Linking Environmental Sustainability and Healthcare: The Effects of an Energy Saving Intervention in Two Hospitals

Set in a real organisational setting, this study examines the challenges of implementing environmentally sustainable behaviour in healthcare. It evaluates the success of a real energy saving behaviour change intervention, based on social marketing principles, which targeted the employees of two National Health Service (NHS) hospitals. It also explores the intervention benefits for three key stakeholders: the organisation/hospitals, hospital employees and patients. A rich secondary dataset containing actual workplace behaviour measures (collected via observations) and self-reported data from employee interviews and patient questionnaires is used for this purpose. The intervention encouraged three employee energy saving actions (called TLC actions): (1) Turn off machines, (2) Lights out when not needed, and (3) Close doors when possible; which led to energy savings and carbon reduction for the two hospitals. Hospital employees reported a greater level of work efficiency as a result of engaging in TLC actions, which increased the 'quiet time' periods in both hospitals. Indirectly, employees' TLC actions also improved patients' quality of sleep (which in turn is positively associated with greater patient hospital experience satisfaction). These findings shed light on the benefits of social marketing interventions targeting energy saving behaviour change for multiple stakeholders in healthcare organisations. They also illustrate connections between environmental sustainability and social and political pillars of corporate social responsibility. Additionally, organisational culture was highlighted as a key challenge in changing practices. To encourage long-term sustainable behaviour, this study recommends a pre-intervention assessment of infrastructure and equipment, the communication of expected benefits to motivate higher involvement of employees, the need for internal green champions and the dissemination of post-intervention feedback on various energy saving and patient indicators

Phyllodes Tumor vs Fibroadenoma: Diagnosis and Management

Case: The patient is a 71 year-old woman who presented with enlarging painful breast mass. She had history of previous excision of a fibroadenoma in her left breast in 1993. She underwent menopause at 52 and does not take estrogen. Diagnostic imaging revealed 4.7cm breast mass, which had increased from prior measurement of 2.8cm to 4.7cm. Core biopsy demonstrated a fibroepithelial neoplasm areas of hypercellular stroma and occasional stromal mitotic figures most consistent with phyllodes tumor. Lumpectomy was performed. Final pathology showed a 4.8cm well-demarcated tumor with mildly pleomorphic spindled cells in the stroma and up to 1 per 10 mitoses per high powered field, consistent with benign phyllodes. The patient was followed every 6 months with imaging for 2 years without recurrence. Conclusions: Phyllodes tumors are rare fibroepithelial tumors of varying metastatic potential that can be mistaken for benign fibroadenomas. Phyllodes tumors should be surgically excised with wide margins, needing radiation or chemotherapy only if recurrent or large (>10cm), whereas fibroadenomas can be managed expectantly if asymptomatic (Gnerlich, 2014). Phyllodes tumors are often diagnosed in women ages 35-55. The patient in this case was diagnosed at a more advanced age with benign disease, although older age is more often associated with increased histologic grade (Mishra, 2013) (Karim, 2009). Borderline and malignant tumors are more likely to recur within two years of resection; there is less data on recurrence rates of benign tumors. Clinical Significance: Phyllodes tumors should be suspected with rapid growth of a known fibroadenoma. Core biopsy should be performed rather than fine needle aspiration for accurate diagnosis. Although phyllodes tumors comprise less than 1% of all breast neoplasms, it is crucial that uncommon pathologies are diagnosed correctly so that patients receive appropriate treatment

Foot-and-mouth disease virus localisation on follicular dendritic cells and sustained induction of neutralising antibodies is dependent on binding to complement receptors (CR2/CR1)

Previous studies have shown after the resolution of acute infection and viraemia, foot-and-mouth disease virus (FMDV) capsid proteins and/or genome are localised in the light zone of germinal centres of lymphoid tissue in cattle and African buffalo. The pattern of staining for FMDV proteins was consistent with the virus binding to follicular dendritic cells (FDCs). We have now demonstrated a similar pattern of FMDV protein staining in mouse spleens after acute infection and showed FMDV proteins are colocalised with FDCs. Blocking antigen binding to complement receptor type 2 and 1 (CR2/CR1) prior to infection with FMDV significantly reduced the detection of viral proteins on FDCs and FMDV genomic RNA in spleen samples. Blocking the receptors prior to infection also significantly reduced neutralising antibody titres, through significant reduction in their avidity to the FMDV capsid. Therefore, the binding of FMDV to FDCs and sustained induction of neutralising antibody responses are dependent on FMDV binding to CR2/CR1 in mice

