Universal screening for meticillin-resistant Staphylococcus aureus : interim results from the NHS Scotland pathfinder project

Following recommendations from a Health Technology Assessment (HTA), a prospective cohort study of meticillin-resistant Staphylococcus aureus (MRSA) screening of all admissions (N = 29 690) to six acute hospitals in three regions in Scotland indicated that 7.5% of patientswere colonised on admission to hospital. Factors associated with colonisation included re-admission, specialty of admission (highest in nephrology, care of the elderly, dermatology and vascular surgery), increasing age, and the source of admission (care home or other hospital). Three percent of all those who were identified as colonised developed hospital-associated MRSA infection, compared with only 0.1% of those not colonised. Specialtieswith a high rate of colonisation on admission also had higher rates of MRSA infection. Very few patients refused screening (11 patients, 0.03%) or had treatment deferred (14 patients, 0.05%). Several organisational issues were identified, including difficulties in achieving complete uptake of screening (88%) or decolonisation (41%); the latter was largely due to short duration of stay and turnaround time for test results. Patient movement resulted in a decision to decontaminate all positive patients rather than just those in high risk specialties as proposed by the HTA. Issues also included a lack of isolation facilities to manage patients with MRSA. The study raises significant concerns about the contribution of decolonisation to reducing risks in hospital due to short duration of stay, and reinforces the central role of infection control precautions. Further study is required before the HTA model can be re-run and conclusions redrawn on the cost and clinical effectiveness of universal MRSA screening

Residual stress of as-deposited and rolled Wire + Arc Additive Manufacturing Ti–6Al–4V components

Wire + arc additive manufacturing components contain significant residual stresses, which manifest in distortion. High-pressure rolling was applied to each layer of a linear Ti–6Al–4V wire + arc additive manufacturing component in between deposition passes. In rolled specimens, out-of-plane distortion was more than halved; a change in the deposits' geometry due to plastic deformation was observed and process repeatability was increased. The Contour method of residual stresses measurements showed that although the specimens still exhibited tensile stresses (up to 500 MPa), their magnitude was reduced by 60%, particularly at the interface between deposit and substrate. The results were validated with neutron diffraction measurements, which were in good agreement away from the baseplate

Control of residual stress and distortion in aluminium wire + arc additive manufacture with rolling

The aluminium alloy wire 2319 is commonly used for Wire + Arc Additive Manufacturing (WAAM). It is oversaturated with copper, like other alloys of the precipitation hardening 2### series, which are used for structural applications in aviation. Residual stress and distortion are one of the biggest challanges in metal additive manufacturing, however this topic is not widely investigated for aluminium alloys. Neutron diffraction measurements showed that the as-built component can contain constant tensile residual stresses along the height of the wall, which can reach the materials' yield strength. These stresses cause bending distortion after unclamping the part from the build platform. Two different rolling techniques were used to control residual stress and distortion. Vertical rolling was applied inter-pass on top of the wall to deform each layer after its deposition. This technique virtually elimiated the distortion, but produced a characteristic residual stress profile. Side rolling instead was applied on the side surface of the wall, after it has been completed. This technique was even more effective and even inverted the distortion. An interesting observation from the neutron diffraction measurements of the stress-free reference was the significantly larger FCC aluminium unit cell dimension in the inter-pass rolled walls as compared to the as-build condition. This is a result of less copper in solid solution with aluminium, indicating greater precipitation and thus, potentially contibuting to improve the strenght of the material

Immunophoretic rapid diagnostic tests as a source of immunoglobulins for estimating malaria sero-prevalence and transmission intensity

