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Despite motor-vehicle safety advancements and increasingly rigorous workplace safety regulations, trauma/suicide remains the leading cause of death under the age of 45 in the United Kingdom. To promote centralisation of care and optimisation of major trauma outcomes, in 2012 the National Health Service introduced the Trauma Network System. To our knowledge, this is the first study to analyse the epidemiology of pelvic and acetabular trauma over a one-year period at a level-1 trauma centre in the United Kingdom, since nationwide introduction of the Trauma Network System.To characterize the epidemiology of high-energy pelvic and acetabular fractures over a one-year period at a level-1 trauma centre, and explore both resources required to care for these patients and opportunities for future research and injury prevention initiatives.227 consecutive patients at a level-1 trauma centre with pelvic and acetabular fractures were analysed between December 2017-December 2018. Paediatric patients (18 years) and fragility fractures were excluded, leaving 175 patients for inclusion in the study. Statistical analysis was performed using Fisher's exact test for categorical variables.72% of pelvic and acetabular fractures occurred in male patients at a median age of 45 years. 15% were the result of a suicide attempt. 48% of patients required pelvic or acetabular surgery, with 38% undergoing further surgery for additional orthopaedic injuries. 43% of patients were admitted to intensive care. The median inpatient stay was 13 days, and the 30- day mortality was 5%. Pelvic ring trauma was more commonly associated with abdominal injury (High energy pelvic and acetabular fractures are associated with concomitant orthopaedic fractures (most commonly spine and lower limb), intensive care admission and prolonged inpatient stays. Most pelvic ring injuries secondary to road traffic accidents are lateral compression type, demonstrating the need for future research to drive advancements in lateral impact vehicle safety along with mental health surveillance for those deemed to be potential suicide risks.

There are extensive studies to date on optical nonlinearities in microcavities at the near and mid-IR wavelengths. Pushing this research into the visible region is equally valuable. Here, we demonstrate a directly pumped, blue band Kerr frequency comb and stimulated Raman scattering (SRS) at 462 nm in a silica nanofiber-coupled whispering gallery microcavity system. Notably, due to the high optical intensities achieved, photodarkening is unavoidable and can quickly degrade the optical quality of both the coupling optical nanofiber and the microcavity, even at very low pump powers. Nonetheless, stable hyperparametric oscillation and SRS are demonstrated in the presence of photodarkening by taking advantage of in-situ thermal bleaching. This work highlights the challenges of silica-based, short wavelength nonlinear optics in high-quality, small mode volume devices and gives an effective method to overcome this apparent limitation, thus providing a baseline for optics research in the blue region for any optical devices fabricated from silica.

This article examines Black motherhood within digital media and how the cultural mediation of Meghan Markle’s pregnancy and motherhood online can be understood. In considering the cultural meaning(...

We report on poly(arylene-imidazoliums), which were synthesized by microwave polycondensation of dialdehyde with bisbenzil and quantitatively functionalized by alkylation. This cationic polyelectrolyte is sterically protected around the C2-position and is stable in 10 M KOH

Background Sputum cytology is currently the gold standard to evaluate cellular inflammation in the airways and phenotyping patients with airways diseases. Sputum eosinophil proportions have been used to guide treatment for moderate to severe asthma. Furthermore, raised sputum neutrophils are associated with poor disease control and impaired lung function in both asthma and COPD and small airways disease in cystic fibrosis. However, induced-sputum analysis is subjective and resource heavy, requiring dedicated specialist processing and assessment; this limits its utility in most clinical settings. Indirect blood eosinophil measures have been adopted in clinical care. However, there are currently no good peripheral blood biomarkers of airway neutrophils. A resource-light sputum processing approach could thus help integrate induced sputum more readily into routine clinical care. New mechanical disruption (MD) methods can rapidly obtain viable single cell suspensions from sputum samples. Aims The aim of this study was to compare MD sputum processing to traditional methods for cell viability, granulocyte proportions and sputum cytokine analysis. Methods Sputum plugs were split and processed using traditional methods and the MD method, and samples were then compared. Results The MD method produced a homogeneous cell suspension in 62 s; 70 min faster than the standard method used. No significant difference was seen between the cell viability (p = 0.09), or the concentration of eosinophils (p = 0.83), neutrophils (p = 0.99) or interleukin-8 (p = 0.86) using MD. Conclusion This cost-effective method of sputum processing could provide a more pragmatic, sustainable means of directly monitoring the airway milieu. Therefore, we recommend this method be taken forward for further investigation.

