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Background The accuracy with which healthcare professionals (HCPs) and risk prediction tools predict outcomes after major lower limb amputation (MLLA) is uncertain. The aim of this study was to evaluate the accuracy of predicting short-term (30 days after MLLA) mortality, morbidity, and revisional surgery. Methods The PERCEIVE (PrEdiction of Risk and Communication of outcomE following major lower limb amputation: a collaboratIVE) study was launched on 1 October 2020. It was an international multicentre study, including adults undergoing MLLA for complications of peripheral arterial disease and/or diabetes. Preoperative predictions of 30-day mortality, morbidity, and MLLA revision by surgeons and anaesthetists were recorded. Probabilities from relevant risk prediction tools were calculated. Evaluation of accuracy included measures of discrimination, calibration, and overall performance. Results Some 537 patients were included. HCPs had acceptable discrimination in predicting mortality (931 predictions; C-statistic 0.758) and MLLA revision (565 predictions; C-statistic 0.756), but were poor at predicting morbidity (980 predictions; C-statistic 0.616). They overpredicted the risk of all outcomes. All except three risk prediction tools had worse discrimination than HCPs for predicting mortality (C-statistics 0.789, 0.774, and 0.773); two of these significantly overestimated the risk compared with HCPs. SORT version 2 (the only tool incorporating HCP predictions) demonstrated better calibration and overall performance (Brier score 0.082) than HCPs. Tools predicting morbidity and MLLA revision had poor discrimination (C-statistics 0.520 and 0.679). Conclusion Clinicians predicted mortality and MLLA revision well, but predicted morbidity poorly. They overestimated the risk of mortality, morbidity, and MLLA revision. Most short-term risk prediction tools had poorer discrimination or calibration than HCPs. The best method of predicting mortality was a statistical tool that incorporated HCP estimation.

Summary of sequence analysis of adenoid cystic carcinoma.

Supplemental Figures and Tables legends

Supplemental Tables 6-11. Supp. Table 6. List of all mutations identified in each of the normal samples. Supp. Table 7. List of the mutations in the unmatched OSCC and leukoplakia samples that were filtered-out as they were present in the normal samples or in the dbSNP. Supp. Table 8. Summary of the number of mutations present in each of the sets of samples and the number that were filtered-out during analysis. Supp. Table 9. Combined list of all mutations identified in Chinese OSCC patients in this study and by Song et. al (16). Supp. Table 10. List of all NOTCH1 mutations identified in Caucasians HNSCC samples. Supp. Table 11. List of all HNSCC samples from Caucasian patients used in this study: including exact site and HPV status.

Supplemental Table 5. List of 108 primer pairs designed by Fluidigm Assay Design Group and used in this study for NOTCH1 amplification. Table summarizes the GC-content, length distribution and location of the Access Array amplicons.

Disruption of NOTCH1 signaling was recently discovered in head and neck cancer. This study aims to evaluate NOTCH1 alterations in the progression of oral squamous cell carcinoma (OSCC) and compare the occurrence of these mutations in Chinese and Caucasian populations. We used a high-throughput PCR-based enrichment technology and next-generation sequencing (NGS) to sequence NOTCH1 in 144 samples collected in China. Forty-nine samples were normal oral mucosa from patients undergoing oral surgery, 45 were oral leukoplakia biopsies, and 50 were chemoradiation-naïve OSCC samples with 22 paired-normal tissues from the adjacent unaffected areas. NOTCH1 mutations were found in 54% of primary OSCC and 60% of premalignant lesions. Importantly, almost 60% of patients with leukoplakia with mutated NOTCH1 carried mutations that were also identified in OSCC, indicating an important role of these clonal events in the progression of early neoplasms. We then compared all known NOTCH1 mutations identified in Chinese patients with OSCC with those reported in Caucasians to date. Although we found obvious overlaps in critical regulatory NOTCH1 domains alterations and identified specific mutations shared by both groups, possible gain-of-function mutations were predominantly seen in Chinese population. Our findings demonstrate that premalignant lesions display NOTCH1 mutations at an early stage and are thus bona fide drivers of OSCC progression. Moreover, our results reveal that NOTCH1 promotes distinct tumorigenic mechanisms in patients from different ethnical populations. Cancer Prev Res; 8(4); 277–86. ©2014 AACR.See related perspectives, p. 259 and p. 262

Supplemental Figure 1. List of all NOTCH1 mutations found in Chinese OSCC patients. A. Mutations identified in 22 tumor-normal pairs. B. Mutations found in 28 OSCC samples without matching normal control.

