Founding Partners Research Articles

Time to Rectify the Neglect? Audit on Prescription Writing the Neglected skill. Audit Ref No: AU/006/01/2021

AimsPrescribing is a neglected skill amongst trainees. Prescription errors can harm patients. A recent Economic analysis published in BMJ Quality & Safety. Estimated that 237 million medication errors occur in England annually. Costing the NHS £98,462,582. Prescribing errors contributed to 21% of the total errors. It is important that all prescribers are aware of principles of safe prescribing. Our aim is to is to establish whether our practice is meeting standards of prescription writing in old age psychiatry ward setup.MethodsWe used prescription standards set by BMA, BNF and SABP (Surrey and Borders Partnership Foundation NHS Trust) to assess all prescriptions. The following parameters were checked: GMC number, Sign, Name of Doctor, Name of drug, Indication, Dose, Route, Frequency, Original start date, current Date, medication timings.Data collection and handlingWe performed a closed loop audit. A retrospective data of 228 prescriptions were collected from August 2020 to January 2021 from patients admitted in Victoria Ward. The data were analysed and presented at departmental meeting. Re-training on prescription writing conducted. New data was prospectively collected comprising of 230 prescriptions from March 2021 to June 2021 to complete the audit cycle.Excel sheet was used to collect the data and to get the results. All Prescription charts were collected from SystmOne (clinical software system). Data from both the Audit's were analysed and compared.ResultsWe found errors in all parameters, except for medication timings. Comparison of the data from the first audit and re-audit showed an increase in prescription errors.There was an increased 20.33% error in writing GMC number, 16.87% error in writing name of the doctor, 12.94% error in indication and 5% error in original start date. There was improvement of 10.88% in one parameter, “Name of the drug”.ConclusionA significant error was found in writing the GMC number and the Doctor's name, despite regular training during induction. There are no clear guidelines on the writing of GMC registration being compulsory on Drug chart. With one exception if online and you are not the patient's regular prescriber, then your GMC registration number is required.Recommendations1.We recommended the trust to issue stamps with GMC number and doctor's name.2.Re-audit in 6 months’ time after introduction of the stamps.3.Quarterly regular training of new Trainee doctors.Service improvementsAfter the Audit was submitted locally, stamps were introduced and issued to junior doctors at Victoria Ward by the Trust.

Attitudes and Experience of Autism and Learning disability(LD): A Survey of Mental Healthcare Staff

AimsTo establish a baseline of staff experience and confidence in autism/LD. To inform how we deliver training going forward. To collect good practice examples of reasonable adjustments. To ascertain knowledge about the appropriate recording for information related to Autism/LDMethodsAll clinical and non-clinical staff of Leeds &York Partnership Foundation Trust(LYPFT), Bradford District Care Foundation Trust(BDCFT), South West Yorkshire Foundation Trust(SWYFT), Voluntary sectors, Local authority and Leeds Community Health Care NHS Trust (LCH)were invited to take part in the anonymised “Staff Autism and LD Survey” through the various trust wide email bulletins. Smart Survey was the platform used. It took about 5–7 minutes to complete, and the survey period was from 21/09/21 to 01/11/21ResultsA total of 225 members of staff across six organisations took part in the survey.76% (170) were from LYPFT, 16(7%) from Voluntary Sector Organisations, 6%(14) from Local Authority and 3% from LCH 3%(7), Missing 14(6%), BDCFT 1%(2), SWYPFT 1%(2)The majority were nurses 23% (52), followed by psychologists 10% (22).18% (41) stated they would be interested in becoming an autism champion for their team/service.Although 89% (200) had heard of the term “reasonable adjustments”, 36% (81) had never seen a ‘hospital passport’ for an autistic or learning-disabled service user.Only 24 (11%) said they knew where to record reasonable adjustments on the electronic patient recordIn general staff were marginally more confident in making reasonable adjustments for people with autism than those with LDMajority of staff preferred : face-to-face training, followed by e-learning and then videocall.ConclusionGenerally, respondents reported feeling neutral or confident with respect to their confidence in recognising, diagnosing, and working with patients with autism. The number of staff that have indicated interest at becoming Autism champions is a testament to the growing interest and increasing awareness about Autism.Regarding learning disability, respondents generally reported feeling neutral or confident across the three areas of recognising moderate to severe learning disability, recognising mild learning disability, and managing/treating mental health problems in service users with learning disability.The very high number of staff (89%) that have heard of the term “reasonable adjustments” is quite commendable and is useful to know when planning what level to ‘pitch’ training in this area.It is interesting however that staff feel more confident at making reasonable adjustments for people with Autism, rather than for LD. One wonders whether it is due to the increasing media publicity about Autism.

