Measuring scattering distributions in scanning helium microscopy

A scanning helium microscope typically utilises a thermal energy helium atom beam, with an energy and wavelength (¡100meV, ∼0.05 nm) particularly sensitive to surface structure. An angular detector stage for a scanning helium microscope is presented that facilitates the in-situ measurement of scattering distributions from a sample. We begin by demonstrating typical elastic and inelastic scattering from ordered surfaces. We then go on to show the role of topography in diffuse scattering from disordered surfaces, observing deviations from simple cosine scattering. In total, these studies demonstrate the wealth of information that is encoded into the scattering distributions obtained with the technique.

Standardizing resolution definition in scanning helium microscopy

Resolution is a key parameter for microscopy, but methods for standardizing its definition are often poorly defined. For a developing technique such as scanning helium microscopy, it is critical that a consensus-based protocol for determining instrument resolution is prepared as a written standard to allow both comparable quantitative measurements of surface topography and direct comparisons between different instruments. In this paper we assess a range of quantitative methods for determining instrument resolution and determine their relative merits when applied to the specific case of the scanning helium microscope (SHeM). Consequently, we present a preliminary protocol for measuring the resolution in scanning helium microscopy based upon utilizing appropriate test samples with sets of slits of well-defined dimensions to establish the quantitative resolution of any similar instrument.

Observation of diffuse scattering in scanning helium microscopy

By studying well defined geometries (microspheres) in scanning helium microscopy (SHeM) the default scattering distribution for technological surfaces in SHeM is found to be diffuse and approximately cosine.

Student nurses and midwives' experiences of teaching and learning about 'making every contact count' health behaviour change programme: Descriptive qualitative study

AIM/OBJECTIVE

To explore nursing/midwifery students' experiences of the teaching and learning of units one and two of a national undergraduate curriculum.

BACKGROUND

The 'National Undergraduate Curriculum for Chronic Disease Prevention and Management: Making Every Contact Count' (MECC) is part of Ireland's national policy to support the prevention of chronic disease by promoting health behaviour change. This is being implemented as a programme within the Irish Health Service and is also being delivered, for the first time in undergraduate medical, allied health and nursing/midwifery education by tertiary education institutes.

DESIGN

Qualitative descriptive research.

METHODS

Purposeful sampling was used to recruit participants (n = 17) from an undergraduate nursing/midwifery programme (n = 131) in one tertiary level Irish institution. Four focus groups were undertaken by two members of the research team, who were not part of the module teaching team. Each focus group was guided by a semi-structured interview guide, recorded and transcribed verbatim. Thematic data analysis was undertaken.

RESULTS

Three main themes were identified, namely: Building foundations and making connections; Personal responsibility and the Ah factor: now I understand.

CONCLUSION

Findings indicate that students had a positive learning experience whilst also highlighting the students' transition to lifelong learning encompassing adult learning and personal responsibility.

Towards the development of a national patient transfer document between residential and acute care-A pilot study

BACKGROUND

A lack of standardisation of documentation accompanying older people when transferring from residential to acute care is common and this may result in gaps in information and in care for older people. In Ireland, this lack of standardisation prompted the development of an evidence based national transfer document.

OBJECTIVES

To pilot a new national transfer document for use when transferring older people from residential to acute care and obtain the perceptions of its use from staff in residential and acute care settings.

METHODS

This was a pre- and post-study design using purposive sampling following the STROBE guidelines. The pilot was conducted in 26 sites providing residential care and three university hospitals providing acute care. Pre-pilot questionnaires focused on current documentation and were distributed to staff in residential care (n = 875). A pilot of the new paper-based transfer document was then conducted over three months and post-pilot questionnaires distributed to staff from both residential and acute care settings (n = 1085). The findings of the pilot study were discussed with multidisciplinary expert advisory and stakeholder groups who recommended some revisions. This consensus informed the development of the final design of the new revised transfer document.

RESULTS

Pre-pilot: 23% response rate; 83% (n = 168) participants agreed/strongly agreed that existing documentation was straightforward to complete but could be more person-centred. Post-pilot: 11% response rate; 75% (n = 93) of participants agreed/strongly agreed that the new transfer document promoted person-centred care but recommended revisions to the new document regarding layout and time to complete.

