Immersing the artist and designer in the needs of the clinician: evolving the brief for distraction and stress reduction in a new Child Protection Unit.

Engaging clinicians in the design of new, less stressful spaces in healthcare is an interdisciplinary challenge for artists and designers. The design brief is the primary means of ensuring shared understanding and success criteria for creative projects (Press and Cooper 2003) and highlights ambitions and constraints for the project. Conventionally the brief is prepared by the client and issued to the artist or designer. This assumes that the client knows at the outset how to articulate needs and is able to envisage the outcome. Alternative processes emerging through co-design and interdisciplinary working assume the brief is developed or evolved jointly as part of the process and is focused on the experience of the user. This paper focuses on the evolution of a meaningful brief for a Child Protection Unit in NHS Greater Glasgow & Clyde’s new Royal Hospital for Children. Development of the brief was driven by the art and design team and aimed at opening up mutual understanding with the clinicians. The visual mapping of dialogue between artist, interactive designer and clinicians provides a novel approach to understanding this key stage of the process. Fremantle co-ordinated the paper. Hepburn undertook the fieldwork and provided the analysis. Fremantle structured the paper and co-ordinated reviews with Hamilton and Sands

Group A Streptococcal S Protein Utilizes Red Blood Cells as Immune Camouflage and Is a Critical Determinant for Immune Evasion.

Group A Streptococcus (GAS) is a human-specific pathogen that evades the host immune response through the elaboration of multiple virulence factors. Although many of these factors have been studied, numerous proteins encoded by the GAS genome are of unknown function. Herein, we characterize a biomimetic red blood cell (RBC)-captured protein of unknown function-annotated subsequently as S protein-in GAS pathophysiology. S protein maintains the hydrophobic properties of GAS, and its absence reduces survival in human blood. S protein facilitates GAS coating with lysed RBCs to promote molecular mimicry, which increases virulence in vitro and in vivo. Proteomic profiling reveals that the removal of S protein from GAS alters cellular and extracellular protein landscapes and is accompanied by a decrease in the abundance of several key GAS virulence determinants. In vivo, the absence of S protein results in a striking attenuation of virulence and promotes a robust immune response and immunological memory

Climate change impacts on agriculture in 2050 under a range of plausible socioeconomic and emissions scenarios

Previous studies have combined climate, crop and economic models to examine the impact of climate change on agricultural production and food security, but results have varied widely due to differences in models, scenarios and input data. Recent work has examined (and narrowed) these differences through systematic model intercomparison using a high-emissions pathway to highlight the differences. This paper extends that analysis to explore a range of plausible socioeconomic scenarios and emission pathways. Results from multiple climate and economic models are combined to examine the global and regional impacts of climate change on agricultural yields, area, production, consumption, prices and trade for coarse grains, rice, wheat, oilseeds and sugar crops to 2050. We find that climate impacts on global average yields, area, production and consumption are similar across shared socioeconomic pathways (SSP 1, 2 and 3, as we implement them based on population, income and productivity drivers), except when changes in trade policies are included. Impacts on trade and prices are higher for SSP 3 than SSP 2, and higher for SSP 2 than for SSP 1. Climate impacts for all variables are similar across low to moderate emissions pathways (RCP 4.5 and RCP 6.0), but increase for a higher emissions pathway (RCP 8.5). It is important to note that these global averages may hide regional variations. Projected reductions in agricultural yields due to climate change by 2050 are larger for some crops than those estimated for the past half century, but smaller than projected increases to 2050 due to rising demand and intrinsic productivity growth. Results illustrate the sensitivity of climate change impacts to differences in socioeconomic and emissions pathways. Yield impacts increase at high emissions levels and vary with changes in population, income and technology, but are reduced in all cases by endogenous changes in prices and other variables

Climate change impacts on agriculture in 2050 under a range of plausible socioeconomic and emissions scenarios

Previous studies have combined climate, crop and economic models to examine the impact of climate change on agricultural production and food security, but results have varied widely due to differences in models, scenarios and input data. Recent work has examined (and narrowed) these differences through systematic model intercomparison using a high-emissions pathway to highlight the differences. This paper extends that analysis to explore a range of plausible socioeconomic scenarios and emission pathways. Results from multiple climate and economic models are combined to examine the global and regional impacts of climate change on agricultural yields, area, production, consumption, prices and trade for coarse grains, rice, wheat, oilseeds and sugar crops to 2050. We find that climate impacts on global average yields, area, production and consumption are similar across shared socioeconomic pathways (SSP 1, 2 and 3, as we implement them based on population, income and productivity drivers), except when changes in trade policies are included. Impacts on trade and prices are higher for SSP 3 than SSP 2, and higher for SSP 2 than for SSP 1. Climate impacts for all variables are similar across low to moderate emissions pathways (RCP 4.5 and RCP 6.0), but increase for a higher emissions pathway (RCP 8.5). It is important to note that these global averages may hide regional variations. Projected reductions in agricultural yields due to climate change by 2050 are larger for some crops than those estimated for the past half century, but smaller than projected increases to 2050 due to rising demand and intrinsic productivity growth. Results illustrate the sensitivity of climate change impacts to differences in socioeconomic and emissions pathways. Yield impacts increase at high emissions levels and vary with changes in population, income and technology, but are reduced in all cases by endogenous changes in prices and other variables.University Corporation for Atmospheric Research 10.13039/100005626Peer Reviewe

