Development of a Clinical Simulation Protocol for the Transfer of a Premature Fetal Manikin to the Perinatal-Life-Support System

Introduction:At present, Perinatal-Life-Support (PLS) research is progressing to offer extreme premature infants an extracorporeal environment for extended growth that mimics the natural womb closely. During the early phase development of this novel life-support technology, validation and training could be facilitated by the use of a medical simulation. By doing so, the need for animal testing can be greatly reduced. Within this abstract, the development to realize a wellorchestrated clinical simulation protocol is described, tailored to the specific needs of novel procedure(s) regarding the transfer of a premature fetus from the maternal uterus to the PLS system.Materials & Methods:Throughout protocol development an iterative approach is used, initiated with a literature analysis and a review of existing obstetrics guidelines for premature births. Next, co-creation sessions and interviews with medical and engineering experts led to a holistic understanding of fetal physiology, patient and specialist needs, current procedures, task divisions, hospital resources and drug specifications. Expert feedback on drafts, checklists and an explanatory step-by-step video, led to multiple re-designs as unforeseen procedural difficulties arose. Verified with available data from literature, multiple perspectives and options were analyzed and weighed to ensure the advancement of a safe, hygienic, effective, and user-friendly simulation protocol.Results:We describe the development process of a simulation protocol and showcase an overview of the current protocol design through an infographic, outlining the different phases and tasks during a transfer procedure and the planning of involved medical experts within the operating theatre. We demonstrate that an iterative approach to protocol development for an unprecedented procedure allows for a comprehensive understanding of the challenges that a transfer to the PLS-system could bring.Conclusions:Using medical simulation during the early phase development process of the PLS-system allows us to train and validate novel practices, in particular the transfer procedure. With the demonstrated approach we aim to establish a thorough simulation protocol by providing a step-by-step plan, informed by literature and expert consultation. We expect to offer a realistic simulation training whilst also informing requirements for the future development of PLS-related devices and their validation

Simulation-based development: shaping clinical procedures for extra-uterine life support technology

Background Research into Artificial Placenta and Artifcial Womb (APAW) technology for extremely premature infants (born < 28 weeks of gestation) is currently being conducted in animal studies and shows promising results. Because of the unprecedented nature of a potential treatment and the high-risk and low incidence of occurrence, translation to the human condition is a complex task. Consequently, the obstetric procedure, the act of transferring the infant from the pregnant woman to the APAW system, has not yet been established for human patients. The use of simulation-based user-centered development allows for a safe environment in which protocols and devices can be conceptualized and tested. Our aim is to use participatory design principles in a simulation context, to gain and inte‑ grate the user perspectives in the early design phase of a protocol for this novel procedure.Methods Simulation protocols and prototypes were developed using an iterative participatory design approach; usability testing, including general and task specifc feedback, was obtained from participants with clinical expertise from a range of disciplines. The procedure made use of fetal and maternal manikins and included animations and protocol task cards.Results Physical simulation with the active participation of clinicians led to the difusion of tacit knowledge and an iteratively formed shared understanding of the requirements and values that needed to be implemented in the procedure. At each sequel, participant input was translated into simulation protocols and design adjustments.Conclusion This work demonstrates that simulation-based participatory design can aid in shaping the future of clinical procedure and product development and rehearsing future implementation with healthcare professional

Simulation-based development: shaping clinical procedures for extra-uterine life support technology

Background Research into Artificial Placenta and Artifcial Womb (APAW) technology for extremely premature infants (born < 28 weeks of gestation) is currently being conducted in animal studies and shows promising results. Because of the unprecedented nature of a potential treatment and the high-risk and low incidence of occurrence, translation to the human condition is a complex task. Consequently, the obstetric procedure, the act of transferring the infant from the pregnant woman to the APAW system, has not yet been established for human patients. The use of simulation-based user-centered development allows for a safe environment in which protocols and devices can be conceptualized and tested. Our aim is to use participatory design principles in a simulation context, to gain and inte‑ grate the user perspectives in the early design phase of a protocol for this novel procedure.Methods Simulation protocols and prototypes were developed using an iterative participatory design approach; usability testing, including general and task specifc feedback, was obtained from participants with clinical expertise from a range of disciplines. The procedure made use of fetal and maternal manikins and included animations and protocol task cards.Results Physical simulation with the active participation of clinicians led to the difusion of tacit knowledge and an iteratively formed shared understanding of the requirements and values that needed to be implemented in the procedure. At each sequel, participant input was translated into simulation protocols and design adjustments.Conclusion This work demonstrates that simulation-based participatory design can aid in shaping the future of clinical procedure and product development and rehearsing future implementation with healthcare professional

CO2 fluxes from three different temperate grazed pastures using Eddy covariance measurements

