Trafford General Hospital

We have assessed the manufacturability and impact of adding graphene platelets in contents of x = 0, 0.01, 0.05, 0.1 wt.% to W-6Ni-4Cu as a model ‘ductile phase toughened’ tungsten heavy alloy (WHA). These alloys are potential candidates for future nuclear technologies and other structural applications in high-temperature radiation environments. Graphene additions were studied as potential reinforcement and to increase the interface density for mechanical and radiation tolerance of the alloy. The materials were produced successfully by cold isostatic pressing of the pre-mixed powders at a compaction pressure of 140 MPa, followed by liquid phase sintering at 1450–1500 °C under reducing 75% H 2 / 25% N 2 atmosphere. The graphene platelets are located at the Ni/Cu matrix-W grain and W-W grain interfaces. The material's density and surface roughness degrade when increasing the graphene content beyond 0.05 wt.%. This is coupled with a sharp reduction in tensile strength and elongation for 0.10 wt.% graphene, whereas those properties undergo an overall increasing trend with graphene content for x ≤ 0.05 wt.%. During tensile deformation of W-6Ni-4Cu (i.e. x = 0), strain localizes primarily in the ductile Ni/Cu matrix and at the matrix-W and W-W interfaces, with crack formation observed at W-W interfaces. However, graphene platelets enhance the load transfer from the matrix to the W grains, and also from grain to grain, therefore promoting a higher degree of cleavage inside the W grains. Graphene additions and cold isostatic pressing offer an avenue to enhance the WHA performance for applications in structures under ever demanding service environments. • W-6Ni-4Cu with graphene platelets up to 0.10 wt% produced by liquid phase sintering. • Graphene platelets found at the Ni/Cu matrix-W grain and W-W grain interfaces. • Material's strength and elongation increase with graphene content up to 0.05 wt.%. • Without graphene, crack formation observed primarily at W-W grain interfaces. • Graphene aids load transfer from the matrix and higher cleavage within W grains.

BackgroundFresh osteochondral allograft (FOCA) is a treatment option for osteochondral lesions of the knee which cause pain, locking, and joint instability. While FOCA aims to eliminate these mechanical symptoms, the biomechanical outcomes of the procedure remain poorly understood. This systematic review aimed to collate and interpret the available literature on the biomechanical outcomes of FOCA.MethodsSystematic searches were performed in three databases using the terms ‘(Knee OR knee joint) AND (FOCA OR fresh osteochondral allograft OR fresh OCA)’. Eligible studies contained objective biomechanical or functional outcomes, such as knee range of motion, strength, or parameters of gait. The National Institute of Health Quality Assessment Tool assessed study quality. Extracted data were synthesised in a spreadsheet and then a linear regression analysis was performed on the available range of motion data (p = 0.05). Data from a prior systematic review on the biomechanical outcomes of autologous chondrocyte implantation (ACI) were also included in this analysis to facilitate interpretation of the results. PROSPERO ID: CRD42024531998.ResultsEight studies with 54 participants met the inclusion criteria. On average, studies included 10 participants with a follow up range of 9–108 months.Knee range of motion was reported to improve post-operatively in each study, and the post-operative range of motion was generally reported to be > 120°. A linear regression analysis showed no correlation between final range of motion and follow-up time (p value – 0.860; R2 - 0.019). These results did not differ statistically from the range of motion data reported in a prior review on ACI outcomes (F = 0.003; p = 0.874).One study also reported an improvement in knee strength following FOCA, while two others commented on improvements to gait, although little numerical data was provided.ConclusionThe limited reporting of improvements to knee range of motion suggest that FOCA has the potential to improve patient quality of life through improved knee function. Linear regression analyses of data presented in this study and obtained from a prior report on the biomechanical outcomes of ACI suggest that the knee ranges of motion following both procedures are comparable. However, further research with larger patient cohorts and consistent methodologies are required to corroborate existing data. This knowledge is important for optimising outcomes via evidence-based rehabilitation programmes.

Mild traumatic brain injury is a common presentation to the emergency department, with current management often focusing on determining whether a patient requires a CT head scan and/or neurosurgical intervention. There is a growing appreciation that approximately 20%–40% of patients, including those with a negative (normal) CT, will develop ongoing symptoms for months to years, often termed post-concussion syndrome. Owing to the requirement for improved diagnostic and prognostic mechanisms, there has been increasing evidence concerning the utility of both imaging and blood biomarkers.Blood biomarkers offer the potential to better risk stratify patients for requirement of neuroimaging than current clinical decisions rules. However, improved assessment of the clinical utility is required prior to wide adoption. MRI, using clinical sequences and advanced quantitative methods, can detect lesions not visible on CT in up to 30% of patients that may explain, at least in part, some of the ongoing problems. The ability of an acute biomarker (be it imaging, blood or other) to highlight those patients at greater risk of ongoing deficits would allow for greater personalisation of follow-up care and resource allocation.We discuss here both the current evidence and the future potential clinical usage of blood biomarkers and advanced MRI to improve diagnostic pathways and outcome prediction following mild traumatic brain injury.

