Naresuan University Journal
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Peatland restoration: controls on sediment production and reductions in carbon and pollutant export
No full textWildfire risk in Community Risk Registers (CRR), Integrated Risk Management Plans (IRMP) and Incident Recording System (IRS)
No full textUsing maps and diagrams, this paper compares relative risk of wildfire as assessed in Integrated Risk Management Plans (IRMP) and Community Risk Registers (CRR), with the actual occurrence of wildfire from the Incident Recording System (IRS). We aim to show and explain why these three data sources convey different pictures of wildfire risk, and how IRS data could help quantify the likelihood of vegetation fire of different magnitudes within and between areas. CRRs are prepared for emergency planning purposes by Local Resilience Forums (LRF). LRFs rate likelihood, impact and overall risk of any hazards affecting local communities within their area. A survey of the 38 CRRs available online for England, Scotland and Wales in February-April 2015, showed that three-quarters included ‘moorland and forest fire’. Also in 2015, Fire and Rescue Services were surveyed to determine whether they had considered and identified wildfire within their IRMPs. Like CRRs, they assess wildfire risk relative to other local risks. In contrast, IRS data gives a quantitative estimate of the actual number of wildfire incidents, how this varies within areas, and allows comparison nationally between areas. Different magnitudes of fire can be mapped, ranging from all vegetation fires regardless of size, duration or appliances deployed, to ‘wildfire’ as defined in the Scottish Wildfire Operational Guidance (2012)
Management of the respiratory distress symptom cluster in lung cancer: a randomised controlled feasibility trial
No full textBackground: Breathlessness, cough and fatigue are distressing symptoms for patients with lung cancer. There is evidence that these three symptoms form a discreet symptom cluster. This study aimed to feasibility test a new non-pharmacological intervention for the management of the Respiratory Distress Symptom Cluster (breathlessness-cough-fatigue) in lung cancer. Method: This was a multi-centre, randomised controlled non-blinded parallel group feasibility trial. Eligible patients (patients with primary lung cancer and ‘bothered’ by at least two of the three cluster symptoms) received usual care plus a multicomponent intervention delivered over two intervention training sessions and a follow-up telephone call or usual care only. Follow-up was for 12 weeks and end-points included: six numerical rating scales (NRS) for breathlessness severity; Dyspnoea-12; Manchester Cough in Lung Cancer scale (MCLS); FACT-Fatigue scale (FACT-F); Hospital Anxiety and Depression scale (HADS); Lung Cancer Symptom Scale (LCSS); and the EQ-5D-3L, collected at baseline, week-4 and week-12. Results: 107 patients were randomised over eight months; however six were removed from further analysis due to protocol violations (intervention group n=50 and control group n=51). Of the ineligible patients (n = 608), 29% reported either not experiencing two or more symptoms or not being ‘bothered’ by at least two symptoms. There was 29% drop-out by week four and by week 12 a further two patients in the control group were lost to follow-up. A sample size calculation indicated that 122 patients per arm would be needed to detect a clinically important difference in the main outcome for breathlessness, cough and fatigue. Conclusions: The study has provided evidence of the feasibility and acceptability of a new intervention in the lung cancer population, and warrants a fully powered trial before we reach any conclusions. The follow-on trial will test the hypothesis that the intervention improves symptom cluster of breathlessness, cough and fatigue better than usual care alone. Full economic evaluation will be conducted in the main trial
Novel systemic therapies for the treatment of psoriasis.
No full textINTRODUCTION: The immunopathogenesis of psoriasis has led to the discovery and development of several promising treatment options for psoriasis, including those that target the IL-17 and IL-23 pathways as well as small molecules that act on intracellular signaling pathways including the Janus kinase inhibitor and phosphodiesterase-4 inhibitor. Studies have demonstrated efficacy although long-term risks are not fully known. This review looks at novel systemic therapies for psoriasis that have emerged recently. Areas covered: Systemic treatments for psoriasis that are in the late phase of development were reviewed, with the main focus on the efficacy and adverse effects of individual treatments. Expert opinion: The future of psoriasis treatment is likely to be based on clinical, genetic and immune biomarkers that will individualize treatment and may potentially optimize disease outcome
Second-line agents in myositis: 1-year factorial trial of additional immunosuppression in patients who have partially responded to steroids.
