The influence of waiting times and sociopolitical variables on public trust in healthcare: A cross-sectional study of the NHS in England.

Objectives: This study aims to assess factors influencing public trust in the National Health Service (NHS) in England, focusing on the impact of waiting times in Accident & Emergency (A&E) departments and for GP-to-specialist cancer referrals. Study design: A cross-sectional survey-based research design was employed, covering the period from July 2022 to July 2023. Methods: Data were collected through YouGov surveys, yielding 7415 responses. Our analysis is based on 6952 of these responses which we were able to aggregate to 42 NHS Integrated Care Boards (ICBs) for A&E waiting times and 106 ICB sub-units for cancer referral times. Multiple regression analysis was conducted, with the dependent variable being trust in the NHS. Results: Waiting times for A&E and cancer referrals did not significantly affect trust in the NHS. However, other sociopolitical factors displayed significant influence. Specifically, being a member of an ethnic minority group, or having voted Conservative in the 2019 general election were associated with lower trust scores. Other variables such as age and local unemployment rate were also significant predictors. Conclusions: Our findings suggest that waiting times for healthcare services have no effect on public trust in the NHS. Instead, trust appears to be largely shaped by sociopolitical factors. Policymakers should therefore look beyond operational efficiency when seeking to bolster trust in the healthcare system.

Real-world deployment of lateral flow SARS-CoV-2 antigen detection in the emergency department to provide rapid, accurate and safe diagnosis of COVID-19.

BACKGROUND: Point-of-care (POC) SARS-CoV-2 lateral-flow antigen detection (LFD) testing in the emergency department (ED) could inform rapid infection control decisions but requirements for safe deployment have not been fully defined. METHODS: Review of LFD test results, laboratory and POC-RT-PCR results and ED-performance metrics during a two-week high SARS-CoV-2 prevalence period followed by several months of falling prevalence. AIM: Determine whether LFD testing can be safely deployed in ED to provide an effective universal SARS-CoV-2 testing capability. FINDINGS: 93% (345/371) of COVID-19 patients left ED with a virological diagnosis during the 2-week universal LFD evaluation period compared to 77% with targeted POC-RT-PCR deployment alone, on background of approximately one-third having an NHS Track and Trace RT-PCR test-result at presentation. LFD sensitivity and specificity was 70.7% and 99.1% respectively providing a PPV of 97.7% and NPV of 86.4% with disease prevalence of 34.7%. ED discharge-delays (breaches) attributable to COVID-19 fell to 33/3532 (0.94%) compared with the preceding POC-RT-PCR period (107/4114 (2.6%); p=<0.0001). Importantly, LFD testing identified 1 or 2 clinically-unsuspected COVID-19 patients/day. Three clinically-confirmed LFD false positive patients were appropriately triaged based on LFD action-card flowchart, and only 5 of 95 false-negative LFD results were inappropriately admitted to non-COVID-19 areas where no onward-transmission was identified. LFD testing was restricted to asymptomatic patients when disease prevalence fell below 5% and detected 1-3 cases/week. CONCLUSION: Universal SARS-CoV-2 LFD testing can be safely and effectively deployed in ED alongside POC-RT-PCR testing during periods of high and low disease prevalence.

Comparison of the development of human embryos cultured in either an EmbryoScope or benchtop incubator.

PURPOSE: In this current study, our main goal was to establish that EmbryoScope incubation environment is comparable to standard incubation. METHODS: The development of sibling human zygotes was compared after culture in either a benchtop incubator (SI) or an EmbryoScope time-lapse incubator (ES). Between May 2015 to April 2016, a total of 581 normally fertilized 2PN, pronuclear-stage embryos, from 47 patients were allocated to culture in either a benchtop incubator (SI) or an EmbryoScope incubator (ES). RESULTS: The development of embryos to cleavage (up to day 3) and blastocyst stages (day 5/6) was compared between the two different incubators. The proportion of good quality embryos was higher in the ES group compared to the SI on day 2 (66.8 vs. 50.5%, P = 0.014) and on day 3 (75.1 vs. 56.0%, P = 0.006). Those differences were statistically significant. A higher proportion of embryos developed to good quality blastocysts when cultured in the EmbryoScope compared to the benchtop (49.4 vs. 42.0%, P = 0.24), but this was not significant. Finally, no significant differences were noted with the proportion of blastocysts chosen for cryopreservation on day 5/6 in the two incubators. CONCLUSIONS: The findings support the view that the EmbryoScope incubator supports at least equivalent in vitro development of human embryos compared to other standard incubation methods and may promote improved development during early cleavage stages.

