Use of ultraviolet-fluorescence-based simulation in evaluation of personal protective equipment worn for first assessment and care of a patient with suspected high-consequence infectious disease

Background: Variations currently exist across the UK in the choice of personal protective equipment (PPE) used by healthcare workers when caring for patients with suspected high-consequence infectious diseases (HCIDs). Aim: To test the protection afforded to healthcare workers by current PPE ensembles during assessment of a suspected HCID case, and to provide an evidence base to justify proposal of a unified PPE ensemble for healthcare workers across the UK. Methods: One ‘basic level’ (enhanced precautions) PPE ensemble and five ‘suspected case’ PPE ensembles were evaluated in volunteer trials using ‘Violet’; an ultraviolet-fluorescence-based simulation exercise to visualize exposure/contamination events. Contamination was photographed and mapped. Findings: There were 147 post-simulation and 31 post-doffing contamination events, from a maximum of 980, when evaluating the basic level of PPE. Therefore, this PPE ensemble did not afford adequate protection, primarily due to direct contamination of exposed areas of the skin. For the five suspected case ensembles, 1584 post-simulation contamination events were recorded, from a maximum of 5110. Twelve post-doffing contamination events were also observed (face, two events; neck, one event; forearm, one event; lower legs, eight events). Conclusion: All suspected case PPE ensembles either had post-doffing contamination events or other significant disadvantages to their use. This identified the need to design a unified PPE ensemble and doffing procedure, incorporating the most protective PPE considered for each body area. This work has been presented to, and reviewed by, key stakeholders to decide on a proposed unified ensemble, subject to further evaluation

‘VIOLET’: a fluorescence-based simulation exercise for training healthcare workers in the use of personal protective equipment

Background Healthcare workers caring for patients with high-consequence infectious diseases (HCIDs) require protection from pathogen exposure, for example by wearing personal protective equipment (PPE). Protection is acquired through the inherent safety of the PPE components, but also their safe and correct use, supported by adequate training and user familiarity. However, the evidence base for HCID PPE ensembles and any associated training is lacking, with subsequent variation between healthcare providers. Aim To develop an evidence-based assessment and training tool for evaluating PPE ensembles and doffing protocols, in the assessment of patients with suspected HCIDs. Methods VIOLET (Visualising Infection with Optimised Light for Education and Training) comprises a healthcare mannequin adapted to deliver simulated bodily fluids containing UV-fluorescent tracers. On demand and remotely operated, the mannequin projectile vomits (blue), coughs (red), has diarrhoea (yellow) and is covered in sweat (orange). Wearing PPE, healthcare staff participate in an HCID risk assessment and examination of the ‘patient’, thereby becoming exposed to these bodily fluids. Contamination of PPE is visualized and body-mapped under UV light before and after removal. Observational findings and participant feedback, around its use as a training exercise, is also recorded. Findings Significant contamination from different exposure events was seen, enabling evaluation of PPE and doffing procedures used. Observational data and participant feedback demonstrated its strengths and success as a training technique. Conclusion Simulation exercises using VIOLET provide evidence-based assessment of PPE ensembles, and are a valuable resource for training of healthcare staff in wearing and safe doffing of PPE

Computer Game Play Reduces Intrusive Memories of Experimental Trauma via Reconsolidation-Update Mechanisms.

Memory of a traumatic event becomes consolidated within hours. Intrusive memories can then flash back repeatedly into the mind's eye and cause distress. We investigated whether reconsolidation-the process during which memories become malleable when recalled-can be blocked using a cognitive task and whether such an approach can reduce these unbidden intrusions. We predicted that reconsolidation of a reactivated visual memory of experimental trauma could be disrupted by engaging in a visuospatial task that would compete for visual working memory resources. We showed that intrusive memories were virtually abolished by playing the computer game Tetris following a memory-reactivation task 24 hr after initial exposure to experimental trauma. Furthermore, both memory reactivation and playing Tetris were required to reduce subsequent intrusions (Experiment 2), consistent with reconsolidation-update mechanisms. A simple, noninvasive cognitive-task procedure administered after emotional memory has already consolidated (i.e., > 24 hours after exposure to experimental trauma) may prevent the recurrence of intrusive memories of those emotional events

Does designation as a UNESCO World Heritage Site influence tourist evaluation of a local destination?

