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Competencies for advanced clinical practice (ACP) hand therapists in first-line management of closed hand fractures: Results of a United-Kingdom (UK) stakeholder consensus study
Full text linkIntroductionIn the United Kingdom [UK], Advanced Clinical Practice (ACP) roles are being developed to improve access to high-quality patient care, where healthcare services are struggling to meet steadily increasing service demands. Increasingly, ACP hand therapists are assessing and treating acute closed hand fractures. However, the knowledge and skills required of these roles has not been identified or standardised.MethodsConsensus recommendations were developed from an expert panel of medical doctors and hand therapists using an electronic Delphi process. Participants were recruited from purposive and snowball sampling. Delphi questions were developed from a literature review and clinician survey and included rating of items open text responses. Consensus was defined as ≥75% agreement. Summary feedback was provided after each round.ResultsThere were 20 panellists (12 medical doctors and 8 hand therapists), of which 18 (90%) completed all rounds. 23 competencies were consistently identified as very important; there was less agreement on how to evidence these competencies.ConclusionThese findings can be used to develop ACP hand therapist roles and provide a framework to guide individual therapists to base their own learning and development. They underpin safe, efficient and costeffective patient care
Honeycomb core inspired design and numerical simulation of heat transfer enhancement for thermal energy storage in heat exchangers
No full textLatent heat storage offers a promising solution to bridge energy supply-demand mismatches, yet its implementation is fundamentally constrained by the low thermal conductivity of phase change materials (PCM). To address this limitation, this study investigates a honeycomb-inspired tube configuration for PCM-based energy storage systems through biomimetic design principles. The comprehensive analysis of the energy and economic benefits of the honeycomb design against four alternative tube topologies, including an in-line Regular hexagon tube arrangement used as a baseline. The results demonstrate that the honeycomb tube arrangement excels in heat transfer performance due to its compact structure. It reduces charging time by 10.35% compared to conventional layouts, reaching a total energy storage density of approximately 235.7 MJ/m ³ and an exergy storage density of 103.6 MJ/m ³. The bio-inspired design demonstrates exceptional economic viability-achieving 31.92 economic index with a unit investment cost of £3.07. The unit energy storage cost and investment cost are reduced by 28.2% and 15.2%, respectively, demonstrating a synergistic improvement in both technical performance and economic benefits. This quantitative comparison validates the honeycomb tube geometry as a viable and effective approach for developing compact, high-performance thermal energy storage systems for applications such as industrial waste heat recovery
Sotrovimab versus usual care in patients admitted to hospital with COVID-19 (RECOVERY): a randomised, controlled, open-label, platform trial
Full text linkBackgroundSotrovimab is a neutralising monoclonal antibody targeting the SARS-CoV-2 spike protein. We aimed to evaluate the efficacy and safety of sotrovimab in the RECOVERY trial, an investigator-initiated, individually randomised, controlled, open-label, adaptive platform trial testing treatments for patients admitted to hospital with COVID-19.MethodsPatients admitted with COVID-19 pneumonia to 107 UK hospitals were randomly assigned (1:1) to either usual care alone or usual care plus a single 1 g infusion of sotrovimab, using web-based unstratified randomisation. Participants were eligible if they were aged at least 18 years, or aged 12–17 years if weighing at least 40kg, and had confirmed COVID-19 pneumonia with no medical history that would put them at significant risk if they participated in the trial. Participants were retrospectively categorised as having a high antigen level if baseline serum SARS-CoV-2 nucleocapsid antigen was above the median concentration (the prespecified primary efficacy population), otherwise they were categorised as having a low antigen level. The primary outcome was 28-day mortality assessed by intention to treat. Safety outcomes were assessed among all participants, regardless of antigen level. Recruitment closed on March 31, 2024, when funding ended. The trial is registered with ISRCTN (50189673) and ClinicalTrials.gov (NCT04381936).FindingsFrom Jan 4, 2022, to March 19, 2024, 1723 patients were enrolled in the RECOVERY sotrovimab comparison. Of these, 828 (48%) were assigned to usual care plus sotrovimab and 895 (52%) were assigned to usual care only. Mean patient age was 70·7 years (SD 14·8) and 1033 (60%) were male. 720 (42%) patients were classified as having a high antigen level, 717 (42%) as having a low antigen level, and 286 (17%) had unknown antigen status. 