Integrity of RNA in long-term-stored cervical liquid-based cytology samples: implications for biomarker research.

Biobanks of cervical screening (LBC) samples annotated with disease status are an invaluable resource to support the development of tools for the risk stratification of disease. Although there is growing interest in the assessment of RNA-based biomarkers, little is known on the suitability and durability of stored clinical samples (commonly used in cervical screening) to support RNA-based research. RNA was extracted from 260 stored LBC samples. Storage at -80°C or -25°C allowed isolation of sufficient RNA for further analysis. RNA was found to be substantially degraded according to Agilent Bioanalyser data. Despite this, RT-qPCR was successful in 95% samples tested. These data suggest that biobanked LBC samples are suitable for RNA-based assessment even if stored for up to 14 years.

COVID-19 managed on respiratory wards and intensive care units: Results from the national COVID-19 outcome report in Wales from March 2020 to December 2021.

BACKGROUND: A COVID-19 hospital guideline was implemented across all 18 acute hospitals in Wales in March 2020, promoting ward management of COVID pneumonitis and data collected across the first 3 Waves of the pandemic (Wave 1 March 1st 2020 to November 1st 2020, Wave 2 November 2st 2020 to February 21st 2021 and Wave 3 June 1st 2021 to December 14th 2021). The aim of this paper is to compare outcomes for patients by admission setting and type of ventilatory support given, with a particular focus on CPAP therapy. METHODS: This is a retrospective observational study of those aged over 18 admitted to hospital with community acquired COVID-19 between March 2020 and December 2021. The outcome of interest was in-hospital mortality. Univariate logistic regression models were used to compare crude outcomes across the waves. Multivariable logistic regression models were used to assess outcomes by different settings and treatments after adjusting for Wave, age, sex, co-morbidity and deprivation. RESULTS: Of the 7,803 records collected, 5,887 (75.4%) met the inclusion criteria. Analysis of those cases identified statistically significant outcome improvements across the waves for all patients combined (Waves 1 to 3: 31.5% to 18.8%, p<0.01), all ward patients (28.9% to 17.7%, p<0.01), and all ICU patients (44.3% to 32.2%, p = 0.03). Sub group analyses identified outcome improvements in ward patients without any oxygen therapy (Waves 1 to 3: 22.2% to 12.7%, p<0.01), with oxygen therapy only (34.0% to 12.9%, p<0.01) and with CPAP only (63.5% to 39.2%, p<0.01). The outcome improvements for ICU patients receiving CPAP only (35.7% to 24.6%, p = 0.31) or invasive ventilation (61.6% to 54.6%, p = 0.43) were not statistically significant though the numbers being admitted to ICU were small. The logistic regression models identified important age and comorbidity effects on outcomes. The multivariable model that took these into account suggested no statistically significantly greater risk of death for those receiving CPAP on the ward compared to those receiving CPAP in ICU (OR 0.89, 95% CI: 0.49 to 1.60). CONCLUSIONS: There were successive reductions in mortality in inpatients over the three Waves reflecting new treatments and better management of complications. Mortality for those requiring CPAP was similar in respiratory wards and ICUs after adjusting for differences in their respective patient populations.

Outcomes from a national screening program for Ukrainian refugees at risk of drug resistant tuberculosis in Wales.

High rates of drug-resistant tuberculosis in Ukraine suggest screening is necessary to mitigate public health hazards for host populations. A pathway was implemented in Wales and data prospectively collected Between 8 April and 21 December 2022. Of 5425 Ukrainian arrivals, notifications were received by TB teams on 2395 (44%) of whom 1955 (82%) were screened. The refugees were young (median age 30, IQR 14-41), and predominantly female (66.1%). Interferon- gamma release assay (IGRA) tests were positive in 112 (6.5%). One Case of active tuberculosis was identified (0.05%). Our data supports European guidelines that routine screening of this population is not recommended, but we remain uncertain as to the risks of this population going forwards.

Modal Decomposition of Acoustic Emissions from Pencil-Lead Breaks in an Isotropic Thin Plate.