CONCLUSIONS

This study highlighted some of the challenges of providing safe, effective and relevant transfer information that is feasible and usable in everyday practice.

IMPLICATIONS FOR PRACTICE

Standardisation and being person-centred are important determining factors in the provision of relevant up to date information on the resident being transferred.

The need for and value of nurse and midwife prescribing: Findings from an Irish research investigation

AIM

The aim of this study is to determine the need for and value of nurse and midwife prescribing in Ireland as identified by these prescribers-the people most able to provide relevant insights and information.

BACKGROUND

Since 2007, nurses and midwives in Ireland who have passed an additional educational program can prescribe medicinal products relative to their clinical practice areas. Research evidence of efficacy is needed now for prescribing sustainability in Ireland and to encourage, if successful, the adoption or expansion of frontline nurse/midwife prescribing rights in other countries.

DESIGN

A qualitative study was undertaken.

METHODS

Interviews with registered nurse and midwife prescribers were conducted in 2017 until data saturation. Constant-comparative coding and categorization of data revealed themes and categories, with explanatory quotes for research trustworthiness and credibility purposes.

RESULTS

Six data themes emerged: (a) more than just writing prescriptions; (b) highly individualized evidence-based specialist care; (c) assured, timely and rapid accessibility to needed care; (d) health system and healthcare efficiency gains; (e) satisfaction with nurse/midwife prescriber services and (f) quality care improvements.

CONCLUSION

Nurse/midwife prescribing in Ireland was identified as needed, safe, effective and cost-effective. Prescribing permitted accessible, thorough and proactive holistic health promotive care to be provided in nurse- or midwife-led outpatient clinics.

Identifying contemporary early retirement factors and strategies to encourage and enable longer working lives: A scoping review

AIM

Accelerating population ageing is raising concern in many countries now in relation to the availability of workers for essential work roles and responsibilities. A scoping research literature review was done to identify factors currently associated with early retirement and contemporary strategies to encourage and support longer working lives.

METHODS

Using the PRISMA-ScR Checklist, we searched the Directory of Open Access Journals and EBSCO Discovery Service for published 2013-2018 research articles using the keyword/MeSH term "early retirement"; 54 English-language articles in peer-review journals were reviewed.

RESULTS

Seven early retirement factors were revealed: Ill health, good health, workplace issues, the work itself, ageism, social norms and having achieved personal financial or pension requirement criteria. Six suggested solutions, none proven effective, were identified: Occupational health programmes, workplace enhancements, work adjustments, addressing ageism, changing social norms and pension changes.

CONCLUSIONS

The evidence base on early retirement prevention is not strong, with qualitative investigations needed for in-depth understandings of early retirement influences and mixed-methods studies needed to test early retirement prevention solutions for their effects.

IMPLICATIONS FOR PRACTICE

Until more evidence is available, every organisation should perform an early retirement risk assessment and identify current versus needed policies and programmes to encourage and enable more middle-aged and older people to work longer.

P919 The correlation between cardiac biomarkers and findings on transthoracic echocardiography in the intensive care unit

BACKGROUND

Trans-thoracic echo (TTE) is a commonly performed non-invasive investigation for the cardiovascular assessment of critically ill patients in the Intensive Care Unit (ICU). Raised cardiac biomarkers are commonly cited as an indication for TTE, however the significance of these biomarker elevations in the critical care setting is unclear.

PURPOSE

The aim of this study was to describe findings on TTE in an Irish ICU cohort and to determine if there was any correlation between these findings and serum N-terminal pro b-type natiuretic (NT-proBNP) and high sensitivity troponin T (HsTnT) levels.

METHODS

Patients admitted to the ICU and who received a TTE between January 2018 and February 2019 were identified. Based on TTE findings, patients were divided into two groups: ‘Normal group’ and ‘Abnormal group’. For the purpose of this study, minor abnormalities including concentric left ventricular hypertrophy, diastolic dysfunction and hyper-dynamic left ventricular function were included in the Normal group. The Abnormal group included reductions in LV function, regional wall motion abnormalities and significant valvular heart disease. Continuous variables were expressed as medians and interquartile range. The groups were compared using the z-test for continuous variables and fishers exact test for categorical variables, with a p value of < 0.05 considered significant.

