Education and training for people working with and caring for those with diabetes

The growing need for healthcare workers to be given education and training in diabetes care, along with the focus on improving self-management of the condition, prompted The Open University to launch 'Diabetes Care', a 20-week, first-level course, in 2005. The course was designed to meet the needs of lay people as well as those wishing to undertake a nationally accredited programme of study. It was immediately oversubscribed and continues to be extremely popular. The course model is being replicated in the design of two additional courses in preparation, 'Understanding Cardiovascular Diseases' and 'Managing Obesity'. – There is a substantial and growing demand for education and training in diabetes and its self-management, as evidenced by the ongoing popularity of the 'Diabetes Care' (SK120) course offered by The Open University – SK120 is a 20-week, entry-level course providing 15 CATS points that has been offered since September 2005 – It is based on a series of case studies presented via a DVD-ROM, a CD-ROM, a course book and online discussion forums – The model is being replicated in the preparation of two further courses focusing on cardiovascular diseases and the management of obesit

Effects of antiplatelet therapy on stroke risk by brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases: subgroup analyses of the RESTART randomised, open-label trial

Background Findings from the RESTART trial suggest that starting antiplatelet therapy might reduce the risk of recurrent symptomatic intracerebral haemorrhage compared with avoiding antiplatelet therapy. Brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases (such as cerebral microbleeds) are associated with greater risks of recurrent intracerebral haemorrhage. We did subgroup analyses of the RESTART trial to explore whether these brain imaging features modify the effects of antiplatelet therapy

Identifying dance in UK higher education

In this panel a group of University academics from six different UK Higher Education institutions, discusses their understandings of their academic environment with regard to both national and institutional contexts to contemplate the notion of common and distinctive features. Questions to be addressed include whether Higher Education in Dance across the UK is in any way uniform, if so, in what ways? Conversely, in what ways do the distinctive features of each setting differentiate dance education from one institution to another. How do commonalities contribute to an identity of UK Dance in HE that is in turn distinct from Dance among institutions elsewhere in the world? What are similarities across other systems? At the heart of the discussion is a partial construct of an identity of Dance in Higher Education in the UK. Viewed from within we could be forgiven for believing that we are all clearly distinct from one another. From beyond the UK it may appear that we have a common approach to Dance in HE that is in certain ways unique and distinct from the work of colleagues from other countries. Doubtlessly there are overlaps with colleagues from elsewhere and that these will probably emerge through the discussion from the floor.  What we hope to uncover in this session is the continuity and diversity of our work and how this is distinct and as such can be either a starting point from which we can learn from our colleagues or what they might learn from us

Creating a data warehouse to support monitoring of NSQHS blood management standard from EMR data

Background: Blood management is an important aspect of healthcare and vital for the well-being of patients. For effective blood management, it is essential to determine the quality and documentation of the processes for blood transfusions in the Electronic Medical Records (EMR) system. The EMR system stores information on most activities performed in a digital hospital. As such, it is difficult to get an overview of all data. The National Safety and Quality Health Service (NSQHS) Standards define metrics that assess the care quality of health entities such as hospitals. To produce these metrics, data needs to be analysed historically. However, data in the EMR is not designed to easily perform analytical queries of the kind which are needed to feed into clinical decision support tools. Thus, another system needs to be implemented to store and calculate the metrics for the blood management national standard. Methods: In this paper, we propose a clinical data warehouse that stores the transformed data from EMR to be able to identify that the hospital is compliant with the Australian NSQHS Standards for blood management. Firstly, the data needed was explored and evaluated. Next, a schema for the clinical data warehouse was designed for the efficient storage of EMR data. Once the schema was defined, data was extracted from the EMR to be preprocessed to fit the schema design. Finally, the data warehouse allows the data to be consumed by decision support tools. Results: We worked with Eastern Health, a major Australian health service, to implement the data warehouse that allowed us to easily query and supply data to be ingested by clinical decision support systems. Additionally, this implementation provides flexibility to recompute the metrics whenever data is updated. Finally, a dashboard was implemented to display important metrics defined by the National Safety and Quality Health Service (NSQHS) Standards on blood management. Conclusions: This study prioritises streamlined data modeling and processing, in contrast to conventional dashboard-centric approaches. It ensures data readiness for decision-making tools, offering insights to clinicians and validating hospital compliance with national standards in blood management through efficient design.</p

Less is more: neural mechanisms underlying anomia treatment in chronic aphasic patients.