Long term survivorship following Scorpio Total Knee Replacement.

BACKGROUND: The Scorpio Total Knee Replacement (TKR) is one of the most commonly used prosthesis in the United Kingdom. Concerns arose at our institution that there was a high revision rate for this prosthesis. No study has assessed survivorship of this prosthesis over 10 years. METHODS: Four hundred and fifty-six consecutive patients, who underwent a primary Scorpio TKR, were clinically and radiologically evaluated. WOMAC, Oxford Knee Score and all complications including the reason for revision surgery were recorded. The Knee Society Roentgenographic Evaluation and Scoring System was used to evaluate all radiographs for prosthesis alignment and degree of subsequent lucency. Survival analysis for the prosthesis was calculated using Kaplan-Meier curves, with revision as an end-point. Patient reported outcome measures were compared against radiographic evaluation. RESULTS: At a mean of 12.5 years (range 10-14 years), 196 (43.0%) patients were available for review; 124 (27.2%) were lost to follow-up and 136 (29.8%) patients had died of unrelated causes. Seven (3.6%) patients required revision surgery at a mean of 5.4 years; five because of aseptic loosening and two because of septic loosening. Cumulative survival for the prosthesis was 99.5% for any cause at five years and 97.4% at 14 years. The mean OKS and WOMAC score at final follow-up was 30.64 (range 12-48) and 74 (18.9-100) respectively. CONCLUSION: The Scorpio TKR has good long term survivorship and functional outcomes. There is no apparent increased revision rate for this prosthesis in our study. LEVEL OF EVIDENCE: Level IV case series.

The weight debate.

Therapeutic interventions administered on Critical Care are often dosed on the basis of patient body size, to ensure treatments are effective in achieving their goals and to prevent harm from overdose. Many treatment modalities use predicted weights estimated from descriptors such as sex, weight and height to reduce error that is associated with using total body weight in critically ill patients. In this article we review the size descriptors that have been described, their origin and calculation. We then examine the role they play in dosing of common therapies utilised in Critical Care and potential areas of research for the future.

Compliance and use of the World Health Organization checklist in U.K. operating theatres.

BACKGROUND: The World Health Organization (WHO) Surgical Safety Checklist is reported to reduce surgical morbidity and mortality, and is mandatory in the U.K. National Health Service. Hospital audit data show high compliance rates, but direct observation suggests that actual performance may be suboptimal. METHODS: For each observed operation, WHO time-out and sign-out attempts were recorded, and the quality of the time-out was evaluated using three measures: all information points communicated, all personnel present and active participation. RESULTS: Observation of WHO checklist performance was conducted for 294 operations, in five hospitals and four surgical specialties. Time-out was attempted in 257 operations (87.4 per cent) and sign-out in 26 (8.8 per cent). Within time-out, all information was communicated in 141 (54.9 per cent), the whole team was present in 199 (77.4 per cent) and active participation was observed in 187 (72.8 per cent) operations. Surgical specialty did not affect time-out or sign-out attempt frequency (P = 0.453). Time-out attempt frequency (range 42-100 per cent) as well as all information communicated (15-83 per cent), all team present (35-90 per cent) and active participation (15-93 per cent) varied between hospitals (P < 0.001 for all). CONCLUSION: Meaningful compliance with the WHO Surgical Safety Checklist is much lower than indicated by administrative data. Sign-out compliance is generally poor, suggesting incompatibility with normal theatre work practices. There is variation between hospitals, but consistency across studied specialties, suggesting a need to address organizational culture issues.