Antipsychotic prescribing choices in patients with First Episode Psychosis

IntroductionAs all first line options in treating First Episode Psychosis (FEP) are similarly effective there is a consensus among prescribing guidelines that clinicians and patients should consider side-effect profile as the ‘driver’ of initial choice of antipsychotic. Anecdotally it has been observed that different care teams prescribe particular medications preferentially.ObjectivesTo evaluate the patterns of antipsychotic prescribing in patients with FEP at the time of initial treatment and over the first year with the Early Intervention Service (EIS).MethodsMedical records of all patients who had completed 1 year of follow-up with EIS in Sussex Partnership Foundation Trust (n=274) were reviewed. The first antipsychotic prescribed and antipsychotic prescribed at 12-months was recorded alongside initiating care team (EIS, non-EIS community services, inpatient services).Results99% (n=272) of patients were prescribed an antipsychotic. 46% were initiated by inpatient serves, 40% non-EIS community services and 14% EIS. Aripiprazole, olanzapine, quetiapine and risperidone accounted for 95% of initial prescriptions. Different care teams prescribed antipsychotics preferentially (p=<0.005) (Fig.1). Rates at which initial medication was continued at 12-months varied according to initial prescription (P=<0.05) (Fig.2).ConclusionsThe frequency that specialist EIS services prescribed aripiprazole as initial treatment contrasts the preference for olanzapine in other services. Olanzapine has a significant metabolic side effect profile, is sedating and was least likely to be continued at 12 months. This raises questions about why non-FEP specialist services prefer olanzapine and whether EIS services can support these services around initial medication choices more likely to be continued throughout the key first year of treatment.DisclosureNo significant relationships.

Analysis of the entrepreneurial process from effectuation and causation logic: a case study in two companies from Minas Gerais

Objective: The article aimed to analyze how the effectuation and causation logics were used in the entrepreneurial process of two companies from Minas Gerais. The effectuation logic is based on issues related to the entrepreneur's decision making and contrasts with the causation logic - which refers to traditional methods of the entrepreneurial process based on planning and determined sequences. Methodology: A qualitative comparative study was carried out in two companies from Minas Gerais. The evidence was obtained from interviews with the founding partners, in addition to observation and documents, and the data analysis was performed using content analysis. Results: The results showed that in the two cases analyzed, the entrepreneurs relied on effectuation logic for setting up the businesses, with little use of causation logic but as the businesses consolidated and moved beyond the initial founding phase, the entrepreneurs took different attitudes, basing their decisions and actions on greater planning and systematic analysis of the context. Limitations: Some studies show that cultural differences can have an influence on the entrepreneurial process and how entrepreneurs make decisions. This variable was not contemplated in this study, which represents a limitation. Additionally, the study analyzed the entrepreneurial process of two companies from Minas Gerais, which does not allow for generalization. Originality/contributions: the work contributes to the national studies on the entrepreneurial process, mainly from the principles that compose the effectuation logic, seeking to identify and classify the decisions and actions of entrepreneurs in the causation and effectuation logics.

On the interplay of loading, myocardial stiffness and contractility in transthoracic acoustic radiation force-induced shear wave measurements in pigs