Previous research with aphasic patients has shown that picture naming can be facilitated by concurrent phonemic cueing [e.g.initial phoneme(s) of the word that the patient is trying to retrieve], both as an immediate word retrieval technique, and when practiced repeatedly over time as a long-term anomia treatment. Here, to investigate the neural mechanisms supporting word retrieval, we adopted—for the first time—a functional magnetic resonance imaging task using the same naming procedure as it occurs during the anomia treatment process. Before and directly after a 6-week anomia treatment programme, 18 chronic aphasic stroke patients completed our functional magnetic resonance imaging protocol—a picture naming task aided by three different types of phonemic cues (whole words, initial phonemes, final phonemes) and a noise-control condition. Patients completed a naming task based on the training materials, and a more general comprehensive battery of language tests both before and after the anomia treatment, to determine the effectiveness and specificity of the therapy. Our results demonstrate that the anomia treatment was effective and specific to speech production, significantly improving both patients’ naming accuracy and reaction time immediately post-treatment (unstandardized effect size: 29% and 17%, respectively; Cohen’s d: 3.45 and 1.83). Longer term gains in naming were maintained 3 months later. Functional imaging results showed that both immediate and long-term facilitation of naming involved a largely overlapping bilateral frontal network including the right anterior insula, inferior frontal and dorsal anterior cingulate cortices, and the left premotor cortex. These areas were associated with a neural priming effect (i.e. reduced blood oxygen level-dependent signal) during both immediate (phonemically-cued versus control-cue conditions), and long-term facilitation of naming (i.e. treated versus untreated items). Of note is that different brain regions were sensitive to different phonemic cue types. Processing of whole word cues was associated with increased activity in the right angular gyrus; whereas partial word cues (initial and final phonemes) recruited the left supplementary motor area, and right anterior insula, inferior frontal cortex, and basal ganglia. The recruitment of multiple and bilateral areas may help explain why phonemic cueing is such a successful behavioural facilitation tool for anomia treatment. Our results have important implications for optimizing current anomia treatment approaches, developing new treatments, and improving speech outcome for aphasic patient

Myhre syndrome is caused by dominant-negative dysregulation of SMAD4 and other co-factors

Myhre syndrome is a connective tissue disorder characterized by congenital cardiovascular, craniofacial, respiratory, skeletal, and cutaneous anomalies as well as intellectual disability and progressive fibrosis. It is caused by germline variants in the transcriptional co-regulator SMAD4 that localize at two positions within the SMAD4 protein, I500 and R496, with I500 V/T/M variants more commonly identified in individuals with Myhre syndrome. Here we assess the functional impact of SMAD4-I500V variant, identified in two previously unpublished individuals with Myhre syndrome, and provide novel insights into the molecular mechanism of SMAD4-I500V dysfunction. We show that SMAD4-I500V can dimerize, but its transcriptional activity is severely compromised. Our data show that SMAD4-I500V acts dominant-negatively on SMAD4 and on receptor-regulated SMADs, affecting transcription of target genes. Furthermore, SMAD4-I500V impacts the transcription and function of crucial developmental transcription regulator, NKX2-5. Overall, our data reveal a dominant-negative model of disease for SMAD4-I500V where the function of SMAD4 encoded on the remaining allele, and of co-factors, are perturbed by the continued heterodimerization of the variant, leading to dysregulation of TGF and BMP signaling. Our findings not only provide novel insights into the mechanism of Myhre syndrome pathogenesis but also extend the current knowledge of how pathogenic variants in SMAD proteins cause disease.</p

Impact of Chlamydia trachomatis in the reproductive setting: British Fertility Society Guidelines for practice

Chlamydia trachomatis infection of the genital tract is the most common sexually transmitted infection and has a world-wide distribution. The consequences of infection have an adverse effect on the reproductive health of women and are a common cause of infertility. Recent evidence also suggests an adverse effect on male reproduction. There is a need to standardise the approach in managing the impact of C. trachomatis infection on reproductive health. We have surveyed current UK practice towards screening and management of Chlamydia infections in the fertility setting. We found that at least 90% of clinicians surveyed offered screening. The literature on this topic was examined and revealed a paucity of solid evidence for estimating the risks of long-term reproductive sequelae following lower genital tract infection with C. trachomatis. The mechanism for the damage that occurs after Chlamydial infections is uncertain. However, instrumentation of the uterus in women with C. trachomatis infection is associated with a high risk of pelvic inflammatory disease, which can be prevented by appropriate antibiotic treatment and may prevent infected women from being at increased risk of the adverse sequelae, such as ectopic pregnancy and tubal factor infertility. Recommendations for practice have been proposed and the need for further studies is identified

Type I interferon receptor (IFNAR2) deficiency reveals Zika virus cytopathicity in human macrophages and microglia

Macrophages are key target cells of Zika virus (ZIKV) infection, implicated as a viral reservoir seeding sanctuary sites such as the central nervous system and testes. This rests on the apparent ability of macrophages to sustain ZIKV replication without experiencing cytopathic effects. ZIKV infection of macrophages triggers an innate immune response involving type I interferons (IFN-I), key antiviral cytokines that play a complex role in ZIKV pathogenesis in animal models. To investigate the functional role of the IFN-I response we generated human induced pluripotent stem cell (iPSC)-derived macrophages from a patient with complete deficiency of IFNAR2, the high affinity IFN-I receptor subunit. Accompanying the profound defect of IFN-I signalling in IFNAR2 deficient iPS-macrophages we observed significantly enhanced ZIKV replication and cell death, revealing the inherent cytopathicity of ZIKV towards macrophages. These observations were recapitulated by genetic and pharmacological ablation of IFN-I signalling in control iPS-macrophages and extended to a model of iPS-microglia. Thus, the capacity of macrophages to support noncytolytic ZIKV replication depends on an equilibrium set by IFN-I, suggesting that innate antiviral responses might counterintuitively promote ZIKV persistence via the maintenance of tissue viral reservoirs relevant to pathogenesis