Role of hydrographical parameters and total organic carbon on mercury allocation along the riverine transect of Beypore, south-west coast of India

1419-1426Distribution of total mercury (THg) was carried out in the sediments of Beypore estuary. The THg concentration in surface sediments varied from 0.03 ppm to 0.17 ppm. The pollution index approach using contamination factor (CF) revealed that the sampling stations are moderately contaminated with respect to mercury. Further, the effects of hydrographical parameters (pH, salinity, dissolved oxygen) and total organic carbon (TOC) of the sediment were studied over the spatial distribution of mercury (Hg). Correlation analysis unveiled THg exhibited significant positive correlations with TOC (R=0.91) and salinity (R=0.744). However significant inverse correlation was observed between pH and Hg (R =-0.93). The C: N ratios suggest that the organic matter is labile in nature. Total organic carbon was found to control the distribution of Hg. It is the first base line study in this estuary

Spatial variability of biochemical composition in coral reef sediments of Kavaratti and Pitti islands, Lakshadweep archipelago

369-378In this study, variability of biochemical composition in the surficial coral reef sediments of Kavaratti and Pitti islands in Lakshadweeep archipelago was investigated. Biochemical composition of sedimentary organic matter from the study area was characterized by the dominance of proteins in Pitti and carbohydrates in Kavaratti over lipids. The percentage ratio of the labile to total organic matter indicated that most of the deposited organic matter was refractory in both environments. The higher PRT:CHO ratios in Pitti sediments compared to that of Kavaratti indicated that in the former there was low dead organic matter accumulation. The lower LPD:CHO ratios estimated for sediments in both islands indicated low quality of labile organic matter to support benthic fauna

Effectiveness of a Short training in Teaching Methodology for entry level Medical Teachers

Background: Teacher education curricula should enable teachers to facilitate learners’ acquiring knowledge, attitudes, behavior and skills that they will need in their profession. Though there are faculty development programmes that are being conducted in India, there are only a few published reports of the same.  Aims & Objectives: To assess the “Effectiveness of a Short training in Teaching Methodology for entry level Medical Teachers.” Settings and Design: A quasi-experimental study with pre-test post-test design and an educational intervention was carried out on 30 consenting Senior Residents at a Medical College in Kochi. Material & Methods: The intervention was eight-hour training in teaching methodology using a curriculum designed by the researcher in consultation with experts. Data analysis was done using SPSS software to compare the pre and post - test scores of the residents. Results: Overall feedback was positive. The participants reported that “they had learned a lot” and were of the view that “the course would help them to put forward better performances” when assigned teaching-learning tasks. The pre-test and post-test scores were compared and significant improvement was found with regard to knowledge, motivation to teach (reflecting attitude change) and practice. Conclusion: A short training in teaching methodology has helped entry level medical teachers to become more effective in their teaching

Preclinical toxicological evaluation of Aloe vera health drinks in wistar rats

Human consumption of Aloe vera as a beverage has recently increased in popularity. These benefits are controversial with some sources pointing out that the putative effects of aloe are unsupported by clinical studies; it is important that marketed products be tested for toxicities following oral consumption. Hence this study was designed to evaluate the toxicological effect of marketed aloe health drinks. Thirty either sex Wistar rats (200-300gm) were enrolled in this study and are divided into 5 groups. Group I receives Normal saline serves as vehicle control, Group II and III receives Product A- Low dose (0.5 ml twice daily, p.o) and High dose (1.0 ml twice daily, p.o) respectively. Group IV and V receives Product B- Low dose (0.5 ml twice daily, p.o) and High dose (1.0 ml twice daily, p.o) respectively. Weekly body weight and daily feed intake were measured. On 28th day total urine output volume, faecal consistency, Haematological, biochemical, and organ weight were measured to assess the toxicity of aloe health drinks. The result of this study shows that continuous usage of aloe health drinks showed milder weight reduction, significant improvement in erythropoiesis also it increases the WBC count and increases the weight of spleen it may confirm the immune modulatory effect of aloe health drink. At the higher doses, it increased the SGOT, SGPT, serum urea and creatinine it may lead to the hepatotoxicity and nephrotoxicity. In gastrointestinal tract on prolonged uses, it produced few lesions and diarrhoea. It might be concluded that prolonged consumption of unprocessed aloe health drink contains latex, an ingredient which has many health risks associated with it. So it can aggravate health problems

Multinational Experiences in Reducing and Preventing the Use of Restraint and Seclusion

Restraint and seclusion (R/S) have been used in many countries and across service sectors for centuries. With the recent and increasing recognition of the harm associated with these procedures, efforts have been made to reduce and prevent R/S. Following a scathing media exposé in 1998 and congressional scrutiny, the United States began a national effort to reduce and prevent R/S use. With federal impetus and funding, an evidence-based practice, the Six Core Strategies1 to Prevent Conflict, Violence and the Use of Seclusion and Restraint, was developed. This model was widely and successfully implemented in a number of U.S. states and is being adopted by other countries, including Finland, Australia, and the United Kingdom. Recently, the first cluster randomized controlled study of the Six Core Strategies in Finland provided the first evidence-based data of the safety and effectiveness of a coercion prevention methodology. Preliminary findings of some of the international efforts are discussed. Reduction in R/S use and other positive outcomes are also reported