In 2020, school closures in England due to the Coronavirus (‘Covid-19’) pandemic resulted in the cancellation of high-stakes examinations and their replacement with teacher-based assessments. These changes represented a significant change for students who had been preparing to undertake examinations for the ‘end-of-school’ General Certificate of Secondary Education (GCSE). This research reports part of a survey that explored the experiences of these students, with a particular focus on students’ psychological responses. Two hundred and twelve students responded to a questionnaire survey that asked them to reflect on their feelings about the changes to the GCSE assessment. Responses were analysed using both thematic and content analysis and revealed five themes: Issues of control; Issues of fairness; Issues of communication and decision making; A shifted path; and The impact of the changes. We re-emphasise the attested value of forms of ongoing dialogue with students about their assessment experiences and consultation with them about decision making in assessment in order to inform planning to optimise student assessment experience.

ObjectivesThe purposes of this study were to determine why chronic obstructive pulmonary disease (COPD) is associated with heart failure (HF). Specific objectives included whether COPD is associated with myocardial fibrosis, whether myocardial fibrosis is associated with hospitalization for HF and death in COPD, and whether COPD and smoking are associated with myocardial inflammation. BackgroundCOPD is associated with HF independent of shared risk factors. The underlying pathophysiological mechanism is unknown. MethodsA prospective, multicenter, longitudinal cohort study of 572 patients undergoing cardiac magnetic resonance (CMR), including 450 patients with COPD and 122 age- and sex-matched patients with a median: 726 days (interquartile range: 492 to 1,160 days) follow-up. Multivariate analysis was used to examine the relationship between COPD and myocardial fibrosis, measured using cardiac magnetic resonance (CMR). Cox regression analysis was used to examine the relationship between myocardial fibrosis and outcomes; the primary endpoint was composite of hospitalizations for HF or all-cause mortality; secondary endpoints included hospitalizations for HF and all-cause mortality. Fifteen patients with COPD, 15 current smokers, and 15 healthy volunteers underwent evaluation for myocardial inflammation, including ultrasmall superparamagnetic particles of iron oxide CMR. ResultsCOPD was independently associated with myocardial fibrosis (p < 0.001). Myocardial fibrosis was independently associated with the primary outcome (hazard ratio [HR]: 1.14; 95% confidence interval [CI]: 1.08 to 1.20; p < 0.001), hospitalization for HF (HR: 1.25 [95% CI: 1.14 to 1.36]); p < 0.001), and all-cause mortality. Myocardial fibrosis was associated with outcome measurements more strongly than any other variable. Acute and stable COPD were associated with myocardial inflammation. ConclusionsThe associations between COPD, myocardial inflammation and myocardial fibrosis, and the independent prognostic value of myocardial fibrosis elucidate a potential pathophysiological link between COPD and HF.

BackgroundThe NHS Mental Health Implementation Plan aims to reduce length of inpatient psychiatric stays to a maximum of 32 days, yet provides little guidance on how to achieve this.Previous studies have attempted to analyse factors influencing length of stay in mental health units, focussing mostly on patient factors. These models fail to sufficiently explain the variation in duration of inpatient stay. We assess how the type of service delivered by a trust, in addition to patient factors, influences length of stay.MethodsWe conducted a retrospective case cohort study in a large inner-city NHS mental health trust for all admissions in a 1 month period. Data was gathered from electronic notes of 105 patients. Descriptive univariate and bivariate analyses were conducted on the data, with multiple regression analysis conducted on statistically significant data.ResultsShort-stay assessment ward admission significantly reduced length of stay. Patients under outpatients or under care co-ordination, admitted through Mental Health Act assessment and formally detained all had longer length of stay. Out of area admissions, locum Consultant care, changing Responsible Clinician and ward transfers all led to longer length of stay. Factors indicating more severe illness such as increased observation level and polypharmacy, as well as diagnoses of psychosis or bipolar disorder were associated with longer duration of stay. Discharges requiring referral to accommodation or rehabilitation led to longer stays. The most significant factors that influenced length of stay were higher observation levels, diagnosis of psychotic illness or bipolar, and discharge to rehabilitation placement.The final model, taking into account all these factors, was able to account for 59.6% of the variability in length of stay.ConclusionsThe study backs up existing literature which shows patient-factors have an influence on length of stay. The study also demonstrates that service-level factors have an impact on the duration of stay. This data may be used to inform further studies which may aid provision of inpatient and community services in the future.

Should a current transformer (CT) secondary winding be left in or inadvertently become open circuited while the primary is energised, then damage may occur to the CT – leaving it inoperable or seriously effecting its measurement accuracy. If the CTs are being utilised in particularly difficult places to access, such as in a gas insulated substation or in a power transformer bushing, this can then lead to an expensive repair to a relatively inexpensive component. To prevent damage occurring to open‐circuited CT's, a range of products are available. These devices are based either on a silicon carbide varistor‐based technology or on a gas discharge tube‐based technology. The purpose of this study is to compare the performance of these devices.