Safety and the flying doctor

Interest, curiosity, or dismay—which feeling predominates when we learn from BBC Newsnight that our NHS employs doctors who commute from Poland to cover the out of hours duties that local GPs are unable to work because they are too tired at night? Is it interest in an innovative solution for modern pan-European healthcare provision, curiosity in discovering huge variations in the standard of living across the medical profession in an open Europe, or dismay that the government’s emphasis, that healthcare practice should be based on the best scientific evidence, is little more than lip service? Working continuously for a long time, particularly at night, increases the risk of making errors and causing injury, which is why many professions limit the number of hours of continuous duty. These risks also apply to the medical profession: tired doctors make mistakes that harm patients (N Engl J Med 2004;351:1838-48) and themselve

Randomized trial of polychromatic blue-enriched light for circadian phase shifting, melatonin suppression, and alerting responses.

Wavelength comparisons have indicated that circadian phase-shifting and enhancement of subjective and EEG-correlates of alertness have a higher sensitivity to short wavelength visible light. The aim of the current study was to test whether polychromatic light enriched in the blue portion of the spectrum (17,000 K) has increased efficacy for melatonin suppression, circadian phase-shifting, and alertness as compared to an equal photon density exposure to a standard white polychromatic light (4000 K). Twenty healthy participants were studied in a time-free environment for 7 days. The protocol included two baseline days followed by a 26-h constant routine (CR1) to assess initial circadian phase. Following CR1, participants were exposed to a full-field fluorescent light (1 × 10 14 photons/cm 2 /s, 4000 K or 17,000 K, n = 10/condition) for 6.5 h during the biological night. Following an 8 h recovery sleep, a second 30-h CR was performed. Melatonin suppression was assessed from the difference during the light exposure and the corresponding clock time 24 h earlier during CR1. Phase-shifts were calculated from the clock time difference in dim light melatonin onset time (DLMO) between CR1 and CR2. Blue-enriched light caused significantly greater suppression of melatonin than standard light ((mean ± SD) 70.9 ± 19.6% and 42.8 ± 29.1%, respectively, p \u3c 0.05). There was no significant difference in the magnitude of phase delay shifts. Blue-enriched light significantly improved subjective alertness (p \u3c 0.05) but no differences were found for objective alertness. These data contribute to the optimization of the short wavelength-enriched spectra and intensities needed for circadian, neuroendocrine and neurobehavioral regulation

FIRST REPORT ON DINOSAUR TRACKS FROM THE BURRO CAN YON FORMATION, SAN JUAN COUNTY, UTAH, USA – EVIDENCE OF A DIVERSE, HITHERTO UN KNOWN LOWER CRETACEOUS DINOSAUR FAUNA

The newly discovered White Mesa tracksite in the Burro Canyon Formation represents a snap shot of a diverse, Lower Cretaceous dinosaur fauna from south-eastern Utah. The tracks were found at a construction site where the sand stone had been bull dozed and broken up. All tracks were found as deep, well-preserved natural casts on the under side of the sand stone slabs. Individual theropod tracks are 19–57 cm in length; one peculiar track shows evidence of a possible pathological swelling in the middle of digit III and an apparently didactyl track is tentatively as signed to a dromaeosaurid. Individual sauropod tracks are found with pes lengths of 36–72 cm, and interestingly, three distinct shapes of manus tracks, ranging from wide banana shaped to rounded and hoof-like. Ornithopods are represented with individual tracks 18–37 cm in length; a single track can possibly be attributed to the thyreophoran ichnogenus Deltapodus. Zircon U-Pb dating places the track-bearing layer in the Barremian, contemporary to the lower Yellow Cat Member of the Cedar Mountain Formation, which has a similar faunal composition based on both tracks and body fossils. This new track-fauna demonstrates the existence of a diverse dinosaurian assemblage in the lower part of the Burro Canyon Formation, which hitherto is not known to yield skeletal remains

