Editorial: International Sustainable Ecological Engineering Design for Society (SEEDS) Conference 2018

Specialty section: This article was submitted to Sustainable Design and Construction, a section of the journal Frontiers in Built Environment</p

Services rendus par les foraminifères benthiques dans l’étude de l’influence des forçages naturels (e.g. changement climatique) et anthropiques sur l’écosystème estuarien. Exemple de la Loire.

Due to its intermediate position between ocean and continent, estuary is located in the heart of the economic, social and cultural activities. Awareness of the need to manage this vulnerable environment, has led in recent years, to an increase in surveillance activities of the environmental quality. Physico-chemical methods, although dominant and indispensable, reach their limits as a tool for environmental management. This is why other ways are being explored, such as evaluating the environmental quality by bio-indicators. It is in this perspective that SEMHABEL project is subscribed (Suivi Environnemental des Micro-HAbitats Benthiques de l’Estuaire de la Loire - Plan Loire Grandeur Nature 2007-2013 - FEDER). This is the first study in the Loire incorporating the use of benthic foraminifera as a new biological approach. Following a sampling cruise in September 2012, 320 samples of surface sediments were collected from Nantes to de Saint-Gildas. The data obtained allowed to represent and analyze the spatial distribution of communities of benthic foraminifera, along the upstream-downstream continuum and following geochemical and sedimentary evolutions. These results are the first support for the establishment of a database that will allow a better understanding of the actual functioning of this ecosystem. Ultimately, we hope to assess the evolution of the estuarine ecosystem according to climate change and catchment area management and to develop a biotic index for routine monitoring of the health of the estuary

Management of Assets and Compliance through the Application of BIM and Digital Twins: A Platform for Innovation in Building Management

Building Information Modelling (BIM) is an intelligent 3D model-based process that gives asset managers the insight and tools to manage buildings and associated infrastructure more efficiently. BIM is the industry standard model to deliver insight on how a building will perform once built and to manage its performance and asset lifecycles. While BIM processes are established for new buildings, older buildings are not maintained, refurbished, or deconstructed using this method. BIM enables the benefits of efficiency, resource management and compliance. It can overcome uncertainties of building condition and deficient documentation that are prevalent in older buildings. It also acts as a centralised platform, accessible by all stakeholders to hold ‘one version of the truth’. Due to complex built forms and increasing legislative pressure from the government for multiple occupancy buildings, a state-of-the-art overview with an easy to use visualisation of compliance and accountability is required for our existing building stock. From a review a step by step proof of Concept (PoC) digital twin model is proposed. The work will show accountable outcomes that can be validated at each stage, the time and cost saving, as well as Halton Housing’s goals of creating places to be proud of, addressing customer safety, and asset strategy can be achieved. The aim is to assist in creating a healthy organisation by improving IT platforms, making it easier for colleagues to do their jobs and promote brand and reputation, cementing position and maintaining a strong voice in the sector. Furthermore, the review will demonstrate how an existing building can be modelled into a digital twin via a 3D BIM implementation. Starting small with clear phases and utilising data already available, the development proposed offers an exciting innovative cross platform implementation, that aims to explore the ‘art of the possible’ and opportunities to scale-up by adding important assets and integrating IOT sensors to gain further insights. Most importantly, the review highlights the advantages to the business at every stage and can adapt to business assets in an exciting and innovative way

Surgical training rotation design: effects of hospital type, rotation theme and duration

Background Entrants into UK surgical specialty training undertake a 2‐year programme of core surgical training, rotating through specialties for varying lengths of time, at different hospitals, to gain breadth of experience. This study aimed to assess whether these variables influenced core surgical trainee (CST) work productivity. Methods Intercollegiate Surgical Curriculum Programme portfolios of consecutive CSTs between 2016 and 2019 were examined. Primary outcome measures were workplace‐based assessment (WBA) completion, operative experience and academic outputs (presentations to learned societies, publications and audits). Results A total of 344 rotations by 111 CSTs were included. Incremental increases in attainment were observed related to the duration of core surgical training rotation. The median number of consultant‐validated WBAs completed during core surgical training were 48 (range 0–189), 54 (10–120) and 75 (6–94) during rotations consisting of 4‐, 6‐ and 12‐month posts respectively (P  < 0·001). Corresponding median operative caseloads (as primary surgeon) were 84 (range 3–357), 110 (44–394) and 134 (56–366) (P  < 0·001) and presentations to learned societies 0 (0–12), 0 (0–14) and 1 (0–5) (P = 0·012) respectively. Hospital type and specialty training theme were unrelated to workplace productivity. Multivariable analysis identified length of hospital rotation as the only factor independently associated with total WBA count (P = 0·001), completion of audit (P = 0·015) and delivery of presentation (P = 0·001) targets. Conclusion Longer rotations with a single educational supervisor, in one training centre, are associated with better workplace productivity. Consideration should be given to this when reconfiguring training programmes within the arena of workforce planning