RESULTS

There were 358 patients admitted to the ICU during the study period. The mean age was 59.8 ± 17 years and over half of the patients (55%) were male. One hundred and fifteen patients (32%) had a reported TTE, of which 55% were normal and 22% had minor abnormalities (Normal group). The remaining 23% showed significant abnormalities (Abnormal group).

The prevalence of a NT-proBNP result over 4 times the upper limit of normal (>4xULN) was not significantly different between groups (67% in Normal group vs 71% in Abnormal group, Fisher exact test statistic value is 0.7887, p < .05). However a HsTnT value >4xULN was more common in the Abnormal group than the Normal group (73% vs 46%, Fisher exact test statistic value is 0.0231, p < .05). Similarly, Median NT-proBNP did not differ significantly between the groups; (2254pg/mL; IQR: 11,758 in the Normal group vs 6428pg/mL; IQR: 5,789 in the Abnormal group, p = 0.52218) but Median HsTnT level was significantly higher in the Abnormal group than Normal group; (123ng/L ; IQR: 656 vs 51ng/L; IQR: 163.5 ,p = 0.0278).

CONCLUSION

TTE is performed commonly in the ICU, with one-third of ICU admissions receiving a TTE. Over 75% were reported as normal or showing only minor abnormalities. NT-Pro BNP was commonly significantly elevated but did not correlate with the subsequent diagnostic yield of significant abnormalities on echocardiography. HsTnT levels were more commonly significantly raised in patients with abnormal TTE results and the role of troponin in this setting requires further evaluation.

182 Feasibility and Usability of a New National Transfer Document for Older Persons: A Pilot Study

Background

There is an increasing number of older persons experiencing transfer episodes between residential and acute care facilities (Griffiths et al. 2014). Current transfer documentation is diverse; often only containing basic information and very little person centred patient information. The objective of this HSE National Clinical Programme for Older People funded study was to develop a national person centred transfer tool, for use during patient transfer between residential and acute services. Following an extensive literature review, focus group interviews with stakeholders and input from an expert panel, a pilot transfer document was developed. This paper reports on the pilot study of this document.

Methods

Researchers, in consultation with the expert panel, developed questionnaires. Questionnaires were quantitative, with three open-ended questions. Of the 28 residential settings and 3 acute settings that were contacted, 26 residential and 3 acute settings (93%) participated in the study. The pre-pilot questionnaire asked staff in residential settings their perceptions on current transfer documentation (n=875). The post-pilot questionnaire asked staff in residential and acute care settings their thoughts on the new transfer document which was used for the pilot (n=1085).

Results

Findings suggest that staff agree that the new transfer tool is person centred, contains relevant patient information and could help communication between healthcare professionals in these settings. Findings also indicate that the length of time to complete the document is of concern, particularly in an emergency and there were suggestions from staff in residential care services that some sections could be prepopulated.

Conclusion

In order to have a transfer document that is efficient, and person centred, there is a need for it to be available electronically and easy for staff to fully complete particularly in an emergency transfer.

155 The Development of a National Transfer Document for Older Persons, when Transferring Between Residential and Acute Care Settings

Background

The transition of older persons between care settings is recognised as a particularly critical and vulnerable period (Renom-Guiteras et al. 2014). Appropriate documentation and processes are key in assisting the provision of quality, safe, person-centred care when transferring older persons from residential to acute care settings. This paper reports on the design phase of a national transfer document for older persons. The objective was to inform the development of a draft national transfer document.

Methods

Development consisted of two phases 1) an integrative review and 2) focus group interviews with stakeholders. The review was guided by Whittemore and Knafl‘s (2005) integrative review framework. Data from studies using both quantitative and qualitative methodologies were extracted and thematically analysed. Using a qualitative descriptive approach, focus group interviews (n=8) were conducted with a convenience sample of key stakeholders (n=68) to establish their perspectives regarding transfer documents. Data were analysed using content analysis. Results from both phases were integrated to guide the development of the draft document. A multidisciplinary panel of experts in older persons care, reviewed and provided feedback on the draft transfer document.