Supplemental Figure 3. A. Association between tumor stage of OSCC patients and NOTCH1 mutation-status. B. Table demonstrates differences in smoking and alcohol consumption rates between the OSCC and leukoplakia patients. C. Table demonstrates differences in smoking and alcohol consumption rates between the OSCC and leukoplakia lesions with mutated NOTCH1. D. The pattern of NOTCH1 base-pair mutations resulting from exposure to tobacco in OSCC and leukoplakia patients (in blue, base-pair mutations that found in both, smokers and non-smokers).

Supplemental Figure 2. List of all NOTCH1 mutations identified in Chinese patients with oral leukoplakia.

Axonal guidance signaling pathway alterations in adenoid cystic carcinoma.

Supplemental Tables 1-4. Supp. Table 1. A. List of all OSCC samples used in this study and clinical/pathological data. B. List of 22 matched tumor-normal pairs. Supp. Table 2. List of all normal samples used in this study and clinical/pathological data. Supp. Table 3. List of all oral leukoplakia samples used in this study and clinical/pathological data. Supp. Table 4. Summary of clinical characteristics for OSCC, leukoplakia and normal samples used in this study.

The transition from student midwife to midwife is an exciting and sometimes anxious time. The need for a robust inclusive preceptorship and induction programme has been highlighted as essential in supporting this transition, yet there is currently no recognised ‘best practice’ model for this. This article discusses the creation of a pilot Welcome Programme to support student midwives during this transition period and into their new role as midwives.

A multivariate risk score model was proposed by Sieira et al in 2017 for sudden death in Brugada syndrome; their validation in 150 patients was highly encouraging, with a C-index of 0.81; however, this score is yet to be validated by an independent group. A total of 192 records of patients with Brugada syndrome were collected from 2 centers in the United Kingdom and retrospectively scored according to a score model by Sieira et al. Data were compiled summatively over follow-up to mimic regular risk re-evaluation as per current guidelines. Sudden cardiac death survivor data were considered perievent to ascertain the utility of the score before cardiac arrest. Scores were compared with actual outcomes. Sensitivity in our cohort was 22.7%, specificity was 57.6%, and C-index was 0.58. In conclusion, up to 75% of cardiac arrest survivors in this cohort would not have been offered a defibrillator if evaluated before their event. This casts doubt on the utility of the score model for primary prevention of sudden death. Inherent issues with modern risk scoring strategies decrease the likelihood of success even in robustly designed tools such as the Sieira score model.

Background The definition of CRM (circumferential resection margins) for oesophageal cancers varies among the international pathological bodies with an ongoing controversy about the optimal definition. There is also no enough data about the prognostic relevance of different sites in CRM. In this study, we examined the prognostic impacts of different CRM distances and sites. Methods This study included patients who had curative oesophagectomy for oesophageal cancer between 2010 till June 2021. Follow up till April 2022 was achieved. CRM status was carefully examined for the distance and site of involved tumour cells. Patients with involved proximal or distal margins were excluded. The outcomes between different CRM margins were retrospectively analysed. The long-term follow up data was obtained via direct contact with the patients during our oncological clinics, cross-checked with our hospital/national patients’ electronic databases. Results 456 patients were included in this study. Involved tumour cells within 1mm of CRM was observed in 192 patients (42.1%). CRM+ ( Conclusions The site and distance of tumour cells within CRM should be rigorously assessed in oesophagectomy specimens. The presence of tumour cells within 1mm of CRM was an independent factor for OS and DFS. The CRM+(0 mm) had significant lower survival rates compared to other CRM+ distances (0.1–1 mm). The involved margin sites within CRM had different survival rates, with superiority towards posterior resection margins.

