Transformative leadership in education: Integrating sustainable healthcare into undergraduate primary care curriculum

Background: Healthcare education must evolve to address one of the greatest public health challenges we face in delivering care that allows future generations to meet their own healthcare needs. The integration of sustainable healthcare practices into medical education is a key step towards environmentally responsible healthcare delivery. Educational leadership plays a crucial role in transforming curricula in a way that prepares our future workforce to better understand and contribute to addressing emerging healthcare challenges. The integration of sustainable healthcare principles into primary care education requires strategic leadership to navigate institutional complexities and ensure meaningful change. Methods: Our team at Imperial College London, comprising both faculty members and student partners, examined the undergraduate primary care curriculum, drawing on the Medical Schools Council sustainable health framework and practical case studies, with the goal of incorporating sustainable healthcare principles. Results: In this paper, we share the process and our framework for integration of sustainable healthcare principles into our curriculum. For educators looking to embark on similar transformations, we share our reflections on the challenges, our solutions and top tips from our experience. Conclusions: We hope our experience and reflections will give educational leaders and institutions a roadmap to prepare future doctors for the challenges of delivering environmentally sustainable healthcare

The interplay of heterogeneity and product detachment in templated polymer copying

Templated copolymerization, in which information stored in the sequence of a heteropolymer template is copied into another polymer product, is the mechanism behind all known methods of genetic information transfer. A key aspect of templated copolymerization is the eventual detachment of the product from the template. A second key feature of natural biochemical systems is that the template-binding free energies of both correctly matched and incorrect monomers are heterogeneous. Previous work has considered the thermodynamic consequences of detachment and the consequences of heterogeneity for polymerization speed and accuracy, but the interplay of both separation and heterogeneity remains unexplored. In this work, we investigate a minimal model of templated copying that simultaneously incorporates both detachment from behind the leading edge of the growing copy and heterogeneous interactions. We first extend existing coarse-graining methods for models of polymerization to allow for heterogeneous interactions. We then show that heterogeneous copying systems with explicit detachment do not exhibit the subdiffusive behavior observed in the absence of detachment when near equilibrium. Next, we show that heterogeneity in correct monomer interactions tends to result in slower, less accurate copying, while heterogeneity in incorrect monomer interactions tends to result in faster, more accurate copying, due to an increased roughness in the free energy landscape of either correct or incorrect monomer pairs. Finally, we show that heterogeneity can improve on known thermodynamic efficiencies of homogeneous copying, but these increased thermodynamic efficiencies do not always translate to increased efficiencies of information transfer

Pull-off strength of mushroom-shaped fibrils adhered to rigid substrates

The exceptional adhesion properties of biological fibrillar structures – such as those found in geckos – have inspired the development of synthetic adhesive surfaces. Among these, mushroom-shaped fibrils have demonstrated superior pull-off strength compared to other geometries. In this study, we employ a computational approach based on a Dugdale cohesive zone model to analyze the detachment behavior of these fibrils when adhered to a rigid substrate. The results provide complete pull-off curves, revealing that the separation process is inherently unstable under load control, regardless of whether detachment initiates at the fibril edge or center. Our findings show that fibrils with a wide, thin mushroom cap effectively reduce stress concentrations and promote central detachment, leading to enhanced adhesion. However, detachment from the center is not observed in all geometries, whereas edge detachment can occur under certain conditions in all cases. Additionally, we investigate the impact of adhesion defects at the fibril center, showing that they can significantly reduce pull-off strength, particularly at high values of the dimensionless parameter . These insights contribute to the optimization of bio-inspired adhesives and microstructured surfaces for various engineering applications

The emotional science lab: exploring social and emotional dynamics in undergraduate biomedical science discovery learning