Results

Within the review, thirty identified papers focused on transfer documentation between residential and acute care. Results indicated that using a standardised document can potentiate the delivery and acceptance of relevant person-centred information between all parties when transferring an older person between residential and acute care settings. Qualitative interview findings highlighted important aspects for consideration regarding the layout, content and format of future transfer documentation. Following collaboration with the expert panel the transfer document was developed for piloting.

Conclusion

Consistency and clarity of information is key for a successful transfer of older persons from residential to acute settings. Information needs to be evidence-based, current, and subject to response and change in accordance with best available international practice.

Key stakeholders' perspectives on the development of a national transfer document, for older persons, when transferring between the residential and acute care settings: A qualitative descriptive study

AIMS AND OBJECTIVES

This study has aimed to examine key stakeholders' perspectives, views and experiences regarding transfer documents, used when an older person is being transferred from a residential to an acute care setting. The objective of the study was to inform, in part, the development of an effective national transfer document.

BACKGROUND

For the effective and safe transfer of older persons from residential to acute care settings, it is important to ensure that the transfer document encapsulates relevant, current and person-centred information to ensure a smooth, quality and safe transition. Evidence highlights that, where documentation has lacked vital and relevant information, the older persons experience negative impacts during the transfer process.

DESIGN

A qualitative descriptive study was conducted, following the COREQ checklist, to establish participants' perspectives, views and experiences of using transfer documents.

METHODS

Focus group interviews (n = 8) were conducted with a convenience sample of key stakeholders (n = 68) in an Irish setting. The data were analysed using content analysis.

RESULTS

The findings have highlighted the important aspects for consideration in the development of future transfer documentation. The three broad categories, used to present the data findings, are (a) existing transfer documentation; (b) design framework; and (c) essentials of care.

CONCLUSIONS

The transfer document of the future is required to be concise, regularly reviewed and with a user-friendly colour-coded design. Essential and current information, with an emphasis on person centeredness, must be in the first page, with more detailed supporting information in the subsequent sections.

Home students' experiences of intercultural learning: A qualitative descriptive design

BACKGROUND

Higher education institutes are witnessing an increase in the cultural and ethnic diversity of their student population. While this adds to the learning experience, there is a dearth of evidence examining how students on nursing programmes, from different cultural and ethnic backgrounds learn with and from each other. There is need for a greater understanding of the factors that both facilitate and inhibit intercultural learning within the classroom.

OBJECTIVES

This study explored the perceptions and experiences of home students on a postgraduate nursing programme, of intercultural learning within the classroom.

DESIGN

A qualitative descriptive design was used.

SETTINGS

Home students enrolled on a suite of postgraduate nursing programmes in one region of Ireland who were registered for co-scheduled modules with international students, were recruited to participate on a voluntary basis.

PARTICIPANTS

Fourteen home students (13 females and 1 male) were purposively sampled.

METHODS

Data were collected using digitally recorded one to one semi-structured interviews (ten 'face to face' and four telephone). Data were thematically analysed using a modified version of Braun and Clarke's (2006) framework.

RESULTS

This study describes the value of intercultural learning in the classroom and draws attention to some of the challenges experienced by home students. Furthermore, it highlights the importance of exploring similarities, whilst respecting differences in prior educational experiences, learning styles and cultural backgrounds. The overarching theme, Navigating intercultural learning describes home students' experiences of developing awareness, connecting and sharing cultural knowledge.

CONCLUSIONS

Intercultural learning takes time and requires commitment, emphasising the need for careful consideration of facilitation techniques, preparation, support and planning pedagogies that encourage effective intercultural learning. The findings make a valuable contribution to existing knowledge on internationalising nurse education, specifically with regards to intercultural relations and the perceptions and experiences of teaching and learning in intercultural classrooms.

Image formation in the scanning helium microscope

The scanning helium microscope (SHeM) is a new addition to the array of available microscopies, particularly for delicate materials that may suffer damage under techniques utilising light or charged particles. As with all other microscopies, the specifics of image formation within the instrument are required to gain a full understanding of the produced micrographs. We present work detailing the basics of the subject for the SHeM, including the specific nature of the projection distortions that arise due to the scattering geometry. Extension of these concepts allowed for an iterative ray tracing Monte Carlo model replicating diffuse scattering from a sample surface to be constructed. Comparisons between experimental data and simulations yielded a minimum resolvable step height of (67 ± 5) µm and a minimum resolvable planar angle of (4.3 ± 0.3)° for the instrument in question.

