i4's Toward Tomorrow Program Enhancing Collaboration, Connections, and Community Using Bioinspired Design

The goal of our i4's Toward Tomorrow Program is to enrich the future workforce with STEM by providing students with an early, inspirational, interdisciplinary experience fostering inclusive excellence. We attempt to open the eyes of students who never realized how much their voice is urgently needed by providing an opportunity for involvement, imagination, invention, and innovation. Students see how what they are learning, designing, and building matters to their own life, community, and society. Our program embodies convergence by obliterating artificially created, disciplinary boundaries to go far beyond STEM or even STEAM by including artists, designers, social scientists, and entrepreneurs collaborating in diverse teams using scientific discoveries to create inventions that could shape our future. Our program connects two recent revolutions by amplifying Bioinspired Design with the Maker Movement and its democratizing effects empowering anyone to innovate and change the world. Our course is founded in original discovery. We explain the process of biological discovery and the importance of scaling, constraints, and complexity in selecting systems for bioinspired design. By spotlighting scientific writing and publishing, students become more science literate, learn how to decompose a biology research paper, extract the principles, and then propose a novel design by analogy. Using careful, early scaffolding of individual design efforts, students build the confidence to interact in teams. Team building exercises increase self-efficacy and reveal the advantages of a diverse set of minds. Final team video and poster project designs are presented in a public showcase. Our program forms a student-centered creative action community comprised of a large-scale course, student-led classes, and a student-created university organization. The program structure facilitates a community of learners that shifts the students' role from passive knowledge recipients to active co-constructors of knowledge being responsible for their own learning, discovery, and inventions. Students build their own shared database of discoveries, classes, organizations, research openings, internships, and public service options. Students find next step opportunities so they can see future careers. Description of our program here provides the necessary context for our future publications on assessment that examine 21st century skills, persistence in STEM, and creativity.

Continuous subcutaneous insulin infusion (CSII) therapy at Derby Teaching Hospitals: sustained benefits in glucose control

AIM

In the short term, continuous subcutaneous insulin infusion (CSII) has been associated with improved glycaemic control, reduced hypoglycaemia and improved quality of life (QOL). However, limited data are available on its long-term benefits, particularly in the UK. We aimed to assess the impact of CSII on longer term outcomes.

METHOD

Patient-level data were obtained for CSII users at Derby Teaching Hospitals, UK. Patient confidence and satisfaction questionnaires using the Likert scale were used to assess confidence in self-management. Comparative statistics were conducted using Pearson's chi-square and Student's t-tests.

RESULTS

Some 258 CSII users were identified (60.1% female, mean age 43.9 ± 13.4 years). Overall, there was significant decrease in HbA_1c from 78 mmol/mol (9.3 ± 2.0%) at baseline, to 69 mmol/mol (8.5 ± 1.3%) at 6 months [mean difference (md): -0.64; 95% confidence interval (95% CI): -0.91 to -0.37; P < 0.0001]; which was sustained at 6 years of follow-up (HbA_1c : 66 mmol/mol, 8.2 ± 1.3%; md: -1.07%; 95% CI: -1.45 to -0.69; P < 0.0001). One hundred and twenty-one patients (47%) responded to the survey, of whom 95 (78.5%) reported a reduction in the frequency of hypoglycaemia; 102 (84.3%) were satisfied with the quality of care received in the insulin pump service.

CONCLUSION

CSII therapy led to a sustained long-term improvement in glycaemic control in addition to a reduction in self-reported hypoglycaemia.

Fancy a cup of scald? - The role of hot beverage burns in paediatric burns admissions in Ireland

Burns and scalds are preventable injuries in children that typically occur in the home. This study aimed to examine the role of hot beverage scalds in paediatric burn admissions in order to identify key target audiences for future safety strategies. Using the Hospital Inpatient Enquiry System (HIPE) a retrospective study of paediatric burn admissions in 2014 examined demographics, cause and severity of injury and location of occurrence. There were 233 paediatric discharges (age 0-18 yrs.) with a principal diagnosis of burn injury; 57% of these occurred in children under three years and 95% of these occurred in the home. Scalds caused 74% of burn injuries; hot beverages accounted for least 33% of these of which 77% were partial thickness and 73% were upper body burns. Effective hot beverage scald prevention strategies, targeted towards caregivers in the home, are required.