Introduction L’Étude longitudinale canadienne sur le vieillissement (ELCV) est une ressource riche, représentative de la population à l’échelle nationale et utilisable à de multiples fins. Même si les municipalités pourraient vouloir utiliser les données de l’ELCV pour répondre à certains besoins stratégiques locaux, on ne sait pas dans quelle mesure les cohortes de l’ELCV sont représentatives des populations à l’échelon municipal. Calgary, ville située en Alberta, étant l’un des 11 sites de collecte de données de l’ELCV, nous avions comme objectif d’examiner dans quelle mesure l’échantillon sur Calgary tiré de l’ELCV était représentatif de la population générale de cette ville en ce qui concerne certaines variables sociodémographiques. Méthodologie Les caractéristiques de référence (le sexe, l’état matrimonial, l’origine ethnique, le niveau de scolarité, le statut vis-à-vis de la retraite, le revenu, le statut vis-à­vis de l’immigration, la migration interne) des participants à l’ELCV du site de collecte des données de Calgary entre 2011 et 2015 ont été comparées à des profils analogues tirés des ensembles de données de l’Enquête nationale auprès des ménages (ENM) de 2011 et du recensement de 2016, qui couvrent les années pendant lesquelles les données sur les participants à l’ELCV ont été recueillies. Résultats Les participants de Calgary à l’ELCV étaient représentatifs de la population de Calgary pour ce qui est de l’âge, du sexe et de l’identité autochtone. Des écarts de plus de 5 % par rapport à l’ENM ou au recensement de 2016 ont cependant été observés en ce qui concerne l’état matrimonial, les éléments associés à la diversité ethnique (c.­à­d. le statut vis­à­vis de l’immigration, le lieu de naissance, la langue non officielle parlée à la maison), la migration interne, le revenu, la situation vis-à-vis de la retraite et le niveau de scolarité. Conclusion Les responsables des études volontaires ont de la difficulté à recruter des cohortes véritablement représentatives. Les collectivités qui choisissent d’utiliser les données de l’ELCV à l’échelle municipale, que ce soit à Calgary ou dans les 10 autres sites de collecte de données, devraient être prudentes lorsqu’elles interprètent les résultats de ces analyses car les participants à l’ELCV pourraient ne pas être parfaitement représentatifs de la population locale en ce qui concerne certaines caractéristiques d’intérêt.

Introduction The Canadian Longitudinal Study on Aging (CLSA) is a rich, nationally representative population-based resource that can be used for multiple purposes. Although municipalities may wish to use CLSA data to address local policy needs, how well localized CLSA cohorts reflect municipal populations is unknown. Because Calgary, Alberta, is home to one of 11 CLSA data collection sites, our objective was to explore how well the Calgary CLSA sample represented the general Calgary population on select sociodemographic variables. Methods Baseline characteristics (i.e. sex, marital status, ethnicity, education, retirement status, income, immigration, internal migration) of CLSA participants who visited the Calgary data collection site between 2011 and 2015 were compared to analogous profiles derived from the 2011 National Household Survey (NHS) and 2016 Census datasets, which spanned the years when data were collected on the CLSA participants. Results Calgary CLSA participants were representative of the Calgary population for age, sex and Indigenous identity. Discrepancies of over 5% with the NHS and/or 2016 Census were found for marital status, measures of ethnic diversity (i.e. immigrant status, place of birth, non-official language spoken at home), internal migration, income, retirement status and education. Conclusion Voluntary studies face challenges in recruiting fully representative cohorts. Communities opting to use CLSA data at a municipal level, including the 10 other CLSA data collection sites, should exercise caution when interpreting the results of these analyses, as CLSA participants may not be fully representative of the local population on select characteristics of interest.

PurposeThis study aimed to look at parents' perceptions of a number of different toy prototypes that represented physical impairments and predictors of these perceptions.Design/methodology/approachA correlational survey design was used. Parents of children aged 4–10 years who identified their child as having a disability (n = 160) and not as having a disability (n = 166) took part. They rated a number of prototypes for likelihood that their child would enjoy playing with them and completed measures of their responses toward children with disabilities and of their own and their child's direct contact with people with disabilities.FindingsIt was found that, among parents of children who did not declare that their child had a disability, the more open the parents were toward disability, the more contact the children had with other children with disabilities and the more likely they were to consider that their child would like to play with a toy prototype representing a physical impairment. This pattern of results was not found among parents who identified their child as having a disability, where instead positive friendship intentions of parents mediated this association.Research limitations/implicationsThese findings have implications for theories informing the positive benefits of disability representation.Practical implicationsThese findings indicate different paths through which parents might be moved to purchase toys that represent physical impairments for their children.Social implicationsThese findings suggest that representative toys might be associated with an open dialogue around the topic of disability.Originality/valueThis is the first study of the responses of parents to toys that represent physical impairments known to the authors.

