Public Health England's recovery tools: potential teaching resources?

The file attached to this record is the author's final peer reviewed version.Training to combat chemical and radiation accidents, incidents or attacks is critical for health professionals due to recent events involving these hazards or their use as unconventional weapons, such as the use of the nerve agent novichok in Salisbury, UK. Health professionals need to have appropriate knowledge and skills to effectively respond to future events involving any of these substances, which requires a rapid and coordinated response from different professionals to protect the environment and minimise the number of people exposed and reduce morbidity and mortality. However, despite chemical and radiation incidents becoming increasingly prevalent, literature reviews have shown that there is a lack of teaching of appropriate competences to face future crises in Europe, particularly amongst clinicians and other health professionals that would be part of the initial response. Thus, De Montfort University (DMU, UK) in collaboration with different academics from the University of Alcalá (Spain) and researchers from Public Health England (PHE) with comprehensive experience in environmental decontamination and restoration, have created a short training course for providing undergraduate/postgraduate students with basic skills to respond to chemical incidents, basic skills that are based on the major competences recently identified by the European Commission [1]. This novel training has been tested with students from different backgrounds in various European universities, recording high degrees of acquisition of the various basic competences that we developed to initially respond to chemical events [2]. To develop the practical part of this chemical training, we have incorporated the novel guidance and methodology developed by PHE to successfully tailor a protection and recovery response to any incident involving chemical substances, which is available in the “UK Recovery Handbook for Chemical Incidents” [3] and its web-based tools: “Chemical Recovery Navigation Tool” (CRNT, [4]) and “Chemical Recovery Record Form” (CRRF, [5]). These innovative resources aid the user to select effective protection, decontamination and restoration techniques or strategies from a pool of up-to-date options applicable to different environments according to the physicochemical properties of the chemical(s) involved and the area affected. The CRNT is accompanied by the CRRF, which facilitates collection and analysis of the necessary data to inform decisions, and an e-learning resource named “Chemical Recovery: Background” (CRB, [6]), which could facilitate the learning of environmental decontamination and restoration. We are currently developing a short training course to cover minor radiation incidents; this radiation training will follow the same methods used to develop the chemical training, but with the specific PHE recovery tools to tackle such events, specifically the “UK Recovery Handbooks for Radiation Incidents” [7] and its associated web-based tools “Radiation Recovery Navigation Tool” (Rad RNT, [8]), one for each environment: food production systems, inhabited areas and drinking water supplies. This communication will explore the use of the PHE’s Recovery Navigation Tools as potential resources to facilitate the acquisition of basic knowledge to tailor protection and recovery interventions for minor chemical and radiation incidents to protect the public

Levels of rare earth elements in hair from a group of young Spanish adults (aged 20-24 years).

The Publisher's final version can be found by following the DOI link.The rapid agricultural, medical and industrial development is occurring on a global scale and bringing with emerging environmental threats for humans. Contamination by rare earth elements (REE) has emerged as a public health concern due to their numerous applications in the current industry. However, little is known about their toxicological effects despite they can accumulate in different organs including brain and bone. To determine the exposure to these contaminants in a young Spanish population, scalp hair samples were collected in 37 young adults (20 to 24 years-old; 28 female and 9 male) from different towns in the Community of Madrid (Spain). Despite being controversial, human hair could be an appropriate tool to determine environmental exposure to inorganic metal contaminants and to estimate the chemical burden in the individual. Lanthanum (La), cerium (Ce), praseodymium (Pr), erbium (Er) and gadolinium (Gd) were analysed in these samples by ICP-MS following appropriate methodologies. The limits of detection were (in ng/g): La (1.87), Ce (4.29), Pr (0.47), Er (0.06) and Gd (0.24 ng/g). Gd was detected only in one of the monitored samples (2.66 ng/g). The concentrations were as follow (median and percentiles are provided in ng/g): La 5.30 (4.22, 7.13), Ce 11.18 (8.97, 15.45), Pr 1.28 (1.04, 1.72) and Er 0.19 (0.14, 0.28). In general, the presence of these metals in the Spanish group’s hair monitored were lower than those reported in environmentally exposed groups, which may indicate that the studied group would have a low exposure to REE. None of these elements showed influence due to sex, although slightly higher levels were observed for La (5.57 vs. 5.17 ng/g), Pr (1.40 vs. 1.27 ng/g), Nd (2.48 vs. 2.29 ng/g) and Er (0.21 vs. 0.19 ng/g) in men’s hair and in women’s hair for Ce (11.58 vs 10.30 ng/g). Despite is unclear, our results would be in agreement with those studies that have suggested that men may be more sensitive to REE than women