The purpose of this study is to explore whether the UNESCO World Heritage Site (WHS) designation affects tourists’ evaluation of the local destination hosting the site, building on a large sample of about 0.8 million tourists who visited Italy over the period 1997-2015. We find that the inscription onto the UNESCO World Heritage List exerts surprisingly a negative effect on the overall evaluation of the destination and also on the evaluation of its artistic assets though the magnitude of the latter is lower. The effect is heterogeneous across visitors, depending on evaluation levels, as well as origin/destinations and demographics. Nonetheless, the presence of multiple WHSs in the same destination tends to increase evaluation suggesting that destination stakeholders with previous experience in dealing with WHS designations are better equipped to manage the complicated relationship between tourism and preservation. Managerial and policy-making implications are discussed

SuperCLASS - III. Weak lensing from radio and optical observations in Data Release 1

We describe the first results on weak gravitational lensing from the SuperCLASS survey: the first survey specifically designed to measure the weak lensing effect in radio-wavelength data, both alone and in cross-correlation with optical data. We analyse 1.53deg2 of optical data from the Subaru telescope and 0.26deg2 of radio data from the e-MERLIN and VLA telescopes (the DR1 data set). Using standard methodologies on the optical data only we make a significant (10σ) detection of the weak lensing signal (a shear power spectrum) due to the massive supercluster of galaxies in the targeted region. For the radio data we develop a new method to measure the shapes of galaxies from the interferometric data, and we construct a simulation pipeline to validate this method. We then apply this analysis to our radio observations, treating the e-MERLIN and VLA data independently. We achieve source densities of 0.5 arcmin−2 in the VLA data and 0.06 arcmin−2 in the e-MERLIN data, numbers which prove too small to allow a detection of a weak lensing signal in either the radio data alone or in cross-correlation with the optical data. Finally, we show preliminary results from a visibility-plane combination of the data from e-MERLIN and VLA which will be used for the forthcoming full SuperCLASS data release. This approach to data combination is expected to enhance both the number density of weak lensing sources available, and the fidelity with which their shapes can be measured

ZNF804a Regulates Expression of the Schizophrenia-Associated Genes PRSS16, COMT, PDE4B, and DRD2

ZNF804a was identified by a genome-wide association study (GWAS) in which a single nucleotide polymorphism (SNP rs1344706) in ZNF804a reached genome-wide statistical significance for association with a combined diagnosis of schizophrenia (SZ) and bipolar disorder. Although the molecular function of ZNF804a is unknown, the amino acid sequence is predicted to contain a C2H2-type zinc-finger domain and suggests ZNF804a plays a role in DNA binding and transcription. Here, we confirm that ZNF804a directly contributes to transcriptional control by regulating the expression of several SZ associated genes and directly interacts with chromatin proximal to the promoter regions of PRSS16 and COMT, the two genes we find upregulated by ZNF804a. Using immunochemistry we establish that ZNF804a is localized to the nucleus of rat neural progenitor cells in culture and in vivo. We demonstrate that expression of ZNF804a results in a significant increase in transcript levels of PRSS16 and COMT, relative to GFP transfected controls, and a statistically significant decrease in transcript levels of PDE4B and DRD2. Furthermore, we show using chromatin immunoprecipitation assays (ChIP) that both epitope-tagged and endogenous ZNF804a directly interacts with the promoter regions of PRSS16 and COMT, suggesting a direct upregulation of transcription by ZNF804a on the expression of these genes. These results are the first to confirm that ZNF804a regulates transcription levels of four SZ associated genes, and binds to chromatin proximal to promoters of two SZ genes. These results suggest a model where ZNF804a may modulate a transcriptional network of SZ associated genes

SuperCLASS - I. The super cluster assisted shear survey: Project overview and data release 1

