How reconfiguration of a minor injuries unit has affected service delivery during the COVID-19 pandemic: a retrospective analysis.

INTRODUCTION: Redeployment of orthopaedic consultants to a minor injuries unit (MIU) during the COVID-19 pandemic provided a unique opportunity to assess the impact of early senior specialist input on patient management. METHODS: Patient demographics, diagnosis, location of injury and disposal method were compared between three 7-day periods: during the April 2020 COVID-19 lockdown (period A), one month prior to period A (period B) and one year prior to period A (period C). Orthopaedic consultants staffed the MIU during period A, and emergency nurse practitioners staffed the MIU during periods B and C. RESULTS: Period A witnessed higher injury severity either due to modified activities or altered healthcare-seeking behaviour during lockdown. For fractures, compared with periods B and C, period A saw a lower rate of referral to fracture clinic (41% vs 100% vs 86%, p<0.001) and higher rate of discharge (38% vs 0% vs 9%, p<0.001). The median time to fracture clinic was also longer (15 days vs 6 days vs 10 days, p<0.001), indicating earlier institution of definitive care. There were no other significant differences between periods with radiology alerts and complaints received remaining largely unchanged. CONCLUSION: Early senior orthopaedic input in the patient journey from MIU had clear benefits, this being most true for fracture diagnoses. Earlier definitive management planning was observed as lower rates of fracture clinic referral, higher rates of discharge and deferred first fracture clinic reviews. This study highlights the benefits of greater partnership between MIU and orthopaedics. As the pandemic subsides and redeployed staff return to normal duties, a modification of this model could be utilised to ensure this partnership is sustainable.

An interdisciplinary review of current and future approaches to improving human-predator relations.

In a world of shrinking habitats and increasing competition for natural resources, potentially dangerous predators bring the challenges of coexisting with wildlife sharply into focus. Through interdisciplinary collaboration among authors trained in the humanities, social sciences, and natural sciences, we reviewed current approaches to mitigating adverse human-predator encounters and devised a vision for future approaches to understanding and mitigating such encounters. Limitations to current approaches to mitigation include too much focus on negative impacts; oversimplified equating of levels of damage with levels of conflict; and unsuccessful technical fixes resulting from failure to engage locals, address hidden costs, or understand cultural (nonscientific) explanations of the causality of attacks. An emerging interdisciplinary literature suggests that to better frame and successfully mitigate negative human-predator relations conservation professionals need to consider dispensing with conflict as the dominant framework for thinking about human-predator encounters; work out what conflicts are really about (they may be human-human conflicts); unravel the historical contexts of particular conflicts; and explore different cultural ways of thinking about animals. The idea of cosmopolitan natures may help conservation professionals think more clearly about human-predator relations in both local and global context. These new perspectives for future research practice include a recommendation for focused interdisciplinary research and the use of new approaches, including human-animal geography, multispecies ethnography, and approaches from the environmental humanities notably environmental history. Managers should think carefully about how they engage with local cultural beliefs about wildlife, work with all parties to agree on what constitutes good evidence, develop processes and methods to mitigate conflicts, and decide how to monitor and evaluate these. Demand for immediate solutions that benefit both conservation and development favors dispute resolution and technical fixes, which obscures important underlying drivers of conflicts. If these drivers are not considered, well-intentioned efforts focused on human-wildlife conflicts will fail.

Prospective surveillance of breast cancer-related lymphoedema in the first-year post-surgery: feasibility and comparison of screening measures.

PURPOSE: To examine the feasibility of a breast cancer-related lymphoedema (BCRL) screening programme. Additionally, to investigate the efficacy of bioimpedance analysis (BIA) compared to circumferential measurements (CM) in detecting BCRL. METHODS: This was a 12-month prospective feasibility study. Participants were recruited from two diagnostic breast clinics and consented to be screened for BCRL. Pre-surgical assessments were conducted, and participants were followed up at quarterly intervals. BIA and CM measurements were conducted at all time points. An L-Dex score of >10 or a 10-U increase from baseline or a ≥5 % increase in proximal, distal or total percentage volume difference (PVD) from baseline was indicative of BCRL. Information was collected on subjective symptoms, potential risk factors, demographics and medical data. Feasibility was based on uptake and retention. RESULTS: One hundred twenty-six participants were recruited with an attrition rate of 16.2 %. Participants' mean age was 59 years with the majority having stage I (63.9 %), infiltrating ductal carcinoma (87.4 %). 31.6 % were identified as having BCRL, 90.3 % detected by CM and 35.5 % by BIA (p = ≤0.0001). We found no significant correlation between BIA and CM. Participants identified as having BCRL had a higher BMI, a recent injury to their 'at-risk' arm and more lymph nodes excised (p = <0.05). These findings were not evident across all time points. A large percentage of participants had transient BCRL when assessed by a lymphoedema physiotherapist. CONCLUSIONS: BCRL screening is acceptable and valued by breast cancer survivors. Work needs to continue to establish the most effective screening tool and the natural behaviour of BCRL within the first-year post-surgery.