This study evaluates the implementation of Safewards on an assessment and treatment unit (ATU) for people with an intellectual disability. There are no previous studies evaluating this model in this context and previous research has focused largely on acute mental health services. The ‘Patient–Staff Conflict Shift Report’ was used at baseline for 1 month and 1 year later, after all the interventions had been implemented, to evaluate the impact of Safewards. Significant reductions were found in conflict and containment measures used within the service after the implementation of Safewards. Staff who led on the interventions were also asked to give feedback on their experiences, the challenges they faced and how they would like to move forward. Safewards was generally seen as a positive approach by the team. Limitations of this study are highlighted and suggestions for future research are made.

Item does not contain fulltext Establishing generalisable humour style profiles promises to have significant value for educational, clinical, and occupational application. However, previous research investigating such profiles has thus far presented inconsistent results. To determine the generalisability and value of humour style profiles, a large and geographically diverse examination of humour styles was conducted through a cross-sectional questionnaire methodology involving 863 participants from across three world regions. Findings identify inconsistencies in the humour style profiles across countries tested and the extant literature, possibly indicative of cultural differences in the behavioural expression of trait humour. Furthermore, when directly compared, humour types, rather than humour styles, consistently provide the greatest predictive value for friendship and well-being outcomes. As such, with respect to both consistency and value, capturing humour style profiles appears to represent a relatively reductionist approach to appreciating the nuances in the use and consequences of humour. 24 p.

IntroductionDeciding whether to proceed with a major lower limb amputation is life-changing and complex, and it is crucial that the right decision is made at the right time. However, medical specialists are known to poorly predict risk when assessing patients for major surgery, and there is little guidance and research regarding decisions about amputation. The process of shared decision-making between doctors and patients during surgical consultations is also little understood. Therefore, the aim of this study is to analyse in depth the communication, consent, risk prediction and decision-making process in relation to major lower limb amputation.Methods and analysisConsultations between patients and surgeons at which major lower limb amputation is discussed will be audio-recorded for 10–15 patients. Semi-structured follow-up interviews with patients (and relatives/carers) will then be conducted at two time points: as soon as possible/appropriate after a decision has been reached regarding surgery, and approximately 6 months later. Semi-structured interviews will also be conducted with 10–15 healthcare professionals working in the UK National Health Service (NHS) involved in amputation decision-making. This will include surgeons, anaesthetists and specialist physiotherapists at 2–4 NHS Health Boards/Trusts in Wales and England. Discourse analysis will be used to analyse the recorded consultations; interviews will be analysed thematically. Finally, workshops will be held with patients and healthcare professionals to help synthesise and interpret findings.Ethics and disseminationThe study has been approved by Wales REC 7 (20/WA/0351). Study findings will be published in international peer-reviewed journal(s) and presented at national and international scientific meetings. Findings will also be disseminated to a wide NHS and lay audience via presentations at meetings and written summaries for key stakeholder groups.

The efficiency of oil processes depends on the product of volumetric sweep and microscopic sweep. In oil recovery by steam injection the microscopic sweep is generally good; however, obtaining a good volumetric sweep can be challenging. This is caused by low density and viscosity of the injected steam combined with the reservoir heterogeneity, in particular existence of thief zone. Consequently, the steam utilization factor measured by steam-to-oil ratio (SOR, kg steam/bbl of oil) for many steam-flooding projects becomes poor. All these issues can be addressed by a successful application of steam foam technology. In steam foam applications, steam (plus a non-condensing gas) is injected simulateneously with a surfactant solution. Under the favorable injection conditions a foam is formed inside the reservoir leading to significant reduction of steam mobility and can eventually improve sweep efficiency. In the literature many successful steam foam pilots have been reported. However, most of these applications are at relatively shallow reservoirs with low pressures and thus low temperatures. In our paper we investigate if steam foam can also be effectively used for applications at high steam temperatures, significantly exceeding 200°C. To test the viability of steam foam technology at high temperatures, we have tested the stability of multiple surfactants at reservoir conditions. For those surfactants that showed good stability, core flood tests have been carried out to test the ability to form foam and to assess the resulting foam strength. Steam foam tests have also been carried out at temperature up to 240°C.

