Informed about Informed Consent: A Qualitative Study of Ethics Education

Informed consent is a foundational concept in modern medicine. Despite physicians’ ethical and legal obligations to obtain informed consent, no standard curriculum exists to teach residents relevant knowledge and skills. This paper presents a qualitative study of residents at one academic medical center. The authors conducted focus groups with trainees in the Departments of Internal Medicine, Emergency Medicine, and Ob/Gyn and analyzed their responses using rigorous qualitative methods. Four themes emerged: First, participants agreed that informed consent and decision-making capacity were relevant in many clinical situations. Second, participants varied widely in their understandings of consent. Third, current resident training was insufficient. Fourth, more training was needed. These results add to the growing literature that ethics education in residency is desired and useful. The findings will help educators craft instruments assessing the prevalence and degree of deficiencies related to informed consent competencies and aid in the development of a model curriculum

Epidemiological surveillance, virulence and public health significance of Listeria spp. from drinking water

Epidemiological surveillance of drinking water from Punjab, India reported occurrence of Listeria spp. in 58.67% of Municipal Corporation (MC), 51.38% submersible pump and 12.5% hand pumps and Escherichia coli in 53.71% of MC, 29.16% submersible pump and none of samples from hand pumps. There was no positive correlation between the simultaneous occurrence of Listeria spp. and E. coli (P < 0.005; R2 = 0.89). Isolates were identified serologically and confirmed by polymerase chain reaction (PCR) amplification using specific primers targeting a 1200 bp fragment of the 16S rRNA gene. All isolates of Listeria spp. were haemolytic on 5% sheep blood agar and positive for congo dye uptake and showed multiple drug resistance, multiple antibiotic resistance (MAR) indices of 0.86 (> 0.2). One isolate of Listeria spp. was molecularly identified by sequencing of 16S rRNA gene, and its gene sequence was submitted to National Center for Biotechnology Information (NCBI) under accession no. JF798637. Using this isolate, histopathological studies were carried out and It caused significant histopathological and ultrastructural alterations in experimentally infected BALB/c mice. The conventional methods cannot predict the presence of these potentially enteropathogenic microorganisms in drinking water and hence represents a serious public health concern.Key words: Epidemiological, Listeria spp., haemolytic, serologically histopathological, multiple antibiotic resistance (MAR)

How children eat may contribute to rising levels of obesity children's eating behaviours: An intergenerational study of family influences

The term ‘obesogenic environment’ is rapidly becoming part of common phraseology. However, the influence of the family and the home environment on children's eating behaviours is little understood. Research that explores the impact of this micro environment and intergenerational influences affecting children's eating behaviours is long overdue. A qualitative, grounded theory approach, incorporating focus groups and semi-structured interviews, was used to investigate the family environment and specifically, the food culture of different generations within families. What emerged was a substantive theory based on ‘ordering of eating’ that explains differences in eating behaviours within and between families. Whereas at one time family eating was highly ordered and structured, typified by the grandparent generation, nowadays family eating behaviours are more haphazard and less ordered, evidenced by the way the current generation of children eat. Most importantly, in families with an obese child eating is less ordered compared with those families with a normal weight child. Ordering of eating' is a unique concept to emerge. It shows that an understanding of the eating process is crucial to the development and improvement of interventions targeted at addressing childhood obesity within the family context

Regulation of the Drosophila Enhancer of split and invected-engrailed Gene Complexes by Sister Chromatid Cohesion Proteins