1389 (81%) patients were vaccinated, 1179 (82%) of 1438 patients with known serostatus had anti-spike antibodies at randomisation, and 1021 (>99%) of 1026 patients with sequenced samples were infected with omicron variants. Among patients with a high antigen level, 82 (23%) of 355 assigned to sotrovimab versus 106 (29%) of 365 assigned usual care died within 28 days (rate ratio 0·75, 95% CI 0·56–0·99; p=0·046). In an analysis of all randomly assigned patients (regardless of antigen status), 177 (21%) of 828 patients assigned to sotrovimab versus 201 (22%) of 895 assigned to usual care died within 28 days (0·95, 0·77–1·16; p=0·60). Infusion reactions were recorded in 12 (2%) of 781 patients receiving sotrovimab. We found no difference between groups in any other safety outcome.InterpretationIn patients admitted to hospital with COVID-19 pneumonia, sotrovimab was associated with reduced mortality in the primary analysis population who had a high serum SARS-CoV-2 antigen concentration at baseline, but not in the overall population. Treatment options for patients admitted to hospital are limited, and mortality in those receiving current standard of care was high. The emergence of high-level resistance to sotrovimab among subsequent SARS-CoV-2 variants restricts its current usefulness, but these results indicate that targeted neutralising antibody therapy could potentially still benefit some patients admitted to hospital who are at high risk of death in an era of widespread vaccination and omicron infection
Labor Market Dynamics and Growth
Full text linkThis paper seeks to understand the implications of incorporating economic growth into a search-theoretic model of the labor market. To this end, a technological diffusion process is embedded into the canonical search and matching model of the labor market. New matches imitate the production process of incumbents. Although the canonical model is only modified slightly, there are stark differences in economic intuition across the two models. Market tightness is equilibrated through a different margin, and comparative statics of the two models are qualitatively different. Additionally, the model with endogenous growth — consistent with empirical data — generates stronger unemployment cyclicality than a similarly calibrated model without endogenous growth
Feasibility of median nerve stimulation for treatment of involuntary movements in ataxia telangiectasia and ataxia with oculomotor apraxia type 1
Full text linkEffect of High-Order Dynamics on In-Plane Single-Impulse Lissajous-to-Lissajous Transfers Around a Collinear Libration Point
Full text linkOrbital transfers between libration point orbits have played a crucial role in meeting diverse mission constraints around a libration point. Existing analytical theories for such transfers, built on the linearization of the circular restricted three-body problem, have shown promising results in developing transfer strategies. However, given the large excursions of actual mission trajectories, the influence of the neglected high-order dynamics is expected to have a nontrivial effect on these transfers. This study proposes a numerical method that iteratively refines the solutions for impulsive transfers obtained from linear theory, based on the semi-analytical Lindstedt–Poincaré expansion. This method not only provides a means for refinement but also enables systematic validations of linear transfer theories within a broader dynamical framework while retaining orbital parameters. The proposed method is applied to in-plane single-impulse transfers between two Lissajous orbits around a collinear libration point in the Sun-Earth+Moon and Earth-Moon systems. The results show that while the linear solutions remain relatively accurate near optimalities, they are significantly disturbed at the two extremities of the Lissajous orbits by the high-order dynamics. The deviation from the linear solutions exhibits a clear dependency on parameters such as the in-plane phase, transfer orbit families, and the libration point, leading to either improvements and deteriorations in the transfer cost. These results provide insights into the validity of existing linear theories and show how the nonlinearity can be leveraged to improve maneuver strategies
Genetic modification in dinoflagellate algae: Some successes, many failures
Full text linkDinoflagellate algae are an extremely important group of eukaryotic algae, found primarily in marine environments. They are responsible for a significant proportion of global primary productivity. Whilst some species are essential symbionts in coral reefs, others form toxic blooms and ‘red tides’, causing mass fish mortality. Understanding the basic biology of these organisms is therefore important not only for studying ecology and the environment, but also for food safety. Despite the fact that genetic engineering tools are at the cornerstone of modern biological research, the ability of researchers to carry out genetic modification in dinoflagellate algae is limited. Here, we examine the challenges facing molecular research in dinoflagellate algae, showing which genetic transformation techniques have worked and which have been less successful. We suggest that further research into nuclear gene expression in these enigmatic algae would greatly aid genetic engineering endeavours
