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INTRODUCTION: Cold sensation is often used to check neuraxial anaesthesia and analgesia. One opportunity to reduce the carbon footprint of anaesthesia is to replace vapo-coolant sprays such as ethyl chloride with a reusable device called the CoolStick, which is cooled in a refrigerator between uses. We designed a study to investigate how long the CoolStick remains at its working temperature, which we defined asâ¯<15⯰C. METHOD: Experiments were undertaken using a thermocouple and digital temperature sensor attached to the CoolStick. We conducted two experiments to assess temperature changes following removal from the refrigerator for 10â¯min; the first investigated passive re-warming in the ambient theatre environment and the second investigated re-warming in simulated use. In our third experiment, we investigated the time taken to cool the device in the refrigerator, following use. Each experiment was repeated three times. RESULTS: In the passive re-warming experiment, the mean CoolStick temperature was 7.3⯰C at the start, and 14.3⯰C after 10â¯min. In the simulated use experiment, the mean CoolStick temperature was 7.3⯰C at the start, and 18.9⯰C at 10â¯min. In the cooling experiment, the mean CoolStick temperature was 15⯰C at the start and 7.6⯰C at 40â¯min. CONCLUSION: Our study indicates that it is feasible to use the CoolStick for providing cold sensation in clinical practice. Further study would be required to directly compare the effectiveness of the device to existing methods such as coolant sprays or ice in the clinical setting.
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Anestesia , Cloreto de Etil , Humanos , Temperatura , Temperatura Baixa , Dor , Temperatura CorporalRESUMO
OBJECTIVES: This study ascertains the views of UK stakeholders on the actual, and possible, impact of a public health licensing objective in their day-to-day work. STUDY DESIGN AND METHODS: Twenty-eight interviews were conducted with members of public health teams who were actively engaged in alcohol licensing in their local area between 2017 and 2019. Six teams were based in Scotland (where there is a public health licensing objective) and 14 in England (where there is no similar objective). RESULTS: Scottish participants reported that while challenges remained in applying the public health licensing objective, progress had been made and the objective was beneficial to their work. Participants in England felt that an objective would increase the legitimacy, value and impact of their contributions. In both Scotland and England, constructive relationships between PHTs, licensing authorities and other key stakeholders were developing suggesting that PHTs could have a sustainable and positive role in licensing. CONCLUSIONS: In many Scottish areas, the alcohol licensing system is evolving to take constructive account of its public health objective. In England, PHTs that have invested resources in engaging in this area have demonstrated an ability to work effectively within licensing systems. Strong support for the adoption of a public health licensing objective among these PHTs adds weights to calls for the UK Government to reconsider its previous decision not to introduce such an objective.
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Bebidas Alcoólicas , Saúde Pública , Consumo de Bebidas Alcoólicas , Inglaterra , Etanol , Humanos , LicenciamentoRESUMO
Maternity claims represent the highest value and second highest number of clinical negligence claims reported to the NHS Litigation Authority (NHSLA). Most obstetric litigation is brought under the law of negligence which requires the claimant to show three things: that a duty of care was owed, that the duty was breached and that the breach caused loss. Training to prevent litigation should focus on 'Clinical' - multidisciplinary, simulation-training and 'Non-Clinical' (starting all discussions with women and their families timely, informing them about 'material' risks and addressing their particular concern, treating decision-making as a team process, using translation services early in the process, even before the emergency occur). Therefore, maternity claims are one of the most frequent and most expensive ones. Each unexpected pregnancy outcome can possibly trigger litigation. Effective training should address both 'clinical' and 'non-clinical' situations.
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Imperícia , Medicina Estatal , Feminino , Humanos , Parto , GravidezAssuntos
Betacoronavirus , Infecções por Coronavirus , Humanos , Sistema Respiratório , Tropismo , Tropismo Viral , Replicação ViralAssuntos
Túnica Conjuntiva , Infecções por Coronavirus , Pandemias , Pneumonia Viral , Betacoronavirus , COVID-19 , Humanos , Imunidade Inata , Sistema Respiratório , SARS-CoV-2 , TropismoRESUMO
AIM: Training in colorectal surgery across Europe is not yet standardized. The European Board of Surgical Qualification (EBSQ) coloproctology examination has been held annually since 1998. The aims of this study were to illustrate the current situation of coloproctology specialization in Europe and to analyse the EBSQ examinations held over the last 20 years. METHOD: A survey, focused on current training and education in colorectal surgery in Europe, was conducted among all national representatives of the European Society of Coloproctology (ESCP) in 2018. Candidate demographics (1998-2018) and the results of the EBSQ examination (2007-2018) were analysed. RESULTS: In Europe, there are currently 26 national colorectal societies, 27 national annual colorectal meetings, 16 national specialized training programmes and 13 national colorectal fellowships. Six countries have board certification in colorectal surgery and five a dedicated examination. During the last 20 years, 475 candidates from 29 countries, of whom 88 (19%) were women, passed the EBSQ examination. The pass rate was higher in younger applicants (< 42 years, P = 0.01). The success rate was higher for candidates with academic experience (more than five publications or presentations) and with an academic title (thesis) (P = 0.01). CONCLUSION: Colorectal surgical training is still not standardized in Europe, although efforts have been made to recognize colorectal surgery as an independent speciality. The number of holders of the EBSQ Diploma has increased over the years, demonstrating the acceptance of the examination among European surgeons. Young candidates with an academic profile are the most successful.