General practitioners and emergency departments (GPED) - Efficient models of care: A mixed-methods study protocol

© Author(s) (or their employer(s)) 2018. Re-use permitted under CC BY. Published by BMJ. Introduction Pressure continues to grow on emergency departments in the UK and throughout the world, with declining performance and adverse effects on patient outcome, safety and experience. One proposed solution is to locate general practitioners to work in or alongside the emergency department (GPED). Several GPED models have been introduced, however, evidence of effectiveness is weak. This study aims to evaluate the impact of GPED on patient care, the primary care and acute hospital team and the wider urgent care system. Methods and analysis The study will be divided into three work packages (WPs). WP-A; Mapping and Taxonomy: Mapping, description and classification of current models of GPED in all emergency departments in England and interviews with key informants to examine the hypotheses that underpin GPED. WP-B; Quantitative Analysis of National Data: Measurement of the effectiveness, costs and consequences of the GPED models identified in WP-A, compared with a no-GPED model, using retrospective analysis of Hospital Episode Statistics Data. WP-C; Case Studies: Detailed case studies of different GPED models using a mixture of qualitative and quantitative methods including: non-participant observation of clinical care, semistructured interviews with staff, patients and carers; workforce surveys with emergency department staff and analysis of available local routinely collected hospital data. Prospective case study sites will be identified by completing telephone interviews with sites awarded capital funding by the UK government to implement GPED initiatives. The study has a strong patient and public involvement group that has contributed to study design and materials, and which will be closely involved in data interpretation and dissemination. Ethics and dissemination The study has been approved by the National Health Service East Midlands - Leicester South Research Ethics Committee: 17/EM/0312. The results of the study will be disseminated through peer-reviewed journals, conferences and a planned programme of knowledge mobilisation

SUCLA2 mutations cause global protein succinylation contributing to the pathomechanism of a hereditary mitochondrial disease

Mitochondrial acyl-coenzyme A species are emerging as important sources of protein modification and damage. Succinyl-CoA ligase (SCL) deficiency causes a mitochondrial encephalomyopathy of unknown pathomechanism. Here, we show that succinyl-CoA accumulates in cells derived from patients with recessive mutations in the tricarboxylic acid cycle (TCA) gene succinyl-CoA ligase subunit-beta (SUCLA2), causing global protein hyper-succinylation. Using mass spectrometry, we quantify nearly 1,000 protein succinylation sites on 366 proteins from patient-derived fibroblasts and myotubes. Interestingly, hyper-succinylated proteins are distributed across cellular compartments, and many are known targets of the (NAD(+))-dependent desuccinylase SIRT5. To test the contribution of hyper-succinylation to disease progression, we develop a zebrafish model of the SCL deficiency and find that SIRT5 gain-of-function reduces global protein succinylation and improves survival. Thus, increased succinyl-CoA levels contribute to the pathology of SCL deficiency through post-translational modifications. The pathomechanism of succinyl-CoA ligase (SCL) deficiency, a hereditary mitochondrial disease, is not fully understood. Here, the authors show that increased succinyl-CoA levels contribute to SCL pathology by causing global protein hyper-succinylation.Peer reviewe

General practitioners working in or alongside the emergency department : the GPED mixed-methods study

Background: Emergency care is facing a steadily rising demand. In response, hospitals have implemented new models of care that locate general practitioners in or alongside the emergency department. Objectives: We aimed to explore the effects of general practitioners working in or alongside the emergency department on patient care, the primary care and acute hospital team, and the wider system, as well as to determine the differential effects of different service models. Design: This was a mixed-methods study in three work packages. Work package A classified current models of general practitioners working in or alongside the emergency department in England. We interviewed national and local leaders, staff and patients to identify the hypotheses underpinning these services. Work package B used a retrospective analysis of routinely available data. Outcome measures included waiting times, admission rates, reattendances, mortality and the number of patient attendances. We explored potential cost savings. Work package C was a detailed mixed-methods case study in 10 sites. We collected and synthesised qualitative and quantitative data from non-participant observations, interviews and a workforce survey. Patients and the public were involved throughout the development, delivery and dissemination of the study. Results: High-level goals were shared between national policy-makers and local leads; however, there was disagreement about the anticipated effects. We identified eight domains of influence: performance against the 4-hour target, use of investigations, hospital admissions, patient outcome and experience, service access, workforce recruitment and retention, workforce behaviour and experience, and resource use. General practitioners working in or alongside the emergency department were associated with a very slight reduction in the rate of reattendance within 7 days; however, the clinical significance of this was judged to be negligible. For all other indicators, there was no effect on performance or outcomes. However, there was a substantial degree of heterogeneity in these findings. This is explained by the considerable variation observed in our case study sites, and the sensitivity of service implementation to local factors. The effects on the workforce were complex; they were often positive for emergency department doctors and general practitioners, but less so for nursing staff. The patient-streaming process generated stress and conflict for emergency department nurses and general practitioners. Patients and carers were understanding of general practitioners working in or alongside the emergency department. We found no evidence that staff concerns regarding the potential to create additional demand were justified. Any possible cost savings associated with reduced reattendances were heavily outweighed by the cost of the service. Limitations: The reliability of our data sources varied and we were unable to complete our quantitative analysis entirely as planned. Participation in interviews and at case study sites was voluntary. Conclusions: Service implementation was highly subject to local context and micro-level influences. Key success factors were interprofessional working, staffing and training, streaming, and infrastructure and support