Mainstreamed Genetic Testing in Ovarian Cancer: Patient Experience of the Testing Process

Objective: Pathogenic BRCA variants account for between 5.8-24.8% of ovarian cancers. The identification of such a variant can have a significant impact on the affected individual and their relatives – determining eligibility for targeted therapies, predicting treatment response and granting access to disease prevention strategies. Cancer services are responding to the increased demand for genetic testing with the introduction of mainstreamed genetic testing via oncology clinics. The study aimed to evaluate patient experience of the mainstreamed genetic testing pathway at a tertiary referral centre in London. / Methods: Study participants were patients diagnosed with high-grade non-mucinous ovarian cancer, tested via a mainstreamed genetic testing pathway at the tertiary referral centre between February 2015 and June 2017. Eligible participants were invited to complete the retrospective study questionnaire. Five quantitative measures with additional free-text items evaluated the patient experience of mainstreamed genetic testing. / Results: The tertiary referral centre tested 170 ovarian cancer patients. Twenty-three pathogenic BRCA mutations were identified (23/170, 13.5%). One-hundred and six patients (106/170, 62.4%) met the study inclusion criteria. Twenty-nine of those invited (29/106, 27.4%) to participate returned the retrospective study questionnaire. Pathogenic BRCA1/2 variants were identified within four respondents (4/29, 13.8%). Motivations for genetic testing related to improved medical management, and the ability to provide relatives with genetic information. Participants did not appear to be adversely affected by result disclosure post mainstreamed genetic testing. Two individuals with a pathogenic variant reported that the support provided by the tertiary referral centre post-result disclosure could have been improved. / Conclusion: Results of the current study support further psychosocial research into the expansion of the mainstreamed genetic testing pathway. The results although promising have also highlighted the importance of genetic awareness within the multidisciplinary team and the provision of timely psychological support from genetic specialists

Carvedilol targets beta-arrestins to rewire innate immunity and improve oncolytic adenoviral therapy

Oncolytic viruses are being tested in clinical trials, including in women with ovarian cancer. We use a drug-repurposing approach to identify existing drugs that enhance the activity of oncolytic adenoviruses. This reveals that carvedilol, a β-arrestin-biased β-blocker, synergises with both wild-type adenovirus and the E1A-CR2-deleted oncolytic adenovirus, dl922-947. Synergy is not due to β-adrenergic blockade but is dependent on β-arrestins and is reversed by β-arrestin CRISPR gene editing. Co-treatment with dl922-947 and carvedilol causes increased viral DNA replication, greater viral protein expression and higher titres of infectious viral particles. Carvedilol also enhances viral efficacy in orthotopic, intraperitoneal murine models, achieving more rapid tumour clearance than virus alone. Increased anti-cancer activity is associated with an intratumoural inflammatory cell infiltrate and systemic cytokine release. In summary, carvedilol augments the activity of oncolytic adenoviruses via β-arrestins to re-wire cytokine networks and innate immunity and could therefore improve oncolytic viruses for cancer patient treatment

