The Shipwrecked Shore and Other Metaphors: what we can learn from occupation of, and representations in, virtual worlds

In cyberspace, one’s body can be represented by one's own description, reality can be disrupted and the plain made beautiful or ‘… the beautiful plain’, (Turkle 1999:643). Our case study (cf Stake 1995) sought to explore the opportunities offered to students when they come to class in a virtual world and a differently created learning space. We consider Bullinghurst and Dünser’s (2012) work on augmenting reality for learners to combine the ‘real and the virtual’ to enable students to deal with the abstract. This paper explores student representations in Second Life, a 3D immersive world (www.secondlife.com), and as we engage, we see that the virtual not only enhances both curriculum and practice, but also an emergent scope for visual hermeneutics as both a digital literacy and analytical research tool. The focus of the case is a first year FoLSC group of students, based in Computing, and a first year module with embedded study and academic skills. Our conclusions suggest that offering learning opportunities in different spaces, can, indeed, disrupt – but in a powerful and positive way

A journey into silence: students, stakeholders and the impact of a strategic Governmental Policy Document in the UK.

For our analysis we draw upon Macherey’s essay ‘The text says what is does not say’ (in Walder 1990) where he argues for the legitimacy of interrogating a text for ‘what it tacitly implies, what it does not say … for in order to say anything there are things which must not be said’ (Ibid 217, his italics). As with society, all works have their margins – the incompleteness that reveals their birth and production … ‘ What is important in the work is what it does not say … what the work cannot say … because there the elaboration of the utterances is acted out in a sort of journey to silence’ (Ibid 218). Our critical analysis of the Government e-learning strategy (2005) reveals that rather than harnessing technology to empower the typically disenfranchised within the educational debate, it is those very stakeholders at the margins who are silenced whilst the interests of those with institutional and economic power are given voice. Our analysis will show that rather than creating a stakeholder society, Government through its policy documents positions the already disempowered as either silent or deficit and our conclusions suggest that rather than a discourse of transformation, ‘regulation not education’ (Lillis 2001), is the real goal of the dominant stakeholders

A novel method of supplying nutrients permits predictable shoot growth and root: shoot ratios of pre-transplant bedding plants

BACKGROUND AND AIMS: Growth of bedding plants, in small peat plugs, relies on nutrients in the irrigation solution. The object of the study was to find a way of modifying the nutrient supply so that good-quality seedlings can be grown rapidly and yet have the high root : shoot ratios essential for efficient transplanting. METHODS: A new procedure was devised in which the concentrations of nutrients in the irrigation solution were modified during growth according to changing plant demand, instead of maintaining the same concentrations throughout growth. The new procedure depends on published algorithms for the dependence of growth rate and optimal plant nutrient concentrations on shoot dry weight Ws (g m–2), and on measuring evapotranspiration rates and shoot dry weights at weekly intervals. Pansy, Viola tricola ‘Universal plus yellow’ and petunia, Petunia hybrida ‘Multiflora light salmon vein’ were grown in four independent experiments with the expected optimum nutrient concentration and fractions of the optimum. Root and shoot weights were measured during growth. KEY RESULTS: For each level of nutrient supply Ws increased with time (t) in days, according to the equation {Delta}Ws/{Delta}t=K2Ws/(100+Ws) in which the growth rate coefficient (K2) remained approximately constant throughout growth. The value of K2 for the optimum treatment was defined by incoming radiation and temperature. The value of K2 for each sub-optimum treatment relative to that for the optimum treatment was logarithmically related to the sub-optimal nutrient supply. Provided the aerial environment was optimal, Rsb/Ro{approx}Wo/Wsb where R is the root : shoot ratio, W is the shoot dry weight, and sb and o indicate sub-optimum and optimum nutrient supplies, respectively. Sub-optimal nutrient concentrations also depressed shoot growth without appreciably affecting root growth when the aerial environment was non-limiting. CONCLUSION: The new procedure can predict the effects of nutrient supply, incoming radiation and temperature on the time course of shoot growth and the root : shoot ratio for a range of growing conditions