General practitioners working in or alongside The emergency department: the GPED mixed-methods study

Background: Emergency care is facing a steadily rising demand. In response, hospitals have implemented new models of care that locate general practitioners in or alongside the emergency department.Objectives: We aimed to explore the effects of general practitioners working in or alongside the emergency department on patient care, the primary care and acute hospital team, and the wider system, as well as to determine the differential effects of different service models.Design: This was a mixed-methods study in three work packages. Work package A classified current models of general practitioners working in or alongside the emergency department in England. We interviewed national and local leaders, staff and patients to identify the hypotheses underpinning these services. Work package B used a retrospective analysis of routinely available data. Outcome measures included waiting times, admission rates, reattendances, mortality and the number of patient attendances. We explored potential cost savings. Work package C was a detailed mixed-methods case study in 10 sites. We collected and synthesised qualitative and quantitative data from non-participant observations, interviews and a workforce survey. Patients and the public were involved throughout the development, delivery and dissemination of the study.Results: High-level goals were shared between national policy-makers and local leads; however, there was disagreement about the anticipated effects. We identified eight domains of influence: performance against the 4-hour target, use of investigations, hospital admissions, patient outcome and experience, service access, workforce recruitment and retention, workforce behaviour and experience, and resource use. General practitioners working in or alongside the emergency department were associated with a very slight reduction in the rate of reattendance within 7 days; however, the clinical significance of this was judged to be negligible. For all other indicators, there was no effect on performance or outcomes. However, there was a substantial degree of heterogeneity in these findings. This is explained by the considerable variation observed in our case study sites, and the sensitivity of service implementation tolocal factors. The effects on the workforce were complex; they were often positive for emergency department doctors and general practitioners, but less so for nursing staff. The patient-streaming process generated stress and conflict for emergency department nurses and general practitioners. Patients and carers were understanding of general practitioners working in or alongside the emergency department. We found no evidence that staff concerns regarding the potential to create additional demand were justified. Any possible cost savings associated with reduced reattendances were heavily outweighed by the cost of the service.Limitations: The reliability of our data sources varied and we were unable to complete our quantitative analysis entirely as planned. Participation in interviews and at case study sites was voluntary.Conclusions: Service implementation was highly subject to local context and micro-level influences. Key success factors were interprofessional working, staffing and training, streaming, and infrastructure and support.Future work: Further research should study the longer-term effects of these services, clinician attitudes to risk and the implementation of streaming. Additional work should also examine the system effectsof national policy initiatives, develop methodologies to support rapid service evaluation and study the relationship between primary and secondary care.Trial registration: This trial is registered as ISRCTN51780222.Funding: This project was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme and will be published in full in Health and Social Care Delivery Research; Vol. 10, No. 30. See the NIHR Journals Library website for further project information

Mitochondrial physiology

As the knowledge base and importance of mitochondrial physiology to evolution, health and disease expands, the necessity for harmonizing the terminology concerning mitochondrial respiratory states and rates has become increasingly apparent. The chemiosmotic theory establishes the mechanism of energy transformation and coupling in oxidative phosphorylation. The unifying concept of the protonmotive force provides the framework for developing a consistent theoretical foundation of mitochondrial physiology and bioenergetics. We follow the latest SI guidelines and those of the International Union of Pure and Applied Chemistry (IUPAC) on terminology in physical chemistry, extended by considerations of open systems and thermodynamics of irreversible processes. The concept-driven constructive terminology incorporates the meaning of each quantity and aligns concepts and symbols with the nomenclature of classical bioenergetics. We endeavour to provide a balanced view of mitochondrial respiratory control and a critical discussion on reporting data of mitochondrial respiration in terms of metabolic flows and fluxes. Uniform standards for evaluation of respiratory states and rates will ultimately contribute to reproducibility between laboratories and thus support the development of data repositories of mitochondrial respiratory function in species, tissues, and cells. Clarity of concept and consistency of nomenclature facilitate effective transdisciplinary communication, education, and ultimately further discovery