Multiannual observations of acetone, methanol, and acetaldehyde in remote tropical atlantic air: implications for atmospheric OVOC budgets and oxidative capacity.

Oxygenated volatile organic compounds (OVOCs) in the atmosphere are precursors to peroxy acetyl nitrate (PAN), affect the tropospheric ozone budget, and in the remote marine environment represent a significant sink of the hydroxyl radical (OH). The sparse observational database for these compounds, particularly in the tropics, contributes to a high uncertainty in their emissions and atmospheric significance. Here, we show measurements of acetone, methanol, and acetaldehyde in the tropical remote marine boundary layer made between October 2006 and September 2011 at the Cape Verde Atmospheric Observatory (CVAO) (16.85° N, 24.87° W). Mean mixing ratios of acetone, methanol, and acetaldehyde were 546 ± 295 pptv, 742 ± 419 pptv, and 428 ± 190 pptv, respectively, averaged from approximately hourly values over this five-year period. The CAM-Chem global chemical transport model reproduced annual average acetone concentrations well (21% overestimation) but underestimated levels by a factor of 2 in autumn and overestimated concentrations in winter. Annual average concentrations of acetaldehyde were underestimated by a factor of 10, rising to a factor of 40 in summer, and methanol was underestimated on average by a factor of 2, peaking to over a factor of 4 in spring. The model predicted summer minima in acetaldehyde and acetone, which were not apparent in the observations. CAM-Chem was adapted to include a two-way sea-air flux parametrization based on seawater measurements made in the Atlantic Ocean, and the resultant fluxes suggest that the tropical Atlantic region is a net sink for acetone but a net source for methanol and acetaldehyde. Inclusion of the ocean fluxes resulted in good model simulations of monthly averaged methanol levels although still with a 3-fold underestimation in acetaldehyde. Wintertime acetone levels were better simulated, but the observed autumn levels were more severely underestimated than in the standard model. We suggest that the latter may be caused by underestimated terrestrial biogenic African primary and/or secondary OVOC sources by the model. The model underestimation of acetaldehyde concentrations all year round implies a consistent significant missing source, potentially from secondary chemistry of higher alkanes produced biogenically from plants or from the ocean. We estimate that low model bias in OVOC abundances in the remote tropical marine atmosphere may result in up to 8% underestimation of the global methane lifetime due to missing model OH reactivity. Underestimation of acetaldehyde concentrations is responsible for the bulk (∼70%) of this missing reactivity.

Cumulus gene expression as a predictor of human oocyte fertilisation, embryo development and competence to establish a pregnancy.

The close relationship between cumulus cell function and oocyte developmental competence indicates that analysis of cumulus gene expression is a potential non-invasive method to aid embryo selection and IVF outcome. Cumulus was isolated from 674 oocytes from 75 women undergoing ICSI and gene expression analysed by quantitative RT-PCR. Cumulus expression of cyclooxygenase 2 (PTGS2) was higher with mature oocytes, whereas brain-derived neurotrophic factor (BDNF) was lower when fertilisation was normal. Expression levels of gremlin (GREM1) and BDNF were weak positive and negative predictors of embryo quality respectively. Ranking of GREM1 expression within cohorts of oocytes showed that oocytes associated with the highest GREM1 expression were more likely to be transferred or cryopreserved than discarded (49 vs 33%, P<0.02), although the clinical pregnancy rate was not significantly different. This study demonstrates both the feasibility and difficulties of this method of analysis in the largest such group studied thus far. Novel relationships between BDNF expression and fertilisation were identified, and the potential value of GREM1 expression as a marker of embryo quality supports the further assessment of GREM1 analysis in the context of embryo selection.

Behavior of TiO2 thin film in a nanocapacitor.

Gold and platinum nanocapacitors have been fabricated using a magnetron sputtering technique. TiO2 is used as a dielectric material to separate the metal layers which act as the parallel plates for the capacitors. The thickness for metal films and TiO2 layer is 80 nm and 400 nm, respectively. Capacitance of the nanocapacitors has been measured and dielectric constant of TiO2 calculated. Both capacitance and dielectric constant are observed to have strong frequency dependence.