Introducing medical parasitology at the University of Makeni, Sierra Leone

The file attached to this record is the author's final peer reviewed version.Capacity building in Sierra Leone (West Africa) is critical to prevent potential future outbreaks similar to the 2013-16 Ebola outbreak that had devastating effects for the country and its poorly developed healthcare system. De Montfort University (DMU) in the United Kingdom (UK), in collaboration with parasitologists from the Spanish Universities of San Pablo CEU and Miguel Hernández de Elche, is leading a project to build the teaching and research capabilities of medical parasitology at the University of Makeni (UniMak, Sierra Leone). This project has two objectives: a) to introduce and enhance the teaching of medical parasitology, both theoretical and practical; and b) to implement and develop parasitology research related to important emerging human parasites such as Cryptosporidium spp. due to their public health significance. Two UniMak academics, hired to help initiate and implement the research part of the project, shared their culturally sensitive public health expertise to broker parasitology research in communities and perform a comprehensive environmental monitoring study for the detection of different emerging human parasites. The presence of targeted parasites are being studied microscopically using different staining techniques, which in turn have allowed UniMak’s academics to learn these techniques to develop new practicals in parasitology. To train UniMak’s academics and develop both parts of our project, a DMU researcher visited UniMak for two weeks in April 2019 and provided a voluntary short training course in basic parasitology, which is currently not taught in any of their programmes, and was attended by 31 students. These sessions covered basic introduction to medical parasitology and life-cycle, pathogenesis, detection, treatment and prevention of: a) coccidian parasites (Cryptosporidium, Cyclospora and Cystoisospora); b) Giardia intestinalis, Entamoeba and free-living amoebas; c) malaria and d) microsporidia. A theoretical session on common staining techniques was also provided. To facilitate the teaching and learning of these parasites, the novel resource DMU e-Parasitology was used, a package developed by the above participating universities and biomedical scientists from the UK National Health Service (NHS): http://parasitology.dmu.ac.uk/ index.htm. Following the two weeks of training, UniMak’s academics performed different curriculum modifications to the undergraduate programme ‘Public Health: Medical Laboratory Sciences’, which includes the introduction of new practicals in parasitology and changes to enhance the content of medical parasitology that will be subjected to examination. Thus, a new voluntary practical on Kinyoun stain for the detection of coccidian parasites was introduced in the final year module of ‘Medical Bacteriology and Parasitology’; eighteen students in pairs processed faecal samples from pigs provided by the Department of Agriculture and Food Security from a nearby farm. Academics at UniMak used the Kinyoun staining unit (available at http://parasitology.dmu.ac.uk/learn/lab/Kinyoun/story_html5.html; [1]) to deliver this practical. Although our project is at a preliminary stage, it has been shown to be effective in promoting the introduction and establishment of medical parasitology at UniMak and could be viewed as a case-study for other universities in low-income countries to promote the United Nations (UN) Sustainable Development Goals (SDGs) and improve public health understanding of infectious diseases

Applicability of monthly CDC case studies to improve reflection in biomedical science students.