Grasslands cover around 25% of the global ice-free land surface, they are used predominantly for forage and livestock production and are considered to contribute significantly to soil carbon (C) sequestration. Recent investigations into using ‘nature-based solutions’ to limit warming to <2 °C suggest up to 25% of GHG mitigation might be achieved through changes to grassland management. In this study we evaluate pasture management interventions at the Rothamsted Research North Wyke Farm Platform, under commercial farming conditions, over two years and consider their impacts on net CO2 exchange. We investigate if our permanent pasture system (PP) is, in the short-term, a net sink for CO2 and whether reseeding this with deep-rooting, high-sugar grass (HS) or a mix of high-sugar grass and clover (HSC) might increase the net removal of atmospheric CO2. In general CO2 fluxes were less variable in 2018 than in 2017 while overall we found that net CO2 fluxes for the PP treatment changed from a sink in 2017 (−5.40 t CO2 ha−1 y−1) to a source in 2018 (6.17 t CO2 ha−1 y−1), resulting in an overall small source of 0.76 t CO2 ha−1 over the two years for this treatment. HS showed a similar trend, changing from a net sink in 2017 (−4.82 t CO2 ha−1 y−1) to a net source in 2018 (3.91 t CO2 ha−1 y−1) whilst the HSC field was a net source in both years (3.92 and 4.10 t CO2 ha−1 y−1, respectively). These results suggested that pasture type has an influence in the atmospheric CO2 balance and our regression modelling supported this conclusion, with pasture type and time of the year (and their interaction) being significant factors in predicting fluxes

BB flavour tagging using charm decays at the LHCb experiment

An algorithm is described for tagging the flavour content at production of neutral $B$ mesons in the LHCb experiment. The algorithm exploits the correlation of the flavour of a $B$ meson with the charge of a reconstructed secondary charm hadron from the decay of the other $b$ hadron produced in the proton-proton collision. Charm hadron candidates are identified in a number of fully or partially reconstructed Cabibbo-favoured decay modes. The algorithm is calibrated on the self-tagged decay modes $B^+ \to J/\psi \, K^+$ and $B^0 \to J/\psi \, K^{*0}$ using $3.0\mathrm{\,fb}^{-1}$ of data collected by the LHCb experiment at $pp$ centre-of-mass energies of $7\mathrm{\,TeV}$ and $8\mathrm{\,TeV}$. Its tagging power on these samples of $B \to J/\psi \, X$ decays is $(0.30 \pm 0.01 \pm 0.01) \%$.Comment: All figures and tables, along with any supplementary material and additional information, are available at http://lhcbproject.web.cern.ch/lhcbproject/Publications/LHCbProjectPublic/LHCb-PAPER-2015-027.htm

Molecular and translational advances in meningiomas.

Meningiomas are the most common primary intracranial neoplasm. The current World Health Organization (WHO) classification categorizes meningiomas based on histopathological features, but emerging molecular data demonstrate the importance of genomic and epigenomic factors in the clinical behavior of these tumors. Treatment options for symptomatic meningiomas are limited to surgical resection where possible and adjuvant radiation therapy for tumors with concerning histopathological features or recurrent disease. At present, alternative adjuvant treatment options are not available in part due to limited historical biological analysis and clinical trial investigation on meningiomas. With advances in molecular and genomic techniques in the last decade, we have witnessed a surge of interest in understanding the genomic and epigenomic landscape of meningiomas. The field is now at the stage to adopt this molecular knowledge to refine meningioma classification and introduce molecular algorithms that can guide prediction and therapeutics for this tumor type. Animal models that recapitulate meningiomas faithfully are in critical need to test new therapeutics to facilitate rapid-cycle translation to clinical trials. Here we review the most up-to-date knowledge of molecular alterations that provide insight into meningioma behavior and are ready for application to clinical trial investigation, and highlight the landscape of available preclinical models in meningiomas

Representational predicaments for employees: Their impact on perceptions of supervisors\u27 individualized consideration and on employee job satisfaction

A representational predicament for a subordinate vis-à-vis his or her immediate superior involves perceptual incongruence with the superior about the subordinate\u27s work or work context, with unfavourable implications for the employee. An instrument to measure the incidence of two types of representational predicament, being neglected and negative slanting, was developed and then validated through an initial survey of 327 employees. A subsequent substantive survey with a fresh sample of 330 employees largely supported a conceptual model linking being neglected and negative slanting to perceptions of low individualized consideration by superiors and to low overall job satisfaction. The respondents in both surveys were all Hong Kong Chinese. Two case examples drawn from qualitative interviews illustrate and support the conceptual model. Based on the research findings, we recommend some practical exercises to use in training interventions with leaders and subordinates. © 2013 Copyright Taylor and Francis Group, LLC