Defence Engagement (Health) between the UK and Ireland since the Good Friday Agreement in 1998

This paper describes the range of Defence Engagement (Health) (DE(H)) activities between Northern Ireland and Ireland following the Good Friday Agreement in April 1998. Although the Agreement made provision for cross-border cooperation in health, the Omagh bombing of August 1998 energised the discussion to provide greater co-ordination of future responses to mass casualty events. The paper describes these DE(H) activities at the Strategic, Operational and Tactical levels to show the integration across these levels and between the agencies of both governments. The paper shows how a DE(H) programme can have a successful strategic effect by finding topics of mutual interest that can bring together two countries in order to provide an effective health and social care provision. This paper forms part of a special issue of BMJ Military Health dedicated to Defence Engagement (.

Ratiometric pathlength calibration of integrating sphere-based absorption cells

Chemical sensors based on optical absorption require accurate knowledge of the optical pathlength of the sample cell. Integrating spheres offer increased pathlengths compared to single pass cells combined with tolerance to misalignment, making them attractive for use in challenging environments subject to vibration. However, the equivalent optical pathlength can be degraded by dirt and / or condensation on the inner surface of the sphere. We present a new scheme for in-situ calibration that uses a ratiometric two-beam approach. Results are presented for an integrating sphere used in the measurement of methane by tunable diode laser spectroscopy (TDLS) at 1651nm. Reduced sphere reflectivity was simulated by applying small areas of black tape on the inner surface. At methane concentrations of 1500ppm and 3125 ppm, for areas of contamination up to 2.3% of the sphere wall, the technique reduced the error from over 50% to within ±4%. At a concentration of 6250 ppm and the most severe fouling corresponding to 2.9% wall coverage, the technique reduced the error from 55-65% to within ±11%.

Integrating cavity based gas cells: a multibeam compensation scheme for pathlength variation

We present a four beam ratiometric setup for an integrating sphere based gas cell, which can correct for changes in pathlength due to sphere wall contamination. This allows for the gas absorption coefficient to be determined continuously without needing to recalibrate the setup. We demonstrate the technique experimentally, measuring methane gas at 1651nm. For example, contamination covering 1.2% of the sphere wall resulted in an uncompensated error in gas absorption coefficient of ≈41%. With the ratiometric scheme, this error was reduced to ≈2%. Potential limitations of the technique, due to subsequent deviations from mathematical assumptions are discussed, including severe sphere window contamination.

Low dose heparin lock (1000 U/mL) maintains tunnelled hemodialysis catheter patency when compared with high dose heparin (5000 U/mL): A randomised controlled trial

Introduction Heparin is commonly used after hemodialysis treatments as a locking solution to prevent catheter thrombosis. The comparative efficacy and safety of different heparin concentrations to maintain catheter patency has been previously reported in retrospective studies. We conducted a prospective, randomised, controlled study of 1000 U/mL heparin (low dose) versus 5000 U/mL heparin (high dose) locking solution to maintain patency of tunnelled catheters. Methods One hundred patients receiving chronic, unit-based hemodialysis with newly placed tunnelled hemodialysis catheters (less than 1 week) were randomly assigned to either a low dose (n = 48) or high dose heparin (n=52). The primary intention-to-treat analysis examined time to malfunction in both groups over a 90 day period. A secondary analysis compared baseline patient characteristics in relation to catheter malfunction. Findings Overall rate of catheter patency loss was 32% of catheters by 90 days. There was no significant difference in time to malfunction of catheters locked with low dose or high dose heparin (P = 0.5770). Time to catheter malfunction was not associated with diabetic, hypertensive or smoking status. There was no difference in mean delivered blood flow rate, venous and arterial pressure, and dialysis adequacy between low dose and high dose groups. No patient suffered a hemorrhagic complication requiring hospitalisation during the study period. Discussion Low dose heparin is adequate to maintain tunnelled hemodialysis catheter patency when compared with high dose heparin. The study also suggests that there is no relationship between catheter malfunction and diabetic, hypertensive or smoking status.

Lower limb complications of diabetes mellitus: a comprehensive review with clinicopathological insights from a dedicated high-risk diabetic foot multidisciplinary team

Diabetic complications in the lower extremity are associated with significant morbidity and mortality, and impact heavily upon the public health system. Early and accurate recognition of these abnormalities is crucial, enabling the early initiation of treatments and thus avoiding or minimizing deformity, dysfunction and amputation. Following careful clinical assessment, radiological imaging is central to the diagnostic and follow-up process. We aim to provide a comprehensive review of diabetic lower limb complications designed to assist radiologists and to contribute to better outcomes for these patients.

Increased incidence of invasive group A streptococcal disease in Ireland, 2012 to 2013

Invasive group A streptococcal (iGAS) infections have been notifiable in Ireland since 2004. Incidence rates (2004-2011) have ranged from 0.8 to 1.65 per 100,000. In 2012, the iGAS rate rose to 2.66 per 100,000 and was associated with a high proportion of emm1 isolates. A further increase in January to June 2013 has been associated with increased prevalence of emm3. Public health departments and clinicians have been alerted to this increase.

The importance of microbiological investigations, medications and artificial feeding in diarrhoea evaluation

BACKGROUND

Diarrhoea in hospitalised patients is usually attributed to medications especially antibiotics, enteral tube feeding or enteropathogenic bacteria particularly Clostridium difficile.

AIMS

The aim of this study was to evaluate the investigations performed on patients who developed diarrhoea during their stay in an acute general hospital.

METHOD

Over 18 working days, an unselected group of adult inpatients who developed diarrhoea following their admission to hospital were reviewed. Symptoms, medications, nutritional support and any investigations performed were assessed.

RESULTS

Eighty-one patients developed diarrhoea. Forty-nine (60%) were receiving antibiotics prior to the development of symptoms, 30 (37%) were being enterally tube fed, 14 (17%) had positive stool for Clostridium difficile A and B toxin and 3 (4%) had salmonella species positive stool.

CONCLUSION

The majority of cases of diarrhoea were related to medications and enteral tube feeding. A small but significant number did develop bacterial infections. In contrast to some suggested guidelines, when investigating hospital acquired diarrhoea, it is considered worthwhile to perform microbiological stool examinations.

Women in contact with Sydney's gay and lesbian community: sexual identity, practice and HIV risks

Total rates are low, but sex with a man remains the main risk for HIV transmission to women in Australia. In February 1998, 774 women in contact with gay, bisexual and lesbian communities completed a two-page questionnaire. Almost all respondents had some social contact with gay men. Two-thirds (503) thought of themselves as lesbian/dyke/homosexual/gay, 13% (100) as bisexual and 17% (133) as heterosexual/straight. In total, 212 women (27%) said they had ever had sex with a gay or bisexual man; 51 women (7%) had done so in the past six months. About 2% of the lesbians said they had recently had sex with a gay/bi man, as had 8% of the heterosexuals and 25% of the bisexuals; 25 women had recently had unprotected vaginal or anal intercourse with a male gay/bi partner. Forty-eight women (6%) had done sex work. Asked about drug use, 61 women (8%) said they had injected in the past six months. Twenty-three women had shared injecting equipment with someone, and five had shared with a gay/bi man. Compared with other women, these women have high rates of injecting drug use. If they have sex with men, these men are more likely to be gay or bisexual than are the male sexual partners of women moving in largely heterosexual milieux. For a case of so-called 'heterosexual' transmission of HIV to occur, neither person need be heterosexual.