Acoustic emission (AE) testing and Lamb wave inspection techniques have been widely used in non-destructive testing and structural health monitoring. For thin plates, the AEs arising from structural defect development (e.g., fatigue crack propagation) propagate as Lamb waves, and Lamb wave modes can be used to provide important information about the growth and localisation of defects. However, few sensors can be used to achieve the in situ wavenumber-frequency modal decomposition of AEs. This study explores the ability of a new multi-element piezoelectric sensor array to decompose AEs excited by pencil lead breaks (PLBs) on a thin isotropic plate. In this study, AEs were generated by out-of-plane (transverse) and in-plane (longitudinal) PLBs applied at the edge of the plate, and waveforms were recorded by both the new sensor array and a commercial AE sensor. Finite element analysis (FEA) simulations of PLBs were also conducted and the results were compared with the experimental results. To identify the wave modes present, the longitudinal and transverse PLB test results recorded by the new sensor array at five different plate locations were compared with FEA simulations using the same arrangement. Two-dimensional fast Fourier Transforms were then applied to the AE wavefields. It was found that the AE modal composition was dependent on the orientation of the PLB direction. The results suggest that this new sensor array can be used to identify the AE wave modes excited by PLBs in both in-plane and out-of-plane directions.

Strategies to promote guideline adoption: lessons learned from the implementation of a national COVID-19 hospital guideline across NHS Wales.

There is little understanding about what proportion of the target audience have read guidelines published through the traditional approach. The COVID-19 pandemic created a particularly difficult scenario for healthcare professionals (HCP) since the evidence base rapidly changed. In response, we established a freely accessible, video-based online resource, which was formally implemented requiring user registration. The guideline rapidly gained more than 4,500 registrants in the first wave alone, including nearly 100% of respiratory, intensive care or emergency unit consultants in Wales. During the first wave, there were nearly 170,000 page views with over 31,000 video plays and an average of 5.8 visits to the site per registrant. Acceptability using an online survey showed widespread support and that the unsubscribe rates were remarkably low. We suggest that this novel approach to guideline implementation achieved its aim of widespread engagement and acceptability and serves as a potential model for future medical guidelines and education beyond COVID-19.

Acoustic Emission Source Characterisation during Fatigue Crack Growth in Al 2024-T3 Specimens.

While acoustic emission (AE) testing can be used as a valuable technique in structural health monitoring and non-destructive testing, little research has been conducted to establish its sources, particularly in 2024-T3 aluminium alloys. The major contribution of this work is that it provides a method to obtain a better linear relationship of count rate with crack growth rate based on waveform. This paper aims to characterise AE sources by synchronising the AE waveforms with load levels and then to propose possible dominant frequency ranges. The AE waveforms during fatigue crack growth in edge-notched 2024-T3 aluminium specimens, from an initial crack length of 10 mm to 70 mm, were collected at two different load ratios R = 0.125 and 0.5. At the same time, the crack growth rate was determined using thermal imaging and associated control software. The AE waveforms obtained were processed using the fast Fourier transform. It was shown that a significantly higher AE count rate was recorded at R = 0.125 compared to R = 0.5 when the maximum load was kept the same. This means that the R-ratio would affect the total amount of AE activities collected. It was also found that the dominant frequency range of the AE waveforms directly related to crack growth was 152-487 kHz, and the ranges due to crack closure were likely to be 310 kHz-316 kHz and 500-700 kHz. Based on the proposed frequency ranges, waveform selection was conducted and a better linear relationship between count rate and crack growth rate was observed. This study provides a better understanding of the AE sources and waveforms for future structural health monitoring applications.

Investigating the Opposing Effect of Two Different Green Tea Supplements on Oxidative Stress, Mitochondrial Function and Cell Viability in HepG2 Cells.

Green tea extract (GTE) improves exercise outcomes and reduces obesity. However, case studies indicate contradictory physiology regarding liver function and toxicity. We studied the effect of two different decaffeinated GTE (dGTE) products, from a non-commercial (dGTE1) and commercial (dGTE2) supplier, on hepatocyte function using the human cell model, HepG2. dGTE1 was protective against hydrogen peroxide (H2O2)-induced apoptosis and cell death by attenuating oxidative stress pathways. Conversely, dGTE2 increased cellular and mitochondrial oxidative stress and apoptosis. A bioavailability study with dGTE showed the major catechin in GTE, EGCG, reached 0.263 µg·ml-1. In vitro, at this concentration, EGCG mimicked the protective effect of dGTE1. GC/MS analysis identified steric acid and higher levels of palmitic acid in dGTE2 versus dGTE1 supplements. We demonstrate the significant biological differences between two GTE supplements which may have potential implications for manufacturers and consumers to be aware of the biological effects of supplementation.