Abstract Funding Acknowledgements Type of funding sources: Public Institution(s). Main funding source(s): Research Foundation Flanders (FWO grant number 1211620N) & TTW-Dutch Heart Foundation partnership program "Early recognition of cardiovascular diseases" (project number 14740) Background Acoustic radiation force-based shear wave elastography (SWE) is a promising technique to non-invasively assess mechanical properties of the heart based on the propagation speed of acoustically induced shear waves. However, the interpretation of cardiac SWE measurements remains complex, and it is unclear how other factors such as loading affect shear wave propagation speed (SWS) measurements in diastole and systole. Purpose We applied transthoracic SWE in a pig model to investigate the dependencies of diastolic and systolic SWS on pressure-volume (PV) loop derived indices of loading, myocardial stiffness and contractility. Methods In 7 pigs, loading conditions were altered (increasing or decreasing preload; increasing afterload) and myocardial stiffness was changed (LAD occlusion for 60-100 minutes followed by 40 minutes of reperfusion). For each intervention, transthoracic SWE measurements were performed in a parasternal long-axis view with a high frame rate ultrasound system (> 6.2 kHz). Recordings of 28 ms were repeated at 34 Hz during 1.5 s to track shear waves throughout the cardiac cycle. To determine systolic and diastolic SWS in a robust manner, a piecewise linear model was fitted to the SWS data of each intervention representing multiple acquisitions, heartbeats and M-lines (fig. 1a). PV loops were recorded simultaneously with SWE measurements to estimate end-diastolic pressure (EDP), end-systolic pressure (ESP), end-diastolic pressure volume relation (EDPVR with exponential coefficient β in fig. 1b) and preload-recruitable stroke work (PRSW). Passive chamber stiffness was evaluated as the local slope of the EDPVR, i.e. β·EDP. Linear regressions and Pearson’s correlation coefficients were calculated. Results Diastolic SWS was significantly correlated to EDP when altering loading (blue in fig. 2a: R = 0.55; p < 0.01) and stiffness (orange in fig. 2a: R = 0.66; p < 0.01). A similar correlation is found between SWS and passive chamber stiffness β·EDP (fig. 2b). Diastolic SWS is more sensitive to changes in stiffness than in loading, as reflected by the larger slope of the regression line (0.79 vs. 0.28 in fig. 2b). Furthermore, systolic SWS significantly correlated with measures of contractility during loading alterations: ESP in fig. 2c (R = 0.69; p < 0.001) and PRSW in fig. 2d (R = 0.63; p = 0.02). However, no significant correlation was found between systolic SWS and contractility during infarct/reperfusion. Conclusion This study shows that diastolic SWS reflects the instantaneous stiffness of the myocardium, but is not a load-independent measure of the intrinsic passive mechanical properties of the heart. Instantaneous stiffness, and thus diastolic SWS, might be altered by loading (due to material non-linearity) or intrinsic mechanical changes. Furthermore, loading experiments suggest that systolic SWS is related to contractility. The relation between SWS and contractility in the presence of myocardial infarct deserves further study. Abstract Figure. Fig. 1: SWS and PV analysis. Abstract Figure. Fig. 2: SWS vs. PV-derived indices.

Os Dilemas de Crescer com Propósito: Caso Mancha Orgânica

ABSTRACT The case presents the dilemma faced in November 2018 by Mancha Orgânica, a startup from Rio de Janeiro that produces organic paints. Mancha Orgânica is guided by principles of sustainability, producing a non-toxic paint from natural elements. Despite the recognition and good commercial results, the founding partners Amon and Pedro along with P&D consultant Martina wondered how to stimulate growth without losing the purpose of a more conscious consumption, considering the productive challenges. The case of Mancha Orgânica aims to propose a discussion about purpose and the challenges faced by purpose-driven companies. The case can be used in the disciplines of Branding or Marketing of lato or stricto sensu graduate programs. With the case, students are expected to develop the necessary skills to examine and differentiate the positioning and challenges of purpose-driven companies.

The Implementation of the Concept of Atmosphere in Kazuyo Sejima’s Architecture

Kazuyo Sejima and Ryue Nishizawa are founding partners of the firm SANAA (Sejima and Nishizawa and Associates) and renowned for their refined simplicity, spatial fluidity, and thoughtful integration into urban contexts. SANAA has developed the architectural ‘atmosphere’ as its design methodology and called it as a landscape (the contemporary scenery) for people. The objective of this paper is to explore the examples of ‘Atmosphere’ in their projects and SANAA’s design methodology to define Atmosphere and discover new design vocabulary for Atmosphere. As a methodology, the interpretation of SANAA's own statements and explanatory texts and exploration to find consistency in fragmentary and multi-faceted statements were conducted. In addition to the analysis of speech, in approaching the atmosphere as an embodied substance, it was attempted to trace and discover which architectural representations are closely related to the concept of atmosphere in the design result. The analysis result had shown that SANAA used three main approached for atmosphere as follows: 1) an expression strategy to reset the hierarchy, 2) an expression strategy of transparency and abstract simplicity to clearly express the architectural concept they want to convey, that is, the essential nature of the project, 3) a strategy of tricks to induce discovery. SANAA has been pursuing a new freedom and has incorporated multiple values into it and tries to embody the concept of atmosphere via the various representational strategies: hierarchical reconstitution of space, transparent and abstract simplification, and non-deceptive trick.