[Clinical pharmacy: Evaluation of physician's satisfactions and expectations in a French regional hospital]

INTRODUCTION

The purpose of the study was to evaluate physician's satisfaction with the clinical pharmacy activities in a French regional hospital.

METHODS

Data were collected by face-to-face interviews carried out by a public health intern with physicians from 14 different departments of medicine and surgery. A specifically designed questionnaire was used for this study. This contained 18 closed-ended questions, 3 open-ended questions and 6 questions relating to the multidisciplinary analysis of prescriptions of elderly patients.

RESULTS

The questionnaire was proposed to 78 physicians, of which 62 replied (participation rate of 79%). Thirty-seven percent were interns (23/62), 19% were assistants (12/62) and 44% were senior physicians (27/62). Clinical pharmacy satisfaction levels were generally very high. In regard to clinical skills, 87% of the physicians were satisfied with pharmacists' competencies and 91% by the pertinence of transmitted information. Ninety-five percent of the physicians were also satisfied by the logistical aspect and the relationship with pharmacists (reactivity, availability and communication). Analysis of the open-ended questions showed that physicians were in favour of the increased presence of clinical pharmacists on the wards.

CONCLUSIONS

This study shows a high level of physician satisfaction in relation to the clinical pharmacy activities in our hospital, and should be viewed as a strong endorsement of the work of the clinical pharmacy. This study highlights some areas of improvement such as increase presence of the clinical pharmacists on the wards. In order to assess periodically our activity, this study must be repeated in the future.

Pulmonary radiofrequency ablation in a district general hospital: is it a safe and effective treatment?

AIM

To analyse the technical success of ablation therapy and the incidence of complications in patients treated with pulmonary ablation and to assess factors affecting local disease control and patient survival in a subgroup with metastatic colorectal cancer.

MATERIALS AND METHODS

Technical success and complications in all patients undergoing lung ablation between June 2009 and July 2015 were recorded. Overall survival and local disease control in a subgroup with metastases from a colorectal primary were calculated. Factors influencing outcome were explored.

RESULTS

Two hundred and seven pulmonary ablations were performed in 86 patients at 156 attendances. Technical success was achieved in 207/207 (100%). Thirty and 90-day mortality was 0%. The major complication rate was 13/86 (15%). One hundred and one metastases were treated in 46 patients with a colorectal primary. This group had a mean ± standard error survival time of 53.58±3.47 months with a 1, 2, 3, 4, and 5-year survival rate of 97.4%, 91.3%, 81.5%, 59.8%, and 48%. There was no statistically significant difference in survival regarding time to development of metastatic disease, the total number of lesions ablated, the initial number of lesions ablated, the maximum size of lesion treated, or unilateral versus bilateral disease. Patients with extrapulmonary disease were found to have a shorter survival from the primary diagnosis. Seventy-eight (77.2%) of the 101 lesions were stable after first RFA. Local relapse was more likely when a metastasis was close to a large (>3 mm) vessel.

CONCLUSION

RFA is a safe and effective procedure that can be performed without on-site cardiothoracic support. Good outcomes depend upon careful patient selection. This study supports its use in oligometastatic disease.

Inter-laboratory study of human in vitro toxicogenomics-based tests as alternative methods for evaluating chemical carcinogenicity: a bioinformatics perspective

The assessment of the carcinogenic potential of chemicals with alternative, human-based in vitro systems has become a major goal of toxicogenomics. The central read-out of these assays is the transcriptome, and while many studies exist that explored the gene expression responses of such systems, reports on robustness and reproducibility, when testing them independently in different laboratories, are still uncommon. Furthermore, there is limited knowledge about variability induced by the data analysis protocols. We have conducted an inter-laboratory study for testing chemical carcinogenicity evaluating two human in vitro assays: hepatoma-derived cells and hTERT-immortalized renal proximal tubule epithelial cells, representing liver and kidney as major target organs. Cellular systems were initially challenged with thirty compounds, genome-wide gene expression was measured with microarrays, and hazard classifiers were built from this training set. Subsequently, each system was independently established in three different laboratories, and gene expression measurements were conducted using anonymized compounds. Data analysis was performed independently by two separate groups applying different protocols for the assessment of inter-laboratory reproducibility and for the prediction of carcinogenic hazard. As a result, both workflows came to very similar conclusions with respect to (1) identification of experimental outliers, (2) overall assessment of robustness and inter-laboratory reproducibility and (3) re-classification of the unknown compounds to the respective toxicity classes. In summary, the developed bioinformatics workflows deliver accurate measures for inter-laboratory comparison studies, and the study can be used as guidance for validation of future carcinogenicity assays in order to implement testing of human in vitro alternatives to animal testing.