RIGHTS : This article is licensed under the BioMed Central licence at http://www.biomedcentral.com/about/license which is similar to the 'Creative Commons Attribution Licence'. In brief you may : copy, distribute, and display the work; make derivative works; or make commercial use of the work - under the following conditions: the original author must be given credit; for any reuse or distribution, it must be made clear to others what the license terms of this work are.Abstract Background Sero-epidemiological methods are being developed as a tool for rapid assessment of malaria transmission intensity. Simple blood collection methods for use in field settings will make this more feasible. This paper describes validation of such a method, by analysing immunoglobulins from blood retained within immunophoretic rapid diagnostic tests (RDTs) for Plasmodium falciparum. RDTs are now widely used for the diagnosis of malaria and estimation of parasite rates, and this method represents a further use for these devices in malaria control. Methods Immunoglobulins eluted from RDTs, designed to detect parasite histidine rich protein-2 (HRP-2), were analysed by indirect ELISA for IgG recognizing the P. falciparum blood stage antigens merozoite surface protein-119 (MSP-119) and apical membrane antigen-1 (AMA-1). Optimal storage conditions for RDTs were evaluated by comparing antibody responses from RDTs stored in dry or humid conditions at 4°C or at ambient temperature (with or without air-conditioning) for 7, 31 or 70 days. Antibody levels estimated using 3,700 RDT samples from attendees at health facilities in North-eastern Tanzania were compared with contemporaneously collected filter paper blood spots (FPBS) and used to estimate seroconversion rates. Results Storage of RDTs at 4°C was optimal for immunoglobulin recovery but short-term storage at ambient temperatures did not substantially affect anti-malarial IgG levels. Results from RDTs were comparable with those from FPBSs, for both antigens. RDT-generated titres tended to be slightly higher than those generated from FPBSs, possibly due to greater recovery of immunoglobulins from RDTs compared to filter paper. Importantly, however, RDT-based seroconversion rates, and hence serological estimates of malaria transmission intensity, agreed closely with those from FPBSs. Conclusion RDTs represent a practical option for collecting blood for sero-epidemiological surveys, with potential cost and logistical advantages over filter paper and other blood collection methods. RDT-based seroepidemiology can be incorporated into routine monitoring of malaria endemicity, providing information to supplement parasite prevalence rates and generating rapid, robust assessment of malaria transmission intensity at minimal extra cost.Published versio

Women’s experiences of wearing therapeutic footwear in three European countries

Background: Therapeutic footwear is recommended for those people with severe foot problems associated with rheumatoid arthritis (RA). However, it is known that many do not wear them. Although previous European studies have recommended service and footwear design improvements, it is not known if services have improved or if this footwear meets the personal needs of people with RA. As an earlier study found that this footwear has more impact on women than males, this study explores women’s experiences of the process of being provided with it and wearing it. No previous work has compared women’s experiences of this footwear in different countries, therefore this study aimed to explore the potential differences between the UK, the Netherlands and Spain. Method: Women with RA and experience of wearing therapeutic footwear were purposively recruited. Ten women with RA were interviewed in each of the three countries. An interpretive phenomenological approach (IPA) was adopted during data collection and analysis. Conversational style interviews were used to collect the data. Results: Six themes were identified: feet being visibly different because of RA; the referring practitioners’ approach to the patient; the dispensing practitioners’ approach to the patient; the footwear being visible as different to others; footwear influencing social participation; and the women’s wishes for improved footwear services. Despite their nationality, these women revealed that therapeutic footwear invokes emotions of sadness, shame and anger and that it is often the final and symbolic marker of the effects of RA on self perception and their changed lives. This results in severe restriction of important activities, particularly those involving social participation. However, where a patient focussed approach was used, particularly by the practitioners in Spain and the Netherlands, the acceptance of this footwear was much more evident and there was less wastage as a result of the footwear being prescribed and then not worn. In the UK, the women were more likely to passively accept the footwear with the only choice being to reject it once it had been provided. All the women were vocal about what would improve their experiences and this centred on the consultation with both the referring practitioner and the practitioner that provides the footwear. Conclusion: This unique study, carried out in three countries has revealed emotive and personal accounts of what it is like to have an item of clothing replaced with an ‘intervention’. The participant’s experience of their consultations with practitioners has revealed the tension between the practitioners’ requirements and the women’s ‘social’ needs. Practitioners need greater understanding of the social and emotional consequences of using therapeutic footwear as an intervention

A short report examining the introduction of routine use of patient reported outcome measures in a mixed oncology population

Aims: People living with treatable but not curable cancer often experience a range of symptoms related to their cancer and its treatment. During the COVID-19 pandemic, face-to-face consultations were reduced and so remote monitoring of these needs was necessary. University Hospitals Sussex implemented the routine use of electronic remote patient-reported outcome measures (PROMs) in a mixed oncology population, focusing on those with treatable but not curable cancers. Materials and methods: Over a 9-month period, patients were invited to register with My Clinical Outcomes (MCO) – a secure online platform for the collection of electronic PROMs. They were prompted by e-mail to complete assessments (EORTC QLQ-C30, EQ-5D-3L and EQ-5D VAS) routinely every 2 weeks. The team monitored patient scores and changes in these prompted clinical interventions. Results: In total, 324 patients completed at least one assessment. The median number of assessments completed by each patient was eight. The most represented tumour groups were secondary breast (28%), prostate (25%) and other (32%). Median scores for the assessments did not deteriorate in a clinically or numerically significant way for patients living with non-curable conditions for the majority of patients monitored. Conclusion: Routine collection of electronic remote PROMs is an effective and useful strategy to provide real-time clinical feedback to teams. With integration into existing systems, online platforms (such as MCO) could provide efficient and patient-centred information for those providing care for people with cancer

