Sussex County Research Articles

Ethical lessons from the ‘undercover nurse’: implications for practice and leadership

BackgroundThe case of Margaret Haywood, the ‘undercover nurse’, is a significant one for the UK's National Health Service (NHS). She investigated complaints made about the Royal Sussex County Hospital and...

Anaesthetists' and surgeons' attitudes towards informed consent in the UK: an observational study

BackgroundThe attitudes of patients' to consent have changed over the years, but there has been little systematic study of the attitudes of anaesthetists and surgeons in this process. We aimed to describe observations made on the attitudes of medical professionals working in the UK to issues surrounding informed consent.MethodA questionnaire made up of 35 statements addressing the process of consent for anaesthesia and surgery was distributed to randomly selected anaesthetists and surgeons in Queen's Medical Centre (Nottingham), Royal Sussex County Hospital (Brighton) and Eastbourne District General Hospital (Eastbourne) during 2007. Participants were asked to what extent they agreed with statements regarding consent.ResultsOf 234 questionnaires distributed, 63% were returned. Of the respondents 79% agreed that the main purpose of the consent process is to respect patient autonomy. While 55% of the examined cohort agreed that the consent process maybe inappropriate as patients do not usually remember all the information given to them. Furthermore, 84% of the participants agreed that what the procedure aims to achieve should be explained to the patient during the consent process. While of the participants, over 70% agreed that major risks of incidence greater than 1/100 should be disclosed to the patient as part of the consent process.ConclusionsThe majority of respondents appear to hold attitudes in standing with current guidelines on informed consent however there was still a significant minority who held more paternalistic views to the consent process bringing into question the need for further training in the area.

Delaware's Indian River Inlet Bridge

Plagued by a serious scour problem, the existing bridge over the Indian River Inlet in Sussex County, Delaware, will be replaced by a 1,750-ft cable-stayed bridge. The new bridge is being constructed under a design–build contract by the team of Skanska and AECOM. The bridge is due to open in summer 2011. As part of this project, a comprehensive structural monitoring system has been designed and will be installed on the bridge to aid in the long-term maintenance and operation of this significant structure. The concept and the design of the monitoring system were proposed by the Center for Innovative Bridge Engineering, University of Delaware. The system has been designed with the intent of providing quantitative data on the long-term performance of the bridge, which can be used to augment the traditional inspection program. The all-fiber-optic system will include 119 embedded and surface-mounted sensors that will measure strain in the deck and pylons; accelerations on the deck, pylons, and cables; deck inclination; chloride penetration in the deck; temperature; and wind speed and direction. Slow, gradual trends resulting from thermal effects and environmental factors will be captured by the monitor data, readings taken on the hour, every hour. Bridge response under intense live loads, such as heavy vehicles and high winds, will be recorded as event data. A series of baseline readings and diagnostic tests will be conducted once the bridge is completed and will be used for future comparisons. The paper presents an overview of the monitoring system and the monitoring program, a description of the way the data will be used, and the owner's perspective.

First Report of the Sting Nematode Belonolaimus longicaudatus on Soybean in Delaware.