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Cirurgia Colorretal , Procedimentos Cirúrgicos do Sistema Digestório , Cirurgiões , Europa (Continente) , Feminino , HumanosRESUMO
OBJECTIVES: The aim of the study was to evaluate the efficacy of dual therapy with lamivudine (3TC), with dose adjustment for renal function, and dolutegravir (DTG) in a subgroup of patients fully suppressed on treatment who were switched because of concerns about comorbidity and toxicity on their current triple drug regimen. METHODS: A retrospective evaluation of clinical and pathological parameters from an electronic patient record from a single centre was carried out. RESULTS: There were no virological failures in 52 patients with a median age of 60.5 years. The median duration of follow-on dual therapy was 2.29 years (28 months; range 1.10-3.34 years). In 25 of 52 (48%) cases, the dose of 3TC was adjusted taking into account reduced renal function, and none of these patients experienced virological failure. Four additional patients discontinued early, because of side effects of the switch, with no failure. CONCLUSIONS: This retrospective review suggests that 3TC and DTG may be effective in controlling viral load in older patients with comorbidities. This regimen appears to be a useful option in the context of comorbidities (including renal impairment) and polypharmacy in older patients. However, this review has been conducted in one centre and in a small population of patients. Therefore, further multicentre trials involving larger populations of patients are needed.
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Fármacos Anti-HIV/uso terapêutico , Infecções por HIV/tratamento farmacológico , Compostos Heterocíclicos com 3 Anéis/uso terapêutico , Rim/efeitos dos fármacos , Lamivudina/uso terapêutico , Adulto , Fármacos Anti-HIV/efeitos adversos , Contagem de Linfócito CD4 , Comorbidade , Quimioterapia Combinada , Feminino , Infecções por HIV/fisiopatologia , Compostos Heterocíclicos com 3 Anéis/efeitos adversos , Humanos , Lamivudina/efeitos adversos , Masculino , Pessoa de Meia-Idade , Oxazinas , Piperazinas , Piridonas , Estudos Retrospectivos , Resultado do Tratamento , Carga ViralRESUMO
Despite causing regular seasonal epidemics with substantial morbidity, mortality and socioeconomic burden, there is still a lack of research into influenza B viruses (IBVs). In this study, we provide for the first time a systematic investigation on the tropism, replication kinetics and pathogenesis of IBVs in the human respiratory tract.Physiologically relevant ex vivo explant cultures of human bronchus and lung, human airway organoids, and in vitro cultures of differentiated primary human bronchial epithelial cells and type-I-like alveolar epithelial cells were used to study the cellular and tissue tropism, replication competence and induced innate immune response of 16 IBV strains isolated from 1940 to 2012 in comparison with human seasonal influenza A viruses (IAVs), H1N1 and H3N2. IBVs from the diverged Yamagata- and Victoria-like lineages and the earlier undiverged period were included.The majority of IBVs replicated productively in human bronchus and lung with similar competence to seasonal IAVs. IBVs infected a variety of cell types, including ciliated cells, club cells, goblet cells and basal cells, in human airway organoids. Like seasonal IAVs, IBVs are low inducers of pro-inflammatory cytokines and chemokines. Most results suggested a higher preference for the conducting airway than the lower lung and strain-specific rather than lineage-specific pathogenicity of IBVs.Our results highlighted the non-negligible virulence of IBVs which require more attention and further investigation to alleviate the disease burden, especially when treatment options are limited.
