Showing papers by "University of Huddersfield published in 2022"

Laser deposition of high-entropy alloys: A comprehensive review

Abstract: Since the advent in 2004, high-entropy alloys (HEAs) have become an attraction for the world and applied in the extensive engineering fields due to their outstanding properties. These materials are exhibiting their potentiality for challenging conditions where coatings are applied through laser deposition technology. Laser deposition techniques containing laser cladding (LC), laser surface alloying (LSA), and laser surface remelting (LSR) are the modern technologies that can be applied for surface modification through HEAs. Nobler properties of the LC-HEA depositions over the conventional alloys have further explored this field in the last few years. Here, this paper provides a comprehensive state-of-the-art review for LC-HEA-based coatings, focusing on the use of laser deposition technique for HEAs, the effect of laser process parameters on mechanical properties, and microstructural evolution. The mechanical characteristics include but are not limited to hardness, wear, corrosion, and erosion resistance are discussed, with regard to their microstructure and phase composition. Besides, the existing problems, possible future developments regarding the LC-HEA depositions are predicted. Due to excellent mechanical properties and functional potential as well as a variety of element constitutions for HEA designing, laser-assisted depositions containing blended HEAs as feedstock material will have promising applications prospects in the field of material science and engineering.

A Brief Review on the Development of Alginate Extraction Process and Its Sustainability

Abstract: Alginate is an attractive marine resource-based biopolymer, which has been widely used in pharmaceutical, food and textile industries. This paper reviewed the latest development of the conventional and alternative processes for alginate extraction from brown seaweed. To improve extraction yield and product quality, various studies have been carried out to optimize the operation condition. Based on literature survey, the most commonly used protocol is soaking milled seaweed in 2% (w/v) formaldehyde, overnight, solid loading ratio of 1:10–20 (dry weight biomass to solution), then collecting the solid for acid pre-treatment with HCl 0.2–2% (w/v), 40–60 °C, 1:10–30 ratio for 2–4 h. Next, the solid residue from the acid pre-treatment is extracted using Na2CO3 at 2–4% (w/v), 40–60 °C, 2–3 h, 1:10–30 ratio. Then the liquid portion is precipitated by ethanol (95%+) with a ratio of 1:1 (v/v). Finally, the solid output is dried in oven at 50–60 °C. Novel extraction methods using ultrasound, microwave, enzymes and extrusion improved the extraction yield and alginate properties, but the financial benefits have not been fully justified yet. To improve the sustainable production of alginate, it is required to promote seaweed cultivation, reduce water footprint, decrease organic solvent usage and co-produce alginate with other value-added products.

