Managing the impact on biodiversity of supply chain companies

Industrial development has had a major role in creating the situation where bio-diverse materials and services essential for sustaining business are under threat. A key contributory factor to biodiversity decline comes from the cumulative impacts of extended supply chain business operations. In order to contribute to stopping this decline, the industrial world needs to form a better understanding of the way it utilizes the business and biodiversity agenda in its wider operations. This thesis investigates the perceptions and attitudes to biodiversity from government, society and a wide cross-section of industry. The research includes the extent of corporate attention to and use of environmental business tools and guidelines in reporting on biodiversity issues. A case study of three companies from different industrial sectors is undertaken to observe procurement and related environmental management of their supply chains. The use of accredited and non-accredited environmental management systems (EMS) are analysed as frameworks for introducing biodiversity aspects into supply chain management. The outcome is a methodology, which can be used either as a bespoke in-house biodiversity management system or within an accredited ISO 14001 EMS, for incorporating the assessment and management of the potential risks and opportunities involving environmental impacts on biodiversity of supply chain companies

Managing the impact on biodiversity of supply chain companies

Industrial development has had a major role in creating the situation where bio-diverse materials and services essential for sustaining business are under threat. A key contributory factor to biodiversity decline comes from the cumulative impacts of extended supply chain business operations. In order to contribute to stopping this decline, the industrial world needs to form a better understanding of the way it utilizes the business and biodiversity agenda in its wider operations. This thesis investigates the perceptions and attitudes to biodiversity from government, society and a wide cross-section of industry. The research includes the extent of corporate attention to and use of environmental business tools and guidelines in reporting on biodiversity issues. A case study of three companies from different industrial sectors is undertaken to observe procurement and related environmental management of their supply chains. The use of accredited and non-accredited environmental management systems (EMS) are analysed as frameworks for introducing biodiversity aspects into supply chain management. The outcome is a methodology, which can be used either as a bespoke in-house biodiversity management system or within an accredited ISO 14001 EMS, for incorporating the assessment and management of the potential risks and opportunities involving environmental impacts on biodiversity of supply chain companies.EThOS - Electronic Theses Online ServiceGBUnited Kingdo

Children's pain history reported by parents and children attending a UK teaching hospital's dental emergency clinic

Poster Presentation 10 from 27th Congress of the International Association of Paediatric Dentistry, Cancun, Mexico, 03 Jul 2019 - 07 Jul 2019.Background: The 2013 UK Children's Dental Health Survey found that 37% of five‐year‐olds and more than half (55%) of eight year‐olds had a dental problem that had caused pain in the previous six months. This study focused on children who had experienced a dental problem, which led them to attend an emergency dental clinic in September to December 2018. Aim: To assess the pain history reported by children and parents attending children's dental emergency clinic (CDEC) in a UK teaching dental hospital. Design: This service evaluation used a structured questionnaire completed by the parents/carers of children aged 0‐15 years before their emergency appointment. The questionnaire recorded the reason for attendance, the pain duration and a child‐reported current pain rating for children aged 4 years and older, using the Wong‐Baker FACES pain rating scale. The parents also rated their children's dental pain on a scale of 0‐10. Clinicians provided a clinical diagnosis, following assessment and investigations. Data was analysed using SPSS. Results: One‐hundred and thirty‐six questionnaires were completed by parents (response rate: 39%). The mean age was 7.4 years (SD = 3.6); 58% of the children were boys. The most commonly represented ethnicities were Caucasian (37%) and Asian (37%). Sixty‐seven percent of children reported dental pain; 27% reported swelling; and 16% reported dental trauma. There was a large variation in the duration of pain (median = 4 days; minimum = 0; maximum = 180). The mean pain ratings reported by the children and parents were 6.5 (SD = 2.9) and 5.9 (SD = 2.7) respectively. There was no significant difference in children's or parent's pain ratings by gender, age and ethnicity. There was a significant association between parents’ and children's pain ratings (R = 0.78, P 0.001). Children who were diagnosed with irreversible pulpitis had the highest self‐reported pain scores (mean = 8.8; SD = 1.7) compared to children diagnosed with dental caries (mean = 7.8; SD = 2.3) and TDI (mean = 4.7; SD = 3.0). Conclusions: Children attending an emergency dental clinic reported highly variable patterns of pain with irreversible pulpitis producing the highest pain rating by children. There was a significant association between children's self‐reported pain scores and parents’ rating of their children's dental pain

Immunohistochemical and transcriptional expression of Matrix Metalloproteinases in full-term human umbilical cord and Human Umbilical Vein Endothelial Cells

