Results on a pedagogic approach for tailoring public health interventions to minimise opportunistic infections.

We are performing curriculum modifications on the first year BSc (Hons) Biomedical Science module “Basic Microbiology” (De Montfort University, UK) to increase students’ knowledge of basic medical parasitology and infectious diseases, so these students can acquire the necessary skills to tackle their final degree module “Medical Microbiology”. Following student feedback on a novel short intervention in 2017/18 to promote awareness about human immunodeficiency virus (HIV), we have created an engaging workshop session to cover not only HIV but also the opportunistic infections that can affect HIV patients that have developed acquired immune deficiency syndrome (AIDS) and how to prevent them. The objective of this work was to evaluate the effectiveness of the improved workshop developed and to collect students’ impressions to perform further modifications if needed. Briefly, students were required to develop public health measures for HIV positive patients with two different degrees of immunosuppression (i.e. with CD4+ T cells in peripheral blood above and below 200 cells/μl) to prevent exposure and infection from opportunistic pathogens such as Cryptosporidium spp., Toxoplasma gondii or Pneumocystis jirovecii from: a) sexual exposures; b) intravenous drug use; b) environment and work; c) food and water; d) foreign travel. Students, following evidence-based public health methodology, tailored their measures or interventions using the most up-to-date information reported in the literature regarding HIV chemoprophylaxis and recent guidelines published by US Department of Health and Human Services on HIV/AIDS treatment and prevention. Interventions were critically analysed with all students in the last 20 min. of the workshop, which was repeated several times due to the number of students (n=203). The objectives of this workshop were evaluated by careful analysis of a specific feedback questionnaire (n=46 out of 203) voluntarily completed by students at the end of the workshop. The questionnaire showed the following feedback: 80.4% (65.2% agreed; 15.2% strongly agreed) indicated that they learnt how to identify public health interventions; and 95.7% (56.5% agreed; 39.1% strongly agreed) indicated that they would be able to establish measures to reduce HIV transmission and prevent opportunistic infections. Additionally, 95.7% (39.1% agreed; 56.5% strongly agreed) indicated that the workshop helped them to understand the relevance of local and global interventions. Finally, 97.8% of responders considered that the content (52.2% agreed; 45.7% strongly agreed) and duration (60.9% agreed; 37% strongly agreed) of the workshop was appropriate; and 89.1% (58.7% agreed; 30.4% strongly agreed) and 73.9% (41.3% agreed; 32.6% strongly agreed) enjoyed and were satisfied with the workshop provided, respectively. In conclusion, the improved workshop developed would seem to be effective for promoting sexual and public health education to minimise opportunistic pathogen infections in relevant patients when delivered to students with a basic knowledge of microbiology and parasitology

Tentative baseline values of less frequently regulated elements in urban park soils of Alcala de Henares, Spain.

Background or baseline concentrations of metals in urban soils are critical to determine risks and establish clean-up decontamination thresholds to protect the public, but these concentrations remain unknown for less frequently regulated and monitored metals in most of the European cities. Iterative 2σ-technique1 and boxplot methods2 were used to establish tentative background values for a variety of metals in soils from urban parks in Alcalá de Henares (Spain), which resulted in the same median values for the elements studied (mg/kg): Ag (0.003), Co (0.8), Mo (0.24), Pt (0.26), Rh (0.15), Sb (0.15) and Y (5.1). The percent differences when comparing these values with the average continental crust3 values were as follows: 47.1, 84.2, 78.8, 83, 34.5, 158, 52.8 and 75.4 for Ag, Co, Mo, Pt, Rh, Sb and Y, respectively. These differences could be explained by the geochemical peculiarities of Alcalá’s soils. Our results are a preliminary step for developing background values following implementation of a further monitoring programme in the urban soils studied

Public Health England's recovery tools: potential teaching resources?

