Crossbow Bolt Injury to the Heart

Case summary A 33-year-old woman was transferred from an outside hospital with a penetrating injury to her right chest. The patient was shot with a crossbow with the entry site to the right breast/chest and a transmediastinal trajectory. She was intubated prior to arrival due to difficulty breathing. Her vital signs remained stable and within normal limits, with good breath sounds, and no evidence of pneumothorax on chest X-ray. The tip of the bolt was palpable at the patient’s left midaxillary line. Chest X-ray in trauma bay showed the transmediastinal trajectory, and the bolt appeared to have a field point (not a broadhead point) (figure 1). A CT of the chest was obtained to assist with surgical planning. Images showed the bolt penetrating the right chest, right ventricle and inferior aspect of the left ventricular muscle, through the stomach, and ending near the tip of the spleen with a fracture of the left seventh ri

Teacher quality, recruitment, and retention: Rapid Evidence Assessment

This rapid evidence assessment identifies areas for future research on teacher quality, recruitment and retention, with the aim of informing the focus of the Education Endowment Foundation’s (EEF’s) future research commissioning on this topic. Given that ensuring access to quality teaching for disadvantaged pupils is expected to be a key mechanism for narrowing the disadvantage gap in attainment, there is a strong rationale for the EEF to build the evidence base on the recruitment and retention of quality teachers. The report set out to scope the field and summarise existing evidence on this topic. The report also identifies gaps in the research; for example, areas that have been researched qualitatively but not investigated experimentally or developed into a testable intervention. The rapid evidence assessment includes two reviews, each summarising a key area of research: - Review 1 focused on measures of (or proxies for) teacher quality commonly used in the literature. - Review 2 focused on strategies for the recruitment, retention and distribution of quality teachers to schools serving disadvantaged communities

Mentors as instructional coaches for new teachers: lessons learnt from the early career framework in England

Purpose: The paper provides analysis of the use of instructional coaching (IC) as a prevalent trend supporting new teachers in the English system and aims to inform ongoing policy development and implementation. The qualitative study examines mentors' conceptualisations and enactment of the role of instructional coach and the readiness of mentors to assume mentors' key stakeholder roles in the professional education of early career teachers (ECTs). Design/methodology/approach: Semi-structured interviews with 37 mentors explored mentors' understandings and experiences of becoming instructional coaches as part of a pilot support initiative to support ECTs in England. Two rounds of interviews were conducted to generate data related to the first six months of mentoring on the programmes. Thematic analysis identified seven semantic themes which describe manifest content found within the data and identify mentors' perceptions of their role and practice as instructional coaches. Three latent themes were developed from mentors' accounts which indicate challenges in becoming an instructional coach in this context. Findings: Concern to apply IC “correctly” according to the programme models was a strong feature amongst both novice and experienced mentors. A key finding is the lack of explicit knowledge of professional learning pedagogies amongst mentors and insecure understanding of how new teachers learn. Assuming the role of instructional coach presented both benefits of having a “model” to follow and disadvantages in fostering limited and over-prescribed concepts and practices related to the learning of new teachers. Research limitations/implications: The study investigated mentors during the first six months of a pilot programme and the paper reports on analysis of one type of data. The research results may lack generalisability, and a longitudinal study is necessary to further explore the validity of the findings. Practical implications: Sustained, high-quality professional learning for mentors is crucial to mentors' role as instructional coaches to enable mentors to develop deep, critical understanding of how IC might support new teachers and how to exercise professional judgement in working with “models”. Judicious use of time and resource is needed to enable mentors to fulfil the potential of national mentoring programmes. Originality/value: The study is timely in its examination of mentors that assume the role of instructional coach as one response to national policy development that makes support for ECTs mandatory. Such strategies have wide international relevance where the retention of new teachers is a policy priority

