Learning Together 1: an educational model for training GPs, paediatricians: initial findings.

Learning Together is primarily an educational intervention, where paediatric registrars [SpRs] and General Practice (GP) registrars [GPSTs] see children together in a primary care setting. Over a six month period in 2013/2014, 44 learning pairs were set up mainly in North East and Central London. Proof of concept for the model at scale was achieved. Reported learning demonstrated: clinical learning themes of new knowledge, skill and communication skills; and collaborative themes of ongoing collaboration, satisfaction with team working and change in attitudes. These themes were identified in both sets of trainees. The self-reported learning is backed up by the results of a retrospective notes review of four common conditions based on NICE guidelines; constipation, asthma, feverish illness and eczema (CAFE). Guidance adherence improved from 57% before the intervention in solo GP training consultations to 72% during the joint clinic intervention (p < 0.01). After the intervention when the GP registrars returned to normal consultations, guidance adherence was 77% compared to before the intervention (p < 0.01). In addition 99% of the parents, who handed in feedback forms or took part in interviews, reported a good experience of care, and 87% reported increased confidence to manage their children's health following the consultation. A second, linked article examines the cost utility of Learning Together in its South London extension

Issues related to direct seeding of rice in rainfed cropping systems in northwest Bangladesh

Economic factors and developments in rice production technologies are the major drivers that have led to the adoption of direct seeding of rice in place of transplanting in Asia. The primary economic motives for a shift to direct seeding are the savings in labor cost and the possibility of crop intensification. A key development challenge in the drought-prone rainfed agriculture of the Barind Tract of northwest Bangladesh is to simultaneously improve the reliability and yield of monsoon rice while improving total system productivity by increasing the area planted to drought-tolerant postrice crops. Research trials and field-scale evaluation by farmers have demonstrated that dry direct seeding or wet seeding of pregerminated rice seed reduces labor for crop establishment, results in rice yields similar to or higher than those from conventional transplanting, and advances harvest by 7-10 days. Earlier harvest has the potential to reduce the risk of terminal drought in rice when the monsoon ends abruptly and increases the opportunity for establishing a postrice crop of chickpea on residual moisture. Herbicide use is essential with direct seeding and this further reduces rice production costs. This modified rice/legume system using direct seeding is knowledge-intensive. Widespread sustained adoption will depend on farmers undertaking timely tillage, adequate land leveling, and timely application of herbicides. Extension/farmer training supported by clear decision support frameworks will be needed to provide farmers with access to the knowledge needed to implement direct seeding effectively

The integration of on-line monitoring and reconfiguration functions using IEEE1149.4 into a safety critical automotive electronic control unit.

This paper presents an innovative application of IEEE 1149.4 and the integrated diagnostic reconfiguration (IDR) as tools for the implementation of an embedded test solution for an automotive electronic control unit, implemented as a fully integrated mixed signal system. The paper describes how the test architecture can be used for fault avoidance with results from a hardware prototype presented. The paper concludes that fault avoidance can be integrated into mixed signal electronic systems to handle key failure modes

Confined compression of collagen hydrogels

Reconstituted collagen hydrogels are often used for in vitro studies of cell-matrix interaction and as scaffolds for tissue engineering. Understanding the mechanical and transport behaviours of collagen hydrogels is therefore extremely important, albeit difficult due to their very high water content (typically > 99.5%). In the present study the mechanical behaviour of collagen hydrogels in confined compression was investigated using biphasic theory (J. Biomech. Eng. 102 (1980) 73), to ascertain whether the technique is sufficiently sensitive to determine differences in the characteristics of hydrogels of between 0.2% and 0.4% collagen. Peak stress, equilibrium stress, aggregate modulus and hydraulic permeability of the hydrogels exhibited sensitivity to collagen content, demonstrating that the technique is clearly able to discriminate between hydrogels with small differences in collagen content and may also be sensitive to factors that affect matrix remodelling. The results also offer additional insight into the deformation-dependent permeability of collagen hydrogels. This study suggests that confined compression, together with biphasic theory, is a suitable technique for assessing the mechanical properties of collagen hydrogels

The effects of decellularisation on the mechanical properties of bone, and subsequent recellularisation of the samples.