The SuperCLuster Assisted Shear Survey (SuperCLASS) is a legacy programme using the e-MERLIN interferometric array. The aim is to observe the sky at L-band (1.4 GHz) to a r.m.s. of 7μJybeam−1 over an area of ∼1deg2 centred on the Abell 981 supercluster. The main scientific objectives of the project are: (i) to detect the effects of weak lensing in the radio in preparation for similar measurements with the Square Kilometre Array (SKA); (ii) an extinction free census of star formation and AGN activity out to z ∼ 1. In this paper we give an overview of the project including the science goals and multiwavelength coverage before presenting the first data release. We have analysed around 400 h of e-MERLIN data allowing us to create a Data Release 1 (DR1) mosaic of ∼0.26deg2 to the full depth. These observations have been supplemented with complementary radio observations from the Karl G. Jansky Very Large Array (VLA) and optical/near infrared observations taken with the Subaru, Canada-France-Hawaii, and Spitzer Telescopes. The main data product is a catalogue of 887 sources detected by the VLA, of which 395 are detected by e-MERLIN and 197 of these are resolved. We have investigated the size, flux, and spectral index properties of these sources finding them compatible with previous studies. Preliminary photometric redshifts, and an assessment of galaxy shapes measured in the radio data, combined with a radio-optical cross-correlation technique probing cosmic shear in a supercluster environment, are presented in companion papers

Description and validation of a Markov model of survival for individuals free of cardiovascular disease that uses Framingham risk factors

BACKGROUND: Estimation of cardiovascular disease risk is increasingly used to inform decisions on interventions, such as the use of antihypertensives and statins, or to communicate the risks of smoking. Crude 10-year cardiovascular disease risk risks may not give a realistic view of the likely impact of an intervention over a lifetime and will underestimate of the risks of smoking. A validated model of survival to act as a decision aid in the consultation may help to address these problems. This study aims to describe the development of such a model for use with people free of cardiovascular disease and evaluates its accuracy against data from a United Kingdom cohort. METHODS: A Markov cycle tree evaluated using cohort simulation was developed utilizing Framingham estimates of cardiovascular risk, 1998 United Kingdom mortality data, the relative risk for smoking related non-cardiovascular disease risk and changes in systolic blood pressure and serum total cholesterol total cholesterol with age. The model's estimates of survival at 20 years for 1391 members of the Whickham survey cohort between the ages of 35 and 65 were compared with the observed survival at 20-year follow-up. RESULTS: The model estimate for survival was 75% and the observed survival was 75.4%. The correlation between estimated and observed survival was 0.933 over 39 subgroups of the cohort stratified by estimated survival, 0.992 for the seven 5-year age bands from 35 to 64, 0.936 for the ten 10 mmHg systolic blood pressure bands between 100 mmHg and 200 mmHg, and 0.693 for the fifteen 0.5 mmol/l total cholesterol bands between 3.0 and 10.0 mmol/l. The model significantly underestimated mortality in those people with a systolic blood pressure greater than or equal to 180 mmHg (p = 0.006). The average gain in life expectancy from the elimination of cardiovascular disease risk as a cause of death was 4.0 years for all the 35 year-old men in the sample (n = 24), and 1.8 years for all the 35 year-old women in the sample (n = 32). CONCLUSIONS: This model accurately estimates 20-year survival in subjects from the Whickham cohort with a systolic blood pressure below 180 mmHg

Managing authenticity and performance in Gulag tourism, Kazakhstan

To date, there has been limited research concerning the methodology and approach to Gulag heritage and how it has been memorialised and commodified for tourism purposes. The recent cultural commodification of the Soviet past and the development of participatory visitor experiences at Gulag museums in Kazakhstan necessitate to advance understandings of the roles authenticity and performance play in the management of Gulag museum practices in the country. Using a qualitative case study research approach based on a combination of semi-structured interviews with stakeholders involved in the development of Gulag tourism including senior management of museums, museum guides, policy-makers, tourism operators, local NGOs and experts in Soviet Gulag heritage, direct observations and qualitative document analysis of two Gulag museums and sites in Kazakhstan, the commodification and management of Soviet Gulag heritage is explored. Results reveal that beyond objects on display and images regarded as interpretive illustrations that allow visitors to connect with the past and verify history, dioramas and staged performances re-enacting various elements of the Gulag life are used as immersive and emotional tools to accentuate the ‘dark’ atmosphere of the epoch and induce a more impactful and participatory visitor experience. The findings contribute to literature on authenticity and performance in Gulag tourism by examining the delicate question of the extent to which stakeholders involved in the management of the Gulag tragedy can offer meaningful visitor experiences that are historically accurate and protect the dignity of the victims while adapting to the dynamic roles of museums as heritage and education sites