sun and on sun‐seeking holidays, and improved readiness to seek shade and reduce sunbathing; 79% of all respondents post‐campaign (n = 556) reported raised skin cancer awareness, and 65% (n = 458) said it influenced them to discuss sun protection with others.  Conclusions: Positive improvements in attitudes and behaviours related to sun protection were seen following the digital campaign in this population of healthcare workers. These improvements along with increased willingness to discuss sun protection with others, including patients, has the potential to further benefit wider society, and supports future digital health promotion initiatives. </p