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Patient-reported outcomes, postoperative pain and pain relief after day case surgery (POPPY): methodology for a prospective, multicentre observational study*
Get PDFBackground: In the UK, approximately 70% of surgical procedures are undertaken as day-cases. Little information exists about recovery from day-case surgery, yet international data highlights patients are at risk of developing significant longer-term health problems including chronic post-surgical pain and persistent postoperative opioid use. The Patient-reported Outcomes, Postoperative Pain and pain relief after daY case surgery (POPPY) study was a national prospective multicentre observational study, measuring short- and longer-term patient-reported outcomes, postoperative pain and pain relief after day-case surgery. Methods: This was a collaborative project led by resident anaesthetists under the Research and Audit Federation of Trainees umbrella. Adult day-case surgical patients were recruited on the day of surgery. Baseline data including patient characteristics; procedure details; pre-operative analgesic use; pre-existing pain; and quality of life scores were recorded. Patients were followed up through automated short message service messages. Short-term (postoperative days 1, 3 and 7) outcomes included: quality of recovery; pain severity; impact of pain on function; and analgesic use. Longer-term outcomes (postoperative day 97) included: quality of life; analgesic use; incidence of chronic post-surgical pain; and incidence persistent postoperative opioid use. Additional outcomes were completed by those patients with chronic post-surgical pain and persistent postoperative opioid use, with 30 patients recruited to a qualitative semi-structured interview study exploring postoperative expectations, recovery, postoperative pain and opioid use. Results: An embedded pilot study at four sites recruited 129 patients. Responses to the automated short message service were gained from 129 patients (100%) at day 1; 116 (89.9%) at day 3; 108 (83.7%) at day 7; and 77 (59.7%) at day 97 postoperatively. The pilot enabled refinement of the methods and processes before the national roll out. Conclusion: This paper outlines the methods for the POPPY study, the largest UK multicentre prospective observational study considering short- and longer-term outcomes following day-case surgery
Changes in the spatiotemporal patterns of COVID-19 in Japan from 2020 through 2023
Get PDFBACKGROUND: The spread of coronavirus disease 2019 (COVID-19) varied among countries. The spatiotemporal trends of COVID-19 in Japan remain understudied. Therefore, this study aimed to conduct a detailed investigation of the spatiotemporal evolution of infections/deaths across prefectures in Japan, to analyze the changing patterns of COVID-19 circulation in metropolitan and nonmetropolitan areas.
METHODS: We extracted data from nationally represented open-source data from January 15, 2020, to May 9, 2023, and we calculated the incidence rate of infection and the mortality. Further the ratios were obtained by dividing those rates in prefectural level by those in national level to make them comparable across country. Then, the spatiotemporal trends of COVID-19 were depicted via heatmaps. A Poisson regression model was used to compare the incidence rate ratios (IRRs) of infection and death between nonmetropolitan and metropolitan prefectures.
RESULTS: During the study period, Japan experienced eight waves of COVID-19 resulting in 33,738,398 confirmed infections and 74,688 deaths. Both infections and deaths increased significantly overtime. Transmission was initially concentrated in metropolitan prefectures. Nonmetropolitan prefectures were protected and had lower numbers of infections and deaths through June 2022. Thereafter, COVID-19 became more widespread, with more localized surges in nonmetropolitan prefectures. Eventually, during the eighth wave (October 16, 2022-May 9, 2023), there was a marked increase in the IRR in nonmetropolitan prefectures reaching 1.25 (95 % confidence interval (CI), 1.15-1.34) for infection and 1.38 (95 % CI, 1.16-1.65) for death.