Children’s charter for lung health

Every child and young person has the right to breathe clean air, with healthy lungs. Preconception, in utero and early life exposures, affect children’s lungs, their lung growth and their...

(Invited) Designing Materials to Revolutionize and Engineer the Future of Clean Energy Technologies

The Materials Genome Initiative (MGI) is a multi-agency partnership that seeks to accelerate the progression of materials research across the Materials Development Continuum. Through use of a computationally led and data-driven approach, MGI promotes the rapid design, discovery, development and deployment of advanced materials that will ensure sustained American leadership in sectors including clean energy. The goals of the MGI include 1) leading a culture shift in materials research through use of an iterative feedback-loop approach, 2) integrating experiment, computation, and theory throughout the materials research community, 3) making digital data accessible and useful to the larger community, and 4) creating a world-class materials science and engineering workforce. The Designing Materials to Revolutionize and Engineer our Future (DMREF) program at the National Science Foundation (NSF) partners with other federal agencies to promote these objectives. DMREF currently supports about one hundred projects that cover the full spectrum of materials research, including several that focus on energy conversion technologies. This talk will provide an overview of the DMREF program and provide specific examples from DMREF teams that are benefitting from collaboration with MGI-related efforts at other federal agencies. Interactions with the U.S. Department of Energy's (DOE) Energy Materials Network (EMN) will be highlighted. Results of the 2021 DMREF competition, future priorities, and funding opportunities for the MGI-related research will be discussed. Figure 1

NOESIS: Surfing the technological wave from Portugal

Noesis, founded in 1995, was a Portuguese business consulting firm that provided services and solutions aimed at supporting its customers to increase competitiveness, facilitate management, reduce costs and optimize processes, having as core competencies the technological background of its founding partners. Because of the company’s tenacity and strategic focus, 11 years later, in the beginning of 2016, Noesis was a leader in the Portuguese Quality Management market for the independent provision of software testing services, according to a study from International Data Corporation. In January 2016, Noesis had more than 500 employees in its different locations: Lisbon, Porto, Coimbra, Brussels, São Paulo, Dublin and Rotterdam, ensuring the adequate response to customer challenges in Portugal and international markets. The company’s outlook was positive, but the competition was increasing, and interest rates were expected to rise in the nearby future. Having a substantial amount of capital leveraging and two failed international ventures (Angola and Brazil), should Noesis continue to invest and grow at a fast pace or take some time to consolidate its operations?

IKEA Foundation partners with Rockefeller Foundation on global climate change initiative

Corporate Philanthropy ReportVolume 36, Issue 9 p. 3-3 News Briefs IKEA Foundation partners with Rockefeller Foundation on global climate change initiative First published: 13 August 2021 https://doi.org/10.1002/cprt.31024Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article. Volume36, Issue9September 2021Pages 3-3 RelatedInformation

Responding to a pandemic with Simulation Based Education (SBE)? Sharing lessons learned from Sussex Partnership Foundation Trust (SPFT)

