Post-operative monitoring of intestinal tissue oxygenation using an implantable microfabricated oxygen sensor

Anastomotic leakage (AL) is a common and dangerous post-operative complication following intestinal resection, causing substantial morbidity and mortality. Ischaemia in the tissue surrounding the anastomosis is a major risk-factor for AL development. Continuous tissue oxygenation monitoring during the post-operative recovery period would provide early and accurate early identification of AL risk. We describe the construction and testing of a miniature implantable electrochemical oxygen sensor that addresses this need. It consisted of an array of platinum microelectrodes, microfabricated on a silicon substrate, with a poly(2-hydroxyethyl methacrylate) hydrogel membrane to protect the sensor surface. The sensor was encapsulated in a biocompatible package with a wired connection to external instrumentation. It gave a sensitive and highly linear response to variations in oxygen partial pressure in vitro, although over time its sensitivity was partially decreased by protein biofouling. Using a pre-clinical in vivo pig model, acute intestinal ischaemia was robustly and accurately detected by the sensor. Graded changes in tissue oxygenation were also measurable, with relative differences detected more accurately than absolute differences. Finally, we demonstrated its suitability for continuous monitoring of tissue oxygenation at a colorectal anastomosis over a period of at least 45 h. This study provides evidence to support the development and use of implantable electrochemical oxygen sensors for post-operative monitoring of anastomosis oxygenation

Loss of murine Paneth cell function alters the immature intestinal microbiome and mimics changes seen in neonatal necrotizing enterocolitis

Necrotizing enterocolitis (NEC) remains the leading cause of gastrointestinal morbidity and mortality in premature infants. Human and animal studies suggest a role for Paneth cells in NEC pathogenesis. Paneth cells play critical roles in host-microbial interactions and epithelial homeostasis. The ramifications of eliminating Paneth cell function on the immature host-microbial axis remains incomplete. Paneth cell function was depleted in the immature murine intestine using chemical and genetic models, which resulted in intestinal injury consistent with NEC. Paneth cell depletion was confirmed using histology, electron microscopy, flow cytometry, and real time RT-PCR. Cecal samples were analyzed at various time points to determine the effects of Paneth cell depletion with and without Klebsiella gavage on the microbiome. Deficient Paneth cell function induced significant compositional changes in the cecal microbiome with a significant increase in Enterobacteriacae species. Further, the bloom of Enterobacteriaceae species that occurs is phenotypically similar to what is seen in human NEC. This further strengthens our understanding of the importance of Paneth cells to intestinal homeostasis in the immature intestine

Dietary Diversity and Its Relationship with Nutritional Status among Adolescents and Adults in Rural India

Dietary diversity is associated with household or individual food availability and intake of nutrients from different food groups and is an important component of nutritional outcome. This study examined the Nutrient Adequacy Ratio (NAR) and the Mean Adequacy Ratio (MAR) of three dietary diversity indices and their relationship with the nutritional status of adolescents and adults in rural regions of two states in India, Wardha district in Maharashtra and Koraput district in Odisha, in 2014. Individual dietary diversity was calculated using 24-hour diet recall (FS24hr) data and household dietary diversity was measured with food frequency data using Berry’s index (DDI) and food scores (FSFFQ). The nutritional status of individuals was assessed using anthropometric indices. The diets in both locations were cereal dominated. It was observed that 51% of adolescent boys and 27% of adolescent girls had ‘thinness’ and stunting. The prevalence of undernutrition was higher among adult women (48%) than adult men (36%). The mean diversity indices were FS24hr of 8, DDI of 89–90 and FSFFQ of 64–66 in the two locations. The FS24hr was found to be positively correlated with the NAR of all nutrients while DDI and FSFFQ were correlated with seven and six nutrients, respectively. The DDI and FS24hr showed an association with MAR if the two locations were combined together. Sensitivity and specificity analysis showed that FS24hr gave more true positives than false positives and the area under the Receiver Operating Characteristic curve was 0.68, implying that this measure truly differentiates individuals having low dietary diversity with low MAR from those with low dietary diversity and a high MAR. All three measures of dietary diversity showed a linear association with the nutritional outcomes of adults, while in the adolescent group only DDI showed a relationship. It is concluded that 24-hour diet recall is a good measure for studying the relationship between dietary diversity and nutritional status in adults

Hygroscopic Growth and Deliquescence of NaCl Nanoparticles Mixed with Surfactant SDS