Device-related pressure ulcers: SECURE prevention. Second edition

Abstract: Journal of Wound CareVol. 31, No. Sup3a International Consensus DocumentFree AccessDevice-related pressure ulcers: SECURE prevention. Second editionAmit Gefen, Paulo Alves, Guido Ciprandi, Fiona Coyer, Catherine T Milne, Karen Ousey, Norihiko Ohura, Nicola Waters, Peter Worsley, Joyce Black, Michelle Barakat-Johnson, Dimitri Beeckman, Jacqui Fletcher, Holly Kirkland-Kyhn, Nils A. Lahmann, Zena Moore, Yohan Payan, Anna-Barbara SchlüerAmit GefenProfessor of Biomedical Engineering, The Herbert J. Berman Chair in Vascular Bioengineering, Department of Biomedical Engineering, Faculty of Engineering, Tel Aviv University, Tel Aviv, IsraelSearch for more papers by this author, Paulo AlvesAssistant Professor and Coordinator, Wounds Research Laboratory, Catholic University of Portugal, Institute of Health Sciences, Centre for Interdisciplinary Research in Health, Lisbon, PortugalSearch for more papers by this author, Guido CiprandiChief Wound Care, Surgical Unit, Division of Plastic and Maxillofacial Surgery, Bambino Gesu’ Children's Hospital, Research Institute, Rome, ItalySearch for more papers by this author, Fiona CoyerProfessor of Nursing (joint appointment), Intensive Care Services, Royal Brisbane and Women's Hospital, School of Nursing, Queensland University of Technology, Brisbane, Australia. Visiting Professor, Institute for Skin Integrity and Infection Prevention, University of Huddersfield, UKSearch for more papers by this author, Catherine T MilneConnecticut Clinical Nursing Associates, Bristol Hospital Wound and Hyperbaric Medicine, Bristol, Connecticut, USSearch for more papers by this author, Karen OuseyProfessor of Skin Integrity, Director, Institute of Skin Integrity and Infection Prevention, School of Human and Health Sciences, Huddersfield University, UK; Clinical Professor, Queensland University of Technology, Australia; Visiting Professor, Royal College of Surgeons in Ireland, Dublin, Republic of IrelandSearch for more papers by this author, Norihiko OhuraProfessor, Department of Plastic, Reconstructive and Aesthetic Surgery, Kyorin University School of Medicine, Tokyo, JapanSearch for more papers by this author, Nicola WatersSenior Research Associate, Health, The Conference Board of Canada; Adjunct Professor, School of Nursing, University of British Columbia Okanagan, Kelowna, British Columbia, CanadaSearch for more papers by this author, Peter WorsleyAssociate Professor in Rehabilitative Bioengineering, Clinical Academic Facility in the School of Health Sciences, University of Southampton, UKSearch for more papers by this author, Joyce BlackProfessor, College of Nursing, University of Nebraska Medical Center. Nebraska, USSearch for more papers by this author, Michelle Barakat-JohnsonClinical Lead and Skin Integrity Lead, HAC Pressure Injury Coordinator, Sydney Local Health District; Adj Associate Professor, Faculty of Medicine and Health, University of Sydney, AustraliaSearch for more papers by this author, Dimitri BeeckmanProfessor, Skin Integrity Research Group (SKINT), Ghent University, Belgium; Professor and Vice-Head, School for Research and Internationalisation, Örebro University, SwedenSearch for more papers by this author, Jacqui FletcherIndependent Nurse Consultant, UKSearch for more papers by this author, Holly Kirkland-KyhnDirector of Wound Care. University of California Davis Medical Center, USSearch for more papers by this author, Nils A. LahmannDeputy Director, Geriatrics Research Group, Charité University Berlin, GermanySearch for more papers by this author, Zena MooreProfessor and Head, School of Nursing and Midwifery. Director, Skin Wounds and Trauma Research Centre, Royal College of Surgeons in Ireland, Dublin, Republic of IrelandSearch for more papers by this author, Yohan PayanResearch Director, Laboratoire TIMC-IMAG, Grenoble Alpes University, FranceSearch for more papers by this author, Anna-Barbara SchlüerAdvanced Nurse Practitioner, Paediatric Skin and Wound Management, Head of the Paediatric Skin Centre, Skin and Wound Management and Department of Nursing Science, University Children's Hospital, Zurich, SwitzerlandSearch for more papers by this authorAmit Gefen; Paulo Alves; Guido Ciprandi; Fiona Coyer; Catherine T Milne; Karen Ousey; Norihiko Ohura; Nicola Waters; Peter Worsley; Joyce Black; Michelle Barakat-Johnson; Dimitri Beeckman; Jacqui Fletcher; Holly Kirkland-Kyhn; Nils A. Lahmann; Zena Moore; Yohan Payan; Anna-Barbara SchlüerPublished Online:26 May 2022https://doi.org/10.12968/jowc.2022.31.Sup3a.S1AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail Executive summaryAlthough great strides have been made to tackle hospital-acquired pressure ulcers (HAPUs), there is a need for greater recognition of device-related pressure ulcers (DRPUs), including their causes, management and prevention. This consensus statement, an updated second edition, aims to continue raising awareness of these largely preventable injuries and, crucially, to stimulate action.DRPUs are relatively common and account for a growing proportion of HAPUs. Updated information on the incidence of DRPUs is described in chapter 1. Although it is recognised that DRPUs increase the financial burden of healthcare, there is little formal analysis of their economic impact. This needs to be addressed; robust evidence on the burden of DRPUs and the value that can be released by adopting prevention strategies is needed to help drive action.Our understanding of the pathophysiology of DRPUs has improved significantly over the past few years; this is described in chapter 2. One crucial difference between PUs and DRPUs is that body-weight forces are less significant in DRPUs, with the force being exerted from a device that is typically strapped or taped onto the body. Devices and their securement may generate high stress concentrations in tissues, leading to cell and tissue-damage pathways associated with sustained deformation.As more evidence is published on DRPUs, recurring themes are emerging, as outlined in chapter 3:The most vulnerable patients are bearing the brunt of DRPUs; paediatric and neonatal patients, and all those needing critical care are particularly susceptible. During the COVID-19 pandemic, a new high-risk population (people with severe COVID-19 infection) emerged. They are at increased risk of DRPUs because of their need for prolonged ventilatory support, especially when ‘proning’Devices associated with DRPUs are often used to perform essential, life-saving functions. They include continuous positive airway pressure (CPAP) masks or endotracheal tubes. Minimising their use is clearly not an option, so practice innovation is neededAlthough the most common locations for DRPUs are the face, ears, lower legs and heels, any location where a device comes into close contact with the skin can be at risk. In the same vein, any device, whether needed for a medical purpose or not, has the capacity to cause injury if its use is not properly managed. Vigilance is needed for all patients.What can be done? The importance of routine risk assessment is covered in chapter 4. Although use of a validated risk assessment tool is the vital first step, this will not be enough on its own. Several steps can be taken to ensure the safe use of devices. These are described in chapter 5 and include device repositioning, cushioning with prophylactic dressings and