Exploring positive hospital ward soundscape interventions

Sound is often considered as a negative aspect of an environment that needs mitigating, particularly in hospitals. It is worthwhile however, to consider how subjective responses to hospital sounds can be made more positive. The authors identified natural sound, steady state sound and written sound source information as having the potential to do this. Listening evaluations were conducted with 24 participants who rated their emotional (Relaxation) and cognitive (Interest and Understanding) response to a variety of hospital ward soundscape clips across these three interventions. A repeated measures ANOVA revealed that the 'Relaxation' response was significantly affected (n(2) = 0.05, p = 0.001) by the interventions with natural sound producing a 10.1% more positive response. Most interestingly, written sound source information produced a 4.7% positive change in response. The authors conclude that exploring different ways to improve the sounds of a hospital offers subjective benefits that move beyond sound level reduction. This is an area for future work to focus upon in an effort to achieve more positively experienced hospital soundscapes and environments.

Radioactivity in drinking water supplies in Western Australia

Radiochemical analysis was carried out on 52 drinking water samples taken from public outlets in the southwest of Western Australia. All samples were analysed for Ra-226, Ra-228 and Pb-210. Twenty five of the samples were also analysed for Po-210, and 23 were analysed for U-234 and U-238. Ra-228 was found in 45 samples and the activity ranged from <4.000 to 296.1 mBq L(-1). Ra-226 was detected in all 52 samples and the activity ranged from 3.200 to 151.1 mBq L(-1). Po-210 was detected in 24 samples and the activity ranged from 0.000 to 114.2 mBq L(-1). These data were used to compute the annual radiation dose that persons of different age groups and also for pregnant and lactating females would receive from drinking this water. The estimated doses ranged from 0.001 to 2.375 mSv y(-1) with a mean annual dose of 0.167 mSv y(-1). The main contributing radionuclides to the annual dose were Ra-228, Po-210 and Ra-226. Of the 52 drinking water samples tested, 94% complied with the current Australian Drinking Water Guidelines, while 10% complied with the World Health Organization's radiological guidelines which many other countries use. It is likely that these results provide an overestimate of the compliance, due to limitations, in the sampling technique and resource constraints on the analysis. Because of the increasing reliance of the Western Australian community on groundwater for domestic and agricultural purposes, it is likely that the radiological content of the drinking water will increase in the future. Therefore there is a need for further monitoring and analysis in order to identify problem areas.

The National Newborn Bloodspot Screening Programme (NNBSP) process review 2010

The National Newborn Bloodspot Screening Programme (NNBSP) incorporates screening for several conditions where early identification helps prevent serious disability or mortality. A national group was established (2009) to plan for the inclusion of screening for cystic fibrosis (CF); as part of this process a review of the existing NNBSP was undertaken. Information was obtained through consultation with the Director of the National Newborn Bloodspot Screening Laboratory (NNBSL) and survey of maternity units (20), Local Health Office (LHO) areas (32), and practicing domiciliary midwives (16). Response rate: hospitals 100%; LHO areas 100%; domiciliary midwives 56%. Potential for strengthening quality assurance was identified e.g. single comprehensive screening register, consistent and timely procedures for checking results. Recommendations, many of which have since been implemented, included overall governance structure, liaison officer, quality assurance programme, ring-fenced funding, standardised unique identifier, dedicated laboratory IT system, secure web-based transmission of results and fail-safe method of tracking samples.