CONCLUSIONS: In Japan, COVID-19 transmission was suppressed for the first 2 years of the pandemic, especially in nonmetropolitan prefectures, but the trends changed over time, and more infections and deaths were observed from late 2022 in nonmetropolitan prefectures. These findings underscore the importance of addressing the geographical disparities that likely exist between metropolitan and nonmetropolitan prefectures Delaying large surges in nonmetropolitan prefectures may be an important takeaway that could aid in the future management of major infectious disease outbreaks
The effects of major abdominal surgery on skeletal muscle mitochondrial respiration in relation to systemic redox status and cardiopulmonary fitness
Get PDFMore complex surgeries are being performed in increasingly sicker patients, resulting in a greater burden of postoperative morbidity. Delineating the metabolic and bioenergetic changes that occur in response to surgical stress may further our understanding about how humans respond to injury and aid the identification of resilient and frail phenotypes. Skeletal muscle biopsies were taken from patients undergoing hepato-pancreatico-biliary surgery at the beginning and end of the procedure to measure mitochondrial respiration and thiol status. Blood samples were taken at the same timepoints to measure markers of inflammation and systemic redox state. A sub-group of patients underwent cardiopulmonary exercise testing prior to surgery, and were assigned to two groups according to their oxygen consumption at anaerobic threshold (≤10 and \u3e10 mL/kg/min) to determine whether redox phenotype was related to cardiorespiratory fitness. No change in mitochondrial oxidative phosphorylation capacity was detected. However, a 26.7% increase in LEAK (uncoupled) respiration was seen after surgery (P = 0.03). Free skeletal muscle cysteine also increased 27.0% (P = 0.003), while S-glutathionylation and other sulfur and nitrogen-based metabolite concentrations remained unchanged. The increase in LEAK was 200% greater in fit patients (P = 0.004). Baseline plasma inflammatory markers, including TNF-⍺ and IL-6 were greater in unfit patients, 96.6% (P = 0.04) and 111.0% (P = 0.02) respectively, with a 58.7% lower skeletal muscle nitrite compared to fit patients. These data suggest that oxidative phosphorylation is preserved during the acute intraoperative period. Increase in free cysteine may demonstrate the muscle’s response to surgical stress to maintain redox balance. The differences in tissue metabolism between fitness groups suggests underlying metabolic phenotypes of frail and resilient patients. For example, increased LEAK in fitter patients may indicate mitochondrial adaptation to stress. Higher baseline measurements of inflammation and lower tissue nitrite in unfit patients, may reflect a state of frailty and susceptibility to postoperative demise
Investigating appropriate artificial intelligence approaches to reliably predict coastal wave overtopping and identify process contributions
Get PDFPredicting coastal wave overtopping is a significant challenge, exacerbated by climate change, increasing the frequency of severe flooding and rising sea levels. Digital twin technologies, which utilise artificial intelligence to mimic coastal processes and dynamics, may offer new opportunities to predict coastal wave overtopping and flooding reliably and computationally efficiently. This study investigates the effectiveness of training various artificial intelligence models using wave buoy, meteorological, and recorded coastal wave overtopping observations to predict the occurrence and frequency of overtopping at 10-minute intervals. These models have the potential for future large-scale global applications in estimating wave overtopping and flood forecasting, particularly in response to climate warming. The model types selected include machine-learning random forests, extreme gradient boosting, support vector machines, and deep-learning neural networks. These models were trained and tested using recorded observational overtopping events, to estimate wave overtopping and flood forecasting in Dawlish and Penzance (Southwest England). The random forests performed exceptionally well by accurately and precisely estimating coastal wave overtopping and non-overtopping 97 % of the time within both locations, outperforming the other models. Moreover, the random forest model outperforms existing process-based and EurOtop-based models. This research has profound implications for increasing preparedness and resilience to future coastal wave overtopping and flooding events by using these random forest models to predict overtopping and flood forecasting on wider global and climate scales. These trained random forests are significantly less computationally demanding than existing process-based models and can incorporate the important effect of wind on overtopping, which was neglected in existing empirical approaches
Lipid Biomarkers for Marine Fungi
