Validation of the cognitive recovery assessments with the Postoperative Quality of Recovery Scale in patients with low-baseline cognition

Patients with pre-surgery cognitive impairment cannot currently be assessed for cognitive recovery after surgery using the Postoperative Quality of Recovery Scale (PostopQRS),as they would mathematically be scored as recovered. The group nonetheless represent a frail cohort at high risk of recovering poorly. We aimed to validate a novel method to score cognitive recovery in patients with low baseline cognition, using the number of low-score tests rather than their numerical values. Face validity was demonstrated in 86 participants in whom both PostopQRS and an 11-item neuropsychological battery were performed. The PostopQRS agreed with neuropsychological categorization of low versus normal cognition 74% of the time, with all but 5 incorrectly coded participants deviating by only 1 neurocognitive test. Cognitive recovery over time was comparable for groups with differing baseline cognitive function, irrespective of whether PostopQRS or neuropsychological methods were used. Discriminant validation was demonstrated in a post hoc analysis of the Steroids in Cardiac Surgery (SIRS) substudy by allocating groups to normal (n=246) or low baseline cognition (n=231) stratified by cognitive recovery on day 1. Recovery was similar for participants with low and normal baseline cognition. Postoperative length of stay was longer in patients with failed cognitive recovery whether they had normal (10.4±10.0 vs. 8.0±5.9 days, P=0.02) or low baseline cognition (12.0±11.1 vs. 8.2±4.7 days, P<0.01). Overall quality of recovery, as well as cognitive, emotive, and physiological recovery in those who recovered was independent of baseline cognition. The modified scoring method for the PostopQRS cognitive domain therefore demonstrates acceptable face and discriminant validity

Incorporating Problem-based Learning in an Undergraduate Allied Health Prerequisite Anatomy and Physiology Course

Anatomy and Physiology (A&P) is one of the final biology prerequisites undergraduate students enroll in before progressing in nursing and allied health degree programs. Using design-based research methods to examine our backward design approach, we defined learning objectives for an advanced A&P lab course, created aligned assessments, and are implementing new activities iteratively over four semesters. We are evaluating student learning outcomes using a previously validated homeostasis concept inventory. Our preliminary results suggest that students experience persisting misconceptions about homeostasis despite instruction, but in future semesters, we aim to support student learning of physiology topics through problem-based learning

A model of toxic neuropathy in Drosophila reveals a role for MORN4 in promoting axonal degeneration

Axonal degeneration is a molecular self-destruction cascade initiated following traumatic, toxic, and metabolic insults. Its mechanism underlies a number of disorders including hereditary and diabetic neuropathies and the neurotoxic side effects of chemotherapy drugs. Molecules that promote axonal degeneration could represent potential targets for therapy. To identify such molecules, we designed a screening platform based on intoxication of Drosophila larvae with paclitaxel (taxol), a chemotherapeutic agent that causes neuropathy in cancer patients. In Drosophila, taxol treatment causes swelling, fragmentation, and loss of axons in larval peripheral nerves. This axonal loss is not due to apoptosis of neurons. Taxol-induced axonal degeneration in Drosophila shares molecular execution mechanisms with vertebrates, including inhibition by both NMNAT (nicotinamide mononucleotide adenylyltransferase) expression and loss of wallenda/DLK (dual leucine zipper kinase). In a pilot RNAi-based screen we found that knockdown of retinophilin (rtp), which encodes a MORN (membrane occupation and recognition nexus) repeat-containing protein, protects axons from degeneration in the presence of taxol. Loss-of-function mutants of rtp replicate this axonal protection. Knockdown of rtp also delays axonal degeneration in severed olfactory axons. We demonstrate that the mouse ortholog of rtp, MORN4, promotes axonal degeneration in mouse sensory axons following axotomy, illustrating conservation of function. Hence, this new model can identify evolutionarily conserved genes that promote axonal degeneration, and so could identify candidate therapeutic targets for a wide-range of axonopathies

The development of linked databases and environmental modelling systems for decision-making in London

