Outbreak of influenza A(H1N1) in a school in southern England

An outbreak of influenza A (subtype H1N1) has occurred in a primary school in West Sussex, southern England [1]. The first cases of illness occurred during the first week of May 2004. One child was admitted to hospital during that week with symptoms of fever, confusion, headache, and conjunctivitis. Staff reported the outbreak to the local health authorities when substantial numbers of children developed symptoms of fever, nausea, vomiting, cough, and sore throat. Information collected through a questionnaire distributed to parents whose children had been absent from school suggested a respiratory viral illness with a serial interval of one to three days, and duration of one to seven days

Educational journeys to colorectal surgical expertise: The place and impact of simulation training

Introduction: This thesis explores how surgical trainees engage in simulation-based training (SBT) as part of a structured programme and how they relate their training to the practice of laparoscopic colorectal surgery in the operating theatre (OT). Both these environments have their own sociocultural fingerprint, that is, social, cultural and cognitive patterns of activity, with a language and discourse unique to them. Conventional insights on how SBT benefits surgical practice outcomes are indicated by improved individual performance in specific technical tasks. In contrast, this thesis explores the strength of the social discourse in which such learning is situated, which mediates SBT to the OT. The research questions are: • Through what social mechanisms are the complex clinical skills of surgery learnt through the Welsh Laparoscopic Colorectal Training Scheme (WLCTS), and translated into the operating theatre context? • How do laparoscopic colorectal trainees perceive the value of and make their training meaningful? • How could the learning theories discussed, inform a framework which can both acknowledge the social experience of simulation in facilitating the negotiation of learning and enable the professional development of the trainees? Deep learning is a social exercise in the creation of ‘semiotic’ signals through negotiating multiple channels of social and material activity. Distributed cognition (DCog) and Cultural-Historical Activity Theory (CHAT) are employed as organising theoretical principles. Methodology: Eight participants were observed across two hemicolectomy courses in the Welsh Laparoscopic Colorectal Training Scheme, where task completion required working in pairs. Over 11 hours of video data were analysed for trainee interactions across the simulated operating table. Scores were assigned to trainees’ prior experience and changes in task complexity and partial regression analysis was used to explore relationships. Nine guided conversation-style interviews were conducted with colorectal trainees immediately after the courses, followed again six to eight months later with seven participants, where they described how they made sense of their co-participation in simulation within their operating practice. Abductive thematic analysis was used on a total of 10½ hours of transcript data, to identify key themes including semiotic signals, negotiated activity and mental rehearsal as a phase between simulation training and operating. Findings: Task complexity was related to task completion time. The shared prior experience of trainees related to improved task completion times rather than individual experience. Prior experience was linked to the way interactive social cues were utilised. Task complexity was linked to the way material artefacts were exchanged between trainees. Meaningful knowledge was acquired and exchanged through the learning design of graduated task activity, model and interaction fidelity, instrument sharing and verbal and non-verbal transactions. Such ‘negotiated knotworking’, as an extension of CHAT, is illustrated by the interactions of these social and material activities. SBT proved valuable in improving the capacity of trainees to reflect and mentally construct the operative context, which becomes important in rehearsing clinical activity. Conclusions: The interaction of social and material exchanges during shared activity is where trainees make sense of their technical skills. Because such shared activity is present in both simulation and operation, simulation needs to provide not just task fidelity, but also an opportunity for social and material interaction in a way that is professionally recognisable in the OT. By utilising co-constructed activity and making use of multiple material and social interactions, the WLCTS enabled the development of surgical language and ‘semiotic’ association of mutual colorectal artifacts. Through mental rehearsal, trainees prepared, planned and made informed decisions. Sharing of prior experience signals the importance of co-dependence in role and activity negotiation. Because of these, socially organised learning theory which contains the operation activities within SBT and OT are suitable candidates for a learning framework

An animal tissue simulation assessing three directional displacement forces on five common tracheostomy securing techniques

Introduction Several methods of securing a tracheostomy tube have been described in the literature including using ties or tapes around the neck and suturing the plastic flange to the neck in various ways. However, there are no wet lab-based studies to objectively determine the force required to displace the tracheostomy tube using different securing techniques. Ours is the first animal tissue simulation study published in the literature. Methods A simulated tracheostomy stoma was created on a sheep neck model. A tracheostomy tube was inserted into the stoma and secured using various methods. Tension tests were conducted to significantly displace the tube from the stoma. Each technique was repeated six times on different sheep necks. All results were analysed using SPSS®. Results Repeat measurements indicated that the largest displacement forces come from an oblique direction while the lowest force values were found at the lateral angle. Averages of displacement showed that medially placed sutures required the largest forces in comparison with other securing methods. Wilcoxon signed-rank testing indicated that medial and continuous suture security resists displacement at forces that otherwise displace flange and interrupted sutures. Conclusions This study has shown that any type of securing suture requires a greater displacement force than the strap of the tracheostomy tube holder alone. Medially placed sutures require a greater displacement force than those placed laterally. Displacement in the lateral direction requires the least force in comparison with movement at perpendicular or oblique angles

The Paracoccus denitrificans NarK-like nitrate and nitrite transporters—probing nitrate uptake and nitrate/nitrite exchange mechanisms