Studying Unmade, Unseen, and Unreleased Film and Television: Histories, Theories, Methods
No full textA comprehensive study uncovering the hidden histories of film and television projects abandoned despite major investment.Unmade, unseen, and unreleased film and television are a strikingly underexplored aspect of media history, even though significant financial investment and creative labour in these industries are devoted to projects that never reach production or distribution. This groundbreaking collection offers a comprehensive examination of this phenomenon, bringing together interdisciplinary perspectives from film history, gender and sexuality studies, industry studies, archival research, and creative practice.Each chapter presents a state-of-the-art overview of a key theme, debate, method, or theory, drawing on illuminating case studies from different historical periods and global contexts. Together, the contributions define what it means for a work to remain unmade, unseen, or unreleased, while showcasing innovative research approaches and mapping the scale of unfinished projects in film and television. Serving as both a foundational text for students and a valuable reference for established researchers, the volume’s scope will offer an essential resource for anyone seeking to understand the hidden histories of the screen industries
Can commensals alter pathogen’s antibiotic resistance during co-culture?
Full text linkIntroduction. Bacterial infections of skin wounds can increase hospitalization duration and lead to worse patient prognoses, especially for burn wounds and diabetic foot ulcers. The two main pathogens which infect these wounds are Pseudomonas aeruginosa and Staphylococcus aureus. However, many other species can be present in wound infections, including skin commensal bacteria such as Staphylococcus epidermidis and Micrococcus luteus.Hypothesis. It was hypothesized that co-infection alters the antibiotic resistance of each species present.Aim. To investigate dual-species commensal-pathogen co-culture and assess the potential influence on the antibiotic resistance of each species.Methodology. The commensal and pathogenic species were grown either separately or in dual-species co-culture, potentially allowing biofilm formation for 24 h and were subsequently treated with antibiotics (ciprofloxacin or tobramycin). The impact of the co-culture growth was compared with single species cultures and the effect of the antimicrobial treatment on both conditions were assessed through Minimum Biofilm Eradication Concentrations (MBECs) and bacterial viable counts.Results. The viability of each bacterial species was reduced in the presence of other species, and this translated to reduced antibiotic resistance (lower MBECs) of P. aeruginosa in particular. The resistance of the other species appeared more dependent on the specific inter-species effects.Conclusion. The inclusion of a commensal species with pathogens in co-culture reduced the antibiotic resistance, and inter-species effects influenced the viability of the pathogens. More realistic antimicrobial resistance assessment protocols accounting for microbial communities could therefore lead to more effective treatments
Numerical Modeling of the Formation of Nearshore Transverse Sandbars by a Phase-Resolving Model
Full text linkThis study employs the FUNWAVE-TVD phase-resolving model to simulate the formation and evolution of Low-energy Transverse Finger Bars (LTFBs) under idealized conditions representative of El Trabucador beach in Spain. The objective is to investigate the underlying mechanisms driving sandbar development and the factors influencing their geometric characteristics. The results confirm that wave-induced cross-shore transport over gentler-than-equilibrium profiles plays a fundamental role in LTFB formation. Experiments conducted on non-erodible beds reveal that double circulation cells can emerge independently of sediment transport. In contrast, on erodible beds, these double circulation cells transition into single circulation cells due to wave refraction caused by the developing bar structures. This transition underscores the dynamic coupling between hydrodynamics and morphology. Sensitivity analyses of the bed friction coefficient show the complex interplay between hydrodynamics and morphodynamics: higher bed friction produces more regular, thinner bars closely aligned with flow patterns, whereas lower bed friction leads to irregular, shorter bars less connected to flow patterns. Despite computational constraints limiting the full replication of natural systems, this study successfully captures key features of LTFBs and supports the formation mechanism proposed in recent literature. The alongshore wavelengths of the simulated sandbars align well with the smallest transverse bars observed at El Trabucador and reported in previous numerical studies
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