CAL and FE: A Welsh perspective

The core of this paper is the result of an investigation into the use of computer‐aided learning (CAL) in further education (FE) colleges in Wales: All institutions surveyed used CAL to some extent in teaching or learning, and academic staff were in some way involved in producing CAL materials in almost all. However, student numbers were found not to be a good indicator of the degree to which CAL is used Furthermore, only two‐thirds of colleges approached claimed to have received any external funding for CAL and distance learning involved only a small proportion of FE students. Nevertheless, the general conclusion drawn is that all FE colleges in Wales use ICTs (information and communication technologies) extensively, although there are significant differences in the equipment/student ratios, and there appears to be little strategic college‐wide planning concerning such developments

Towards Earlier Discharge, Better Outcomes, Lower Costs: Stroke rehabilitation in Ireland

Towards Earlier Discharge, Better Outcomes, Lower Cost is a new and valuable study which adds to our understanding of how to better patient outcomes within the budgetary realities of our current healthcare system. This study, undertaken by the ESRI and the RCSI with the support of the Irish Heart Foundation, provides a strong economic justification for policymakers to develop Ireland's community rehabilitation and care services, and equally, shows the potential benefits for patients that can come from healthcare research. This study brought together a range of disciplines and expertise to build on the previous Irish Heart Foundation-supported study, The Cost of Stroke in Ireland, undertaken by researchers at the ESRI and RCSI. We would like to acknowledge the hard work and input of all those involved in the research for this study, especially the researchers in the ESRI, NUIG, RCSI, King's College London and the team in the IHF. We would also like to acknowledge the invaluable guidance of the steering group, many of whom are clinical professionals directly involved in delivering stroke care. We would like to thank the HSE for contributing funding to this research. It is hoped that more research of this nature, which provides an evidence base for the development of Irish healthcare, might be considered in the near future.</p

Is repeat fine needle aspiration required in thyroid nodules with initial benign cytology? Results from a large Irish series

Background : Fine needle aspiration (FNA) cytology is the preferred method for assessing thyroid nodules for malignancy. Concern remains about the rate of false negative results. The primary aim of this study is to investigate the malignancy rate of thyroid nodules initially classified as benign (Thy 2). Methods: We retrospectively examined 658 nodules in 653 (429 female) patients between January 2013 to December 2017. All FNA biopsies (FNABs) were performed under ultrasound (US) guidance by a radiologist with expertise in thyroid pathology. Nodules were cytologically classified according to the UK Royal College of Pathologists guidelines. Decisions about further management were made at a regular thyroid multidisciplinary meeting. Follow up of the Thy 2 nodules was determined based on clinical and radiological criteria. Results: The mean age (± SD) was 53.2 (14.6) years. Five hundred out of 658 (76.0%) nodules were classified as Thy 2 (benign) after the first FNAB. Of these thyroid nodules initially classified as benign, 208 (41.6%) underwent repeat FNAB and 9 (1.8%) were surgically removed without repeat FNAB. The remainder were followed up clinically and/or radiologically. Seven (1.4%) of nodules initially classified as Thy 2 were later shown to be or to harbor malignancy after a follow-up of 74.5 (± 19.7) months. Papillary thyroid microcarcinomas were found co-incidentally in two thyroid glands of benign nodules, giving a true prevalence of 5/500 (1.0%). Conclusions: With a well targeted FNAB, the false negative rate of an initial benign thyroid FNA is very low thus routine second FNAB is not required in patients with a thyroid nodule initially deemed benign. Multidisciplinary input is imperative in informing decision making.</p

Activation of the epidermal growth factor receptor (EGFR) by a novel metalloprotease pathway

Neutrophil Elastase (NE) is a pro-inflammatory protease present at higher than normal levels in the lung during inflammatory disease. NE regulates IL-8 production from airway epithelial cells and can activate both EGFR and TLR4. TACE/ADAM17 has been reported to trans-activate EGFR in response to NE. Here, using 16HBE14o-human bronchial epithelial cells we demonstrate a new mechanism by which NE regulates both of these events. A high molecular weight soluble metalloprotease activity detectable only in supernatants from NE-treated cells by gelatin and casein zymography was confirmed to be meprin alpha by Western immunoblotting. In vitro studies demonstrated the ability of NE to activate meprin alpha, which in turn could release soluble TGFalpha and induce IL-8 production from 16HBE14o- cells. These effects were abrogated by actinonin, a specific meprin inhibitor. NE-induced IL-8 expression was also inhibited by meprin alpha siRNA. Immunoprecipitation studies detected EGFR/TLR4 complexes in NE-stimulated cells overexpressing these receptors. Confocal studies confirmed colocalization of EGFR and TLR4 in 16HBE14o- cells stimulated with meprin alpha. NFkappaB was also activated via MyD88 in these cells by meprin alpha. In bronchoalveolar lavage fluid from NE knock-out mice infected intra-tracheally with Pseudomonas aeruginosa meprin alpha was significantly decreased compared with control mice, and was significantly increased and correlated with NE activity, in bronchoalveolar lavage fluid from individuals with cystic fibrosis but not healthy controls. The data describe a previously unidentified lung metalloprotease meprin alpha, and its role in NE-induced EGFR and TLR4 activation and IL-8 production