Spatial updating during rotation: the role of vestibular information and mental activity

The remarkable accuracy with which healthy subjects can monitor their orientation while walking in darkness has been attributed to a process whereby awareness of orientation is automatically updated by information derived from active locomotion. The aim of this study was, first, to determine the contribution of vestibular information to the perception of orientation without vision, by comparing the accuracy of judgments of orientation following passive (seated) rotation about an earth-vertical axis with those following active (locomotor) rotation. The second aim was to assess whether monitoring orientation is indeed automatic, or whether it requires some degree of mental effort. This was evaluated by assessing whether accuracy in monitoring multiple passive or active rotations was affected by asking subjects to perform a mental task (that is, counting backwards) during rotation. The results indicated that although reliance on the primarily vestibular information available during passive rotation enabled subjects to accurately monitor single turns of up to 180 degrees, subjects were able to judge orientation after multiple turns more accurately after active rotation than after passive rotation, owing to the additional sensorimotor feedback gained from active locomotion. Accuracy in judging orientation was substantially impaired by backwards counting during both passive and active locomotion. This finding confirms that monitoring orientation during multiple turns in darkness necessitates central processing and adds to the growing body of evidence for the influence of mental activity on the perception and control of orientation.

Pyrazinamide is not active against Mycobacterium tuberculosis residing in cultured human monocyte-derived macrophages

SETTING

Mycobacteriology Laboratory, National Jewish Medical and Research Center, Denver, Colorado.

OBJECTIVE

To evaluate the antimicrobial activity of pyrazinamide against Mycobacterium tuberculosis in cultured human monocyte-derived normal and activated macrophages.

DESIGN

Monocytes separated from human blood were incubated in plastic plates for seven days to mature into macrophage monolayers. After activation with TNF-alpha or IFN-gamma or without prior treatment, the macrophages were infected with M. tuberculosis. Various concentrations of pyrazinamide (PZA), morphazinamide (MZA) or isoniazid (INH) were added the next day, and the viable counts of the intracellular bacteria were determined at days 0, 4, and 8.

RESULTS

No inhibitory activity of PZA at any concentration was detected, while clear dose-dependent bacteriostatic and bactericidal activities were demonstrated by MZA and INH in the same experimental model.

CONCLUSIONS

PZA has neither bacteriostatic nor bactericidal activity against M. tuberculosis persisting or multiplying in cultured monocyte-derived human macrophages, and it might be that the well-known effectiveness of this drug in tuberculosis patients is not related to its supposed activity against intracellular bacterial subpopulations.

Neurotrophic factor Neuritin modulates T cell electrical and metabolic state for the balance of tolerance and immunity

The adaptive T cell response is accompanied by continuous rewiring of the T cell's electric and metabolic state. Ion channels and nutrient transporters integrate bioelectric and biochemical signals from the environment, setting cellular electric and metabolic states. Divergent electric and metabolic states contribute to T cell immunity or tolerance. Here, we report in mice that neuritin (Nrn1) contributes to tolerance development by modulating regulatory and effector T cell function. Nrn1 expression in regulatory T cells promotes its expansion and suppression function, while expression in the T effector cell dampens its inflammatory response. Nrn1 deficiency in mice causes dysregulation of ion channel and nutrient transporter expression in Treg and effector T cells, resulting in divergent metabolic outcomes and impacting autoimmune disease progression and recovery. These findings identify a novel immune function of the neurotrophic factor Nrn1 in regulating the T cell metabolic state in a cell context-dependent manner and modulating the outcome of an immune response.

154 SAFEGUARDING ADULTS AT RISK OF ABUSE—IDENTIFYING KNOWLEDGE GAPS AMONGST HOSPITAL STAFF TO GUIDE POLICY IMPLEMENTATION AND TRAINING

Background

Safeguarding is the protection of health, wellbeing and life free from abuse. Abuse is a a violation of a person’s human and civil rights; forms include psychological, financial, physical, sexual, neglect and self-neglect. Health Service Executive (HSE) drafted the 2019 ‘Adult Safeguarding Policy’ for adults at risk of abuse to replace the 2014 version. In preparation for implementation a tertiary hospital founded a Safeguarding Committee in 2021. A core objective was establishing staff understanding, experience of safeguarding and education needs to guide future training.

Methods

10-question survey of 223 staff; included doctors, nurses, allied health professionals, medical social workers, healthcare assistants, porters, psychologists.

Results

91% response rate.

184 (91%) staff were familiar with the term ‘safeguarding’; only 44% were aware of the HSE 2019 policy. 129 (64%) had experience with a case of suspected abuse. Most common forms were financial, psychological and self-neglect (n = 60, 47, 39 respectively). Sexual abuse was least common (n = 10).

47% felt ‘somewhat’ confident recognising possible abuse compared to 42% who felt ‘extremely’ or ‘very’ confident.

61% were ‘somewhat’ or ‘not so’ confident about the next steps for suspected abuse; only 11% were ‘extremely’ confident.

49% felt ‘extremely’ or ‘very’ confident in reporting a suspected abuse case; 50% felt ‘somewhat’ or ‘not so’ confident.

Most common reasons for lack of confidence were lack of training, unclear reporting process and lack of experience with cases of abuse. Medical social workers were most confident; doctors were the least.

170 (84%) wanted more safeguarding training—the most popular options were online or in-person training.

Conclusion

Gaps in knowledge and confidence were identified amongst staff for cases of suspected abuse. This will guide future training in the hospital in line with the HSE Adult Safeguarding policy.