Background Academics from De Montfort University (DMU, UK) in collaboration with other EU universities, virologists and first responders are developing training for health science students to deal with biological incidents. Initially the training is being tested with final year students enrolled on the BSc Biomedical Science (Hons) and in the BMedSci Medical Science (Hons) degree programmes in 2016/17 at DMU. To improve the limited clinical skills of these students, a series of parasitology case studies have been introduced, where students will need to reflect on their knowledge and search for information from different sources to propose possible diagnoses. Reflection is an essential learning tool for developing aspects such autonomous working, critical and analytical thinking and integration of theory with practice (Quintanilla et al., 2016). Methods A series of teaching sessions (theoretical and practical) has been created related to emergency preparedness and response (Peña-Fernández et al., 2016). Students are provided with different scenarios to develop an intervention programme to protect human health in the aftermath of a biological incident involving different biological agents including emerging parasites. During the theoretical component of the training students are provided with different slides collected from the Laboratory Identification of Parasitic Diseases of Public Health Concern (DPDx) (CDC, 2016). Students, by peer group interaction, provide a possible “diagnosis” for each clinical case based on the clinical features presented and microscopic slides provided. Critical thinking is encouraged. Results Although our results are preliminary and we need to evaluate the students’ feedback, the introduction of clinical case-studies has shown to facilitate the acquisition of some clinical skills, particularly in the biomedical science cohort. This is informed by the high level of students’ interaction during these sessions and the formulation of appropriate questions. Students have also shown some gradual improvement in the resolution of clinical case studies throughout the course. Conclusions Despite the fact that student feedback will not be collected until the end of the course, students have display strong engagement and interest in these workshops through interim module level feedback. A priori, these case-studies have been shown to be effective in facilitating the acquisition of different transversal competences including critical thinking, clinical skills, communication and team work

Interest shown by medical students at University of San Pablo CEU (Spain) regarding prevention and response to outbreaks of infection

The release of biological hazards during biological incidents, bioterrorism or outbreaks of infection has shown to represent a significant challenge for healthcare professionals as it can involve significant numbers of patients and represent a global public health threat. Healthcare educators should provide students with the necessary skills in medical preparedness and response to these incidents to protect the public. However, this is not standardised in the medical curriculum. An innovative teaching group at De Montfort University (DMU, UK) in collaboration with first responders that worked during the 2014-2016 Ebola outbreak in a Public Health England (PHE) mobile laboratory in Sierra Leone, have developed different, novel teaching training sessions to provide health science students with the necessary skills to respond to these events. We have tested the training sessions with students from three different undergraduate (BSc Biomedical and Medical Science) and postgraduate (MSc Advanced Biomedical Science) human health programmes at DMU. In general, these sessions were shown to be successful in providing students with basic skills to respond to minor biological incidents (Peña-Fernández et al., 2017), although we do not know if these could be adopted to develop standardized curricula across any human health degree in the European Union (EU). Therefore, the purpose of this work was twofold: a) to assess the effectiveness of the specialised training session that covers the medical response to protect public health with medical students; and b) to determine the effectiveness of the training session, initially developed in England, in a non-English EU university. To meet these objectives, we have simplified this specialised training and delivered it to final year students of the Medicine degree at the University of San Pablo CEU (USP-CEU, Spain) during an Eramus+ mobility grant for academics in April 2017. The two hour training provided consisted of developing a complete intervention programme to deal with an outbreak of Crimean-Congo haemorrhagic fever (CCFH) virus following the steps of evidence-based public health. CCFH is a haemorrhagic fever virus causing devastating disease symptoms that result in intense and prolonged suffering in humans and has become an increasing global health concern. This paper will describe the teaching resources used and a comprehensive analysis of students’ feedback to this training. Briefly: the specific questionnaire used has shown high levels of engagement and satisfaction [100% (31.2% agreed; 68.8% strongly agreed)] with the USP-CEU medical students. Despite its short duration, this training would be successful in providing medical students with the necessary skills to respond to a biological event. Thus, 100% (31.2% agreed; 68.8% strongly agreed) of these students reported that they learnt how to establish some public health interventions to protect humans in the aftermath of an outbreak of infection. Moreover, all USP-CEU responders have described that they gained appropriate knowledge of public health prevention and preparedness against these events (37.5% agreed; 62.5 strongly agreed). Finally, the Erasmus+ mobility grant for academics has been shown to be a relevant tool and resource to strengthen curricula development and validation in higher education