Social and Emotional Learning (SEL) is seldom explicitly considered in science-based higher education (HE), yet we argue that group-based lab learning both requires, and facilitates, the development of valuable interpersonal and emotion skills. This study focuses on Year 1 and Year 2 Biomedical Science undergraduates, working in groups to undertake an innovative, discovery-based laboratory module. It explores students’ perceptions of how emotions impact science discovery learning and whether and how they used and developed social and emotional skills in this learning context. We draw together theories that explain the development of emotional intelligence and how people influence each other’s emotions, and apply them to an HE context. Data were collected using questionnaires and semi-structured interviews, and analysis identified three key themes: Situated and social emotion in the lab, Awareness of interpersonal emotional influence, SEL as experiential and relational. These give insight into the subtle yet powerful ways that students work with emotion in the process of collaborative discovery learning, and with peers. We identify successful strategies and challenges, and make recommendations for embedding SEL in Science, Technology, Engineering and Mathematics (STEM) HE settings. These include approaches to integrate context-relevant emotion skills development both explicitly and implicitly, and nurture peer emotional scaffolding

Survival outcomes and impact of targeted PAH therapy in portopulmonary hypertension in the PVRI GoDeep meta-registry

Portopulmonary hypertension (PoPH), a type of pulmonary arterial hypertension (PAH) in patients with liver disease, is associated with high morbidity and mortality. The relationship between cardiopulmonary hemodynamics, PAH therapy, and survival in PoPH remains unclear. We performed a retrospective cohort study of PoPH patients from the international pulmonary hypertension (PH) meta-registry, PVRI GoDeep. PAH was defined by a mean pulmonary arterial pressure > 20 mmHg, pulmonary arterial wedge pressure ≤ 15 mmHg, and a pulmonary vascular resistance (PVR) > 2 Wood Units. PoPH diagnoses were assigned by each center's PH specialist based on international guidelines at the time of enrollment. 246 incident PoPH patients met eligibility criteria and were included in the analysis, equally split between males (51%) and females (49%), with a median age of 54 years. When compared to both patients with IPAH and those with other subtypes of PAH (not classified as PoPH or IPAH), those with PoPH had significantly lower 5-year survival rates (46% vs. 68% vs. 65%, log-rank p < 0.001). Amongst the PoPH patients, however, there was no significant difference in 5-year survival when dichotomized by disease severity, either by a PVR of 5 Wood Units or a CI of 2.5 L/min/m2. Treatment of the PoPH patients with PAH-targeted therapies was associated with significantly higher 5-year survival rates compared to those not receiving such treatments, as shown by Kaplan–Meier analysis. This survival benefit was observed for PDE5i (50% vs. 34%, log-rank p = 0.029), ERA (58% vs. 34%, log-rank p < 0.001), and the combination of PDE5i and/or ERA (51% vs. 22%, log-rank p < 0.001), as well as any PAH-targeting treatment (50% vs. 26%, log-rank p = 0.007). Corresponding survival advantage was noted when including only PoPH patients with MELD Score ≥ 13. PoPH is a disease with significantly worse long-term survival than other PAH subtypes, but targeted PAH therapy is associated with a robust survival benefit. Survival did not differ across high-risk PVR and cardiac index thresholds, suggesting the factors that influence prognosis and survival in PoPH may be unique as compared to other PAH subtypes, and warrant further investigation

Actionable genetic variants in 4,198 Scottish participants from the Orkney and Shetland founder populations and implementation of return of results

The benefits of returning clinically actionable genetic results to participants in research cohorts are accruing, yet such a genome-first approach is challenging. Here, we describe the implementation of return of such results in two founder populations from Scotland. Between 2005 and 2015, we recruited >4,000 adults with grandparents from Orkney and Shetland into the Viking Genes research cohort. The return of genetic data was not offered at baseline, but in 2023, we sent invitations to participants for consent to return of actionable genetic findings. We generated exome sequence data from 4,198 participants and used the American College of Medical Genetics and Genomics (ACMG) v.3.2 list of 81 genes, ClinVar review, and pathogenicity status, plus manual curation, to develop a pipeline to identify potentially actionable variants. We identified 104 individuals (2.5%) with 108 actionable genotypes at 39 variants in 23 genes and validated these. Working with the NHS Clinical Genetics service, which provided genetic counseling and clinical verification of the research results, and after expert clinical review, we notified 64 consenting participants (or their next of kin) of their actionable genotypes. Ten actionable variants across seven genes (BRCA1, BRCA2, ATP7B, TTN, KCNH2, MUTYH, and GAA) have risen 50- to >3,000-fold in frequency through genetic drift in ancestral island localities. Viking Genes is one of the first UK research cohorts to return actionable findings, providing an ethical and logistical exemplar of return of results. The genetic structure in the Northern Isles of Scotland with multiple founder effects provides a unique opportunity for a tailored approach to disease prevention through genetic screening

