IoT: the internal and external threat

John Curry, Senior Lecturer in Computing at Bath Spa University, and Nick Drage, a specialist in cyber security, discuss what CISOs should be doing about the security threats emanating from the internet of things

Sepsis biomarkers in unselected patients on admission to intensive or high-dependency care

Although many sepsis biomarkers have shown promise in selected patient groups, only C-reactive protein and procalcitonin (PCT) have entered clinical practice. The aim of this study was to evaluate three promising novel sepsis biomarkers in unselected patients at admission to intensive care. We assessed the performance of pancreatic stone protein (PSP), soluble CD25 (sCD25) and heparin binding protein (HBP) in distinguishing patients with sepsis from those with a non-infective systemic inflammatory response and the ability of these markers to indicate severity of illness. METHODS: Plasma levels of the biomarkers, PCT and selected inflammatory cytokines were measured in samples taken from 219 patients during the first six hours of admission to intensive or high dependency care. Patients with a systemic inflammatory response were categorized as having sepsis or a non-infective aetiology, with or without markers of severity, using standard diagnostic criteria. RESULTS: Both PSP and sCD25 performed well as biomarkers of sepsis irrespective of severity of illness. For both markers the area under the receiver operating curve (AUC) was greater than 0.9; PSP 0.927 (0.887 to 0.968) and sCD25 0.902 (0.854 to 0.949). Procalcitonin and IL6 also performed well as markers of sepsis whilst in this intensive care unit (ICU) population, HBP did not: PCT 0.840 (0.778 to 0.901), IL6 0.805 (0.739 to 0.870) and HBP 0.607 (0.519 to 0.694). Levels of both PSP and PCT reflected severity of illness and both markers performed well in differentiating patients with severe sepsis from severely ill patients with a non-infective systemic inflammatory response: AUCs 0.955 (0.909 to 1) and 0.837 (0.732 to 0.941) respectively. Although levels of sCD25 did not correlate with severity, the addition of sCD25 to either PCT or PSP in a multivariate model improved the diagnostic accuracy of either marker alone. CONCLUSIONS: PSP and sCD25 perform well as sepsis biomarkers in patients with suspected sepsis at the time of admission to intensive or high dependency care. These markers warrant further assessment of their prognostic value. Whereas previously published data indicate HBP has clinical utility in the emergency department, it did not perform well in an intensive-care population

A longitudinal interpretative phenomenological analysis of the process of kidney recipients’ resolution of complex ambiguities within relationships with their living donors

Much previous research into living kidney donation has focused on the decision making of the donor, despite evidence suggesting this may be a more psychologically challenging time for the recipient. This longitudinal study explores the experiences of four recipients of kidneys from living donors throughout the transplant process. Transcripts were analysed using Interpretative Phenomenological Analysis (IPA). Three themes arose from the data, which were: Changing perceptions of relationships with kidney donors; Upbeat, temporal strategies for remaining positive; and Journey of the self. Findings from the first theme are presented in detail here. It was found that each participants’ relationship with their donor grew and developed in different ways, presenting their own complex challenges in terms of developing relationships and ambiguity around the decision to use the chosen donor

Historical trends of PBDEs and HBCDs in sediment cores from Sydney estuary, Australia

This paper presents the first historical data on the occurrence of polybrominated diphenyl ethers (PBDEs) and hexabromocyclododecane (HBCDs) in estuarine sediment from Australia. Sediment cores and surficial sediment samples were collected from four locations within Sydney estuary, Australia. Large increases in concentrations were observed for all compounds between 1980 and 2014, especially for BDE-209 (representative usage of Deca-BDE commercial mixture), which was found in surficial sediment at an average concentration of 42 ng/g thy wt (21-65 ng/g dry wt). PBDE congeners representative of both the Penta- and Octa-BDE commercial mixtures (Sigma 6PBDEs) were also found in their highest concentrations in surficial sediments (average: 1.3 ng/g dry wt; range: 0.65-2.5 ng/g dry wt). PBDE concentrations in surficial sediments were relatively high when compared with those presented in the available literature. This suggests that their input into the Sydney estuary has not decreased since their bans almost a decade earlier. After a sharp increase in the 1990s, HBCD concentrations peaked at an average of 3.5 ng/g dry wt (1.8-53 ng/g dry wt) in surficial samples. With global legislation on HBCDs allowing its usage for the next 10 years, it is expected that its input into the estuary is likely to continue. (C) 2015 Elsevier B.V. All rights reserved

Dental and maxillofacial radiology: confidence, knowledge and skills in the newly graduated dentist

Introduction The UK General Dental Council says that the new graduate will have the range of skills required to begin working as part of a dental team and be well-prepared for independent practice. This study examines the views of new dental graduates in the area of dental and maxillofacial radiology. Materials and methods A questionnaire survey of newly graduated dentists in Wales and South West England asked about their experience of undergraduate education in dental and maxillofacial radiology, and their confidence in the use and interpretation of imaging techniques in early independent practice. Results Most survey participants were confident in the teaching they had received in dental radiography and radiology, and that they could apply their knowledge and understanding to the more common investigations used in general dental practice. They were less confident in the uncommonly used techniques, such as oblique lateral and lateral cephalometric views. Discussion This study is encouraging in that new dental graduates say that their undergraduate education has given them the knowledge to be able to take, interpret and make clinical diagnoses using the commonest radiological investigations. This tends to validate the undergraduate education received and identifies areas to improve. Conclusion New dental graduates are confident in their knowledge and skills, and apply these to the most commonly used radiological investigations used in general dental practice

