Integrating Nanomechanical Property Testing into a Correlative Imaging Workflow

This work is aimed at creating a cohesive workflow between correlative imaging techniques and nanomechanical property testing for materials analysis. There exist multiple features of a material, on varying length scales, that can determine its performance in its desired function. As technology advances new materials are developed to address new problems with more and more taking their inspiration from nature. The use of different techniques individually has been able to shed light on either the structure, property, or function of the materials, either manufactured or biological. Understanding has developed that the three aspects; structure, property, and function are related and should be considered together when analysing a material. Combining multiple techniques in a workflow will allow for revealing the ‘whole picture’ of the material. The methods of materials analysis used in this research are X-ray micro-CT, scanning electron microscopy (SEM), light microscopy, X-ray fluorescence (XRF), and nanoindentation. Each of the methods used here requires specific preparation methods prior to testing and one testing method may make the sample unsuitable for another testing method. Therefore, planning the sequence of testing before commencing is of high importance. Putting into place a workflow will not only reduce the likelihood of inhibiting further testing procedures but also reduce the time taken for completing a comprehensive analysis. The workflow proposed here takes into consideration what information can be gained as well as preparation techniques. Initially, this thesis will discuss correlative imaging detailing, sample preparation, and the capabilities of these techniques in uncovering the internal nano – to the macro-structure of antler bone and barnacle plate organisation, as well as the chemical uniformity of the inorganic phase of antler bone across the cross-section and the elongated crystallographic structures unique to the barnacle ala. Secondly, XRF will be explored for its role in the chemical analysis of biological materials and where this technique can be placed into the workflow to impact the overall understanding of the chemical composition in this instance in the application of antlers. Finally covered will be nanomechanical property testing for both stand-alone equipment and in-situ indentation. The suggested position for this technique in the workflow will be explained as it is used as the final connecting piece in determining the structure-function-property relationship of the material due to how the previous methods have directed the research process. Correlating the accelerated property mapping technique to the crystallographic structures in barnacle plates showed a reduced hardness in the elongated crystal region. Nanoindentation of the antler bone showed differences in modulus between the transverse and cross-sections as well as a reduction in average hardness between the male antler and the female reindeer that had calves and those that did not. Each of the individual pieces of information in this workflow when brought together unveils the hidden structure-property-function relationship in materials to provide an in-depth understanding

Use of UKCAT scores in student selection by UK medical schools, 2006-2010

<p>Abstract</p> <p>Background</p> <p>The United Kingdom Clinical Aptitude Test (UKCAT) is a set of cognitive tests introduced in 2006, taken annually before application to medical school. The UKCAT is a test of aptitude and not acquired knowledge and as such the results give medical schools a standardised and objective tool that all schools could use to assist their decision making in selection, and so provide a fairer means of choosing future medical students.</p> <p>Selection of students for UK medical schools is usually in three stages: assessment of academic qualifications, assessment of further qualities from the application form submitted via UCAS (Universities and Colleges Admissions Service) leading to invitation to interview, and then selection for offer of a place. Medical schools were informed of the psychometric qualities of the UKCAT subtests and given some guidance regarding the interpretation of results. Each school then decided how to use the results within its own selection system.</p> <p>Methods</p> <p>Annual retrospective key informant telephone interviews were conducted with every UKCAT Consortium medical school, using a pre-circulated structured questionnaire. The key points of the interview were transcribed, 'member checked' and a content analysis was undertaken.</p> <p>Results</p> <p>Four equally popular ways of using the test results have emerged, described as Borderline, Factor, Threshold and Rescue methods. Many schools use more than one method, at different stages in their selection process. Schools have used the scores in ways that have sought to improve the fairness of selection and support widening participation. Initially great care was taken not to exclude any applicant on the basis of low UKCAT scores alone but it has been used more as confidence has grown.</p> <p>Conclusions</p> <p>There is considerable variation in how medical schools use UKCAT, so it is important that they clearly inform applicants how the test will be used so they can make best use of their limited number of applications.</p

A novel hybrid approach of activated carbon and ultrasound cavitation for the intensification of palm oil mill effluent (POME) polishing