Get PDFMarine fungi play key roles as parasites and saprotrophs in marine ecosystems and are important degraders of organic matter. They likely facilitate the remineralisation of marine carbon, thus have a profound impact on marine biogeochemical cycles. However, as little is known about their global abundance and biomass, fungi are yet to be included in biogeochemical models. Lipid biomarkers can be used to assess microbial abundance and biomass due to their specificity and may be utilised to explore the viability and trophic dynamics of marine microbial communities. Although lipid biomarkers for fungi have been used in terrestrial environments, such as soils, for many years, seldom few have investigated whether these are applicable for fungi in marine environments. This thesis set out to explore the composition of lipids across a range of marinederived fungi and assess how environmental fluctuations might induce lipid remodelling in fungal cells. Although intact polar membrane lipids have been widely used as biomarkers of marine bacteria and archaea, Chapter 3 of this thesis includes only the second survey of intact polar lipids in cultures of marine fungi. The results of this chapter indicate that fungal lipids can be used to generate a ‘fingerprint’ using multivariate statistical approaches, which can distinguish marine isolates from fungi obtained from soils. Due to the dynamic nature of marine environments, microbes can be subjected to nutrient and oxygen deprivation over short timescales. In Chapter 4, we explored the impact of starvation on intact polar lipids and fatty acids in the marine yeast Aureobasidium pullulans, a saprotroph found throughout the global oceans. The results indicated that starvation induced rapid phospholipid degradation and increased the production of exophilins. In addition, fatty acids were remodelled and Aureobasidium pullulans accumulated the signature fungal biomarkers, the 18:2ω6 fatty acid and membrane sterol, ergosterol, during starvation. Although cell growth was arrested during starvation, cultures of A. pullulans could be rejuvenated by nutrient resupply. In Chapter 5 the effect of anoxic growth was assessed on the fatty acid and sterol constitution of Mucor circinelloides, a facultative anaerobe isolated from intertidal sediments. Although sterols are often analysed in low-oxygen environments, such as sediments, to study microbial communities, this work demonstrated that anoxic growth diminished the synthesis of ergosterol in Mucor circinelloides. This indicates that sterols do not afford a quantitative estimate of fungal biomass in low-oxygen environments. Nucleic acid-based research, which has extraordinary taxonomic specificity, has enabled the characterisation of fungi from a range of marine environments. However, environmental DNA (eDNA) does not necessarily afford a quantitative estimate of fungal biomass. In Chapter 6, a dual approach combining lipid biomarkers and eDNA was utilised to explore how different methods of environmental analysis may result in divergent accounts of fungal abundance in coastal sediment. Results indicated that fatty acids could distinguish unique microbial assemblages over a short vertical depth gradient, but that signature biomarkers for fungi (i.e., ergosterol) did not corroborate with abundance profiles obtained from eDNA. Collectively, the chapters of this thesis provide a study of the intact polar lipids, fatty acids, and sterols produced by marine-derived fungi. In addition, some insight is obtained about how extreme environmental conditions may impact the physiology of fungi in marine environments
New Ethereum-based distributed PKI with a reward-and-punishment mechanism
Get PDFThis paper explores the critical role of Public Key Infrastructure (PKI) in ensuring the security of electronic transactions, particularly in validating the authenticity of websites in online environments. Traditional Centralised PKIs (CPKIs) relying on Certificate Authorities (CAs) face a significant drawback due to their susceptibility to a single point of failure. To address this concern, Decentralised PKIs (DPKIs) have emerged as an alternative. However, both centralised and decentralised approaches encounter specific challenges. Researchers have made several attempts using blockchain-based PKI, which implements a reward and punishment mechanism to enhance the security of traditional PKI. Most of the attempts are focused on CA-based PKI, which still suffers from the risk of a single point of failure. Inspired by ETHERST, which is a blockchain-based PKI that implements Web of Trust (WoT) with reward and punishment, we introduce ETHERST version 3.0, with improvements in its secure level algorithm that enhances trustworthiness measurement. Comparative simulations between ETHERST version 2.0 and ETHERST version 3.0 reveal the superior performance of the latter in trustworthiness measurement and ensure the higher security of a virtual community. The new simulation algorithm with different node type definitions and assumptions presents results through tables and graphs, showing that ETHERST version 3.0 outperforms ETHERST version 2.0. This research contributes to advancing the field by introducing an innovative PKI solution with enhanced trustworthiness and security features
Exploring The Terminology Associated with Nurses Caring For Children And Their Families.