The future of marine fisheries management and conservation in the United Kingdom: Lessons learnt from over 100 years of biased policy

Marine wild-capture fisheries depend on the capacity of the ocean to provide a flow of harvestable resources to sustain the industry. Paradoxically, conventional fishing often undermines these resources by degrading the environment and overexploiting fish stocks. Many UK fisheries have declined for over a century due to a biased focus on their social-economic value and lack of recognition that they are social-ecological systems and need to be managed as such. With the UK’s recent transition to an independent coastal state, the Fisheries Act (2020) and associated Joint Fisheries Statement provide an opportunity to correct this. Focusing on the ecological foundations, a more sustainable future for UK fisheries may be achieved by: (1) implementing a conservative quota setting system based on Maximum Sustainable Yield (MSY), defined as that which would occur when the biomass of a population of the target species is at 50% of that estimated at carrying capacity, to set catch limits rather than targets. The biomass of fish stocks should be allowed to regenerate to a minimum of 120% of that which will achieve MSY to provide a buffer against the uncertainty in ecological response to climate change. (2) Fishing capacity should be reduced while redistributing a greater share of the quota to sectors of the fleet that are demonstrably more sustainable; recognising that short term compensation may be required by some to mitigate the impacts of displaced activity until the benefits of stock recovery are realised. (3) Greater restrictions should be applied to ensure the most damaging fishing techniques (e.g. bottom trawling and dredging) are prohibited as appropriate in the network of marine protected areas. Protection should be enforced to promote the regeneration of degraded habitats and restoration of fish populations to help achieve the objectives as set out in the Ac

Measurement and modelling of the residual stresses in autogenous and narrow gap laser welded AISI grade 316L stainless steel plates

Thick-section austenitic stainless steels have widespread industrial applications, where stress-corrosion cracking is often of major concern. Problems tend to arise in the vicinity of welds, where substantial residual stresses often reside. This paper describes an investigation into the residual stresses in autogenous high power laser welds and narrow gap laser welds (NGLW) in 10 mm thick AISI grade 316L steel plates, using both neutron diffraction and the contour method. The influences of laser power, welding speed and the time interval between weld passes on residual stress were analysed. For the NGLW process, finite element modelling was employed to understand the influence of thermal history on residual stress. The results for the NGLW technique show that the laser power has a significant effect on the peak value of residual stress, while the welding speed has a more significant influence on the width of the region sustaining tensile stresses

Foot health education for people with rheumatoid arthritis : the practitioner's perspective

Background: Patient education is considered to be a key role for podiatrists in the management of patients with rheumatoid arthritis (RA). Patient education has undoubtedly led to improved clinical outcomes, however no attempts have been made to optimise its content or delivery to maximise benefits within the context of the foot affected by rheumatoid arthritis. The aim of this study was to identify the nature and content of podiatrists' foot health education for people with RA. Any potential barriers to its provision were also explored. Methods: A focus group was conducted. The audio dialogue was recorded digitally, transcribed verbatim and analysed using a structured, thematic approach. The full transcription was verified by the focus group as an accurate account of what was said. The thematic analysis framework was verified by members of the research team to ensure validity of the data. Results: Twelve members (all female) of the north west Podiatry Clinical Effectiveness Group for Rheumatology participated. Six overarching themes emerged: (i) the essence of patient education; (ii) the content; (iii) patient-centred approach to content and timing; (iv) barriers to provision; (v) the therapeutic relationship; and (vi) tools of the trade. Conclusion: The study identified aspects of patient education that this group of podiatrists consider most important in relation to its: content, timing, delivery and barriers to its provision. General disease and foot health information in relation to RA together with a potential prognosis for foot health, the role of the podiatrist in management of foot health, and appropriate self-management strategies were considered to be key aspects of content, delivered according to the needs of the individual. Barriers to foot health education provision, including financial constraints and difficulties in establishing effective therapeutic relationships, were viewed as factors that strongly influenced foot health education provision. These data will contribute to the development of a patient-centred, negotiated approach to the provision of foot health education for people with RA