259 AN AUDIT OF DNACPR FORM USAGE IN A LEVEL 4 HOSPITAL FOLLOWING RE-DESIGN AND IMPLICATIONS FOR ITS FUTURE USE

Background

In 2020 during the Covid-19 pandemic our hospital introduced a new green DNACPR form with 2 significant changes. It now specifies if the patient is or is not for resuscitation (as a yes/no choice) and a Treatment Escalation Plan (TEP) has moved to the front of the page from the back. A subsequent audit found that 19% of inpatients had forms completed, of which 68% stated DNACPR and 29% for CPR. 76% of forms had a TEP (versus 56% on the old forms). We repeated the hospital wide audit in 2022 to assess if the improvement in TEP documentation was sustained, and if it was used on all patients or primarily to document DNACPR decisions.

Methods

The hospital-wide audit was performed on the 25.05.2022. Charts were reviewed on medical and surgical wards. ICU patients were excluded. The following data were recorded: Resuscitation status, form completion, presence of a TEP, if the date of admission and form completion were recorded, if the name of doctor and nature of discussion with patient and family were documented, and if the TEP was consistent with the most recent clinical notes. The data was compared to the 2020 audit and against the Hospital’s DNAR & TEP policy.

Results

634 inpatients were identified. 15.7% (100) had a form completed of which 92% stated DNAR. One of these did not have a TEP. The doctor’s name and grade were clearly documented on all forms.

Conclusion

99% of patients who were not for CPR had a TEP indicating sustained improvement since the introduction of the new form. Given 83.3% of patients did not have any documented resuscitation status the approach of documenting yes or no for resuscitation is not being utilised. A return to a dedicated form that indicates someone should not undergo attempts at resuscitation may offer more clarity.

Water Environment Research Foundation (WERF) anaerobic digestion and related processes, odour and health effects study

Biosolids odour emissions can affect the ability of wastewater utilities to implement beneficial biosolids processing and reuse programs. Communities often become more sensitised and vocal about biosolids issues, once they experience odours emanating from a nearby site. Odour impacts from biosolids, including potential human health effects, have been targeted recently by many national and local newspapers, citizens' groups, and regulatory agencies, who have raised significant concerns, ranging from viable disposal methods/sites to outright bans. Many national and local regulatory agencies in the United States are considering biosolids disposal bans in their communities because of misinformation, poor science, and citizen pressure, but primarily because of odour impact concerns. The wastewater industry has a relatively poor understanding of the operations and treatment parameters that influence biosolids odour emissions. Thus, wastewater treatment plants are often unable to control the odour quality of the biosolids that are delivered into communities. A research study to demonstrate the influence of anaerobic digestion, mechanical dewatering, and storage design and operating parameters on the odour quality of the final product was performed and is the subject of this paper. Established and new sampling and analytical methods were used to measure biosolids odour emissions from 11 test sites in North America. By determining the impacts of these control variables on biosolids odour quality, design and operations of anaerobic digestion systems might be enhanced. This paper also summarises a corollary study performed as part of the WERF research study that addresses the health effects of biosolids odours.

Smoking and hypertension as predictors of cardiovascular risk in population studies

Hypertension is a powerful independent contributor to cardiovascular morbidity and mortality, on average conferring a threefold increase in risk at all ages and in both sexes. Coronary heart disease is now the chief lethal sequela of hypertension, occurring at a rate two to three times higher in hypertensives than in normotensives. The risk of cardiovascular morbidity and mortality is also greatly affected by cigarette smoking. For each 10 cigarettes per day there is an incremental increase in cardiovascular mortality in men (18%) and in women (31%). The risk of coronary heart disease that is associated with hypertension varies over an eightfold range depending on coexistent risk factors. Smoking increases the cardiovascular risk, at any level of blood pressure, for coronary heart disease, stroke and cardiac failure. The risk of peripheral arterial disease is particularly adversely affected. Trials of antihypertensive therapy to reduce the coronary heart disease risk have yielded disappointing results, very likely because of failure to correct for blood lipids and cigarette smoking. These trials have consistently shown that cigarette smoking has a powerful effect on the risk of coronary heart disease whether the patients were treated for hypertension or not. Data from the Framingham Study have shown a prompt halving of the coronary heart disease risk in those who give up smoking compared to those who continue to smoke, regardless of the duration of the habit. Hypertensives who smoke one pack of cigarettes a day can quickly reduce the risk by 35-40% by not smoking. Switching to filter cigarettes offers no advantage.(ABSTRACT TRUNCATED AT 250 WORDS)

Early Pregnancy Ultrasound and Management: Effect of a Multifaceted Training on Physician Knowledge

Vaginal bleeding is a common event in early pregnancy, with 20-40% of pregnancies affected. Prompt diagnosis and management of bleeding is important, both to reduce morbidity and to avoid excessive emotional distress. This was a prospective study of an educational programme aimed at Obstetrics and Gynaecology BST trainees in the National Maternity Hospital, Dublin. The educational programme consisted of didactic lectures, and simulation and practical sessions. A questionnaire reviewing early pregnancy complications was used to assess participant knowledge. Six trainees participated in the programme, with five (83%) answering the questionnaire. The pre-education questionnaire showed a generally poor level of knowledge of early pregnancy complications with 8/50 (16%) questions answered correctly. Following the educational intervention there was a statistically significant increase in participant knowledge with 45/50 (90%) questions answered correctly. A significant increase in participant knowledge of early pregnancy complications followed our multifaceted educational programme. Study limitations exist, however we have shown the potential value of our educational programme.