Redcar Primary Care Hospital

The development of efficient and commercially viable bioprocesses is essential for reducing the need for fossil-derived products. Increasingly, pharmaceuticals, fuel, health products and precursor compounds for plastics are being synthesized using bioprocessing routes as opposed to more traditional chemical technologies. Production vessels or reactors are required for synthesis of crude product before downstream processing for extraction and purification. Reactors are operated either in discrete batches or, preferably, continuously in order to reduce waste, cost and energy. This review describes the oscillatory baffled reactor (OBR), which, generally, has a niche application in performing 'long' processes in plug flow conditions, and so should be suitable for various bioprocesses. We report findings to suggest that OBRs could increase reaction rates for specific bioprocesses owing to low shear, good global mixing and enhanced mass transfer compared with conventional reactors. By maintaining geometrical and dynamic conditions, the technology has been proved to be easily scaled up and operated continuously, allowing laboratory-scale results to be easily transferred to industrial-sized processes. This is the first comprehensive review of bioprocessing using OBRs. The barriers facing industrial adoption of the technology are discussed alongside some suggested strategies to overcome these barriers. OBR technology could prove to be a major aid in the development of commercially viable and sustainable bioprocesses, essential for moving towards a greener future.

Abstract Three examples of the use of hypnosis in counselling show the variable effects of experiences in the creation of fear, anxiety and disabling phobia. Therapy may be directed to an apparently single cause of a few weeks' duration, or to a many‐layered complex of over 40 years' existence. The processes of resolution may be jointly agreed by client and counsellor or else no clear path to improvement may be identified. The present paper describes three patients with different problems who had high levels of fear or anxiety about receiving injections in botulinum toxin clinics. Individual differences in causes, history and personality made an integrated approach the logical choice. Successful outcomes showed that hypnosis, adaptedly adjoined with mainly behavioural and cognitive methods of counselling, can be of very great assistance in enabling patients to receive injections essential to treatment, and can usefully be made part of multidisciplinary team provision. Copyright © 2001 British Society of Experimental and Clinical Hypnosis

Delusional parasitosis is an uncommon disorder and is probably underdiagnosed - several factors contribute including lack of recognition/difficulty in arriving to a conclusion by a clinician, or the reluctance to seek help or even rejection of the diagnosis by a patient. Patients present with pruritus, excoriations, stinging or formication for which no physical explanation can be found. There is the belief on the part of the patient that their skin is infested by insects or inanimate objects. It is estimated that a dermatologist may see one case every 7 years (Suh, 2018). Morgellons disease is a disputed condition which may fall under the umbrella term of delusional parasitosis. In this condition any areas of concern on the skin are believed to contain foreign material, usually coloured fibres. There is often an overlap of delusional parasitosis with other mental health problems such as depression and anxiety. Successful treatment requires a multi-modal approach in the form of medication (usually antipsychotics), psychotherapy and the input of various specialists (dermatology and psychiatry). Primary care -general practitioners in particular - has a central role to play by orchestrating this process so that a satisfactory outcome is achieved.