Return of large fin whale feeding aggregations to historical whaling grounds in the Southern Ocean

Fin whales (Balaenoptera physalus quoyi) of the Southern Hemisphere were brought to near extinction by twentieth century industrial whaling. For decades, they had all but disappeared from previously highly frequented feeding grounds in Antarctic waters. Our dedicated surveys now confirm their return to ancestral feeding grounds, gathering at the Antarctic Peninsula in large aggregations to feed. We report on the results of an abundance survey and present the first scientific documentation of large fin whale feeding aggregations at Elephant Island, Antarctica, including the first ever video documentation. We interpret high densities, re-establishment of historical behaviours and the return to ancestral feeding grounds as signs for a recovering population. Recovery of a large whale population has the potential to augment primary productivity at their feeding grounds through the effects of nutrient recycling, known as 'the whale pump'. The recovery of fin whales in that area could thus restore ecosystem functions crucial for atmospheric carbon regulation in the world's most important ocean region for the uptake of anthropogenic CO2

Re-valuation of annual cytology using HPV self-sampling to upgrade prevention (REACH UP): A feasibility study in women living with HIV in the UK

Introduction: Current UK guidelines for cervical cancer screening are based on the assumption that most women living with HIV (WLWH) are also high-risk (HR) human papillomavirus (HPV)-positive. We aimed to provide data on prevalence of HR-HPV in WLWH in the UK and to assess feasibility and acceptability of HR-HPV self-sampling in this group. // Methods: Women living with HIV attending six HIV services in London/south of England, with no history of cervical cancer, were enrolled. Participants self-collected a vaginal swab for the detection of HR-HPV, completed a survey about sexual/gynaecological history, attitudes towards annual screening and perception of HR-HPV self-sampling, and were asked to have their annual cervical smear. // Results: In all, 67 women were included: 86.5% were of black ethnicity, the median (range) age was 47 (24–60) years, median CD4 T-cell count was 683 cells/µL [interquartile range (IQR): 527–910], and 95.4% had viral load ≤ 50 copies/mL. All performed the vaginal swab. Eighteen (27%) had no cervical smear results; none of these women attended HIV services where this was routinely offered. No cervical samples were positive for HR-HPV. Three-quarters (75.8%) of participants reported adherence to annual screening, with only one woman (1.5%) attending irregularly. On visual analogue scales (from 0 to 100), median (IQR) acceptability and necessity of smear tests were 100 (75–100) and 100 (85–100), respectively. // Conclusions: Our results suggest that the prevalence of HR-HPV in WLWH in the UK may be low. Self-sampling seems to be acceptable, suggesting, if validated, its potential role in supporting less frequent smear testing and improving screening uptake in WLW

Update on Streptococcus suis research and prevention in the era of antimicrobial restriction: 4th International Workshop on S. suis

Streptococcus suis is a swine pathogen and a zoonotic agent afflicting people in close contact with infected pigs or pork meat. Sporadic cases of human infections have been reported worldwide. In addition, S. suis outbreaks emerged in Asia, making this bacterium a primary health concern in this part of the globe. In pigs, S. suis disease results in decreased performance and increased mortality, which have a significant economic impact on swine production worldwide. Facing the new regulations in preventive use of antimicrobials in livestock and lack of effective vaccines, control of S. suis infections is worrisome. Increasing and sharing of knowledge on this pathogen is of utmost importance. As such, the pathogenesis and epidemiology of the infection, antimicrobial resistance, progress on diagnosis, prevention, and control were among the topics discussed during the 4th International Workshop on Streptococcus suis (held in Montreal, Canada, June 2019). This review gathers together recent findings on this important pathogen from lectures performed by lead researchers from several countries including Australia, Canada, France, Germany, Japan, Spain, Thailand, The Netherlands, UK, and USA. Finally, policies and recommendations for the manufacture, quality control, and use of inactivated autogenous vaccines are addressed to advance this important field in veterinary medicine