In late July of 2005, several, large, irregular areas of severely chlorotic, stunted, and dead soybean plants were observed in two fields of soybean (Glycine max), 8.05 km apart, in sandy soil (94% sand, 2% silt, and 4% clay) in southwestern Sussex County, DE. The grower also had observed stunted corn the previous year in the same areas and thought the fields had a fertility problem. The morphology of adults and molecular analyses of the juveniles isolated from soil samples established the identity of the species as the sting nematode, Belonolaimus longicaudatus (1-4). The population density was 216 nematodes per 250 cm3 of soil. Morphological characters used for identification included female body, stylet and tail length, shape of head, stylet knobs, tail and tail terminus, number of lines in the lateral field, and vulva percentage in relation to body length. The male characters critical for identification were the following: body, stylet, spicule, and gubernaculum length; shape of head and stylet knobs; and number of lines in the lateral field. Measurements of females (n = 5) included body length (range = 2,035 to 2,120 μm, mean = 2,073.7, standard deviation [SD] = 37.0), stylet (117.0 to 127.5, 123.4, 4.5), V% (48.4 to 52.3, 50.6, 1.5), and tail (109 to 140, 120, 14.2). The lateral field had one incisure. Shape of head, stylet knobs, and tail were also consistent with B. longicaudatus. Males (n = 4) were characterized by the body length (range = 1,500 to 2,070 μm, mean = 1,753.3, SD = 290.2), stylet (117.0 to 127.5, 121.5, 5.4), spicules (41 to 50, 47, 5.2), and gubernaculum (17.0 to 18.5, 17.8, 0.8). Molecular diagnosis as B. longicaudatus was confirmed by sequencing two ribosomal DNA markers from three juveniles. Sequence of the internal transcribed spacer region ITS1 and 2 (GenBank Accession No. GQ896549) from this population was 99% identical to Florida isolate BlCi6 (DQ672368), and the 28S large ribosomal subunit D2-D3 expansion region (GQ896548) was 99% identical to Florida isolate BlCi4 (DQ672344). A high degree of similarity (>98%) was also shared by several other B. longicaudatus sequences (1). This detection represents a new state record in Delaware for B. longicaudatus. Since this detection in 2005, there have been no new reports of other observations of sting nematode or spread from these two fields tilled by the same farm operator in Delaware. Elsewhere, B. longicaudatus is known to occur in subtropical regions of the lower coastal plain, from Virginia to Florida and along the Gulf Coast into Texas. On the east coast, USDA Nematode Collection records document this nematode from Florida, Georgia, New Jersey, and South Carolina. Within Delaware, another sting nematode species, Belonolaimus maritimus, was detected on American beachgrass (Ammophila breviligulata) and bitter panicgrass (Panicum amarum var. amarulum) from Fenwick Island, near the Maryland border. Sting nematodes have also been reported in Burlington County, NJ.

High Dose Botulinum Toxin is Safe and Effective in the Management of Chronic Anal Fissure

High Dose Botulinum Toxin is Safe and Effective in the Management of Chronic Anal Fissure

Miguelromeroite, the Mn analogue of sainfeldite, and redefinition of villyaellenite as an ordered intermediate in the sainfeldite-miguelromeroite series

Based on single-crystal structure refinements, miguelromeroite, Mn 5 (H 2 O) 4 (AsO 3 OH) 2 (AsO 4 ) 2 , from the Ojuela mine, Mapimi, Durango, Mexico, is described as a new species corresponding to the Mn-dominant member of a series with sainfeldite, Ca 5 (H 2 O) 4 (AsO 3 OH) 2 (AsO 4 ) 2 , and type villyaellenite, (Mn,Ca)Mn 2 Ca 2 (H 2 O) 4 (AsO 3 OH) 2 (AsO 4 ) 2 , from Sainte-Marie aux Mines, Alsace, France, is redefined as an ordered intermediate species in the series. Miguelromeroite is monoclinic, C2/c, a = 18.030(1), b = 9.2715(5), c = 9.7756(5) Å, β = 96.266(2)°, V = 1624.4(2) Å 3 , Z = 4. At the Ojuela mine, miguelromeroite occurs as a compact spray of orangepink, prismatic crystals up to 4 cm in length. Crystals are elongate on [001] with forms {100}, {110} and {101}. Physical properties: pale pink streak, transparent, vitreous luster, brittle, good {100} cleavage, conchoidal fracture, Mohs hardness ~4, measured density 3.69(3) g/cm 3 , and calculated density 3.714 g/cm 3 . Optical properties: biaxial (-), n α 1.713(2), n β 1.723(2), n γ 1.729(2), 2V meas 70(5)°, 2V calc 75°, orientation X = b, Z ^ c = 40° in obtuse β, pleochroic pale pink, Z >> X > Y. Miguelromeroite is named for Miguel Romero Sanchez (1926-1997) in recognition for his dedication to documenting and preserving Mexico’s rich mineral heritage. Miguelromeroite also occurs at the Veta Negra mine, Tierra Amarilla, Copiapó Province, Chile, at Sterling Hill, Ogdensburg, Sussex County, New Jersey, and at the Gozaisho mine, Iwaki, Fukushima Prefecture, Honshu Island, Japan. Some material from the Gozaisho mine may correspond to another ordered species in the series with the formula (Ca,Mn)Mn 2 Ca 2 (H 2 O) 4 (AsO 3 OH) 2 (AsO 4 ) 2