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Vírus da Influenza B/fisiologia , Organoides/patologia , Organoides/virologia , Sistema Respiratório/patologia , Sistema Respiratório/virologia , Tropismo Viral , Animais , Brônquios/patologia , Diferenciação Celular , Cães , Células Epiteliais/virologia , Eritrócitos/citologia , Humanos , Imunidade Inata , Imuno-Histoquímica , Vírus da Influenza A Subtipo H1N1/fisiologia , Vírus da Influenza A Subtipo H3N2/fisiologia , Concentração Inibidora 50 , Pulmão/patologia , Células Madin Darby de Rim Canino , Técnicas de Cultura de Órgãos , PerusRESUMO
In patients with advanced and recurrent colorectal cancer, surgical resection with clear margins is the greatest challenge and is limited by known anatomical constraints. Preoperative or intra-operative assessment of the limits of surgical dissection may help to explore the possibility of improving resectability through either targeted external beam radiotherapy or intra-operative radiotherapy. Professor Chang reviews the evidence base and potential advantages and disadvantages of this approach, whilst the expert panel agree a consensus on the evidence for assessment and therapy of such patients.
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Braquiterapia/métodos , Colectomia/métodos , Neoplasias Colorretais/radioterapia , Neoplasias Colorretais/cirurgia , Cuidados Intraoperatórios/métodos , Procedimentos Cirúrgicos Robóticos/métodos , Neoplasias Colorretais/mortalidade , Neoplasias Colorretais/patologia , Consenso , Intervalo Livre de Doença , Feminino , Humanos , Masculino , Terapia Neoadjuvante/métodos , Invasividade Neoplásica/patologia , Estadiamento de Neoplasias , Seleção de Pacientes , Cuidados Pré-Operatórios/métodos , Prognóstico , Dosagem Radioterapêutica , Medição de Risco , Análise de SobrevidaRESUMO
Approximately 10-15% of patients present with an advanced rectal cancer that extends beyond the conventional total mesorectal excision (TME) planes. In such cases extending the surgery to ensure resection with clear margins (R0 resection) is essential in order to achieve long-term cure. Professor Holm describes the techniques of beyond-TME exenterative surgery, the methods of patient selection and outcomes.
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Atitude do Pessoal de Saúde , Margens de Excisão , Protectomia/métodos , Neoplasias Retais/patologia , Neoplasias Retais/cirurgia , Consenso , Feminino , Humanos , Imageamento por Ressonância Magnética/métodos , Masculino , Mesocolo/cirurgia , Invasividade Neoplásica/patologia , Estadiamento de Neoplasias , Exenteração Pélvica , Prognóstico , Neoplasias Retais/mortalidade , Medição de Risco , Cirurgiões/psicologia , Análise de SobrevidaRESUMO
From the patient's perspective, cancer cure with full preservation of function is a crucial goal. There are many advances that have emerged which may make this possible in a greater proportion of patients without compromising oncological outcomes. Professor Tekkis reviews the options and evidence to date for 'organ preservation' and the expert panel discuss the implications for current and future patient care.
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Quimiorradioterapia/métodos , Recidiva Local de Neoplasia/mortalidade , Tratamentos com Preservação do Órgão/métodos , Neoplasias Retais/patologia , Neoplasias Retais/terapia , Quimiorradioterapia/mortalidade , Consenso , Intervalo Livre de Doença , Feminino , Humanos , Masculino , Invasividade Neoplásica/patologia , Recidiva Local de Neoplasia/patologia , Recidiva Local de Neoplasia/terapia , Estadiamento de Neoplasias , Seleção de Pacientes , Prognóstico , Neoplasias Retais/mortalidade , Medição de Risco , Análise de Sobrevida , Resultado do TratamentoRESUMO
Magnetic resonance imaging plays an increasingly important role in evaluating the effect of cancer treatment. Imaging alone cannot predict pathological complete response and imaging interpretation should be combined with clinical information and endoscopy findings to predict complete response. Professor Blomqvist reviews current and future imaging techniques and whether the quantitative can add significant or important prognostic information over the current qualitative techniques.
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Imagem de Difusão por Ressonância Magnética/métodos , Terapia Neoadjuvante/métodos , Neoplasias Retais/diagnóstico por imagem , Neoplasias Retais/terapia , Quimiorradioterapia/métodos , Consenso , Intervalo Livre de Doença , Feminino , Humanos , Masculino , Invasividade Neoplásica/patologia , Estadiamento de Neoplasias , Protectomia/métodos , Prognóstico , Neoplasias Retais/mortalidade , Neoplasias Retais/patologia , Medição de Risco , Análise de SobrevidaRESUMO
Seagrass meadows suffered large-scale declines in the past century. The 'wasting disease', pathognomonically associated with Labyrinthula zosterae, reduced populations of Zostera marina on both sides of the North Atlantic in, and since, the 1930s, coinciding with intensive agricultural use of artificial fertilizers and herbicides. This study tests the long-standing hypothesis that nutrient enrichment and a herbicide increases vulnerability to pathogens. Z. marina shoots from the Thames Estuary grown in elevated nitrate concentrations had significantly higher rates of infection by L. zosterae than controls, but not by Aplanochytrium sp., another slime-mould like protist. Z. marina shoots grown in 2µg·l-1 Diuron solutions and infected separately by L. zosterae and Aplanochytrium sp. had significantly higher wasting indices than controls. The results identified Aplanochytrium sp. as another opportunistic pathogen causing a seagrass wasting-type disease and support the hypothesis that pollution by herbicides and nitrate increases the susceptibility of Z. marina to infections.