Nurse and midwifery prescribing in Ireland: A scope-of-practice development for worldwide consideration

For 10 years, select Irish nurses and midwives who pass a rigorous 6 month theory and practical program can prescribe medications and other medicinal products. Given the need for timely, accessible, and affordable health-care services in all countries, this nursing/midwifery education and practice development is worthy of examination. Irish nurse/midwife prescribing occurred following long-term deliberative nursing profession advocacy, nursing education planning, nursing administration and practice planning, interdisciplinary health-care team support and complementary efforts, and government action. A review of documents, research, and other articles was undertaken to examine this development process and report evaluative information for consideration by other countries seeking to improve their health-care systems. Nurse/midwife prescribing was accomplished successfully in Ireland, with the steps taken there to initiate and establish nurse/midwife prescribing of value internationally.

Potential and challenges for learning during acute medical/surgical placement for intellectual disability, mental health and midwifery students

In Ireland nursing and midwifery degree programmes involve four pathways to registration. Three of which, intellectual disability and mental health nursing and midwifery require students to undertake acute medical/surgical placements offering learning opportunities caring for patients with complex needs in settings beyond their core discipline. This paper focuses on findings from a descriptive qualitative study exploring intellectual disability and mental health nursing and midwifery students experiences of such placements. Data analysis identified three themes: Getting ready, Navigating the way and Getting through. Feelings of stress and uncertainty are described by participants when moving from familiarity within a chosen discipline to an unfamiliar environment. Findings have influenced specific placement structures with local health service partners. While our study focuses on an Irish context, findings have relevance for student education in other jurisdictions. Enhancing preparation and support for students undertaking unfamiliar placements needs to be a constant endeavour. Such foundations will foster valuable experiences where students can feel part of a team, gain confidence, enhance skills and transfer meaningful learning to their core practice discipline. Further research is needed to explore the views of preceptors, ward managers and Clinical Placement Coordinators.

A simple counter-flow cooling system for a supersonic free-jet beam source assembly

A simple design for an inexpensive, cooled, free-jet beam source is described. The source assembly features an integrated cooling system as supplied by a counter-flow of chilled nitrogen, and is composed primarily of off-the-shelf tube fittings. The design facilitates rapid implementation and eases subsequent alignment with respect to any downstream beamline aperture. The source assembly outlined cools the full length of the stagnation volume, offering temperature control down to 100 K and long-term temperature stability better than ±1 K.

Unlocking new contrast in a scanning helium microscope

Delicate structures (such as biological samples, organic films for polymer electronics and adsorbate layers) suffer degradation under the energetic probes of traditional microscopies. Furthermore, the charged nature of these probes presents difficulties when imaging with electric or magnetic fields, or for insulating materials where the addition of a conductive coating is not desirable. Scanning helium microscopy is able to image such structures completely non-destructively by taking advantage of a neutral helium beam as a chemically, electrically and magnetically inert probe of the sample surface. Here we present scanning helium micrographs demonstrating image contrast arising from a range of mechanisms including, for the first time, chemical contrast observed from a series of metal–semiconductor interfaces. The ability of scanning helium microscopy to distinguish between materials without the risk of damage makes it ideal for investigating a wide range of systems.

Scanning helium microscopy uses neutral atoms to image traditionally challenging materials (e.g. delicate, insulating and magnetic samples) non-destructively with absolute surface sensitivity. This work reports the first observation of chemical contrast in helium microscopy via inelastic scattering.