Personalising Health — The West Sussex Story

This article describes the journey that West Sussex PCT and County Council have set out on to test and experiment how personalisation in health can improve patient outcomes and experience of health care. The journey is far from over, but the article describes the importance of top‐level commitment and leadership, the progress we have made, the lessons we have learned and some of the challenges we see ahead. It is about local action and learning, and does not presume to suggest it is the right or the best approach. The article is a case study to follow up the article about self‐directed support in health by Rita Brewis in the previous Issue of this journal. West Sussex is a provisional DH pilot area for the introduction of personal health budgets, and is a member of the Staying in Control programme. West Sussex County Council has been an individual budget pilot site, and has nearly 2,000 people receiving individual budgets and a target that all adults receiving social care will be offered self‐directed support by April 2010.

The Beat

Vol. 117, No. 10 NewsOpen AccessThe Beat Erin E. Dooley Erin E. Dooley Search for more papers by this author Published:1 October 2009https://doi.org/10.1289/ehp.117-a438bAboutSectionsPDF ToolsDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InRedditEmail Vehicles Concentrate NicotineA study by Patrick Breysse et al. published online 25 August 2009 ahead of print in Tobacco Control found that vehicle passengers riding with smokers may be exposed to nicotine levels 40–50% higher than those found in restaurants and bars that permit smoking. Nicotine concentrations inside vehicles increased twofold for every cigarette smoked, and while opening the windows reduced smoke somewhat, it did not eliminate exposure within the vehicle. Breysse et al. state the levels are unacceptable for nonsmoking passengers, especially children, who are at increased risk for secondhand smoke–related health problems..USDA Maps Local Food ProductionUntil recently, low fuel prices meant the U.S. food system could rely on food imported from other countries, but rising transport costs and regional food shortages and crop failures are among several factors encouraging a closer look at local food production. Wayne Honeycutt and colleagues at the Agricultural Research Service are now mapping data from Maine to Virginia on weather, soil, land use, and water availability to model potential crop production and determine local food production capacity. They say expanding opportunities for local food production could stimulate rural development and offset the risk of food shortages by diversifying and increasing local production in other areas.Fredon Township School playgroundSchool Averts EMF-Related ClosureThe debate over the safety of electromagnetic fields (EMFs) nearly closed a New Jersey school this fall until the state’s biggest electric utility and the Sussex County Board of Education reached an eleventh-hour settlement. The board had planned to close the K–6 Fredon Township School 1 October 2009 because the existing high-voltage power line crossing the school’s playground had been found to emit EMF levels more than 8 times the WHO-recommended maximum of 3 milligauss. Under the settlement, Public Service Electric & Gas Co. agreed to pay $95,000 to relocate playgrounds located under its lines. There is limited evidence that EMFs from power lines may be a risk factor for childhood leukemia.Colorimetric “Nose” Alerts Chemical HandlersIn a report published online 13 September 2009 in Nature Chemistry, Kenneth Suslick and colleagues present a postage stamp–sized electronic sensor capable of quickly and inexpensively detecting toxic chemicals and their concentrations through color visualization. The pattern created by color changes in the disposable 36-dye sensor array identifies both the toxicant and its concentration. The sensor can detect more chemicals than previous methods and produces most results within 2 minutes. The researchers have developed a handheld version similar to a card-scanning device that uses LED illumination and an ordinary camera.Take-Home Dust Boosts Car Seat Lead LevelsSeveral studies have established that lead-exposed workers can carry lead-contaminated dust off the jobsite on their clothing, shoes, and tools. In the 21 August 2009 MMWR Tina Bernier et al. report the first known cases of childhood lead poisoning attributed to take-home lead dust deposited onto car safety seats. No contamination was found in the six children’s homes, leading the researchers to examine family vehicles and car seats, where high lead levels were found. Although previous studies have recommended monitoring blood lead levels among children of lead-exposed workers, no standards exist for levels of lead dust contamination in vehicles or on child car safety seats.Indoor Greenery Releases VOCsPeace lilies, snake plants, weeping figs (ficus trees), and areca palms are just a few of the houseplants that have been shown to remove volatile organic compounds (VOCs) from indoor air, but a new study by Dong Sik Yang et al. in the August 2009 issue of HortScience finds they can also release these chemicals. The authors found these four types of houseplants released 12–23 VOCs, and although the researchers did not quantify potential exposures, they did note that emissions were higher during the day than at night. The authors attributed the VOCs to pesticides used in nurseries, microorganisms living in the growing medium, and offgassing of plastic planters.FiguresReferencesRelatedDetails Vol. 117, No. 10 October 2009Metrics About Article Metrics Publication History Originally published1 October 2009Published in print1 October 2009 Financial disclosuresPDF download License information EHP is an open-access journal published with support from the National Institute of Environmental Health Sciences, National Institutes of Health. All content is public domain unless otherwise noted. Note to readers with disabilities EHP strives to ensure that all journal content is accessible to all readers. However, some figures and Supplemental Material published in EHP articles may not conform to 508 standards due to the complexity of the information being presented. If you need assistance accessing journal content, please contact ehponline@niehs.nih.gov. Our staff will work with you to assess and meet your accessibility needs within 3 working days.

