Encouraging practitioners in infection prevention and control to publish: a cross-sectional survey

Aim: The aim of this cross-sectional survey was to determine the views of infection prevention and control practitioners (IPCPs) on publishing research. Methods: A convenience sample was obtained by approaching delegates at the 2015 Infection Prevention Society conference and data was captured via a hand-held electronic device. Findings: Of the 79 respondents most (83%) read Journal of Infection Prevention (JIP) and found it useful for informing their practice (72%). However, most (91%) had never published in JIP, and less than half (40%) published elsewhere. The main barrier to publication was not having work suitable for publication (38%). Support (37%), training in writing for publication (10%) and time (9%) were considered to be important facilitators in encouraging respondents to publish. Discussion: Strategies that support IPCPs in developing their writing skills may encourage more IPCPs to disseminate evidence to support best practice by publishing their work in peer reviewed journals

19th century London dust-yards: A case study in closed-loop resource efficiency

The material recovery methods used by dust-yards in early 19th century London, England and the conditions that led to their development, success and decline are reported. The overall system developed in response to the market value of constituents of municipal waste, and particularly the high coal ash content of household ‘dust’. The emergence of lucrative markets for ‘soil’ and ‘breeze’ products encouraged dust-contractors to recover effectively 100% of the residual wastes remaining after readily saleable items and materials had been removed by the thriving informal sector. Contracting dust collection to the private sector allowed parishes to keep the streets relatively clean, without the need to develop institutional capacity, and for a period this also generated useful income. The dust-yard system is, therefore, an early example of organised, municipal-wide solid waste management, and also of public–private sector participation. The dust-yard system had been working successfully for more than 50 years before the Public Health Acts of 1848 and 1875, and was thus important in facilitating a relatively smooth transition to an institutionalised, municipally-run solid waste management system in England. The dust-yards can be seen as early precursors of modern materials recycling facilities (MRFs) and mechanical–biological treatment (MBT) plants; however, it must be emphasised that dust-yards operated without any of the environmental and occupational health considerations that are indispensable today. In addition, there are analogies between dust-yards and informal sector recycling systems currently operating in many developing countries

Oligoclonal expansions of CD8(+) T cells in chronic HIV infection are antigen specific

Acute HIV infection is associated with a vigorous immune response characterized by the proliferation of selected T cell receptor V beta (BV)-expressing CD8(+) T cells. These 'expansions', which are commonly detected in the peripheral blood, can persist during chronic HIV infection and may result in the dominance of particular clones. Such clonal populations are most consistent with antigen-driven expansions of CD8(+) T cells. However, due to the difficulties in studying antigen-specific T cells in vivo, it has been hard to prove that oligoclonal BV expansions are actually HIV specific. The use of tetrameric major histocompatibility complex-peptide complexes has recently enabled direct visualization of antigen-specific T cells ex vivo but has not provided information on their clonal composition. We have now made use of these tetrameric complexes in conjunction with anti-BV chain-specific monoclonal antibodies and analysis of cytotoxic T lymphocyte lines/clones to show that chronically clonally expanded CD8(+) T cells are HIV specific in vivo

Osmoregulatory bicarbonate secretion exploits H(+)-sensitive haemoglobins to autoregulate intestinal O2 delivery in euryhaline teleosts

