Generational and occupational differences in human factors knowledge and awareness: a comparison study.

INTRODUCTION: Increasing healthcare sector litigation, accountability and governance has resulted in the identification of human factors (HF) as a common source of error. Both NHS and military doctors must have awareness of HF to enhance safety and productivity. There is limited published evidence examining knowledge of HF in these two healthcare professional groups. METHODS: Doctors of all grades and specialties across the NHS and 3 military groups including the Defence Deanery within the UK were invited to complete a 10-item web-based survey. Questions focused on training undertaken, HF knowledge and potential future training needs. RESULTS: The survey link was emailed to 250 military and 1400 NHS doctors, 191 military and 776 NHS responded (response rate: 76% and 55%, respectively). Military doctors above foundation trainees are more familiar with HF, have had more training and recognise a requirement for additional training. Military foundation trainees had similar responses to their NHS colleagues. Doctors who had not undertaken any HF training are less likely to appreciate its value, with almost 60% of senior NHS doctors reporting no training. Foundation trainees have more training in HF than their senior peers when military seniors are excluded and more frequently identified a need for further training. Junior doctors identified stress, fatigue, communication and leadership more frequently, with seniors identifying work environment and music in theatre correctly more often. CONCLUSION: Non-training grade doctors are less likely to seek HF training. Military doctors are more familiar with HF and have undertaken more training. Given the role of HF in communication, human error, potential litigation, stress, conflict and gross negligence manslaughter convictions, further education is vital.

Specialist infantry and defence engagement.

In 2015, the UK government published the National Strategic Defence and Security Review (SDSR) 2015, which laid out their vision for the future roles and structure of the UK Armed Forces. SDSR 2015 envisaged making broader use of the Armed Forces to support missions other than warfighting. One element of this would be to increase the scale and scope of defence engagement (DE) activities that the UK conducts overseas. DE activities traditionally involve the use of personnel and assets to help prevent conflict, build stability and gain influence with partner nations as part of a short-term training teams. This paper aimed to give an overview of the Specialist Infantry Group and its role in UK DE. It will explore the reasons why the SDSR 2015 recommended their formation as well as an insight into future tasks.

The body in isolation: The physical health impacts of incarceration in solitary confinement.

We examine how solitary confinement correlates with self-reported adverse physical health outcomes, and how such outcomes extend the understanding of the health disparities associated with incarceration. Using a mixed methods approach, we find that solitary confinement is associated not just with mental, but also with physical health problems. Given the disproportionate use of solitary among incarcerated people of color, these symptoms are most likely to affect those populations. Drawing from a random sample of prisoners (n = 106) in long-term solitary confinement in the Washington State Department of Corrections in 2017, we conducted semi-structured, in-depth interviews; Brief Psychiatric Rating Scale (BPRS) assessments; and systematic reviews of medical and disciplinary files for these subjects. We also conducted a paper survey of the entire long-term solitary confinement population (n = 225 respondents) and analyzed administrative data for the entire population of prisoners in the state in 2017 (n = 17,943). Results reflect qualitative content and descriptive statistical analysis. BPRS scores reflect clinically significant somatic concerns in 15% of sample. Objective specification of medical conditions is generally elusive, but that, itself, is a highly informative finding. Using subjective reports, we specify and analyze a range of physical symptoms experienced in solitary confinement: (1) skin irritations and weight fluctuation associated with the restrictive conditions of solitary confinement; (2) un-treated and mis-treated chronic conditions associated with the restrictive policies of solitary confinement; (3) musculoskeletal pain exacerbated by both restrictive conditions and policies. Administrative data analyses reveal disproportionate rates of racial/ethnic minorities in solitary confinement. This analysis raises the stakes for future studies to evaluate comparative prevalence of objective medical diagnoses and potential causal mechanisms for the physical symptoms specified here, and for understanding differential use of solitary confinement and its medically harmful sequelae.

The Effects of Temperature and Ethanol on Proanthocyanidin Adsorption to Grape Cell Wall Material in the Presence of Anthocyanins.

The quantitative and qualitative impacts of anthocyanins on proanthocyanidin adsorption to grape-derived cell wall material were investigated in fifteen unique systems of varying temperatures, ethanol concentrations, and proanthocyanidin concentrations. Proanthocyanidin solutions were exposed to cell wall material and monitored for changes in concentration over 24 h. Increases in both temperature and ethanol resulted in a larger retention of proanthocyanidins in solution and typically faster adsorption kinetics. Analysis of the solution after exposure to cell wall revealed a significant reduction in the molecular weight of proanthocyanidins present in solution, suggesting that anthocyanins do not alter a previously described mechanism of preferentially binding large molecular weight molecules. Additionally, a reduction in polymeric pigment abundance was noted in most conditions, suggesting rapid formation of polymeric pigment in the model solution and preferential adsorption of the polymeric pigment to cell wall material. Compared to a previous study of proanthocyanidin adsorption in the absence of anthocyanins, a significantly larger percentage of proanthocyanidin material was lost via adsorption-up to 70% of available material. In a winemaking context, this may suggest a preferential loss of polymeric pigment via adsorption to cap cell wall material compared to non-pigmented proanthocyanidins and free anthocyanins.

