Student attitudes regarding the educational value and welfare implications in the use of model eyes and live dogs in teaching practical fundus examination: evaluation of responses from 40 students

This study sought to document student opinions on the educational value and welfare implications of use of artificial model eyes and live dogs in the training of veterinary students in examination of the canine fundus. Forty students who had undertaken a practical class on canine fundoscopy involving both use of artificial model eyes and live dogs were asked to complete a short questionnaire using a Likert scale to gauge their opinion on whether the use of live dogs and artificial eyes was very valuable (scoring 2), valuable (1), a neutral response (0), not particularly valuable (-1) or not at all valuable (-2) and to write a free text response on their views of the educational value and welfare implications of using artificial model eyes or live dogs in training for ophthalmic examination of the canine ocular fundus. Likert responses were 1.84±0.37 for using live greyhounds and 0.58±0.79 for using simulator eyes (p<0.0001). Thematic analysis of the written responses showed that while the artificial eyes were considered somewhat valuable in initial training, the live dogs were significantly preferred for their realism and the opportunity to examine the eye while handling a live animal. In conclusion, while model eyes are valuable initial training in use of the ophthalmoscope for funduscopic examination, students consider that examining the eye in the live dog is significantly more valuable and that the welfare of dogs thus used is not in their view unduly compromised

What is the contribution of physician associates in hospital care in England? A mixed methods, multiple case study.

OBJECTIVES: To investigate the deployment of physician associates (PAs); the factors supporting and inhibiting their employment and their contribution and impact on patients' experience and outcomes and the organisation of services. DESIGN: Mixed methods within a case study design, using interviews, observations, work diaries and documentary analysis. SETTING: Six acute care hospitals in three regions of England in 2016-2017. PARTICIPANTS: 43 PAs, 77 other health professionals, 28 managers, 28 patients and relatives. RESULTS: A key influencing factor supporting the employment of PAs in all settings was a shortage of doctors. PAs were found to be acceptable, appropriate and safe members of the medical/surgical teams by the majority of doctors, managers and nurses. They were mainly deployed to undertake inpatient ward work in the medical/surgical team during core weekday hours. They were reported to positively contribute to: continuity within their medical/surgical team, patient experience and flow, inducting new junior doctors, supporting the medical/surgical teams' workload, which released doctors for more complex patients and their training. The lack of regulation and attendant lack of authority to prescribe was seen as a problem in many but not all specialties. The contribution of PAs to productivity and patient outcomes was not quantifiable separately from other members of the team and wider service organisation. Patients and relatives described PAs positively but most did not understand who and what a PA was, often mistaking them for doctors. CONCLUSIONS: This study offers new insights concerning the deployment and contribution of PAs in medical and surgical specialties in English hospitals. PAs provided a flexible addition to the secondary care workforce without drawing from existing professions. Their utility in the hospital setting is unlikely to be completely realised without the appropriate level of regulation and authority to prescribe medicines and order ionising radiation within their scope of practice

Vertical flow in the Southern Ocean estimated from individual moorings

In this study, we demonstrate that oceanic vertical velocities can be estimated from individual mooring measurements, even for non-stationary flow. This result is obtained under three assumptions: i. weak diffusion (Péclet number ≫1), ii. weak friction (Reynolds number ≫1), and iii. small inertial terms (Rossby number ≪1). The theoretical framework is applied to a set of 4 moorings located in the Southern Ocean. For this site, the diagnosed vertical velocities are highly variable in time, their standard deviation being one-to-two orders of magnitude greater than their mean. We demonstrate that the time-averaged vertical velocities are largely induced by geostrophic flow, and can be estimated from the time-averaged density and horizontal velocities. This suggests that local time-mean vertical velocities are primarily forced by the time-mean ocean dynamics, rather than by e.g. transient eddies or internal waves. We also show that, in the context of these four moorings, the time-mean vertical flow is consistent with stratified Taylor column dynamics in the presence of a topographic obstacle

