\u27iDentity\u27 and governance in synthetic biology: norms and counter norms in the \u27international genetically engineered machine\u27 (iGEM) competition

A number of commentaries preoccupied with the legal, social and ethical implications of synthetic biology have emphasised that an important element shaping options for its future governance will be the normative ethos that is adopted by the emerging field. One venue that has regularly been identified as central to the development of this normative ethos is the International Genetically Engineered Machine (iGEM) Competition, an annual synthetic biology competition, which attracts thousands of students from across the world. The ideal values promoted by iGEM of collaboration, interdisciplinarity, sharing of results, and overt commitment to the consideration of social and ethical implications of scientific work, are frequently interpreted as offering a model for the future development of the field. In the discussion that follows it will be noted that many of iGEM’s normative aspirations appear to be difficult to convert into practice and that many of the paths which various forms of synthetic biology appear to be following deviate from the types of values iGEM publicly promotes. Policy makers are invited to make a more realistic assessment of iGEM’s capacity to contribute (via generating a distinct synthetic biology normative ethos) to the future governance of the emerging field

'Learning together': Sharing international experience on new models of primary care

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Health inequalities, multimorbidity, and primary care in Scotland

Scotland has an ageing population and the widest health inequalities in Western Europe. Multiple health conditions develop ∼10–15 years earlier in deprived areas than in affluent areas. General practice is central to the effective and safe management of such complex multiple health conditions, but the inverse care law has permeated deprived communities (‘Deep End’ general practices) for the past 50 years. A new, radical, Scottish GP contract was introduced in April 2018, which has a vision to improve quality of care through cluster working and expansion of the multidisciplinary team (MDT), enabling GPs to deliver ‘expert generalism’ to patients with complex needs. It states a specific intention to address health inequalities and also to support the integration of health and social care. Here, we discuss recent evidence for whether the ambition of the new GP contract, to reduce health inequalities, is being achieved

Smoking cessation interventions for patients with coronary heart disease and comorbidities:an observational cross-sectional study in primary care

Background: Little is known about how smoking cessation practices in primary care differ for patients with coronary heart disease (CHD) who have different comorbidities. Aim: To determine the association between different patterns of comorbidity and smoking rates and smoking cessation interventions in primary care for patients with CHD. Design: and setting Cross-sectional study of 81 456 adults with CHD in primary care in Scotland. Method: Details of eight concordant physical comorbidities, 23 discordant physical comorbidities, and eight mental health comorbidities were extracted from electronic health records between April 2006 and March 2007. Multilevel binary logistic regression models were constructed to determine the association between these patterns of comorbidity and smoking status, smoking cessation advice, and smoking cessation medication (nicotine replacement therapy) prescribed. Results: The most deprived quintile had nearly three times higher odds of being current smokers than the least deprived (odds ratio [OR] 2.76; 95% confidence interval [CI] = 2.49 to 3.05). People with CHD and two or more mental health comorbidities had more than twice the odds of being current smokers than those with no mental health conditions (OR 2.11; 95% CI = 1.99 to 2.24). Despite this, those with two or more mental health comorbidities (OR 0.77; 95% CI = 0.61 to 0.98) were less likely to receive smoking cessation advice, but absolute differences were small. Conclusion: Patterns of comorbidity are associated with variation in smoking status and the delivery of smoking cessation advice among people with CHD in primary care. Those from the most deprived areas and those with mental health problems are considerably more likely to be current smokers and require additional smoking cessation support

Work in Progress: The WSU Model for Engineering Mathematics Education

This paper summarizes progress to date on the WSU model for engineering mathematics education, an NSF funded curriculum reform initiative at Wright State University. The WSU model seeks to increase student retention, motivation and success in engineering through application-driven, just-in-time engineering math instruction. The WSU approach involves the development of a novel freshman-level engineering mathematics course EGR 101, as well as a large-scale restructuring of the engineering curriculum. By removing traditional math prerequisites and moving core engineering courses earlier in the program, the WSU model shifts the traditional emphasis on math prerequisite requirements to an emphasis on engineering motivation for math, with a just-in-time structuring of the new math sequence. This paper summarizes the development to date of the WSU model for engineering mathematics education, including a preliminary assessment of student performance and perception during the initial implementation of EGR 101. In addition, an assessment of first-year retention results is anticipated in time for the conference

