Assessment of the Effectiveness of the Portuguese Implementation. VRU-TOO Deliverable 12.

The work of VRU-TOO is targeted specifically at the application of AlT for the reduction of risk and the improvement of comfort for vulnerable road users, namely pedestrians. To achieve this, the project has combined pilot implementations in three countries (UK, Greece and portugal) with behavioural studies and the development of computer simulation techniques. At the same time the pilot implementations have been co-ordinated with local and national policy priorities. This deliverable presents the results from a trial that was carried out on a major arterial road just outside the central area of Porto, Portugal The objective of the trial was to show that it was possible to improve the safety and mobility of pedestrians at a junction and crossing facility which was situated adjacent to a large school by intelligent manipulation of the signal settings. Pedestrian detectors were attached to the traffic signals in order to detect pedestrians as they approached the crossing point. As a result of this detection, in certain circumstances, the signal cycle would be advanced so as to reduce the time until the signals would change to present the pedestrian with an opportunity to cross the road. The detectors would also allow the green time for pedestrians to be extended if there was sufficient demand, allowing safer and more comfortable crossing periods. Finally the pedestrian green time could also be reduced in order to avoid wasted time, if there was no pedestrian demand, thus allowing a more optimised functioning of the junction. In order to evaluate the effectiveness of this treatment an extensive "before and after" analysis was carried out to determine the changes in safety and mobility, especially for child pedestrians. The evaluation of the trial was carried out by using the data collected to assess whether the pre- specified objectives have been achieved. The implications of the results are then discussed as well as their implication to the more general installation of such measures in the Portuguese contex

Mesothelioma: exploring psychological effects on veterans and their family caregivers

Background: In the UK, around one in eight adults aged over 65 years is a veteran of the UK armed forces. There is little research into the experiences of veterans with mesothelioma and their family caregivers. Aim: To explore the psychological effects of mesothelioma on UK veterans and their family caregivers from the caregivers’ perspective. Method: Purposive sampling was used to recruit six participants to this qualitative interview study. Individual semi-structured interviews were conducted and data were analysed using interpretative phenomenological analysis. Findings: There was an underlying influence of the military background on several facets of caregivers’ and veterans’ experiences. Veterans and caregivers made efforts to ‘just keep on going’. Psychological benefits were derived from having a stoic outlook, retaining one’s sense of humour, being goal-oriented and putting others first. Holding to high military standards such as loyalty led to broken trust and anger. Straightforward ‘need to know’ communication is a priority in the armed forces and this also influenced caregivers’ and veterans’ experiences. Conclusion: It is important that nurses are aware of the specific cultural factors present in armed forces veterans and their caregivers so that they can assess and address their needs adequately

Osteosarcoma growth on trabecular bone mimicking structures manufactured via laser direct write

This paper describes the direct laser write of a photocurable acrylate-based PolyHIPE (High Internal Phase Emulsion) to produce scaffolds with both macro- and microporosity, and the use of these scaffolds in osteosarco-ma-based 3D cell culture. The macroporosity was introduced via the application of stereolithography to produce a clas-sical woodpile structure with struts having an approximate diameter of 200 ?m and pores were typically around 500 ?m in diameter. The PolyHIPE retained its microporosity after stereolithographic manufacture, with a range of pore sizes typically between 10 and 60 ?m (with most pores between 20 and 30 ?m). The resulting scaffolds were suitable substrates for further modification using acrylic acid plasma polymerisation. This scaffold was used as a structural mimic of the trabecular bone and in vitro determination of biocompatibility using cultured bone cells (MG63) demon-strated that cells were able to colonise all materials tested, with evidence that acrylic acid plasma polymerisation im-proved biocompatibility in the long term. The osteosarcoma cell culture on the 3D printed scaffold exhibits different growth behaviour than observed on tissue culture plastic or a flat disk of the porous material; tumour spheroids are ob-served on parts of the scaffolds. The growth of these spheroids indicates that the osteosarcoma behave more akin to in vivo in this 3D mimic of trabecular bone. It was concluded that PolyHIPEs represent versatile biomaterial systems with considerable potential for the manufacture of complex devices or scaffolds for regenerative medicine. In particular, the possibility to readily mimic the hierarchical structure of native tissue enables opportunities to build in vitro models closely resembling tumour tissue

The psychological effects of mesothelioma in the UK military context from the carer’s perspective: a qualitative study

Mesothelioma is an incurable asbestos-related cancer with a high symptom burden. Its long lead time means cases in the military context tend to be amongst veterans. Research into the lived experience of mesothelioma is sparse. Research shows British veterans and their families are likely to have particular needs accessing health services and support. This study explored the psychological effects of mesothelioma in the UK military context from the carer's perspective. It comprised a secondary data analysis of interview data plus semi-structured interviews with family carers of UK veterans with a mesothelioma diagnosis. Themes developed included ‘ Going the extra mile’; ‘Shifts in previously robust characteristics and roles’; and ‘Needing to know’. Military culture impacted both patients and carers, with participants reporting a reluctance to show weakness. Carers experienced guilt and traumatic stress symptoms. Moral injury was reported relating to carers’ interactions with the Ministry of Defence (MOD) and the National Health Service (NHS)