Nitrate and nitrite transport across biological membranes is often facilitated by protein transporters that are members of the major facilitator superfamily. Paracoccus denitrificans contains an unusual arrangement whereby two of these transporters, NarK1 and NarK2, are fused into a single protein, NarK, which delivers nitrate to the respiratory nitrate reductase and transfers the product, nitrite, to the periplasm. Our complementation studies, using a mutant lacking the nitrate/proton symporter NasA from the assimilatory nitrate reductase pathway, support that NarK1 functions as a nitrate/proton symporter while NarK2 is a nitrate/nitrite antiporter. Through the same experimental system, we find that Escherichia coli NarK and NarU can complement deletions in both narK and nasA in P. denitrificans, suggesting that, while these proteins are most likely nitrate/nitrite antiporters, they can also act in the net uptake of nitrate. Finally, we argue that primary sequence analysis and structural modelling do not readily explain why NasA, NarK1 and NarK2, as well as other transporters from this protein family, have such different functions, ranging from net nitrate uptake to nitrate/nitrite exchange

Assessment of technical parameters and skills training to inform a simulation-based training program for semi-automated robotic colonoscopy

Background and study aims Video-colonoscopy, despite being the gold-standard for diagnosis of colorectal lesions, has limitations including patient discomfort and risk of complications. This study assessed training characteristics and acceptability in operators of a new robotic colonoscope (RC). Materials and methods Participants (n = 9) with varying degrees of skill and background knowledge in colonoscopy performed colonoscopies with a RC on a simulation-based training model. Quantitative procedure-related and qualitative operator-related parameters were recorded. Results Polyp detection rate was highest in the novice group (91.67 %) followed by experts (86.11 %), then equally, trainees and video gamers (79.17 %). Four participants repeated the procedure at a follow-up session. Each participant improved cecal intubation time and had the same or higher polyp detection rate. The potential role for RC was identified for an out-of-hospital environment and as a novel diagnostic tool. Conclusions Results from this pilot suggest that operators at all skill levels found the RC acceptable and potentially useful as a diagnostic tool. Acquisition of skills with RC seems to improve rapidly to a clinically relevant level with simulation-based trainin

Improving harmonization and standardization of expanded newborn screening results by optimization of the legacy flow injection analysis tandem mass spectrometry methods and application of a standardized calibration approach

Background Newborn screening (NBS) laboratories in the United Kingdom adhere to common protocols based on single analyte cutoff values (COVs); therefore, interlaboratory harmonization is of paramount importance. Interlaboratory variation for screening analytes in UK NBS laboratories ranges from 17% to 59%. While using common stable isotope internal standards has been shown to significantly reduce interlaboratory variation, instrument set-up, sample extraction, and calibration approach are also key factors. Methods Dried blood spot (DBS) extraction processes, instrument set-up, mobile-phase composition, sample introduction technique, and calibration approach of flow injection analysis–tandem mass spectrometry (FIA-MS/MS) methods were optimized. Inter- and intralaboratory variation of methionine, leucine, phenylalanine, tyrosine, isovaleryl-carnitine, glutaryl-carnitine, octanoyl-carnitine, and decanoyl-carnitine were determined pre- and postoptimization, using 3 different calibration approaches. Results Optimal recovery of analytes from DBS was achieved with a 35-min extraction time and 80% methanol (150 μL). Optimized methodology decreased the mean intralaboratory percentage relative SD (%RSD) for the 8 analytes from 20.7% (range 4.1–46.0) to 5.4% (range 3.0–8.5). The alternative calibration approach reduced the mean interlaboratory %RSD for all analytes from 16.8% (range 4.1–25.0) to 7.1% (range 4.1–11.0). Nuclear magnetic resonance analysis of the calibration material highlighted the need for standardization. The purities of isovaleryl-carnitine and glutaryl-carnitine were 85.13% and 69.94% respectively, below the manufacturer’s stated values of ≥98%. Conclusions For NBS programs provided by multiple laboratories using single analyte COVs, harmonization and standardization of results can be achieved by optimizing legacy FIA-MS/MS methods, adopting a common analytical protocol, and using standardized calibration material rather than internal calibration

Separate Origins of Group I Introns in Two Mitochondrial Genes of the Katablepharid Leucocryptos marina

Mitochondria are descendants of the endosymbiotic α-proteobacterium most likely engulfed by the ancestral eukaryotic cells, and the proto-mitochondrial genome should have been severely streamlined in terms of both genome size and gene repertoire. In addition, mitochondrial (mt) sequence data indicated that frequent intron gain/loss events contributed to shaping the modern mt genome organizations, resulting in the homologous introns being shared between two distantly related mt genomes. Unfortunately, the bulk of mt sequence data currently available are of phylogenetically restricted lineages, i.e., metazoans, fungi, and land plants, and are insufficient to elucidate the entire picture of intron evolution in mt genomes. In this work, we sequenced a 12 kbp-fragment of the mt genome of the katablepharid Leucocryptos marina. Among nine protein-coding genes included in the mt genome fragment, the genes encoding cytochrome b and cytochrome c oxidase subunit I (cob and cox1) were interrupted by group I introns. We further identified that the cob and cox1 introns host open reading frames for homing endonucleases (HEs) belonging to distantly related superfamilies. Phylogenetic analyses recovered an affinity between the HE in the Leucocryptos cob intron and two green algal HEs, and that between the HE in the Leucocryptos cox1 intron and a fungal HE, suggesting that the Leucocryptos cob and cox1 introns possess distinct evolutionary origins. Although the current intron (and intronic HE) data are insufficient to infer how the homologous introns were distributed to distantly related mt genomes, the results presented here successfully expanded the evolutionary dynamism of group I introns in mt genomes