Several complementary experimental and theoretical methodologies were used to explore water uptake on sodium chloride (NaCl) particles containing varying amounts of sodium dodecyl sulfate (SDS) to elucidate the interaction of water with well-defined, environmentally relevant surfaces. Experiments probed the hygroscopic growth of mixed SDS/NaCl nanoparticles that were generated by electrospraying aqueous 2 g/L solutions containing SDS and NaCl with relative NaCl/SDS weight fractions of 0, 5, 11, 23, or 50 wt/wt %. Particles with mobility-equivalent diameters of 14.0(±0.2) nm were size selected and their hygroscopic growth was monitored by a tandem nano-differential mobility analyzer as a function of relative humidity (RH). Nanoparticles generated from 0 and 5 wt/wt % solutions deliquesced abruptly at 79.1(±1.0)% RH. Both of these nanoparticle compositions had 3.1(±0.5) monolayers of adsorbed surface water prior to deliquescing and showed good agreement with the Brunauer−Emmett−Teller and the Frenkel−Halsey−Hill isotherms. Above the deliquescence point, the growth curves could be qualitatively described by Köhler theory after appropriately accounting for the effect of the particle shape on mobility. The SDS/NaCl nanoparticles with larger SDS fractions displayed gradual deliquescence at a RH that was significantly lower than 79.1%. All compositions of SDS/NaCl nanoparticles had monotonically suppressed mobility growth factors (GFm) with increasing fractions of SDS in the electrosprayed solutions. The Zdanovskii−Stokes−Robinson model was used to estimate the actual fractions of SDS and NaCl in the nanoparticles; it suggested the nanoparticles were enhanced in SDS relative to their electrospray solution concentrations. X-ray photoelectron spectroscopy (XPS), FTIR, and AFM were consistent with SDS forming first a monolayer and then a crystalline phase around the NaCl core. Molecular dynamics simulations of water vapor interacting with SDS/NaCl slabs showed that SDS kinetically hinders the initial water uptake. Large binding energies of sodium methyl sulfate (SMS)−(NaCl)4, H2O−(NaCl)4, and SMS−H2O−(NaCl)4 calculated at the MP2/cc-pVDZ level suggested that placing H2O in between NaCl and surfactant headgroup is energetically favorable. These results provide a comprehensive description of SDS/NaCl nanoparticles and their properties

Collaborative multidisciplinary learning : quantity surveying students’ perspectives

The construction industry is highly fragmented and is known for its adversarial culture, culminating in poor quality projects not completed on time or within budget. The aim of this study is thus to guide the design of QS programme curricula in order to help students develop the requisite knowledge and skills to work more collaboratively in their multi-disciplinary future workplaces. A qualitative approach was considered appropriate as the authors were concerned with gathering an initial understanding of what students think of multi-disciplinary learning. The data collection method used was a questionnaire which was developed by the Behaviours4Collaboration (B4C) team. Knowledge gaps were still found across all the key areas where a future QS practitioner needs to be collaborative (either as a project contributor or as a project leader) despite the need for change instigated by the multi-disciplinary (BIM) education revolution. The study concludes that universities will need to be selective in teaching, and innovative in reorienting, QS education so that a collaborative BIM education can be effected in stages, increasing in complexity as the students’ technical knowledge grows. This will help students to build the competencies needed to make them future leaders. It will also support programme currency and delivery

Dynamics of extracellular polymeric substance (EPS) production and loss in an estuarine, diatom-dominated, microalgal biofilm over a tidal emersion-immersion period.

We studied patterns of production and loss of four different extracellular polymeric substance (EPS) fractions - colloidal carbohydrates, colloidal EPS (cEPS), hot water (HW)-extracted and hot bicarbonate (HB)-extracted fractions - and community profiles of active (RNA) bacterial communities by use of Terminal-Restriction Fragment Length Polymorphism (T-RFLP) analysis of reverse transcription-polymerase chain reaction amplified 16S rRNA in mudflats in the Colne Estuary, United Kingdom, over two tidal emersion-immersion cycles. Colloidal carbohydrates and intracellular storage carbohydrate (HW) increased during tidal emersion and declined during tidal cover. The dynamics of cEPS and uronic acid content were closely coupled, as were the HB fraction and HB uronic acids. Changes in monosaccharide profiles of HW and HB fractions occurred during the diel period, with some similarity between cEPS and HB fractions. Increasing enzymatic release rates of reducing sugars and increased reducing sugar content were correlated with increased concentrations of colloidal carbohydrate and cEPS during the illuminated emersion period, and with the amount of HB-extracted uronic acids (the most refractory EPS fraction measured). Loss of reducing sugars was high, with sediment concentrations far below those predicted by the measured in situ release rates, T-RFLP analysis revealed no significant shifts in the overall taxonomic composition of the active bacterial community. However, 12 of the 59 terminal restriction fragments identified showed significant changes in relative abundance during the tidal cycle. Changes in the relative abundance of three particular terminal restriction fragments (bacterial taxa) were positively correlated to the rate of extracellular hydrolysis. Losses of chlorophyll a and colloidal and cEPS (up to 50-60) occurred mainly in the first 30 min after tidal cover. About half of this may be owing to in situ degradation, with "wash away" into the water column accounting for the remainder. © 2006, by the American Society of Limnology and Oceanography, Inc