Matrix metalloproteinases (MMPs) are extracellular zinc-dependent endopeptidases involved in the degradation and remodelling of extracellular matrix in physiological and pathological processes. MMPs also have a role on cell proliferation, migration, differentiation, angiogenesis and apoptosis. Umbilical cord is a special organ subjected to many changes during pre-natal life and whose cells can maintain a certain degree of plasticity also in post-natal period; for example recently they have been used as a source of stem cells. In this work we investigated the expression of MMPs in human umbilical cord and Human Umbilical Vein Endothelial Cells (HUVEC) though immunohistochemistry, RT-PCR and gelatin zymography. MMP-2 protein is expressed in the amniotic epithelium of human umbilical cord and in few sub-epithelial fibroblasts, while MMP-3 and MMP-10 only in the umbilical epithelium. MMP-8, MMP-9 and MMP-13 immunoreactivity is localised in the epithelium and in Wharton\u2019s jelly mesenchymal cells. Immunocytochemistry also revealed protein expression for MMP-2, 3, 8, 9 and 10 in cultured HUVEC. In agreement with immunohistochemical data, RT-PCR analysis performed on samples of whole umbilical cord confirmed the transcriptional expression for the genes encoding all the six matrix metalloproteinases investigated, while in HUVEC only the expression of MMP-2, 3, 9, 10 and 13 mRNAs was detected. Gelatin zymograpgy showed a clear MMP-2 and MMP-9 enzymatic activity in the conditioned medium of HUVEC at different culture passages, suggesting that HUVEC secrete gelatinases, that afterwards undergo extracellular activation, and this ability is not affected by passage number

Correlations between patient-perceived outcome and objectively-measured biomechanical change following total knee replacement

Background: Total Knee Replacement (TKR) surgery is being utilised in a younger, more active population with greater functional expectations. Understanding whether patient-perceived measures of function reflect objective biomechanical measures is critical in understanding whether functional limitations can be adequately captured within a clinical setting. Research Question: Do changes in objective gait biomechanics measures reflect patient-reported outcome measures at approximately 12 months following TKR surgery? Methods: Three-dimensional gait analysis was performed on 41 patients with OA who were scheduled for TKR surgery, 22 of which have returned for a (9–24 month) follow-up assessment. Principal Component Analysis was used to define features of variation between OA subjects and an additional 31 non-pathological control subjects. These were used to train the Cardiff Classifier, an objective classification technique, and subsequently quantify changes following TKR surgery. Patient-perceived changes were also assessed using the Oxford Knee Score (OKS), Knee Outcome Survey (KOS), and Pain Audit Collection System scores (PACS). Pearson and Spearman correlation coefficients were calculated to establish the relationship between changes in objectively-measured and perceived outcome

Modelling clinical narrative as computable knowledge:The NICE computable implementation guidance project

Introduction: Translating narrative clinical guidelines to computable knowledge is a long‐standing challenge that has seen a diverse range of approaches. The UK National Institute for Health and Care Excellence (NICE) Content Advisory Board (CAB) aims ultimately to (1) guide clinical decision support and other software developers to increase traceability, fidelity and consistency in supporting clinical use of NICE recommendations, (2) guide local practice audit and intervention to reduce unwarranted variation, (3) provide feedback to NICE on how future recommendations should be developed. Objectives: The first phase of work was to explore a range of technical approaches to transition NICE toward the production of natively digital content. Methods: Following an initial ‘collaborathon’ in November 2022, the NICE Computable Implementation Guidance project (NCIG) was established. We held a series of workstream calls approximately fortnightly, focusing on (1) user stories and trigger events, (2) information model and definitions, (3) horizon‐scanning and output format. A second collaborathon was held in March 2023 to consolidate progress across the workstreams and agree residual actions to complete. Results: While we initially focussed on technical implementation standards, we decided that an intermediate logical model was a more achievable first step in the journey from narrative to fully computable representation. NCIG adopted the WHO Digital Adaptation Kit (DAK) as a technology‐agnostic method to model user scenarios, personae, processes and workflow, core data elements and decision‐support logic. Further work will address indicators, such as prescribing compliance, and implementation in document templates for primary care patient record systems. Conclusions: The project has shown that the WHO DAK, with some modification, is a promising approach to build technology‐neutral logical specifications of NICE recommendations. Implementation of concurrent computable modelling by multidisciplinary teams during guideline development poses methodological and cultural questions that are complex but tractable given suitable will and leadership

The TM6SF2 E167K genetic variant induces lipid biosynthesis and reduces apolipoprotein B secretion in human hepatic 3D spheroids

There is a high unmet need for developing treatments for nonalcoholic fatty liver disease (NAFLD), for which there are no approved drugs today. Here, we used a human in vitro disease model to understand mechanisms linked to genetic risk variants associated with NAFLD. The model is based on 3D spheroids from primary human hepatocytes from five different donors. Across these donors, we observed highly reproducible differences in the extent of steatosis induction, demonstrating that inter-donor variability is reflected in the in vitro model. Importantly, our data indicates that the genetic variant TM6SF2 E167K, previously associated with increased risk for NAFLD, induces increased hepatocyte fat content by reducing APOB particle secretion. Finally, differences in gene expression pathways involved in cholesterol, fatty acid and glucose metabolism between wild type and TM6SF2 E167K mutation carriers (N = 125) were confirmed in the in vitro model. Our data suggest that the 3D in vitro spheroids can be used to investigate the mechanisms underlying the association of human genetic variants associated with NAFLD. This model may also be suitable to discover new treatments against NAFLD

