Supervision of redeployed surgical trainees during the COVID-19 pandemic: what have we learnt and how can we improve?

Objective When cases of patients presenting with Coronavirus Disease 2019 (COVID-19) overwhelmed existing services in the United Kingdom (UK), surgical trainees were redeployed to assist frontline efforts. This project characterises the effects of redeployment on the supervision of these trainees. The resulting generation of practical recommendations could be implemented for future crises. Design A qualitative approach was utilised, comprised of seven phenomenological interviews with surgical and intensive care consultants, as well as redeployed surgical trainees. Interview recordings were transcribed and subsequently analysed using Thematic Analysis. Setting The project utilised participants currently in surgical training within the London deanery across a variety of surgical specialties representing several UK National Health Service (NHS) Trusts. Participants Three types of participants were interviewed. Four interviews were conducted with redeployed surgical trainees, across all stages of training, in full time employment who were redeployed for two weeks or more. One interview was conducted with an educational supervisor of multiple redeployed trainees. The third group comprised two consultant intensivists who supervised redeployed trainees within their respective departments. Results Four themes were developed: ‘Responding to an unforeseen crisis’, ‘Maintaining surgical identity and culture; A fish out of water?’, ‘Trainee supervision and support’ and ‘Preparation and sequelae’. Participants described a sense of obligation to the pandemic effort. Many described a significant interruption to training, however communication of this to surgical supervisors was suboptimal with minimal mitigation. Supervisors on the frontline were challenged by the assessment of trainee competence and acceptance into a new community of practice. Both trainees and supervisors described the management of uncertainty, advocating for the use of reflective practice to ensure preparation for the future. Conclusion This project presents an insight into several potentially long-lasting effects on surgical training. The recommendations generated may be applicable to trainees returning to work from time out of training, increasing the utility of this work

Inhibition of pituitary-adrenal secretion by a corticotropin releasing hormone antagonist in humans.

Corticotropin releasing hormone (CRH) is the primary modulator of ACTH release from the pituitary, and a neuromodulator in limbic and autonomic brain regions. Dysfunction of CRH-mediated neurotransmission is emerging as a critical mechanism in several disorders. Therefore, modulation of CRH availability at receptor sites is a potentially powerful therapeutic tool. Inhibitory analogues of CRH have been tested in rodents and primates, but their safety and hormonal effects in humans are unknown. We administered a CRH-antagonist, alpha-helical-CRH-(9-41) to six individuals. Each received two intravenous infusions: 50 micrograms kg-1 on day 1, and 100 micrograms kg-1 on the following morning. These doses block both endocrine and central effects of CRH in experimental animals. ACTH, cortisol, electrolytes, glucose and autonomic parameters were monitored in comparison with control values. Infusion of CRH antagonist did not alter heart rate, blood pressure, temperature or plasma electrolytes and glucose. Pre-infusion plasma ACTH levels averaged 26.8 +/- 6.7 pg ml-1 on day 1, and 29.0 +/- 5.8 pg ml-1 on day 2. Post-infusion values were 11.8 +/- 2 and 11.5 +/- 2.4 pg ml-1, significantly lower than pre-infusion levels. Plasma cortisol levels, which averaged 21.4 +/- 4 micrograms dl-1 on the first morning and 22.9 +/- 4.2 on the second, also decreased significantly after CRH antagonist infusions (to 14.0 +/- 2.9 micrograms dl-1 on day 1, and 13.9 +/- 3.0 micrograms dl-1 on day 2). Hormonal changes were transient, and circadian rhythm was not affected. Though not measured formally, euphoria, anxiety or somnolence were not observed. In conclusion, CRH antagonist administration to adults reduces hormonal secretion by pituitary corticotrophs, with resulting decrease in plasma ACTH and cortisol

Infantile spasms: hypothesis-driven therapy and pilot human infant experiments using corticotropin-releasing hormone receptor antagonists.