Managing Injuries of the Neck Trial (MINT) : design of a randomised controlled trial of treatments for whiplash associated disorders

Background: A substantial proportion of patients with whiplash injuries develop chronic symptoms. However, the best treatment of acute injuries to prevent long-term problems is uncertain. A stepped care treatment pathway has been proposed, in which patients are given advice and education at their initial visit to the emergency department (ED), followed by review at three weeks and physiotherapy for those with persisting symptoms. MINT is a two-stage randomised controlled trial to evaluate two components of such a pathway: 1. use of The Whiplash Book versus usual advice when patients first attend the emergency department; 2. referral to physiotherapy versus reinforcement of advice for patients with continuing symptoms at three weeks. Methods: Evaluation of the Whiplash Book versus usual advice uses a cluster randomised design in emergency departments of eight NHS Trusts. Eligible patients are identified by clinicians in participating emergency departments and are sent a study questionnaire within a week of their ED attendance. Three thousand participants will be included. Patients with persisting symptoms three weeks after their ED attendance are eligible to join an individually randomised study of physiotherapy versus reinforcement of the advice given in ED. Six hundred participants will be randomised. Follow-up is at 4, 8 and 12 months after their ED attendance. Primary outcome is the Neck Disability Index (NDI), and secondary outcomes include quality of life and time to return to work and normal activities. An economic evaluation is being carried out. Conclusion: This paper describes the protocol and operational aspects of a complex intervention trial based in NHS emergency and physiotherapy departments, evaluating two components of a stepped-care approach to the treatment of whiplash injuries. The trial uses two randomisations, with the first stage being cluster randomised and the second individually randomised

The pervasive role of biological cohesion in bedform development

Sediment fluxes in aquatic environments are crucially dependent on bedform dynamics. However, sediment-flux predictions rely almost completely on clean-sand studies, despite most environments being composed of mixtures of non-cohesive sands, physically cohesive muds and biologically cohesive extracellular polymeric substances (EPS) generated by microorganisms. EPS associated with surficial biofilms are known to stabilize sediment and increase erosion thresholds. Here we present experimental data showing that the pervasive distribution of low levels of EPS throughout the sediment, rather than the high surficial levels of EPS in biofilms, is the key control on bedform dynamics. The development time for bedforms increases by up to two orders of magnitude for extremely small quantities of pervasively distributed EPS. This effect is far stronger than for physical cohesion, because EPS inhibit sand grains from moving independently. The results highlight that present bedform predictors are overly simplistic, and the associated sediment transport processes require re-assessment for the influence of EPS

Informing National Health Service patients about participation in clinical research: A comparison of opt-in and opt-out approaches across the United Kingdom

Objective: Recruitment to clinical research in the NHS remains challenging. One barrier is accessing patients to discuss research participation. Two general approaches are used in the UK to facilitate this: an ‘opt-in’ approach (when clinicians communicate research opportunities to patients) and an ‘opt-out’ approach (all patients have the right to be informed of relevant research opportunities). No evidence-based data are available, however, to inform the decision about which approach is preferable. This study aimed to collect information from ‘opt-in’ and ‘opt-out’ Trusts and identify which of the two approaches is optimal for ensuring NHS patients are given opportunities to discuss research participation. Method: This sequential mixed methods study comprised three phases: (1) an Appreciative Inquiry across UK Trusts, and (2) online surveys and (3) focus groups with NHS staff and patients at a representative mental health Trust. Results: The study was conducted between June and October 2019. Out of seven NHS Mental Health Trusts contacted (three ‘opt-out’ and four ‘opt-in’), only four took part in phase 1 of the study and three of them were ‘opt-out’ Trusts. Benefits of an ‘opt-out’ approach included greater inclusivity of patients and the removal of research gatekeepers, whilst the involvement of research-active clinicians and established patient-clinician relationships were cited as important to ‘opt-in’ success. Phase 2 and 3 were conducted at a different Trust (Oxford Health NHS Foundation Trust, OHNHSFT) which was using an ‘opt-in’ approach. Of 333 staff and member survey responders, 267 (80.2%) favoured moving to an ‘opt-out’ approach (phase 2). Nineteen staff and 16 patients and carers participated in focus groups (phase 3). Concern was raised by staff regarding the lack of time for clinical research, with clinical work taking precedence over research; patients were concerned about a lack of research activity; all considered research to be beneficial and were supportive of a move to ‘opt-out’. Conclusion: Findings suggest that ‘opt-out’ is more beneficial than ‘opt-in’, with the potential to vastly increase patient access to research opportunities and to enable greater equality of information provision for currently marginalised groups. This should ensure that healthcare research is more representative of the entire population, including those with a mental health diagnosis