Semi-dwarfing Rht-B1 and Rht-D1 loci of wheat differ significantly in their influence on resistance to Fusarium head blight

Fusarium head blight (FHB) is an important disease of wheat worldwide. Soissons is one of the most resistant varieties grown in UK. The current study was undertaken to identify QTL for FHB resistance in Soissons and to determine whether the semi-dwarfing alleles Rht-B1b and Rht-D1b have a similar influence on susceptibility to FHB. A Soissons (Rht-B1b; Rht-D1a) x Orvantis (Rht-B1a; Rht-D1b) doubled haploid (DH) population was assessed for FHB resistance in three trials. Soissons contributed a single, stable major FHB QTL linked to the Rht-D1 locus. In contrast, the Rht-B1b allele (contributed by Soissons) conferred no negative effect on FHB resistance, even conferring a very minor positive effect in one trial. The influence of the Rht-B1b and Rht-D1b alleles on FHB resistance was further investigated using both Mercia and Maris Huntsman near-isogenic lines. Under high disease pressure both Rht-B1b and Rht-D1b significantly decreased Type 1 resistance (resistance to initial infection). However, whilst Rht-D1b has no effect on Type 2 resistance (resistance to spread of the fungus within the spike), Rht-B1b significantly increased Type 2 resistance. Our study demonstrates that the choice of semi-dwarfing gene used in plant breeding programmes may be a significant consideration where resistance to FHB is an important breeding target.

Semi-dwarfing Rht-B1 and Rht-D1 loci of wheat differ significantly in their influence on resistance to Fusarium head blight

Fusarium head blight (FHB) is an important disease of wheat worldwide. Soissons is one of the most resistant varieties grown in UK. The current study was undertaken to identify QTL for FHB resistance in Soissons and to determine whether the semi-dwarfing alleles Rht-B1b and Rht-D1b have a similar influence on susceptibility to FHB. A Soissons (Rht-B1b; Rht-D1a) x Orvantis (Rht-B1a; Rht-D1b) doubled haploid (DH) population was assessed for FHB resistance in three trials. Soissons contributed a single, stable major FHB QTL linked to the Rht-D1 locus. In contrast, the Rht-B1b allele (contributed by Soissons) conferred no negative effect on FHB resistance, even conferring a very minor positive effect in one trial. The influence of the Rht-B1b and Rht-D1b alleles on FHB resistance was further investigated using both Mercia and Maris Huntsman near-isogenic lines. Under high disease pressure both Rht-B1b and Rht-D1b significantly decreased Type 1 resistance (resistance to initial infection). However, whilst Rht-D1b has no effect on Type 2 resistance (resistance to spread of the fungus within the spike), Rht-B1b significantly increased Type 2 resistance. Our study demonstrates that the choice of semi-dwarfing gene used in plant breeding programmes may be a significant consideration where resistance to FHB is an important breeding target.

Use of P300 and a dementia rating scale in the evaluation of cognitive dysfunction in MS

The assessment of mental dysfunction in multiple sclerosis and discrimination from the secondary effects of sensory and motor deficits has comparability to similar work done on dementia in Alzheimer's disease and Parkinson disease. Two approaches to testing might include adaptation of the Alzheimer Disease Assessment Scale and inclusion of the P300 component of the event-related auditory evoked potential.

Serum cystatin C, enzymuria, tubular proteinuria and early renal insult in type 2 diabetes

This study investigates the association between serum cystatin C, serum creatinine concentrations, N-acetyl-beta-D-glucosaminidase (NAG enzymuria), urine alpha1-microglobulin (alpha1-MG) and beta2-microglobulin (beta2-MG) levels in subjects with type 2 diabetes (n=40, 20M/20F, age range 25-65 years; duration of diabetes 8-10 years) and age- and gender-matched healthy controls (n= 20). Exclusion criteria were absence of gross proteinuria, hypertension, dyslipidaemia or cardiovascular disease. Fasting blood samples and mid-stream specimen of urine (MSSU) were collected and serum creatinine, cystatin C, urine creatinine, NAG enzymuria, alpha1-MG and beta2-MG were measured. Diabetic subjects were separated into two groups based on albumin:creatinine concentration ratio. Group A: <3.5 (mg/mmol creatinine), group B: 3.5-35 (mg/mmol creatinine). While serum creatinine concentrations remained within the laboratory reference range for all groups, serum cystatin C concentration (mg/L) was significantly increased in group B (1.79 +/- 0.42 [mean +/- SD] compared to both control [0.81 +/- 0.10] and group A values [0.95 +/- 0.10]; both P<0.001). NAG enzymuria (units/mmol creatinine) was increased in both diabetic groups compared to control values (group B: 122 +/- 7, group A: 70 +/- 5, controls 27 +/- 2, all P<0.001). alpha1-microglobulin (microg/mmol creatinine) concentrations, similar in both the control group and group A diabetics at 1.10 +/- 0.10 and 1.11 +/- 0.21, respectively, were significantly elevated in group B at 2.10 +/- 0.41 (both P<0.01). Similarly, elevated beta2-MG (microg/mmol creatinine) levels were also observed in group B compared to both group A and control values (3.20 +/- 0.21 vs. 1.80 +/- 0.51 and 0.91 +/- 0.11, respectively; both P<0.001). In addition, group B levels were significantly higher than group A (P<0.001). These observations suggest that serum cystatin C is a more appropriate and effective biomarker for the overall estimation of GFR than serum creatinine values. In addition, increased serum cystatin C values were also associated with early renal tubular insult in subjects with type 2 diabetes, as characterised by increased NAG enzymuria, alpha1- and beta2-microglobulin excretion.