moisture control (only where possible and clinically appropriate). Of key importance is the development of an institutional protocol and champions to ensure all necessary steps are adopted.For any of these changes to be put into practice, awareness of DRPUs needs to increase. A number of proposals are outlined in chapter 6. A change of focus among health professionals and policy makers, along with more investment in education and training, are needed. All patients being managed with a medical device must be considered as at high risk.The pandemic introduced the world to the problem of DRPUs in health professionals caused by the extended wear of personal protective equipment. Health professionals also have a right to expect institutional protocols and provision of devices that protect them from DRPUs.Cutting-edge ideas and technologies that may be available in the future are described in chapter 7. When designing new products, manufacturers of medical devices have a duty of care to investigate the risks of DRPUs associated with their products and mitigate them, wherever possible. Our developing understanding of how the design, structure and materials used in medical devices contribute to DRPUs will help us develop new solutions for tomorrow.The first step is for everyone involved to ask themselves, ‘what can I do to help?’ There is work to be done—your journey to reduce DRPUs starts here!ForewordIn February 2019, an international group of medical, clinical and bioengineering experts met in London to develop the first edition of an international consensus statement on device-related pressure ulcers (DRPUs). Following a rigorous process of scientific discussion, the statement was drafted, reviewed by an international independent committee of external experts and published in JWC in February 20201 shortly before the breakout of the COVID-19 pandemic. It was, at the time, the most comprehensive synthesis of understanding of the aetiology of DRPUs and the technologies and clinical protocols that can be used to mitigate them.The pandemic was, and still is, a game-changer, as it instantly brought the effects of DRPUs into sharp focus, particularly in regard to the use of ventilation equipment and the management of critically ill patients in the prone position for prolonged periods.With the rise in reports of DRPUs and the change in global circumstances, the topic of prevention and treatment of this form of skin damage became more time-sensitive than ever. The expert panel recognised this early during the pandemic and, as a first reaction to the change in circumstances, published an update article, to complement the consensus statement. This focused on skin damage under personal protective equipment (PPE) in health professionals—a new category of DRPUs that had not been widely experienced in our lifetime prior to the pandemic.2This was not sufficient to capture the knowledge generated over the course of the pandemic. To continue supporting patients and health professionals, the consensus panel gathered in March 2021 to update their consensus statement, sharing the knowledge collected and the lessons learned since the first edition was published. The aim was to provide frontline staff with updated, clear, simple guidance on how to mitigate the risk of DRPUs during the pandemic and beyond, with in-depth content on the development and implementation of long-term prevention strategies.Like its predecessor, this second edition is aimed at generalists and specialists, as well as biomedical and non-biomedical engineers and other health professionals in clinical practice, academia, research and industry. It starts by updating the aetiology and pathophysiology of DRPUs, explaining how medical devices and objects that encounter the skin and apply forces onto it can cause cell and tissue deformation. This is followed by the assessment, prevention and management of DRPUs, including under the current pandemic circumstances.The consensus statement discusses the devices that are most associated with DRPUs and the biomechanical reasons for the risks they pose, with reference to the most recent scientific and medical literature. It also aims to inform policymakers and health professionals at all levels on the critical need for DRPU prevention through identification of the root causes, the scale of the problem, the damage they pose to quality of life, and the financial implications for institutions, insurers and governments.Greater awareness of the growing problem of DRPU formation will lead to better adoption of prevention protocols and much-needed new preventive technologies and design improvements. This edition, therefore, specifies the revised requirements that should inform the development of medical technologies for the prophylaxis of DRPUs; these relate to the shape, materials and construction features of medical devices, with reference to their effects on the skin and underlying tissues.In conclusion, under the historical circumstances of the COVID-19 pandemic, we felt it was critical to regroup the team of global experts to record their detailed advice on the prevention and treatment of DRPUs. We are pleased to present this second edition, which reflects these multidisciplinary international efforts. It is a cornerstone in our persistent struggle to mitigate DRPUs during the pandemic and beyond.Professor Amit Gefen — Panel ChairAims and terminologyPurpose of this documentFor this second edition, the panel met virtually to address the need for greater recognition of device-related pressure ulcers (DRPUs) and their causes, management and prevention. This document is intended to stimulate action and covers:The anatomy and composition of tissue in relation to the patient's ageThe pathogenesis of DRPUs, with a focus on why devices are associated with pressure ulcerationDevices, both medical and non-medical, associated with DRPU formationAssessment of patients with DRPUsSafe use of devices to prevent or manage DRPUs, including the impact of altered processes of care that have occurred as a result of the COVID-19 pandemic for both patients (eg, the increased use of proning), health professionals (eg, the prolonged use of personal protective equipment (PPE)) and the general publicInitiatives to raise awareness of DRPUs among health professionalsMedical-device design characteristics and features relevant to DRPUs and their preventionFuture research required on the prevention of DRPUs, with particular reference to product design, regulation and monitoring technologies.The ultimate objective of this consensus statement is to improve patients' outcomes and safety during episodes of care.A note on terminologyGlobally, several different names are used to describe pressure ulcers (PUs). Pressure injury (PI) is currently used by the National Pressure Injury Advisory Panel (NPIAP; formerly National Pressure Ulcer Advisory Panel)1 and the Pan Pacific Pressure Injury Alliance (PPPIA). Other terms proposed are ‘deformation injury’, ‘pressure damage’ and ‘decubitus’. To date, PI has been adopted in Australasia, although not entirely in the US and Canada and not in Europe. The terminology used is often site-specific. The different categories of PUs have been summarised by the NPIAP.1 The term ‘deformation injury’ focuses on the primary fast-acting damage mechanism—tissue deformation—that leads to rapid cell death and tissue breakdown.Throughout this document, the