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Diurona/toxicidade , Doenças das Plantas/etiologia , Poluentes Químicos da Água/toxicidade , Zosteraceae/efeitos dos fármacos , Herbicidas/toxicidade , Interações Hospedeiro-Patógeno , Nitratos/toxicidade , Doenças das Plantas/microbiologia , Dinâmica Populacional , Estramenópilas/patogenicidade , Zosteraceae/microbiologiaRESUMO
Functionally graded, multi-layered coatings are designed to provide corrosion protection over a range of operating conditions typically found in industrial gas turbines. A model incorporating diffusion, equilibrium thermodynamics and oxidation has been developed to simulate the microstructural evolution within a multi-layered coating system. The phase and concentration profiles predicted by the model have been compared with an experimental multi-layered system containing an Al-rich outer layer, a Cr-enriched middle layer and an MCrAlY-type inner layer deposited on a superalloy substrate. The concentration distribution and many microstructural features observed experimentally can be predicted by the model. The model is expected to be useful for assessing the microstructural evolution of multilayer coated systems which can be potentially used on industrial gas turbine aerofoils.
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Vírus da Influenza A/isolamento & purificação , Influenza Humana/virologia , Neuraminidase/farmacologia , Infecções Respiratórias/virologia , Suscetibilidade a Doenças , Humanos , Influenza Humana/prevenção & controle , Lectinas/metabolismo , Ácido N-Acetilneuramínico/metabolismo , Sistema Respiratório/virologia , Infecções Respiratórias/prevenção & controleRESUMO
AIM: The study evaluated function and quality of life (QoL) in all patients having restorative proctocolectomy (RPC) in Denmark for ulcerative colitis (UC) from 1980 to 2010. Inclusion of all patients in one country has never previously been achieved. METHOD: All patients who had had a RPC in Denmark, from the first case in 1980 to the last case in 2010, were studied. A cross-sectional questionnaire survey was performed, and function and QoL were assessed using a standardized questionnaire - the Short-Form 36 (SF36) - and the inflammatory bowel disease questionnaire (IBDQ). RESULTS: The median duration of follow up was 11 (range, 1-30) years. Apart from deaths, pouch failures and research protection, data on function and QoL were obtained from 1047 (85%) of 1229 patients who had a functioning pouch at the time of the investigation. More female patients than male patients experienced urgency (56% vs 44%, P = 0.0021). The median number of bowel movements per 24 h was 7 (range, 1-23) in female patients and 6 (range, 1-20) in male patients (P < 0.001). Pad usage was more frequent among female patients than among male patients (62% vs 38%, P < 0.001). A higher incidence of major incontinence (P = 0.009) and use of pads (P = 0.01) was found among patients who had been operated on 21-30 years previously compared with those operated on 11-20 years previously. The prevalence of urgency was higher in patients who received surgery 0-10 years previously compared with 11-20 years previously (P = 0.009). The total IBDQ score was higher in male patients than in female patients (P < 0.001). Male patients scored higher in five of eight SF36 domains (P < 0.001). CONCLUSION: Female patients had more urgency, a higher frequency of defaecation and higher pad usage. This was associated with a reduced QoL. Nevertheless, RPC resulted in good function and a high degree of satisfaction in most patients.
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Colite Ulcerativa/cirurgia , Bolsas Cólicas/efeitos adversos , Defecação/fisiologia , Incontinência Fecal/epidemiologia , Proctocolectomia Restauradora/efeitos adversos , Qualidade de Vida , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Colite Ulcerativa/psicologia , Estudos Transversais , Dinamarca/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Proctocolectomia Restauradora/psicologia , Fatores Sexuais , Inquéritos e Questionários , Fatores de Tempo , Resultado do TratamentoRESUMO
We study the temperature flow of conductivities in a gated GaAs two-dimensional electron gas (2DEG) containing self-assembled InAs dots and compare the results with recent theoretical predictions. By changing the gate voltage, we are able to tune the 2DEG density and thus vary disorder and spin-splitting. Data for both the spin-resolved and spin-degenerate phase transitions are presented, the former collapsing to the latter with decreasing gate voltage and/or decreasing spin-splitting. The experimental results support a recent theory, based on modular symmetry, which predicts how the critical Hall conductivity varies with spin-splitting.