Background and rationaleInfantile spasms (IS) are an age-specific seizure disorder occurring in 1:2,000 infants and associated with mental retardation in approximately 90% of affected individuals. The costs of IS in terms of loss of lifetime productivity and emotional and financial burdens on families are enormous. It is generally agreed that the seizures associated with IS respond poorly to most conventional anticonvulsants. In addition, in the majority of patients, a treatment course with high-dose corticotropin (ACTH) arrests the seizures completely within days, often without recurrence on discontinuation of the hormone. However, the severe side effects of ACTH require development of better treatments for IS. Based on the rapid, all-or-none and irreversible effects of ACTH and on the established physiological actions of this hormone, it was hypothesized that ACTH eliminated IS via an established neuroendocrine feedback mechanism involving suppression of the age-specific endogenous convulsant neuropeptide corticotropin-releasing hormone (CRH). Indeed, IS typically occur in the setting of injury or insult that activate the CNS stress system, of which CRH is a major component. CRH levels may be elevated in the IS brain, and the neuropeptide is known to cause seizures in infant rats, as well as neuronal death in brain regions involved in learning and memory. If 'excess' CRH is involved in the pathogenesis of IS, then blocking CRH receptors should eliminate both seizures and the excitotoxicity of CRH-receptor-rich neurons subserving learning and memory.Patients and methodsWith FDA approval, alpha-helical CRH, a competitive antagonist of the peptide, was given as a phase I trial to 6 infants with IS who have either failed conventional treatment or who have suffered a recurrence. The study was performed at the Clinical Research Center of the Childrens Hospital, Los Angeles. The effects of alpha-helical CRH on autonomic parameters (blood pressure, pulse, temperature, respiration) were determined. In addition, immediate and short-term effects on ACTH and cortisol and on electrolytes and glucose were examined. The potential efficacy of alpha-helical CRH for IS was studied, using clinical diaries and video EEG.Resultsalpha-Helical CRH, a peptide, did not alter autonomic or biochemical parameters. Blocking peripheral CRH receptors was evident from a transient reduction in plasma ACTH and cortisol. No evidence for the compound's penetration of the blood-brain barrier was found, since no central effects on arousal, activity or seizures and EEG patterns were observed. In addition, a striking resistance of the patients' plasma ACTH to the second infusion of alpha-helical CRH was noted.ConclusionsPeptide analogs of CRH do not cross the blood-brain barrier, and their effects on peripheral stress hormones are transient and benign. Nonpeptide compouds that reach CNS receptors are required to test the hypothesis that blocking CRH receptors may ameliorate IS and its cognitive consequences

Supporting parent-child conversations in a history museum

BACKGROUND: Museums can serve as rich resources for families to learn about the social world through engagement with exhibits and parent-child conversation about exhibits. AIMS: This study examined ways of engaging parents and child about two related exhibits at a cultural and history museum. Sample participants consisted of families visiting the Animal Antics and the Gone Potty exhibits at the British Museum. METHODS: Whilst visiting two exhibits at the British Museum, 30 families were assigned to use a backpack of activities, 13 were assigned to a booklet of activities, and 15 were assigned to visit the exhibits without props (control condition). RESULTS: Compared to the families in the control condition, the interventions increased the amount of time parents and children engaged together with the exhibit. Additionally, recordings of the conversations revealed that adults asked more questions related to the exhibits when assigned to the two intervention conditions compared to the control group. Children engaged in more historical talk when using the booklets than in the other two conditions. CONCLUSIONS: The findings suggest that providing support with either booklets or activities for children at exhibits may prove beneficial to parent-child conversations and engagement with museum exhibits

Predicting grade school scientific literacy from aspects of the early home science environment

Fostering scientific literacy has become an increasingly salient goal as evidence accumulates regarding the early emergence of foundational skills and knowledge in this domain, as well as their relation to long-term success and engagement. Despite the potential that the home context has for nurturing early scientific literacy, research specifying its role has been limited. In this longitudinal study, we examined associations between children’s early science-related experiences at home and their subsequent scientific literacy. Following on our previous work, we specifically considered parent causal-explanatory talk, as well as the degree to which parents facilitate access to science-related materials and experiences. A group of 153 children from diverse backgrounds were evaluated across 5 annual waves of data collection from preschool entry (Mage = 3.41) through first grade (Mage = 7.92). Results demonstrate that parent invitations for children to explain causal phenomena had strong concurrent relations to scientific literacy but showed little relation to subsequent literacy. In contrast, the broader home science environment at preschool entry, particularly in the form of exposure to science-related activities, predicted scientific literacy over the next 4 years. The directionality and specificity of these relations were clarified through the inclusion of measures of cognitive and broader home experiences as controls in regression analyses. Overall, our investigation revealed that exposure to science-related input provided by parents has particularly powerful potential for shaping scientific literacy when children are very young. Implications for parent-focused interventions that promote science literacy are discussed

Global and local concerns: What attitudes and beliefs motivate farmers to mitigate and adapt to climate change?

