The predominant serotypes were III (n=258, 60%) and Ia (n=73, 17%); five serotypes (Ia, Ib, II, III, V) comprised 94% (n=377) of serotyped isolates (n=402). Interpretation: The incidence of invasive infant GBS disease in the UK and Ireland has increased since 2000-2001. The burden of EOD incidence has not declined despite the introduction of national prevention guidelines. New strategies for prevention are required.
Group B Streptococcus (GBS) is a common intestinal colonizer during the neonatal period, but also may cause late-onset sepsis or meningitis in up to 0.5% of otherwise healthy colonized infants after day 3 of life. Transmission routes and risk factors of this late-onset form of invasive GBS disease (iGBS) are not fully understood. Cases of iGBS with recurrence (n=25) and those occurring in parallel in twins/triplets (n=32) from the UK and Ireland (national surveillance study 2014/15) and from Germany and Switzerland (retrospective case collection) were analyzed to unravel shared (in affected multiples) or fixed (in recurrent disease) risk factors for GBS disease. The risk of iGBS among infants from multiple births was high (17%), if one infant had already developed GBS disease. The interval of onset of iGBS between siblings was 4.5 days and in recurrent cases 12.5 days. Disturbances of the individual microbiome, including persistence of infectious foci are suggested e.g. by high usage of perinatal antibiotics in mothers of affected multiples, and by the association of an increased risk of recurrence with a short term of antibiotics [aOR 4.2 (1.3-14.2), P=0.02]. Identical GBS serotypes in both recurrent infections and concurrently infected multiples might indicate a failed microbiome integration of GBS strains that are generally regarded as commensals in healthy infants. The dynamics of recurrent GBS infections or concurrent infections in multiples suggest individual patterns of exposure and fluctuations in host immunity, causing failure of natural niche occupation.
Summary. Between 1972 and 1988, 832 consecutive patients were treated for acute leukaemia at St. Bartholomew's Hospital; a retrospective analysis has been conducted to determine the clinical course and outcome for 101 who have survived $ 10 years following treatment. At a median follow-up of 16 years (range 10±28 years), 86 patients (86 out of 834 total, 11%) were still alive. Long-term follow-up of patients who have survived $ 10 years following treatment for acute leukaemia revealed that most patients were in normal health, although a significant number of complications had occurred.
Two fabrics, 100% cotton and 100% nylon, were abraded with Stoll (inflated diaphragm), Schiefer, and Accelerotor instruments. Fabrics were given nine levels of abrasion, ranging from slight distortion of the fabric surface to fabric rupture, with each type of instrument. After abrasion, selected physical properties of the fabrics were measured and microscopic studies were made to determine the types of fabric, yarn, and fiber damage caused by the three abraders.The Stoll abrader caused severe fabric damage at very low levels of abrasion because the abradant pressure was highly localized in the center of the abraded area. The Schiefer and Accelerotor instruments caused uniform abrasion over the entire areas and abrasive damage to the fabric structure built up more slowly than with the Stoll. Both the Accelerotor and the Schiefer were more sensitive to differences in fiber toughness than was the Stoll. An imbalance between warp and filling yarn crimps had a much greater effect on the rate of damage and point of attack for the two flat abrasion testers than it had on Accelerotor abrasion. The tumbling action of the Accelerotor caused the greatest increases in fabric thickness by shaking fiber ends loose from the yarn structure and then cutting or breaking them off more slowly than did the Stoll abrader.
Background The development of a new innovative service the St Joseph’s First Contact Team was identified in April 2012 as the critical project to commence the 3 year transformational change programme to develop community services. This pilot aspired to improve access to the ‘front door’ of St Joseph’s, improving response times for patients, their families and carer’s, ensuring all those referred were appropriately signposted to the whole range of services provided appropriate for them. The team consists of multi-professionals who are either in the team physically or as virtual members. Aims of the Service were To provide high quality, patient and carer focused, value driven services and experiences To meet the changing needs of local communities Be more responsive to our local communities Meet the strategic priorities of local Clinical Commissioning Groups and GPs Continue to meet the mission and core values of the Hospice Encourage innovation and develop staff Share specialist knowledge and skills of end of life care with community partners Approach Used Utilising transformational change methodology, working groups were established to develop the project and to guide and influence service development. Patient and service users were consulted and their views informed the service model. Outcomes Outcomes-were measured using quantitative data demonstrating activity, referrals response times and user feedback. Qualitative review of assessments undertaken by the FCT and other related professionals during the pilot period was undertaken. Various methodologies were used to collect data including user and staff surveys and the PAL care system. Applications to Practice The first contact team has transformed how we respond to our referrals and has promoted multi professional working and greater understanding of the range of services offered to patients, carers and families. A working group led by the Lead Nurse will continue to develop and monitor the quality and service to meet the changing needs of our diverse communities.
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