Ultrasound-guided fine-needle aspiration cytology of lesions in the head and neck performed without local anaesthesia – An analysis of pain perception

Introduction Ultrasound-guided fine-needle aspiration cytology is commonly carried out in the head and neck. The aim was to examine the amount of pain experienced by patients undergoing this procedure carried out without the use of local anaesthetic. Methods A questionnaire was given to 109 consecutive patients undergoing ultrasound-guided fine-needle aspiration cytology containing a visual analogue scale. Patients were asked to mark with a vertical line on the 100 mm horizontal scale amount of pain they experienced during the biopsy. The pain was subsequently categorised as ‘no pain’, ‘mild pain’, ‘moderate pain’ or ‘severe pain’ based on previous pain studies. Results Hundred patients completed the visual analogue scale section of the questionnaire satisfactorily. Twenty-one patients experienced no pain, 62 experienced mild pain and 17 experienced moderate pain. No patients experienced severe pain. Further analysis showed that females had significantly higher visual analogue scale scores (Mann–Whitney test: U = 925.5, z = 2.211, P = 0.027). Patients who were aware that they were going to have a biopsy had significantly lower visual analogue scale scores than those who were not aware (Mann–Whitney test: U = 859.5, z = 2.263, P = 0.024). Conclusions Ultrasound-guided fine-needle aspiration cytology is generally a well-tolerated procedure with pain scores being higher in females. It is advised that patients are told by the referring clinician the need for biopsy as this reduces the amount of pain experienced. Keywords: Biopsy, ultrasound, pai

Desensitization protocol enabling pediatric crossmatch-positive renal transplantation: successful HLA-antibody-incompatible renal transplantation of two highly sensitized children

BACKGROUND: Renal transplantation improves quality of life (QoL) and survival in children requiring renal replacement therapy (RRT). Sensitization with development of a broad-spectrum of anti-HLA antibodies as a result of previous transplantation or after receiving blood products is an increasing problem. There are no published reports of desensitization protocols in children allowing renal transplantation from HLA-antibody-incompatible living donors. METHODS: We adopted our well-established adult desensitization protocol for this purpose and undertook HLA antibody-incompatible living donor renal transplants in two children: a 14-year-old girl and a 13-year-old boy. RESULTS: After 2 and 1.5 years of follow-up, respectively, both patients have stable renal allograft function despite a rise in donor-specific antibodies in one case. CONCLUSIONS: HLA-incompatible transplantation should be considered in selected cases for sensitized children

LGBT+ Health Teaching within the Undergraduate Medical Curriculum

INTRODUCTION: The lesbian, gay, bisexual, and transgender (LGBT+) population experience health and social inequalities, including discrimination within healthcare services. There is a growing international awareness of the importance of providing healthcare professionals and students with dedicated training on LGBT+ health. // METHODS: We introduced a compulsory teaching programme in a large London-based medical school, including a visit from a transgender patient. Feedback was collected across four years, before (n = 433) and after (n = 541) the session. Student confidence in using appropriate terminology and performing a clinical assessment on LGBT+ people was assessed with five-point Likert scales. Fisher exact tests were used to compare the proportion responding "agree" or "strongly agree". // RESULTS: Of the students, 95% (CI 93-97%) found the teaching useful with 97% (96-99%) finding the visitor's input helpful. Confidence using appropriate terminology to describe sexual orientation increased from 62% (58-67%) to 93% (91-95%) (Fisher p < 0.001) and gender identity from 41% (36-46%) to 91% (88-93%) (p < 0.001). Confidence in the clinical assessment of a lesbian, gay or bisexual patient increased from 75% (71-79%) to 93% (90-95%) (p < 0.001), and of a transgender patient from 35% (31-40%) to 84% (80-87%) (p < 0.001). // DISCUSSION: This teaching programme, written and delivered in collaboration with the LGBT+ community, increases students' confidence in using appropriate language related to sexual orientation and gender identity, and in the clinical assessment of LGBT+ patients

High alcohol intake in deceased donors has no effect on pancreas graft survival: a registry analysis

Outcomes of pancreas transplantation from donors with high alcohol consumption are poorly described. The UK Transplant Registry was used to determine whether donor alcohol intake influenced pancreas survival in simultaneous pancreas–kidney (SPK) transplants performed between 2006 and 2012 (n = 770). Recipients were stratified by donor alcohol intake: group I (n = 122)—high recent alcohol intake (>21 or >14 units of alcohol/week in males or females, respectively) or previous alcohol abuse and group II (n = 648)—low/unknown current intake and no previous alcohol abuse. Median current alcohol intake was higher in group I than group II: 36.3 vs. 10 units/week; P 50 units/week (P = 0.41). Pancreas donors with past alcohol abuse or current high intake are common, and graft outcomes appear to be acceptable. This analysis suggests that high donor alcohol intake, by itself, should not exclude consideration of pancreas transplantation