Innovation and adaptation in the Ontario grape and wine industry: An integrated, transdisciplinary response to climate change

With scientific consensus supporting a 4oC increase in global mean temperature over the next century and increased frequency of severe weather events, adaptation to climate change is critical. Given the dynamic and complex nature of climate change, a transdisciplinary approach toward adaptation can create an environment that supports knowledge sharing and innovation, improving existing strategies and creating new ones. The Ontario wine industry provides a case study to illustrate the benefits of this approach. We describe the formation and work of the Ontario Grape and Wine Research Network within this context, and present some preliminary results to highlight the opportunities for innovation that will drive the successful adaption of the Ontario grape and wine industry.Thank you to all our partners in The Ontario Grape and Wine Research Network. The support of the Ontario Research Fund for Research Excellence Funding (Round 5), Ontario Grape and Wine Research Inc., the Wine Council of Ontario, the Grape Growers of Ontario, and the Winery and Growers Alliance of Ontario is gratefully acknowledged

The significance of seniority for women managers’ interpretations of organizational restructuring

This paper examines the impact of restructuring within the transport and logistics sector on women managers working at senior and less senior (middle/junior management) levels of the organization. The majority of women experienced increased performance pressures and heavier workloads as well as an increase in working hours. At the same time, there were pressures to work at home (i.e. week-ends and evenings) and reduced opportunities to work from home (i.e. during normal office hours). Management level emerged as an important factor in how these changes were interpreted. Senior managers perceived more positive outcomes in terms of increased motivation and loyalty. Despite a longer working week, they were less likely to report low morale as an outcome from long hours. In fact, irrespective of management level, women working shorter hours were more likely to report low morale as an outcome. Results are discussed in relation to literature on restructuring and careers, in terms of perceptual framing and in relation to different levels of investment in the organization

Implementation of electronic patient clinical records in ambulances in the UK: a national survey.

Background: The roll-out of electronic Patient Clinical Records (ePCR) across UK ambulance services has been an important aspect of modernisation. Electronic Records in Ambulances (ERA) is a two-year study which aims to describe the opportunities and challenges of implementing ePCR and associated technology in emergency ambulances. Our study includes a baseline survey of progress implementing ePCR in all UK ambulance services providing a snapshot of current usage. Methods: We carried out semi-structured telephone interviews with information managers in each ambulance service in the UK. We asked them about the systems in use, the process and current stage of implementation and explored the perceived value of using ePCR. If services did not use ePCR we asked about plans for future introduction. The interviews were transcribed and thematically analysed, by three members of the research team. Results: We completed interviews with 22 managers from 13 services. Implementation varied across the UK. Seven services were using electronic records. Four services had adopted electronic records but, at the time of interview, had reverted to paper with the intention of implementing a new ePCR. Two services still used paper but hoped to move to ePCR in the future. Those who had fully implemented ePCR reported mixed success in terms of staff compliance, and in realising the potential benefits offered by ePCR to link with primary and secondary care

LKB1 Inactivation Dictates Therapeutic Response of Non-Small Cell Lung Cancer to the Metabolism Drug Phenformin

SummaryThe LKB1 (also called STK11) tumor suppressor is mutationally inactivated in ∼20% of non-small cell lung cancers (NSCLC). LKB1 is the major upstream kinase activating the energy-sensing kinase AMPK, making LKB1-deficient cells unable to appropriately sense metabolic stress. We tested the therapeutic potential of metabolic drugs in NSCLC and identified phenformin, a mitochondrial inhibitor and analog of the diabetes therapeutic metformin, as selectively inducing apoptosis in LKB1-deficient NSCLC cells. Therapeutic trials in Kras-dependent mouse models of NSCLC revealed that tumors with Kras and Lkb1 mutations, but not those with Kras and p53 mutations, showed selective response to phenformin as a single agent, resulting in prolonged survival. This study suggests phenformin as a cancer metabolism-based therapeutic to selectively target LKB1-deficient tumors

Ambulance attendance for Substance and/or Alcohol use in a Pandemic (ASAP): Interrupted time series analysis of incidents