Three hundred and thirty cycles of preimplantation genetic diagnosis for serious genetic disease: clinical considerations affecting outcome.

OBJECTIVE: To report on our experience with preimplantation genetic diagnosis (PGD) cycles performed for serious genetic disease in relation to the clinical factors affecting outcome. DESIGN: Retrospective review of data from a single centre. SETTING: Tertiary referral PGD centre in a London teaching hospital. METHODS: The PGD cycles included 172 cycles for chromosome rearrangements, 96 cycles for single-gene disorders and 62 cycles for X-linked disorders. In vitro fertilisation was the preferred method in chromosome rearrangement and X-linked cases, while intra cytoplasmic sperm injection was used in all single-gene disorders. Appropriate in situ hybridisation fluorescence probes were used in chromosome rearrangement and X-linked cases and polymerase chain reaction was used in single-gene disorders. All pregnancies were followed till delivery. MAIN OUTCOME MEASURE: Live birth rate per PGD cycle started. RESULTS: Eighty-six percent of cycles started (283) reached oocyte retrieval and 3743 eggs were collected, of which 2086 fertilised normally (55.7%). Two hundred and fifty cycles (76%) had embryos sutiable for biopsy on day 3 of in vitro culture, 1714 embryos were biopsied, and in 205 cycles (62%), there was at least one unaffected embryo available for transfer, resulting in 90 pregnancies, 68 clinical pregnancies and 58 live birth. The live birth rate was 18% per cycle started, 21% per egg retrieval and 28% per embryo transfer which significantly affected the live birth outcome. Woman age, number of eggs collected and achieving cryopreservation of surplus embryos had no statistically significant effect on treatment outcome. CONCLUSIONS: The live birth outcome of PGD cycles for serious genetic disorder is modest and is affected by the number of embryos genetically suitable for transfer.

Preimplantation genetic diagnosis of skin fragility-ectodermal dysplasia syndrome.

Skin fragility-ectodermal dysplasia syndrome is an autosomal recessive disorder caused by loss-of-function mutations in the desmosomal protein, plakophilin 1. Clinically, there may be considerable morbidity from extensive skin erosions and painful fissures on the palms and soles. In the absence of any specific treatment, prenatal diagnosis is an option for couples at reproductive risk of recurrence. In 2000, we developed and applied a single cell nested polymerase chain reaction protocol to test one couple for compound heterozygous plakophilin 1 gene mutations by preimplantation genetic diagnosis (PGD). Although pregnancy was established, an unrelated trisomy 22 led to a spontaneous abortion. However, eight embryos of known genetic status were cryopreserved at that stage, and we planned to undertake subsequent frozen embryo replacement cycles that might lead to the birth of an unaffected child in this family. Embryo cryopreservation was carried out in June 2000 using standard protocols in a three-step freezing procedure. Four embryos were thawed in March 2003, one of which was viable and was used in a frozen embryo replacement cycle, but pregnancy did not occur. The remaining four embryos were thawed in February 2004, two of which were viable (both carriers of the paternal mutation) and these were used in a second frozen embryo replacement cycle, and a singleton pregnancy was established. The child's plakophilin 1 genotype was assessed by direct nucleotide sequencing across the site of both potential mutations. Following two frozen embryo replacement cycles, and almost 4 years after the initial embryo biopsy and mutation analysis, a pregnancy was achieved that progressed to term with the birth of a healthy baby girl. Nucleotide sequencing of cord blood DNA, taken immediately after delivery, showed that the child was a heterozygous carrier of the paternal mutation but not of the maternal mutation. This case demonstrates the value of embryo cryopreservation, which can increase the number of embryo replacement procedures and hence the cumulative pregnancy rate per retrieval cycle. Moreover, this is the first report of successful full-term pregnancy and birth of a healthy baby following exclusion of a severe genodermatosis by PGD. The successful outcome of PGD in this case illustrates what is technically possible for couples at risk of recurrence of a severe inherited skin disease.