Evaluation of a fast-track service for the provision of radiologically inserted gastrostomy (RIG) tubes in head and neck cancer patients

Introduction: Gastrostomy feeding is an important method of providing enteral nutrition in head and neck cancer patients. At the Royal Sussex County Hospital, a fast-track service has been established for the provision of radiologically inserted gastrostomies (RIGs) in head and neck cancer patients, in order that cancer treatment is not delayed. The purpose of this study was to evaluate this service and assess the complications of RIGs.

Thomas Sharp and the post‐war replanning of Chichester: conflict, confusion and delay

Thomas Sharp was a planner of skill and sensitivity to context, very active in replanning smaller historic towns and cities after the Second World War. His 1949 plan for Chichester was well received locally and nationally, but led to fierce debates and conflict with the West Sussex County Council, newly elevated to the status of Planning Authority, who wished to widen the main streets that Sharp felt gave the town its Georgian character. The Ministry of Transport supported the imposition of standard carriageway and pavement widths. The Ministry of Town and Country Planning temporized and delayed approval of the Development Plan. By the 1960s Sharp’s report seemed to have been forgotten, and a new culture of conservation radically changed planning policy. Perhaps Sharp’s real legacy here was in delaying damaging proposals, and promoting a more holistic approach to ‘townscape’.

John Fairbourne Horley

John Fairbourne Horley won a scholarship to Guy’s from Epsom College. After surgical posts at Winchester and Plymouth he switched to haematology. In 1955 he was appointed consultant haematologist to...

The Death Penalty in Delaware: An Empirical Study

This article reports the findings of the first phase of a three phase empirical study of the death penalty in Delaware. In phase 1, we examined only cases in which the defendant was sentenced to death. While our findings are preliminary, there appear to be, as numerous other studies have found in other jurisdictions, race of victim effects. Seventy percent of the death sentences were imposed in white victim cases, even though the majority of the murder victims are black. Additionally, Delaware has one of the highest death sentencing rates in the country. This high rate appears to be the result of a change in the Delaware death sentencing scheme from jury to judge sentencing. When that change was implemented, the number of death sentences rose dramatically. Our preliminary findings also reveal a geographic effect. Two thirds of the death sentences were imposed in New Castle County, 29% were imposed in Kent County and only 5% of the death sentences resulted from murders which occurred in Sussex County. Finally, in analyzing the outcomes of the cases in which the defendant was sentenced to death on appeal, we found an overall error rate of 44%.

