Extended scope of nursing practice: a multicentre randomised controlled trial of appropriately trained nurses and pre-registration house officers in pre-operative assessment in elective general surgery

Aim/ Principal Research Question:1) To determine whether pre-operative assessment carried out by an appropriately trained nurse (ATN) is equivalent in quality to that carried out by a pre-registration house officer (PRHO).2) To assess whether pre-assessments carried out by ATNs and PRHOs are equivalent in terms of cost.3) To determine whether assessments carried out by ATNs are acceptable to patients.4) To investigate the quality of communication between senior medical staff and ATNs.Factors of Interest:The extended role of appropriately trained nurses and pre-registration house officers in pre-operative assessment in elective general surgery.Methods:The study design was principally a prospective randomised equivalence trial but was accompanied by additional qualitative assessment of patient and staff perceptions, and an economic evaluation.The intervention consisted of a pre-operative assessment carried out by either an ATN or a PRHO. Of the patients who completed the study with a full evaluation, 926 patients were randomised to the PRHO arm of the trial and 948 to the ATN arm. Three ATNs took part in the study, one from each centre, together with a total of 87 PRHOs.Immediately following the initial assessment of a patient by a PRHO or an ATN, one of a number of clinical research fellows, all specialist registrars in anaesthetics, repeated the assessment and recorded it on a study form, together with a list of investigations required. The clinical research fellow then evaluated the competency of the initial assessor by comparing the quality of their assessment with their own. Any deficiencies in ordering of investigations and referral to other specialities were met in order to maximise patient care.Sample groups:All patients attending at one site for assessment prior to general anaesthetic for elective general, vascular, urological or breast surgery were potentially included in the study. Of 1907 patients who were randomised, 1874 completed the study with a full evaluation.The study was carried out at four NHS hospitals, three of which were teaching hospitals, in three NHS Trusts in Southampton, Sheffield and Doncaster.Outcome measures:Three areas of ATN and PRHO performance were judged separately, history taking, examination and ordering of tests, and each was graded into one of four categories, the most important of which was under-assessment, which would possibly have affected peri-operative management. In the case of ordering of tests, it was possible to have both over- and under-assessed a patient on different tests.Findings:The pre-operative assessments carried out by the ATNs were essentially equivalent to those performed by the PRHOs in terms of under-assessment that might possibly have affected peri-operative management, although there was variation between the ATNs in terms of the quality of history taking. This may be related to the low number of patients seen at one study site.PRHOs ordered significantly more unnecessary tests than the ATNs. The substitution of ATNs for PRHOs was calculated to be cost neutral.The results of the qualitative assessment showed that the use of ATNs for pre-operative assessment was acceptable to patients; however, there was no evidence that communication between senior medical staff and those carrying out pre-operative assessments was improved by their introduction.Conclusions:This study demonstrated no reason to inhibit the development of fully nurse-led pre-operative assessment, provided that the nurses are appropriately trained and maintain sufficient workload to retain skills.Implications for Further Research:Further research is needed in the following areas:1) the extent and type of training needed for nurses undertaking the pre-operative assessment role2) the use, costs and benefits of routine pre-operative testing.<br/

Block to granular-like transition in dense bubble flows

We have experimentally investigated 2-dimensional dense bubble flows underneath inclined planes. Velocity profiles and velocity fluctuations have been measured. A broad second-order phase transition between two dynamical regimes is observed as a function of the tilt angle $\theta$. For low $\theta$ values, a block motion is observed. For high $\theta$ values, the velocity profile becomes curved and a shear velocity gradient appears in the flow.Comment: Europhys. Lett. (2003) in pres

e-VLBI observations of Circinus X-1: monitoring of the quiescent and flaring radio emission on AU scales

A recent detection of the peculiar neutron star X-ray binary Circinus X-1 with electronic very long baseline interferometry (e-VLBI) prompted the suggestion that compact, non-variable radio emission persists through the entire 16.6-day orbit of the binary system. We present the results of a high angular resolution monitoring campaign conducted with the Australian Long Baseline Array in real-time e-VLBI mode. e-VLBI observations of Circinus X-1 were made on alternate days over a period of 20 days covering the full binary orbit. A compact radio source associated with Circinus X-1 was clearly detected at orbital phases following periastron passage but no compact radio emission was detected at any other orbital phase, ruling out the presence of a persistent, compact emitting region at our sensitivity levels. The jet was not resolved at any epoch of our 1.4-GHz monitoring campaign, suggesting that the ultrarelativistic flow previously inferred to exist in this source is likely to be dark. We discuss these findings within the context of previous radio monitoring of Circinus X-1.Comment: Accepted for publication in MNRAS. 7 pages, 5 figure

Recombinant Adeno-Associated Virus Utilizes Host Cell Nuclear Import Machinery To Enter the Nucleus