AimsIn March 2020 SPFT was preparing for the first wave of the COVID-19 pandemic. Senior medical leadership supported the rapid development and delivery of SBE workshop for assessment and management of physically unwell patients in a psychiatric setting in the context of COVID-19. The training was delivered to 102 psychiatrists across 10 sessions over 4 weeks.A learning review was completed to identify lessons learned from the delivery of this SBE workshop.MethodThe intervention was reviewed using open-space feedback from attendees, interviews with facilitators and medical leadership, and SWOT (Strengths, Weaknesses, Opportunities, Threats) analysis.ResultOverall, the simulation project met its pre-determined objectives of increasing confidence and competence in the medical workforce in the context of COVID-19 and physical health. Development and delivery of the workshop was rapid, with request to delivery taking 4 days.A summary of the key lessons include:An existing simulation faculty within the trust was essential, allowing for rapid identification of key stakeholders and those able to deliver the project.A “direct-line” relationship to senior leadership enabled the project to be dynamic and responsive to changing demands as COVID-19 guidelines and objectives evolved.Redeploying higher trainees with SBE experience to develop the project as a focussed team allowed for rapid delivery which was resource-effective.The workforce found reassurance from understanding what was not expected of them, as much as what was. For example, making clear that Arterial Blood Gases would not be introduced to the psychiatric setting.There is an ongoing learning need for physical health training through SBE in non-covid scenarios.SBE can be an effective intervention for a range of medical grades and covering a large geographical area.There are opportunities for developing multi-disciplinary training on physical health in psychiatry.ConclusionWe have outlined some of the key learning outcomes from a successfully implemented SBE project during the first COVID-19 wave in spring 2020. The project has cemented the role of the relatively new simulation faculty within the trust and highlighted the effectiveness of close collaboration between leadership and a small, dedicated group of facilitators. The project has continued to be used for training new staff members and the resources have been widely shared, used by other NHS trusts and also internationally.

The person behind the label: co-production as a tool in teaching about borderline personality disorder

AimsThe overarching aim of the session was to address and reduce stigma around Borderline Personality Disorder among doctors. The three main objectives were:To increase empathy and understanding around Borderline Personality Disorder by exposing junior doctors to service user perspectives outside a clinical setting;To address knowledge gaps identified by junior doctors in a self-reported questionnaire disseminated prior to the teaching session;To offer junior doctors a basic psychological framework to base their assessment and formulation of service users with personality disorders.Background‘Borderline Personality Disorder: The Person Behind the Label’ was the title of the first co-produced teaching session in the Leeds and York Partnership Foundation Trust (LYPFT). Prior to the teaching session, an online questionnaire was sent out to trainees. The results highlighted three key issues:Negative attitudes towards service users with personality disorders;Poor subjective knowledge of the psychological models of personality disorders;Perception among trainees that they do not receive adequate training to deal with the challenges service users with personality disorders present.MethodA teaching session was co-produced by a team of two service users, a principal clinical psychologist within the Leeds Personality Disorder Network (PDN) and a core Psychiatry trainee. It was delivered in a 75 minute session to 40 attendees consisting of both trainee doctors and consultants.ResultFeedback was collected immediately after the session through the use of anonymous feedback forms. The response to the training was overwhelmingly positive with all 28 respondents rating the session as 4/5 or 5/5 on a satisfaction scale ranging from 1 (poor) to excellent (5). Key themes from the feedback included appreciation for the service user perspective and teaching on psychological theory. The fourth question in the questionnaire: “How will this teaching impact your work?” produced the highest number of responses (25/28) and provided evidence that the above listed objectives of the session were met.ConclusionCo-produced teaching has great potential to address negative attitudes around highly stigmatised conditions by bridging the gap that often exists between service users and mental health professionals.

Physical Health Simulation Based Education (SBE) for psychiatrists in the first COVID-19 wave: improving the competence and confidence of the medical workforce

AimsAt the start of the COVID-19 pandemic there was significant uncertainty for the NHS and it's workforce. Within psychiatry, there was an expectation that junior doctors would be redeployed, with senior psychiatrists stepping down to cover physical health and on-call duties.Senior leadership in mental health trusts were also preparing for COVID-19 outbreaks on psychiatric wards and were developing strategies for managing a novel illness with a poorly understood clinical course. Many psychiatrist expressed anxieties around their competency in assessing and managing acutely physically unwell patients in a mental health setting.This project aimed to improve confidence of psychiatrists in core physical health competencies through devising and delivering an evolving SBE package.MethodSussex Partnership Foundation Trust redeployed two higher trainees from their simulation faculty to work full time on developing a SBE package. This was requested by senior leadership to deliver training about assessing and managing physically unwell patients in the context of COVID-19. This training was devised as a 90 minute didactic lecture following by 90 minutes of SBE.This was delivered at 6 sites through 10 opt-in sessions available to all doctors in the trust over 4 weeks. Pre and post-course questionnaires were given to all participants to measure the effect.Result102 medical staff attended the SBE workshops. Feedback was completed by 93 (91%) doctors prior to the course and 97 (95%) post. Before the workshop, 33% did not feel they had a structured approach for assessing an acutely unwell patient, which reduced to 0% after completing the course.On a 5-point Likert scale, confidence in managing COVID-19 symptoms increased from 2.54/5 to 4.07/5 overall with 89% of doctors feeling “confident” or “very confident”. There were similar increases in confidence in managing critically unwell patients (2.7/5 pre; 3.95/5 post) and in identifying alternative causes for acutely unwell patients (2.63/5 pre; 4.02/5 post).ConclusionThis project demonstrates that SBE is an effective way to rapidly develop effective interventions for the medical workforce, increasing confidence in the face of significant uncertainty and reducing anxiety within the system to meet the learning needs identified by medical leadership.As part of this project Sussex Partnership Medical Education freely shared the workshop materials, which were later adopted and used by psychiatry departments internationally.