Background Accurate prediction of outcomes following surgery with high morbidity and mortality rates is essential for informed shared decision-making between patients and clinicians. It is unknown how accurately healthcare professionals predict outcomes following major lower-limb amputation (MLLA). Several MLLA outcome-prediction tools have been developed. These could be valuable in clinical practice, but most require validation in independent cohorts before routine clinical use can be recommended. The primary aim of this study is to evaluate the accuracy of healthcare professionals’ predictions of outcomes in adult patients undergoing MLLA for complications of chronic limb-threatening ischaemia (CLTI) or diabetes. Secondary aims include the validation of existing outcome-prediction tools. Method This study is an international, multicentre prospective observational study including adult patients undergoing a primary MLLA for CLTI or diabetes. Healthcare professionals’ accuracy in predicting outcomes at 30-days (death, morbidity and MLLA revision) and 1-year (death, MLLA revision and ambulation) will be evaluated. Sixteen existing outcome-prediction tools specific to MLLA will be examined for validity. Data collection began on 1 October 2020; the end of follow-up will be 1 May 2022. The C-statistic, Hosmer–Lemeshow test, reclassification tables and Brier score will be used to evaluate the predictive performance of healthcare professionals and prediction tools, respectively. Study registration and dissemination This study will be registered locally at each centre in accordance with local policies before commencing data collection, overseen by local clinician leads. Results will be disseminated to all centres, and any subsequent presentation(s) and/or publication(s) will follow a collaborative co-authorship model., PERCEIVE (PrEdiction of Risk and Communication of outcome following major lower limb amputation—a collaboratiVE study) is an international, multicentre prospective observational study including adult patients undergoing a primary major lower-limb amputation (MLLA) for chronic limb-threatening ischaemia (CLTI) or diabetes. It aims to evaluate the accuracy of healthcare professionals’ predictions of outcomes in adult patients undergoing MLLA for complications of CLTI or diabetes. Secondary aims include the validation of existing outcome-prediction tools in this patient cohort.

This research was funded by the Biotechnology and Biological Sciences Research Council (BB/M009343/1 to D.J.E), an ISSF award from The Wellcome Trust to the BSRC, University of St Andrews, and a Royal Society Newton Advanced Fellowship (NA160353 to Y.F.C). The APC was funded by The University of St Andrews. Positive-strand RNA virus evolution is partly attributed to the process of recombination. Although common between closely genetically related viruses, such as within species of the Enterovirus genus of the Picornaviridae family, inter-species recombination is rarely observed in nature. Recent studies have shown recombination is a ubiquitous process resulting in a wide range of recombinant genomes and progeny viruses. While not all recombinant genomes yield infectious virus progeny, their existence and continued evolution during replication has critical implications for evolution of the virus population. In this study we utilised an in vitro recombination assay to demonstrate inter-species recombination events between viruses from four enterovirus species’, A-D. We show that inter-species recombinant genomes are generated in vitro with polymerase template-switching events occurring within the virus polyprotein coding region. However, these genomes did not yield infectious progeny virus. Analysis and attempted recovery of a constructed recombinant cDNA revealed a restriction in positive- but not negative -strand RNA synthesis, indicating a significant block in replication. This study demonstrates the propensity for inter-species recombination at the genome level but suggests that significant sequence plasticity would be required in order to overcome blocks in the virus life cycle and allow for the production of infectious virus. Publisher PDF