The cohesin protein complex was first recognized for holding sister chromatids together and ensuring proper chromosome segregation. Cohesin also regulates gene expression, but the mechanisms are unknown. Cohesin associates preferentially with active genes, and is generally absent from regions in which histone H3 is methylated by the Enhancer of zeste [E(z)] Polycomb group silencing protein. Here we show that transcription is hypersensitive to cohesin levels in two exceptional cases where cohesin and the E(z)-mediated histone methylation simultaneously coat the entire Enhancer of split and invected-engrailed gene complexes in cells derived from Drosophila central nervous system. These gene complexes are modestly transcribed, and produce seven of the twelve transcripts that increase the most with cohesin knockdown genome-wide. Cohesin mutations alter eye development in the same manner as increased Enhancer of split activity, suggesting that similar regulation occurs in vivo. We propose that cohesin helps restrain transcription of these gene complexes, and that deregulation of similarly cohesin-hypersensitive genes may underlie developmental deficits in Cornelia de Lange syndrome

Comparison among five hydrodynamic codes with a diverging-converging nozzle experiment

A realistic open-cycle gas-core nuclear rocket simulation model must be capable of a self-consistent nozzle calculation in conjunction with coupled radiation and neutron transport in three spatial dimensions. As part of the development effort for such a model, five hydrodynamic codes were used to compare with a converging-diverging nozzle experiment. The codes used in the comparison are CHAD, FLUENT, KIVA2, RAMPANT, and VNAP2. Solution accuracy as a function of mesh size is important because, in the near term, a practical three-dimensional simulation model will require rather coarse zoning across the nozzle throat. In the study, four different grids were considered. (1) coarse, radially uniform grid, (2) coarse, radially nonuniform grid, (3) fine, radially uniform grid, and (4) fine, radially nonuniform grid. The study involves code verification, not prediction. In other words, the authors know the solution they want to match, so they can change methods and/or modify an algorithm to best match this class of problem. In this context, it was necessary to use the higher-order methods in both FLUENT and RAMPANT. In addition, KIVA2 required a modification that allows significantly more accurate solutions for a converging-diverging nozzle. From a predictive point of view, code accuracy with no tuning is an important result. The most accurate codes on a coarse grid, CHAD and VNAP2, did not require any tuning. Their main comparison among the codes was the radial dependence of the Mach number across the nozzle throat. All five codes yielded a very similar solution with fine, radially uniform and radially nonuniform grids. However, the codes yielded significantly different solutions with coarse, radially uniform and radially nonuniform grids. For all the codes, radially nonuniform zoning across the throat significantly increased solution accuracy with a coarse mesh. None of the codes agrees in detail with the weak shock located downstream of the nozzle throat, but all the codes indicated the presence of a weak downstream shock

Trialling technologies to reduce hospital in‐patient falls: an agential realist analysis

This paper analyses the 'failure' of a patient safety intervention. Our study was part of an RCT of bed and bedside chair pressure sensors linked to radio pagers to prevent bedside falls in older people admitted to hospital. We use agential realism within science and technology studies to examine the fall and its prevention as a situated phenomenon of knowledge that is made and unmade through intra-actions between environment, culture, humans and technologies. We show that neither the intervention (the pressure sensor system), nor the outcome (fall prevention) could be disentangled from the broader sociomaterial context of the ward, the patients, the nurses and (especially) their work through the RCT. We argue that the RCT design, by virtue of its unacknowledged assumptions, played a part in creating the negative findings. The study also raises wider questions about the kind of subjectivities, agencies and power relations these entanglements might effect and (re)produce in the hospital ward

Recent advances in single-cell subcellular sampling

Recent innovations in single-cell technologies have opened up exciting possibilities for profiling the omics of individual cells. Minimally invasive analysis tools that probe and remove the contents of living cells enable cells to remain in their standard microenvironment with little impact on their viability. This negates the requirement of lysing cells to access their contents, an advancement from previous single-cell manipulation methods. These novel methods have the potential to be used for dynamic studies on single cells, with many already providing high intracellular spatial resolution. In this article, we highlight key technological advances that aim to remove the contents of living cells for downstream analysis. Recent applications of these techniques are reviewed, along with their current limitations. We also propose recommendations for expanding the scope of these technologies to achieve comprehensive single-cell tracking in the future, anticipating the discovery of subcellular mechanisms and novel therapeutic targets and treatments, ultimately transforming the fields of spatial transcriptomics and personalised medicine