Get PDFBackground and aim:The terms for Registered Nurses who care for the families of children and young people (CYP) differs from country to country. Nurses in the United Kingdom can register as ‘Children’s Nurses’ and ‘Pediatric Nurses’, whereas in most countries it is as ‘Registered Nurses’. Less is known about other important roles, such as family nurses and public health nurses to name a few. The aim of this study was to identify terminology and roles of nurses who care for families and their children to inform a larger research project: The ASTOUND study. Methods: An online cross-sectional survey launched between May-August 2024. Distributed to members of International Family Nursing Association, International Network for Child & Family Centred Care and via snowballing to contacts within global countries. Questions were developed by the researchers and an expert panel from the ASTOUND study. Results: Results were analysed using content analysis. There were 76 responses across 34 countries with at least one response from all six continents and Oceania. As this was an open survey to all global contacts with the link, we were unable to capture non-response rates. 20 different terms were recorded. 18 countries recorded one term and 16 having more than one term. Prevalent terms were ‘Paediatric/Pediatric Nurse’ (n=28), followed by ‘Children’s Nurse’ (n=7), ‘Child Health Nurse’ (n=5), ‘Neonatology’ or ‘Neonatal Nurse’ (n=3) and ‘Public Health Nurse’ (n=2). 15 additional terms recorded. An open textbox noted additional findings, including differences in terms depending on the countries state/province, the setting or the age of the population. Discussion and conclusions:There are examples of terms rooted in history and culture, however, there is no clear unification. The survey offers a snapshot of international terms across responding countries, yet the shifting of terms may change between country to country in the future
Improving quality of life through smart public transport: The interplay of technological and non-technological approaches in London and Tehran
Get PDFTransportation plays a significant role in shaping quality of life in cities, affecting physical and mental health, socio-economic dynamics, and environmental sustainability. Traffic congestion and air pollution – common consequences of urban traffic – exacerbate these concerns, underscoring the importance of promoting public transport as an environmentally friendly alternative to private vehicle usage. Enhancing the quality of public transportation not only helps retain current users, but also attracts new passengers, ultimately reducing personal car use and its adverse effects in cities. While smart technologies offer opportunities to improve public transport by enhancing comfort, reliability, safety, accessibility, and affordability, the integration of these technologies is shaped by both technological and non-technological factors.This thesis investigates the role of smart technologies and non-technological factors shaping them in improving public transportation systems, focusing on Tehran and London as case studies. Tehran serves as the primary case study, while London provides a comparative framework to better understand the challenges and opportunities in Tehran’s public transport system. The research considers the demographic, geographic, infrastructure, and governance contexts of both cities to analyse similarities and differences related to their public transport systems. Through this comparative analysis, recommendations are developed to enhance Tehran’s capacity for implementing smart technologies in its public transport. The findings demonstrate that technology alone cannot be viewed as a neutral or universally applicable solution; its effectiveness relies on a range of other, often non-technological, factors. This study reveals that smart technologies cannot be directly transferred from one city to another without considering the contextual differences between them. Furthermore, the relationship between technological advancements and non-technological factors is reciprocal and complex. The research highlights that technological improvements in public transport systems must be accompanied by visionary strategy, effective governance, and active passenger engagement in decision-making processes. These non-technological factors are critical to the successful integration of smart technologies, ensuring they align with the specific needs and conditions of each city.In conclusion, this research underscores the importance of a holistic approach to public transport improvements, where both technological and non-technological factors are considered. This interconnectedness suggests that these factors must be studied and addressed together in order to enhance the reliability, safety, and comfort of public transport systems. The study offers key insights and recommendations for policymakers, particularly in Tehran, to enable them to develop more effective strategies for integrating smart technologies into their public transport networks
Nurses’ knowledge and practice in the care of patients with delirium in the intensive care unit: a service evaluation project proposal
Get PDF#400WORDS: CHIEF NURSING OFFICER’S RESEARCH FELLOWS EVIDENCE IMPLEMENTATION PROJECT
“Fish in different water, to survive or to thrive?” Understanding Direct-Entry Pre-Sessional Chinese Students’ Learning Experiences during COVID-19 and its Aftermath
Get PDFThis thesis explores the learning experiences of direct-entry pre-sessional Chinese students in the UK during the COVID-19 pandemic and its aftermath, using Pierre Bourdieu’s theoretical framework. Through the metaphor of students as fish in different water , the research examines how these learners navigate and adapt to new educational environments that often starkly contrast with their prior experiences.The study employs a two-stage semi-structured interview process with student participants, first in China during their online pre-sessional courses and later in the UK during their degree programmes. All interviews were conducted in Mandarin Chinese to ensure linguistic and cultural accessibility. Additionally, expert interviews with lecturers provide complementary insights into the students\u27 experiences.The thematic analysis suggests that students encounter significant challenges when transitioning between fields, as they navigate the unfamiliar water of their new learning environments. While some students thrive by strategically accumulating cultural capital deemed valuable in the UK context, others struggle, facing confusion and frustration due to a lack of understanding or alignment with established academic practices.The findings emphasise the need for greater awareness at both individual and institutional levels about the complexities of cross-field learning. Students could benefit from adjusting their expectations and addressing skill and knowledge gaps, while universities should strive to create more inclusive and supportive environments for these particular groups of students. By fostering mutual understanding and preparedness, the chances for students to thrive, rather than merely survive, can be significantly enhanced