Remote assessment in adults with Autism or ADHD: A service user satisfaction survey.

Advances in digital health have enabled clinicians to move away from a reliance on face to face consultation methods towards making use of modern video and web-based conferencing technology. In the context of the COVID-19 pandemic, remote telecommunication methods have become much more common place in mental health settings. The current study sought to investigate whether remote telecommunication methods are preferable to face to face consultations for adults referred to an Autism and ADHD Service during the COVID-19 pandemic. Also, whether there are any differences in preferred consultation methods between adults who were referred for an assessment of Autism as opposed to ADHD. 117 service users who undertook assessment by the ADHD and Autism Service at South West Yorkshire NHS Partnership Foundation Trust from April to September 2020 completed an adapted version of the Telehealth Usability Questionnaire (TUQ). Results demonstrated that service users found remote telecommunication to be useful, effective, reliable and satisfactory. Despite this, almost half of service users stated a general preference for face to face consultations. There was no difference in the choice of methods of contact between Autism and ADHD pathways. Remote telecommunication methods were found to be an acceptable medium of contact for adults who undertook an assessment of Autism and ADHD at an NHS Service during the COVID-19 pandemic.

The Italian Node of the European Integrated Data Archive

Abstract The Orfeus European Integrated Data Archive (EIDA) provides a federated approach to the dissemination of seismological waveform data and ensures access to 12 regional seismological data centers—the EIDA nodes. The Istituto Nazionale di Geofisica e Vulcanologia (INGV) is one of the founding partners of this EIDA federation and manages the EIDA data distribution node in Italy. INGV has actively managed the smaller MedNet archive since 1990 and adopted a more comprehensive and systematic approach to seismological data archiving since 2007. The Italian EIDA node data archive currently totals 90 TBytes of waveform data available for download, originating from 25 networks and 974 stations, provided by INGV, MedNet, or contributed by various partner institutions. Geographically, it covers mainly Italy and some stations from the Mediterranean region. The archive is currently growing at a rate of approximately 11 TB/yr. INGV recently strengthened its data management capabilities, resources, and infrastructure to effectively respond to the growing scale of station inventory, archive, and volumes of delivered data, and to acknowledge increasing attention toward open data sharing, appropriate attribution, and FAIR principles (Findability, Accessibility, Interoperability, and Reuse), as well as higher demands on data quality and expectations of the scientific user community. To this end, it established a dedicated internal unit in charge of all relevant activities related to the Italian EIDA node. In this article, we address key aspects of the EIDA node in Italy such as evolution and status of the seismological waveform archive, and we describe the technical, organizational, and operational setup of data and service management. We also outline ongoing activities and future evolutions aiming to further increase the quality of services, data availability, data and metadata quality, resilience, and sustainability.

Closed-chest measurement of diastolic and systolic shear wave speed to assess myocardial stiffness