This is the final version of the article. Available from Springer Verlag via the DOI in this record.Marine teleost fish secrete bicarbonate (HCO3 (-)) into the intestine to aid osmoregulation and limit Ca(2+) uptake by carbonate precipitation. Intestinal HCO3 (-) secretion is associated with an equimolar transport of protons (H(+)) into the blood, both being proportional to environmental salinity. We hypothesized that the H(+)-sensitive haemoglobin (Hb) system of seawater teleosts could be exploited via the Bohr and/or Root effects (reduced Hb-O2 affinity and/or capacity with decreasing pH) to improve O2 delivery to intestinal cells during high metabolic demand associated with osmoregulation. To test this, we characterized H(+) equilibria and gas exchange properties of European flounder (Platichthys flesus) haemoglobin and constructed a model incorporating these values, intestinal blood flow rates and arterial-venous acidification at three different environmental salinities (33, 60 and 90). The model suggested red blood cell pH (pHi) during passage through intestinal capillaries could be reduced by 0.14-0.33 units (depending on external salinity) which is sufficient to activate the Bohr effect (Bohr coefficient of -0.63), and perhaps even the Root effect, and enhance tissue O2 delivery by up to 42 % without changing blood flow. In vivo measurements of intestinal venous blood pH were not possible in flounder but were in seawater-acclimated rainbow trout which confirmed a blood acidification of no less than 0.2 units (equivalent to -0.12 for pHi). When using trout-specific values for the model variables, predicted values were consistent with measured in vivo values, further supporting the model. Thus this system is an elegant example of autoregulation: as the need for costly osmoregulatory processes (including HCO3 (-) secretion) increases at higher environmental salinity, so does the enhancement of O2 delivery to the intestine via a localized acidosis and the Bohr (and possibly Root) effect.Underlying research materials, i.e. raw data, is accessible by contacting the corresponding author, Dr. Rod Wilson at [email protected]. This research was supported by BBSRC and NERC grants (BB/D005108/1 and NE/H010041/1) to RWW and an NSERC Discovery grant to CJB. We would like to thank Jan Shears for excellent technical support and fish husbandry

Severe generalised hypersensitivity reaction to topical neomycin after cataract surgery: a case report

<p>Abstract</p> <p>Introduction</p> <p>Systemic hypersensitivity reactions to topical ophthalmic treatment occur rarely, but when they do they can be severe as highlighted by this case.</p> <p>Case presentation</p> <p>A post-operative cataract surgery patient developed a severe and generalised hypersensitivity reaction following topical treatment with Maxitrol (Dexamethasone and Neomycin) eye drops. The patient reported a previous allergic reaction to Neomycin.</p> <p>Conclusion</p> <p>This case report emphasises the importance of a thorough drug and allergy history when patients are seen at pre-assessment or clerked in for surgery.</p

The disappearance of the "revolving door" patient in Scottish general practice: successful policies

&lt;b&gt;Background&lt;/b&gt; We describe the health of "revolving door" patients in general practice in Scotland, estimate changes in their number over the timescale of the study, and explore reasons for changes, particularly related to NHS and government policy.&lt;p&gt;&lt;/p&gt; &lt;b&gt;Methods&lt;/b&gt; A mixed methods predominantly qualitative study, using a grounded theory approach, set in Scottish general practice. Semi-structured interviews were conducted with professional key informants, 6 Practitioner Services staff who administer the GP registration system and 6 GPs with managerial or clinical experience of working with "revolving door" patients. Descriptive statistical analysis and qualitative analysis of patient removal episodes linked with routine hospital admissions, outpatient appointments, drug misuse treatment episodes and deaths were carried out with cohorts of "revolving door" patients identified from 1999 to 2005 in Scotland.&lt;p&gt;&lt;/p&gt; &lt;b&gt;Results&lt;/b&gt; A "revolving door" patient is removed 4 or more times from GP lists in 7 years. Patients had complex health issues including substance misuse, psychiatric and physical health problems and were at high risk of dying. There was a dramatic reduction in the number of "revolving door" patients during the course of the study.&lt;p&gt;&lt;/p&gt; &lt;b&gt;Conclusions&lt;/b&gt; "Revolving door" patients in general practice had significant health problems. Their numbers have reduced dramatically since 2004 and this probably resulted from improved drug treatment services, pressure from professional bodies to reduce patient removals and the positive ethical regulatory and financial climate of the 2004 GMS GP contract. This is a positive development for the NHS