In response to agriculture\u27s vulnerability and contribution to climate change, many governments are developing initiatives that promote the adoption of mitigation and adaptation practices among farmers. Since most climate policies affecting agriculture rely on voluntary efforts by individual farmers, success requires a sound understanding of the factors that motivate farmers to change practices. Recent evidence suggests that past experience with the effects of climate change and the psychological distance associated with people\u27s concern for global and local impacts can influence environmental behavior. Here we surveyed farmers in a representative rural county in California\u27s Central Valley to examine how their intention to adopt mitigation and adaptation practices is influenced by previous climate experiences and their global and local concerns about climate change. Perceived changes in water availability had significant effects on farmers\u27 intention to adopt mitigation and adaptation strategies, which were mediated through global and local concerns respectively. This suggests that mitigation is largely motivated by psychologically distant concerns and beliefs about climate change, while adaptation is driven by psychologically proximate concerns for local impacts. This match between attitudes and behaviors according to the psychological distance at which they are cognitively construed indicates that policy and outreach initiatives may benefit by framing climate impacts and behavioral goals concordantly; either in a global context for mitigation or a local context for adaptation

Substantial carbon loss respired from a corn-soybean agroecosystem highlights the importance of careful management as we adapt to changing climate

Understanding agroecosystem carbon (C) cycle response to climate change and management is vital for maintaining their long-term C storage. We demonstrate this importance through an in-depth examination of a ten-year eddy covariance dataset from a corn-corn-soybean crop rotation grown in the Midwest United States. Ten-year average annual net ecosystem exchange (NEE) showed a net C sink of -0.39 Mg C ha-1 yr-1. However, NEE in 2014 and 2015 from the corn ecosystem was 3.58 and 2.56 Mg C ha-1 yr-1, respectively. Most C loss occurred during the growing season, when photosynthesis should dominate and C fluxes should reflect a net ecosystem gain. Partitioning NEE into gross primary productivity (GPP) and ecosystem respiration (ER) showed this C \u27burp\u27 was driven by higher ER, with a 51% (2014) and 57% (2015) increase from the ten-year average (15.84 Mg C ha-1 yr-1). GPP was also higher than average (16.24 Mg C ha-1 yr-1) by 25% (2014) and 37% (2015), but this was not enough to offset the C emitted from ER. This increased ER was likely driven by enhanced soil microbial respiration associated with ideal growing season climate, substrate availability, nutrient additions, and a potential legacy effect from drought

How Can I Drink Safely?; Perception Versus the Reality of Alcohol Consumption

This article investigates differences between perception and actual consumption of alcohol in young adults within the UK, suggesting that inaccurate information in the public domain may hamper those seeking to drink safely plus the development of moderate drinking cultures. Results confirm that inaccurate information may be preventing the development of safe drinking behaviours among certain groups. In addition, they indicate that some groups choose to ignore safe consumption limits in particular circumstances. Results indicate that many government strategies aimed at reducing unsafe drinking behaviour are inaccurately targeted; changing male public consumption behaviour may trigger changes in female behaviour

Creative and Stylistic Devices Employed by Children During a Storybook Narrative Task: A Cross-Cultural Study

Purpose: The purpose of this study was to analyze the effects of culture on the creative and stylistic features children employ when producing narratives based on wordless picture books. Method: Participants included 60 first- and second-grade African American, Latino American, and Caucasian children. A subset of narratives based on wordless picture books collected as part of a larger study was coded and analyzed for the following creative and stylistic conventions: organizational style (topic centered, linear, cyclical), dialogue (direct, indirect), reference to character relationships (nature, naming, conduct), embellishment (fantasy, suspense, conflict), and paralinguistic devices (expressive sounds, exclamatory utterances). Results: Many similarities and differences between ethnic groups were found. No significant differences were found between ethnic groups in organizational style or use of paralinguistic devices. African American children included more fantasy in their stories, Latino children named their characters more often, and Caucasian children made more references to the nature of character relationships. Conclusion: Even within the context of a highly structured narrative task based on wordless picture books, culture influences children’s production of narratives. Enhanced understanding of narrative structure, creativity, and style is necessary to provide ecologically valid narrative assessment and intervention for children from diverse cultural backgrounds