This investigation focuses on activated carbon (AC) adsorption and ultrasound (US) cavitation for polishing the palm oil mill effluent (POME). Both AC adsorption and US cavitation were investigated individually, in series and operating them in a combined way. The efficiency of above processes has been evaluated in terms of removal of chemical oxygen demand (COD) and total suspended solids (TSS). For the individual operation, the optimisation studies were carried out by using the following conditions: AC dosage (50–200 g/L); contact time (2, 4, 6 h); US power amplitude (50% and 80%) and US cavitation time (30–180 min). The optimisation studies utilising US power amplitude (50%) and cavitation time (15 min) followed by AC adsorption using minimum AC dosage (50 g/L) and contact time (30 min) resulted in ∼100% COD and 83.33% TSS removals which meets the discharge limits set by the Department of Environment (DoE), Malaysia. The hybrid operation was also studied by simultaneously employing AC adsorption and US cavitation and it was observed that an adsorption dosage of 50 g/L resulted into achieving 73.08% COD and 98.33% TSS removals within 15 min of US irradiation. With the possibility of continuous and feasible sonochemical reactors, this hybrid approach of US cavitation followed by AC adsorption could be an alternative processing technique for POME polishing

Effects of antiplatelet therapy on stroke risk by brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases: subgroup analyses of the RESTART randomised, open-label trial

Background Findings from the RESTART trial suggest that starting antiplatelet therapy might reduce the risk of recurrent symptomatic intracerebral haemorrhage compared with avoiding antiplatelet therapy. Brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases (such as cerebral microbleeds) are associated with greater risks of recurrent intracerebral haemorrhage. We did subgroup analyses of the RESTART trial to explore whether these brain imaging features modify the effects of antiplatelet therapy

Inflammatory bowel disease patient‐reported quality assessment should drive service improvement: A national survey of UK IBD units and patients

© 2022 The Authors. Published by Wiley. This is an open access article available under a Creative Commons licence. The published version can be accessed at the following link on the publisher’s website: https://doi.org/10.1111/apt.17042Background & Aims Healthcare service provision in inflammatory bowel disease (IBD) is often designed to meet targets set by healthcare providers rather than those of patients. It is unclear whether this meets the needs of patients, as assessed by patients themselves. This nationwide study assessed patients' experience of IBD and the healthcare they received, aiming to identify factors in IBD healthcare provision associated with perceived high-quality care. Methods Using the 2019 IBD Standards as a framework, a national benchmarking tool for quality assessment in IBD was developed by IBD UK, comprising a Patient Survey and Service Self-Assessment. Results In all, 134 IBD services and 9757 patients responded. Perceived quality of care was lowest in young adults then increased with age, was higher in males and those >2 years since diagnosis. No hospital services met all the National IBD Standards for recommended workforce numbers. Key metrics associated with patient-reported high-quality care were as follows: identification as a tertiary centre, patient information availability, shared decision-making, rapid response to contact for advice, access to urgent review, joint medical/surgical clinics and access to research (all p < 0.001). Higher numbers of IBD nurse specialists in a service was strongly associated with patients receiving regular reviews and having confidence in self-management and reporting high-quality care. Conclusions This extensive patient and healthcare provider survey emphasises the importance of aspects of care less often measured by clinicians, such as communication, shared decision-making and provision of information, and demonstrates that IBD nurse specialists are crucial to meeting the needs of people living with IBD.This work was supported by Crohn's & Colitis UK.Published onlin

Mortality Among Adults With Cancer Undergoing Chemotherapy or Immunotherapy and Infected With COVID-19