Stall Inception in Low-Pressure Ratio Fans

A combined experimental and computational test program, with two low-pressure ratio aero-engine fans, has been used to identify the flow mechanisms at stall inception and the subsequent stall cell growth. The two fans have the same rotor tip clearance, annulus design, and downstream stators, but different levels of tip loading. The measurement data show that both the fans stall via spike-type inception, but that the growth of the stall cell and the final cell size is different in each fan. The computations, reproducing both the qualitative and quantitative behavior of the steady-state and transient measurements, are used to identify the flow mechanisms at the origin of stall inception. In one fan, spillage of tip leakage flow upstream of the leading edge plane is responsible. In the other, sudden growth of casing corner separation blockage leads to stall. These two mechanisms are in accord with the findings from core compressors. However, the transonic aerodynamics and the low hub-to-tip radius ratio of the fans lead to the following two findings: first, the casing corner separation is driven by shock-boundary layer interaction and second, the spanwise loading distribution of the fan determines whether the spike develops into full-span or part-span stall and both types of behavior are represented in the present work. Finally, the axial momentum flux of the tip clearance flow is shown to be a useful indicator of the leakage jet spillage mechanism. A simple model is provided that links the tip loading, stagger, and solidity with the tip clearance axial momentum flux, thereby allowing the aerodynamicist to connect, qualitatively, design parameters with the stall behavior of the fan.</jats:p

High g-Force Rollercoaster Rides Induce Sinus Tachycardia but No Cardiac Arrhythmias in Healthy Children

This is the final version of the article. Available from Springer Verlag via the DOI in this record.Theme park operators and medical professionals advise children with heart conditions against using rollercoaster rides, but these recommendations are not evidence-based. The underlying assumption is that the combination of adrenergic stimulation through stress and acceleration might trigger arrhythmias in susceptible individuals. We conducted a cross-sectional observational study to assess heart rate and rhythm in healthy children during commercial rollercoaster rides. Twenty healthy children (9 male) aged 11-15 (mean 13.3 ± 1.4) years underwent continuous heart rate and rhythm monitoring (2-lead ECG) from 5 min before until 10 min after each of 4 high speed (>50 km h(-1)), high g-force (>4) commercial rollercoaster rides. Total recording time was 13 h 20 min. No arrhythmic events were detected. Resting heart rate was 81 ± 10 b min(-1) and increased to 158 ± 20 b·min(-1) during rides. The highest mean HR (165 ± 23 b min(-1)) was observed on the ride with the lowest g-force (4.5 g), but one of the highest speeds (100 km h(-1)). Anticipatory tachycardia (126 ± 15 b min(-1)) within 5 min was frequently observed. A 10 min recovery HR (124 ± 17 b min(-1)) was 56 % greater than resting HR. The speed and g-force experienced on roller coasters induce sinus tachycardia but do not elicit pathological arrhythmias in healthy children.This work was supported by the National Institute for Health Research (NIHR) Biomedical Research Unit in Cardiovascular Disease at the University Hospitals Bristol NHS Foundation Trust and the University of Bristol. Dr Pieles is the holder of an NIHR Academic Clinical Lectureship in Paediatric Cardiology. We would like to thank Novacor Ltd (Swanley, Kent, UK) for providing portable ECG monitoring equipment and Thorpe Park (Merlin Entertainments PLC, Poole, Dorset, UK) for their support during data acquisition. We thank all of the children and their families for participating in this study

Challenges and opportunities of the COVID-19 pandemic for perinatal mental health care: a mixed-methods study of mental health care staff

The aim of this study was to explore staff perceptions of the impact of the COVID-19 pandemic on mental health service delivery and outcomes for women who were pregnant or in the first year after birth ('perinatal' women). Secondary analysis was undertaken of an online mixed-methods survey open to all mental health care staff in the UK involving 363 staff working with women in the perinatal period. Staff perceived the mental health of perinatal women to be particularly vulnerable to the impact of stressors associated with the pandemic such as social isolation (rated by 79.3% as relevant or extremely relevant; 288/363) and domestic violence and abuse (53.3%; 192/360). As a result of changes to mental health and other health and social care services, staff reported feeling less able to assess women, particularly their relationship with their baby (43.3%; 90/208), and to mobilise safeguarding procedures (29.4%; 62/211). While 42% of staff reported that some women engaged poorly with virtual appointments, they also found flexible remote consulting to be beneficial for some women and helped time management due to reductions in travel time. Delivery of perinatal care needs to be tailored to women's needs; virtual appointments are perceived not to be appropriate for assessments but may be helpful for some women in subsequent interactions. Safeguarding and other risk assessment procedures must remain robust in spite of modifications made to service delivery during pandemics