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IntroductionGabapentin is an antiepileptic drug currently licensed to treat epilepsy and neuropathic pain but has been used off-label to treat acute postoperative pain. The GAP study will compare the effectiveness, cost-effectiveness and safety of gabapentin as an adjunct to standard multimodal analgesia versus placebo for the management of pain after major surgery.Methods and analysisThe GAP study is a multicentre, double-blind, randomised controlled trial in patients aged 18 years and over, undergoing different types of major surgery (cardiac, thoracic or abdominal). Patients will be randomised in a 1:1 ratio to receive either gabapentin (600 mg just before surgery and 600 mg/day for 2 days after surgery) or placebo in addition to usual pain management for each type of surgery. Patients will be followed up daily until hospital discharge and then at 4 weeks and 4 months after surgery. The primary outcome is length of hospital stay following surgery. Secondary outcomes include pain, total opioid use, adverse health events, health related quality of life and costs.Ethics and disseminationThis study has been approved by the Research Ethics Committee . Findings will be shared with participating hospitals and disseminated to the academic community through peer-reviewed publications and presentation at national and international meetings. Patients will be informed of the results through patient organisations and participant newsletters.Trial registration numberISRCTN63614165.

Purpose The use of microstereolithography (μSL) parts as micro-injection molding (μIM) tools greatly reduces the time and cost to product and offers unique solutions for complex design issues. However, they present challenges to designers because of their strength, thermal characteristics and shorter lifetimes as compared to other mold materials. The purpose of this study is to use SL to build rapid injection mold tools directly combining micro features for short-run production. Design/methodology/approach In total, three tool inserts were produced. Two different μSL mold inserts were produced and evaluated in terms of different build approaches of micro features. One of the inserts includes micro features built horizontally, while the other one collaborates features built vertically, both having same geometrical dimensions. To evaluate the replication capability of prototype tools, two different thicknesses were set for micro features, that is, 30 and 120 μm. The mold inserts were assembled on a metallic mold frame and tested with polypropylene (PP). Findings It was observed that using inappropriate resin to fabricate the mold inserts can lead to inaccurate geometrical dimensions of the tool. Therefore, the material with high glass transition temperature (Tg) and low thermal conductivity is preferred. Also, the results of this research work showed that the processed material and technology play an important role both on part quality and tool life. After investigating the tool failure mechanisms during the injection, it was observed that tool failure occurred mainly because of excessive flexural stresses and ejection forces during the cavity filling and part ejection phases, respectively. Originality/value The paper describes the capability of μSL mold inserts for the production of small batches of micro-cantilevers which are used in MEMS relays.

The Public Health Act of 1848 was the culmination of what A. S. Wohl has termed the ‘first stage’ in the British public health movement which followed the publication in 1842 of Edwin Chadwick’s famous Report on the Sanitary Conditions of the Labouring Population of Great Britain. The Act not only established a General Board of Health but also had provisions for local authorities to form local boards of health with extensive powers over town infrastructure, including the management of water supply and sewage disposal, and the regulation and control of offensive trades, unfit habitations, and ‘nuisance’ removal. Establishment of local boards was initially slow as the clauses that provided for them were permissive rather than mandatory, and although the General Board could impose them on districts where the death rate exceeded 23:1000 these powers were rarely enacted.2 Paradoxically, it was the smaller towns which enjoyed relatively salubrious living conditions which evinced most enthusiasm for adopting the Act. Thus the average population of the first fifteen places to petition for a local board of health consisted of less than 18,000 inhabitants.3 Foremost amongst these pioneers was the town of Croydon, located about twelve miles south of London and with a midnineteenth century population of about 20,000. Its local board was the first to install a continuous piped water supply and sewage removal1 Comment in Croydon Chronicle (CC) 13 Apr. 1867. 2 A.S. Wohl, Endangered Lives. Public Health in Victorian Britain (London,1983), 149-50. For a recent re-evaluation of Chadwick’s work see C. Hamlin, Public Health and Social Justice in the Age of Chadwick (Cambridge, 1998).

Polymeric micro-cantilevers (Cs) are rapidly becoming popular for MEMS applications such as chemo- and bio-sensing as well as purely electromechanical applications such as microrelays. Polymer materials present suitable physical and chemical properties combined with low-cost mass production. Hence, micro-cantilevers made of polymers indicate much more biocompatibility and adaptability of rapid prototyping along with mechanical properties. This research emphasizes the analysis for microstructure of micro-cantilevers arrays in micro-injection molding. The finite element simulation in a three-dimensional inertia-free, incompressible flow is presented. A control volume scheme with a fixed finite element mesh is employed to predict melt front advancement. Two types of polymers polypropylene (PP) SABIC 56M10 and acrylonitrile butadiene styrene (ABS) Magnum 8434 were used as the material for the implementation of simulations.

