Use of an earthworm lysosomal biomarker for the ecological assessment of pollution from an industrial plastics fire

A low-cost field technique employing retention of the dye neutral-red by lysosomes in coelomocyte cells taken from earthworms (Lumbricus castaneus), was used as a means of assessing the ecological effects (if any) of an industrial accident. Earthworms and soil samples were collected at the site of a large industrial plastics fire in Thetford, UK along a 200 m transect leading from the factory perimeter fence, over a layer of molten plastic impregnated soil and into the surrounding forest. Coelomic fluid extracted from the earthworms was dye-loaded with neutral-red and lysosomal leaking observed. Metal residues in soil and earthworms were found to be highly elevated close to the factory perimeter and to rapidly drop to background levels within the first 50 m of the transect. Coelomocyte cells taken from earthworms adjacent to the factory perimeter showed the shortest period of neutral-red retention (2 min); cells taken from worms further into the surrounding forest had a longer retention time (12 min), whilst cells taken from worms from a control site showed even greater retention times (25 min). Thus, the neutral-red retention times correlated negatively with measured residues of heavy metals in the earthworms, the higher the body metal concentration the shorter the retention time. This field trial has demonstrated the validity of using an in vitro cellular biomarker technique for use in biological impact assessment along gradients of contamination.

Prevalence, Nature, Severity and Risk Factors for Prescribing Errors in Hospital Inpatients: Prospective Study in 20 UK Hospitals

Introduction: It has been suggested that doctors in their first year of post-graduate training make a disproportionate number of prescribing errors.

Obkective: This study aimed to compare the prevalence of prescribing errors made by first-year post-graduate doctors with that of errors by senior doctors and non-medical prescribers and to investigate the predictors of potentially serious prescribing errors.

Methods: Pharmacists in 20 hospitals over 7 prospectively selected days collected data on the number of medication orders checked, the grade of prescriber and details of any prescribing errors. Logistic regression models (adjusted for clustering by hospital) identified factors predicting the likelihood of prescribing erroneously and the severity of prescribing errors.

Results: Pharmacists reviewed 26,019 patients and 124,260 medication orders; 11,235 prescribing errors were detected in 10,986 orders. The mean error rate was 8.8 % (95 % confidence interval [CI] 8.6-9.1) errors per 100 medication orders. Rates of errors for all doctors in training were significantly higher than rates for medical consultants. Doctors who were 1 year (odds ratio [OR] 2.13; 95 % CI 1.80-2.52) or 2 years in training (OR 2.23; 95 % CI 1.89-2.65) were more than twice as likely to prescribe erroneously. Prescribing errors were 70 % (OR 1.70; 95 % CI 1.61-1.80) more likely to occur at the time of hospital admission than when medication orders were issued during the hospital stay. No significant differences in severity of error were observed between grades of prescriber. Potentially serious errors were more likely to be associated with prescriptions for parenteral administration, especially for cardiovascular or endocrine disorders.

Conclusions: The problem of prescribing errors in hospitals is substantial and not solely a problem of the most junior medical prescribers, particularly for those errors most likely to cause significant patient harm. Interventions are needed to target these high-risk errors by all grades of staff and hence improve patient safety.

The influence of area level social deprivation on preoperative disease severity and postoperative outcomes following unicompartmental knee joint replacement

BACKGROUND: This study investigated the effect of socioeconomic deprivation on preoperative disease and outcome following unicompartmental knee replacement (UKR).

METHODS: 307 Oxford UKRs implanted between 2008 and 2013 under the care of one surgeon using the same surgical technique were analysed. Deprivation was quantified using the Northern Ireland Multiple Deprivation Measure. Preoperative disease severity and postoperative outcome were measured using the Oxford Knee Score (OKS).

RESULTS: There was no difference in preoperative OKS between deprivation groups. Preoperative knee range of motion (ROM) was significantly reduced in more deprived patients with 10° less ROM than least deprived patients. Postoperatively there was no difference in OKS improvement between deprivation groups (p=0.46), with improvements of 19.5 and 21.0 units in the most and least deprived groups respectively. There was no significant association between deprivation and OKS improvement on unadjusted or adjusted analysis. Preoperative OKS, Short Form 12 mental component score and length of stay were significant independent predictors of OKS improvement. A significantly lower proportion of the most deprived group (15%) reported being able to walk an unlimited distance compared to the least deprived group (41%) one year postoperatively.

CONCLUSION: More deprived patients can achieve similar improvements in OKS to less deprived patients following UKR.

LEVEL OF EVIDENCE: 2b - retrospective cohort study of prognosis.

Finite-element investigation of cold-formed steel portal frames in fire

This paper presents the results of a full-scale site fire test performed on a cold-formed steel portal frame building with semi-rigid joints. The purpose of the study is to establish a performance-based approach for the design of such structures in fire boundary conditions. In the full-scale site fire test, the building collapsed asymmetrically at a temperature of 714°C. A non-linear elasto-plastic finite-element shell model is described and is validated against the results of the full-scale test. A parametric study is presented that highlights the importance of in-plane restraint from the side rails in preventing an outwards sway failure for both a single portal and full building geometry model. The study also demonstrates that the semi-rigidity of the joints should be taken into account in the design. The single portal and full building geometry models display a close match to site test results with failure at 682°C and 704°C, respectively. A design case is described in accordance with Steel Construction Institute design recommendations. The validated single portal model is tested with pinned bases, columns protected, realistic loading and rafters subject to symmetric uniform heating in accordance with the ISO 834 standard fire curve; failure occurs at 703°C.

Bouyid v Belgium: The “minimum level of severity” and Human Dignity's Role in Article 3 ECHR

The Grand Chamber of the European Court of Human Rights recently delivered an important judgment on Article 3 ECHR in the case of Bouyid v Belgium. In Bouyid, the Grand Chamber was called upon to consider whether slaps inflicted on a minor and an adult in police custody were in breach of Article 3 ECHR, which provides that ‘No one shall be subjected to torture or to inhuman or degrading treatment or punishment’. Overruling the Chamber judgment in the case, the Grand Chamber ruled by 14 votes to 3 that there had been a substantive violation of Article 3 in that the applicants had been subjected to degrading treatment by members of the Belgian police; it found that there had been a breach of the investigative duty under Article 3 also. In this comment, I focus on the fundamental basis of disagreement between the majority of the Grand Chamber and those who found themselves in dissent, on the question of whether there had been a substantive breach of Article 3. The crux of the disagreement lay in the understanding and application of the test of ‘minimum level of severity’, which the ECtHR has established as decisive of whether a particular form of ill-treatment crosses the Article 3 threshold, seen also in light of Article 3’s absolute character, which makes it non-displaceable – that is, immune to trade-offs of the type applicable in relation to qualified rights such as privacy and freedom of expression. I consider the way the majority of the Grand Chamber unpacked and applied the concept of dignity – or ‘human dignity’ – towards finding a substantive breach of Article 3, and briefly distil some of the principles underpinning the understanding of human dignity emerging in the Court’s analysis.