term PU is used. It should be taken to encompass the other terminologies used to cover tissue damage or injury caused by pressure, shear and tissue deformation.Glossary of abbreviationsBIPAP: bilevel positive airway pressureCPAP: continuous positive airway pressureDRPU: device-related pressure ulcerDVT: deep vein thrombosisECG: electrocardiogramECMO: extracorporeal membrane oxygenationEEG: electroencephalogramEPUAP: European Pressure Ulcer Advisory PanelHAPU: hospital-acquired pressure ulcerICU: intensive care unitIPC: intermittent pneumatic compressionMDRPU: medical device-related pressure ulcerMMP: matrix metalloproteinasesNIBP: non-invasive blood pressure cuffsNIPPV: non-invasive positive pressure ventilationNIV: non-invasive ventilationNPIAP: National Pressure Injury Advisory PanelNPWT: negative pressure wound therapyNSRAS: neonatal skin risk assessment scalePPE: personal protective equipmentPPPIA: Pan Pacific Pressure Injury AlliancePPUPET: paediatric pressure ulcer prediction and evaluation toolPU: pressure ulcerRCT: randomised controlled trialROS: reactive oxygen speciesSEM: sub-epidermal moistureSIRA+P: skin injury risk assessment and preventionTEWL: transepidermal water lossChapter 1: introductionPressure ulcers (PUs) are defined by the European Pressure Ulcer Advisory Panel (EPUAP), the National Pressure Injury Advisory Panel (NPIAP, formerly known as the NPUAP) and the Pan Pacific Pressure Injury Alliance (PPPIA) as:1‘Localised damage to the skin and underlying soft tissue usually over a bony prominence or related to a medical or other device. The injury can present as intact skin or an open ulcer and may be painful. The injury occurs as a result of intense and/or prolonged pressure or pressure in combination with shear. The tolerance of soft tissue for pressure and shear may also be affected by microclimate, nutrition, perfusion, comorbidities and condition of the soft tissue’.This general definition defines all PU types and encompasses various causal factors. However, the focus of this consensus statement is pressure ulceration related to device use.The key causal components of PU formation are exposure to pressure and shear. Friction contributes to shear, but on its own is not a direct cause of pressure ulceration. In many PUs, the main cause of pressure and the associated shear forces is body weight—for example, when a patient is immobilised in a semi-Fowler's position for extended periods on a support surface. Such pressure, friction and shear cause tissue deformation, local microcirculatory impairment and inflammation that, together, lead to pressure ulceration, typically observed in bony anatomical sites such as the sacrum, ischium, trochanter and heel. In contrast, the NPIAP states that medical device-related pressure ulcers (MDRPUs):2‘…result from the use of devices designed and applied for diagnostic or therapeutic purposes. The resultant pressure injury generally conforms to the pattern or shape of the device.’The NPIAP extended the definition of a medical device to include objects such as spectacles and devices without a medical purpose. To differentiate device-related pressure ulcers (DRPU) from PUs arising from body-weight forces, the panel proposes the following definition of and explanation for DRPU:‘A DRPU involves interaction with a device or object that is in direct contact with skin … or is transdermally implanted under the skin, causing focal and localised forces that deform the superficial and deep underlying tissues. A DRPU, which is caused by a device or object, is distinct from a PU, which is caused primarily by body-weight forces. The localised nature of the device's interaction with the patient's tissue results in the appearance of skin and deeper tissue damage that mimics that of the device in shape and distribution.’The term DRPU focuses the health professional and others on pressure ulceration caused by contact with medical devices only. Importantly, a DRPU may be caused by a medical device, object or product without a medical purpose. Throughout this consensus statement, the term DRPU is used to emphasise the importance of understanding that pressure ulceration may be related either to medical or non-medical devices. This is covered in more detail in chapter 3.Briefly, medical devices associated with pressure ulceration may include products used to sustain life in sick patients—for example, continuous positive airway pressure (CPAP) masks, oxygen therapy tubing, endotracheal tubes, bilevel positive airway pressure (BIPAP) equipment, indwelling lines, monitoring devices such as pulse oximetry, or assistive devices such as orthotics, prosthetics and bed frames. Paediatric patients are particularly susceptible. Devices or objects associated with PUs that do not have a specific medical purpose may include the patient's own property and objects left on their bed or support surface, such as mobile/cell phones and jewellery. During the COVID-19 pandemic, many forms of skin damage resulted from PPE and the prolonged use of respirators.Like a PU, a DRPU can be categorised as I–IV, unstageable or deep tissue pressure injury, depending on its depth and the number of tissue layers involved.2 However, DRPUs can be difficult to classify as they often occur in regions with minimal soft tissue, such as the nasal bridge and ears. Nevertheless, most DRPUs are category I and II, but up to a quarter may be unstageable.3 A DRPU on the bridge of the nose, where the tissue has no padding, may rapidly progress from category I to category IV or unstageable once the skin integrity has been compromised. Damage to mucosal tissue, for example on the lips or nares, from medical devices is not staged but referred to as a mucosal DRPU.4International pressure ulcer guidelinesGuidelines on the prevention and management of PUs, including to varying extents DRPUs, have been published by several international consensus groups and wound management societies.The 2019 EPUAP/NPIAP/PPPIA guideline is the most widely cited. This consensus statement has taken account of guidelines used globally, including those from the EPUAP/NPIAP/PPPIA.1,2EpidemiologyPatients managed using medical devices are more likely to develop a PU or skin breakdown; DRPUs are relatively common.3,5 For example, in an US hospital setting, the overall rate of PUs in inpatients was 5.4%, of which 34.5% were DRPUs.3 Elsewhere, it has been observed that DRPUs may account for as much as 61–81% of all hospital-acquired PUs (HAPUs), depending on the care setting and patient subpopulations.6,7 A recent systematic review and meta-analysis reported that the estimated pooled incidence and prevalence of DRPUs in over 126,000 patients in 29 studies was 12% and 10%, respectively,8 although, as the authors state, these data are limited by the heterogeneity of the data collection.During the first waves of the COVID-19 pandemic, many care settings observed a sharp increase in the incidence or prevalence of DRPUs over and above these numbers.9,10,11 Some studies reported that around three-quarters of all DRPUs were among patients with a COVID-19-positive diagnosis.10,12Some trends quickly emerged. One concern was the development of DRPUs related to the use of invasive and non-invasive ventilation equipment.9 Another was the widespread use of proning, in which critically ill individuals are laid face-down for long periods, resulting in higher rates of DRPUs on the face