Burden of nosocomial COVID-19 in Wales: results from a multicentre retrospective observational study of 2508 hospitalised adults.

The burden of nosocomial SARS-CoV-2 infection remains poorly defined. We report on the outcomes of 2508 adults with molecularly-confirmed SARS-CoV-2 admitted across 18 major hospitals, representing over 60% of those hospitalised across Wales between 1 March and 1 July 2020. Inpatient mortality for nosocomial infection ranged from 38% to 42%, consistently higher than participants with community-acquired infection (31%-35%) across a range of case definitions. Those with hospital-acquired infection were older and frailer than those infected within the community. Nosocomial diagnosis occurred a median of 30 days following admission (IQR 21-63), suggesting a window for prophylactic or postexposure interventions, alongside enhanced infection control measures.

Protocol for the development of the Wales Multimorbidity e-Cohort (WMC): data sources and methods to construct a population-based research platform to investigate multimorbidity.

INTRODUCTION: Multimorbidity is widely recognised as the presence of two or more concurrent long-term conditions, yet remains a poorly understood global issue despite increasing in prevalence.We have created the Wales Multimorbidity e-Cohort (WMC) to provide an accessible research ready data asset to further the understanding of multimorbidity. Our objectives are to create a platform to support research which would help to understand prevalence, trajectories and determinants in multimorbidity, characterise clusters that lead to highest burden on individuals and healthcare services, and evaluate and provide new multimorbidity phenotypes and algorithms to the National Health Service and research communities to support prevention, healthcare planning and the management of individuals with multimorbidity. METHODS AND ANALYSIS: The WMC has been created and derived from multisourced demographic, administrative and electronic health record data relating to the Welsh population in the Secure Anonymised Information Linkage (SAIL) Databank. The WMC consists of 2.9 million people alive and living in Wales on the 1 January 2000 with follow-up until 31 December 2019, Welsh residency break or death. Published comorbidity indices and phenotype code lists will be used to measure and conceptualise multimorbidity.Study outcomes will include: (1) a description of multimorbidity using published data phenotype algorithms/ontologies, (2) investigation of the associations between baseline demographic factors and multimorbidity, (3) identification of temporal trajectories of clusters of conditions and multimorbidity and (4) investigation of multimorbidity clusters with poor outcomes such as mortality and high healthcare service utilisation. ETHICS AND DISSEMINATION: The SAIL Databank independent Information Governance Review Panel has approved this study (SAIL Project: 0911). Study findings will be presented to policy groups, public meetings, national and international conferences, and published in peer-reviewed journals.

Understanding and responding to COVID-19 in Wales: protocol for a privacy-protecting data platform for enhanced epidemiology and evaluation of interventions.

INTRODUCTION: The emergence of the novel respiratory SARS-CoV-2 and subsequent COVID-19 pandemic have required rapid assimilation of population-level data to understand and control the spread of infection in the general and vulnerable populations. Rapid analyses are needed to inform policy development and target interventions to at-risk groups to prevent serious health outcomes. We aim to provide an accessible research platform to determine demographic, socioeconomic and clinical risk factors for infection, morbidity and mortality of COVID-19, to measure the impact of COVID-19 on healthcare utilisation and long-term health, and to enable the evaluation of natural experiments of policy interventions. METHODS AND ANALYSIS: Two privacy-protecting population-level cohorts have been created and derived from multisourced demographic and healthcare data. The C20 cohort consists of 3.2 million people in Wales on the 1 January 2020 with follow-up until 31 May 2020. The complete cohort dataset will be updated monthly with some individual datasets available daily. The C16 cohort consists of 3 million people in Wales on the 1 January 2016 with follow-up to 31 December 2019. C16 is designed as a counterfactual cohort to provide contextual comparative population data on disease, health service utilisation and mortality. Study outcomes will: (a) characterise the epidemiology of COVID-19, (b) assess socioeconomic and demographic influences on infection and outcomes, (c) measure the impact of COVID-19 on short -term and longer-term population outcomes and (d) undertake studies on the transmission and spatial spread of infection. ETHICS AND DISSEMINATION: The Secure Anonymised Information Linkage-independent Information Governance Review Panel has approved this study. The study findings will be presented to policy groups, public meetings, national and international conferences, and published in peer-reviewed journals.