Phospholipase Czeta causes Ca2+ oscillations and parthenogenetic activation of human oocytes.

At fertilization in mammals the sperm activates development of the oocyte by inducing a prolonged series of oscillations in the cytosolic free Ca2+ concentration. One theory of signal transduction at fertilization suggests that the sperm cause the Ca2+ oscillations by introducing a protein factor into the oocyte after gamete membrane fusion. We recently identified this sperm-specific protein as phospholipase Czeta (PLCzeta), and we showed that PLCzeta triggers Ca2+ oscillations in unfertilized mouse oocytes. Here we report that microinjection of the complementary RNA for human PLCzeta causes prolonged Ca2+ oscillations in aged human oocytes that had failed to fertilize during in vitro fertilization or intracytoplasmic sperm injection. The frequency of Ca2+ oscillations was related to the concentration of complementary RNA injected. At low concentrations, PLCzeta stimulated parthenogenetic activation of oocytes. These embryos underwent cleavage divisions and some formed blastocysts. These data show that PLCzeta is a novel parthenogenetic stimulus for human oocytes and that it is unique in its ability to mimic the repetitive nature of the Ca2+ stimulus provided by the sperm during human fertilization.

Work practices and histopathological changes in the tenosynovium in carpal tunnel syndrome in men.

The aim of this prospective study was to assess whether the fibrous thickening of the carpal tunnel tenosynovium is influenced by working practices. We did this by investigating 50 men (58 hands) with idiopathic carpal tunnel syndrome, who were undergoing carpal tunnel decompression. Occupational history, including vibration tool exposure, and presence of callosities and/or ingrained dirt on hands was recorded at the time of surgery. The flexor tenosynovium was biopsied, and assessed histologically by an observer blinded to occupational history. Occupational group, age, weight and smoking showed no significant association with fibrous tenosynovial thickening. There was also no significant association between fibrous tenosynovial thickening and the presence of hand callosities/in-grained dirt or regular use of vibration tools. Thus no association was found between heavy occupational hand usage and the development of fibrous tenosynovial thickening around tendons within the carpal tunnel.

LPA1 receptor-deficient mice have phenotypic changes observed in psychiatric disease.

Several psychiatric diseases, including schizophrenia, are thought to have a developmental aetiology, but to date no clear link has been made between psychiatric disease and a specific developmental process. LPA(1) is a G(i)-coupled seven transmembrane receptor with high affinity for lysophosphatidic acid. Although LPA(1) is expressed in several peripheral tissues, in the nervous system it shows relatively restricted temporal expression to neuroepithelia during CNS development and to myelinating glia in the adult. We report the detailed neurological and behavioural analysis of mice homozygous for a targeted deletion at the lpa(1) locus. Our observations reveal a marked deficit in prepulse inhibition, widespread changes in the levels and turnover of the neurotransmitter 5-HT, a brain region-specific alteration in levels of amino acids, and a craniofacial dysmorphism in these mice. We suggest that the loss of LPA(1) receptor generates defects resembling those found in psychiatric disease.

Initial management of ocular hypertension and primary open-angle glaucoma: an evaluation of the royal college of ophthalmologists' guidelines.