My heart is racing! Psychophysiological dynamics of skilled racecar drivers

Our purpose was to test the multi-action plan (MAP) model assumptions in which athletes’ psychophysiological patterns differ among optimal and suboptimal performance experiences. Nine professional drivers competing in premier race categories (e.g., Formula 3, Porsche GT3 Cup Challenge) completed the study. Data collection involved monitoring the drivers’ perceived hedonic tone, accuracy on core components of action, posture, skin temperature, respiration rate, and heart rate responses during a 40-lap simulated race. Time marks, gathered at three standardized sectors, served as the performance variable. The A1GP racing simulator (Allinsport, Modena) established a realistic race platform. Specifically, the Barcelona track was chosen due to its inherently difficult nature characterized by intermittent deceleration points. Idiosyncratic analyses showed large individual differences in the drivers’ psychophysiological profile, as well as distinct patterns in regards to optimal and suboptimal performance experiences. Limitations and future research avenues are discussed. Action (e.g., attentional control) and emotion (e.g., biofeedback training) centered applied sport psychology implications are advanced

Comparing physician associates and foundation year two doctors-in-training undertaking emergency medicine consultations in England: a mixed-methods study of processes and outcomes.

OBJECTIVES: To compare the contribution of physician associates to the processes and outcomes of emergency medicine consultations with that of foundation year two doctors-in-training. DESIGN: Mixed-methods study: retrospective chart review using 4 months' anonymised clinical record data of all patients seen by physician associates or foundation year two doctors-in-training in 2016; review of a subsample of 40 records for clinical adequacy; semi-structured interviews with staff and patients; observations of physician associates. SETTING: Three emergency departments in England. PARTICIPANTS: The records of 8816 patients attended by 6 physician associates and 40 foundation year two doctors-in-training; of these n=3197 had the primary outcome recorded (n=1129 physician associates, n=2068 doctor); 14 clinicians and managers and 6 patients or relatives for interview; 5 physician associates for observation. PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcome was unplanned re-attendance at the same emergency department within 7 days. SECONDARY OUTCOMES: consultation processes, clinical adequacy of care, and staff and patient experience. RESULTS: Re-attendances within 7 days (n=194 (6.1%)) showed no difference between physician associates and foundation year two doctors-in-training (OR 0.87, 95% CI 0.61 to 1.24, p=0.437). If seen by a physician associate, patients were more likely receive an X-ray investigation (OR 2.10, 95% CI 1.72 to 4.24), p<0.001), after adjustment for patient characteristics, triage severity of condition and statistically significant clinician intraclass correlation. Clinical reviewers found almost all patients' charts clinically adequate. Physician associates were evaluated as assessing patients in a similar way to foundation year two doctors-in-training and providing continuity in the team. Patients were positive about the care they had received from a physician associate, but had poor understanding of the role. CONCLUSIONS: Physician associates in emergency departments in England treated patients with a range of conditions safely, and at a similar level to foundation year two doctors-in-training, providing clinical operational efficiencies

Observed eddy-internal wave interactions in the Southern Ocean

The physical mechanisms that remove energy from the Southern Ocean’s vigorous mesoscale eddy field are not well understood. One proposed mechanism is direct energy transfer to the internal wave field in the ocean interior, via eddy-induced straining and shearing of preexisting internal waves. The magnitude, vertical structure, and temporal variability of the rate of energy transfer between eddies and internal waves is quantified from a 14-month deployment of a mooring cluster in the Scotia Sea. Velocity and buoyancy observations are decomposed into wave and eddy components, and the energy transfer is estimated using the Reynolds-averaged energy equation. We find that eddies gain energy from the internal wave field at a rate of −2.2 ± 0.6 mW m−2, integrated from the bottom to 566 m below the surface. This result can be decomposed into a positive (eddy to wave) component, equal to 0.2 ± 0.1 mW m−2, driven by horizontal straining of internal waves, and a negative (wave to eddy) component, equal to −2.5 ± 0.6 mW m−2, driven by vertical shearing of the wave spectrum. Temporal variability of the transfer rate is much greater than the mean value. Close to topography, large energy transfers are associated with low-frequency buoyancy fluxes, the underpinning physics of which do not conform to linear wave dynamics and are thereby in need of further research. Our work suggests that eddy–internal wave interactions may play a significant role in the energy balance of the Southern Ocean mesoscale eddy and internal wave fields

The effectiveness and cost-effectiveness of acupressure for the control and management of chemotherapy-related acute and delayed nausea: Assessment of Nausea in Chemotherapy Research (ANCHoR), a randomised controlled trial

Chemotherapy-induced nausea and vomiting remain difficult symptoms to manage in clinical practice. As standard antiemetic drugs do not fully eliminate these symptoms, it is important to explore the adjuvant role of non-pharmacological and complementary therapies in antiemetic management approaches. Acupressure is one such treatment showing highly suggestive evidence so far of a positive effect, meriting further investigation

