Modernizing Biomedical Training: Replacing Live Animal Laboratories with Human Simulation

This chapter reviews the global trend towards a modernization of biomedical education in favor of simulation-based training methods, which studies confirm improve student learning and transference of applied skills to clinical practice, reduce laboratory costs, and spare animals from harmful procedures

Exploring the use of high and low demand simulation for human performance assessment during multiorgan retrieval with the joint scrub practitioner

INTRODUCTION: The National Organ Retrieval Service (NORS) 2015 review recommended a Joint Scrub Practitioner for abdominal and cardiac teams during combined organ retrieval. To evaluate the feasibility of this role, and to understand the functional implications, this study explores the use of simulation and provides a novel and comprehensive approach to assess individual and team performance in simulated multiorgan retrievals. METHODS: Two high-fidelity simulations were conducted in an operating theatre with porcine organs, en bloc, placed in a mannequin. For donation after brainstem death (DBD) simulation, an anaesthetic machine provided simulated physiological output. Retrievals following donation after circulatory death (DCD) began with rapid arrival in theatre of the mannequin. Cardiothoracic (lead surgeon) and abdominal (lead and assistant surgeons; joint scrub practitioner, n=9) teams combined for the retrievals. Data collected before, during and after simulations used self-report and expert observers to assess: attitudinal expectations, mental readiness, mental effort, non-technical skills, teamwork, task workload and social validation perceptions. RESULTS: Attitudinal changes regarding feasibility of a joint scrub practitioner for DBD and DCD are displayed in the main body. There were no significant differences in mental readiness prior to simulations nor in mental effort indicated afterwards; however, variance was noted between simulations for individual team members. Non-technical skills were slightly lower in DCD than in DBD. Global ratings of teamwork were significantly (p<0.05) lower in DCD than in DBD. Measures of attitude indicated less support for the proposed joint scrub practitioner role for DCD than for DBD. DISCUSSION: The paper posits that the joint scrub practitioner role in DCD multiorgan retrieval may bring serious and unanticipated challenges. Further work to determine the feasibility of the NORS recommendation is required. Measures of team performance and individual psychological response can inform organ retrieval feasibility considerations nationally and internationally

Predicting Puget Sound\u27s organic carbon—and why we need enhanced monitoring

How much has the total organic carbon deposited into the water column and sediments of Puget Sound increased due to human activity? How has that increase impacted sediment flux rates, hypoxia and the carbonate system balance? These are two important questions with answers that are still elusive. To date, both marine and freshwater organic carbon measurements in Puget Sound are relatively sparse. In the long-term, inadequate temporal and spatial organic carbon data may lead to an incomplete and incoherent understanding of carbon cycling in the Puget Sound. The Salish Sea Model, developed by PNNL in collaboration with Department of Ecology, provides insights into the extent of organic carbon loading and concentrations in the Puget Sound. Model scenario runs indicate that autochtonous organic detritus derived from increased productivity related to human nitrogen loading, combined with allochthonous carbon from direct loading due to human activity, has resulted in an increased loading of non-algal organic carbon ranging from 20 and 25% in a significant portion of the Puget Sound’s main basin, as well as in multiple inlets. This increase in organic carbon is expected to have an impact in heterotrophic respiration rates and eutrophication. This presentation will focus on loading rates and predicted organic carbon concentrations throughout the Puget Sound using the Salish Sea Model. It will point to the need for enhanced dissolved and particulate organic carbon measurements in our region, as well as basin-scale measurements of respiration rates, to optimize the alignment of on-going, long term monitoring and modeling efforts

Surgical reversal of prolonged blindness from a metastatic neuroblastoma

Reports of tumor-related anterior visual pathway blindness that have resolved after surgical decompression are rare. The longest reported duration of tumor-related blindness completely reversed by optic nerve decompression is 3 days. We describe a pediatric patient with 7 days of no light perception who experienced reversal of blindness following tumor resection and optic nerve decompression.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/47141/1/381_2004_Article_1062.pd

CCRI 2017 Year in Review

This book presents an overview of CCRI's research activities during 2017

Presence of π…π and C-H…π interactions in the new Schiff base 2- {(E)-[(3-tert-butyl-1-phenyl-1H-pyrazol-5-yl)imino]methyl}phenol : experimental and DFT computational studies

A combined theoretical and experimental study on the structure, infrared and UVeVis data of 2-{(E)-[(3-tert-butyl-1-phenyl-1H-pyrazol-5-yl)imino]methyl}phenol (3), is presented. Theoretical geometry optimization and its IR spectrum were carried out using the Density Functional Theory (DFT), while for the theoretical UV-Vis spectrum, the Time-Dependent DFT (TD-DFT) method was used. The supramolecular analysis of the compound evidenced the presence of π… π interactions between the phenol and pyrazole rings and the presence of C-H … π interactions between the methyl group and the phenyl rings which form chains of molecules parallel to the plane (100)

Global epidemiology of hyperthyroidism and hypothyroidism

Thyroid hormones are essential for growth, neuronal development, reproduction and regulation of energy metabolism. Hypothyroidism and hyperthyroidism are common conditions with potentially devastating health consequences that affect all populations worldwide. Iodine nutrition is a key determinant of thyroid disease risk; however, other factors, such as ageing, smoking status, genetic susceptibility, ethnicity, endocrine disruptors and the advent of novel therapeutics, including immune checkpoint inhibitors, also influence thyroid disease epidemiology. In the developed world, the prevalence of undiagnosed thyroid disease is likely falling owing to widespread thyroid function testing and relatively low thresholds for treatment initiation. However, continued vigilance against iodine deficiency remains essential in developed countries, particularly in Europe. In this report, we review the global incidence and prevalence of hyperthyroidism and hypothyroidism, highlighting geographical differences and the effect of environmental factors, such as iodine supplementation, on these data. We also highlight the pressing need for detailed epidemiological surveys of thyroid dysfunction and iodine status in developing countries

Barriers to and enablers of diabetic retinopathy screening attendance: a systematic review of published and grey literature

AIMS: To identify and synthesize studies reporting modifiable barriers/enablers associated with retinopathy screening attendance in people with Type 1 or Type 2 diabetes, and to identify those most likely to influence attendance. METHODS: We searched MEDLINE, EMBASE, PsycINFO, Cochrane Library and the 'grey literature' for quantitative and qualitative studies to February 2017. Data (i.e. participant quotations, interpretive summaries, survey results) reporting barriers/enablers were extracted and deductively coded into domains from the Theoretical Domains Framework; with domains representing categories of theoretical barriers/enablers proposed to mediate behaviour change. Inductive thematic analysis was conducted within domains to describe the role each domain plays in facilitating or hindering screening attendance. Domains that were more frequently coded and for which more themes were generated were judged more likely to influence attendance. RESULTS: Sixty-nine primary studies were included. We identified six theoretical domains ['environmental context and resources' (75% of included studies), 'social influences' (51%), 'knowledge' (51%), 'memory, attention, decision processes' (50%), 'beliefs about consequences' (38%) and 'emotions' (33%)] as the key mediators of diabetic retinopathy screening attendance. Examples of barriers populating these domains included inaccurate diabetic registers and confusion between routine eye care and retinopathy screening. Recommendations by healthcare professionals and community-level media coverage acted as enablers. CONCLUSIONS: Across a variety of contexts, we found common barriers to and enablers of retinopathy screening that could be targeted in interventions aiming to increase screening attendance