O332 Opportunistic infections in immunocompromised but virologically suppressed HIV-1 infected patients

Address: 1Royal Free and University College Medical School, London, UK, 2Copenhagen HIV Programme, Panum Institute, Copenhagen, Denmark, 3Academisch Medisch Centrum bij de Universiteit van Amsterdam, Amsterdam, Netherlands, 4Istituto Di Clinica Malattie Infettive e Tropicale, Milan, Italy, 5Hospital Clinic i Provincial, Barcelona, Spain, 6Royal Sussex County Hospital, Brighton, UK, 7Medical University, Gdansk, Poland and 8Medical Academy Botkin Hospital, St Petersburg, Russian Federation * Corresponding author

John Andrew Carron Brown

John Carron Brown was known affectionately by his Norwich colleagues as JCB. After qualification and completion of positions as house surgeon at the Middlesex Hospital, John served as ship’s surgeon...

Documenting telephone advice

Clinical OtolaryngologyVolume 32, Issue 6 p. 497-498 Documenting telephone advice S. Massey, S. Massey Royal Sussex County Hospital, Brighton and Sussex University Hospitals NHS Trust, Eastern Road, Brighton BN2 5BE, UK.E-mail: [email protected]Search for more papers by this authorP. Das, P. Das Royal Sussex County Hospital, Brighton and Sussex University Hospitals NHS Trust, Eastern Road, Brighton BN2 5BE, UK.E-mail: [email protected]Search for more papers by this author S. Massey, S. Massey Royal Sussex County Hospital, Brighton and Sussex University Hospitals NHS Trust, Eastern Road, Brighton BN2 5BE, UK.E-mail: [email protected]Search for more papers by this authorP. Das, P. Das Royal Sussex County Hospital, Brighton and Sussex University Hospitals NHS Trust, Eastern Road, Brighton BN2 5BE, UK.E-mail: [email protected]Search for more papers by this author First published: 07 December 2007 https://doi.org/10.1111/j.1749-4486.2007.01511.xRead the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume32, Issue6December 2007Pages 497-498 RelatedInformation

31 Can we achieve the government??s 18- week target for myocardial perfusion imaging?

Department of Nuclear Medicine, Royal Sussex County Hospital, Brighton, UK British Nuclear Medicine Society Oral and Poster Abstracts 2007

Management development through self managed learning: the case of West Sussex County Council

PurposeTo identify how other authorities in England applied Self managed learning to management development and learning opportunities. The success of the programme within WSCC offered an opportunity to identify good practice.Design/methodology/approachThe article discusses the application of self‐managed learning within West Sussex County Councils Advanced Management Development Programme.FindingsIt has been identified that the use of self‐managed learning has proved an invaluable technique for getting individuals to think and learn about their own personal development as well as committing to the development of the county council. It has heightened managers' ability to think more strategically and use their learning in practical applications within the workplace.Originality/valueThis article is a useful case study in applying self managed learning to management development, it is not only a clear and coherent programme but also shows the degree of partnership working that is being undertaken with the local university to ensure that delegates not only get a huge amount of learning and development from it but also succeed in achieving a recognised qualification which can lead to a Masters in strategic management

The Delaware Valley in the Early Republic: Architecture, Landscape, and Regional Identity

Of all the regions of America, perhaps the least understood is the Mid-Atlantic. Some scholars have gone so far as to suggest that it is not a single region because of its diverse cultural traditions. Others argue that diversity is the defining characteristic of the region dating back to the seventeenth century, when most of it was part of the Dutch colony of New Netherland. Gabrielle M. Lanier's new book takes regionalism to a new level of complexity by exploring the relationship among ethnicity, regional identity, and localism in three places in the lower Delaware Valley in the period from 1780 to 1830. The three localities are Warwick Township in Lancaster County, Pennsylvania; Northwest Fork Hundred in Sussex County, Delaware, near the Maryland border; and Mannington Township in Salem County, New Jersey. Each represents a different cultural landscape and a different relationship between people and the material landscape. Lanier compares travel accounts and tax records in the predominantly German Warwick Township, Pennsylvania, to those in nearby more heterogeneous townships, and she finds that ethnic differences in architecture were less pronounced than travel accounts indicated. When she surveyed the material culture of western Sussex County, Delaware, she describes a “landscape on the margins” (pp. 70–103), more closely linked to the slaveholding Chesapeake Bay than to the Delaware Valley. Her most intriguing analysis is of Manning-ton Township, New Jersey, where she sees the characteristic patterned brickwork houses as reinvented monuments to “the ancestral landscape” (pp. 104–44) of the Quaker elite in a hierarchical “hydraulic society” (p. 126) shaped by the tradition of banked meadows.