Randomized trial showing efficacy and safety of twice-daily remogliflozin etabonate for the treatment of type 2 diabetes.

We compared the efficacy of twice-daily doses of remogliflozin etabonate (RE) and once-daily pioglitazone with placebo for reduction in glycated haemoglobin (HbA1c) concentration. In this 12-week, double-blind, randomized, active- and placebo-controlled trial, 336 treatment-naïve subjects with type 2 diabetes and an HbA1c of 7.0-9.5% (53-80 mmol/mol) were randomized to RE (50, 100, 250, 500 or 1000 mg twice daily), matching placebo or 30 mg pioglitazone once daily. The primary endpoint was change in HbA1c from baseline. Other endpoints included changes in body weight, lipid levels, safety and tolerability. RE produced a decreasing dose response in HbA1c at week 12 (p < 0.001), with reductions in HbA1c versus placebo ranging from 0.64 to 1.07% (p < 0.001). Statistically significant reductions in body weight for RE compared with placebo were also observed. Twice-daily RE resulted in a dose-ordered improvement in glycaemic control and was generally well tolerated.

Electrochemical study of silver thiosulphate reduction in the absence and presence of ultrasound.

The electrochemical reduction of silver thiosulphate was studied potentiostatically on platinum electrodes in the absence and presence of ultrasound (20 kHz). This system is irreversible and the reaction is both diffusion and kinetically controlled. The slowest step is the kinetic reaction especially the chemisorption of ions at the electrode surface. Ultrasound greatly improves the mass transport, which can be explained by changing from diffusion to mainly convection. This paper reports the effect of ultrasound upon electrode kinetic and mass-transport parameters at various RDE rotation speeds and ultrasonic intensities. It was found that the heterogeneous rate constant (kf) is improved in the presence of ultrasound due to the increase in the formal or standard heterogeneous rate constant (k0) (approximately by 10-fold under sonication).

The effect of sonication on microbial disinfection using hypochlorite.

Ultrasound alone is capable of killing bacteria when sufficient power is applied but ultrasound at low powers can also be used to improve the effectiveness biocides. In this paper, we explore the effect of the timing of the ultrasonic treatment at 20 and 850 kHz on the biocidal efficiency of sodium hypochlorite solution towards Escherchia coli suspensions. A remarkable frequency effect has been noted. At the lower frequency of 20 kHz the improvement in biocidal activity is greatest when the ultrasound is applied at the same time as the hypochlorite. At the higher frequency of 850 kHz the improvement is best when ultrasound is used as a pre-treatment immediately followed by hypochlorite addition under normal (silent) conditions. The kill rate achieved for pre-treatment using 850 kHz and simultaneous treatment using 20 kHz are very similar. However the former involves less acoustic energy and so is considered to be the more efficient.

Sonovoltammetric studies on copper in buffered alkaline solution.

The effect of ultrasound on the voltammetry of copper in alkaline solution is reported. At pH 7 the electrode surface remains active after scanning to ca. +1.0 V (vs. SCE) and the effects of ultrasound show the expected substantial enhancement in limiting current due to improved mass transport under ultrasound. However at pH 9, whereas the silent scan is only slightly altered in gross detail from that obtained at pH 7, the sonicated scan is significantly different. This shows the expected current increase only up until ca. +0.6 V (vs. SCE), where there is a substantial loss of current showing a passivation phenomenon that is enhanced by ultrasound. In addition, during the reverse (reduction) scan under ultrasound an anodic peak appears. This suggests reactivation of the electrode during the cathodic sweep, possibly by reductive removal of a transient species from the electrode/(hydr)oxide interface at a potential where oxidation still occurs. Increasing the pH to 11 further shifts the cathodic peaks in the silent voltammogram.

The sonoelectrooxidation of thiophene S-oxides.

Thiophene-S-oxides (thiophene monoxides) are relatively new compounds, less stable than the better-known thiophene-S-dioxides. They are useful as synthons for a range of applications, including in the production of pharmaceuticals. They have interesting photochemical properties, but in this presentation we contrast the electro-oxidative voltammetry of differently substituted derivatives. We also compare carbocyclic compounds such as tetracyclone, the electro-oxidation of which at relatively high potentials has never been reported in silent or insonated conditions.

Potential for the use of ultrasound in the extraction of antioxidants from Rosmarinus officinalis for the food and pharmaceutical industry.