Using Self-Determination Theory in research and evaluation in primary care

BACKGROUND: Multimorbidity (the co‐existence of two or more long‐term conditions within an individual) is a complex management challenge, with a very limited evidence base. Theories can help in the design and operationalization of complex interventions. OBJECTIVE: This article proposes self‐determination theory (SDT) as a candidate theory for the development and evaluation of interventions in multimorbidity. METHODS: We provide an overview of SDT, its use in research to date, and its potential utility in complex interventions for patients with multimorbidity based on the new MRC framework. RESULTS: SDT‐based interventions have mainly focused on health behaviour change in the primary prevention of disease, with limited use in primary care and chronic conditions management. However, SDT may be a useful candidate theory in informing complex intervention development and evaluation, both in randomized controlled trials and in evaluations of ‘natural experiments’. We illustrate how it could be used multimorbidity interventions in primary care by drawing on the example of CARE Plus (a primary care‐based complex intervention for patients with multimorbidity in deprived areas of Scotland). CONCLUSIONS: SDT may have utility in both the design and evaluation of complex interventions for multimorbidity. Further research is required to establish its usefulness, and limitations, compared with other candidate theories. PATIENT OR PUBLIC CONTRIBUTION: Our funded research programme, of which this paper is an early output, has a newly embedded patient and public involvement group of four members with lived experience of long‐term conditions and/or of being informal carers. They read and commented on the draft manuscript and made useful suggestions on the text. They will be fully involved at all stages in the rest of the programme of research

A mixed-methods evaluation of patients’ views on primary care multi-disciplinary teams in Scotland

BackgroundExpanding primary care multi-disciplinary teams (MDTs) was a key component of the 2018 Scottish GP contract, with over 4,700 MDT staff appointed since then.AimTo explore patients’ views on primary care MDT expansion in Scotland.Design and methods(1) Survey of patients recently consulting a GP in deprived-urban, affluent-urban and remote/rural areas, assessing awareness of five MDT roles and attitudes towards receptionist signposting; (2) 30 individual interviews exploring MDT-care experiences.ResultsOf 1,053 survey respondents, most were unaware of the option of MDT rather than GP consultations for three out of five roles (69% unaware of link worker appointments; 68% mental health nurse; 58% pharmacist). Reception signposting was less popular in deprived-urban areas (34% unhappy vs 29% in remote/rural vs 21% affluent-urban; p&lt;0.001), and in patients with multimorbidity (31% unhappy vs 24% in non-multimorbid; p&lt;0.05).Two-thirds of interviewees had multimorbidity and almost all reported positive MDT-care experiences. However, MDT-care was generally seen as a supplement rather than a substitute for GP care. Around half of patients expressed concerns about reception signposting. These patients were more likely to also express concerns about GP access in general. Both of these concerns were more common in deprived-urban areas than in remote/rural or affluent-urban areas.ConclusionMDT-care has expanded in Scotland with limited patient awareness. Although patients understand its potential value, many are unhappy with reception signposting to first-contact MDT care, especially those in deprived-urban areas living with multimorbidity. This represents a barrier to the aims of the new GP contract.<br/

Mitsui-7, heat-treated, and nitrogen-doped multi-walled carbon nanotubes elicit genotoxicity in human lung epithelial cells.

Background: The unique physicochemical properties of multi-walled carbon nanotubes (MWCNT) have led to many industrial applications. Due to their low density and small size, MWCNT are easily aerosolized in the workplace making respiratory exposures likely in workers. The International Agency for Research on Cancer designated the pristine Mitsui-7 MWCNT (MWCNT-7) as a Group 2B carcinogen, but there was insufficient data to classify all other MWCNT. Previously, MWCNT exposed to high temperature (MWCNT-HT) or synthesized with nitrogen (MWCNT-ND) have been found to elicit attenuated toxicity; however, their genotoxic and carcinogenic potential are not known. Our aim was to measure the genotoxicity of MWCNT-7 compared to these two physicochemically-altered MWCNTs in human lung epithelial cells (BEAS-2B & SAEC). Results: Dose-dependent partitioning of individual nanotubes in the cell nuclei was observed for each MWCNT material and was greatest for MWCNT-7. Exposure to each MWCNT led to significantly increased mitotic aberrations with multi- and monopolar spindle morphologies and fragmented centrosomes. Quantitative analysis of the spindle pole demonstrated significantly increased centrosome fragmentation from 0.024-2.4 [mu]g/mL of each MWCNT. Significant aneuploidy was measured in a dose-response from each MWCNT-7, HT, and ND; the highest dose of 24 [mu]g/mL produced 67, 61, and 55%, respectively. Chromosome analysis demonstrated significantly increased centromere fragmentation and translocations from each MWCNT at each dose. Following 24 h of exposure to MWCNT-7, ND and/or HT in BEAS-2B a significant arrest in the G1/S phase in the cell cycle occurred, whereas the MWCNT-ND also induced a G2 arrest. Primary SAEC exposed for 24 h to each MWCNT elicited a significantly greater arrest in the G1 and G2 phases. However, SAEC arrested in the G1/S phase after 72 h of exposure. Lastly, a significant increase in clonal growth was observed one month after exposure to 0.024 [mu]g/mL MWCNT-HT & ND. Conclusions: Although MWCNT-HT & ND cause a lower incidence of genotoxicity, all three MWCNTs cause the same type of mitotic and chromosomal disruptions. Chromosomal fragmentation and translocations have not been observed with other nanomaterials. Because in vitro genotoxicity is correlated with in vivo genotoxic response, these studies in primary human lung cells may predict the genotoxic potency in exposed human populations