Objectives A novel analytical framework was used to re-examine and extend Cheng, Hardy and Markland’s (2009) hierarchical model of anxiety. The modified model was characterized by six first order constructs, with worry, private self-focus and public self-focus representing cognitive anxiety, somatic tension and autonomous hyperactivity representing physiological anxiety and perceived control representing the regulatory dimension. It was hypothesized that these six first order constructs were formative indicators of the second order factors and this hypothesis was tested using Partial Least Squares analysis. Factor validity of the original hierarchical model proposed by Cheng et al. was investigated. Subsequently, items were refined, the hierarchical model extended, and factor and predictive validity investigated further. Method Prospective data was collected from three samples (N = 174, 516, 43), and a series of factor analyses were conducted including Confirmatory Factor Analysis and Partial Least Squares modeling. Multivariate analysis examined the predictive validity of the model using a performance measure as the dependent variable. Results The original model revealed a poor fit, with poor item loadings and discriminant validity. Subsequent analysis established a refined 25 item measure, which produced support for a fully differentiated hierarchical model of competitive anxiety. MANOVA revealed a significant effect for the control factor, with those achieving superior performance reporting significantly higher levels of perceived control. Conclusions A fully differentiated hierarchical model was supported, which crucially depicts the first order factors of competitive anxiety that form the 3 s order dimensions. This provides a model that is a better fit with theory and provides a more refined diagnosis tool for applied sport psychologists.

A patient with an abdominal aortic aneurysm can have surgical management through either an open or endovascular approach. The use of an endovascular approach has benefits for the patient by being a less invasive approach with initially lower mortality and morbidity and lower lengths of hospital stay, although longer term outcomes match open techniques. The endovascular technique requires more specialist equipment, including stents and imaging equipment. In the UK they are usually performed in specialist hospitals with teams of interventional radiologists, vascular surgeons and anaesthetists working together. Patients presenting for endovascular repair of their abdominal aortic aneurysm can present the anaesthetist with range of complex comorbidities which require specific management and optimization pre-operatively. The intraoperative management of the patient can vary, depending on patient, surgical and anaesthetic factors, from local anaesthetic, regional techniques or general anaesthesia. The postoperative complications are generally minimal, but the patients require lifelong follow up, making the procedure more expensive than an open procedure.

Introduction A spontaneous type I electrocardiogram (ECG) pattern and/or unheralded syncope are conventionally used as risk markers for primary prevention of sudden cardiac arrest/death (SCA/SCD) in Brugada syndrome (BrS). In this study, we determine the prevalence of conventional and newer markers of risk in those with and without previous aborted SCA events. Methods All patients with BrS were identified at our institute. History of symptoms was obtained from medical tests or from interviews. Other markers of risk were also obtained, such as presence of (1) spontaneous type I pattern, (2) fractionated QRS (fQRS), (3) early repolarization (ER) pattern, (4) late potentials on signal‐averaged ECG (SAECG), and (5) response to programmed electrical stimulation. Results In 133 patients with Bars, 10 (7%) patients (mean age = 39 ± 11 years; nine males) were identified with a previous ventricular fibrillation/ventricular tachycardia episode (n = 8) or requiring cardio‐pulmonary resuscitation (n = 2). None of these patients had a prior history of syncope before their SCA event. Only two (20%) patients reported a history of palpitations or dizziness. None had apneic breathing and three (30%) patients had a family history of SCA. From their ECGs, a spontaneous pattern was only found in one (10%) of these patients. Further, 10% of patients had fQRS, 17% had late potentials on SAECG, 20% had deep S waves in lead I, and 10% had an ER pattern in the peripheral leads. No significant differences were observed in the non‐SCA group. Conclusion The majority of BrS patients with previous aborted SCA events did not have a spontaneous type I and/or prior history of syncope. Conventional and newer markers of risk appear to only have limited ability to predict SCA.

Copyright © 2021 Mullen and Jones. Competitive state anxiety is an integral feature of sports performance but despite its pervasiveness, there is still much debate concerning the measurement of the construct. Adopting a network approach that conceptualizes symptoms of a construct as paired associations, we proposed re-examining competitive state anxiety as a system of interacting components in a dataset of 485 competitive athletes from the UK. Following a process of data reduction, we estimated a network structure for 15 items from the modified Three Factor Anxiety Inventory using the graphical LASSO algorithm. We then examined network connectivity using node predictability. Exploratory graph analysis was used to detect communities in the network and bridge expected influence calculated to estimate the influence of items from one community to items in other communities. The resultant network produced a range of node predictability values. Community detection analysis derived three communities that corresponded with previous research and several nodes were identified that bridged these communities. We conclude that network analysis is a useful tool to explore the competitive state anxiety response and we discuss how the results of our analysis might inform the assessment of the construct and how this assessment might inform interventions.

