Lewes Victoria Hospital

The control of the inflammatory response induced by the implantation of foreign biomaterials is fundamental in determining tissue healing. It has been shown that the activation of specific macrophage pathways upon contact with a biomaterial can lead either to a chronic inflammation preventing a physiological tissue repair or to an improved tissue healing. In the case of bone repair, calcium phosphate cements with good osteoconductivity properties have been successfully applied in bone defect filling and repair, but poor handling properties, insufficient viscous flow and unmatched degradation rate are still problems that remain unsolved. In this study, a strontium-doped hydroxyapatite (HA) gel was modified by integrating branched poly(epsilon-lysine) dendrons with third-generation branches exposing phosphoserine (SrHA/G3-K PS). The interaction of this material with macrophages was investigated in vitro, focusing on the secretion and gene expression of specific pro-inflammatory cytokines. Our results showed that the addition of strontium and G3-K PS to HA sol-gel could down-regulate the gene expression of inflammatory factors such as IL-1β, TNF-α and MCP-1, while increasing the gene expression of IL-6, a cytokine known for its osteogenic effect. These results were further confirmed by ELISA test of the respective protein concentrations. When exposed to supernatants of macrophage culture in the presence of strontium and G3-K PS, osteoblast viability was promoted with elevated osteogenic gene markers, in terms of OPG, ALP, OCN and COL-I. In vivo implantation experiments using an osteoporotic rat model with bone defect further confirmed that the addition of G3-K PS to HA could dramatically promote new bone regeneration. Although the introduction of strontium improved the degradation properties of the injectable materials, no positive effect on promoting in vivo bone regeneration was observed.

This chapter is largely autobiographical, drawing from the author’s personal experience of sudden, unexpected child death and its aftermath. The chapter discusses this personal experience in detail, thereby setting the scene for the rest of the book and also explores ‘what survives the storm’ as a way of introducing culturally populist narratives of bereavement and grieving. This is developed within a discussion of what it means to be a ‘bereaved parent’ as well as what is culturally permissible in this designated role. Finally, the chapter considers the production of the book itself as a ‘place for experience’ and of meaning-making in the aftermath of a sudden, unexpected child death.

This chapter sets the sociopolitical setting in which sudden, unexpected child deaths occur. Beginning with a discussion of relevant literature on safeguarding, the chapter considers the ‘emotional politics’ which surround high-profile child deaths, as well as the media coverage and inquiries which are often established as a consequence. Building from this, the chapter moves to a consideration of the literature on death and dying, including current debates on assisted dying and good death, together with the online practices which are currently transforming the field. Drawing from this literature, the chapter takes a psychosocial perspective to argue that child deaths may be inaccessible to thought in a Western culture dominated by scientific progression and a concomitant narrative that death is somehow a failure.

BackgroundThe National Strategy for Sexual Health and HIV talks about improving access to genito-urinary medicine (GUM) services by providing Level 2 services in other settings, including primary care. Rural teenagers often find it hard to access GUM services due to distance and time constraints. They may also dislike consulting their own General Practitioners (GPs) due to concerns about confidentiality.Aims/ObjectivesPoor access to sexual health and family planning services was noticed in our rural area. A small Level 2 service was set up within a GP practice in January 2011. It was designed in conjunction with, and widely promoted at, local schools and colleges. A walk in service, running once a week; it offers diagnosis and treatment of most STIs, registration for C card, and all forms of contraception including long acting reversible contraception (LARC). It also offers pregnancy testing, HIV testing, signposting and advice. Emergency contraception is offered at any time of the week. There are three members of staff, a GP, practice nurse and health care assistant.Results432 patients were seen, with a median age of 17, drawn from a large geographical area. 75% were female and 20% under 16. New to follow-up ratio was 3:1. 261 chlamydia tests were offered with an 11% positivity rate. 137 young people have been registered for the C card, with a short education session, and LARC was discussed with 216 patients. 102 prescriptions for oral contraceptives were given and 23 injections of Depo Provera. 17 contraceptive implants and two coils were inserted. A patient satisfaction survey with a sample size of 38 showed high satisfaction ratings. Offering a service within the non-threatening environment of a GP surgery was approved highly, and most felt that their right to confidentiality had been upheld.ConclusionsIn a semi-rural area, primary care can provide an effective, accessible and popular alternative to traditional CaSH services.

Although the issues surrounding the introduction of wind energy into electricity networks tend to be controversial, an increasing number of analytical studies suggest that the issues can be addressed at modest cost. This paper first discusses the key characteristics of electricity networks in order to establish the technical framework within which wind operates. Drawing on actual data from western Denmark, it is shown that the additional fluctuations encountered by system operators are measurable – and manageable. The importance of aggregation is emphasised and recent data from the British system operator are used as a basis for an estimate of additional balancing costs with wind energy penetration levels up to 40%. Above a penetration level of about 5%, additional costs are incurred as the ‘capacity credit’ of wind falls, which reduces the load factor of thermal plant. Combining this ‘backup’ cost with the costs of extra balancing, it is suggested that the extra cost to the consumer of wind variability at the 40% level is likely to be around £6/MWh – about 5% of the typical domestic electricity price. Factors that may reduce this extra cost, such as demand-side management and better wind forecasting, are also discussed.