There is increasing evidence to support the safety and reliability of ultrasound-guided regional anaesthesia (regional nerve ‘blocks’ using local anaesthetic drugs) in the setting of elective orthopaedic surgery. In response to a patient safety incident that occurred while under general anaesthesia (GA), we set out to offer awake regional nerve blocks to high-risk patients as a safe alternative to GA. Between September 2010 and July 2011, 43 patients scheduled for elective upper limb surgery on ‘high-risk lists’ were given a regional anaesthetic for their operation. Patients were followed up by telephone interview 24 hours post-surgery to monitor complications and to gain patient feedback. We also assessed regional anaesthesia in terms of efficiency and patient satisfaction. Overall 42/43 patients were successfully blocked (1/43 converted to GA). ‘Blocked’ patients were able to bypass the ‘post anaesthesia care unit’, and could proceed straight to the ward after their operation in the majority of cases. Nobody was dissatisfied with their anaesthetic, and 40/41 would chose regional anaesthesia again over GA. Ultrasound-guided regional anaesthesia is a reliable alternative to GA and is associated with high patient acceptability. In the setting of a UK NHS district general hospital, availability of ultrasound-guided regional anaesthesia may help to improve patient safety, patient choice and postoperative efficiency. The findings of the service evaluation support our ongoing use of this technique.

Multiple breath washout (MBW) in infants presents a number of technical challenges. Conventional MBW is based on simultaneous measurement of flow and gas concentrations. These two signals are aligned and combined to derive expired gas volumes from which lung volumes and measures of ventilation inhomogeneity are calculated. Accuracy of measurement becomes increasingly vulnerable to errors in gas signal alignment at fast respiratory rates. In this paper we describe an alternative method of performing MBW in infants. Expired gas is collected and analyzed to derive functional residual capacity (FRC) and lung clearance index (LCI). This eliminates the need for simultaneous measurement of flow, and integration of flow and gas signals, and significantly reduces deadspace.A highly accurate lung model incorporating BTPS conditions was used to generate realistic infant breathing parameters: FRC of 100-250 mls with respiratory rate of 20-60 min(-1) . In vitro accuracy of FRC measurement using the novel MBW method was assessed using the model.Overall mean error (standard deviation) of FRC measurement was -1.0 (3.3)% with 90% of tests falling within ±5%.FRC measurement using the novel method has superior accuracy in vitro than previously described systems. By uncoupling the measurement of gas volumes from real-time flow and gas measurement, this system offers an alternative method of MBW which is well suited to infants.

Polymeric micro-cantilevers (Cs) are rapidly becoming popular for MEMS applications such as chemo- and biosensing as well as purely electromechanical applications such as microrelays. Polymer materials present suitable physical and chemical properties combined with low-cost mass production. Hence, micro-cantilevers made of polymers indicate much more biocompatibility and adaptability of rapid prototyping along with mechanical properties. This research studies the effects of three process and one size factors on the filling behaviour in micro cavity, and the role of each in the replication of micro parts using different polymer materials i.e. polypropylene (PP) SABIC 56M10 and acrylonitrile butadiene styrene (ABS) Magnum 8434 . In particular, the following factors are considered: barrel temperature, mould temperature, injection speed and the thickness of micro features. The study revealed that the barrel temperature and the injection speed are the key factors affecting the flow length of micro features replicated in PP and ABS. For both materials, an increase of feature sizes improves the melt flow. However, the melt fill of micro features does not increase linearly with the increase of their thickness., {"references":["C. A. Griffiths et al., The finite element analysis of melt flow behavior in\nmicro-injection moulding Process, J. Eng. Manuf. 2008, pp. 1107-1118.","F. H. C. Heussler et. al., Three-dimensional Navier–Stokes simulations\nof buoyant, vertical miscible Hele-Shaw displacements, J. Fluid Mech.\n2014, pp. 157–183.","C. A. Griffiths et. al., The effects of tool surface quality in microinjection\nmoulding J. Mater. Proc. Technol. 2007, pp. 418–427.","M. S. Kim and S. M. Kim, Filling Behavior of Polymer Melt in Micro\nInjection Molding for V-Grooves Pattern, J. Korean Soc. Manuf. Tech.\nEng. 2014, pp. 291-298.","U. R. O. Theilade, Surface micro topography replication in injection\nmoulding, PhD Thesis, Technical University of Denmark, 2005."]}

Victorian Britain experienced acute problems of sewage disposal which were brought about by the expansion of population and its agglomeration into large urban areas. Sanitarians condemned the inadequacy of traditional methods of waste removal, but the gradual extension of the disposal of refuse by water led to the pollution of natural watercourses, and the costs of the construction of sewerage systems put an extensive financial burden on urban ratepayers. An essential part of the long Victorian debate on improved sanitation was the belief that sewage was a valuable commodity, the agricultural utilization of which would generate substantial income to offset the costs associated with sanitary reforms. It took nearly half-a-century for it to be established that optimism on this count was misplaced, and this article examines the course of the debate with particular reference to Victorian attitudes to resource conservation, environmental values and the relationships between town and country.

Review of John Hassan, A History of Water in Modern England and Wales

The effect on the n.m.r. spectral parameters of dissolving five different phosphoryl and thiophosphoryl compounds in a series of organic solvents of varying protonic acidity was studied. For all five of these compounds, the absolute magnitudes of the coupling constants for the directly bonded magnetically active nuclei increased with solvent acidity, whilst there was also a concurrent small change in the chemical shift(s). These and related results are discussed in terms of association with the acidic solvent through hydrogen bonding at the phosphoryl oxygen atom (or thiophosphoryl sulphur atom). Some pertinent semi-empirical LCAO–MO–SCF calculations have been carried out for these molecules, with and without hydrogen bonding.