Predictors of New-Onset Atrial Fibrillation in Geriatric Trauma Patients

Geriatric patients (age \u3e65) comprise a growing segment of the trauma population. New-onset atrial fibrillation may occur after injury, complicating clinical management and resulting in significant morbidity and mortality. This study was undertaken to identify clinical and demographic factors associated with new-onset atrial fibrillation among geriatric trauma patients . Methods: In this case control study, eligible participants included admitted trauma patients age 65 and older who developed new-onset atrial fibrillation during the hospitalization. Controls were admitted trauma patients who were matched for age and injury severity score, who did not develop atrial fibrillation. We evaluated the associations between new-onset atrial fibrillation and clinical characteristics, including patient demographics, health behaviors, chronic medical conditions, and course of care. Results: Data were available for 63 cases and 25 controls. Patients who developed atrial fibrillation were more likely to be male, compared to controls (49% versus 24%; odds ratio 3.0[1.0, 8.9]). Other demographic and clinical factors were not associated with new-onset atrial fibrillation, including mechanism of injury, co-morbid medical conditions, drug or alcohol use, surgical procedures, and intravenous fluid administration. Conclusions: Male geriatric trauma patients were at higher risk for developing new-onset atrial fibrillation. Other demographic and clinical factors were not associated with new-onset atrial fibrillation. Competing Interests: The authors report no conflicts of interest

Evaluation of Education Maintenance Allowance Pilots : Leeds and London first year evidence

This report refers to findings from the first year of the EMA pilot in Leeds and London, which was September 1999 to August 2000

LifeTrain: Driving lifelong learning for biomedical professionals

This article describes LifeTrain — the European common framework for continuing professional development in the biomedical sciences. An important goal of LifeTrain is to support biomedical professionals to work collaborativelyacross disciplines, sectors and national boundaries. LifeTrain is an open community with a unifying goal; it brings together many excellent, but disparate, activities into a process towards establishing a focused and coherentframework for continuing professional development in the biomedical sciences. This collaborative approach provides the critical mass to make a major contribution to strengthen the skills and competencies of biomedical professionals in a rapidly changing environment. LifeTrain's signatories, which include multinational pharmaceutical companies, research infrastructures, professional and scientific bodies, higher-education institutes and research institutes, have agreed to the principles of the framework and to continue to collaborate to implement LifeTrain. We warmly invite others to join us

Strong anion exchange-mediated phosphoproteomics reveals extensive human non-canonical phosphorylation

Phosphorylation is a key regulator of protein function under (patho)physiological conditions, and defining site‐specific phosphorylation is essential to understand basic and disease biology. In vertebrates, the investigative focus has primarily been on serine, threonine and tyrosine phosphorylation, but mounting evidence suggests that phosphorylation of other “non‐canonical” amino acids also regulates critical aspects of cell biology. However, standard methods of phosphoprotein characterisation are largely unsuitable for the analysis of non‐canonical phosphorylation due to their relative instability under acidic conditions and/or elevated temperature. Consequently, the complete landscape of phosphorylation remains unexplored. Here, we report an u nbiased p hosphopeptide enrichment strategy based on strong a nion ex change (SAX ) chromatography (UPAX ), which permits identification of histidine (His), arginine (Arg), lysine (Lys), aspartate (Asp), glutamate (Glu) and cysteine (Cys) phosphorylation sites on human proteins by mass spectrometry‐based phosphoproteomics. Remarkably, under basal conditions, and having accounted for false site localisation probabilities, the number of unique non‐canonical phosphosites is approximately one‐third of the number of observed canonical phosphosites. Our resource reveals the previously unappreciated diversity of protein phosphorylation in human cells, and opens up avenues for high‐throughput exploration of non‐canonical phosphorylation in all organisms

A stromal cell niche sustains ILC2-mediated type-2 conditioning in adipose tissue.