Digital learning: pivoting to creativity

In my year with the Department of Nursing, I have been privileged to observe the embodiment of the humanising curriculum (Todres et al 2009), and seen the ways in which the nursing team, in a wide range of contexts, support students to bond with each other, build cohort identity and help student nurses develop that sense of belonging to the academic discipline of Nursing. This is challenging enough, but studying and learning are also embodied activities. How can we get our students ready to bring their whole embodied selves into their learning experience when they are working from home and online

How space design and technology can support the Pharmacy Practice Model Initiative through interprofessional collaboration

Purpose: The Pharmacy Practice Model Initiative (PPMI) calls pharmacists to more direct patient care and increased responsibility for medication-related outcomes, as a means of achieving greater safety, improving outcomes and reducing costs. This article acknowledges the value of interprofessional collaboration to the PPMI and identifies the implications of the Initiative for space design and technology, both of which stand to help the Initiative gather additional support. Summary: The profession of pharmacy has for some time now become increasingly vocal about its desire to take on greater responsibility for patient outcomes. With drug costs representing the largest portion of a hospital’s pharmacy budget and reimbursements becoming more contingent on readmission avoidance, the pharmacy’s influence on a hospital’s bottom line is significant. More importantly, study after study is showing that with greater pharmacist intervention, patient outcomes improve. This article addresses the ways in which developments in the fields of technology and facility design can assist in the deployment of the PPMI. Conclusion: As the PPMI achieves a critical level of support from inside and outside the pharmacy, and more empirical research emerges regarding the improved outcomes and cost savings of increasing the roles of both clinical pharmacists and pharmacy technicians, the industry sectors of healthcare technology and healthcare design stand ready to assist in the execution of this new model. By encouraging pharmacists, doctors and nurses to work together – and all caregivers to work with facility designers, biomedical engineers and IT specialists, there is the increased likelihood of these fields turning to each other to problem-solve together, all for the ultimate benefit to patients and their families

A pilot randomised controlled trial of cognitive behavioural therapy for antenatal depression.

BACKGROUND: Few trials have evaluated the effectiveness of psychological treatment in improving depression by the end of pregnancy. This is the first pilot randomised controlled trial (RCT) of individual cognitive behavioural therapy (CBT) looking at treating depression by the end of pregnancy. Our aim was to assess the feasibility of delivering a CBT intervention modified for antenatal depression during pregnancy. METHODS: Women in North Bristol, UK between 8-18 weeks pregnant were recruited through routine contact with midwives and randomised to receive up to 12 sessions of individual CBT in addition to usual care or to continue with usual care only. Women were eligible for randomisation if they screened positive on a 3-question depression screen used routinely by midwives and met ICD-10 criteria for depression assessed using the clinical interview schedule - revised version (CIS-R). Two CBT therapists delivered the intervention. Follow-up was at 15 and 33 weeks post-randomisation when assessments of mental health were made using measures which included the CIS-R. RESULTS: Of the 50 women assessed for the trial, 36 met ICD-10 depression criteria and were randomised: 18 to the intervention and 18 to usual care. Thirteen of the 18 (72%) women who were allocated to receive the intervention completed 9 or more sessions of CBT before the end of pregnancy. Follow-up rates at 15 and 33 weeks post-randomisation were higher in the group who received the intervention (89% vs. 72% at 15 weeks and 89% vs. 61% at 33 weeks post-randomisation). At 15 weeks post-randomisation (the end of pregnancy), there were more women in the intervention group (11/16; 68.7%) who recovered (i.e. no longer met ICD-10 criteria for depression), than those receiving only usual care (5/13; 38.5%). CONCLUSIONS: This pilot trial shows the feasibility of conducting a large RCT to assess the effectiveness of CBT for treating antenatal depression before the end of pregnancy. The intervention could be delivered during the antenatal period and there was some evidence to suggest that it could be effective. TRIAL REGISTRATION: ISRCTN44902048

Evaluation of in vitro activity of fosfomycin, and synergy in combination, in Gram-negative bloodstream infection isolates in a UK teaching hospital