Negative capacitance in multidomain ferroelectric superlattices

The stability of spontaneous electrical polarization in ferroelectrics is fundamental to many of their current applications, which range from the simple electric cigarette lighter to non-volatile random access memories1. Research on nanoscale ferroelectrics reveals that their behaviour is profoundly different from that in bulk ferroelectrics, which could lead to new phenomena with potential for future devices2, 3, 4. As ferroelectrics become thinner, maintaining a stable polarization becomes increasingly challenging. On the other hand, intentionally destabilizing this polarization can cause the effective electric permittivity of a ferroelectric to become negative5, enabling it to behave as a negative capacitance when integrated in a heterostructure. Negative capacitance has been proposed as a way of overcoming fundamental limitations on the power consumption of field-effect transistors6. However, experimental demonstrations of this phenomenon remain contentious7. The prevalent interpretations based on homogeneous polarization models are difficult to reconcile with the expected strong tendency for domain formation8, 9, but the effect of domains on negative capacitance has received little attention5, 10, 11, 12. Here we report negative capacitance in a model system of multidomain ferroelectric–dielectric superlattices across a wide range of temperatures, in both the ferroelectric and paraelectric phases. Using a phenomenological model, we show that domain-wall motion not only gives rise to negative permittivity, but can also enhance, rather than limit, its temperature range. Our first-principles-based atomistic simulations provide detailed microscopic insight into the origin of this phenomenon, identifying the dominant contribution of near-interface layers and paving the way for its future exploitation

UK recovery guidance and advice for the remediation of the environment following a chemical incident.

Global events have shown that chemical incidents can have huge consequences on human health, the environment and society. It is important that in the event of such an occurrence, the appropriate tools and technical guidance are available to ensure that remediation can be completed quickly and efficiently. Public Health England (PHE) is leading the development of a series of recovery handbooks with support from other Government Departments and Agencies. The UK Chemical Recovery Handbook was published in 2012[1], and includes guidance and advice on the recovery and remediation of the environment in the post-accident (post-acute) phase and focusses on environmental clean- up methods. The Handbook provides a framework for developing and selecting an effective recovery strategy following a chemical incident, and contains a compendium of practicable, evidence based recovery options for Inhabited Areas, Food Production Systems and Water Environments [2]. Public Health England is also developing a chemical and radiation recovery decision support tool, in collaboration with UK Government Departments and Agencies. It is envisaged that the decision support tool will assist users navigating through the recovery handbooks and provide a consistent methodology to compare remediation techniques and a framework for documenting the parameters, assumptions and information used to reach the decision on how to remediate the affected environment following a chemical or radiation incident. [1] Wyke-Sanders et al. (2012). The UK Recovery Handbook for Chemical Incidents. Available at: https://www. gov.uk/government/collections/recovery- remediation-and-environmental- decontamination [2] Nisbet et al. (2009). UK Recovery Handbooks for Radiation Incidents. Available at: https://www.gov.uk/ government/collections/recovery- remediation-and-environmental- decontaminatio

Curriculum modifications for teaching parasitology and infectious diseases in a Biomedical Science degree