The file attached to this record is the author's final peer reviewed version.Training to combat chemical and radiation accidents, incidents or attacks is critical for health professionals due to recent events involving these hazards or their use as unconventional weapons, such as the use of the nerve agent novichok in Salisbury, UK. Health professionals need to have appropriate knowledge and skills to effectively respond to future events involving any of these substances, which requires a rapid and coordinated response from different professionals to protect the environment and minimise the number of people exposed and reduce morbidity and mortality. However, despite chemical and radiation incidents becoming increasingly prevalent, literature reviews have shown that there is a lack of teaching of appropriate competences to face future crises in Europe, particularly amongst clinicians and other health professionals that would be part of the initial response. Thus, De Montfort University (DMU, UK) in collaboration with different academics from the University of Alcalá (Spain) and researchers from Public Health England (PHE) with comprehensive experience in environmental decontamination and restoration, have created a short training course for providing undergraduate/postgraduate students with basic skills to respond to chemical incidents, basic skills that are based on the major competences recently identified by the European Commission [1]. This novel training has been tested with students from different backgrounds in various European universities, recording high degrees of acquisition of the various basic competences that we developed to initially respond to chemical events [2]. To develop the practical part of this chemical training, we have incorporated the novel guidance and methodology developed by PHE to successfully tailor a protection and recovery response to any incident involving chemical substances, which is available in the “UK Recovery Handbook for Chemical Incidents” [3] and its web-based tools: “Chemical Recovery Navigation Tool” (CRNT, [4]) and “Chemical Recovery Record Form” (CRRF, [5]). These innovative resources aid the user to select effective protection, decontamination and restoration techniques or strategies from a pool of up-to-date options applicable to different environments according to the physicochemical properties of the chemical(s) involved and the area affected. The CRNT is accompanied by the CRRF, which facilitates collection and analysis of the necessary data to inform decisions, and an e-learning resource named “Chemical Recovery: Background” (CRB, [6]), which could facilitate the learning of environmental decontamination and restoration. We are currently developing a short training course to cover minor radiation incidents; this radiation training will follow the same methods used to develop the chemical training, but with the specific PHE recovery tools to tackle such events, specifically the “UK Recovery Handbooks for Radiation Incidents” [7] and its associated web-based tools “Radiation Recovery Navigation Tool” (Rad RNT, [8]), one for each environment: food production systems, inhabited areas and drinking water supplies. This communication will explore the use of the PHE’s Recovery Navigation Tools as potential resources to facilitate the acquisition of basic knowledge to tailor protection and recovery interventions for minor chemical and radiation incidents to protect the public

Levels of rare earth elements in hair from a group of young Spanish adults (aged 20-24 years).

The Publisher's final version can be found by following the DOI link.The rapid agricultural, medical and industrial development is occurring on a global scale and bringing with emerging environmental threats for humans. Contamination by rare earth elements (REE) has emerged as a public health concern due to their numerous applications in the current industry. However, little is known about their toxicological effects despite they can accumulate in different organs including brain and bone. To determine the exposure to these contaminants in a young Spanish population, scalp hair samples were collected in 37 young adults (20 to 24 years-old; 28 female and 9 male) from different towns in the Community of Madrid (Spain). Despite being controversial, human hair could be an appropriate tool to determine environmental exposure to inorganic metal contaminants and to estimate the chemical burden in the individual. Lanthanum (La), cerium (Ce), praseodymium (Pr), erbium (Er) and gadolinium (Gd) were analysed in these samples by ICP-MS following appropriate methodologies. The limits of detection were (in ng/g): La (1.87), Ce (4.29), Pr (0.47), Er (0.06) and Gd (0.24 ng/g). Gd was detected only in one of the monitored samples (2.66 ng/g). The concentrations were as follow (median and percentiles are provided in ng/g): La 5.30 (4.22, 7.13), Ce 11.18 (8.97, 15.45), Pr 1.28 (1.04, 1.72) and Er 0.19 (0.14, 0.28). In general, the presence of these metals in the Spanish group’s hair monitored were lower than those reported in environmentally exposed groups, which may indicate that the studied group would have a low exposure to REE. None of these elements showed influence due to sex, although slightly higher levels were observed for La (5.57 vs. 5.17 ng/g), Pr (1.40 vs. 1.27 ng/g), Nd (2.48 vs. 2.29 ng/g) and Er (0.21 vs. 0.19 ng/g) in men’s hair and in women’s hair for Ce (11.58 vs 10.30 ng/g). Despite is unclear, our results would be in agreement with those studies that have suggested that men may be more sensitive to REE than women

Importance of teaching environmental contamination and decontamination in human health science degrees