and PUs occurring in areas not usually reported, such as the nipples or genitalia.12 A third high-profile observation related to health professionals at the frontline of the pandemic having to wear PPE for prolonged periods, which resulted in DRPUs and other skin reactions.9The COVID-19 pandemic has been, and still is, a game-changer in the context of DRPU formation. Whereas previously, DRPUs were an understudied area, the increasing incidence observed during the pandemic and the changes in ways that patients are positioned—which makes it more complex to position and check devices—has certainly raised the profile of this issue. During the first waves, much was learned about the risks of DRPU formation, and many insights into how the risk can be reduced have since been developed and published, representing a huge and rapid advance in this field.The pandemic is likely to continue to affect global healthcare systems and it is anticipated that the associated increased risk of DRPU formation will remain for several years to come. This is a good time for updated guidance and advice on how to minimise DRPUs, including those challenges specifically associated with a COVID-19-positive diagnosis, so that health professionals are well informed to provide the very best care for their patients and are well prepared to manage the wider issue of device-related pressure ulceration.Occurrence by settingDevices used in intensive care are particularly associated with DRPUs.13,14,15 This is not surprising given that critically ill patients in intensive care units (ICUs) often have the highest number of devices in situ. In a 2019 systematic review of the incidence, prevalence and severity of DRPUs in ICUs, pooled estimates revealed incidence rates of 3.7% and prevalence rates of 33.7%. Again, the wide ranges reflect the heterogeneity of the data collection between the 13 studies evaluated.14 Since this review, Coyer et al. reported a DRPU prevalence of 4.3% in intensive care patients.16 Wille et al. stated that the overall incidence of DRPUs or skin breakdown caused by pulse oximeters in a surgical ICU was 5%.17 Mehta et al. reported that the point prevalence of DRPUs in a ICU setting was 19.2%.18Occurrence rates can be lower in other settings. An unpublished incidence audit of DRPUs in Kyorin University Hospital, Japan, conducted over 12 months from 1 February 2018 to 31 January 2019, demonstrated the difference between ICU and general wards. The incidence of DRPUs in ICUs was 2.8%, which is consistent with published data. On general wards it was 0.4%. This lower incidence is likely to be a result of the higher number of devices used in ICU compared with general wards. Table 1 summarises the key results of DRPU incidence and prevalence data.Table 1. Summary of the incidence and prevalence of DRPUsReferenceSetting detailsFindingOverallBlack et al.3US hospital inpatients (n=2079)PU occurrence: 5.4%DRPU occurrence: 34.5%*Jackson et al.8Systematic review of 29 studies (126,150 eligible patients)Pooled DRPU incidence: 12%Pooled DRPU prevalence: 10%Data from intensive care settingsBarakat-Johnson et al.14Systematic review of 13 studiesPooled DRPU incidence: 3.7% (95% CI: 0–14.4%)Pooled DRPU prevalence: 33.7% (95% CI: 22.6–45.8%)Coyer et al.169Patients in six ICUs in two major medical centres (one in the US and one in Australia)DRPU incidence: 3.1%Wille et al.17125 patients in a surgical ICUFrequency of pulse oximeter-induced digital injury: 5%Data from other settingsKyorin University Hospital unpublished DRPU auditICU and general wards in a Japanese hospitalDRPU incidence in ICUs: 2.8%DRPU incidence in general wards: 0.14%Schlüer et al.274204 children in 13 Swiss hospitalsPrevalence of PUs: 26.5%Prevalence of DRPUs: 38.5%Visscher and Taylor25741 neonatal intensive care patientsPremature neonates: 1.5 PUs per 1000 daysTerm infants: 2.7 PUs per 100 daysJiang et al.229Health and non-healthcare professionals in 161 hospitals in ChinaPrevalence of skin injuries: 42.8%Prevalence of DRPUs: 30%Rosner et al.233Health professionals (n=31) in a New York hospitalPrevalence of skin breakdown: 18.1% within 3 hours; 44% after 3 hours of mask useAcne: 53.1%*Proportion of PUs that were DRPUsDRPUs—device-related pressure ulcers; ICU—intensive care unit; PU—pressure ulcer; CI—confidence intervalTable 1. Summary of the incidence and prevalence of DRPUsView as image HTML Neonates, infants and paediatricsDRPUs have been reported in around 7% of all paediatric patients.19,20 They are more common in younger children and can account for up to one half of all PUs identified in some high-risk patient populations, such as in neonatal and intensive care settings or in persons with conditions such as spina bifida.19,21,23,24 Infants who develop DRPUs are likely to be younger post-partum, with a shorter gestation; they develop DRPUs more rapidly than patients with PUs caused by body weight.25 Mechanical ventilation and a respiratory diagnosis are associated with higher risk of DRPU formation.26 In newborns, devices may severely and permanently affect and distort nasal cartilage.27 The incidence of DRPUs in paediatric patients may be as high as 28%, with non-invasive mechanical ventilation associated with ulceration (relative risk ratio 12.24).15,28,29,30,31,32,33,34Data collected by an author of this document in a single paediatric hospital in Italy during the height of the pandemic suggest that the relative burden of DRPUs in paediatrics is growing. Advances in paediatric medicine over the past decade mean that neonates, infants and children with complex medical conditions can now receive treatment, whereas in the past this option may not have been available. These seriously ill children often need long periods in ICU and interventions involving multiple medical devices. Data presented in Fig 1 show that, as a result of this general trend, there was an increase in DRPUs in paediatrics treated in this hospital. During this three-year period, there were noticeably more DRPUs than PUs during the first year of life (n=69 neonates): 44 (37%) and 25 (14%), respectively. In line with the literature, DRPUs were most commonly observed in the occiput, ear, foot and amputation stump, with orotracheal and nasogastric tubes, central lines and ventilation masks being the main culprits. It is clear that the burden of DRPUs in the paediatric specialty needs particular focus.Fig 1. Change in the proportion of DRPUs in recent years in a single institution. Over a three-year period, despite a small overall decline in the number of PUs generally, the proportion caused by medical devices (DRPU) increased from 32% (33/104) in 2018 to 46% (44/96) in 2020. Data provided by Guido Ciprandi.DRPU–device-related pressure ulcer; PU–pressure ulcerOccurrence by type of deviceAlthough many kinds of devices have the potential to cause DRPUs, there is a high association between DRPUs and respiratory devices, regardless of setting;18,35 up to 68% of DRPUs are associated with respiratory devices,13 of which 20% are linked with BIPAP or CPAP devices, where ulceration occurred on the bridge of the nose, cheeks and/or nasolabial fold.6 The incidence of DRPUs related to non-invasive ventilation (NIV) has been shown to range from 5–50% for 2–4 hours of continuous usage and up to 100% after 48 hours of wearing a face mask.36 Prevalence of skin breakdown may be over 14% in general-hospital patients with respiratory failure