Regenerative medicine strategies involving decellularised extracellular matrix scaffolds are developing fast and, in particular, decellularized bone has been proposed for bone tissue engineering. This study aimed to establish decellularisation and recellularisation protocols and to measure the Young’s modulus and pore size of the decellularised trabecular bone samples. Twelve bovine cancellous proximal femur samples (7mm x 7mm x 2mm) were decellularised by six cycles of overnight incubation at 37°C using two protocols: A – 10mM Tris, 1mM EDTA, 0.1% v/v Triton X-100 and B – method A plus 0.5% w/v trypsin. Decellularisation was confirmed by the absence of DNA staining with DAPI both by detecting any DNA remaining on the bone matrix spectrofluorometrically, and by microscopic examination. Young's modulus was determined before and after incubation through compression testing at 1 mm/s up to 400N (8.16MPa). The porosity of the bone samples before and after decellularisation was measured using a mercury porosimeter. Recellularisation using HOS cells (seeded at 5x105 cells per cm2bone) progressed for up to 3 weeks in DMEM supplemented with L-ascorbic acid, β-glycerophosphate, dexamethasone, FCS, PEST, and NEAA. Bone samples were placed onto non-adherent dishes and adherent dishes. The extent of recellularisation was compared in static and dynamic culture conditions using a roller incubator set at 15 rpm to effect dynamic conditions. DAPI staining revealed that protocol B removed all measurable DNA from the bone samples (Figure 1). Decellularisation did not affect Young’s modulus (Figure 2). Pore diameters did not differ with decellularisation and were in the ideal range for cell growth. Mean ALP activity (Figure 3A) and MTT reduction (Figure 3C) was greater on the adherent surface than on non-adherent surface albeit non-significantly. There was no significant difference between static and dynamic conditions in ALP activities between 3 and 7 days (Figure 3B). Data suggests that cells proliferated more readily when samples were placed in adherent dishes (Figure 3D). This work has established appropriate protocols to make donor bone scaffolds with appropriate porosity to allow reseeding with human bone cells.These could be used to repair bone defects in recipient patients

Delivery of an injectable biomaterial to the striatum- a computational analysis

The delivery of a cell-embedded hydrogel to the striatum is a promising strategy for Parkinson’s disease.In this study, a computational model of the intrastriatal injection was used to analyze the delivery process

Flow simulation of a natural polymer in a syringe-needle delivery device

Neurodegenerative diseases, such as Parkinson's disease, affect a large num- ber of the erderly population and still remain untreated. In recent years, cell therapy has emerged as a promising therapeutic strategy. To increase cell viability, biomaterials are of- ten used as scaffolds and facilitate cell deposition, through injection, to the site of interest. However, fluid forces acting on the cells during injection may lead to their disruption or death. This study aims to develop a novel device for the delivery of a cell-embedded, in situ forming, collagen hydrogel. A preliminary simulation study on constricted channels rep- resenting the syringe was performed to gain insight into the effect of needle diameter and syringe geometry. Straight needles emanating co-axially from syringes of various geome- tries were computationally modelled in the two-dimensional space, using OpenFOAMⓇ. The natural collagen solution was modelled as a continuum medium, without cells, and the flow was assumed incompressible, with non-Newtonian fluid constitutive behaviour. The effects of needle diameter and syringe geometry on velocity and shear stresses were examined. The results highlight the importance of geometric characteristics on the design of new cell delivery devices. If cells pass from the syringe barrel to the needle, the pressure drop and the increased velocity could damage them. This is more likely to occur using higher Gauge needles. Further analysis is required including simulations of cells during injection and analysis of their deformation

Struggling for food in a time of crisis: Responsibility and paradox

Responsibility is a useful lens through which to examine the current state of food poverty in the UK in the context of the Covid‐19 crisis, noting that this concept contains several paradoxes. Currently, responsibility involves the voluntary sector, the food industry and the state, a situation which the author has been exploring for the last five years in an ethnographic study of food poverty and food aid in the UK. Food aid organizations, especially food banks, have mushroomed during the period of austerity. This reveals the first paradox: namely, that the existence of food banks conveys the message that ‘something is being done’, but in actuality this is very far from being sufficient to meet the needs of either the ‘old’ or ‘new’ food insecure. The second paradox is that at the onset of the crisis, a government which had been responsible for inflicting austerity on the country for 10 years, dramatically reversed some of its policies. However, predictably, this did not change the situation vis‐à‐vis food insecurity. The third paradox is that the frequent rhetoric invoking the two world wars has not resulted in lessons being learned – notably, the creation of a ministry to deal with food and rationing, as in the Second World War. The final paradox relates to Brexit and its likely deleterious effects on food security, particularly if no ‘deal’ is achieved with the European Union, as seems likely. The voluntary food aid sector, try as it may, cannot possibly assume responsibility for the long‐standing and now hugely increased problems of food insecurity. That belongs to the state