Spatial covariance of herbivorous and predatory guilds of forest canopy arthropods along a latitudinal gradient.

In arthropod community ecology, species richness studies tend to be prioritised over those investigating patterns of abundance. Consequently, the biotic and abiotic drivers of arboreal arthropod abundance are still relatively poorly known. In this cross-continental study, we employ a theoretical framework in order to examine patterns of covariance among herbivorous and predatory arthropod guilds. Leaf-chewing and leaf-mining herbivores, and predatory ants and spiders, were censused on > 1000 trees in nine 0.1 ha forest plots. After controlling for tree size and season, we found no negative pairwise correlations between guild abundances per plot, suggestive of weak signals of both inter-guild competition and top-down regulation of herbivores by predators. Inter-guild interaction strengths did not vary with mean annual temperature, thus opposing the hypothesis that biotic interactions intensify towards the equator. We find evidence for the bottom-up limitation of arthropod abundances via resources and abiotic factors, rather than for competition and predation.

Rapamycin restrains platelet procoagulant responses via FKBP-mediated protection of mitochondrial integrity.

BACKGROUND AND PURPOSE: Rapamycin is a potent immunosuppressant and anti-proliferative agent used clinically to prevent organ transplant rejection and for coating coronary stents to counteract restenosis. Rapamycin complexes with the immunophilin FKBP12, which subsequently binds and inhibits mTORC1. Despite several reports demonstrating that rapamycin affects platelet-mediated responses, the underlying mechanism of how it alters platelet function is poorly characterised. This study aimed to elucidate the effect of rapamycin on platelet procoagulant responses. EXPERIMENTAL APPROACH: The effect of rapamycin on platelet activation and signalling was investigated alongside the catalytic mTOR inhibitors KU0063794 and WYE-687, and the FKBP12-binding macrolide FK506. KEY RESULTS: Rapamycin affects platelet procoagulant responses by reducing externalisation of the procoagulant phospholipid phosphatidylserine, formation of balloon-like structures and local generation of thrombin. Catalytic mTOR kinase inhibitors did not alter platelet procoagulant processes, despite having a similar effect as rapamycin on Ca2+ signalling, demonstrating that the effect of rapamycin on procoagulant responses is independent of mTORC1 inhibition and not linked to a reduction in Ca2+ signalling. FK506, which also forms a complex with FKBP12 but does not target mTOR, reduced platelet procoagulant responses to a similar extent as rapamycin. Both rapamycin and FK506 prevented the loss of mitochondria integrity induced by platelet activation, one of the central regulatory events leading to PS externalisation. CONCLUSIONS AND IMPLICATIONS: Rapamycin suppresses platelet procoagulant responses by protecting mitochondrial integrity in a manner independent of mTORC1 inhibition. Rapamycin and other drugs targeting FKBP immunophilins could aid the development of novel complementary anti-platelet therapies.

Psychological Distress in Solitary Confinement: Symptoms, Severity, and Prevalence in the United States, 2017-2018.

Objectives. To specify symptoms and measure prevalence of psychological distress among incarcerated people in long-term solitary confinement.Methods. We gathered data via semistructured, in-depth interviews; Brief Psychiatric Rating Scale (BPRS) assessments; and systematic reviews of medical and disciplinary files for 106 randomly selected people in solitary confinement in the Washington State Department of Corrections in 2017. We performed 1-year follow-up interviews and BPRS assessments with 80 of these incarcerated people, and we present the results of our qualitative content analysis and descriptive statistics.Results. BPRS results showed clinically significant symptoms of depression, anxiety, or guilt among half of our research sample. Administrative data showed disproportionately high rates of serious mental illness and self-harming behavior compared with general prison populations. Interview content analysis revealed additional symptoms, including social isolation, loss of identity, and sensory hypersensitivity.Conclusions. Our coordinated study of rating scale, interview, and administrative data illustrates the public health crisis of solitary confinement. Because 95% or more of all incarcerated people, including those who experienced solitary confinement, are eventually released, understanding disproportionate psychopathology matters for developing prevention policies and addressing the unique needs of people who have experienced solitary confinement, an extreme element of mass incarceration.

Platelet surface marker analysis by mass cytometry.