Introduction. Fosfomycin has retained activity against many multi-drug resistant (MDR) Gram-negatives, and may be useful against extended spectrum beta-lactamase (ESBL) producing and carbapenem-resistant Enterobacterales to improve clinical outcomes.Hypothesis/Gap Statement. There are few data from the UK on the susceptibility of invasive Gram-negative isolates to fosfomycin, especially in the era of increasing use of oral fosfomycin for urinary tract infections (UTIs).Aim. We evaluated fosfomycin susceptibility against 100 consecutive Gram-negative bloodstream isolates, both individually, and in combination with other mechanistically similar and differing antibiotics. The aim was to investigate the synergy between antibiotic combinations against several E. coli, K. pneumoniae and P. aeruginosa isolates with variable levels of resistance.Methodology. Disc diffusion and MIC test strip methods applying revised EUCAST guidelines for Fosfomycin were used, followed by the MTS™ 'cross synergy' method for 'resistant' isolates as defined below: (a) Fosfomycin resistant by MIC test strip; (b) MDR isolates defined as being resistant to ≥3 classes of antibiotics (based on routine sensitivity testing; beta lactams were considered as a single class), and/or (c) AMP C or ESBL or carbapenemase producers (or carbapenem resistant). FIC Index (Fractional Inhibitory Concentration Index) calculations were used to interpret findings, whereby: FIC = (MICA combination A+B/ MIC agent A) + (MICB combination A+B/ MIC agent B). A result of ≤0.5 was taken to indicate 'synergy', >0.5 and ≤1.0 to indicate 'additive' effect, >1.0 and ≤4.0 to indicate 'indifference', and >4.0 to indicate 'antagonism'.Results. We found that 95/100 isolates were susceptible to fosfomycin by MIC test strip, with 88/100 isolates susceptible to fosfomycin by disc, based on EUCAST guideline breakpoints. A total of 30/100 isolates (the more 'resistant' of the 100) were eligible for synergy testing according to our definitions (see Methodology), with the remaining 70 isolates not tested further. Seventeen out of 30 were MDR, 2/30 were AMP C producers and 9/30 were ESBL producers. Overall, 34/300 (11 %) of all combination tests showed synergy and 161/300 (54 %) were additive. Synergy was most commonly detected between fosfomycin and beta-lactam antibiotics, including piperacillin/tazobactam (10/30; 33 %), ceftazidime/avibactam (10/30; 30 %), and temocillin (8/30; 27 %). An additive effect was most commonly detected with aztreonam (25/30; 83 %) and meropenem (25/30; 83 %), but 100 % indifference was found with tigecycline (30/30). No antagonism was identified with any antibiotic combination.Conclusion. Fosfomycin non-susceptibility by MIC test strip was unusual. Synergy was variable when combining fosfomycin with other antibiotics against the more 'resistant' isolates. Synergistic/additive effects were detected for beta-lactam/fosfomycin combinations in >80 % of all such combinations, suggesting beta-lactams may be the preferred partner for fosfomycin. Agents with a discordant site of action were more likely to result in indifference. Antagonism was not detected

Combining mirtazapine with SSRIs or SNRIs for treatment-resistant depression: The MIR RCT