A basic requirement for a city's growth is the availability of land, raw material and water. For continued and sustainable development of today’s cities we must be able to meet these basic requirements whilst being mindful of the environment and its relationship with anthropogenic activity. The heterogeneous and complex nature of urban systems where there are obvious environmental and anthropogenic inter-dependencies necessitates a more holistic approach to decision-making. New developments such as linked databases of environmental data and integrated environmental modelling systems provide new ways of organising cross-disciplinary information and a means to apply this to explain, explore and predict the urban systems response to environmental change. In this paper we show how, accessibility to linked databases, detailed understanding of the geology and integrated environmental modelling solutions has the potential to provide decision-makers and policy developers with the science based information needed to understand and address these challenges

Verifying a quasi-classical spin model of perturbed quantum rewinding in a Fermi gas

We systematically test a quasi-classical spin model of a large spin-lattice in energy space, with a tunable, reversible Hamiltonian and effective long-range interactions. The system is simulated by a weakly interacting Fermi gas undergoing perturbed quantum rewinding using radio-frequency(RF) pulses. The model reported here is found to be in a quantitative agreement with measurements of the ensemble-averaged energy-resolved spin density. This work elucidates the effects of RF detunings on the system and measurements, pointing the way to new correlation measurement methods.Comment: 13 pages 8 figure

The application of componentised modelling techniques to catastrophe model generation

In this paper we show that integrated environmental modelling (IEM) techniques can be used to generate a catastrophe model for groundwater flooding. Catastrophe models are probabilistic models based upon sets of events representing the hazard and weights their likelihood with the impact of such an event happening which is then used to estimate future financial losses. These probabilistic loss estimates often underpin re-insurance transactions. Modelled loss estimates can vary significantly, because of the assumptions used within the models. A rudimentary insurance-style catastrophe model for groundwater flooding has been created by linking seven individual components together. Each component is linked to the next using an open modelling framework (i.e. an implementation of OpenMI). Finally, we discuss how a flexible model integration methodology, such as described in this paper, facilitates a better understanding of the assumptions used within the catastrophe model by enabling the interchange of model components created using different, yet appropriate, assumptions

Improving the accessibility and re-use of environmental models through provision of model metadata : a scoping study

This poster presents the results of a scoping study funded under a recent Natural Environment Research Council (NERC) Environmental Data Call. The work was undertaken by the British Geological Survey (Nottinghamshire, UK) in collaboration with HR Wallingford (Oxfordshire, UK). This investigation was designed to better understand the problem that whilst the input data used for modelling frequently has metadata data available, and metadata is often routinely created for the datasets created by modelling, there was perceived to be a lack of schemes and systems to record metadata about the modelling process itself. From this analysis gaps in metadata provision were identified, and recommendations for further work to address these were identified

Effect of total arterial grafting in the Arterial Revascularization Trial

Objectives The Arterial Revascularization Trial (ART) was designed to compare 10-year survival in bilateral versus single internal thoracic artery grafts. The intention-to-treat analysis has showed comparable outcomes between the 2 groups but an explanatory analysis suggested that those receiving 2 or more arterial grafts had better survival. Whether the exclusive use of arterial grafts provide further benefit is unclear. Methods We performed an exploratory analysis of the ART based on conduits actually received (as-treated principle). From ART cohort, only patients receiving at least 3 grafts were included. The final population consisted of 1084, 1010, and 390 patients in the single arterial graft (SAG) group, in the multiple arterial graft (MAG) group (2 or more arterial grafts with additional saphenous veins) and total arterial graft (TAG) group (3 or more arterial grafts only) respectively. Inverse probability of treatment weighting was used for comparison. Results When compared with the SAG group, there was a significant trend toward a reduction of 10-year mortality in the MAG and TAG group (test for trend P = .02). The TAG group was associated with the lowest risk of late mortality (hazard ratio, 0.68; 95% confidence interval, 0.48-0.96; P = .03) and with a significant risk reduction of the composite of death/myocardial infarction/stroke and repeat revascularization (hazard ratio, 0.71; 95% confidence interval, 0.53-0.94; P = .02). Conclusions When compared with SAG, both MAG and TAG represent valuable strategies to improve clinical outcomes following coronary artery bypass grafting but TAG can potentially provide further benefit.</p