The Application of NCaRBS to the Trendelenburg Test and Total Hip Arthroplasty Outcome

This paper compares the frontal plane hip func- tion of subject’s known to have had hip arthroplasty via either the lateral (LA) or posterior (PA) surgical approaches and a group of subjects associated with no pathology (NP). This is investigated through the Trendelenburg test using 3D motion analysis and classification. Here, a recent develop- ment on the Classification and Ranking Belief Simplex (CaRBS) technique, able to undertake n-state classification, so termed NCaRBS is employed. The relationship between post-operative hip function measured during a Trendelen- burg Test using three patient characteristics (pelvic obliquity, frontal plane hip moment and frontal plane hip power) of LA, PA and NP subjects are modelled together. Using these characteristics, the classification accuracy was 93.75% for NP, 57.14% for LA, 38.46% for PA. There was a clear distinction between NP and post-surgical function. 3/6 LA subjects and 6/8 PA subjects were misclassified as having NP function, implying that greater function is restored following the PA to surgery. NCaRBS achieved a higher accuracy (65.116%) than through a linear discriminant analysis (48.837%). A Neural Network with two-nodes achieved the same accuracy (65.116%) and as expected was further improved with three-nodes (69.767%). A valuable benefit to the employment of the NCaRBS technique is the graphical exposition of the contribution of patient characteristics to the classification analysis

Minimally invasive and computer-navigated total hip arthroplasty: a qualitative and systematic review of the literature

ABSTRACT: BACKGROUND: Both minimally invasive surgery (MIS) and computer-assisted surgery (CAS) for total hip arthroplasty (THA) have gained popularity in recent years. We conducted a qualitative and systematic review to assess the effectiveness of MIS, CAS and computer-assisted MIS for THA. METHODS: An extensive computerised literature search of PubMed, Medline, Embase and OVIDSP was conducted. Both randomised clinical trials and controlled clinical trials on the effectiveness of MIS, CAS and computer-assisted MIS for THA were included. Methodological quality was independently assessed by two reviewers. Effect estimates were calculated and a best-evidence synthesis was performed. RESULTS: Four high-quality and 14 medium-quality studies with MIS THA as study contrast, and three high-quality and four medium-quality studies with CAS THA as study contrast were included. No studies with computer-assisted MIS for THA as study contrast were identified. Strong evidence was found for a decrease in operative time and intraoperative blood loss for MIS THA, with no difference in complication rates and risk for acetabular outliers. Strong evidence exists that there is no difference in physical functioning, measured either by questionnaires or by gait analysis. Moderate evidence was found for a shorter length of hospital stay after MIS THA. Conflicting evidence was found for a positive effect of MIS THA on pain in the early postoperative period, but that effect diminished after three months postoperatively. Strong evidence was found for an increase in operative time for CAS THA, and limited evidence was found for a decrease in intraoperative blood loss. Furthermore, strong evidence was found for no difference in complication rates, as well as for a significantly lower risk for acetabular outliers. CONCLUSIONS: The results indicate that MIS THA is a safe surgical procedure, without increases in operative time, blood loss, operative complication rates and component malposition rates. However, the beneficial effect of MIS THA on functional recovery has to be proven. The results also indicate that CAS THA, though resulting in an increase in operative time, may have a positive effect on operative blood loss and operative complication rates. More importantly, the use of CAS results in better positioning of acetabular component of the prosthesis

A Genome-Wide Association Study of Diabetic Kidney Disease in Subjects With Type 2 Diabetes

Identification of sequence variants robustly associated with predisposition to diabetic kidney disease (DKD) has the potential to provide insights into the pathophysiological mechanisms responsible. We conducted a genome-wide association study (GWAS) of DKD in type 2 diabetes (T2D) using eight complementary dichotomous and quantitative DKD phenotypes: the principal dichotomous analysis involved 5,717 T2D subjects, 3,345 with DKD. Promising association signals were evaluated in up to 26,827 subjects with T2D (12,710 with DKD). A combined (T1D+T2D) GWAS was performed using complementary data available for subjects with T1D, which, with replication samples, involved up to 40,340 diabetic subjects (and 18,582 DKD cases). Analysis of specific DKD phenotypes identified a novel signal near GABRR1 (rs9942471, p=4.5×10-8) associated with 'microalbuminuria' in European T2D cases. However, no replication of this signal was observed in Asian subjects with T2D, or in the equivalent T1D analysis. There was only limited support, in this substantially enlarged analysis, for association at previously-reported DKD signals, except for those at UMOD and PRKAG2, both associated with 'EGFR'. We conclude that, despite challenges in addressing phenotypic heterogeneity, access to increased sample sizes will continue to provide more robust inference regarding risk-variant discovery for DKD.</p