Tumor innate immunity primed by specific interferon-stimulated endogenous retroviruses.

Mesenchymal tumor subpopulations secrete pro-tumorigenic cytokines and promote treatment resistance1-4. This phenomenon has been implicated in chemorefractory small cell lung cancer and resistance to targeted therapies5-8, but remains incompletely defined. Here, we identify a subclass of endogenous retroviruses (ERVs) that engages innate immune signaling in these cells. Stimulated 3 prime antisense retroviral coding sequences (SPARCS) are oriented inversely in 3' untranslated regions of specific genes enriched for regulation by STAT1 and EZH2. Derepression of these loci results in double-stranded RNA generation following IFN-γ exposure due to bi-directional transcription from the STAT1-activated gene promoter and the 5' long terminal repeat of the antisense ERV. Engagement of MAVS and STING activates downstream TBK1, IRF3, and STAT1 signaling, sustaining a positive feedback loop. SPARCS induction in human tumors is tightly associated with major histocompatibility complex class 1 expression, mesenchymal markers, and downregulation of chromatin modifying enzymes, including EZH2. Analysis of cell lines with high inducible SPARCS expression reveals strong association with an AXL/MET-positive mesenchymal cell state. While SPARCS-high tumors are immune infiltrated, they also exhibit multiple features of an immune-suppressed microenviroment. Together, these data unveil a subclass of ERVs whose derepression triggers pathologic innate immune signaling in cancer, with important implications for cancer immunotherapy

TransfOrming Transnational intErcultural sensitivity for Midwifery students through an inclusive mobility model: A mixed-method evaluation of the TOTEMM project

Background: Contemporary midwifery curricula require that student midwives have insight and understanding of global health practice and intercultural sensitivity. The current mobility model excludes large numbers of students from engaging in transnational learning. Objectives: 1) to evaluate midwifery students' experiences of blended mobility; 2) to investigate if the combination of virtual and physical mobility activities supported development of intercultural sensitivity and soft skills. Design: Multi-centre mixed-methods study. Settings: Four European Higher Education Institutions located in England, Italy, Estonia and The Netherlands. Participants: Sixty-four midwifery students studying in one of the four partner institutions selected as study sites and who participated in the TOTEMM blended mobility scheme took part in the evaluation. Methods: Data were collected through two online surveys, face-to-face focus groups and learning analytics. Descriptive summary statistical analysis of survey data was undertaken. Focus group discussions were subjected to thematic analysis. Findings from the quantitative survey and qualitative focus groups were merged using a convergent mixed methods approach. Learning Analytics were interpreted as complementary to the above components, to further triangulate the findings. Results: Both virtual and physical components were evaluated positively by students, with high engagement confirmed by learning analytics. A statistically significant increase in the mean of the Total Intercultural Sensitivity Scale score was seen between the pre- and post-mobility surveys, indicating participation in the TOTEMM mobility model was associated with enhanced intercultural sensitivity. Positive effects on confidence, open-mindedness, empathy, interaction and non-judgment were shared by participants. Conclusions: TOTEMM is an innovative inclusive approach to enable a diverse student group to benefit from transnational learning, including the development of intercultural sensitivity. The TOTEMM blended mobility model has potential for integration into future midwifery curricula and programmes in the four partner settings involved in TOTEMM and utility for the wider European context

The ClinGen Epilepsy Gene Curation Expert Panel—Bridging the divide between clinical domain knowledge and formal gene curation criteria

