Off-Site Technologies: Can Panelised Off-Site Construction Be The Solution To London's Housing Crisis?

House prices in the UK have risen in the last ten years, yet house construction is at its lowest level since 1924. According to estimates, Britain will face a housing shortage of roughly a million homes by 2025 in a nation where up to 70% of adults are accustomed to owning their own home. The UK is known to have the highest rates of homeownership in Europe, but it is getting more difficult due to lack of affordable housing due to low wages and high standard of living increases. LSBU's Centre for the Integrated Delivery of the Built Environment (IDoBE) is at the forefront of this research looking at developing solutions for sustainable living. The aim of this study is to investigate how the use of Panelised systems and materials can increase the current housing shortage. The housing industry is generally dominated by traditional method of construction which has a limited range of products to resolve this housing crisis. The methodology adopted will be the use of both qualitative and quantitative data which includes carrying out extensive literature review and case study analysis. The findings suggest that the housing shortage in London is a crisis that stems from affordability/availability and subsequently suggests the adoption of Panelised Offsite Construction as a smart and affordable solution to the problem. However, it is necessary to implement new policies that would effectively support, stimulate, and maintain housing growth. This outcome will be used to understand how best to implement modern methods of construction

Mixed integer programming model for optimizing the layout of an ICU vehicle

<p>Abstract</p> <p>Background</p> <p>This paper presents a Mixed Integer Programming (MIP) model for designing the layout of the Intensive Care Units' (ICUs) patient care space. In particular, this MIP model was developed for optimizing the layout for materials to be used in interventions. This work was developed within the framework of a joint project between the Madrid Technical Unverstity and the Medical Emergency Services of the Madrid Regional Government (SUMMA 112).</p> <p>Methods</p> <p>The first task was to identify the relevant information to define the characteristics of the new vehicles and, in particular, to obtain a satisfactory interior layout to locate all the necessary materials. This information was gathered from health workers related to ICUs. With that information an optimization model was developed in order to obtain a solution. From the MIP model, a first solution was obtained, consisting of a grid to locate the different materials needed for the ICUs. The outcome from the MIP model was discussed with health workers to tune the solution, and after slightly altering that solution to meet some requirements that had not been included in the mathematical model, the eventual solution was approved by the persons responsible for specifying the characteristics of the new vehicles. According to the opinion stated by the SUMMA 112's medical group responsible for improving the ambulances (the so-called "coaching group"), the outcome was highly satisfactory. Indeed, the final design served as a basis to draw up the requirements of a public tender.</p> <p>Results</p> <p>As a result from solving the Optimization model, a grid was obtained to locate the different necessary materials for the ICUs. This grid had to be slightly altered to meet some requirements that had not been included in the mathematical model. The results were discussed with the persons responsible for specifying the characteristics of the new vehicles.</p> <p>Conclusion</p> <p>The outcome was highly satisfactory. Indeed, the final design served as a basis to draw up the requirements of a public tender. The authors advocate this approach to address similar problems within the field of Health Services to improve the efficiency and the effectiveness of the processes involved. Problems such as those in operation rooms or emergency rooms, where the availability of a large amount of material is critical are eligible to be dealt with in a simmilar manner.</p

Evaluation of andrological indices and testicular histology following administration of varied doses of nicotine

This study is aimed at determining the effect of Nicotine on male fertility by evaluating some andrological parameters of male Wistar rat such as sperm parameters (spermatozoa count and motility), serum concentration of testosterone and testicular weight. Histopathology of the testis was also carried out on the effect of nicotine on testicular microstructure. 20 adult male rats were randomly divided into four groups, the test groups were administered with 0.2mg/100g, 0.4/100g and 0.6/100g body weight daily for 30 days while the control were administered with 2mls 0.9% physiological saline. Nicotine caused a significant reduction (P &lt; 0.05) and (P&lt; 0.01) in the mean values of sperm count, serum testosterone concentration and testicular weight in the test when compared with the control. Also, in the test group, the deleterious effect of nicotine on the sperm parameters and testosterone concentration was corroborated by histopathology which revealed a marked degeneration of germ cell layers in the seminiferous tubule and disruption of interstitial cells of the testis thereby interfering with spermatogenesis and testosterone secretion while there was no visible change in the control group. It was concluded that nicotine exerted toxic effect on the germ cell layers in seminiferous tubule with concomitant reduction in reproductive potentials of the male rat whilst showing no significant change in sperm motility. Nicotine and nicotine based products should therefore be taken with caution in cases of infertility. Key words: germ cells, testes, testosterone, fertility, spermatogenesis