The file attached to this record is the author's final peer reviewed version.A novel short training in environmental toxicology, risk assessment and decontamination was created in the specialty of “Industrial Pharmacy and Galenic” at the University of Alcalá (UAH, Spain) in 2013-14 to provide postgraduate pharmacists with basic skills, tools and knowledge to decontaminate environments affected by chemical accidents. These students completed a highly specialised research-led workshop (training) to decontaminate an open water system affected by a chemical industry spill accident using the “UK Recovery Handbook for Chemical Incidents” (UKRHCI; Wyke-Sanders et al., 2012). The UKRHCI has been developed by Public Health England (PHE) and includes an innovative methodology to select appropriate decontamination options and techniques to tackle environments impacted by chemicals. This training was modified in 2015/16 to introduce the innovative PHE virtual resource “Chemical Recovery Navigation Tool” (CRNT; published in 2015) that follows the same methodology and resources described in the UKRHCI. Comprehensive students’ feedback, including a SWOT analysis (weaknesses, threats, strengths and opportunities), was collected to investigate the implemented changes in our training. The modifications undertaken raised high levels of student satisfaction. Briefly: 100% students reported that the CRNT facilitated the understanding of the training and the selection of recovery options to respond to the case scenario proposed. Students described as strength that the workshop was very interesting, interactive and novel, and its execution in English (as the training was delivered at the Spanish university UAH). The possibility of working in environmental toxicology and decontamination was described as an opportunity. Students highlighted as weaknesses and threats its low relation with the pharmaceutical industry and brief duration (5 hours). This academic course (2016/17), a comprehensive modification has been undertaken at De Montfort University (DMU, UK) to adapt this novel training to a range of different human health science programmes, including master’s students attending the MSc. Advanced Biomedical Science programme at DMU and undergraduate Pharmacy students at the University of San Pablo CEU (USP-CEU, Spain). An Erasmus+ mobility grant for academics was satisfactorily used to validate this short training at USP-CEU earlier in 2017. A specific feedback-questionnaire distributed in both academic arenas have provided the following results: 85.7% (USP-CEU) and 50% (50% neither agree nor disagree; DMU) of students enjoyed the workshop provided. 83% of the master’s students (DMU) and 100% of undergraduate students (USP-CEU) reported that they learnt how to select appropriate recovery options to decontaminate the open water and urban environments proposed. Finally, 42.9% (57.1% neither agree nor disagree) and 83% of students have recommended the incorporation of more similar training in each programme respectively (USP-CEU and DMU). The short training described in this paper have shown to be effective in improving students’ knowledge and skills to restore environments impacted by chemical agents. We consider that all human health undergraduate programmes should teach some topics on environmental toxicology and decontamination due to the increasing use of toxic and carcinogenic chemicals by people and industries around the world

Evaluating the effect of age and area of residence in the metal and metalloid contents in human hair and urban topsoils

The file attached to this record is the author's final peer reviewed version. The Publisher's final version can be found by following the DOI link.Monitoring the levels of trace elements in hair can allow estimating the effects of the geographical location and also can provide a notion of the metal body burden. However, the use of human hair is controversial due to the different confounding factors that could affect the presence of trace elements in hair. As a result, a comprehensive monitoring study was performed in Alcalá de Henares, one of the major cities in the Madrid region, Spain. Trace elements have been monitored in urban topsoils and in human hair of two well-defined and healthy groups of population: children (6–9 years) and adolescents (13–16 years). The city was divided into four areas or zones with different characteristics to assess the possible effect of area of residence and age in the presence of Al, As, Be, Cd, Cr, Cu, Hg, Mn, Pb, Sn, Ti, Tl and Zn in soils and hair. There is no current hypothesis that explains the possible effect of the area of monitoring in the distribution of Be, Cr, Ni, Sn and Ti found in these urban soils, maybe because urban soils receive high disturbance, and there are many factors involved. The presence of most of the trace elements monitored was significantly higher in the hair of the children population, except for Sn and Zn. This could be attributed mainly to dietary habits. Other factors influencing metal content in hair such as environmental factors would have had a minimal effect in the population groups here studied. Finally, none of the levels of trace elements studied in hair were significantly correlated with levels measured in the topsoils of public parks in Alcalá de Henares, with the exception of Pb in adolescent participants