PURPOSE: The purpose of this study was to identify any consensus of opinion among consultant ophthalmologists in Wales with respect to the initial management of glaucoma referrals based on the published guidelines of the Royal College of Ophthalmologists (RCO) and to compare consultant opinion with the practice in a typical hospital. METHOD: The RCO guidelines document was studied to identify clear statements, which could be adopted as standards for audit purposes. A questionnaire was designed and sent to all consultant ophthalmologists in Wales (n=37) to obtain their opinions. An audit was performed of 100 consecutive patients referred to our unit as glaucoma suspects with regard to initial management. Descriptive statistical analysis was performed. RESULTS: A good response rate for a postal questionnaire was obtained (81%) with 79.1% of responders finding the guidelines of at least some help. Levels of agreement with the definitions of ocular hypertension (OH) and primary open-angle glaucoma (POAG) were 76.7 and 86.7%, respectively. There was consensus of consultant opinion regarding many of the elements of the baseline clinical assessment with the significant exceptions of the necessity for dilated fundoscopy, gonioscopy, retinal nerve fibre layer assessment, and drawing of optic discs. The various 'clinical scenarios' for management of the RCO document were not all endorsed. The clinical audit results of the initial management of glaucoma referrals accurately reflected the consensus of the consultant opinion. DISCUSSION: The RCO guidelines document represents a useful contribution to the management of patients with OH and POAG. Nevertheless, considerable variation in opinion exists concerning even the most basic areas. With the advent of clinical governance, bridging the gap between the conclusions of College working parties and realities of everyday practice will assume greater importance.

Electromagnetic augmentation of antibiotic efficacy in infection of orthopaedic implants.

Infection of orthopaedic implants is a significant problem, with increased antibiotic resistance of adherent 'biofilm' bacteria causing difficulties in treatment. We have investigated the in vitro effect of a pulsed electromagnetic field (PEMF) on the efficacy of antibiotics in the treatment of infection of implants. Five-day biofilms of Staphylococcus epidermidis were grown on the tips of stainless-steel pegs. They were exposed for 12 hours to varying concentrations of gentamicin or vancomycin in microtitre trays at 37 degrees C and 5% CO2. The test group were exposed to a PEMF. The control tray was not exposed to a PEMF. After exposure to antibiotic the pegs were incubated overnight, before standard plating onto blood agar for colony counting. Exposure to a PEMF increased the effectiveness of gentamicin against the five-day biofilms of Staphylococcus epidermidis. In three of five experiments there was reduction of at least 50% in the minimum biofilm inhibitory concentration. In a fourth experiment there was a two-log difference in colony count at 160 mg/l of gentamicin. Analysis of variance (ANOVA) confirmed an effect by a PEMF on the efficacy of gentamicin which was significant at p < 0.05. There was no significant effect with vancomycin.

Bier's block using prilocaine: safe, cheap and well tolerated.

OBJECTIVES: To examine the safety of prilocaine Bier's block performed for Colles fracture manipulation, and assess patient satisfaction. METHOD: Fifteen-year retrospective review of all patients undergoing Colles fracture manipulation with a prilocaine Bier's block looking for the incidence of significant neurological or cardiovascular events. A confidential questionnaire was administered to 50 consecutive patients to assess patient satisfaction with the method of anaesthesia. RESULTS: 1504 males with mean age 48 years and 5906 females with mean age 66 years received a prilocaine Bier's block for distal radial fracture manipulation. There were no documented incidences of anaphylaxis, arrhythmia, convulsions or collapse. Of 50 consecutive patients, all but two were satisfied with this form of anaesthesia. The pressure cuff inflation was considered the worst part of the procedure. CONCLUSION: Bier's block performed with prilocaine is at least as safe as other commonly used methods of anaesthesia for distal radial fracture reduction with high patient satisfaction. The procedure can be safely carried out by a single medical practitioner with appropriate patient monitoring and assistance from trained nursing staff.

Electromagnetic fields for bone healing.

Electrical stimulation has been applied in a number of different ways to influence tissue healing. Most of the early work was carried out by orthopedic surgeons looking for new ways of enhancing fracture healing, particularly those fractures that had developed into nonunions. Electrical energy can be supplied to a fracture by direct application of electrodes or inducing current by use of pulsed electromagnetic field or capacitive coupling. Many of these techniques have not been standardized, so interpretation of the literature can be difficult and misleading. Despite this, there have been a few good laboratory and clinical studies to investigate the effect of electrical stimulation on fracture healing, which are reviewed. These do not permit recommendation or rejection of the technique per se; however, there is some room for optimism. The authors present some of the guidelines for using this treatment modality but suggest that all treatment should be carried out as part of a clinical trial in order to generate reliable data.