Highly interacting machining feature recognition via small sample learning

Abstract: In the area of intelligent manufacturing, recognising the interacting features on a CAD model is a critical yet challenging task as topology structures of features are damaged due to the feature interaction. Some of the learning-based feature recognition methods produce less favourable results when recognising highly interacting features, while some require a significant amount of 3D models for training, which present an increasing challenge in a real world scenario, especially whenever collecting large training data becomes too difficult and time-consuming. To this end, effective highly interacting feature recognition via small sample learning becomes bottleneck for learning-based methods. To tackle the above issue, the paper proposes a novel method named RDetNet based on single-shot refinement object detection network (RefineDet) which is capable of recognising highly interacting features with small training samples. In addition, the paper further utilises several data augmentation (DA) strategies to increase the amount of relevant 3D training models. Experiments carried out in this paper show that the proposed method yields favourable results in recognising highly interacting features by using small training samples (e.g. 32 models per class).

“Sehat Sahulat Program”: A Leap into the Universal Health Coverage in Pakistan

Abstract: Universal Health Coverage (UHC), initiative from the World Health Organization (WHO), is a means to provide the human right to health by providing essential health services to everyone, enabling disease prevention, treatment, rehabilitation, and palliative care. In line with the WHO recommendations, the UHC was first introduced in Pakistan in Khyber Pakhtunkhwa (KP) province under the name 'Sehat Sahulat Programme' (SSP), literally 'Health Facility Program' in 2015. The provincial Government in Punjab approved a similar initiative in Punjab, the largest province (by population) of the country, and the program was later rolled out in Islamabad Capital Territory (ICT), Azad and Jammu Kashmir (AJK), Gilgit Baltistan (GB), Sindh, and Baluchistan provinces leaping into the nation-wide coverage. This article provides a current overview of the UHC initiative in Pakistan, analyses its progress in appraising key milestones, and makes recommendations to achieve a robust universal health coverage across Pakistan.

Current strategies to induce selective killing of HIV‐1‐infected cells

Abstract: Although combination antiretroviral therapy (ART) has led to significant HIV-1 suppression and improvement in immune function, persistent viral reservoirs remain that are refractory to intensified ART. ART poses many challenges such as adherence to drug regimens, the emergence of resistant virus, and cumulative toxicity resulting from long-term therapy. Moreover, latent HIV-1 reservoir cells can be stochastically activated to produce viral particles despite effective ART and contribute to the rapid viral rebound that typically occurs within 2 weeks of ART interruption; thus, lifelong ART is required for continued viral suppression. Several strategies have been proposed to address the HIV-1 reservoir such as reactivation of HIV-1 transcription using latency reactivating agents with a combination of ART, host immune clearance and HIV-1-cytotoxicity to purge the infected cells—a “shock and kill” strategy. However, these approaches do not take into account the multiple transcriptional and translational blocks that contribute to HIV-1 latency or the complex heterogeneity of the HIV-1 reservoir, and clinical trials have thus far failed to produce the desired results. Here, we describe alternative strategies being pursued that are designed to kill selectively HIV-1-infected cells while sparing uninfected cells in the absence of enhanced humoral or adaptive immune responses.

Identification and quantification of chimeric sequencing reads in a highly multiplexed <scp>RAD</scp> ‐seq protocol

Abstract: Highly multiplexed approaches have become common in genomic studies. They have improved the cost-effectiveness of genotyping hundreds of individuals using combinatorially barcoded adapters. These strategies, however, can potentially misassigned reads to incorrect samples. Here, we used a modified quaddRAD protocol to analyse the occurrence of index hopping and PCR chimeras in a series of experiments with up to 100 multiplexed samples per sequencing lane (639 samples in total). We created two types of sequencing libraries: four libraries of type A, where PCRs were run on individual samples before multiplexing, and three libraries of type B, where PCRs were run on pooled samples. We used fixed pairs of inner barcodes to identify chimeric reads. Type B libraries show a higher percentage of misassigned reads (1.15%) than type A libraries (0.65%). We also quantify the commonly undetectable chimeric sequences that occur whenever multiplexed groups of samples with different outer barcodes are sequenced together on a single flow cell. Our results suggest that these types of chimeric sequences represent up to 1.56% and 1.29% of reads in type A and B libraries, respectively. We also show that increasing the number of mismatches allowed for barcode rescue to above 2 dramatically increases the number of recovered chimeric reads. We provide recommendations for developing highly multiplexed RAD-seq protocols and analysing the resulting data to minimize the generation of chimeric sequences, allowing their quantification and a finer control on the number of PCR cycles necessary to generate enough input DNA for library preparation.