The field of epilepsy genetics is advancing rapidly and epilepsy is emerging as a frequent indication for diagnostic genetic testing. Within the larger ClinGen framework, the ClinGen Epilepsy Gene Curation Expert Panel is tasked with connecting two increasingly separate fields: the domain of traditional clinical epileptology, with its own established language and classification criteria, and the rapidly evolving area of diagnostic genetic testing that adheres to formal criteria for gene and variant curation. We identify critical components unique to the epilepsy gene curation effort, including: (a) precise phenotype definitions within existing disease and phenotype ontologies; (b) consideration of when epilepsy should be curated as a distinct disease entity; (c) strategies for gene selection; and (d) emerging rules for evaluating functional models for seizure disorders. Given that de novo variants play a prominent role in many of the epilepsies, sufficient genetic evidence is often awarded early in the curation process. Therefore, the emphasis of gene curation is frequently shifted toward an iterative precuration process to better capture phenotypic associations. We demonstrate that within the spectrum of neurodevelopmental disorders, gene curation for epilepsy-associated genes is feasible and suggest epilepsy-specific conventions, laying the groundwork for a curation process of all major epilepsy-associated genes

The expansion and performance of national newborn screening programmes for cystic fibrosis in Europe

Background: Newborn screening (NBS) for cystic fibrosis (CF) is a well-established public health strategy with international standards. The aim of this study was to provide an update on NBS for CF in Europe and assess performance against the standards.Methods: Questionnaires were sent to key workers in each European country.Results: In 2016, there were 17 national programmes, 4 countries with regional programmes and 25 countries not screening in Europe. All national programmes employed different protocols, with IRT-DNA the most common strategy. Five countries were not using DNA analysis. In addition, the processing and structure of programmes varied considerably. Most programmes were achieving the ECFS standards with respect to timeliness, but were less successful with respect to sensitivity and specificity.Conclusions: There has been a steady increase in national CF NBS programmes across Europe with variable strategies and outcomes that reflect the different approaches. (C) 2016 European Cystic Fibrosis Society. Published by Elsevier B.V. All rights reserved

The effects of kisspeptin on β-cell function, serum metabolites and appetite in humans

Aims: To investigate the effect of kisspeptin on glucose-stimulated insulin secretion and appetite in humans. Materials and methods: In 15 healthy men (age: 25.2 ± 1.1 years; BMI: 22.3 ± 0.5 kg m−2), we compared the effects of 1 nmol kg−1 h−1 kisspeptin versus vehicle administration on glucose-stimulated insulin secretion, metabolites, gut hormones, appetite and food intake. In addition, we assessed the effect of kisspeptin on glucose-stimulated insulin secretion in vitro in human pancreatic islets and a human β-cell line (EndoC-βH1 cells). Results: Kisspeptin administration to healthy men enhanced insulin secretion following an intravenous glucose load, and modulated serum metabolites. In keeping with this, kisspeptin increased glucose-stimulated insulin secretion from human islets and a human pancreatic cell line in vitro. In addition, kisspeptin administration did not alter gut hormones, appetite or food intake in healthy men. Conclusions: Collectively, these data demonstrate for the first time a beneficial role for kisspeptin in insulin secretion in humans in vivo. This has important implications for our understanding of the links between reproduction and metabolism in humans, as well as for the ongoing translational development of kisspeptin-based therapies for reproductive and potentially metabolic conditions

Development of Sensory, Motor and Behavioral Deficits in the Murine Model of Sanfilippo Syndrome Type B

BACKGROUND: Mucopolysaccharidosis (MPS) IIIB (Sanfilippo Syndrome type B) is caused by a deficiency in the lysosomal enzyme N-acetyl-glucosaminidase (Naglu). Children with MPS IIIB develop disturbances of sleep, activity levels, coordination, vision, hearing, and mental functioning culminating in early death. The murine model of MPS IIIB demonstrates lysosomal distention in multiple tissues, a shortened life span, and behavioral changes. PRINCIPAL FINDINGS: To more thoroughly assess MPS IIIB in mice, alterations in circadian rhythm, activity level, motor function, vision, and hearing were tested. The suprachiasmatic nucleus (SCN) developed pathologic changes and locomotor analysis showed that MPS IIIB mice start their daily activity later and have a lower proportion of activity during the night than wild-type controls. Rotarod assessment of motor function revealed a progressive inability to coordinate movement in a rocking paradigm. Purkinje cell counts were significantly reduced in the MPS IIIB animals compared to age matched controls. By electroretinography (ERG), MPS IIIB mice had a progressive decrease in the amplitude of the dark-adapted b-wave response. Corresponding pathology revealed shortening of the outer segments, thinning of the outer nuclear layer, and inclusions in the retinal pigmented epithelium. Auditory-evoked brainstem responses (ABR) demonstrated progressive hearing deficits consistent with the observed loss of hair cells in the inner ear and histologic abnormalities in the middle ear. CONCLUSIONS/SIGNIFICANCE: The mouse model of MPS IIIB has several quantifiable phenotypic alterations and is similar to the human disease. These physiologic and histologic changes provide insights into the progression of this disease and will serve as important parameters when evaluating various therapies