16S rRNA and As-Related Functional Diversity: Contrasting Fingerprints in Arsenic-Rich Sediments from an Acid Mine Drainage

To gain an in-depth insight into the diversity and the distribution of genes under the particular evolutionary pressure of an arsenic-rich acid mine drainage (AMD), the genes involved in bacterial arsenic detoxification (arsB, ACR3) and arsenite oxidation (aioA) were investigated in sediment from Carnoulès (France), in parallel to the diversity and global distribution of the metabolically active bacteria. The metabolically active bacteria were affiliated mainly to AMD specialists, i.e., organisms detected in or isolated from AMDs throughout the world. They included mainly Acidobacteria and the non-affiliated "Candidatus Fodinabacter communificans," as well as Thiomonas and Acidithiobacillus spp., Actinobacteria, and unclassified Gammaproteobacteria. The distribution range of these organisms suggested that they show niche conservatism. Sixteen types of deduced protein sequences of arsenite transporters (5 ArsB and 11 Acr3p) were detected, whereas a single type of arsenite oxidase (AioA) was found. Our data suggested that at Carnoulès, the aioA gene was more recent than those encoding arsenite transporters and subjected to a different molecular evolution. In contrast to the 16S ribosomal RNA (16S rRNA) genes associated with AMD environments worldwide, the functional genes aioA, ACR3, and to a lesser extent arsB, were either novel or specific to Carnoulès, raising the question as to whether these functional genes are specific to high concentrations of arsenic, AMD-specific, or site-specific.

Improving social functioning and reducing social isolation and loneliness among people with enduring mental illness: Report of a randomised controlled trial of supported socialisation

BACKGROUND

This randomised controlled trial examined if for people with enduring mental illness, being supported to socialise leads to improved social functioning, increased self-esteem and extended social networks; a reduction in social isolation, social, emotional and family loneliness and a reduction in illness symptoms, namely depression.

METHODS

A prospective randomised controlled trial was undertaken from November 2007 to September 2011. Service users with a diagnosis of enduring mental illness (>18 years) were invited to participate. Participants were randomly allocated to intervention or control group conditions in a 1:1 ratio. Intervention group participants were matched with a volunteer partner, asked to engage in social/leisure activities for 2 hours weekly over a 9-month period, and received a €20 stipend monthly. Control group participants received a €20 monthly stipend and were asked to engage in a weekly social/leisure activity. Social functioning, the primary outcome, was measured using the Social Functioning Scale (SFS) at three time points (baseline, midpoint and endpoint).

FINDINGS

In all, 107 people completed this study. There were no significant differences between control and intervention groups at the commencement of the intervention on demographic characteristics or the main outcome measures of interest. Overall social functioning positively changed throughout the three time points from a mean of 99·7 (standard deviation (SD) = 15.1) at baseline, to a mean of 106.0 (SD = 27.0) at the endpoint for the control group, and from a mean of 100·4 (SD = 15.0) at Time 1 for the intervention group, to a mean of 104.1 (SD = 23.4) at the endpoint for the intervention group.

CONCLUSIONS

The intervention showed no statistical differences between the control and intervention groups on primary or secondary outcome measures. The stipend and the stipend plus volunteer partner led to an increase in recreational social functioning; a decrease in levels of social loneliness, in depression and in the proportion living within a vulnerable social network.

A highly contrasting scanning helium microscope

We present a scanning helium microscope equipped to make use of the unique contrast mechanisms, surface sensitivity, and zero damage imaging the technique affords. The new design delivers an order of magnitude increase in the available helium signal, yielding a higher contrast and signal-to-noise ratio. These improvements allow the microscope to produce high quality, intuitive images of samples using topological contrast, while setting the stage for investigations into further contrast mechanisms.

Diversity and spatiotemporal dynamics of bacterial communities: physicochemical and other drivers along an acid mine drainage

Deciphering the biotic and abiotic factors that control microbial community structure over time and along an environmental gradient is a pivotal question in microbial ecology. Carnoulès mine (France), which is characterized by acid waters and very high concentrations of arsenic, iron, and sulfate, provides an excellent opportunity to study these factors along the pollution gradient of Reigous Creek. To this end, biodiversity and spatiotemporal distribution of bacterial communities were characterized using T-RFLP fingerprinting and high-throughput sequencing. Patterns of spatial and temporal variations in bacterial community composition linked to changes in the physicochemical conditions suggested that species-sorting processes were at work in the acid mine drainage. Arsenic, temperature, and sulfate appeared to be the most important factors that drove the composition of bacterial communities along this continuum. Time series investigation along the pollution gradient also highlighted habitat specialization for some major members of the community (Acidithiobacillus and Thiomonas), dispersal for Acidithiobacillus, and evidence of extinction/re-thriving processes for Gallionella. Finally, pyrosequencing revealed a broader phylogenetic range of taxa than previous clone library-based diversity. Overall, our findings suggest that in addition to environmental filtering processes, additional forces (dispersal, birth/death events) could operate in AMD community.