Purpose The purpose of this paper is to design, build and test a low power high frequency (HF) transmitter that can be received by the Super Dual Auroral Radar Network (SuperDARN) radar installed at SANAE IV, the 4th South African National Antarctic Expedition Station. It is proposed that it may be possible to do propagation studies using the radar and the fixed frequency, ground-based HF transmitter beacon. Interpretation of the measurements can be used to study the ionosphere, especially Travelling Ionospheric Disturbances, which are signatures of atmospheric gravity waves. Design/methodology/approach In the absence of the actual deployment of the HF transmitter beacon in Antarctica, extensive simulations have been done to evaluate the expected performance of the transmitter in relation to the SuperDARN. A field trial has been executed between Hermanus (34.4241° S, 19.2247° E) and Pretoria (34.0558° S, 18.4589° E) in South Africa. In future, the beacon will be placed at the South Pole with its antenna radiating towards SANAE IV. Findings The HF transmitter conforms to the power and frequency stability requirements both during propagation tests conducted between Hermanus and Pretoria, as well as when the device was exposed to temperatures that ranged from +40°C to −45°C in a thermal chamber. Propagation in Antarctica is expected to differ from the field tests conducted due to the differences in density and dynamics of the polar ionosphere, compared to the mid-latitude ionosphere. Originality/value Space weather research, including forecasting atmospheric gravity waves and determining the expected electron density profile of the ionosphere, is of great scientific interest. The data received from the HF beacon can be used to study and characterize the ionosphere of the region between the South Pole and SANAE IV. Parameters of the ionosphere, such as electron density, geomagnetic storm effects, ionospheric motions and sky wave propagation paths will be better understood from analysing the signal received from this transmitter after it has been reflected and refracted by the ionosphere.

Background: Increasing rates of opioid-related overdose have been identified globally. Treatment for opioid use disorders (OUD) includes medications for opioid use disorder (MOUD) alongside behavio...

Background: Digital interventions can be tailored to the individual and allow automated collection of data. Computer-assisted therapy program ‘Breaking Free Online’ (BFO) is delivered within ‘Chang...

Purpose The purpose of this review is to discuss the development of Wixela™ Inhub™, a generic equivalent of Advair Diskus®, a fixed-dose combination of fluticasone propionate/salmeterol powder for oral inhalation for patients with asthma whose symptoms are not controlled with inhaled corticosteroids alone and for those with chronic obstructive pulmonary disease (COPD) who are at a high risk for exacerbations. Summary We provide an overview of the Inhub device and the bioequivalence studies that have been conducted to date. Briefly, the in vitro performance, improvements in forced expiratory volume in 1 s, and the fluticasone propionate/salmeterol dose strengths for Wixela Inhub and Advair Diskus were comparable. Conclusion The bioequivalence demonstrated by the totality of clinical and in vitro data supports the use of Wixela Inhub and provides a treatment option for patients with asthma or COPD., Plain Language Summary The Wixela™ Inhub™ device has been developed as a generic equivalent of Advair Diskus®, and provides a combination treatment for patients with asthma whose symptoms are not controlled with inhaled corticosteroids alone and for those with chronic obstructive pulmonary disease (COPD) who are at a high risk for exacerbations. We provide information about the Inhub device and studies conducted to show how Inhub and Diskus are comparable products. Based on the similar results between the two devices, Inhub can be used as a treatment option for patients with asthma or COPD.

Multi-energy systems (MES) are attracting increasing attention driven by its potential to offer significant flexibility in future smart grids. At the residential level, the roll-out of smart meters and rapid deployment of smart energy devices call for autonomous multi-energy management systems which can exploit real-time information to optimally schedule the usage of different devices with the aim of minimizing end-users’ energy costs. This paper proposes a novel real-time autonomous energy management strategy for a residential MES using a model-free deep reinforcement learning (DRL) based approach, combining state-of-the-art deep deterministic policy gradient (DDPG) method with an innovative prioritized experience replay strategy. This approach is tailored to align with the nature of the problem by posing it in multi-dimensional continuous state and action spaces, facilitating more cost-effective control strategies to be devised. The superior performance of the proposed approach in reducing end-user’s energy cost while coping with the MES uncertainties is demonstrated by comparing it against state-of-the-art DRL methods as well as conventional stochastic programming and robust optimization methods in numerous case studies in a real-world scenario.

Background: Wixela® Inhub® is a dry powder inhaler approved as a generic equivalent to Advair® Diskus® (fluticasone propionate [FP]/salmeterol fixed-dose combination) for patients with asthma or chronic obstructive pulmonary disease (COPD). This study aimed at confirming the local (lung) therapeutic equivalence of both the FP and salmeterol components of Wixela Inhub (test [T]) to Advair Diskus (reference [R]) after inhalation. Methods: This randomized, double-blind, double-dummy, placebo-controlled, parallel-group study in patients ≥18 years with mild-to-moderate persistent asthma compared the local therapeutic equivalence (using forced expiratory volume in 1 second [FEV1]) of FP/salmeterol (100/50 μg) after inhaled delivery via T and R. Results: Randomized patients (N = 1127) received T (n = 512), R (n = 512), or placebo (n = 103). T and R significantly increased day 1 FEV1 area under the effect curve over 12 hours of the change from baseline (AUC[0–12]) and day 29 trough FEV1 over placebo, indicating that these endpoints were sufficiently sensitive for evaluation of bioequivalence. On day 1, T and R each increased FEV1 AUC(0–12) over placebo (3.134 L•h [T], 2.677 L•h [R]; each p