No full textOBJECTIVE: Ciclosporin and MTX are used in idiopathic inflammatory myopathies (DM and PM) when patients incompletely respond to glucocorticoids. Their effectiveness is unproved in randomized controlled trials (RCTs). We evaluated their benefits in a placebo-controlled factorial RCT. METHODS: A 56-week multicentre factorial-design double-blind placebo-controlled RCT compared steroids alone, MTX (15-25 mg weekly) plus steroids, ciclosporin (1-5 mg/kg/day) plus steroids and all three treatments. It enrolled adults with myositis (by Bohan and Peter criteria) with active disease receiving corticosteroids. RESULTS: A total of 359 patients were screened and 58 randomized. Of the latter, 37 patients completed 12 months of treatment, 7 were lost to follow-up and 14 discontinued treatment. Patients completing 12 months of treatment showed significant improvement (P <0.001 on paired t-tests) in manual muscle testing (14% change), walking time (22% change) and function (9% change). Intention to treat and completer analyses indicated that ciclosporin monotherapy, MTX monotherapy and ciclosporin/MTX combination therapy showed no significant treatment effects in comparison with placebo. CONCLUSION: Neither MTX nor ciclosporin (by themselves or in combination) improved clinical features in myositis patients who had incompletely responded to glucocorticoids. TRIAL REGISTRATION: International Standard Randomized Controlled Trial Number Register; http://www.controlled-trials.com/; ISRCTN40085050
Sutured tendon repair; a multi-scale finite element model
No full textFollowing rupture, tendons are sutured to reapproximate the severed ends and permit healing. Several repair techniques are employed clinically, with recent focus towards high-strength sutures, permitting early active mobilisation thus improving resultant joint mobility. However, the arrangement of suture repairs locally alters the loading environment experienced by the tendon. The extent of the augmented stress distribution and its effect on the tissue is unknown. Stress distribution cannot be established using traditional tensile testing, in vivo, or ex vivo study of suture repairs. We have developed a 3D finite element model of a Kessler suture repair employing multiscale modelling to represent tendon microstructure and incorporate its highly orthotropic behaviour into the tissue description. This was informed by ex vivo tensile testing of porcine flexor digitorum profundus tendon. The transverse modulus of the tendon was 0.2551 [Formula: see text] 0.0818 MPa and 0.1035 [Formula: see text] 0.0454 MPa in proximal and distal tendon samples, respectively, and the interfibrillar tissue modulus ranged from 0.1021 to 0.0416 MPa. We observed an elliptically shaped region of high stress around the suture anchor, consistent with a known region of acellularity which develop 72 h post-operatively and remain for at least a year. We also observed a stress shielded region close to the severed tendon ends, which may impair collagen fibre realignment during the remodelling stage of repair due to the lack of tensile stress
Two-particle Bose???Einstein correlations in pp collisions at 0.9 and 7 TeV measured with the ATLAS detector
No full textA qualitative study to explore how professionals in the United Kingdom make decisions to test children for a sickle cell carrier status
No full textFacilitating large-scale implementation of evidence based health care: Insider accounts from a co-operative inquiry
No full textBackground: Facilitators are known to be influential in the implementation of evidence-based health care (EBHC). However, little evidence exists on what it is that they do to support the implementation process. This research reports on how knowledge transfer associates (KTAs) working as part of the UK National Institute for Health Research 'Collaboration for Leadership in Applied Health Research and Care' for Greater Manchester (GM CLAHRC) facilitated the implementation of EBHC across several commissioning and provider health care agencies. Methods: A prospective co-operative inquiry with eight KTAs was carried out comprising of 11 regular group meetings where they reflected critically on their experiences. Twenty interviews were also conducted with other members of the GM CLAHRC Implementation Team to gain their perspectives of the KTAs facilitation role and process. Results: There were four phases to the facilitation of EBHC on a large scale: (1) Assisting with the decision on what EBHC to implement, in this phase, KTAs pulled together people and disparate strands of information to facilitate a decision on which EBHC should be implemented; (2) Planning of the implementation of EBHC, in which KTAs spent time gathering additional information and going between key people to plan the implementation; (3) Coordinating and implementing EBHC when KTAs recruited general practices and people for the implementation of EBHC; and (4) Evaluating the EBHC which required the KTAs to set up (new) systems to gather data for analysis. Over time, the KTAs demonstrated growing confidence and skills in aspects of facilitation: research, interpersonal communication, project management and change management skills. Conclusion: The findings provide prospective empirical data on the large scale implementation of EBHC in primary care and community based organisations focusing on resources and processes involved. Detailed evidence shows facilitation is context dependent and that 'one size does not fits all'. Co-operative inquiry was a useful method to enhance KTAs learning. The evidence shows that facilitators need tailored support and education, during the process of implementation to provide them with a well-rounded skill-set. Our study was not designed to demonstrate how facilitators contribute to patient health outcomes thus further prospective research is required