Group-2 innate lymphoid cells (ILC2), type-2 cytokines, and eosinophils have all been implicated in sustaining adipose tissue homeostasis. However, the interplay between the stroma and adipose-resident immune cells is less well understood. We identify that white adipose tissue-resident multipotent stromal cells (WAT-MSCs) can act as a reservoir for IL-33, especially after cell stress, but also provide additional signals for sustaining ILC2. Indeed, we demonstrate that WAT-MSCs also support ICAM-1-mediated proliferation and activation of LFA-1-expressing ILC2s. Consequently, ILC2-derived IL-4 and IL-13 feed back to induce eotaxin secretion from WAT-MSCs, supporting eosinophil recruitment. Thus, MSCs provide a niche for multifaceted dialogue with ILC2 to sustain a type-2 immune environment in WAT

A multi-decade record of high quality fCO2 data in version 3 of the Surface Ocean CO2 Atlas (SOCAT)

The Surface Ocean CO2 Atlas (SOCAT) is a synthesis of quality-controlled fCO2 (fugacity of carbon dioxide) values for the global surface oceans and coastal seas with regular updates. Version 3 of SOCAT has 14.7 million fCO2 values from 3646 data sets covering the years 1957 to 2014. This latest version has an additional 4.6 million fCO2 values relative to version 2 and extends the record from 2011 to 2014. Version 3 also significantly increases the data availability for 2005 to 2013. SOCAT has an average of approximately 1.2 million surface water fCO2 values per year for the years 2006 to 2012. Quality and documentation of the data has improved. A new feature is the data set quality control (QC) flag of E for data from alternative sensors and platforms. The accuracy of surface water fCO2 has been defined for all data set QC flags. Automated range checking has been carried out for all data sets during their upload into SOCAT. The upgrade of the interactive Data Set Viewer (previously known as the Cruise Data Viewer) allows better interrogation of the SOCAT data collection and rapid creation of high-quality figures for scientific presentations. Automated data upload has been launched for version 4 and will enable more frequent SOCAT releases in the future. High-profile scientific applications of SOCAT include quantification of the ocean sink for atmospheric carbon dioxide and its long-term variation, detection of ocean acidification, as well as evaluation of coupled-climate and ocean-only biogeochemical models. Users of SOCAT data products are urged to acknowledge the contribution of data providers, as stated in the SOCAT Fair Data Use Statement. This ESSD (Earth System Science Data) “living data” publication documents the methods and data sets used for the assembly of this new version of the SOCAT data collection and compares these with those used for earlier versions of the data collection (Pfeil et al., 2013; Sabine et al., 2013; Bakker et al., 2014). Individual data set files, included in the synthesis product, can be downloaded here: doi:10.1594/PANGAEA.849770. The gridded products are available here: doi:10.3334/CDIAC/OTG.SOCAT_V3_GRID

Dermatitis and Aging-Related Barrier Dysfunction in Transgenic Mice Overexpressing an Epidermal-Targeted Claudin 6 Tail Deletion Mutant

The barrier function of the skin protects the mammalian body against infection, dehydration, UV irradiation and temperature fluctuation. Barrier function is reduced with the skin's intrinsic aging process, however the molecular mechanisms involved are unknown. We previously demonstrated that Claudin (Cldn)-containing tight junctions (TJs) are essential in the development of the epidermis and that transgenic mice overexpressing Cldn6 in the suprabasal layers of the epidermis undergo a perturbed terminal differentiation program characterized in part by reduced barrier function. To dissect further the mechanisms by which Cldn6 acts during epithelial differentiation, we overexpressed a Cldn6 cytoplasmic tail deletion mutant in the suprabasal compartment of the transgenic mouse epidermis. Although there were no gross phenotypic abnormalities at birth, subtle epidermal anomalies were present that disappeared by one month of age, indicative of a robust injury response. However, with aging, epidermal changes with eventual chronic dermatitis appeared with a concomitant barrier dysfunction manifested in increased trans-epidermal water loss. Immunohistochemical analysis revealed aberrant suprabasal Cldn localization with marked down-regulation of Cldn1. Both the proliferative and terminal differentiation compartments were perturbed as evidenced by mislocalization of multiple epidermal markers. These results suggest that the normally robust injury response mechanism of the epidermis is lost in the aging Involucrin-Cldn6-CΔ196 transgenic epidermis, and provide a model for evaluation of aging-related skin changes