Embedding Wound Hygiene into a proactive wound healing strategy

Abstract: Since a panel published the first consensus document on Wound Hygiene in March 2020, there has been a flurry of activity in support of this newly established concept in proactive wound healing.1 The document concluded that all wounds, particularly hard-to-heal ones, will benefit from Wound Hygiene, which should be initiated at the first referral, following a full holistic assessment to identify the wound aetiology and comorbidities, and then implemented at every dressing change until full healing occurs.1 The consensus has since been bolstered by educational webinars; competency-based skills training and support; development of international Wound Hygiene ambassadors; a survey of 1478 respondents, published in July 2021;2 and a case study supplement, published in January 2022, featuring a range of wound types, anatomies and underlying conditions on the improvements in wound-healing progress that can be achieved.3 Wound Hygiene has gained its own identity and is now a term in and of itself, that encompasses a 4-step protocol of care. It is an antibiofilm approach that is increasingly being used across wound care. The results of the survey2 were particularly encouraging for seeing how far Wound Hygiene has come, and how quickly: More than half (57.4%) had heard of the concept of Wound Hygiene Of those, 75.3% have implemented Wound Hygiene Overall, following implementation of Wound Hygiene, 80.3% of respondents reported improved healing rates.2 However, the top three barriers identified by the survey-lack of confidence, competence and research data-show that there is more to be done to support Wound Hygiene in practice.2 As a result, a consensus panel of international key opinion leaders convened virtually in the summer of 2021 to discuss what has been done so far, the outputs of the survey, and ideas for addressing the unmet needs identified by the results. The result is this publication, which represents an addendum to the initial consensus document, broadening support for implementation of Wound Hygiene. This document will reflect on the reasons Wound Hygiene has been successful in its first two years of implementation, reiterating its DNA: Do not wait to treat hard-to-heal wounds Use a simple 4-step approach Enable all healthcare professionals to implement and use Wound Hygiene. The document will also discuss the evolution of the Wound Hygiene concept, focusing on how and when to implement Wound Hygiene on all tissue types of hard-to-heal wounds, and proposing what these are. The panel has expanded the framework in which Wound Hygiene is used, with the ultimate objective of introducing the concept of 'embedding Wound Hygiene intro a proactive wound healing strategy.' Key inefficiencies are often observed along the journeys of people living with hard-to-heal wounds. The limited number of specialised healthcare professionals and the resulting delays in reaching them may increase the likelihood of a hard-to-heal wound developing. In a world where so much is happening so quickly that we may, at times, feel powerless to drive change, the panel wants to provide further guidance to propel the use of Wound Hygiene. The concept of Wound Hygiene is resonating, and the panel wants you to know that in whatever region you work, in whatever area of clinical practice, you are enabled to make this change. Wielding the 4-step Wound Hygiene protocol consistently is a key action every healthcare professional in every care setting can take to tackle the global wound care crisis. Wound Hygiene has taken off-now, where do we want to land? In a place where Wound Hygiene is practised on all wounds, at every stage, until healing. The panel once again recognises that the community of global healthcare providers should consider their local standards and guidelines when applying the recommendations of this document. To this end, the panel has created a flexible 3-phase framework that situates Wound Hygiene as integral to proactive wound healing. The panel hopes you will continue to implement Wound Hygiene and see the benefits it can bring to people living with wounds, as well as those who care for them.

Doing marketing differently: an artnography of cathartic consumption in trauma

Abstract: This work illustrates what kinds of consumption emerge during a traumatic life event, theorising the interweaving of trauma and catharsis through the medium of art and craft consumption. The methodological context sits within a non-representational theory where the data are narrated through the purchases and findings, physical, emotional and cognitive engagement with art and craft materials, through to the eventual place, value and story of the made artefact itself. The work presents three main contributions: an empirical understanding of therapeutic art consumption within trauma; a methodological experiment in how using non-representational theory centred on creative processes can develop worthy modes of data collection, organisation, and analysis; and the theoretical development of a consumption framework towards a theory of cathartic consumption during trauma.

Enzyme pre-milling treatments improved milling performance of chickpeas by targeting mechanisms of seed coat and cotyledon adhesion with various effects on dhal quality

Abstract: Background Dehulling and splitting are important elements of the milling process to produce dhal from pulses However, grain that is difficult-to-mill due to tightly adhered seed coats or cotyledons that resist separation make it difficult to achieve high quality dhal Milling yields are reduced, energy inputs into the milling process are increased and the resulting dhal can be of poorer quality, chipped or abraded Results Eight enzyme pre-treatments were chosen based on the hypothesised mechanisms of seed coat and cotyledon adhesion established in prior papers Using a difficult-to-mill chickpea (Cicer arietinum L) genotype, we examined the effects of these pre-treatments, over time, on laboratory scale milling performance and dhal quality We pioneered a texture analyser method to measure the flex of the cotyledons and the force required to cleave the cotyledons The enzyme-induced changes ranged from negative (tough seed coat, weight loss, deleterious colour and texture, increased visual damage to cotyledons and increased kibble loss, concave cotyledons, increased flex, and changes in taste) to positive (brittle seed coat, increased seed volume, improved dehulling efficiency and splitting yield, reduced cotyledon cleavage force, and acceptable dhal quality and taste) Conclusion All pre-treatments improved milling performance compared with milling the raw seed, but there was considerable variation between them Two pre-treatments showed no improvement in milling yields compared with the water control, and several pre-treatments resulted in unacceptable qualities Three pre-treatments, endo-Polygalacturonanase, alpha-Galactosidase and Cellulase, show potential for commercial milling applications and could assist pulse millers globally to achieve high quality dhal whilst minimising milling effort This article is protected by copyright All rights reserved