Recombinant adeno-associated viral (rAAV) vectors have garnered much promise in gene therapy applications. However, widespread clinical use has been limited by transduction efficiency. Previous studies suggested that the majority of rAAV accumulates in the perinuclear region of cells, presumably unable to traffic into the nucleus. rAAV nuclear translocation remains ill-defined; therefore, we performed microscopy, genetic, and biochemical analyses in vitro in order to understand this mechanism. Lectin blockade of the nuclear pore complex (NPC) resulted in inhibition of nuclear rAAV2. Visualization of fluorescently labeled particles revealed that rAAV2 localized to importin-β-dense regions of cells in late trafficking steps. Additionally, small interfering RNA (siRNA) knockdown of importin-β partially inhibited rAAV2 nuclear translocation and inhibited transduction by 50 to 70%. Furthermore, coimmunopreciptation (co-IP) analysis revealed that capsid proteins from rAAV2 could interact with importin-β and that this interaction was sensitive to the small GTPase Ran. More importantly, mutations to key basic regions in the rAAV2 capsid severely inhibited interactions with importin-β. We tested several other serotypes and found that the extent of importin-β interaction varied, suggesting that different serotypes may utilize alternative import proteins for nuclear translocation. Co-IP and siRNA analyses were used to investigate the role of other karyopherins, and the results suggested that rAAV2 may utilize multiple import proteins for nuclear entry. Taken together, our results suggest that rAAV2 interacts with importin-β alone or in complex with other karyopherins and enters the nucleus via the NPC. These results may lend insight into the design of novel AAV vectors that have an enhanced nuclear entry capability and transduction potential

Simple and objective prediction of survival in patients with lung cancer: staging the host systemic inflammatory response

Background. Prediction of survival in patients diagnosed with lung cancer remains problematical. The aim of the present study was to examine the clinical utility of an established objective marker of the systemic inflammatory response, the Glasgow Prognostic Score, as the basis of risk stratification in patients with lung cancer. Methods. Between 2005 and 2008 all newly diagnosed lung cancer patients coming through the multidisciplinary meetings (MDTs) of four Scottish centres were included in the study. The details of 882 patients with a confirmed new diagnosis of any subtype or stage of lung cancer were collected prospectively. Results. The median survival was 5.6 months (IQR 4.8–6.5). Survival analysis was undertaken in three separate groups based on mGPS score. In the mGPS 0 group the most highly predictive factors were performance status, weight loss, stage of NSCLC, and palliative treatment offered. In the mGPS 1 group performance status, stage of NSCLC, and radical treatment offered were significant. In the mGPS 2 group only performance status and weight loss were statistically significant. Discussion. This present study confirms previous work supporting the use of mGPS in predicting cancer survival; however, it goes further by showing how it might be used to provide more objective risk stratification in patients diagnosed with lung cancer

The first resolved imaging of milliarcsecond-scale jets in Circinus X-1

We present the first resolved imaging of the milliarcsecond-scale jets in the neutron star X-ray binary Circinus X-1, made using the Australian Long Baseline Array. The angular extent of the resolved jets is ~20 milliarcseconds, corresponding to a physical scale of ~150 au at the assumed distance of 7.8 kpc. The jet position angle is relatively consistent with previous arcsecond-scale imaging with the Australia Telescope Compact Array. The radio emission is symmetric about the peak, and is unresolved along the minor axis, constraining the opening angle to be less than 20 degrees. We observe evidence for outward motion of the components between the two halves of the observation. Constraints on the proper motion of the radio-emitting components suggest that they are only mildly relativistic, although we cannot definitively rule out the presence of the unseen, ultra-relativistic (Lorentz factor >15) flow previously inferred to exist in this system.Comment: Accepted for publication in MNRAS Letters. 6 pages, 4 figure

Are we heading towards a replicability crisis in energy efficiency research? A toolkit for improving the quality, transparency and replicability of energy efficiency impact evaluations

Several high-profile replication failures have called into question the reproducibility of results in medicine, neuroscience, genetics, psychology and economics (Camerer et al. 2016). A paper published in Science found that just one third of psychology studies could be replicated when the study was run for a second time (OSC 2015). To our knowledge, there have been no attempted replications of energy efficiency studies; so can we be confident that the estimated energy savings from policy initiatives like the European roll out of smart meters will be realised? Or that electric vehicles will reduce carbon emissions by predicted levels? Or is energy heading towards its own reproducibility crisis? Researchers call for the increased use of randomised control trials (RCTs) to evaluate energy efficiency policy and the introduction of protocols or guidelines for conducting experiments (Vine et al. 2014; Frederiks et al. 2016). However, no guidelines for increasing reproducibility have been proposed. Moreover, RCTs are just one method for causal analysis and RCTs cannot answer all important causal questions. This paper will outline research methods for improved impact assessment of energy efficiency policy, including RCTs, but also quasi-experiments and systematic reviews that go beyond the conclusions of single experiments. It will then present tools for increasing replicability: pre-registration of trials; pre-analysis plans; reporting standards; synthesis tools and; publication of datasets with computer code in data repositories. Based on work by our research group at the UCL Energy Institute, we recognize that not all of these tools (mostly from medical trials) provide ‘off-the-shelf’ models for energy efficiency evaluations, and so consider adaptations for energy research. Our aim is to stimulate discussion and get feedback from the research community at ECEEE so the toolkit can be developed and potentially adopted more widely

2,4,5-Tris(biphenyl-2-yl)-1-bromo­benzene

In the title compound, C42H29Br, the dihedral angles between the central benzene ring and the three attached benzene rings are very similar, lying in the range 52.65 (6)–57.20 (7)°. Of the dihedral angles between the rings of the o-biphenyl substituents, two are similar [46.34 (7) and 47.35 (7)°], while the other differs significantly [64.17 (7)°]. In the crystal, mol­ecules are linked into centrosymmetric dimers by two weak C—H⋯π inter­actions