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

Exclusion zone phenomena in water -- a critical review of experimental findings and theories

The existence of the exclusion zone (EZ), a layer of water in which plastic microspheres are repelled from hydrophilic surfaces, has now been independently demonstrated by several groups. A better understanding of the mechanisms which generate EZs would help with understanding the possible importance of EZs in biology and in engineering applications such as filtration and microfluidics. Here we review the experimental evidence for EZ phenomena in water and the major theories that have been proposed. We review experimental results from birefringence, neutron radiography, nuclear magnetic resonance, and other studies. Pollack and others have theorized that water in the EZ exists has a different structure than bulk water, and that this accounts for the EZ. We present several alternative explanations for EZs and argue that Schurr's theory based on diffusiophoresis presents a compelling alternative explanation for the core EZ phenomenon. Among other things, Schurr's theory makes predictions about the growth of the EZ with time which have been confirmed by Florea et al. and others. We also touch on several possible confounding factors that make experimentation on EZs difficult, such as charged surface groups, dissolved solutes, and adsorbed nanobubbles.Comment: 14 pg

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

Investigating DNA Double Strand Breaks (DSB) in Mammalian Cells by Novel Fluorescent Reporters

An efficient DNA damage response is critical for maintaining the integrity of the mammalian genome, and ensuring the accurate transfer of genetic information between generations. Of particular biological relevance are DNA double strand breaks (DSB), which if repaired incorrectly may contribute to carcinogenesis. Review of contemporary literature has led to the identification of protein interactions and transcriptional events, tightly associated with the mammalian DSB response. Characteristics of selected events have been manipulated, with the notion of developing a reporter system that offers a sensitive and rapid method of detecting DSB in living mammalian cell models. Work presented here provides a quantitative evaluation of DSB generation in various mammalian cell lines, following chemical and irradiation treatment, and highlights the limitations of currently used markers. A series of recombinant proteins comprising peptide interacting domains, which exhibit altered spatio-temporal dynamics in relation with each other following DSB induction, are proposed as potential reporters of damage in mammalian cells. Novel gene constructs have been engineered that encode these peptide interacting domains, sandwiched between fluorescence-resonance-energy transfer (FRET) capable proteins. DSB specific events are predicted to induce peptide interactions that may be tracked in real time, by monitoring alterations in the fluorescent properties of such a recombinant protein. In an alternative approach, the transcriptional up-regulation of RAD52 mRNA following DSB induction was extended to whole cells. Optimisation of a fluorescent molecular beacon probe complementary to mammalian RAD52 mRNA is described, and data obtained in mammalian cells following DSB induction supports the notion that RAD52 is actively transcribed as part of the DSB response

PROJECT D-306, ADDITION TO 3720 BUILDING

The purpose of this project is to provide additional general laboratory space at the 3720 Building to meet current program needs. The proposed addition, approximately 1750 to 2250 square feet, will be attached to the north end of the building. It is requested that a directive modification be issued approving continued Title II design effort and construction of the proposed addition

The Effects of X-irradiation and Anti-lymphocyte Serum on the Responses to Tumour Allografts

The growth of a CBA mammary adenocarcinoma has been studied following transplantation to syngeneic and allogeneic recipients, with particular reference to the susceptibilities of the primary and secondary responses elicited by the tumour allografts, to impairment by whole-body X-irradiation and by treatment with rabbit-anti-mouse lymphocyte serum. In syngeneic recipients, the diameter of tumour implants increases linearly with time and there is no difference in the growth curves in females and in males. Later tumour generations grow faster than earlier generations. In allogeneic recipients, there is a relationship between the tumour diameter on day 21 (T) and the dose of X-irradiation (D) administered before implantation

A value-based approach to optimizing long-term maintenance plans for a multi-asset k-out-of-N system

Devising a long-term maintenance plan for a system of large infrastructure assets is an exacting task. Any maintenance activity that induces system downtime can incur a massive production or service loss. This problem becomes increasingly challenging for a system of which the performance is based on the collective output of assets. Current approaches that optimise each asset in isolation or consider a binary performance relationship insufficiently address this issue because the negligence of performance interactions among assets results in an inaccurate cost estimation. To overcome these hurdles, we formulate a mathematical model that explicitly demonstrates dynamic risk of production loss according to the system aggregate output. Further, we propose an integrated solution method that couples a finite loop search with a Genetic Algorithm. Application of our model to a real-world case study has proved to simultaneously strike the balance between cost and risk. Validated by Monte Carlo simulation, the proposed model has shown to outperform existing approaches. By systematically scheduling maintenance actions over the planning horizon, the resultant strategy has demonstrated to offer considerable maintenance cost savings and significantly prolong the average asset life. Sensitivity analyses also evince the robustness of the proposed model under the volatility in key parameters.EPSRC (This does not appear on the submitted manuscript yet, but will be added in the final proof

A role for topoisomerase IIα in the formation of radiation-induced chromatid breaks

Chromatid breaks in cells exposed to low dose irradiation are thought to be initiated by DNA double-strand breaks (DSB), and the frequency of chromatid breaks has been shown to increase in DSB rejoining deficient cells. However, the underlying causes of the wide variation in frequencies of G2 chromatid breaks (or chromatid ‘radiosensitivity') in irradiated T-lymphocytes from different normal individuals and cancer cases are as yet unclear. Here we report evidence that topoisomerase IIα expression level is a factor determining chromatid radiosensitivity. We have exposed the promyelocytic leukaemic cell line (HL60) and two derived variant cell lines (MX1 and MX2) that have acquired resistance to mitoxantrone and low expression of topoisomerase II α, to low doses of γ-radiation and scored the induced chromatid breaks. Chromatid break frequencies were found to be significantly lower in the variant cell lines, compared with their parental HL60 cell line. Rejoining of DSB in the variant cell lines was similar to that in the parental HL60 strain. Our results indicate the indirect involvement of topoisomerase IIα in the formation of radiation-induced chromatid breaks from DSB, and suggest topoisomerase IIα as a possible factor in the inter-individual variation in chromatid radiosensitivity