The file attached to this record is the author's final peer reviewed version. The Publisher's final version can be found by following the DOI linkRecent outbreaks threatening public health involving contaminated water or food with different microorganisms such as Escherichia coli or Cyclospora spp. in Europe as well as the 2014-16 Ebola crisis in West Africa have highlighted the relevance of teaching parasitology and infectious diseases to future biomedical scientists. The BSc Biomedical Science (BMS) programme at De Montfort University (DMU, Leicester, UK) is accredited by the Institute of Biomedical Sciences (IBMS). However, the dedicated time to study these topics was very little, limited to two 15 credit modules focused on general and basic medical microbiology. A series of important modifications have been undertaken since 2016 to ensure that our graduates receive comprehensive knowledge in parasitology/infectious diseases following the subject-specific threshold standards described by the Quality Assurance Agency (QAA, 2015). New lectures in these topics (virus, fungi, helminths, infectious diseases) were incorporated in our Basic Microbiology level 4 module after expanding this to 30 credits in the academic course 2016/17. Highly specialised training related with emerging parasites (e.g. Cyclospora, microsporidia) and haemorrhagic fever virus (e.g. Crimean-Congo Haemorrhagic Fever virus) was introduced in our level 6 Medical Microbiology module (15 credits), based on a successful novel teaching experience created by first responders to the Ebola outbreak in West Africa. Validated feedback questionnaires to assess the training were collected as well as final module level feedback (MLF) for each module through Blackboard. Students have highlighted high levels of engagement in both modules, specifically in the training provided in Medical Microbiology (n=121). Thus, some students have highlighted in the MLF that the case studies (e.g. related with free-living amoebas and Cyclospora spp.) “improved my understanding” and were “engaging”. The specific questionnaire has highlighted that 77.5% of final year students enjoyed the novel workshop created to respond to an outbreak of infection affecting the UK following evidence-based public health methodology. However, the module that has shown more improvement in the students’ satisfaction was Basic Microbiology (n=196), which showed a significant increase from 20% in the 2015/16 academic year to 64% in the current academic session. The MLF of Basic Microbiology has also reported the following results: 95% (41% definitely agree, 54% agree) of students have highlighted that this first year module provided them with opportunities to apply what they learnt; and 94% considered that the feedback provided was clear and fair. Despite these results should be considered as preliminary, we consider that the initial changes undertaken in the BMS programme at DMU to date could improve students’ understanding of emerging diseases, specifically about how to study and prevent emerging infectious diseases to protect public health. Future proposed improvements include the development of a complete e-learning package for students and academics for teaching these topics in collaboration with Universities from Spain and practising Biomedical Scientists from the National Health Service. These resources will be accessible throughout 2017/18

Potential presence of microsporidia in clinical faecal specimens from the Isle of Man.

Human-related microsporidia Enterocytozoon bieneusi and Encephalitozoon spp. have emerged as opportunistic infectious agents affecting both immunocompromised and immunocompetent individuals. A pilot study to determine the potential presence of microsporidia in the general population that have attended Nobles’ Hospital in Isle of Man (UK) since January 2018 was performed. Thirty eight faecal samples submitted to the Nobles’ Hospital microbiology lab for routine testing were analysed via microscopy using the Modified Trichrome stain. Encephalitozoon spp. spores were observed in 4 samples, specifically 3 female from a range of ages (24 yr, 65yr and 89 yr old) and one male (69 yr old). These four patients were presented with diarrhoea in a semi-liquid/liquid form. Other symptoms included vomiting (89 yr old female), abdominal pain (24 yr old female), right flank pain (68 yr old male), dehydration (89 yr old female) and acute kidney injury (89 yr old female). Campylobacter spp. growth was also detected in one sample (65 yr old female). Although preliminary, our results indicate Encephalitozoon spp. were observed in faecal samples from patients in the Isle of Man presenting with diarrhoea, for which further studies will be required to determine the species and the pathogenic involvement of these pathogens in these patients. To our knowledge, this is the first study of the presence of microsporidia in human faecal samples in Isle of Man. A more comprehensive study is needed to determine the occurrence of microsporidia in patients attending with a diarrheic picture to focus attention on the need to include microsporidial diagnosis in their management