Maximum-Likelihood Parameter Estimation in Terahertz Time-Domain Spectroscopy

We present a maximum-likelihood method for parameter estimation in terahertz time-domain spectroscopy. We derive the likelihood function for a parameterized frequency response function, given a pair of time-domain waveforms with known time-dependent noise amplitudes. The method provides parameter estimates that are superior to other commonly used methods and provides a reliable measure of the goodness of fit. We also develop a simple noise model that is parameterized by three dominant sources and derive the likelihood function for their amplitudes in terms of a set of repeated waveform measurements. We demonstrate the method with applications to material characterization

Medium-Chain Fatty Acids Rescue Motor Function and Neuromuscular Junction Degeneration in a Drosophila Model of Amyotrophic Lateral Sclerosis

Amyotrophic lateral sclerosis (ALS) is an adult-onset neurodegenerative disease characterised by progressive degeneration of the motor neurones. An expanded GGGGCC (G4C2) hexanucleotide repeat in C9orf72 is the most common genetic cause of ALS and frontotemporal dementia (FTD); therefore, the resulting disease is known as C9ALS/FTD. Here, we employ a Drosophila melanogaster model of C9ALS/FTD (C9 model) to investigate a role for specific medium-chain fatty acids (MCFAs) in reversing pathogenic outcomes. Drosophila larvae overexpressing the ALS-associated dipeptide repeats (DPRs) in the nervous system exhibit reduced motor function and neuromuscular junction (NMJ) defects. We show that two MCFAs, nonanoic acid (NA) and 4-methyloctanoic acid (4-MOA), can ameliorate impaired motor function in C9 larvae and improve NMJ degeneration, although their mechanisms of action are not identical. NA modified postsynaptic glutamate receptor density, whereas 4-MOA restored defects in the presynaptic vesicular release. We also demonstrate the effects of NA and 4-MOA on metabolism in C9 larvae and implicate various metabolic pathways as dysregulated in our ALS model. Our findings pave the way to identifying novel therapeutic targets and potential treatments for ALS

White Matter Integrity and Processing Speed in Sickle Cell Anemia

Objective The purpose of this retrospective cross-sectional study was to investigate whether changes in white matter integrity are related to slower processing speed in sickle cell anemia. Methods Thirty-seven patients with silent cerebral infarction, 46 patients with normal MRI, and 32 sibling controls (age range 8–37 years) underwent cognitive assessment using the Wechsler scales and 3-tesla MRI. Tract-based spatial statistics analyses of diffusion tensor imaging (DTI) and neurite orientation dispersion and density imaging (NODDI) parameters were performed. Results Processing speed index (PSI) was lower in patients than controls by 9.34 points (95% confi- dence interval: 4.635–14.855, p = 0.0003). Full Scale IQ was lower by 4.14 scaled points (95% confidence interval: −1.066 to 9.551, p = 0.1), but this difference was abolished when PSI was included as a covariate (p = 0.18). There were no differences in cognition between patients with and without silent cerebral infarction, and both groups had lower PSI than controls (both p < 0.001). In patients, arterial oxygen content, socioeconomic status, age, and male sex were identified as predictors of PSI, and correlations were found between PSI and DTI scalars (fractional anisotropy r = 0.614, p < 0.00001; r = −0.457, p < 0.00001; mean diffusivity r = −0.341, p = 0.0016; radial diffusivity r = −0.457, p < 0.00001) and NODDI parameters (intracellular volume fraction r = 0.364, p = 0.0007) in widespread regions. Conclusion Our results extend previous reports of impairment that is independent of presence of infarction and may worsen with age. We identify processing speed as a vulnerable domain, with deficits potentially mediating difficulties across other domains, and provide evidence that reduced processing speed is related to the integrity of normal-appearing white matter using microstructure parameters from DTI and NODDI