Interventions to enhance the teaching of toxicology at a UK University

Following the recent communication from the European Societies of Toxicology (EUROTOX) advising that toxicology training and expertise is being eroded in the European Union, we have reviewed the teaching status of this subject in all the bioscience undergraduate courses offered at De Montfort University (DMU, UK). The courses reviewed were: Biomedical Science, Health and Wellbeing in Society, Speech and Language Therapy, Medical Science, Pharmaceutical and Cosmetic Science, Forensic Science and Pharmacy. None of these courses dedicate a complete module to the study of toxicology although they teach some aspects of toxicology following the subject-specific threshold standards described by the UK Quality Assurance Agency for Higher Education. Similar results are found in other UK Universities, although a comprehensive study on the status of toxicology teaching is needed. We have not found any undergraduate courses currently offered in the UK that contained the word “toxicology” in their title. These results are in agreement with EUROTOX, which indicated that toxicology has been generally integrated into other bioscience disciplines and is mainly offered as part of a taught postgraduate degree programme in Europe. Owing to these observations, our teaching group is performing different strategies to enhance the teaching of toxicology at DMU as we consider that the learning of this science is critically important to enable future health professionals to protect human health. These strategies included the development of specialised teaching/workshop sessions in toxicology that can be easily included in any undergraduate bioscience module. Thus, during 2016/17 we collected comprehensive feedback (during an Erasmus+ mobility grant for academics) from human health students about their views on the teaching of toxicology and one of the specialised workshops in a programme that does not offer a module in toxicology (BMedSci Medical Science, DMU) and one that does (MPharm. Pharmacy, University of San Pablo CEU, Spain). A high proportion of the students consulted requested more teaching of toxicology or the introduction of more specialised toxicology in their programmes. Thus, 85% of second year BMedSci students indicated that they would like to receive more toxicology training. Also, 42.9% (57.1% neither agree nor disagree) of fourth year MPharm. students suggested the incorporation of specialised environmental toxicology workshops within their course and all of them considered the environmental toxicology training relevant to their general toxicology module. Other strategies implemented include the enhancement of research in toxicology in our university by offering final projects on these topics to undergraduate and postgraduate students, as well as completion of PhDs. Finally, DMU has recently recruited two toxicologists as academic staff, allowing us to promote the teaching/research of toxicology as well as exploring the possibility of developing postgraduate content for the teaching of toxicology. More efforts should be considered to enhance the teaching of this subject in any bioscience programme, as the current status of toxicology in the UK has been eroded

Interest shown by medical students at University of San Pablo CEU (Spain) regarding prevention and response to outbreaks of infection

The release of biological hazards during biological incidents, bioterrorism or outbreaks of infection has shown to represent a significant challenge for healthcare professionals as it can involve significant numbers of patients and represent a global public health threat. Healthcare educators should provide students with the necessary skills in medical preparedness and response to these incidents to protect the public. However, this is not standardised in the medical curriculum. An innovative teaching group at De Montfort University (DMU, UK) in collaboration with first responders that worked during the 2014-2016 Ebola outbreak in a Public Health England (PHE) mobile laboratory in Sierra Leone, have developed different, novel teaching training sessions to provide health science students with the necessary skills to respond to these events. We have tested the training sessions with students from three different undergraduate (BSc Biomedical and Medical Science) and postgraduate (MSc Advanced Biomedical Science) human health programmes at DMU. In general, these sessions were shown to be successful in providing students with basic skills to respond to minor biological incidents (Peña-Fernández et al., 2017), although we do not know if these could be adopted to develop standardized curricula across any human health degree in the European Union (EU). Therefore, the purpose of this work was twofold: a) to assess the effectiveness of the specialised training session that covers the medical response to protect public health with medical students; and b) to determine the effectiveness of the training session, initially developed in England, in a non-English EU university. To meet these objectives, we have simplified this specialised training and delivered it to final year students of the Medicine degree at the University of San Pablo CEU (USP-CEU, Spain) during an Eramus+ mobility grant for academics in April 2017. The two hour training provided consisted of developing a complete intervention programme to deal with an outbreak of Crimean-Congo haemorrhagic fever (CCFH) virus following the steps of evidence-based public health. CCFH is a haemorrhagic fever virus causing devastating disease symptoms that result in intense and prolonged suffering in humans and has become an increasing global health concern. This paper will describe the teaching resources used and a comprehensive analysis of students’ feedback to this training. Briefly: the specific questionnaire used has shown high levels of engagement and satisfaction [100% (31.2% agreed; 68.8% strongly agreed)] with the USP-CEU medical students. Despite its short duration, this training would be successful in providing medical students with the necessary skills to respond to a biological event. Thus, 100% (31.2% agreed; 68.8% strongly agreed) of these students reported that they learnt how to establish some public health interventions to protect humans in the aftermath of an outbreak of infection. Moreover, all USP-CEU responders have described that they gained appropriate knowledge of public health prevention and preparedness against these events (37.5% agreed; 62.5 strongly agreed). Finally, the Erasmus+ mobility grant for academics has been shown to be a relevant tool and resource to strengthen curricula development and validation in higher education

