Mobilizing an action research programme in a live construction project setting

Building on previous work addressing Action Research (AR) in the construction management field, this paper examines the application of AR methods and techniques on a project pioneering a new form of project insurance: IPI (Integrated Project Insurance). The practicalities of mobilizing a sustained AR programme on a live construction project are explored as the relationship between innovation (IPI), professional practice and academic research enquiry are juxtaposed. The methodological challenges and perceived values of AR are re-evaluated in the light of practitioner opinion and industry desire to learn and improve practices across the sector. The empirical insights facilitate a re-assessment of AR in a construction project context in 4 distinct ways: the nature of the AR learning loop is clarified for a construction project context; the role of project participants in the AR process are examined; the workings of AR “interventions” are explored and the rationale and philosophical assumptions underlying an AR programme in a construction management domain are re-assessed. The informative insights will assist researchers considering an AR programme whilst the supportive recognition of professionals highlights how AR is a potentially valuable approach for industry and academia to work together to create knowledge and refine practice co-operatively

Mobilizing BIM in a collaborative project environment

This paper reports on the application of BIM methods an innovative project in the UK that is pioneering a new form of project insurance (Integrated Project Insurance) that joins project partners together as a virtual company. The paper examines the processes put in place to optimize BIM usage whilst reviewing the problems and issues encountered; the observations of a researcher being combined with the reflections of the BIM Information Manager. It is noted that mobilizing a comprehensive BIM-centric system is a complex and difficult undertaking, with new roles and responsibilities needing to be created, that put extra pressures on project partners. The positive results of using BIM in a collaborative environment are noted as the findings suggest inclusive contractual arrangements facilitate enhanced BIM use. The insights inform understanding of mobilizing BIM in a collaborative project environment as it is argued that only a fully collaborative project environment can realise the full benefits of BIM

The most problematic symptoms of prion disease - an analysis of carer experiences

Objectives: Prion diseases are rare dementias that most commonly occur sporadically, but can be inherited or acquired, and for which there is no cure. We sought to understand which prion disease symptoms are most problematic for carers, to inform the development of outcome measures. Design: Self-completed questionnaire with follow-up of a subset of participants by structured interview. Setting: A nested study in the UK National Prion Monitoring Cohort, a longitudinal observational study. Participants and measurements: 71 carers, of people with different prion diseases with a wide range of disease severity, identified 236 of their four most problematic symptoms by questionnaire which were grouped into ten domains. Structured interviews were then done to qualitatively explore these experiences. Eleven family carers of people with prion disease were selected, including those representative of a range of demographics and disease subtypes and those who cared for people with prion disease, living or recently deceased. Interviews were transcribed and formally studied. Results: The six most problematic symptom domains were: mobility and coordination; mood and behavior; personal care and continence; eating and swallowing; communication; and cognition and memory. The prevalence of these symptoms varied significantly by disease stage and type. A formal analysis of structured interviews to explore these domains is reported. Conclusions: We make suggestions about how healthcare professionals can focus their support for people with prion disease. Clinical trials that aim to generate evidence regarding therapies that might confer meaningful benefits to carers should consider including outcome measures that monitor the symptomatic domains we have identified as problematic

Prion strains viewed through the lens of cryo-EM

Mammalian prions are lethal transmissible pathogens that cause fatal neurodegenerative diseases in humans and animals. They consist of fibrils of misfolded, host-encoded prion protein (PrP) which propagate through templated protein polymerisation. Prion strains produce distinct clinicopathological phenotypes in the same host and appear to be encoded by distinct misfolded PrP conformations and assembly states. Despite fundamental advances in our understanding of prion biology, key knowledge gaps remain. These include precise delineation of prion replication mechanisms, detailed explanation of the molecular basis of prion strains and inter-species transmission barriers, and the structural definition of neurotoxic PrP species. Central to addressing these questions is the determination of prion structure. While high-resolution definition of ex vivo prion fibrils once seemed unlikely, recent advances in cryo-electron microscopy (cryo-EM) and computational methods for 3D reconstruction of amyloids have now made this possible. Recently, near-atomic resolution structures of highly infectious, ex vivo prion fibrils from hamster 263K and mouse RML prion strains were reported. The fibrils have a comparable parallel in-register intermolecular β-sheet (PIRIBS) architecture that now provides a structural foundation for understanding prion strain diversity in mammals. Here, we review these new findings and discuss directions for future research

Preclinical detection of infectivity and disease-specific PrP in blood throughout the incubation period of prion disease.

Variant Creutzfeldt-Jakob disease (vCJD) is a fatal neurodegenerative disorder characterised by accumulation of pathological isoforms of the prion protein, PrP. Although cases of clinical vCJD are rare, there is evidence there may be tens of thousands of infectious carriers in the United Kingdom alone. This raises concern about the potential for perpetuation of infection via medical procedures, in particular transfusion of contaminated blood products. Accurate biochemical detection of prion infection is crucial to mitigate risk and we have previously reported a blood assay for vCJD. This assay is sensitive for abnormal PrP conformers at the earliest stages of preclinical prion disease in mice and precedes the maximum infectious titre in blood. Not only does this support the possibility of screening asymptomatic individuals, it will also facilitate the elucidation of the complex relationship that exists between the ensemble of abnormal PrP conformers present in blood and the relationship to infectivity

Estimation of the number of inherited prion disease mutation carriers in the UK

Inherited prion diseases (IPD) are a set of rare neurodegenerative diseases that are always caused by mutation of the prion protein gene (PRNP). These are highly heterogeneous in clinical presentation and best described by the specific gene mutation, but traditionally include the canonical syndromes familial Creutzfeldt-Jakob disease, Gerstamann-Straussler-Scheinker syndrome, and fatal familial insomnia. In the UK, care of IPD patients and clinical PRNP sequencing have been carried out almost exclusively by the National Prion Clinic and affiliated laboratories since the disease gene was discovered in 1989. Using data obtained over 30 years (1990-2019), this study aimed to provide a greater understanding of the genetic prevalence of IPD using multiple complementary methods. A key source of bias in rare disorders is ascertainment, so we included an analysis based on capture-recapture techniques that may help to minimise ascertainment bias. 225 patients, with 21 different IPD mutations were identified, varying in frequency (with 8/21 mutations comprising over 90% observed cases), derived from 116 kindreds and 151 3-generation families. We estimated a total of 303 UK families (95% CI = 222, 384) segregate IPD mutations, 1091 (95% CI = 720, 1461) UK mutation carriers and a lifetime risk of approximately 1 in 60,000. Simpler methods of measuring prevalence based on extrapolation from the annual incidence of disease, and large scale genomic studies, result in similar estimates of prevalence. These estimates may be of value for planning preventive trials of therapeutics in IPD mutation carriers, prevention of prion disease transmission and provision of specialist services