Osteosarcoma growth on trabecular bone mimicking structures manufactured via laser direct write

This paper describes the direct laser write of a photocurable acrylate-based PolyHIPE (High Internal Phase Emulsion) to produce scaffolds with both macro- and microporosity, and the use of these scaffolds in osteosarco-ma-based 3D cell culture. The macroporosity was introduced via the application of stereolithography to produce a clas-sical woodpile structure with struts having an approximate diameter of 200 ?m and pores were typically around 500 ?m in diameter. The PolyHIPE retained its microporosity after stereolithographic manufacture, with a range of pore sizes typically between 10 and 60 ?m (with most pores between 20 and 30 ?m). The resulting scaffolds were suitable substrates for further modification using acrylic acid plasma polymerisation. This scaffold was used as a structural mimic of the trabecular bone and in vitro determination of biocompatibility using cultured bone cells (MG63) demon-strated that cells were able to colonise all materials tested, with evidence that acrylic acid plasma polymerisation im-proved biocompatibility in the long term. The osteosarcoma cell culture on the 3D printed scaffold exhibits different growth behaviour than observed on tissue culture plastic or a flat disk of the porous material; tumour spheroids are ob-served on parts of the scaffolds. The growth of these spheroids indicates that the osteosarcoma behave more akin to in vivo in this 3D mimic of trabecular bone. It was concluded that PolyHIPEs represent versatile biomaterial systems with considerable potential for the manufacture of complex devices or scaffolds for regenerative medicine. In particular, the possibility to readily mimic the hierarchical structure of native tissue enables opportunities to build in vitro models closely resembling tumour tissue

Living with mesothelioma : a qualitative study of the experiences of male military veterans in the UK

Purpose The UK has the highest incidence of mesothelioma in the world. Evidence in the United States suggests that mesothelioma may disproportionately affect military veterans. However, there has been no investigation of the experience of UK veterans living with mesothelioma. Military Mesothelioma Experience Study (MiMES) aimed to understand the experience and health/support needs of British Armed Forces personnel/veterans with mesothelioma. Methods Semi-structured interviews were conducted with 13 veterans living with mesothelioma, and nine family members of veterans living with mesothelioma. Participants were recruited via charities and asbestos support groups. Data were analysed using thematic analysis. Results Participants’ experiences are presented using three themes, i) exposure to asbestos and awareness of asbestos related diseases, ii) using military strategies to cope with mesothelioma and iii) preferences for information and support. MiMES indicates that the nature and range of UK military veterans' asbestos exposure is varied and not limited to high risk occupations. Participants knowledge of asbestos and experience of mesothelioma influenced their experiences of diagnosis. Participants had coping strategies influenced by their military experiences. Assistance in navigating health and military systems was considered beneficial, especially if support was provided by professionals with knowledge or experience of the military. Attributes which may inhibit veterans from seeking professional support are discussed. Conclusion MiMES provides insight into how UK military veterans experience and cope with mesothelioma. Key implications focus the role that Mesothelioma Nurse Specialists, Asbestos Support Groups and veterans groups play in providing acceptable support for UK veterans

A methodology for the production of microfabricated electrospun membranes for the creation of new skin regeneration models

The continual renewal of the epidermis is thought to be related to the presence of populations of epidermal stem cells residing in physically protected microenvironments (rete ridges) directly influenced by the presence of mesenchymal fibroblasts. Current skin in vitro models do acknowledge the influence of stromal fibroblasts in skin reorganisation but the study of the effect of the rete ridge-microenvironment on epidermal renewal still remains a rich topic for exploration. We suggest there is a need for the development of new in vitro models in which to study epithelial stem cell behaviour prior to translating these models into the design of new cell-free biomaterial devices for skin reconstruction. In this study we aimed to develop new prototype epidermal-like layers containing pseudo-rete ridge structures for studying the effect of topographical cues on epithelial cell behaviour. The models were designed using a range of 3D electrospun microfabricated scaffolds. This was achieved via the utilisation of polyethylene glycol diacrylate (PEDGA) to produce a reusable template over which Poly (3-hydrroxybutyrate-co-3-hydroxyvalerate) (PHBV) was electrospun. Initial investigations studied the behaviour of keratinocytes cultured on models using plain scaffolds (without the presence of intricate topography) versus keratinocytes cultured on scaffolds containing micro-features

The mental health and well-being implications of a mesothelioma diagnosis: a mixed methods study