Sequential Compression Biomechanical Device Versus Primary Amputation in Patients With Critical Limb Ischemia

Introduction:

Patients with critical limb ischemia (CLI), who are unsuitable for intervention, face the consequence of primary amputation. Sequential compression biomechanical device (SCBD) therapy provides a limb salvage option for these patients.

Objectives:

To assess the outcome of SCBD in patients with severe CLI who are unsuitable for revascularization. Primary end points were limb salvage and 30-day mortality.

Methods:

From 2005 to 2012, 189 patients with severe CLI were not suitable for revascularization. In all, 171 joined the SCBD program. We match controlled 75 primary amputations.

Results:

All patients were Rutherford category 4 or higher. Sustained clinical improvement was 68% at 1 year. Mean toe pressure increased from 19.9 to 35.42 mm Hg, P < .0001. Mean popliteal flow increased from 35.44 to 55.91 cm/sec, P < .0001. The 30-day mortality was 0.6%. Limb salvage was 94% at 5 years. Freedom from major adverse clinical events was 62.5%. All-cause survival was 69%. Median cost of managing a primary amputation patient is €29 815 compared to €3985 for SCBD. We treated 171 patients with artassist at a cost of €681 965. However, primary amputation for 75 patients cost €2 236 125.

Conclusion:

The SCBD therapy is a cost-effective and clinically effective solution in patients with CLI having no option of revascularization. It provides adequate limb salvage while providing relief of rest pain without any intervention.

Evaluating clinical competence assessment

AIM

To evaluate clinical competence assessment in pre-registration BSc nursing programmes in one geographical area in the Republic of Ireland.

METHOD

A mixed method approach comprising focus group interviews and survey questionnaires was used. The sample comprised preceptors and nursing students across three disciplines of nursing--general, mental health and intellectual (learning) disability. Methods of analysis were thematic analysis and the Statistical Package for Social Sciences (SPSS) (Version 15).

RESULTS

Students' and preceptors' views of competence assessment and the process of competence assessment are reported. The study focused on language complexity, the assessment framework, the amount of time allocated for interviews and achievement of purpose. The main conclusions were that language needs to be user-friendly, the process needs to be easy to follow and all aspects of clinical competence must be assessed. The response rate from students was 87% but the preceptor response rate was lower (30%).

CONCLUSION

Competence based assessment in the clinical environment is a core component of pre-registration nurse education programmes. Competing demands in the clinical environment challenge both the student and preceptor during the competence assessment process.

Nonoperative active management of critical limb ischemia: initial experience using a sequential compression biomechanical device for limb salvage

Critical limb ischemia (CLI) patients are at high risk of primary amputation. Using a sequential compression biomechanical device (SCBD) represents a nonoperative option in threatened limbs. We aimed to determine the outcome of using SCBD in amputation-bound nonreconstructable CLI patients regarding limb salvage and 90-day mortality. Thirty-five patients with 39 critically ischemic limbs (rest pain = 12, tissue loss = 27) presented over 24 months. Thirty patients had nonreconstructable arterial outflow vessels, and five were inoperable owing to severe comorbidity scores. All were Rutherford classification 4 or 5 with multilevel disease. All underwent a 12-week treatment protocol and received the best medical treatment. The mean follow-up was 10 months (SD +/- 6 months). There were four amputations, with an 18-month cumulative limb salvage rate of 88% (standard error [SE] +/- 7.62%). Ninety-day mortality was zero. Mean toe pressures increased from 38.2 to 67 mm Hg (SD +/- 33.7, 95% confidence interval [CI] 55-79). Popliteal artery flow velocity increased from 45 to 47.9 cm/s (95% CI 35.9-59.7). Cumulative survival at 12 months was 81.2% (SE +/- 11.1) for SCBD, compared with 69.2% in the control group (SE +/- 12.8%) (p = .4, hazards ratio = 0.58, 95% CI 0.15-2.32). The mean total cost of primary amputation per patient is euro29,815 ($44,000) in comparison with euro13,900 ($20,515) for SCBD patients. SCBD enhances limb salvage and reduces length of hospital stay, nonoperatively, in patients with nonreconstructable vessels.

