Action learning and healthcare: affinities and challenges

Action learning has been used in healthcare settings to bring about changes to how services are delivered, to help individuals to develop their knowledge and skills, including leadership development, and to enable the development of collective abilities and communities of practice. It is evident that there are some positive elements in the healthcare environment that support the processes of action learning – what we might call affinities between the environment and these processes. However, those who have practised action learning in these environments also know that difficulties and disablers can arise, to derail or block the processes – what we might, perhaps optimistically, call challenges

‘You're kinda passing a test’: A phenomenological study of women's experiences of breastfeeding

Background: Despite an increasing research base about what helps or hinders breastfeeding, there is a dramatic drop in breastfeeding prevalence within the first 6 weeks. Aim: To explore the experiences of breastfeeding women. Methods: This study used interpretive phenomenology to research the experiences of 22 women who had all breastfed their youngest baby for at least 11 days. Data were collected using in-depth interviews when the women's babies were between 3-6 months of age. Thematic analysis was used to analyse findings. Findings: The women described tensions and mixed messages regarding breastfeeding, and contradictions between public health messages promoting breastfeeding and the support received to continue breastfeeding. The women also described how these approaches and messages affected their breastfeeding experiences, and how they managed breastfeeding as a result. Conclusions: The findings from this study revealed a patriarchal healthcare support system for breastfeeding whereby the women felt under surveillance and expected to perform to a prescribed ideal, but also a lack of support for exclusive breastfeeding after the initial postnatal period. These findings have clear implications for practice and policy

Automatic segmentation of the hippocampus for preterm neonates from early-in-life to term-equivalent age.

INTRODUCTION: The hippocampus, a medial temporal lobe structure central to learning and memory, is particularly vulnerable in preterm-born neonates. To date, segmentation of the hippocampus for preterm-born neonates has not yet been performed early-in-life (shortly after birth when clinically stable). The present study focuses on the development and validation of an automatic segmentation protocol that is based on the MAGeT-Brain (Multiple Automatically Generated Templates) algorithm to delineate the hippocampi of preterm neonates on their brain MRIs acquired at not only term-equivalent age but also early-in-life. METHODS: First, we present a three-step manual segmentation protocol to delineate the hippocampus for preterm neonates and apply this protocol on 22 early-in-life and 22 term images. These manual segmentations are considered the gold standard in assessing the automatic segmentations. MAGeT-Brain, automatic hippocampal segmentation pipeline, requires only a small number of input atlases and reduces the registration and resampling errors by employing an intermediate template library. We assess the segmentation accuracy of MAGeT-Brain in three validation studies, evaluate the hippocampal growth from early-in-life to term-equivalent age, and study the effect of preterm birth on the hippocampal volume. The first experiment thoroughly validates MAGeT-Brain segmentation in three sets of 10-fold Monte Carlo cross-validation (MCCV) analyses with 187 different groups of input atlases and templates. The second experiment segments the neonatal hippocampi on 168 early-in-life and 154 term images and evaluates the hippocampal growth rate of 125 infants from early-in-life to term-equivalent age. The third experiment analyzes the effect of gestational age (GA) at birth on the average hippocampal volume at early-in-life and term-equivalent age using linear regression. RESULTS: The final segmentations demonstrate that MAGeT-Brain consistently provides accurate segmentations in comparison to manually derived gold standards (mean Dice\u27s Kappa \u3e 0.79 and Euclidean distance CONCLUSIONS: MAGeT-Brain is capable of segmenting hippocampi accurately in preterm neonates, even at early-in-life. Hippocampal asymmetry with a larger right side is demonstrated on early-in-life images, suggesting that this phenomenon has its onset in the 3rd trimester of gestation. Hippocampal volume assessed at the time of early-in-life and term-equivalent age is linearly associated with GA at birth, whereby smaller volumes are associated with earlier birth

Effect of Mono and Di-rhamnolipids on Biofilms Pre-formed by Bacillus subtilis BBK006.

Different microbial inhibition strategies based on the planktonic bacterial physiology have been known to have limited efficacy on the growth of biofilms communities. This problem can be exacerbated by the emergence of increasingly resistant clinical strains. Biosurfactants have merited renewed interest in both clinical and hygienic sectors due to their potential to disperse microbial biofilms. In this work, we explore the aspects of Bacillus subtilis BBK006 biofilms and examine the contribution of biologically derived surface-active agents (rhamnolipids) to the disruption or inhibition of microbial biofilms produced by Bacillus subtilis BBK006. The ability of mono-rhamnolipids (Rha-C10-C10) produced by Pseudomonas aeruginosa ATCC 9027 and the di-rhamnolipids (Rha-Rha-C14-C14) produced by Burkholderia thailandensis E264, and phosphate-buffered saline to disrupt biofilm of Bacillus subtilis BBK006 was evaluated. The biofilm produced by Bacillus subtilis BBK006 was more sensitive to the di-rhamnolipids (0.4 g/L) produced by Burkholderia thailandensis than the mono-rhamnolipids (0.4 g/L) produced by Pseudomonas aeruginosa ATCC 9027. Rhamnolipids are biologically produced compounds safe for human use. This makes them ideal candidates for use in new generations of bacterial dispersal agents and useful for use as adjuvants for existing microbial suppression or eradication strategies