Mass cytometry is a next generation flow cytometry technology which analyzes cells one at a time (up to 1000/sec) using mass spectrometry to detect probes labeled with rare-earth metals. Rare-earth metals detected by mass spectrometry have extremely low backgrounds and can be identified with high resolution enabling the routine simultaneous detection of more than 45 probes on each cell without the need for complex compensation matrices. Here we describe a panel of 14 platelet-specific metal-conjugated antibodies (targeting cluster of differentiation [CD] 9, CD29, CD31, CD36, CD41, CD42a, CD42b, CD61, CD62P, CD63, CD107a, CD154, glycoprotein [GP] VI and activated integrin αIIbß3) and methods for staining and analysis of platelets by mass cytometry. High dimensional clustering algorithms, which take into account the levels of all 14 markers detected by mass cytometry on each cell, allow identification of platelet subpopulations not previously appreciated. We previously reported that platelet heterogeneity identified by mass cytometry appears similar across healthy donors and consistent over time. High dimensional analysis revealed the presence of a platelet subpopulation with significantly higher levels of surface expression of activated GPIIb-IIIa and P-selectin suggesting this subpopulation may play a greater role in thrombus formation than other platelet subpopulations. Thus, analysis by mass cytometry of platelet heterogeneity and subpopulations may suggest distinct biological roles for different platelet subpopulations and may be useful in evaluating inherited or acquired platelet disorders and platelet function in health and disease.

Heat-Dependent Desorption of Proanthocyanidins from Grape-Derived Cell Wall Material under Variable Ethanol Concentrations in Model Wine Systems.

Desorption of proanthocyanidins (PA) from grape cell wall material (CWM) was investigated in solutions of varying ethanol concentrations and increasing temperature. The results reveal the reversibility of PA-CWM interactions and the role that temperature and ethanol concentration play in the extent of PA desorption. Sequentially raising temperature from 15 to 35 °C resulted in desorption of up to 48% of the initial adsorbed PA. A comparison to a phenolic extraction model showed significant differences between the predicted and actual amount of PA that desorbed from the CWM. This suggests that the initial conditions of temperature and ethanol concentration must be considered when estimating PA extraction in red wine production. Under typical winemaking conditions, a significant amount of PA may be irreversibly adsorbed if exposed to CWM at low temperature (i.e., cold soak). A compositional analysis suggests the selective desorption of large molecular weight PA from CWM under all experimental conditions. Additionally, a preferential desorption of skin-derived PA over seed-derived PA was noted in the absence of ethanol.

Do theatre staff use face masks in accordance with the manufacturers' guidelines of use?

AIM: Surgical face masks are worn by theatre staff to protect the surgical site from airborne contamination and the wearer from bodily fluid splash. This observational/audit aimed to assess whether theatre staff wear masks in accordance with manufacturers'/Centers for Disease Control and Prevention (CDC) guidelines of use. METHODS: A total of 1034 surgically scrubbed staff were assessed on their technique of applying surgical face masks, compared to the CDC guidelines as manufacturers' guidelines were not available as per Health and Safety Executive guidelines. RESULTS: Only 18% of surgically scrubbed staff fully complied with the CDC guidelines on the application of a face mask. Compliance was worst in urology, ophthalmology and vascular surgeons, whereas orthopaedic and plastic surgeons were the most compliant. DISCUSSION: Compliance with CDC face mask guidelines may have an impact on surgical site infections (SSI) and protection of staff from body fluid splash, but most staff do not comply with these guidelines. CONCLUSIONS: Most operating theatre staff do not apply a face mask using correct technique, outlined in CDC guidance, which may increase SSI rates. Staff are not aware of existing guidelines for donning a mask.

Critical roles for the phosphatidylinositide 3-kinase isoforms p110ß and p110γ in thrombopoietin-mediated priming of platelet function.

Thrombopoietin (TPO) enhances platelet activation through activation of the tyrosine kinase; JAK2 and the lipid kinase phosphatidylinositide 3-kinase (PI3K). The aim of our study was to identify the PI3K isoforms involved in mediating the effect of TPO on platelet function and elucidate the underlying mechanism. We found that p110ß plays an essential role in TPO-mediated (i) priming of protease-activated receptor (PAR)-mediated integrin αIIbß3 activation and α-granule secretion, (ii) synergistic enhancement of PAR-mediated activation of the small GTPase RAP1, a regulator of integrin activation and (iii) phosphorylation of the PI3K effector Akt. More importantly, the synergistic effect of TPO on phosphorylation of extracellular-regulated kinase (ERK1/2) and thromboxane (TxA2) synthesis was dependent on both p110ß and p110γ. p110ß inhibition/deletion, or inhibition of p110γ, resulted in a partial reduction, whereas inhibiting both p110ß and p110γ completely prevented the synergistic effect of TPO on ERK1/2 phosphorylation and TxA2 synthesis. The latter was ablated by inhibition of MEK, but not p38, confirming a role for ERK1/2 in regulating TPO-mediated increases in TxA2 synthesis. In conclusion, the synergistic effect of TPO on RAP1 and integrin activation is largely mediated by p110ß, whereas p110ß and p110γ contribute to the effect of TPO on ERK1/2 phosphorylation and TxA2 formation.