Introduction: The Ambulance attendance for Substance and/or Alcohol use in a Pandemic (ASAP) study explores incidents during the COVID-19 lockdown in the East Midlands region of the United Kingdom (23/03/2020-04/07/2020). Method: Retrospective cross-sectional count per day of ambulance attendances from the East Midlands Ambulance Service Trust. Ambulance attendances relating to alcohol or other drug use in the year prior, during lockdown, and weeks following, were examined using interrupted time series analysis by patient demographics and geographical location. Results: 36,104 records were identified (53.7% male, 84.5% ethnicity classified as white, mean age 38.4 years). A significant drop in the number of attendances per day at the start of lockdown (-25.24, CI -38.16, -12.32) was observed, followed by gradual increase during the ongoing lockdown period (0.36, CI 0.23, 0.46). Similar patterns were found across genders, age groups 16-64, and urban/rural locations. Discussion: The pattern of ambulance attendances for alcohol or other drug use changed during the COVID-19 lockdown period. Conclusion: Lockdown significantly affected the use of ambulances for incidents involving alcohol or other drug use, impacting on healthcare services. Further research into hazardous use of alcohol or other drugs during the lockdown periods is needed to inform policy, planning and public health initiatives

Randomised controlled trial of an innovative hypoglycaemia pathway for self-care at home and admission avoidance: a partnership approach with a regional ambulance trust

Background: Hypoglycaemia is a common and potentially life-threatening condition in people with diabetes, commonly caused by medications such as insulin. Hypoglycaemic events often require in-patient treatment and/or follow-up with a diabetes specialist nurse (DSN) or GP to make adjustments to medication. This referral pathway commonly relies on patient self-referral to primary care, and as a result many patients are not actively followed up and go on to experience repeat hypoglycaemic events. Methods: Randomised controlled trial in partnership with East Midlands Ambulance Service NHS Trust. People with diabetes calling out an ambulance for a severe hypoglycaemic episode and meeting the eligibility criteria were randomised to either a novel DSN-led pathway or to their general practice for routine follow-up. Primary outcome was proportion of participants with a documented consultation with a healthcare professional to discuss the management of their diabetes within 28 days of call-out. Results: 162 people were randomised to one of the pathways (73 DSN arm, 89 GP arm) with 81 (50%, 35 DSN, 46 GP) providing full consent to be followed up. Due to lower than anticipated randomisation and consent rates, the recruitment target was not met. In the 81 participants who provided full consent, there were higher rates of consultation following the call-out when referred to a DSN compared to primary care (90% vs. 65%). Of the 81 participants, 26 (32%) had a second call-out within 12 months. Conclusions: Consultation rates following the call-out were high in the DSN-led arm, but there was insufficient power to complete the planned comparative analysis. The study highlighted the difficulty in recruitment and delivery of research in pre-hospital emergency care. Further work is needed to provide more feasible study designs and consent procedures balancing demands on ambulance staff time with the need for robust well-designed evaluation of referral pathways

MMP-1 activation contributes to airway smooth muscle growth and asthma severity

Introduction: Matrix metalloproteinase-1 and mast cells are present in the airways of people with asthma. We hypothesised that matrix metalloproteinase-1 could be activated by mast cells and increase asthma severity. Methods: Patients with stable asthma and healthy controls underwent spirometry, methacholine challenge, bronchoscopy and their airway smooth muscle cells were grown in culture. A second asthma group and controls had symptom scores, spirometry and bronchoalveolar lavage before and after rhinovirus-induced asthma exacerbations. Extra-cellular matrix was prepared from decellularised airway smooth muscle cultures. Matrix metalloproteinase-1 protein and activity were assessed. Results: Airway smooth muscle cells generated pro-matrix metalloproteinase-1 which was proteolytically activated by mast cell tryptase. Airway smooth muscle treated with activated mast cell supernatants produced extra-cellular matrix which enhanced subsequent airway smooth muscle growth by 1.5 fold (p<0.05) which was dependent on matrix metalloproteinase-1 activation. In asthma, airway pro-matrix metalloproteinase-1 was 5.4 fold higher than control subjects (p=0.002). Mast cell numbers were associated with airway smooth muscle proliferation and matrix metalloproteinase-1 protein associated with bronchial hyper-responsiveness. During exacerbations, matrix metalloproteinase-1 activity increased and was associated with fall in FEV1 and worsening asthma symptoms. Conclusions: Matrix metalloproteinase-1 is activated by mast cell tryptase resulting in a pro-proliferative extra-cellular matrix. In asthma, mast cells are associated with airway smooth muscle growth, matrix metalloproteinase-1 levels are associated with bronchial hyper-responsiveness and matrix metalloproteinase-1 activation with exacerbation severity. Our findings suggest that airway smooth muscle/mast cell interactions contribute to asthma severity by transiently increasing matrix metalloproteinase activation, airway smooth muscle growth and airway responsiveness

Whitefield News

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