A novel mechanical lung model of pulmonary diseases to assist with teaching and training

BACKGROUND: A design concept of low-cost, simple, fully mechanical model of a mechanically ventilated, passively breathing lung is developed. An example model is built to simulate a patient under mechanical ventilation with accurate volumes and compliances, while connected directly to a ventilator. METHODS: The lung is modelled with multiple units, represented by rubber bellows, with adjustable weights placed on bellows to simulate compartments of different superimposed pressure and compliance, as well as different levels of lung disease, such as Acute Respiratory Distress Syndrome (ARDS). The model was directly connected to a ventilator and the resulting pressure volume curves recorded. RESULTS: The model effectively captures the fundamental lung dynamics for a variety of conditions, and showed the effects of different ventilator settings. It was particularly effective at showing the impact of Positive End Expiratory Pressure (PEEP) therapy on lung recruitment to improve oxygenation, a particulary difficult dynamic to capture. CONCLUSION: Application of PEEP therapy is difficult to teach and demonstrate clearly. Therefore, the model provide opportunity to train, teach, and aid further understanding of lung mechanics and the treatment of lung diseases in critical care, such as ARDS and asthma. Finally, the model's pure mechanical nature and accurate lung volumes mean that all results are both clearly visible and thus intuitively simple to grasp

TESSA: A toolkit for rapid assessment of ecosystem services at sites of biodiversity conservation importance

Sites that are important for biodiversity conservation can also provide significant benefits (i.e. ecosystem services) to people. Decision-makers need to know how change to a site, whether development or restoration, would affect the delivery of services and the distribution of any benefits among stakeholders. However, there are relatively few empirical studies that present this information. One reason is the lack of appropriate methods and tools for ecosystem service assessment that do not require substantial resources or specialist technical knowledge, or rely heavily upon existing data. Here we address this gap by describing the Toolkit for Ecosystem Service Site-based Assessment (TESSA). It guides local non-specialists through a selection of relatively accessible methods for identifying which ecosystem services may be important at a site, and for evaluating the magnitude of benefits that people obtain from them currently, compared with those expected under alternative land-uses. The toolkit recommends use of existing data where appropriate and places emphasis on enabling users to collect new field data at relatively low cost and effort. By using TESSA, the users could also gain valuable information about the alternative land-uses; and data collected in the field could be incorporated into regular monitoring programmes

Levetiracetam versus phenytoin for second-line treatment of paediatric convulsive status epilepticus (EcLiPSE): a multicentre, open-label, randomised trial

Background Phenytoin is the recommended second-line intravenous anticonvulsant for treatment of paediatric convulsive status epilepticus in the UK; however, some evidence suggests that levetiracetam could be an effective and safer alternative. This trial compared the efficacy and safety of phenytoin and levetiracetam for second-line management of paediatric convulsive status epilepticus.Methods This open-label, randomised clinical trial was undertaken at 30 UK emergency departments at secondary and tertiary care centres. Participants aged 6 months to under 18 years, with convulsive status epilepticus requiring second-line treatment, were randomly assigned (1:1) using a computer-generated randomisation schedule to receive levetiracetam (40 mg/kg over 5 min) or phenytoin (20 mg/kg over at least 20 min), stratified by centre. The primary outcome was time from randomisation to cessation of convulsive status epilepticus, analysed in the modified intention-to-treat population (excluding those who did not require second-line treatment after randomisation and those who did not provide consent). This trial is registered with ISRCTN, number ISRCTN22567894.Findings Between July 17, 2015, and April 7, 2018, 1432 patients were assessed for eligibility. After exclusion of ineligible patients, 404 patients were randomly assigned. After exclusion of those who did not require second-line treatment and those who did not consent, 286 randomised participants were treated and had available data: 152 allocated to levetiracetam, and 134 to phenytoin. Convulsive status epilepticus was terminated in 106 (70%) children in the levetiracetam group and in 86 (64%) in the phenytoin group. Median time from randomisation to cessation of convulsive status epilepticus was 35 min (IQR 20 to not assessable) in the levetiracetam group and 45 min (24 to not assessable) in the phenytoin group (hazard ratio 1·20, 95% CI 0·91–1·60; p=0·20). One participant who received levetiracetam followed by phenytoin died as a result of catastrophic cerebral oedema unrelated to either treatment. One participant who received phenytoin had serious adverse reactions related to study treatment (hypotension considered to be immediately life-threatening [a serious adverse reaction] and increased focal seizures and decreased consciousness considered to be medically significant [a suspected unexpected serious adverse reaction]). Interpretation Although levetiracetam was not significantly superior to phenytoin, the results, together with previously reported safety profiles and comparative ease of administration of levetiracetam, suggest it could be an appropriate alternative to phenytoin as the first-choice, second-line anticonvulsant in the treatment of paediatric convulsive status epilepticus

Predicting plant diversity patterns in Madagascar : understanding the effects of climate and land cover change in a biodiversity hotspot