Partial Volume Segmentation of Brain MRI Scans of any Resolution and Contrast

Partial voluming (PV) is arguably the last crucial unsolved problem in Bayesian segmentation of brain MRI with probabilistic atlases. PV occurs when voxels contain multiple tissue classes, giving rise to image intensities that may not be representative of any one of the underlying classes. PV is particularly problematic for segmentation when there is a large resolution gap between the atlas and the test scan, e.g., when segmenting clinical scans with thick slices, or when using a high-resolution atlas. In this work, we present PV-SynthSeg, a convolutional neural network (CNN) that tackles this problem by directly learning a mapping between (possibly multi-modal) low resolution (LR) scans and underlying high resolution (HR) segmentations. PV-SynthSeg simulates LR images from HR label maps with a generative model of PV, and can be trained to segment scans of any desired target contrast and resolution, even for previously unseen modalities where neither images nor segmentations are available at training. PV-SynthSeg does not require any preprocessing, and runs in seconds. We demonstrate the accuracy and flexibility of the method with extensive experiments on three datasets and 2,680 scans. The code is available at https://github.com/BBillot/SynthSeg.Comment: accepted for MICCAI 202

Sophorolipid biosurfactants: Possible uses as antibacterial and antibiofilm agent.

Biosurfactants are amphipathic, surface-active molecules of microbial origin which accumulate at interfaces reducing interfacial tension and leading to the formation of aggregated micellular structures in solution. Some biosurfactants have been reported to have antimicrobial properties, the ability to prevent adhesion and to disrupt biofilm formation. We investigated antimicrobial properties and biofilm disruption using sophorolipids at different concentrations. Growth of Gram negative Cupriavidus necator ATCC 17699 and Gram positive Bacillus subtilis BBK006 were inhibited by sophorolipids at concentrations of 5% v/v with a bactericidal effect. Sophorolipids (5% v/v) were also able to disrupt biofilms formed by single and mixed cultures of B. subtilis BBK006 and Staphylococcus aureus ATCC 9144 under static and flow conditions, as was observed by scanning electron microscopy. The results indicated that sophorolipids may be promising compounds for use in biomedical application as adjuvants to other antimicrobial against some pathogens through inhibition of growth and/or biofilm disruption

Multi-Scaled Explorations of Binding-Induced Folding of Intrinsically Disordered Protein Inhibitor IA3 to its Target Enzyme

Biomolecular function is realized by recognition, and increasing evidence shows that recognition is determined not only by structure but also by flexibility and dynamics. We explored a biomolecular recognition process that involves a major conformational change – protein folding. In particular, we explore the binding-induced folding of IA3, an intrinsically disordered protein that blocks the active site cleft of the yeast aspartic proteinase saccharopepsin (YPrA) by folding its own N-terminal residues into an amphipathic alpha helix. We developed a multi-scaled approach that explores the underlying mechanism by combining structure-based molecular dynamics simulations at the residue level with a stochastic path method at the atomic level. Both the free energy profile and the associated kinetic paths reveal a common scheme whereby IA3 binds to its target enzyme prior to folding itself into a helix. This theoretical result is consistent with recent time-resolved experiments. Furthermore, exploration of the detailed trajectories reveals the important roles of non-native interactions in the initial binding that occurs prior to IA3 folding. In contrast to the common view that non-native interactions contribute only to the roughness of landscapes and impede binding, the non-native interactions here facilitate binding by reducing significantly the entropic search space in the landscape. The information gained from multi-scaled simulations of the folding of this intrinsically disordered protein in the presence of its binding target may prove useful in the design of novel inhibitors of aspartic proteinases

Organic residues in archaeology - the highs and lows of recent research

YesThe analysis of organic residues from archaeological materials has become increasingly important to our understanding of ancient diet, trade and technology. Residues from diverse contexts have been retrieved and analysed from the remains of food, medicine and cosmetics to hafting material on stone arrowheads, pitch and tar from shipwrecks, and ancient manure from soils. Research has brought many advances in our understanding of archaeological, organic residues over the past two decades. Some have enabled very specific and detailed interpretations of materials preserved in the archaeological record. However there are still areas where we know very little, like the mechanisms at work during the formation and preservation of residues, and areas where each advance produces more questions rather than answers, as in the identification of degraded fats. This chapter will discuss some of the significant achievements in the field over the past decade and the ongoing challenges for research in this area.Full text was made available in the Repository on 15th Oct 2015, at the end of the publisher's embargo period

Robust imaging of hippocampal inner structure at 7T: in vivo acquisition protocol and methodological choices

International audienceOBJECTIVE:Motion-robust multi-slab imaging of hippocampal inner structure in vivo at 7T.MATERIALS AND METHODS:Motion is a crucial issue for ultra-high resolution imaging, such as can be achieved with 7T MRI. An acquisition protocol was designed for imaging hippocampal inner structure at 7T. It relies on a compromise between anatomical details visibility and robustness to motion. In order to reduce acquisition time and motion artifacts, the full slab covering the hippocampus was split into separate slabs with lower acquisition time. A robust registration approach was implemented to combine the acquired slabs within a final 3D-consistent high-resolution slab covering the whole hippocampus. Evaluation was performed on 50 subjects overall, made of three groups of subjects acquired using three acquisition settings; it focused on three issues: visibility of hippocampal inner structure, robustness to motion artifacts and registration procedure performance.RESULTS:Overall, T2-weighted acquisitions with interleaved slabs proved robust. Multi-slab registration yielded high quality datasets in 96 % of the subjects, thus compatible with further analyses of hippocampal inner structure.CONCLUSION:Multi-slab acquisition and registration setting is efficient for reducing acquisition time and consequently motion artifacts for ultra-high resolution imaging of the inner structure of the hippocampus