Utility of Ankyrin 3 as a Prognostic Marker in Androgen-Receptor-Positive Breast Cancer Running Title: Prognostic Value of ANK3 in AR-Positive Breast Cancer

© 2019, Springer Science+Business Media, LLC, part of Springer Nature. Purpose: Androgen receptor (AR) and AR signaling pathways are thought to play a role in breast cancer (BC) and are potentially related to treatment responses and outcomes. Ankyrin 3 (ANK3) is associated with AR stability in cancer cells. In the present study, we investigated the clinicopathological utility of ANK3 expression with emphasis on AR and its associated signalling pathway at transcriptomic and proteomic phases. Patients and methods: The Molecular Taxonomy of Breast Cancer International Consortium (METABRIC) cohort (n = 1980) and The Cancer Genome Atlas (TCGA) dataset (n = 1039) were used to assess the expression and significance of ANK3 mRNA and other AR signalling pathway-associated gene signature. Using immunohistochemistry, ANK3 protein expression was evaluated in large (n = 982) cohort of early-stage BC with long-term follow-up and compared with clinicopathological characteristics and its prognostic value in the whole cohort and the subgroups stratified by AR protein expression. Results: An AR-related gene signature was developed, comprising 20 genes, which included ANK3. This AR-related gene signature was significantly associated with AR mRNA expression, oestrogen receptor, human epidermal growth factor receptor 2 (HER2) status and the patients’ outcomes. In tumours with high AR protein expression (n = 614), high ANK3 protein expression was significantly associated with progesterone receptor positivity and it was independently associated with the good outcomes (p = 0.025). Conclusions: This study indicates that ANK3 is related to AR signalling pathway and is associated with BC prognosis

The impact of electronic versus paper-based data capture on data collection logistics and on missing scores in thyroid cancer patients.

The purpose of this study was to investigate the impact of the type of data capture on the time and help needed for collecting patient-reported outcomes as well as on the proportion of missing scores. In a multinational prospective study, thyroid cancer patients from 17 countries completed a validated questionnaire measuring quality of life. Electronic data capture was compared to the paper-based approach using multivariate logistic regression. A total of 437 patients were included, of whom 13% used electronic data capture. The relation between data capture and time needed was modified by the emotional functioning of the patients. Those with clinical impairments in that respect needed more time to complete the questionnaire when they used electronic data capture compared to paper and pencil (OR &lt;sub&gt;adj&lt;/sub&gt; 24.0; p = 0.006). This was not the case when patients had sub-threshold emotional problems (OR &lt;sub&gt;adj&lt;/sub&gt; 1.9; p = 0.48). The odds of having the researcher reading the questions out (instead of the patient doing this themselves) (OR &lt;sub&gt;adj&lt;/sub&gt; 0.1; p = 0.01) and of needing any help (OR &lt;sub&gt;adj&lt;/sub&gt; 0.1; p = 0.01) were lower when electronic data capture was used. The proportion of missing scores was equivalent in both groups (OR &lt;sub&gt;adj&lt;/sub&gt; 0.4, p = 0.42). The advantages of electronic data capture, such as real-time assessment and fewer data entry errors, may come at the price of more time required for data collection when the patients have mental health problems. As this is not uncommon in thyroid cancer, researchers need to choose the type of data capture wisely for their particular research question

Systematic review of MCDM approach applied to the medical case studies of COVID-19: trends, bibliographic analysis, challenges, motivations, recommendations, and future directions