Application of a population balance model to a perfusion in vitro toxicity system

Perfusion cell culture is different to static cell culture: In perfusion culture, steady state concentrations of nutrients and metabolites can be achieved. When a toxin is added to the medium, it is administered to the cells at a defined constant concentration. Perfusion culture is favourable for time series analysis of experimental data because assays can be performed online in the outflowing medium at a high time resolution. The cytotoxicity exerted by cadmium chloride (CdCl(2)) on LLC-PK(1) cells was investigated in static and in perfusion culture using the EpiFlow system in order to compare both the techniques. For this comparison, cytotoxicity was assessed by the release of the cytosolic enzyme lactate dehydrogenase (LDH), and by the potential of viable cells to reduce resazurin. The results showed a greater sensitivity of LLC-PK(1) monolayers to CdCl(2) with continuous exposure in perfusion culture as compared to a single or repeated dose in static culture, as evidenced by increased LDH release and decreased resazurin reduction. These differences between static and perfusion culture were ascribed to different delivery rates of toxin to the site of absorption. Cadmium accumulation of the cells was measured and found to be higher under perfusion conditions than under static conditions. Time series analysis of the LDH release in perfusion culture was performed by establishing a deterministic population balance model of cell death. An empirical death rate function that accounts for accumulation of the toxin was introduced and could be successfully verified.

A fluorescent microplate assay for exocytosis in alveolar type II cells

The authors describe a simple, reliable, and quantitative assay to monitor exocytotic fusion of lamellar bodies (LBs) in adherent rat alveolar type II (AT II) cells. The assay is based on fluorescence measurements of LB-plasma membrane (PM) fusions modified for the use in multiwell culture plates to obtain a high-sample throughput. In particular, it is based on the presence of a highly light-absorbing dye in the cell supernatants to increase the specificity of fluorescence signals and to yield pseudo-confocal information from the cells. When the assay was tested with agonist-(ATP) and phorbolester-induced stimulation of LB-PM fusions, the authors found a good correlation with direct microscopic investigations based on single cell recordings. To further validate the assay, they used Curosurf at 10 mg/ml. However, it influenced neither the basal nor the ATP-stimulated rate of LB-PM fusions. This was corroborated by the fact that Curosurf had no effect on resting Ca (2+) levels nor the ATP induced Ca (2+) signals. The results cast new light on previous findings that surfactant phospholipids decrease the rate of secretion in AT II cells in a dose-dependent way. The authors conclude that the inhibitory effect exerted by phospholipids might be due to action on a later step in exocytosis, probably associated with exocytotic fusion pore expansion and content release out of fused vesicles.

Formation of ochratoxin A and aflatoxins following the use of propionic acid as a grain preservative for storing damp barley

The growth of storage moulds was studied in barley at 22% and approximately 28% moisture content treated with the recommended and reduced commercial doses of propionic acid over a 6 month storage period at 20°C. Experimental sample size was 5 kg barley per lot. Barley was fully protected against the growth ofA. flavus and aflatoxin formation when the recommended dose was applied. However, the treatment was less effective in controlling growth ofP. verrucosum and preventing ochratoxin A formation such that by 4 to 6 months of storage, the fungus had started to develop and toxin had formed even in some of the samples treated with propionic acid. The risk of the development of ochratoxin A during storage increased as the optimum dose was reduced, particularly for barley at 22% moisture content.