Background: Depression is usually managed in primary care and antidepressants are often the first-line treatment, but only half of those treated respond to a single antidepressant. Objectives: To investigate whether or not combining mirtazapine with serotonin–noradrenaline reuptake inhibitor (SNRI) or selective serotonin reuptake inhibitor (SSRI) antidepressants results in better patient outcomes and more efficient NHS care than SNRI or SSRI therapy alone in treatment-resistant depression (TRD). Design: The MIR trial was a two-parallel-group, multicentre, pragmatic, placebo-controlled randomized trial with allocation at the level of the individual. Setting: Participants were recruited from primary care in Bristol, Exeter, Hull/York and Manchester/Keele. Participants: Eligible participants were aged ≥ 18 years; were taking a SSRI or a SNRI antidepressant for at least 6 weeks at an adequate dose; scored ≥ 14 points on the Beck Depression Inventory-II (BDI-II); were adherent to medication; and met the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, criteria for depression. Interventions: Participants were randomised using a computer-generated code to either oral mirtazapine or a matched placebo, starting at a dose of 15 mg daily for 2 weeks and increasing to 30 mg daily for up to 12 months, in addition to their usual antidepressant. Participants, their general practitioners (GPs) and the research team were blind to the allocation. Main outcome measures: The primary outcome was depression symptoms at 12 weeks post randomization compared with baseline, measured as a continuous variable using the BDI-II. Secondary outcomes (at 12, 24 and 52 weeks) included response, remission of depression, change in anxiety symptoms, adverse events (AEs), quality of life, adherence to medication, health and social care use and cost-effectiveness. Outcomes were analysed on an intention-to-treat basis. A qualitative study explored patients’ views and experiences of managing depression and GPs’ views on prescribing a second antidepressant. Results: There were 480 patients randomised to the trial (mirtazapine and usual care, n = 241; placebo and usual care, n = 239), of whom 431 patients (89.8%) were followed up at 12 weeks. BDI-II scores at 12 weeks were lower in the mirtazapine group than the placebo group after adjustment for baseline BDI-II score and minimisation and stratification variables [difference –1.83 points, 95% confidence interval (CI) –3.92 to 0.27 points; p = 0.087]. This was smaller than the minimum clinically important difference and the CI included the null. The difference became smaller at subsequent time points (24 weeks: –0.85 points, 95% CI –3.12 to 1.43 points; 12 months: 0.17 points, 95% CI –2.13 to 2.46 points). More participants in the mirtazapine group withdrew from the trial medication, citing mild AEs (46 vs. 9 participants). Conclusions: This study did not find convincing evidence of a clinically important benefit for mirtazapine in addition to a SSRI or a SNRI antidepressant over placebo in primary care patients with TRD. There was no evidence that the addition of mirtazapine was a cost-effective use of NHS resources. GPs and patients were concerned about adding an additional antidepressant. Limitations: Voluntary unblinding for participants after the primary outcome at 12 weeks made interpretation of longer-term outcomes more difficult. Future work: Treatment-resistant depression remains an area of important, unmet need, with limited evidence of effective treatments. Promising interventions include augmentation with atypical antipsychotics and treatment using transcranial magnetic stimulation

Whitefield News

File includes: January 2016 Volume 3, Issue 7 February 2016 Volume 3, Issue 8 March 2016 Volume 3, Issue 9 April 2016 Volume 3, Issue 10 May 2016 Volume 3, Issue 11 June 2016 Volume 3, Issue 12 July 2016 Volume 4, Issue 1 August 2016 Volume 4, Issue 2 September 2016, Volume 4, Issue 3 October 2016, Volume 4, Issue 4 November 2016, Volume 4, Issue 5 December 2016, Volume 4, Issue

<i>De Novo</i> and Rare Variants at Multiple Loci Support the Oligogenic Origins of Atrioventricular Septal Heart Defects

Congenital heart disease (CHD) has a complex genetic etiology, and recent studies suggest that high penetrance de novo mutations may account for only a small fraction of disease. In a multi-institutional cohort surveyed by exome sequencing, combining analysis of 987 individuals (discovery cohort of 59 affected trios and 59 control trios, and a replication cohort of 100 affected singletons and 533 unaffected singletons) we observe variation at novel and known loci related to a specific cardiac malformation the atrioventricular septal defect (AVSD). In a primary analysis, by combining developmental coexpression networks with inheritance modeling, we identify a de novo mutation in the DNA binding domain of NR1D2 (p.R175W). We show that p.R175W changes the transcriptional activity of Nr1d2 using an in vitro transactivation model in HUVEC cells. Finally, we demonstrate previously unrecognized cardiovascular malformations in the Nr1d2tm1-Dgen knockout mouse. In secondary analyses we map genetic variation to protein-interaction networks suggesting a role for two collagen genes in AVSD, which we corroborate by burden testing in a second replication cohort of 100 AVSDs and 533 controls (p = 8.37e-08). Finally, we apply a rare-disease inheritance model to identify variation in genes previously associated with CHD (ZFPM2, NSD1, NOTCH1, VCAN, and MYH6), cardiac malformations in mouse models (ADAM17, CHRD, IFT140, PTPRJ, RYR1 and ATE1), and hypomorphic alleles of genes causing syndromic CHD (EHMT1, SRCAP, BBS2, NOTCH2, and KMT2D) in 14 of 59 trios, greatly exceeding variation in control trios without CHD (p = 9.60e-06). In total, 32% of trios carried at least one putatively disease-associated variant across 19 loci,suggesting that inherited and de novo variation across a heterogeneous group of loci may contribute to disease risk