Advancing Mental heaLth Provision In PHarmacY (AMPLIPHY): A feasibility study

Abstract: Specifically-designed community pharmacy-based services represent opportunities to support people with their mental health. As few such services exist worldwide, the Advancing Mental HeaLth Provision In PharmacY (AMPLIPHY) was designed with stakeholders. The purpose was to support people with their mental health when initiated on new prescription or change in drug, dose or quantity of antidepressant, through a series of consultations (up to 3 months).The aim was to evaluate the feasibility of the AMPLIPHY service. The objectives were to: i) pilot the service; ii) examine anonymous consultation data to understand patients' characteristics, priorities and consultation focus and iii) Evaluate pharmacists' experiences.This service evaluation involved a concurrent mixed methods design. Patient characteristics were extracted from consultation notes and descriptive statistics applied. Content analysis was used to summarise consultation foci and comparisons between patients' priorities with consultation content were made. Pharmacists were interviewed at the start (n = 10) and end (n = 4) of the pilot with themes identified using thematic analysis.Seventy-six patients participated (63% of recruitment target). The median age was 39 (IQR 28-47) and 62% were female. Seventy percent of patients had one consultation, 26% had two and 4% had three. Prescription for new antidepressant was the most common reason for entry (74%) and sertraline was most prescribed (46%). Consultations commonly focussed on life experience (n = 51), medication (n = 47), health (n = 42), support (n = 36) and patients' expression of their feelings (n = 31). The pharmacists' experiences were summarised in three themes: i) Motivation, ii) Practicalities and iii) Experience and Outcomes.Pharmacists were motivated to deliver this novel service and some patients were willing to join the service. Analysis of patient demographics, consultation notes and interviews provide insight into the strengths and challenges of the service and provides a blueprint for future service developments.

Improvements of pre-emptive identification of particle accelerator failures using binary classifiers and dimensionality reduction

Abstract: In this paper we look at the properties of the Spallation Neutron Source (SNS) Differential Beam Current Monitor (DCM) data and various methods of data transformation to improve pre-emptive detection of machine trips. Foundation of the approach is the analysis of new underlying data and understanding various properties with the goal of faster classification, higher precision and higher recall with the aim to reduce false positives as low as required. The result of the research presented in this paper are a binary classifier capable of predicting accelerator failures with millisecond classification time, 96% precision, 58% true positive and 0% false positive rate and optimization techniques enabling real-time implementations.

COVID-19 Mixed Impact on Hospital Antimicrobial Stewardship Activities: A Qualitative Study in UK-Based Hospitals

Abstract: Antimicrobial resistance (AMR) is a well-known global threat due to the subsequent increase in antimicrobial usage. Several antimicrobial stewardship (AMS) strategies have been implemented to curb irrational prescribing and reduce the AMR burden. However, since the beginning of the COVID-19 pandemic, it has enormously impacted the healthcare system and jeopardized public health, causing millions of deaths globally. Our semi-structured qualitative study aimed to explore the impact of COVID-19 on AMS activities in the UK hospitals. Seventeen interviews were conducted with health care professionals who were part of AMS teams (consultant medical microbiologists, infectious disease consultants, antimicrobial pharmacists). Interviews were audio-recorded and transcribed. An inductive thematic framework was adopted to analyse and create the themes. After agreement of the hierarchical framework definition, all transcripts were coded accordingly. Four main themes and 15 sub-themes were identified. These main themes were: (1) AMS activities or strategies before and during the pandemic; (2) challenges to implementing AMS activities before and during the pandemic; (3) information from public authorities on AMS during the pandemic; and (4) new AMS activities/strategies adopted during the pandemic. Staff vacancies, redeploying of AMS staff to other duties and meeting the burden related to the COVID-19 and lack of resources were the most frequently identified contributing factors to withheld AMS activities during the pandemic. However, modifications to the hybrid working environment, i.e., remote or flexible working, allowed for resumption of AMS activities including virtual ward rounds, virtual meetings and other activities. Further research needs to assess the impact of the hybrid delivery system on AMS activities.

Doing together: reflections on facilitating the co-production of participatory action research with marginalised populations

Abstract: Recognising the limited literature detailing the practical application of co-production principles and practices within sport, exercise and health research, critical reflections on co-production principles and practice are shared here, drawing on two participatory action research (PAR) projects in the United Kingdom (UK). Co-production and PAR are distinguished, and their commonalities discussed. Both projects were facilitated by occupational therapists and concerned with health inequities and social justice. The Voices for Inclusive Activity project brought disabled people together online to explore more accessible and inclusive approaches to evaluate disability sport and physical activity. The Positive Mental Attitude project took place with a community-based football league for people with experience of mental distress and explored the nature and value of participation. Both projects involved researching with people who are often excluded from research. Addressing power imbalances can function to engage marginalised people in processes of knowledge production and enable social justice. Co-production offers useful principles that are democratic, inclusive, collaborative, and participatory, but the process is not straightforward. The reflections within this paper focus on the challenges and opportunities the first and second authors faced as facilitators of co-produced research. Participant and co-researcher quotes reveal how participatory methods and approaches address gaps in experiential knowledge of exclusion and marginalisation. The potential for co-produced research to influence policy and practice is outlined.