Importance: Large cohorts of patients with active cancers and COVID-19 infection are needed to provide evidence of the association of recent cancer treatment and cancer type with COVID-19 mortality. // Objective: To evaluate whether systemic anticancer treatments (SACTs), tumor subtypes, patient demographic characteristics (age and sex), and comorbidities are associated with COVID-19 mortality. // Design, Setting, and Participants: The UK Coronavirus Cancer Monitoring Project (UKCCMP) is a prospective cohort study conducted at 69 UK cancer hospitals among adult patients (≥18 years) with an active cancer and a clinical diagnosis of COVID-19. Patients registered from March 18 to August 1, 2020, were included in this analysis. // Exposures: SACT, tumor subtype, patient demographic characteristics (eg, age, sex, body mass index, race and ethnicity, smoking history), and comorbidities were investigated. // Main Outcomes and Measures: The primary end point was all-cause mortality within the primary hospitalization. // Results: Overall, 2515 of 2786 patients registered during the study period were included; 1464 (58%) were men; and the median (IQR) age was 72 (62-80) years. The mortality rate was 38% (966 patients). The data suggest an association between higher mortality in patients with hematological malignant neoplasms irrespective of recent SACT, particularly in those with acute leukemias or myelodysplastic syndrome (OR, 2.16; 95% CI, 1.30-3.60) and myeloma or plasmacytoma (OR, 1.53; 95% CI, 1.04-2.26). Lung cancer was also significantly associated with higher COVID-19–related mortality (OR, 1.58; 95% CI, 1.11-2.25). No association between higher mortality and receiving chemotherapy in the 4 weeks before COVID-19 diagnosis was observed after correcting for the crucial confounders of age, sex, and comorbidities. An association between lower mortality and receiving immunotherapy in the 4 weeks before COVID-19 diagnosis was observed (immunotherapy vs no cancer therapy: OR, 0.52; 95% CI, 0.31-0.86). // Conclusions and Relevance: The findings of this study of patients with active cancer suggest that recent SACT is not associated with inferior outcomes from COVID-19 infection. This has relevance for the care of patients with cancer requiring treatment, particularly in countries experiencing an increase in COVID-19 case numbers. Important differences in outcomes among patients with hematological and lung cancers were observed

Effects of antiplatelet therapy after stroke due to intracerebral haemorrhage (RESTART): a randomised, open-label trial

Background: Antiplatelet therapy reduces the risk of major vascular events for people with occlusive vascular disease, although it might increase the risk of intracranial haemorrhage. Patients surviving the commonest subtype of intracranial haemorrhage, intracerebral haemorrhage, are at risk of both haemorrhagic and occlusive vascular events, but whether antiplatelet therapy can be used safely is unclear. We aimed to estimate the relative and absolute effects of antiplatelet therapy on recurrent intracerebral haemorrhage and whether this risk might exceed any reduction of occlusive vascular events. Methods: The REstart or STop Antithrombotics Randomised Trial (RESTART) was a prospective, randomised, open-label, blinded endpoint, parallel-group trial at 122 hospitals in the UK. We recruited adults (≥18 years) who were taking antithrombotic (antiplatelet or anticoagulant) therapy for the prevention of occlusive vascular disease when they developed intracerebral haemorrhage, discontinued antithrombotic therapy, and survived for 24 h. Computerised randomisation incorporating minimisation allocated participants (1:1) to start or avoid antiplatelet therapy. We followed participants for the primary outcome (recurrent symptomatic intracerebral haemorrhage) for up to 5 years. We analysed data from all randomised participants using Cox proportional hazards regression, adjusted for minimisation covariates. This trial is registered with ISRCTN (number ISRCTN71907627). Findings: Between May 22, 2013, and May 31, 2018, 537 participants were recruited a median of 76 days (IQR 29–146) after intracerebral haemorrhage onset: 268 were assigned to start and 269 (one withdrew) to avoid antiplatelet therapy. Participants were followed for a median of 2·0 years (IQR [1·0– 3·0]; completeness 99·3%). 12 (4%) of 268 participants allocated to antiplatelet therapy had recurrence of intracerebral haemorrhage compared with 23 (9%) of 268 participants allocated to avoid antiplatelet therapy (adjusted hazard ratio 0·51 [95% CI 0·25–1·03]; p=0·060). 18 (7%) participants allocated to antiplatelet therapy experienced major haemorrhagic events compared with 25 (9%) participants allocated to avoid antiplatelet therapy (0·71 [0·39–1·30]; p=0·27), and 39 [15%] participants allocated to antiplatelet therapy had major occlusive vascular events compared with 38 [14%] allocated to avoid antiplatelet therapy (1·02 [0·65–1·60]; p=0·92). Interpretation: These results exclude all but a very modest increase in the risk of recurrent intracerebral haemorrhage with antiplatelet therapy for patients on antithrombotic therapy for the prevention of occlusive vascular disease when they developed intracerebral haemorrhage. The risk of recurrent intracerebral haemorrhage is probably too small to exceed the established benefits of antiplatelet therapy for secondary prevention