The British Army's contribution to tropical medicine.

Infectious disease has burdened European armies since the Crusades. Beginning in the 18th century, therefore, the British Army has instituted novel methods for the diagnosis, prevention and treatment of tropical diseases. Many of the diseases that are humanity's biggest killers were characterised by medical officers and the acceptance of germ theory heralded a golden era of discovery and development. Luminaries of tropical medicine including Bruce, Wright, Leishman and Ross firmly established the British Army's expertise in this area. These innovations led to the prevention of many deaths of both military personnel and civilians. British Army doctors were instrumental in establishing many of the teaching facilities that we now consider to be global leaders in tropical medicine. The impact of the Army in this field has certainly been significant in the past and its contribution continues to this day.

Mass Cytometry Reveals Distinct Platelet Subtypes in Healthy Subjects and Novel Alterations in Surface Glycoproteins in Glanzmann Thrombasthenia.

Mass cytometry (MC) uses mass spectrometry to simultaneously detect multiple metal-conjugated antibodies on single cells, thereby enabling the detailed study of cellular function. Here, for the first time, we applied MC to the analysis of platelets. We developed a panel of 14 platelet-specific metal-tagged antibodies (targeting cluster of differentiation [CD] 9, CD29, CD31, CD36, CD41, CD42a, CD42b, CD61, CD62P, CD63, CD107a, CD154, glycoprotein [GP] VI and activated integrin αIIbß3) and compared this panel with two fluorescence flow cytometry (FFC) panels (CD41, CD42b, and CD61; or CD42b, CD62P, and activated integrin αIIbß3) in the evaluation of activation-dependent changes in glycoprotein expression on healthy subject and Glanzmann thrombasthenia (GT) platelets. High-dimensional analysis of surface markers detected by MC identified previously unappreciated subpopulations of platelets in healthy donors. As expected, MC and FFC revealed that GT platelets had significantly reduced CD41, CD61, and activated integrin αIIbß3 surface expression. MC also revealed that surface expression of CD9, CD42a and CD63 were elevated, CD31, CD154 and GPVI were reduced and CD29, CD36, CD42b, CD62P and CD107a were similar on GT platelets compared to healthy donor platelets. In summary, MC revealed distinct platelet subtypes in healthy subjects and novel alterations in surface glycoproteins on GT platelets.

Extended operating times are more efficient, save money and maintain a high staff and patient satisfaction.

Current public sector austerity measures necessitate efficiency savings throughout the NHS. Performance targets have resulted in activity being performed in the private sector, waiting list initiative lists and requests for staff to work overtime. This has resulted in staff fatigue and additional agency costs. Adoption of extended operating theatre times (0800-1800 hours) may improve productivity and efficiency, with potentially significant financial savings; however, implementation may adversely affect staff morale and patient compliance. A pilot period of four months of extended operating times (4.5 hour sessions) was completed and included all theatre surgical specialties. Outcome measures included: the number of cases completed, late starts, early finishes, cancelled operations, theatre overruns, preoperative assessment and 18-week targets. The outcomes were then compared to pre-existing normal working day operating lists (0900-1700). Theatre staff, patient and surgical trainee satisfaction with the system were also considered by use of an anonymous questionnaire. The study showed that in-session utilisation time was unchanged by extended operating hours 88.7% (vs 89.2%). The service was rated as 'good' or 'excellent' by 87.5% of patients. Over £345,000 was saved by reducing premium payments. Savings of £225,000 were made by reducing privately outsourced operation and a further £63,000 by reviewing staff hours. Day case procedures increased from 2.8 to 3.2 cases/day with extended operating. There was no significant increase in late starts (5.1% vs 6.8%) or cancellation rates (0.75% vs 1.02%). Theatre over-runs reduced from 5% to 3.4%. The 18 weeks target for surgery was achieved in 93.7% of cases (vs 88.3%). The number of elective procedures increased from 4.1 to 4.89 cases/day. Only 13.33% of trainees (n = 33) surveyed felt that extended operating had a negative impact on training. The study concludes that extended operating increased productivity from 2.8 patients per session to 3.2 patients per session with potential savings of just over £2.4 million per financial year. Extrapolating this to the other 155 trusts in England could be a potential saving of £372 million per year. Staff, trainee and patient satisfaction was unaffected. An improved 18 weeks target position was achieved with a significant reduction in private sector work. However, some staff had difficulty with arranging childcare and taking public transport and this may prevent full implementation.