Haemodynamic and electrocardiographic consequences of severe nicorandil toxicity

A 35 year old woman was admitted to the emergency department two hours after ingesting 60x20 mg tablets of nicorandil, total 1.2 g. The dominant feature of icorandil toxicity was profound peripheral vasodilatation associated with coronary hypoperfusion. Despite widespread electrocardiographic signs of myocardial ischaemia, there was no evidence of myocardial damage and no serious cardiac arrhythmia. Volume loading and pressor support proved to be an effective treatment strategy.

Role of computerized tomography (CT) scan of the chest in patients with newly diagnosed head and neck cancers

Chest metastases and second primaries are not uncommon in patients with head and neck cancer. Early detection of a second site of malignant disease may alter prognosis and management. This study assessed the diagnostic yield of chest radiographs compared with computerized tomography (CT) in a series of patients with head and neck cancer. Forty-four consecutive patients with a head and neck squamous cell carcinoma (SCC) attending the head and neck surgery department of Cumberland Infirmary, Carlisle, between January 2000 and December 2000 were included in this prospective study. Patients with lymphomas and localized cancers of the skin and lip were excluded. Thirty men and 14 women, with a mean age of 67 years, were assessed. All had chest radiographs and chest CT at the same time as the CT scan of the primary site. Only one patient had a true positive finding on chest radiograph. Five patients had an abnormal chest CT. Of these, two had multiple lung metastases, and another patient had biopsy-proved bronchogenic carcinoma and underwent surgical excision. The sensitivity and specificity of CT scan was 100% and 95%, as opposed to 33% and 97% for chest radiograph.

Should paediatric units have bereavement support posts?

Eight bereavement support posts in paediatrics and maternity were established using the experience of the Child Bereavement Trust (CBT). Evaluation showed that staff welcomed the informal support and teaching for themselves, as well as support for families; 67% of staff who returned questionnaires felt care for bereaved families had improved as a result of the posts. Many felt that there had been a positive effect on staff retention and stress levels.

Survival from out-of-hospital cardiac arrest in the Geelong region of Victoria, Australia

OBJECTIVE

To study the outcome from prehospital cardiac arrest managed by ambulance personnel, and to examine overall survival rates from successful resuscitation.

METHODS

A retrospective analysis was made of 115 patient care records of prehospital cardiac arrests with attempted resuscitation between July 1996 and September 1999. All cases had a presumed primary cardiac cause for their cardiac arrest.

RESULTS

Overall survival, defined as admitted to hospital alive, was 22 subjects (19.1%), with five subjects (4.3%) being discharged from hospital neurologically intact. Of the patients who survived to the emergency department, six (5%) had initially presented in pulseless electrical activity and 16 (14%) presented with ventricular fibrillation. No patients presented with ventricular tachycardia and no survivors presented in asystole. Median response interval from time of call to arrival of initial crew at patient's side was 9 min. No patients survived when response interval was greater than 14 min. Bystander cardiopulmonary resuscitation was being performed on 55 patients (48%) on arrival of initial ambulance crew; 68.2% of patients surviving to hospital having had bystander cardiopulmonary resuscitation.

CONCLUSION

Decreasing time delays in accessing the patient is crucial to improving outcome in out-of-hospital cardiac arrest.

Sarcoplasmic reticulum Ca(2+)-ATPase of sea cucumber smooth muscle: regulation by K(+) and ATP

Although several Ca(2+)-ATPase isoforms have been described in vertebrates, little is known about Ca(2+)-transport in the muscle of invertebrates. In the microsomal fraction obtained from the sea cucumber (Ludwigothurea grisea) longitudinal body wall smooth muscle, we identified a Ca(2+)-transport ATPase that is able to transport Ca(2+) at the expense of ATP hydrolysis. This enzyme has a high affinity for both Ca(2+) and ATP, an optimum pH around 7.0, and - different from the vertebrate sarcoplasmic reticulum Ca(2+)-ATPases isoforms so far described - is activated 3- to 5-fold by K(+) but not by Li(+), at all temperatures, Ca(2+) and ATP concentrations tested. Calcium accumulation by the sea cucumber microsomes is inhibited by Mg/ATP concentrations >1 mM and the accumulated Ca(2+) is released to the medium when the ATP concentration is raised from 0.1 to 4.0 mM.