Ultrasound was used to increase the extraction efficiency of carnosic acid from the herb Rosmarinus officinalis using butanone, ethyl acetate and ethanol as solvents. Both dried and fresh leaves of the herb were extracted and, when performed at the same temperature, sonication improved the yields of carnosic acid for all three solvents and shortened the extraction times. Sonication also reduced the solvent effect so that ethanol, which is a poor solvent under conventional conditions, reached a similar level of extraction efficiency to the other two when sonicated. The extraction of dried herb with ethanol proved to be more efficient than that of fresh material, probably due to the water present in the latter.

The development and evaluation of ultrasound for the treatment of bacterial suspensions. A study of frequency, power and sonication time on cultured Bacillus species.

Some species of bacteria produce colonies and spores which agglomerate in spherical clusters (Bacillus subtilis) and this serves as a protection for the organisms inside against biocidal attack. Flocs of fine particles e.g. clay can entrap bacteria which can also protect them against the biocides. It is because of problems such as these that alternative methods of disinfecting water are under active investigation. One such method is the use of power ultrasound, either alone or in combination with other methods. Ultrasound is able to inactivate bacteria and deagglomerate bacterial clusters or flocs through a number of physical, mechanical and chemical effects arising from acoustic cavitation. The aim of this study was to investigate the effect of power ultrasound at different powers and frequencies on Bacillus subtilis. Viable plate count techniques were used as a measure of microbial activity. Results showed a significant increase in percent kill for Bacillus species with increasing duration of exposure and intensity of ultrasound in the low-kilohertz range (20 and 38 kHz). Results obtained at two higher frequencies (512 and 850 kHz) indicated a significant increase in bacteria count suggesting declumping. In assessing the bacterial kill with time under different sonication regimes three types of behaviour were characterized: High power ultrasound (lower frequencies) in low volumes of bacterial suspension results in a continuous reduction in bacterial cell numbers i.e. the kill rate predominates. High power ultrasound (lower frequencies) in larger volumes results in an initial rise in cell numbers suggesting declumping of the bacteria but this initial rise then falls as the declumping finishes and the kill rate becomes more important. Low intensity ultrasound (higher frequencies) gives an initial rise in cell numbers as a result of declumping. The kill rate is low and so there is no significant subsequent decrease in bacterial cell numbers.

Potential uses of ultrasound in the biological decontamination of water.

In the past there was a prevailing feeling in industry that power ultrasound would be too expensive to use for water treatment on an industrial scale. This was based on calculations involving the direct scale up of power consumption in small-scale (generally batch) laboratory experiments. In recent times this attitude has changed somewhat as a result of the installation of a number of ultrasonic devices in operational water or sewage treatment plants. In our laboratories we have investigated the decontamination of water under the influence of ultrasound alone and in conjunction with other treatments. The results, particularly when applied to flowing systems, indicate a real future for sonochemistry in water treatment.

Sonoelectrochemical effects in electro-organic systems.

This paper describes recent studies in organic sonoelectrochemistry at Coventry University, including the oxidation of thiophene monoxides, degradation of dye pollutants, formation of conducting polymers and electrosynthetic modification of proteins.

A novel angular geometry for the sonochemical silver recovery process at cylinder electrodes.

In order to obtain maximum ultrasonic effect upon electrochemical silver recovery, mass transfer measurements were investigated. The effect on limiting current of changing the position of an ultrasonic horn tip (i.e. vertical and horizontal) and using a cylinder electrode (CE), was studied in an attempt to find the optimum position required for maximum sonoelectrochemical effect. The importance of the ultrasonic intensity, the electrode-horn distance and positioning (angle) in assigning limiting currents was also investigated. For the CE placed at an angle of 45 degrees with respect to the ultrasonic horn, it was suggested that the 50% increase in limiting current for the 'face-on' geometry is caused by an approximately 50% decrease in diffusion layer thickness for the 'face-on' geometry compared to the 'angular' geometry due to the difference in the sonicated areas for both geometries.

The development and evaluation of electrolysis in conjunction with power ultrasound for the disinfection of bacterial suspensions.

There is an increasing incidence in health problems related to environmental issues that originate from inadequate treatment of potable waters. This has compelled scientists and engineers to engage in innovative technologies to achieve a maximum disinfection at affordable costs. Some species of bacteria produce colonies and spores that can agglomerate in spherical clusters and thus protect organisms on the inside of the cluster against biocidal attack. Flocs of fine particles (e.g., clay) can entrap bacteria and this can also protect them against the biocides. Other bacteria have the ability to mutate, thus building up resistance to conventional biocides (e.g., chlorine). Ultrasound has been shown to be effective in improving the effectiveness of biocides such as chlorine. The aim of this present study was to investigate the effect of electrolysis and power ultrasound as a disinfection treatment and to provide a greater knowledge of the fundamentals of disinfection through the production of hypochlorite in situ from saline solution via electrolysis. The electrode materials investigated were, carbon (felt and graphite), copper and stainless steel rods. The results show that sonication appears to amplify the effect of electrolysis. A combination of both treatments is significantly better than sonication or electrolysis alone.