British guidelines recommend epidemiological treatment for all chlamydia contacts during the look back period. Some UK sexual health clinics follow a test and wait process for chlamydia contacts presenting after 14 days of exposure. The aim of this retrospective service evaluation was to determine the potential impact of implementing such a process for chlamydia contacts at our clinic. We reviewed the patient records of 548 chlamydia contacts over a 1-year period, and 588 patients with chlamydia over a 5-month period. Demographic and clinical characteristics data were collected. Chlamydia prevalence was 46% (254/548) in contacts, with prevalence varying by age (p=.008) and sexual risk (p=.04), but not by time since exposure (p=.29). For patients with chlamydia, there was a mean of 1.9 days between results notification and attending for treatment; a mean of 2.2 attempts were required to contact patients to return for treatment. Chlamydia prevalence in contacts is high. Not giving empirical treatment to contacts presenting after 14 days of exposure would result in 13.1% of the cohort needing to return for treatment. Patients found to have chlamydia returned promptly once informed of positive results.

Background Policy throughout the United Kingdom promotes involvement of patients and public members in research to benefit patient care and health outcomes. PRIME Centre Wales is a national research centre, developing and coordinating research about primary and emergency care which forms 90% of health service encounters. In this paper, we describe our approach to public involvement and engagement in PRIME Centre Wales (hereafter called PRIME), in particular: how this approach has developed; ways in which public members contribute to PRIME activity; the strengths and limitations of our approach, challenges and future opportunities. PRIME ensures work is relevant to service users, carers, the public and policy makers by incorporating comprehensive patient and public involvement in every phase of our work. Approach PRIME has policies and processes to enable and promote successful public involvement and engagement across research activities. This ensures public perspectives and patient experiences are integrated throughout research development, implementation and dissemination and in managing and delivering PRIME strategy over a 10 year timescale. A public/patient group called SUPER is a key resource providing wide-ranging perspectives via email and face-to-face discussion. We collect information on processes and experiences to assess value and impact, to guide ongoing involvement and engagement. A funded post provides leadership and support to staff and to public/patient contributors to facilitate collaborations. Discussion A stable, well-resourced structure has provided the timescales to build strong relationships and embed diverse approaches to public involvement and engagement within PRIME. Researchers and public contributors have committed to collaborations, developed knowledge and skills and sustained relationships. Effective approaches incorporate values and actions which, when operating together, strengthen processes and outcomes of public involvement and engagement. Conclusion Supportive context, motivation and time are necessary to foster values and practices that enable effective public involvement and engagement. PRIME has embedded public involvement and engagement across research activities and structures. Central is the public/patient group SUPER offering experience-based expertise to add value to the research cycle. This innovative model, aligned with best practice, enhances relevance and quality of primary and emergency care research to benefit patients and the general population.

ObjectiveTo explore patients’ experience of receiving pain relief injection for suspected hip fracture from paramedics at the location of the injury.DesignQualitative interviews within a feasibility trial about an alternative to routine prehospital pain management for patients with suspected hip fracture.SettingPatients treated by paramedics in the catchment area of one emergency department in South Wales.ParticipantsSix patients and one carer of a patient who received fascia iliaca compartment block (FICB).InterventionFICB administered to patients with suspected hip fracture by trained paramedics. We randomly allocated eligible patients to FICB—a local anaesthetic injection directly into the hip region—or usual care—most commonly morphine—using audited scratch cards.OutcomesAcceptability and experience of receiving FICB, assessed through interview data. We audio-recorded, with participants’ consent, and conducted thematic analysis of interview transcripts. The analysis team comprised two researchers, one paramedic and one lay member.ResultsPatients had little or no memory of being offered, consenting to or receiving FICB. They recalled the reassuring manner and high quality of care received. They accepted FICB without question. Partial or confused memory characterised experience of subsequent hospital care until surgery. They said their priorities when calling for emergency help were to receive effective care. After hospital treatment, they wanted to regain their health and mobility and resume the quality of life they experienced before their injury.ConclusionsThis study did not raise any concerns about the acceptability of FICB administered at the scene of injury by paramedics to people with suspected hip fracture. It adds to existing evidence about patient and carer experience of on-scene care for people with suspected hip fracture. Further research is needed to assess safety, effectiveness and cost effectiveness of this health technology in a new setting.Trial registration numberNCT60065373.