Two years' analysis of environmental recovery training for biological incidents

Environmental recovery in the aftermath of a biological incident is one of the key areas to consider when tailoring a response to protect human health and minimise the spread of the biological agent(s) involved. However, recent studies have highlighted general national and international emergency weaknesses including a lack of preparedness in health care professionals and emergency responders to tackle these events. We undertook a web-based, non-systematic search for biological response training in human health undergraduate programmes in the UK, by using the Google™ search engine. To the best of our knowledge, there are no undergraduate courses in the UK that directly address this topic. Only a few postgraduate programmes present some information about responding to biological incidents but they do not cover the different phases of a biological incident response, which are: preparedness and situation assessment; exposure assessment; acute health effects; long term health effects; and recovery phase. In order to develop appropriate training, academics from De Montfort University (DMU, Leicester, UK) and the University of Alcalá (Spain) in collaboration with first responders (biomedical scientists) to the 2014-16 Ebola outbreak in Sierra Leone, have developed specific training for undergraduate human health degree students to respond to biological incidents. We have created basic competences to develop this training and distributed them into six domains following the recommendations of the European Commission for medical responders to CBRN emergencies [1]: identification of the risk and risk analysis; toxicological effect of biological agents; planning and organisation of an intervention programme; environmental planning; communication and information management; safety and personal protective equipment; societal and ethical reflections. Following the basic competences created, we developed different training sessions with two components, theoretical (lectures and seminars) and practical (research-led workshop), to cover each of the different phases of an appropriate response to any biological incident. The specific training that covers the recovery phase has been delivered to postgraduate students from the MSc programme in Advanced Biomedical Science at DMU since 2016/17 due to the more manageable student number, time available to deliver the training and greater background knowledge of the class. The analysis of the feedback provided by the first cohort of students indicated high levels of engagement and interest in this training session. We performed some minor modifications following the students’ feedback and delivered it this academic course 2017/18 (n=9) to gain more information about its effectiveness in facilitating the specific basic competences covered in this training including the resources used to tailor a recovery response to the case scenario proposed (an outbreak due to Cyclospora spp.) such as the UK Recovery Handbook for Biological Incidents (UKRHBI; PHE, 2015 [2]). All students were satisfied with this training and all highlighted that the tools used aided their learning about environmental recovery (33.3% agreed; 66.7% strongly agreed). All participants indicated that the UKRHBI was an appropriate resource for tailoring a recovery response. Finally, students indicated that they would have liked to have more time to develop a response to the case scenario proposed (the workshop was 2 hours long)

Can international trip experiences at DMU (#DMUGlobal, UK) provide transversal and work competences?

De Montfort University (DMU, Leicester, UK) is highly committed to promote different strategies to facilitate the acquisition of the key transversal competences and skills recently defined by the European Union for future students in the European Higher Education Area (European Commission, May 2017), including skills to manage complex information and resolve complex global challenges, capabilities for creative and autonomous thinking, effective communication, engagement with local communities and promotion of social inclusion and mobility. To promote internationalisation, DMU developed a specific programme named #DMUglobal in September 2013 that includes the European mobility programmes (Erasmus+) and DMU academic-led trips. The #DMUglobal trips involve a short-term visit to another country that is offered to any DMU student. To the best of our knowledge, #DMUglobal provides one of the most comprehensive international experience programmes at any UK university. The DMU Faculty of Health & Life Sciences offered a novel #DMUglobal trip to visit New York (NYC, US) in the 2017/18 academic course to determine potential public health risks due to environmental contamination by carbon monoxide (CO). A total of 45 students from different programmes, specifically BSc Biomedical Science, BMedSci Medical Science and BSc Healthcare Science (Audiology), visited NYC in January 2018 for 5 days together with two academics that supervised the different activities. Briefly, students were divided into small groups to measure levels of CO from different locations in NYC using small CO detector devices. Once they returned to DMU, students analysed the collected data to determine any potential human risks and completed a poster by the end of January 2018. Posters were peer-reviewed by these students, which selected the best one to be presented at a DMU research conference in Summer 2018. We used qualitative and quantitative methods to analyse whether students that undertook this international experience gained some of the above competences and other such as the memo factors (curiosity, confidence, serenity, decisiveness and vigour). Thirty students completed a feedback-questionnaire, which showed high levels of enjoyment in participating in this novel global trip (43.3% agreed, 50% strongly agreed) and pointed to teamwork as the best part of the CO monitoring activity. Furthermore, 83.3% indicated that they gained or improved specific skills such as communication, engagement with local communities and broadened their cultural horizons (33.3% agreed, 50% strongly agreed). Also, 73.3% highlighted that they gained some presentation skills and 70% described that producing the poster helped them to understand the topic. Moreover, 73.3% of students that completed the questionnaire indicated that they will use the knowledge learnt in their studies. In the open answer questions, students suggested some improvements for future trips including the provision of more sensitive CO monitors and the creation of extra activities relevant for biomedical science. These results could indicate that the #DMUglobal trips could be an effective strategy to facilitate and promote many of the key competences described