Factors influencing primary care physicians recommending patients to use digital health technologies for self-management: a cross-sectional study across 20 countries

Background Expanding access to self-management via Digital Health Technologies may supplement traditional care, mitigating pressures on primary care through self-management. Primary Care Physicians (PCP) can play a critical role in the integration of digital health technologies into patient care, but it is unclear what factors influence PCPs’ recommendation of such technologies. Aims To identify the factors associated with PCPs recommending digital health technologies to patients for self-management before and during the pandemic. Methods PCPs across 20 countries completed an online questionnaire between June and September 2020. The outcome was a self-report of recommending patients to at least one of six listed forms of digital health technologies. Univariable logistic regression models were performed to explore factors associated with recommending digital health technologies to patients before and during the pandemic. Results 1,592 PCPs were included. Before the pandemic, the odds of recommending digital health technologies for self-management were lower for PCPs not involved in teaching, or practising in Turkey, Australia, Chile, Colombia, France, Italy, Poland, Portugal, Slovenia, and Spain. During the pandemic, PCPs practising in rural settings had higher odds of starting to recommend digital health technologies, as well as those from Brazil, Colombia, and Italy. There was no significant difference in recommending digital health technologies before and during the pandemic. Conclusions Involvement in teaching (pre-pandemic) and practising in a rural setting (during the pandemic) positively influenced the recommendation of digital health technologies. Significant variation in recommending digital health technologies was present across countries

Impact of physical growth and development on paediatric lower-limb prosthetic provision: prosthetist perspectives and clinical casefile analysis from Cambodia

Introduction: Growth affects prosthetic provision in children, leading to socket fit issues and prosthetic length discrepancy. Despite increasing numbers of paediatric amputations, no studies have systematically analysed clinical casefiles or interviewed prosthetists to identify growth-related challenges and mitigation strategies, particularly in low-resource environments where polypropylene (PP) technology is used. This study addresses this gap by interviewing prosthetists and analysing clinical casefiles. Methods: This study combined qualitative interviews with Cambodian prosthetists and analysis of 62 clinical casefiles. Casefile analysis documented growth-related issues, adjustment methods, and time between interventions. Thematic analysis was applied to interviews. Results: Five themes were identified, highlighting that: sockets and their use can account for growth through careful oversizing and using liners/socks; handcrafted adjustments that rely on thermoplastic technology can also accommodate for growth; lack of adjustment increases waste and clinical attendance; poor socket fit causes pain and residual limb problems; and growth issues result in universal problems of socket fit issues and prosthetic length discrepancy. Discussion: This study is the first to interview paediatric prosthetists to assess growth related challenges, identify mitigation strategies and combine these qualitative findings with hard clinical evidence. PP prosthetic systems offer cost-effectiveness and increased adjustability compared to modular components and carbon fibre sockets. However, this adjustability is still limited, leading to waste of resources and increased clinical time. Finally, longer-than-recommended replacement timelines are concerning, and more research is necessary to understand these longer delays. Addressing these limitations is crucial, particularly in low-resource environments, to improve accessibility and prevent secondary impairments

Multi-layered defense against oscillations

Increasing shares of inverter-based resources (IBRs) in power grids are triggering complex dynamic interactions and new stability challenges. A particular challenge for system operators is poorly damped sub-synchronous oscillations (SSO) induced by adverse interaction among IBRs through the network. These oscillations are difficult to foresee, threaten system security and often force grid operators to limit the instantaneous share of IBRs. The Control and Power research group at Imperial College London are working with the Network Operability team in National Energy System Operator (NESO) in the UK to develop a multi-layered defense strategy to identify and mitigate the risk of poorly damped SSO. Starting from advanced IBR control design which is the genesis of the SSO problem, these layers are: 1) an enhanced IBR connection compliance process capture the risk of SSO more comprehensively, 2) new system strength metrices to identify parts of the grid vulnerable to SSO, 3) characterize operating point dependency of IBRs to detect incipient SSO near real-time and 4) post-event root-cause analysis for targeted and effective mitigation of SSO. Success of this research will enable secure grid operation with high fractions of renewables to facilitate net zero transition