Functionalized Boron Nitride Nanosheets: A Thermally Rearranged Polymer Nanocomposite Membrane for Hydrogen Separation.

Amino functionalized boron nitride nanosheets (FBN) were incorporated into a crosslinked, thermally rearranged polyimide (XTR) to fabricate FBN-XTR nanocomposite membrane. The FBN-XTR membrane exhibited a small decrease in H2 permeability but demonstrated a remarkably increased H2 gas selectivity over other gases, compared with XTR. The XTR membrane heat-treated at 425 °C had a H2 permeability of 210 Barrers and a H2 /CH4 separation factor of 24.1, whereas the nanocomposite membrane with 1 wt % FBN exhibited a H2 permeability of 110 Barrers and H2 /CH4 separation factor of 275, an order of magnitude greater. At 1 wt % FBN loading, the FBN-XTR membrane showed three times higher tensile strength and 60 % higher elongation than pristine XTR membrane. In addition, FBN-XTR was found to be able to be readily processed into thin-film membranes for practical H2 separation applications.

British Thoracic Society Guideline for the initial outpatient management of pulmonary embolism.

The following is a summary of the recommendations and good practice points for the BTS Guideline for the initial outpatient management of pulmonary embolism. Please refer to the full guideline for full information about each section.

Super-formable pure magnesium at room temperature.

Magnesium, the lightest structural metal, is difficult to form at room temperature due to an insufficient number of deformation modes imposed by its hexagonal structure and a strong texture developed during thermomechanical processes. Although appropriate alloying additions can weaken the texture, formability improvement is limited because alloying additions do not fundamentally alter deformation modes. Here we show that magnesium can become super-formable at room temperature without alloying. Despite possessing a strong texture, magnesium can be cold rolled to a strain at least eight times that possible in conventional processing. The resultant cold-rolled sheet can be further formed without cracking due to grain size reduction to the order of one micron and inter-granular mechanisms becoming dominant, rather than the usual slip and twinning. These findings provide a pathway for developing highly formable products from magnesium and other hexagonal metals that are traditionally difficult to form at room temperature.Replacing steel or aluminium vehicle parts with magnesium would result in reduced emissions, but shaping magnesium without cracking remains challenging. Here, the authors successfully extrude and roll textured magnesium into ductile foil at low temperatures by activating intra-granular mechanisms.

Stress corrosion cracking and corrosion fatigue characterisation of MgZn1Ca0.3 (ZX10) in a simulated physiological environment.

Magnesium (Mg) alloys have attracted great attention as potential materials for biodegradable implants. It is essential that an implant material possesses adequate resistance to cracking/fracture under the simultaneous actions of corrosion and mechanical stresses, i.e., stress corrosion cracking (SCC) and/or corrosion fatigue (CF). This study investigates the deformation behaviour of a newly developed high-strength low-alloy Mg alloy, MgZn1Ca0.3 (ZX10), processed at two different extrusion temperatures of 325 and 400°C (named E325 and E400, respectively), under slow strain tensile and cyclic tension-compression loadings in air and modified simulated body fluid (m-SBF). Extrusion resulted in a bimodal grain size distribution with recrystallised grain sizes of 1.2 µm ± 0.8 µm and 7 ± 5 µm for E325 and E400, respectively. E325 possessed superior tensile and fatigue properties to E400 when tested in air. This is mainly attributed to a grain-boundary strengthening mechanism. However, both E325 and E400 were found to be susceptible to SCC at a strain rate of 3.1×10-7s-1 in m-SBF. Moreover, both E325 and E400 showed similar fatigue strength when tested in m-SBF. This is explained on the basis of crack initiation from localised corrosion following tests in m-SBF.

Optimization of a Novel Binding Motif to (E)-3-(3,5-Difluoro-4-((1R,3R)-2-(2-fluoro-2-methylpropyl)-3-methyl-2,3,4,9-tetrahydro-1H-pyrido[3,4-b]indol-1-yl)phenyl)acrylic Acid (AZD9496), a Potent and Orally Bioavailable Selective Estrogen Receptor Downregulator and Antagonist.