ArachnoServer 2.0, an updated online resource for spider toxin sequences and structures

ArachnoServer (www.arachnoserver.org) is a manually curated database providing information on the sequence, structure and biological activity of protein toxins from spider venoms. These proteins are of interest to a wide range of biologists due to their diverse applications in medicine, neuroscience, pharmacology, drug discovery and agriculture. ArachnoServer currently manages 1078 protein sequences, 759 nucleic acid sequences and 56 protein structures. Key features of ArachnoServer include a molecular target ontology designed specifically for venom toxins, current and historic taxonomic information and a powerful advanced search interface. The following significant improvements have been implemented in version 2.0: (i) the average and monoisotopic molecular masses of both the reduced and oxidized form of each mature toxin are provided; (ii) the advanced search feature now enables searches on the basis of toxin mass, external database accession numbers and publication date in ArachnoServer; (iii) toxins can now be browsed on the basis of their phyletic specificity; (iv) rapid BLAST searches based on the mature toxin sequence can be performed directly from the toxin card; (v) private silos can be requested from research groups engaged in venoms-based research, enabling them to easily manage and securely store data during the process of toxin discovery; and (vi) a detailed user manual is now available

A retrospective cohort study of differential attainment, COVID and chaos: taking the difference out of a terrible trinity

Background: This study aimed to evaluate core surgical training (CST) differential attainment related to coronavirus disease 2019 (COVID-19), gender and ethnicity. The hypothesis was that COVID-19 adversely influenced CST outcomes. Methods: A retrospective cohort study of 271 anonymised CST records was undertaken at a UK Statutory Education Body. Primary effect measures were Annual Review of Competency Progression Outcome (ARCPO), Membership of the Royal College of Surgeons (MRCS) examination pass and Higher Surgical Training National Training Number (NTN) appointment. Data were collected prospectively at ARCP and analysed with non-parametric statistical methods in SPSS. Results: CSTs numbering 138 completed training pre-COVID and 133 peri-COVID. ARCPO 1, 2 and 6 were 71.9% pre-COVID versus 74.4% peri-COVID (P = 0.844). MRCS pass rates were 69.6% pre-COVID versus 71.1% peri-COVID (P = 0.968), but NTN appointment rates diminished (pre-COVID 47.4% vs. peri-COVID 36.9%, P = 0.324); none of the above varied by gender or ethnicity. Multivariable analyses by three models revealed: ARCPO was associated with gender [m:f 1:0.87, odds ratio (OR) 0.53, P = 0.043] and CST theme (Plastics vs. General OR 16.82, P = 0.007); MRCS pass with theme (Plastics vs. General OR 8.97, P = 0.004); NTN with the Improving Surgical Training run-through programme (OR 5.00, P < 0.001). Programme retention improved peri-COVID (OR 0.20, P = 0.014) with pan University Hospital rotations performing better than Mixed or District General-only rotations (OR 6.63, P = 0.018). Conclusion: Differential attainment profiles varied 17-fold, yet COVID-19 did not influence ARCPO or MRCS pass rates. NTN appointment fell by one-fifth peri-COVID, but overall training outcome metrics remained robust despite the existential threat

Using ordinal logistic regression to evaluate the performance of laser-Doppler predictions of burn-healing time

Background Laser-Doppler imaging (LDI) of cutaneous blood flow is beginning to be used by burn surgeons to predict the healing time of burn wounds; predicted healing time is used to determine wound treatment as either dressings or surgery. In this paper, we do a statistical analysis of the performance of the technique. Methods We used data from a study carried out by five burn centers: LDI was done once between days 2 to 5 post burn, and healing was assessed at both 14 days and 21 days post burn. Random-effects ordinal logistic regression and other models such as the continuation ratio model were used to model healing-time as a function of the LDI data, and of demographic and wound history variables. Statistical methods were also used to study the false-color palette, which enables the laser-Doppler imager to be used by clinicians as a decision-support tool. Results Overall performance is that diagnoses are over 90% correct. Related questions addressed were what was the best blood flow summary statistic and whether, given the blood flow measurements, demographic and observational variables had any additional predictive power (age, sex, race, % total body surface area burned (%TBSA), site and cause of burn, day of LDI scan, burn center). It was found that mean laser-Doppler flux over a wound area was the best statistic, and that, given the same mean flux, women recover slightly more slowly than men. Further, the likely degradation in predictive performance on moving to a patient group with larger %TBSA than those in the data sample was studied, and shown to be small. Conclusion Modeling healing time is a complex statistical problem, with random effects due to multiple burn areas per individual, and censoring caused by patients missing hospital visits and undergoing surgery. This analysis applies state-of-the art statistical methods such as the bootstrap and permutation tests to a medical problem of topical interest. New medical findings are that age and %TBSA are not important predictors of healing time when the LDI results are known, whereas gender does influence recovery time, even when blood flow is controlled for. The conclusion regarding the palette is that an optimum three-color palette can be chosen 'automatically', but the optimum choice of a 5-color palette cannot be made solely by optimizing the percentage of correct diagnoses