Inositol 1,3,4,5,6-pentakisphosphate 2-kinase is a distant IPK member with a singular inositide binding site for axial 2-OH recognition

Inositol phosphates (InsPs) are signaling molecules with multiple roles in cells. In particular Graphic (InsP6) is involved in mRNA export and editing or chromatin remodeling among other events. InsP6 accumulates as mixed salts (phytate) in storage tissues of plants and plays a key role in their physiology. Human diets that are exclusively grain-based provide an excess of InsP6 that, through chelation of metal ions, may have a detrimental effect on human health. Ins(1,3,4,5,6)P5 2-kinase (InsP5 2-kinase or Ipk1) catalyses the synthesis of InsP6 from InsP5 and ATP, and is the only enzyme that transfers a phosphate group to the axial 2-OH of the myo-inositide. We present the first structure for an InsP5 2-kinase in complex with both substrates and products. This enzyme presents a singular structural region for inositide binding that encompasses almost half of the protein. The key residues in substrate binding are identified, with Asp368 being responsible for recognition of the axial 2-OH. This study sheds light on the unique molecular mechanism for the synthesis of the precursor of inositol pyrophosphates

Seismic reflection imaging of mixing processes in Fram Strait

The West Spitsbergen Current, which flows northward along the western Svalbard continental slope, transports warm and saline Atlantic water (AW) into the Arctic Ocean. A combined analysis of high-resolution seismic images and hydrographic sections across this current has uncovered the oceanographic processes involved in horizontal and vertical mixing of AW. At the shelf break, where a strong horizontal temperature gradient exists east of the warmest AW, isopycnal interleaving of warm AW and surrounding colder waters is observed. Strong seismic reflections characterize these interleaving features, with a negative polarity reflection arising from an interface of warm water overlying colder water. A seismic-derived sound speed image reveals the extent and lateral continuity of such interleaving layers. There is evidence of obliquely aligned internal waves emanating from the slope at 450–500 m. They follow the predicted trajectory of internal S2 tidal waves and can promote vertical mixing between Atlantic and Arctic-origin waters

Effect of adeno-associated virus (AAV)-mediated overexpression of PEPCK-M (Pck2) on Clenbuterol-induced muscle growth

We previously identified PEPCK-M (encoded by the Pck2 gene) to be highly up-regulated in skeletal muscle of pigs treated with Ractopamine, an anabolic beta-adrenergic receptor agonist. To determine whether PEPCK-M had a causative role in modulating the skeletal muscle growth response to Ractopamine, we used adeno-associated virus 1 (AAV1) to over-express Pck2 (AAV-Pck2) in murine skeletal muscle. A contralateral limb design was employed, such that each mouse served as its own control (injected with a GFP-only expressing AAV1, labelled AAV-GFP). Daily injections of Clenbuterol (1 mg/kg for 21 days) or vehicle control were also carried out to assess the effects of AAV-Pck2 overexpression on the anabolic response to a beta-adrenergic agonist. AAV-Pck2 overexpression in leg muscles of male C57BL6/J mice for 4 weeks (6–10 weeks of age) increased Pck2 mRNA (~100-fold), protein (not quantifiable) and enzyme activity (~3-fold). There was a trend (p = 0.0798) for AAV-Pck2 overexpression to reduce TA muscle weights, but there was no significant effect on muscle fibre diameters or myosin heavy chain isoform (MyHC) mRNA expression. When skeletal muscle growth was induced by daily administration of Clenbuterol (for 21 days), overexpression of AAV-Pck2 had no effect on the growth response, nor did it alter the expression of Phosphoserine Aminotransferase-1 (Psat1) or Asparagine Synthetase (Asns) mRNA or the Clenbuterol-induced decreases in MyHC IIa and IIx mRNA expression (p = 0.0065 and p = 0.0267 respectively). However AAV-Pck2 overexpression reduced TA muscle weights (p = 0.0434), particularly in the Control (vehicle treated) mice (p = 0.059 for AAV x Clenbuterol interaction) and increased the expression of Seryl-tRNA Synthetase (Sars) mRNA (p = 0.0477). Hence, contrary to the original hypothesis, AAV-Pck2 overexpression reduced TA muscle weights and did not mimic or alter the muscle hypertrophic effects of the beta-adrenergic agonist, Clenbuterol