Me and My Big Data: Understanding Citizens Data Literacies - Final report

We all leave data traces as we move through our digital lives. Some of this is intentional as we sign up to services or make purchases, but much of it is not. In some if not many cases, our actions online are tracked coercively and without our knowledge. This may be cookies and apps tracking us across our various internet interactions or data we post into social media about ourselves. Much of it may be collected, amalgamated, and processed by the platforms we knowingly use, or passed on to third parties for such purposes as advertising, marketing, or political campaigning. How much do we as citizens know about where our data goes, the uses to which it is put and what impacts this might then have upon us? These questions form the heart of the ‘Me and my big data – developing citizens’ data literacies’ project. The project was conceived before many recent events and incidents that highlighted the issue of how data about us, as citizens, is collected, processed, and used. In the UK and the USA the Cambridge Analytica scandal, issues of ‘fake news’ and mis-/dis-/mal-information in social media, and concerns about COVID-19 tracking apps are examples of developments that have brought questions of data use to the fore. Yet as we finish writing this report citizens in Afghanistan are actively deleting social media profiles for fear of the abuses and surveillance that the new government can do with their data. There are also fears about the potential uses the Taliban regime may make of the e-Tazkira system a biometric identity card used by Afghanistan’s National Statistics and Information Authority. This includes fingerprints, iris scans and a photograph, as well as voter registration databases. Suddenly citizens become aware of their data traces, as they are of stark concern and potentially deadly consequence. The political and civil rights issues of such systems also remain important in the UK, Europe, and the USA. Here we see contrasting models of minimal, decentralised and citizen-controlled data sharing (such as the EU vaccine passport) compared to centralised amalgamated data systems such as the original plans for NHS contact tracing system. One addresses user privacy rights while the other may create a data set of use to medical research. The data traces we leave can therefore have material consequences, both good and ill, for individuals, communities and societies and are becoming bound up in our civil, consume and personal rights. Much prior research has focused on technical solutions to data sharing, its regulation or on broader questions of data and digital rights. In this project we have focused on the exploring the extent of citizens understanding of how their data may be collected and utilised by platforms, companies, organisations or the state. The intention being to develop potential policy intervention recommendations or educational materials to improve citizens ‘data literacies’. As both the project data collection and external events unfolded, the complexities of the issues, the size of the gaps in knowledge and significant differences in awareness between different demographic groups became very clear. Overall, it seems we lack key awareness of what is happening to our data, nor are we the engaged data citizens we might hope to be and that may be needed in a highly ‘datafied’ society. This report focuses on the main research findings along with our basic policy and education recommendations and principles. A following educational and intervention guidance report will provide a more practical set of ideas for activities that organisations, groups and policy makers might wish to undertake

How was it for you? Experiences of participatory design in the UK health service

Improving co-design methods implies that we need to understand those methods, paying attention to not only the effect of method choices on design outcomes, but also how methods affect the people involved in co-design. In this article, we explore participants' experiences from a year-long participatory health service design project to develop ‘Better Outpatient Services for Older People’. The project followed a defined method called experience-based design (EBD), which represented the state of the art in participatory service design within the UK National Health Service. A sample of participants in the project took part in semi-structured interviews reflecting on their involvement in and their feelings about the project. Our findings suggest that the EBD method that we employed was successful in establishing positive working relationships among the different groups of stakeholders (staff, patients, carers, advocates and design researchers), although conflicts remained throughout the project. Participants' experiences highlighted issues of wider relevance in such participatory design: cost versus benefit, sense of project momentum, locus of control, and assumptions about how change takes place in a complex environment. We propose tactics for dealing with these issues that inform the future development of techniques in user-centred healthcare design

WD + MS systems as the progenitor of SNe Ia

We show the initial and final parameter space for SNe Ia in a ($\log P^{\rm i}, M_{\rm 2}^{\rm i}$) plane and find that the positions of some famous recurrent novae, as well as a supersoft X-ray source (SSS), RX J0513.9-6951, are well explained by our model. The model can also explain the space velocity and mass of Tycho G, which is now suggested to be the companion star of Tycho's supernova. Our study indicates that the SSS, V Sge, might be the potential progenitor of supernovae like SN 2002ic if the delayed dynamical-instability model due to Han & Podsiadlowski (2006) is appropriate. Following the work of Meng, Chen & Han (2009), we found that the SD model (WD + MS) with an optically thick wind can explain the birth rate of supernovae like SN 2006X and reproduce the distribution of the color excess of SNe Ia. The model also predicts that at least 75% of all SNe Ia may show a polarization signal in their spectra.Comment: 6 pages, 2 figures, accepted for publication in Astrophysics & Space Science (Proceeding of the 4th Meeting on Hot Subdwarf Stars and Related Objects, edited by Zhanwen Han, Simon Jeffery & Philipp Podsiadlowski