Variability in nomenclature of benign laryngeal pathology based on video laryngoscopy with and without stroboscopy

To assess the extent of interobserver variability in the nomenclature of benign laryngeal pathology based on evaluation of video-endoscopies with and without stroboscopy. Eight video clips of benign laryngeal conditions were viewed by 35 non-voice specialist ENT surgeons. The surgeons viewed the clips in groups of varying sizes with no discussion between them and were asked to make only one diagnosis for each lesion. Specialist voice clinic in the department of ENT at The Royal Sussex County Hospital in Brighton, UK. Participating ENT surgeons were all either registrars or consultants working at different centres in UK, recruited by the author. None were voice specialists. Interobserver agreement was measured using kappa statistics. Variation was widespread with only two of the eight cases (25%) showing agreement of over 75%. Agreement could be analysed statistically as moderate at best (kappa=0.5 with a 95% confidence interval from 0.5 to 0.6). The seniority of the laryngologist was also analysed with consultants and senior trainees (specialist registrar years 4-6) having better agreement than junior trainees (specialist registrar years 1-3). The generally accepted optimum treatment for different benign laryngeal pathologies varies substantially. However, our results shows a significant high-level interobserver variability in their diagnosis by non-voice specialists, thus reducing the reliability of outcome data and treatment recommendations. It is therefore important to try and lower this interobserver variability, possibly by widespread use of improved diagnostic technology, stricter/more universally accepted definitions and supervised training of junior doctors in a voice clinic environment.

Locating and estimating the extent of Delmarva fox squirrel habitat using an airborne LiDAR profiler

Two thousand five hundred thirty-nine kilometers of airborne laser profiling and videography data were acquired over the state of Delaware during the summer of 2000. The laser ranging measurements and video from approximately one-half of that data set (1304 km) were analyzed to identify and locate forested sites that might potentially support populations of Delmarva fox squirrel (DFS, Sciurus niger cinereus). The DFS is an endangered species previously endemic to tall, dense, mature forests with open understories on the Eastern Shore of the Chesapeake Bay. The airborne LiDAR employed in this study can measure forest canopy height and canopy closure, but cannot measure or infer understory canopy conditions. This airborne LiDAR profiler, then, must be viewed as a tool that identifies and locates potential, not actual, habitat. Fifty-three potentially suitable DFS sites were identified in the 1304 km of flight transect data. Each of the 53 sites met the following criteria according to the LiDAR and video record: (1) at least 120 m of contiguous forest; (2) an average canopy height >20 m; (3) an average canopy closure of > 80%; and (4) no roofs, impervious surface (e.g., asphalt, concrete), and/or open water anywhere along the 120 m length of the laser segment. Thirty-two of the 53 sites were visited on the ground and measurements taken for a DFS habitat suitability model. Seventy-eight percent of the sites (25 of 32) were judged by the model to be suited to supporting a DFS population. All of the LiDAR flight data, 2539 km, were analyzed to estimate county and statewide forest area in different height/canopy closure classes. Approximately 3.3% of Delaware (17,137 ha) supports forest over 20 m tall with crown closures exceeding 80%; the corresponding county percentages are Newcastle County—6.1% (6823 ha), Kent County—2.2% (3431 ha), and Sussex County—2.7% (6883 ha). Estimates of average within-patch crossing distance and average between-patch distances are reported, by county, and for the state. Study results indicate that: 1) systematic airborne LiDAR data can be used to screen extensive areas to locate potential DFS habitat; 2) 78% of sites meeting certain minimum length, height, and canopy closure criteria will support DFS populations, according to a habitat suitability model; 3) airborne LiDAR can be used to calculate county and state acreage estimates of potential habitat, and 4) the linear transect data can be used to calculate patch statistics. The authors suggest that the systematic county and state flight lines can be revisited at intervals to monitor changes to the areal extent of potential habitat over time.