High benzene concentrations can favour Gram-positive bacteria in groundwaters from a contaminated aquifer

Exposure to pollution exerts strong selective pressure on microbial communities, which may affect their potential to adapt to current or future environmental challenges. In this microcosm study, we used DNA fingerprinting based on 16S rRNA genes to document the impact of high concentrations of benzene on two bacterial communities from a benzene-contaminated aquifer situated below a petrochemical plant (SIReN, UK). The two groundwaters harboured distinct aerobic benzene-degrading communities able to metabolize benzene to below detection levels (1 microg L(-1)). A benzene concentration of 100 mg L(-1) caused a major shift from Betaproteobacteria to Actinobacteria, in particular Arthrobacter spp. A similar shift from Betaproteobacteria to Arthrobacter spp. and Rhodococcus erythropolis was observed in minimal medium (MM) inoculated with a third groundwater. These Gram-positive-dominated communities were able to grow on benzene at concentrations up to 600 mg L(-1) in groundwater and up to 1000 mg L(-1) in MM, concentrations that cause significant solvent stress to cellular systems. Therefore, Gram-positive bacteria were better competitors than Gram-negative organisms under experimental conditions of high benzene loads, which suggests that solvent-tolerant Gram-positive bacteria can play a role in the natural attenuation of benzene or the remediation of contaminated sites.

Heterogeneous aerobic benzene-degrading communities in oxygen-depleted groundwaters

A sandstone aquifer beneath a petrochemicals plant (SIReN site, UK) is heterogeneously contaminated with benzene and oxygen-depleted. Despite low redox potentials in three of the most contaminated groundwaters (benzene concentrations from 17.8 to 294 mg L(-1)), we observed aerobic benzene degradation in microcosms, indicating the presence in situ of a latent community of obligate aerobic microorganisms or an active community of facultative aerobes responding rapidly to oxygen ingress. Moreover, benzene degradation occurred at the ambient pH of 8.9 and 9.4, considerably more alkaline conditions than previously reported. 16S rRNA analyses showed that the groundwater microcosm communities were distinct from each other, despite sharing the function of aerobic benzene degradation. From DNA fingerprinting, one consortium was dominated by Acidovorax spp., another by Pseudomonas spp.; these benzene-degrading consortia were similar to the in situ communities, perhaps indicating that these organisms are active in situ and degrading benzene microaerophilically or by denitrification. Conversely, in the third sample, benzene degradation occurred only after the community changed from a Rhodoferax-dominated community to a mix of Rhodococcus and Hydrogenophaga spp. Four of the main benzene-degrading strains were brought into culture: Hydrogenophaga and Pseudomonas spp., and two strains of Rhodococcus erythropolis, a ubiquitous and metabolically versatile organism.

Effects of long-term benzene pollution on bacterial diversity and community structure in groundwater

In this study we analysed the relationship between bacterial community structures and geochemistry of groundwater in a sandstone aquifer (SIReN site) impacted mainly by BTEX hydrocarbons (benzene, toluene, ethylbenzene and xylenes), of which benzene is most abundant. The long-term presence of benzene reduced bacterial diversity: in groundwaters contaminated with more than 1.8 x 10(4) microg l(-1) of benzene, bacterial diversity was half of that in clean groundwaters. Terminal restriction fragment length polymorphism (T-RFLP) analysis of 16S rDNA revealed that the community structures were very similar in uncontaminated groundwaters, whereas communities subjected to long-term benzene contamination were different, not only from uncontaminated groundwater communities, but also from each other. Canonical correspondence analysis of the community profiles and the geochemical data showed that this divergence in community structure was not primarily caused by the direct toxic or stressful effects of benzene, but by the environmental changes brought about by benzene metabolism, in particular a decrease in redox potential.