Climate and land cover change are driving a major reorganization of terrestrial biotic communities in tropical ecosystems. In an effort to understand how biodiversity patterns in the tropics will respond to individual and combined effects of these two drivers of environmental change, we use species distribution models (SDMs) calibrated for recent climate and land cover variables and projected to future scenarios to predict changes in diversity patterns in Madagascar. We collected occurrence records for 828 plant genera and 2186 plant species. We developed three scenarios, (i.e., climate only, land cover only and combined climate-land cover) based on recent and future climate and land cover variables. We used this modelling framework to investigate how the impacts of changes to climate and land cover influenced biodiversity across ecoregions and elevation bands. There were large-scale climate- and land cover-driven changes in plant biodiversity across Madagascar, including both losses and gains in diversity. The sharpest declines in biodiversity were projected for the eastern escarpment and high elevation ecosystems. Sharp declines in diversity were driven by the combined climate-land cover scenarios; however, there were subtle, region-specific differences in model outputs for each scenario, where certain regions experienced relatively higher species loss under climate or land cover only models. We strongly caution that predicted future gains in plant diversity will depend on the development and maintenance of dispersal pathways that connect current and future suitable habitats. The forecast for Madagascar's plant diversity in the face of future environmental change is worrying: regional diversity will continue to decrease in response to the combined effects of climate and land cover change, with habitats such as ericoid thickets and eastern lowland and sub-humid forests particularly vulnerable into the future

The impact of surgical delay on resectability of colorectal cancer: An international prospective cohort study

AIM: The SARS-CoV-2 pandemic has provided a unique opportunity to explore the impact of surgical delays on cancer resectability. This study aimed to compare resectability for colorectal cancer patients undergoing delayed versus non-delayed surgery. METHODS: This was an international prospective cohort study of consecutive colorectal cancer patients with a decision for curative surgery (January-April 2020). Surgical delay was defined as an operation taking place more than 4 weeks after treatment decision, in a patient who did not receive neoadjuvant therapy. A subgroup analysis explored the effects of delay in elective patients only. The impact of longer delays was explored in a sensitivity analysis. The primary outcome was complete resection, defined as curative resection with an R0 margin. RESULTS: Overall, 5453 patients from 304 hospitals in 47 countries were included, of whom 6.6% (358/5453) did not receive their planned operation. Of the 4304 operated patients without neoadjuvant therapy, 40.5% (1744/4304) were delayed beyond 4 weeks. Delayed patients were more likely to be older, men, more comorbid, have higher body mass index and have rectal cancer and early stage disease. Delayed patients had higher unadjusted rates of complete resection (93.7% vs. 91.9%, P = 0.032) and lower rates of emergency surgery (4.5% vs. 22.5%, P < 0.001). After adjustment, delay was not associated with a lower rate of complete resection (OR 1.18, 95% CI 0.90-1.55, P = 0.224), which was consistent in elective patients only (OR 0.94, 95% CI 0.69-1.27, P = 0.672). Longer delays were not associated with poorer outcomes. CONCLUSION: One in 15 colorectal cancer patients did not receive their planned operation during the first wave of COVID-19. Surgical delay did not appear to compromise resectability, raising the hypothesis that any reduction in long-term survival attributable to delays is likely to be due to micro-metastatic disease

A distance too far away : a novel and exegesis

This practice-led research examines the generative function of loss in fiction that explores themes of grief and longing. This research considers how loss may be understood as a structuring mechanism through which characters evaluate time, resolve loss and affect future change. The creative work is a work of literary fiction titled A Distance Too Far Away. Aubrey, the story’s protagonist, is a woman in her twenties living in Brisbane in the early 1980s, carving out an independent life for herself away from her family. Through a flashback narrative sequence, told from the perspective of the twelve year narrator, Aubrey retraces a significant point of rupture in her life following a series of family tragedies. A Distance Too Far Away explores the tension between belonging and freedom, and considers how the past provides a malleable space for illuminating desire in order to traverse the gap between the world as it is and the world as we want it to be. The exegetical component of this research considers an alternative critical frame for interpreting the work of American author Anne Tyler, a writer who has had a significant influence on my own practice. Frequently criticised for creating sentimental and inert characters, many critics observe that nothing happens in Tyler’s circular plots. This research challenges these assertions, and through a contextual analysis of Tyler’s Ladder of Years (1995) investigates how Tyler engages with memory and nostalgia in order to move across time and resolve loss

Ideological Resilience and Disruption: Reproducing and Resisting Gender and Racial Inequality in Cases of Teacher Sexual Misconduct

Through a comparative analysis of the media coverage and legal treatment of a national sample of criminal cases involving sexual contact between teachers and their adolescent students, this research examines how gender and racial inequalities are reproduced and resisted in the news media and criminal justice system. Using regression analysis of sentencing outcomes, I find support for the selective chivalry hypothesis, which suggests that female defendants who adhere to dominant gender expectations experience leniency in the criminal justice system while female defendants who are viewed as gender deviants are treated especially punitively. I also employ qualitative discourse analysis of the new media coverage and court room construction of a subsample of 66 cases to consider how inequality is reproduced and resisted. I draw on a conceptualization of hegemonic ideology as a set of symbolic resources that individuals have differential access to depending on their location in the matrix of privilege and oppression. Using this conceptualization, I elaborate how defense attorneys strategically draw on patriarchal views of women's passivity to reduce the culpability of their female clients, how prosecuting attorneys resist these hegemonic ideals and demand that the sexual perpetrating of both male and female defendants be taken seriously, and how judges discursively perform neutrality even while making sentencing decisions that are shaped by gender ideology. I also analyze the media framing of these cases, including how the explosion of discourse around cases involving white female perpetrators relates to the regulation of female sexuality and how the politics of Black respectability are used to frame cases involving Black male defendants. Finally, I analyze the constructed and contested nature of sexual victimhood, and how the differential access to claims of "worthy victimhood" identity relates to the race and gender of the adolescent victim