The effect of ultrasound upon the oxidation of thiosulphate on stainless steel and platinum electrodes.

Ultrasound was found to increase the oxidation peak current and hence the decomposition rate of thiosulphate 50-fold compared to silent conditions. The effects of the ultrasonic frequency (20 and 38 kHz) and power upon the electrochemical oxidation of thiosulphate in aqueous KCl (1 mol dm-3) at stationary stainless steel and platinum electrodes were studied chronoamperometrically and potentiostatically (at various scan rates). No sigmoidal-shaped voltammograms were observed for the redox couple S4O6(2-)/S2O3(2-) in the presence of ultrasound. However, application of ultrasound to this redox couple provided an increase in the oxidation peak current at the frequencies employed, the magnitude of which varied with concentration, scan rate and ultrasonic power. Under sonication at 20 and 38 kHz, the oxidation peak potential shifted anodically with increasing ultrasonic power. This anodic shift in potential may be due to the formation of hydroxyl radicals, changes in electrode surface composition and complex adsorption phenomena. The large increase in oxidation peak currents and the rates of decomposition of thiosulphate, in the presence of ultrasound, are explained in terms of enhanced mass transfer at the electrode due to cavitation and acoustic streaming together with microstreaming coupled with adsorption phenomena. It is also shown that changes in macroscopic temperature throughout the experiment are insufficient to cause the observed enhanced diffusion.

Controlling emissions from electroplating by the application of ultrasound.

Ultrasonic irradiation applied either above the surface of a chromic acid plating bath or through the plating bath itself during the process of chromium electroplating reduces the emissions of hazardous chromic acid mist The use of ultrasound is particularly effective at high current densities. The results suggest that sonication during the electroplating of chromium may provide a useful method of controlling chrome mist emission without the need for a chemical additive (mist suppressant). In conjunction with lip extraction this could lead to a more efficient process since the use of ultrasound has been shown to be of benefit in the electroplating process itself.

Electrochemical behaviour of zinc in 20 kHz sonicated NaOH electrolytes.

This paper describes the influence of 20 kHz ultrasound upon the corrosion behaviour of zinc in NaOH electrolytes. A systematic study of the effects exerted by ultrasound on the electrochemical interface was first carried out, so as to determine the transmitted power and to characterize mass transfer at the electrode. Then attention was focused on the corrosion passivation mechanism of zinc in sonicated NaOH solutions (0.1 and 1 M). Investigations were carried out using electrochemical techniques to determine corrosion and passivation kinetics parameters. SEM analysis of the sonicated zinc surfaces provides complementary information on the oxide layer composition and structure.

The extraction of rutin from flower buds of Sophora japonica.

The efficiency of extraction of rutin from Sophora japonica is improved by ultrasound but is dependent on the solvent employed. Rutin is a compound with antioxidant activity and aqueous solvents appear to be unsuitable for ultrasonic extractions due to the formation of free radicals from the insonation of the solvent. The application of ultrasound to methanolic extraction gave a significant reduction in extraction time and an increase in maximum yield.

Double-structured ultrasonic high frequency reactor using an optimised slant bottom.

The present work has been carried out in order to design a new type of ultrasonic reactor consisting of a double-structured tank. The inner working compartment is built with a slant bottom to allow a better ultrasonic transmission. This paper reports the effect of the inclination angle on acoustic efficiency for several different plates, e.g. two plates made of glass (2 mm and 3 mm thickness) and one made of PVC (3 mm thickness). The acoustic efficiency was determined as the ratio of the signal measured by a hydrophone in the presence of the plate to that signal in the absence of the plate. Having optimised the system, the ultrasonic powers in the inner and the outer compartments of the slant bottom reactor were determined by hydrogen peroxide dosimetry.

Dye effluent decolourisation using ultrasonically assisted electro-oxidation.

Solutions of the acidic dye, Sandolan Yellow, were subjected to sonolysis, electrolysis and sonoelectrolysis. Decolourisation did not take place using ultrasound alone but was achieved using an electro-oxidation process. The rate of electro-chemical decolourisation in the absence of ultrasound was dependent on the type of electrode used, electrolyte concentration, reaction temperature and the current density. Electro-oxidation of Sandolan Yellow using platinum electrodes was enhanced using ultrasound when carried out in a semi-sealed cell, which minimised the effects of ultrasonic degassing.