Purpose Mesothelioma is an incurable, asbestos-related cancer with a poor prognosis. There is scant evidence about the mental health and well-being impacts on patients and carers living with the illness. This study aimed to investigate mesothelioma's impact on mental health and well-being and the scale of mental health conditions in patients and informal carers. Methods A mixed-methods design was used: a cross-sectional survey of mesothelioma patients and informal carers plus semi-structured interviews with patients and carers. The survey used validated scales collecting data on mental health aspects of mesothelioma: the EQ5D to assess health-related quality-of-life; the Hospital Anxiety and Depression scale; the PCL-5 to assess Posttraumatic Stress; and the Posttraumatic Growth Inventory. The datasets were integrated during analysis. Results 96 useable survey responses were received. A clinical level of depression was reported by 29 participants (30.21%), of anxiety by 48 (50%), of posttraumatic distress disorder by 32 (33.33%), and of posttraumatic growth by 34 (35.42%). Carers had worse scores than patients. Three main themes were developed from interviews with 10 patients and 11 carers: ‘Prognosis’, ‘Support from services’, and ‘Social connections and communication’. Conclusions Healthcare professionals delivering a mesothelioma diagnosis require regular training in communication skills plus updating in current treatment options, so they provide an appropriate mix of realism and hope. Better signposting to mental health support is needed for patients and carers. Our introduction of posttraumatic growth into the mesothelioma literature is novel. We recommend specialist nurses are trained to recognise, understand, and foster posttraumatic growth

UV-Casting on methacrylated PCL for the production of a peripheral nerve implant containing an array of porous aligned microchannels

Peripheral nerves are basic communication structures guiding motor and sensory information from the central nervous system to receptor units. Severed peripheral nerve injuries represent a large clinical problem with relevant challenges to successful synthetic nerve repair scaffolds as substitutes to autologous nerve grafting. Numerous studies reported the use of hollow tubes made of synthetic polymers sutured between severed nerve stumps to promote nerve regeneration while providing protection for external factors, such as scar tissue formation and inflammation. Few approaches have described the potential use of a lumen structure comprised of microchannels or microfibers to provide axon growth avoiding misdirection and fostering proper healing. Here, we report the use of a 3D porous microchannel-based structure made of a photocurable methacrylated polycaprolactone, whose mechanical properties are comparable to native nerves. The neuro-regenerative properties of the polymer were assessed in vitro, prior to the implantation of the 3D porous structure, in a 6-mm rat sciatic nerve gap injury. The manufactured implants were biocompatible and able to be resorbed by the host’s body at a suitable rate, allowing the complete healing of the nerve. The innovative design of the highly porous structure with the axon guiding microchannels, along with the observation of myelinated axons and Schwann cells in the in vivo tests, led to a significant progress towards the standardized use of synthetic 3D multichannel-based structures in peripheral nerve surgery

Candidate gene association study in pediatric acute lymphoblastic leukemia evaluated by Bayesian network based Bayesian multilevel analysis of relevance

Background: We carried out a candidate gene association study in pediatric acute lymphoblastic leukemia (ALL) to identify possible genetic risk factors in a Hungarian population. Methods: The results were evaluated with traditional statistical methods and with our newly developed Bayesian network based Bayesian multilevel analysis of relevance (BN-BMLA) method. We collected genomic DNA and clinical data from 543 children, who underwent chemotherapy due to ALL, and 529 healthy controls. Altogether 66 single nucleotide polymorphisms (SNPs) in 19 candidate genes were genotyped. Results: With logistic regression, we identified 6 SNPs in the ARID5B and IKZF1 genes associated with increased risk to B-cell ALL, and two SNPs in the STAT3 gene, which decreased the risk to hyperdiploid ALL. Because the associated SNPs were in linkage in each gene, these associations corresponded to one signal per gene. The odds ratio (OR) associated with the tag SNPs were: OR = 1.69, P = 2.22x10-7 for rs4132601 (IKZF1), OR = 1.53, P = 1.95x10-5 for rs10821936 (ARID5B) and OR = 0.64, P = 2.32x10-4 for rs12949918 (STAT3). With the BN-BMLA we confirmed the findings of the frequentist-based method and received additional information about the nature of the relations between the SNPs and the disease. E.g. the rs10821936 in ARID5B and rs17405722 in STAT3 showed a weak interaction, and in case of T-cell lineage sample group, the gender showed a weak interaction with three SNPs in three genes. In the hyperdiploid patient group the BN-BMLA detected a strong interaction among SNPs in the NOTCH1, STAT1, STAT3 and BCL2 genes. Evaluating the survival rate of the patients with ALL, the BN-BMLA showed that besides risk groups and subtypes, genetic variations in the BAX and CEBPA genes might also influence the probability of survival of the patients. Conclusions: In the present study we confirmed the roles of genetic variations in ARID5B and IKZF1 in the susceptibility to B-cell ALL. With the newly developed BN-BMLA method several gene-gene, gene-phenotype and phenotype-phenotype connections were revealed. We showed several advantageous features of the new method, and suggested that in gene association studies the BN-BMLA might be a useful supplementary to the traditional frequentist-based statistical method