Scabies outbreaks in residential care homes: factors associated with late recognition, burden and impact. A mixed methods study in England

Scabies is an important public health problem in residential care homes. Delayed diagnosis contributes to outbreaks, which may be prolonged and difficult to control. We investigated factors influencing outbreak recognition, diagnosis and treatment, and staff experiences of outbreak control, identifying areas for intervention. We carried out a semi-structured survey of managers, affected residents and staff of seven care homes reporting suspected scabies outbreaks in southern England over a 6-month period. Attack rates ranged from 2% to 50%, and most cases had dementia (37/39, 95%). Cases were diagnosed clinically by GPs (59%) or home staff (41%), none by dermatologists. Most outbreaks were attributable to avoidably late diagnosis of the index case. Participants reported considerable challenges in managing scabies outbreaks, including late diagnosis and recognition of outbreaks; logistically difficult mass treatment; distressing treatment processes and high costs. This study demonstrates the need for improved support for care homes in detecting and managing these outbreak

Measuring access: how accurate are patient-reported waiting times?

Introduction: A national audit of waiting times in England’s genitourinary medicine clinics measures patient access. Data are collected by patient questionnaires, which rely upon patients’ recollection of first contact with health services, often several days previously. The aim of this study was to assess the accuracy of patient-reported waiting times. Methods: Data on true waiting times were collected at the time of patient booking over a three-week period and compared with patient-reported data collected upon clinic attendance. Factors contributing to patient inaccuracy were explored. Results: Of 341 patients providing initial data, 255 attended; 207 as appointments and 48 ‘walk-in’. The accuracy of patient-reported waiting times overall was 52% (133/255). 85% of patients (216/255) correctly identified themselves as seen within or outside of 48 hours. 17% of patients (17/103) seen within 48 hours reported a longer waiting period, whereas 20% of patients (22/108) reporting waits under 48 hours were seen outside that period. Men were more likely to overestimate their waiting time (10.4% versus 3.1% p<0.02). The sensitivity of patient-completed questionnaires as a tool for assessing waiting times of less than 48 hours was 83.5%. The specificity and positive predictive value were 85.5% and 79.6%, respectively. Conclusion: The overall accuracy of patient reported waiting times was poor. Although nearly one in six patients misclassified themselves as being seen within or outside of 48 hours, given the under and overreporting rates observed, the overall impact on Health Protection Agency waiting time data is likely to be limited

Investigation of Frequency-Domain and Time-Domain Free-Space Material Measurements

Electromagnetic material characterization is the process of determining the complex permittivity and permeability of a test sample. The primary goal of this thesis is to develop a new two-transmission material measurement method to decrease the error associated with using a reflection measurement. The transmission method uses a sample transmission measurement and an acrylic-backed sample transmission measurement. This technique is first demonstrated in a rectangular waveguide system then extended to frequency-domain and time-domain focus arch free-space systems. The frequency-domain free-space calibration process decreases accuracy at the band edges. The use of a digital oscilloscope with a time-domain reflectometer (TDR) module should increase accuracy by removing the windowing and transforming operations and is a secondary goal of this thesis. The two transmission method is compared to the NRW method to validate the two transmission method in all three measuring devices

AMTV headway sensor and safety design

A headway sensing system for an automated mixed traffic vehicle (AMTV) employing an array of optical proximity sensor elements is described, and its performance is presented in terms of object detection profiles. The problem of sensing in turns is explored experimentally and requirements for future turn sensors are discussed. A recommended headway sensor configuration, employing multiple source elements in the focal plane of one lens operating together with a similar detector unit, is described. Alternative concepts including laser radar, ultrasonic sensing, imaging techniques, and radar are compared to the present proximity sensor approach. Design concepts for an AMTV body which will minimize the probability of injury to pedestrians or passengers in the event of a collision are presented

'BUT WHAT AM I GOING TO SAY?" Some advice to medical students about dealing with feelings of inadequacy

Nil abstrac

Analysis Of Hofstedes 5-D Model: The Implications Of Conducting Business In Saudi Arabia

This paper analyzes the business and legal environment of Saudi Arabia using Hofstedes five dimensions: power distance, individualism vs. collectivism, masculinity vs. femininity, uncertainty avoidance, and short-term orientation vs. long-term orientation. The purpose of this paper is to provide a comparative analysis of several key traits of the culture in the United States and Saudi Arabia, examine various concepts in Saudi Arabias business environment that are illustrative of its ranking, and demonstrate the continued viability of Hofstedes model as a stepping-stone to appreciation of culture

Exploring the costs and outcomes of sexually transmitted infection (STI) screening interventions targeting men in football club settings: preliminary cost-consequence analysis of the SPORTSMART pilot randomised controlled trial

Background: The objective of this study was to compare the costs and outcomes of two sexually transmitted infection (STI) screening interventions targeted at men in football club settings in England, including screening promoted by team captains. Methods: A comparison of costs and outcomes was undertaken alongside a pilot cluster randomised control trial involving three trial arms: (1) captain-led and poster STI screening promotion; (2) sexual health advisor-led and poster STI screening promotion and (3) poster-only STI screening promotion (control/comparator). For all study arms, resource use and cost data were collected prospectively. Results: There was considerable variation in uptake rates between clubs, but results were broadly comparable across study arms with 50% of men accepting the screening offer in the captain-led arm, 67% in the sexual health advisor-led arm and 61% in the poster-only control arm. The overall costs associated with the intervention arms were similar. The average cost per player tested was comparable, with the average cost per player tested for the captain-led promotion estimated to be £88.99 compared with £88.33 for the sexual health advisor-led promotion and £81.87 for the poster-only (control) arm. Conclusions: Costs and outcomes were similar across intervention arms. The target sample size was not achieved, and we found a greater than anticipated variability between clubs in the acceptability of screening, which limited our ability to estimate acceptability for intervention arms. Further evidence is needed about the public health benefits associated with screening interventions in non-clinical settings so that their cost-effectiveness can be fully evaluated