Objectives A national pre-registration pharmacist recruitment scheme, which replaces the local recruitment models, was introduced in England and Wales in 2017. This study aimed to explore pharmacy students' behaviour and associated factors in their selection of pre-registration training programmes. Methods A mixed-method study using (a) analysis of data from all applicants (n = 2694) of the national recruitment scheme, (b) an online survey and (c) a virtual focus group was undertaken. Survey and focus group questions were developed based on the Theoretical Domains Framework (TDF). Descriptive and inferential analysis of quantitative data was undertaken using Stata software. Qualitative data from focus groups and responses from the open-ended questions were analysed using framework technique. Key findings A vast majority of applicants (n = 2182, 83.9%) selected a hospital training programme as their first ranked preference, with the rest opting for community pharmacy. Urban areas, particularly London, were most popular geographically. A total of 307 survey responses were returned. Long-term career aspirations, followed by geographical factors, were rated most highly in applicants' decision-making. Qualitative data from survey and focus group demonstrated information about programmes/employers, perceived opportunity for skills development and aspiration towards a career path as key contributory factors in their decision-making. Conclusions Secondary care was the most desirable destination for pharmacy students to undertake early career training. The clinical roles and career opportunities in community pharmacy needs to be promoted as there is a risk that community pharmacy training programme places may be seen as a ‘left over’ opportunity for less competitive candidates to uptake.

Ryan Coogler's Black Panther (2018) constitutes an intervention within representations of blackness within American culture. In a landscape in which the vast majority of depictions of black people ...

Despite the increasing visibility of queerness and queer folks in American popular culture, there is a concerning dissonance between this symbolic cultural progression, and the reality of queer liv...

International audience; Academic Core Facilities are optimally situated to improve the quality of preclinical research by implementing quality control measures and offering these to their users.

With the principles of reticular chemistry, metal-organic frameworks (MOFs)with enhanced storage and catalytic capabilities have been prepared. This dissertationpresents the synthesis of azo-IRMOF-74-III for controllable release of cargomolecules as well as the catalytic testing of MOF-525-Mn and an isoreticular seriesof MOFs based on the MOF-5 framework. The variation of pore metrics inthese frameworks show the versatility of reticular chemistry and their applicationin catalytic reactions.First, an azobenzene containing MOF-74 analogue was prepared by incorporatingthe azobenezne moiety into the organic linker used to prepare MOF-74.Cargo molecules were trapped inside the structure based on size constraints andcontrollably released via modulation of UV irradiation to induce a trans to cisisomerization on the organic linker. The variation in the linker lengh shows thatspecic cargo molecules can be trapped by changing the size of the one-dimensionalpore in reticular frameworks.In addition to changing pore size, density of catalytic sites inside a pore wasinvestigated through the isoreticular synthesis of a series of MOFs, modeled after MOF-5 but containing various amounts of 2-aminoterephthalic acid. These aminegroups were post-synthetically modied to contain catalytically active Pd sites andheterogeneous Heck coupling was performed. A inverse relationship was observedbetween the amount of framework metalation and reaction yield and selectivity.This is attributed to pore blocking from post-synthetic modication at highermetal loadings.Finally, a manganese porphyrin containing MOF, MOF-525-Mn, was synthesizedand its activity tested through the epoxidation of alkenes using molecularoxygen. High catalytic activity was observed for all alkenes and this is the rstinstance of MOF epoxidation using molecular oxygen, a ubiquitous industrial oxidant.Another MOF containing the same catalytically active porphyrin but in adierent topology, MOF-545-Mn, was also tested for catalytic activity to determinethe eect of MOF topology on heterogeneous catalysis.The variation of pore metrics is demonstrated through each chapter and showhow powerful and useful reticular chemistry is through variation of structuralelements for specic uses. While catalytic MOFs are in their infancy, the future isbright for catalytically active MOFs to come to the forefront of chemical industry.

A novel polymer polybis(dimethyl stannyl)ferrocene was synthesized through both metal catalyzed intermolecular dehydrogenative condensation and ring-opening polymerization. This polymer was the first evidence of a dibridged polyferrocenyl stannane, and was found to be of low to moderate molecular weight by gel permation chromatography and 1H NMR spectroscopy. This polymer displayed extensive electronic communication observed previously synthesized monobridged ferrocenyl stannane polymers. The first tristanna-bridged 3.3]ferrocenophane was discovered through an amine coupling of a tin amine, and 1,1’bis(dimethyl stannyl) ferrocene. The [3.3]ferrocenophane displayed a strong interaction between connected ferrocenes despite the large distance, (8.49 Å) between Fe centers. Finally, a new and improved synthesis of 1,1,2,2-tetramethyldistanna-[2]ferrocenophane was found. This metal catalyzed intramolecular dehydrogenative coupling employs Pd2(dba)3 as a catalyst and yields 90% product. All products were characterized where possible 1H, 13C, and 119Sn NMR and UV-Visible spectrocopy, as well as through cyclic voltammetry and DFT modeling.