When COVID-19 spread in China in December 2019, thousands of studies have focused on this pandemic. Each presents a unique perspective that reflects the pandemic’s main scientific disciplines. For example, social scientists are concerned with reducing the psychological impact on the human mental state especially during lockdown periods. Computer scientists focus on establishing fast and accurate computerized tools to assist in diagnosing, preventing, and recovering from the disease. Medical scientists and doctors, or the frontliners, are the main heroes who received, treated, and worked with the millions of cases at the expense of their own health. Some of them have continued to work even at the expense of their lives. All these studies enforce the multidisciplinary work where scientists from different academic disciplines (social, environmental, technological, etc.) join forces to produce research for beneficial outcomes during the crisis. One of the many branches is computer science along with its various technologies, including artificial intelligence, Internet of Things, big data, decision support systems (DSS), and many more. Among the most notable DSS utilization is those related to multicriterion decision making (MCDM), which is applied in various applications and across many contexts, including business, social, technological and medical. Owing to its importance in developing proper decision regimens and prevention strategies with precise judgment, it is deemed a noteworthy topic of extensive exploration, especially in the context of COVID-19-related medical applications. The present study is a comprehensive review of COVID-19-related medical case studies with MCDM using a systematic review protocol. PRISMA methodology is utilized to obtain a final set of (n = 35) articles from four major scientific databases (ScienceDirect, IEEE Xplore, Scopus, and Web of Science). The final set of articles is categorized into taxonomy comprising five groups: (1) diagnosis (n = 6), (2) safety (n = 11), (3) hospital (n = 8), (4) treatment (n = 4), and (5) review (n = 3). A bibliographic analysis is also presented on the basis of annual scientific production, country scientific production, co- occurrence, and co-authorship. A comprehensive discussion is also presented to discuss the main challenges, motivations, and recommendations in using MCDM research in COVID-19-related medial case studies. Lastly, we identify critical research gaps with their corresponding solutions and detailed methodologies to serve as a guide for future directions. In conclusion, MCDM can be utilized in the medical field effectively to optimize the resources and make the best choices particularly during pandemics and natural disasters

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

Molecular imaging in oncology: the acceptance of PET/CT and the emergence of MR/PET imaging

In the last decade, PET-only systems have been phased out and replaced with PET-CT systems. This merger of a functional and anatomical imaging modality turned out to be extremely useful in clinical practice. Currently, PET-CT is a major diagnostic tool in oncology. At the dawn of the merger of MRI and PET, another breakthrough in clinical imaging is expected. The combination of these imaging modalities is challenging, but has particular features such as imaging biological processes at the same time in specific body locations

Global economic burden of unmet surgical need for appendicitis

Background: There is a substantial gap in provision of adequate surgical care in many low-and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. Methods: Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism. Results: Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality was US $92 492 million using approach 1 and$73 141 million using approach 2. The economic burden of not providing surgical care to the standards of high-income countries was $95 004 million using approach 1 and$75 666 million using approach 2. The largest share of these costs resulted from premature death (97.7 per cent) and lack of access (97.0 per cent) in contrast to lack of quality. Conclusion: For a comparatively non-complex emergency condition such as appendicitis, increasing access to care should be prioritized. Although improving quality of care should not be neglected, increasing provision of care at current standards could reduce societal costs substantially

Laparoscopy in management of appendicitis in high-, middle-, and low-income countries: a multicenter, prospective, cohort study.

BACKGROUND: Appendicitis is the most common abdominal surgical emergency worldwide. Differences between high- and low-income settings in the availability of laparoscopic appendectomy, alternative management choices, and outcomes are poorly described. The aim was to identify variation in surgical management and outcomes of appendicitis within low-, middle-, and high-Human Development Index (HDI) countries worldwide. METHODS: This is a multicenter, international prospective cohort study. Consecutive sampling of patients undergoing emergency appendectomy over 6 months was conducted. Follow-up lasted 30 days. RESULTS: 4546 patients from 52 countries underwent appendectomy (2499 high-, 1540 middle-, and 507 low-HDI groups). Surgical site infection (SSI) rates were higher in low-HDI (OR 2.57, 95% CI 1.33-4.99, p = 0.005) but not middle-HDI countries (OR 1.38, 95% CI 0.76-2.52, p = 0.291), compared with high-HDI countries after adjustment. A laparoscopic approach was common in high-HDI countries (1693/2499, 67.7%), but infrequent in low-HDI (41/507, 8.1%) and middle-HDI (132/1540, 8.6%) groups. After accounting for case-mix, laparoscopy was still associated with fewer overall complications (OR 0.55, 95% CI 0.42-0.71, p < 0.001) and SSIs (OR 0.22, 95% CI 0.14-0.33, p < 0.001). In propensity-score matched groups within low-/middle-HDI countries, laparoscopy was still associated with fewer overall complications (OR 0.23 95% CI 0.11-0.44) and SSI (OR 0.21 95% CI 0.09-0.45). CONCLUSION: A laparoscopic approach is associated with better outcomes and availability appears to differ by country HDI. Despite the profound clinical, operational, and financial barriers to its widespread introduction, laparoscopy could significantly improve outcomes for patients in low-resource environments. TRIAL REGISTRATION: NCT02179112