An exposome connectivity paradigm for the mechanistic assessment of the effects of prenatal and early life exposure to metals on neurodevelopment.

The exposome paradigm through an integrated approach to investigating the impact of perinatal exposure to metals on child neurodevelopment in two cohorts carried out in Slovenia (PHIME cohort) and Greece (HERACLES cohort) respectively, is presented herein. Heavy metals are well-known neurotoxicants with well-established links to impaired neurodevelopment. The links between in utero and early-life exposure to metals, metabolic pathway dysregulation, and neurodevelopmental disorders were drawn through urinary and plasma untargeted metabolomics analysis, followed by the combined application of in silico and biostatistical methods. Heavy metal prenatal and postnatal exposure was evaluated, including parameters indirectly related to exposure and health adversities, such as sociodemographic and anthropometric parameters and dietary factors. The primary outcome of the study was that the identified perturbations related to the TCA cycle are mainly associated with impaired mitochondrial respiration, which is detrimental to cellular homeostasis and functionality; this is further potentiated by the capacity of heavy metals to induce oxidative stress. Insufficient production of energy from the mitochondria during the perinatal period is associated with developmental disorders in children. The HERACLES cohort included more detailed data regarding diet and sociodemographic status of the studied population, allowing the identification of a broader spectrum of effect modifiers, such as the beneficial role of a diet rich in antioxidants such as lycopene and ω-3 fatty acids, the negative effect the consumption of food items such as pork and chicken meat has or the multiple impacts of fish consumption. Beyond diet, several other factors have been proven influential for child neurodevelopment, such as the proximity to pollution sources (e.g., waste treatment site) and the broader living environment, including socioeconomic and demographic characteristics. Overall, our results demonstrate the utility of exposome-wide association studies (EWAS) toward understanding the relationships among the multiple factors that determine human exposure and the underlying biology, reflected as omics markers of effect on neurodevelopment during childhood.

A strategy to maintain safety in clinical incidents.

NHS team leaders are often in a position where they have to not only manage and control a clinical situation but also become actively involved in delivering patient care because of low staffing levels or inappropriate skill mixes. This increases the potential for loss of situational awareness and risk to patient and staff safety. "Inner and outer circles" offers a strategy that could reduce risks and increase patient safety. It is used in pre-hospital and industrial environments and could easily be adapted to inpatient and other settings.

Reflecting reality: pager simulations in undergraduate education.

BACKGROUND: Fifth-year medical students build on their experiences of simulation and clinical placement to undertake a period of pager contact, during which they must respond appropriately to a variety of 'bleep' messages, culminating in the team management of a complex scenario. CONTEXT: In anticipation of their graduation to foundation-year doctors, fifth-year students in their final term on clinical placement at Lancashire Teaching Hospitals experience a period of time on call, when they receive a series of pager messages that they must manage whilst on clinical placement. They are expected to manage the variety of random events as if they were doctors on call. INNOVATION: With the agreement of all affected parties, students experience some simulated events of the type that they may experience while on call as foundation-year doctors. They are required to respond appropriately to these and are offered feedback on performance after they gather for a cardiac arrest simulation. DISCUSSION: This has been a very popular and impactful experience for final-term undergraduates as they anticipate the challenges of becoming foundation-year doctors. The need for effective management of clinical and non-technical skills presented in an ill-defined problem space is an appropriate challenge that serves to reassure them about their capacity to manage the unexpected. [The students] are expected to manage the variety of random events as if they were doctors on call.

Human patient simulation can aid staff training in non-invasive ventilation.

Non-invasive ventilation is increasingly used on general wards to manage respiratory disease and staffneed training and clinical experience to use this technique effectively. This article describes a training course that used human patient simulation to improve healthcare professionals' skills and confidence in using and adjusting noninvasive ventilation.

Study of the depletion of lincomycin residues in honey extracted from treated honeybee (Apis mellifera L.) colonies and the effect of the shook swarm procedure.

Bee colonies were treated with 1.2g lincomycin hydrochloride per hive (single treatment in sucrose solution) and samples of honey were then collected at intervals over a 41-week period. The samples were analysed for lincomycin using Liquid Chromatography-Mass Spectrometry/Mass Spectrometry (LC-MS/MS). The highest mean concentration of lincomycin (pooled analytical results for brood and super honey) was 24 microugg(-1) 3 days after treatment, a mean of 3.5 microgg(-1) after 129 days. The shook swarm procedure was investigated and resulted in a lincomycin concentration of 34 microgg(-1) in honey (pooled results for brood and super honey) 3 days after treatment, declining to 0.38 microgg(-1) 129 days after treatment. Lincomycin was persistent in the hive and detected in all over winter (290 days after dosing) samples of honey collected from both non-shook swarmed and shook swarmed colonies. The results overall indicate that lincomycin parent is a suitable marker compound to detect lincomycin misuse in apiculture.

Understanding the mechanism of injury and kinetic forces involved in traumatic injuries.

In this article, the author describes the kinetic forces patients can be subjected to during traumatic incidents or accidents and how these impact on injuries.