Phase I Study of Safety and Immunogenicity of an Escherichia coli-Derived Recombinant Protective Antigen (rPA) Vaccine to Prevent Anthrax in Adults

The fatal disease caused by Bacillus anthracis is preventable with a prophylactic vaccine. The currently available anthrax vaccine requires a lengthy immunization schedule, and simpler and more immunogenic options for protection against anthrax are a priority for development. In this report we describe a phase I clinical trial testing the safety and immunogenicity of an anthrax vaccine using recombinant Escherichia coli-derived, B. anthracis protective antigen (rPA).A total of 73 healthy adults ages 18-40 were enrolled and 67 received 2 injections separated by 4 weeks of either buffered saline placebo, or rPA formulated with or without 704 µg/ml Alhydrogel® adjuvant in increasing doses (5, 25, 50, 100 µg) of rPA. Participants were followed for one year and safety and immunologic data were assessed. Tenderness and warmth were the most common post-injection site reactions. No serious adverse events related to the vaccine were observed. The most robust humoral immune responses were observed in subjects receiving 50 µg of rPA formulated with Alhydrogel® with a geometric mean concentration of anti-rPA IgG antibodies of 283 µg/ml and a toxin neutralizing geometric 50% reciprocal geometric mean titer of 1061. The highest lymphoproliferative peak cellular response (median Lymphocyte Stimulation Index of 29) was observed in the group receiving 25 µg Alhydrogel®-formulated rPA.The vaccine was safe, well tolerated and stimulated a robust humoral and cellular response after two doses.ClinicalTrials.gov NCT00057525

Live, Attenuated Influenza A H5N1 Candidate Vaccines Provide Broad Cross-Protection in Mice and Ferrets

BACKGROUND: Recent outbreaks of highly pathogenic influenza A H5N1 viruses in humans and avian species that began in Asia and have spread to other continents underscore an urgent need to develop vaccines that would protect the human population in the event of a pandemic. METHODS AND FINDINGS: Live, attenuated candidate vaccines possessing genes encoding a modified H5 hemagglutinin (HA) and a wild-type (wt) N1 neuraminidase from influenza A H5N1 viruses isolated in Hong Kong and Vietnam in 1997, 2003, and 2004, and remaining gene segments derived from the cold-adapted (ca) influenza A vaccine donor strain, influenza A/Ann Arbor/6/60 ca (H2N2), were generated by reverse genetics. The H5N1 ca vaccine viruses required trypsin for efficient growth in vitro, as predicted by the modification engineered in the gene encoding the HA, and possessed the temperature-sensitive and attenuation phenotypes specified by the internal protein genes of the ca vaccine donor strain. More importantly, the candidate vaccines were immunogenic in mice. Four weeks after receiving a single dose of 10(6) 50% tissue culture infectious doses of intranasally administered vaccines, mice were fully protected from lethality following challenge with homologous and antigenically distinct heterologous wt H5N1 viruses from different genetic sublineages (clades 1, 2, and 3) that were isolated in Asia between 1997 and 2005. Four weeks after receiving two doses of the vaccines, mice and ferrets were fully protected against pulmonary replication of homologous and heterologous wt H5N1 viruses. CONCLUSIONS: The promising findings in these preclinical studies of safety, immunogenicity, and efficacy of the H5N1 ca vaccines against antigenically diverse H5N1 vaccines provide support for their careful evaluation in Phase 1 clinical trials in humans

Trainee perspective of the causes of stress and burnout in surgical training: a qualitative study from Wales

Objectives Stress and burn-out among surgical trainees has been reported most prevalent in core surgical trainees (CST) and female trainees in particular. This study aimed to identify factors perceived by CSTs to be associated with stress and burnout in those at risk. Design An open-ended questionnaire was distributed to 79 CSTs and two researchers categorised responses independently, according to Michie’s model of workplace stress. Setting A UK regional postgraduate medical region (Wales). Participants Sixty-three responses were received; 42 males, 21 females. The response rate was 79.7%. Results Inter-rater reliability was good (k=0.792 (79.2%), p<0.001). The most common theme of Michie’s model related to CST stress and burnout was career development, with most statements associated with curriculum, examination and academic demands required to attain a CST certificate of completion of training, and higher surgical national training number appointment. This was closely followed by those intrinsic to the job with recurrent discussion around the difficulties balancing work perceived to be service provision (ward work and on-calls), outpatient clinic and operative experience. Conversely, the most common themes relevant to stress and burnout among female trainees were associated with relationships at work (primarily the male-dominated nature of surgery), extraorganisational factors (family–work life balance) and individual characteristics (personality and physiological differences). Conclusion CSTs’ perceptions regarding the causes of National Health Service related stress and burnout are numerous, and these findings provide a basis for the development of targeted stressor counter-measures to improve training and well-being