The discovery of an orally bioavailable selective estrogen receptor downregulator (SERD) with equivalent potency and preclinical pharmacology to the intramuscular SERD fulvestrant is described. A directed screen identified the 1-aryl-2,3,4,9-tetrahydro-1H-pyrido[3,4-b]indole motif as a novel, druglike ER ligand. Aided by crystal structures of novel ligands bound to an ER construct, medicinal chemistry iterations led to (E)-3-(3,5-difluoro-4-((1R,3R)-2-(2-fluoro-2-methylpropyl)-3-methyl-2,3,4,9-tetrahydro-1H-pyrido[3,4-b]indol-1-yl)phenyl)acrylic acid (30b, AZD9496), a clinical candidate with high oral bioavailability across preclinical species that is currently being evaluated in phase I clinical trials for the treatment of advanced estrogen receptor (ER) positive breast cancer.

Carbon Nanotube/Alumina/Polyethersulfone Hybrid Hollow Fiber Membranes with Enhanced Mechanical and Anti-Fouling Properties.

Carbon nanotubes (CNTs) were incorporated into alumina/polyethersulfone hollow fibre membranes to enhance the mechanical property and the efficiency of water treatment. Results show that the incorporation of CNTs can greatly limit the formation of large surface pores, decrease the void size in support layers and improve the porosity and pore connectivity of alumina/polyethersulfone membranes. As a result of such morphology change and pore size change, both improved flux and rejection were achieved in such CNTs/alumina/polyethersulfone membranes. Moreover, the CNTs/alumina/PES membranes show higher antifouling ability and the flux recoveries after being fouled by bovine serum albumin (BSA) and humic acid were improved by 84.1% and 53.2% compared to the samples without CNT incorporation. Besides the improvement in water treatment performance, the incorporation of CNTs enhanced the tensile properties of inorganic/polymer membranes. Therefore, such CNTs/alumina/PES hollow fiber membranes are very promising candidates for good filter media in industry, considering their high efficiency and high mechanical properties.

Brachial artery pseudoaneurysm.

We describe a case of an elderly man who presented with an upper arm swelling that had developed following a humeral fracture 8 months previously. The swelling was painless but associated with significantly diminished motor function of his right hand and concurrent paraesthaesia. On examination, a large pulsatile mass was identified and CT angiography confirmed the presence of an 11×7 cm brachial artery pseudoaneurysm. The patient underwent surgical repair in which a fragment of the humerus was found to have punctured the brachial artery resulting in a pseudoaneurysm. The patient had an uncomplicated postoperative period and was discharged 2 days later having regained some motor function in his right hand.

An evaluation of the infection control potential of a UV clinical podiatry unit.

BACKGROUND: Infection control is a key issue in podiatry as it is in all forms of clinical practice. Airborne contamination may be particularly important in podiatry due to the generation of particulates during treatment. Consequently, technologies that prevent contamination in podiatry settings may have a useful role. The aims of this investigation were twofold, firstly to determine the ability of a UV cabinet to protect instruments from airborne contamination and secondly to determine its ability to remove microbes from contaminated surfaces and instruments. METHOD: A UV instrument cabinet was installed in a University podiatry suite. Impact samplers and standard microbiological techniques were used to determine the nature and extent of microbial airborne contamination. Sterile filters were used to determine the ability of the UV cabinet to protect exposed surfaces. Artificially contaminated instruments were used to determine the ability of the cabinet to remove microbial contamination. RESULTS: Airborne bacterial contamination was dominated by Gram positive cocci including Staphylococcus aureus. Airborne fungal levels were much lower than those observed for bacteria. The UV cabinet significantly reduced (p < 0.05) the observed levels of airborne contamination. When challenged with contaminated instruments the cabinet was able to reduce microbial levels by between 60% to 100% with more complex instruments e.g. clippers, remaining contaminated. CONCLUSIONS: Bacterial airborne contamination is a potential infection risk in podiatry settings due to the presence of S. aureus. The use of a UV instrument cabinet can reduce the risk of contamination by airborne microbes. The UV cabinet tested was unable to decontaminate instruments and as such could pose an infection risk if misused.