Impact of 5 years of hepatitis C testing and treatment in the North East of England prisons.

Hepatitis C virus infection (HCV) is prevalent in prisons. Therefore, effective prison HCV services are critical for HCV elimination programmes. We aimed to evaluate the efficacy of a regional HCV prison testing and treatment programme. Between July 2017 and June 2022, data were collected prospectively on HCV test offer and uptake rates, HCV Antibody (HCV-Ab) and HCV-RNA positivity, treatment starts and outcomes for new inmates incarcerated in three prisons. Rates of HCV-Ab and RNA positivity at reception, incidence of new HCV infections and reinfection following treatment were determined. From a total of 39,652 receptions, 33,028 (83.3%) were offered HCV testing and 20,394 (61.7%) completed testing. Including all receptions, 24.5% of tests (n = 4995) were HCV-Ab positive and 8.4% of tests (n = 1713) were HCV-RNA positive. When considering the first test for each individual (median age 34 years; 88.1% male), 14.8% (n = 1869) and 7.2% (n = 905) were HCV-Ab and HCV-RNA positive, respectively. The incidence of new HCV-Ab and RNA positivity was 5.1 and 3.3 per 100 person-years, respectively. Of 1145 HCV viraemic individuals, 18 died within 6 months and 150 were rapidly transferred out of area, leaving 977 individuals with outcomes. Of these, 835 (85.5%) received antivirals and 47 spontaneously cleared the infection, leaving 95 (9.7%) untreated. 607 (72.7%) achieved SVR. 95 patients had reinfection post-treatment (rate 10.1 cases per 100 person-years). Testing for HCV has increased in our prisons and the majority with viraemia are initiated on antiviral treatment. Reassuringly, a significant fall in frequency of HCV-RNA positivity at prison reception was observed suggesting progress towards HCV elimination.

Applications and Life Cycle Assessment of Shape Memory Polyethylene Terephthalate in Concrete for Crack Closure.

Shape memory polymer (SMP) products have been developed for application as crack closure devices in concrete. They have been made from PET in the form of both fibres and hollow tubes. Here, manufacturing methods using die-drawing and mandrel-drawing to induce shape memory are reported. The fibre-based devices are incorporated into concrete and, upon triggering, exert shrinkage restraint forces that close cracks in the concrete. The evolution of shrinkage restraint force in the fibres as manufactured was measured as a function of temperature, showing stresses in excess of 35 MPa. Tendons consisting of fibre bundles are incorporated into concreate beams subjected to controlled cracking. When activated, the tendons reduce the crack widths by 80%. The same fibres are used to produce another class of device known as knotted fibres, which have knotted ends that act as anchor points when they incorporated directly into concrete. Upon activation within the cracked concrete, these devices are shown to completely close cracks. The tubes are used to enclose and restrain prestressed Kevlar fibres. When the tubes are triggered, they shrink and release the prestress force in the Kevlar, which is transferred to the surrounding concrete in the form of a compressive force, thereby closing cracks. The Kevlar fibres also provide substantial reinforcement after activation. The devices are shown to be able to partially and fully close cracks that have been opened to 0.3 mm and achieve post-activation flexural strengths comparable to those of conventional reinforced and prestressed structural elements. Finally, a preliminary life cycle assessment study was used to assess the carbon footprint a nominal unit of concrete made with SMPs fibres compared to conventional concrete.

Panic and perjury: a psychosocial exploration of agency.

The aim of this article is to explore the predicament of one man in difficult circumstances, in order to produce a psychosocial analysis that could contribute to a social psychological understanding of agency. After a brief review of the problem of dualism in theorizing agency and relevant developments in theories of self, and a critique of assumptions about unitary rational subjects, we emphasize the effects of unconscious conflict on choice and agency. We also identify the importance of including people's biographically motivated investments in specific discursive positions. Vince, a middle-aged, working-class man from the north of England, the subject of our case study, had already been faced with difficult choices in order to hold on to a job that was bad for him. Now the choice appeared to be taken out of his hands by an illness without a discernible organic base and with no prospect of improvement that, for 5 months, had forced him to be on sick leave. Our approach in this paper, based on interpretation of material from two interviews, is to detail the multiple and contradictory meanings of Vince's job to him. In each of three areas - the daily experience of the job, the meaning of having a respectable job, and Vince's relationship with his boss - we illustrate the power of a psychosocial analysis to escape the limitations of both voluntaristic and deterministic accounts of individual action. In conclusion we define the agent of choice in Vince's case as the divided psychosocial subject of unconscious conflict; a subject located in social realities mediated not only by social discourses but by psychic defences.