Abstract Funding Acknowledgements Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Research Foundation Flanders (FWO): grant 1211620N TTW – Dutch Heart Foundation partnership program "Earlier recognition of cardiovascular diseases": project number 14740 Background Echocardiographic shear wave elastography (SWE) encompasses all ultrasound techniques tracking shear wave (SW) motion in the cardiac wall, of which the propagation speed is linked to the intrinsic mechanical properties. SWs can be induced naturally, for example by valve closure, or externally by using an acoustic radiation force (ARF). Although the latter is technically more demanding, it enables instantaneous stiffness assessment throughout the entire cardiac cycle (fig. a). However, it is unknown how factors such as cardiac loading and contractility, next to intrinsic mechanical properties, affect ARF-based SW speeds. Purpose We performed transthoracic SWE measurements in pigs to study the effects of hemodynamic alterations, inotropic state and myocardial infarction (MI) on diastolic and systolic SW speeds. Methods Different cardiac conditions were considered in three pigs: (i) baseline (BL), (ii) preload decrease (PD), (iii) afterload increase (AI), (iv) preload increase (PI), (v) administration of dobutamine (DOB), (vi) BL2, (vii) MI through 60-100 min. occlusion of the LAD and (viii) 40 min. reperfusion (REP). For each condition, transthoracic high frame rate ARF-based SWE acquisitions were taken in a parasternal long-axis view with a research ultrasound system. SWs were induced in the septum at 34 Hz during 1.5 s to track SW speeds throughout the cardiac cycle (fig. a&b). Systolic and diastolic SW speeds were determined from the 10% highest and lowest median values per condition, respectively. Left ventricular pressure-volume (PV) loops were recorded to estimate end-diastolic pressure (EDP), end-systolic pressure (ESP) and passive chamber stiffness (dPdV). dPdV was determined as the slope of the tangent to the fitted end-diastolic PV relationship at mean ED volume. Linear regressions and Pearson’s correlation coefficients were computed. Results Diastolic SW speed was correlated to EDP for conditions with changes in loading, and to dPdV for conditions with changes in chamber stiffness (fig. c). Both relationships were significant, with a moderate positive correlation for EDP (R = 0.48, p = 0.02) and a strong positive correlation for dPdV (R = 0.76, p < 0.01). Furthermore, the observed change in diastolic SW speed was smaller when altering EDP compared to dPdV (0.4 m/s vs. 1.0 m/s). For systolic SW speed, very strong positive correlations were found with ESP (R = 0.91, p < 0.01), and with dPdV (R = 0.81, p < 0.01) in fig. d. Conclusion This study shows that both diastolic and systolic SW speed are related to passive chamber stiffness. Moreover, loading also influenced systolic SW speed and, to a lesser extent, diastolic SW speed, presumably because of material nonlinearity. Systolic SW speed is linked to contractility as well. Thus, while SWs after valve closure occur at a certain moment in the cardiac cycle, the timing of ARF-based SWs can be chosen such to assess specific aspects of the cardiac (structural and functional) status. Abstract Figure.

Rucaparib in patients with BAP1-deficient or BRCA1-deficient mesothelioma (MiST1): an open-label, single-arm, phase 2a clinical trial

Malignant mesothelioma remains an incurable cancer, with no effective treatments in the setting of relapsed disease. Homologous recombination deficiency predicts sensitivity to poly (ADP-ribose) polymerase (PARP) inhibitors. In mesothelioma, BRCA1-associated protein 1 carboxy-terminal hydrolase (BAP1), which regulates DNA repair, is frequently mutated. We aimed to test the hypothesis that BAP1-deficient or BRCA1-deficient mesotheliomas would be sensitive to PARP inhibition by rucaparib. We did a single-centre, open-label, single-arm, phase 2a trial in Leicester, UK, with prospective molecular stratification (Mesothelioma-Stratified Therapy 1 [MiST1]). Patients aged 18 years or older who had radiologically progressing, histologically confirmed, malignant mesothelioma after at least one course of systemic treatment; with cytoplasmic-BAP1-deficient or BRCA1-deficient mesothelioma (pleural or peritoneal or other primary localisation), and who met the other inclusion criteria, were deemed eligible. All eligible patients who consented to take part were given rucaparib 600 mg twice a day orally, for six cycles of 28 days, or until disease progression, unacceptable toxicity, withdrawal of consent, or death. Response was measured by CT scan every 6 weeks. The primary outcome was disease control (complete response, partial response, or stable disease) at 12 weeks in all patients who received study drug; secondary outcomes were the safety and toxicity profile, objective response rate (proportion of complete or partial responses), and disease control rate at 24 weeks. Recruitment is now closed. This trial is registered with ClinicalTrials.gov, NCT03654833. Between Feb 9 and June 10, 2019, we enrolled 26 molecularly and clinically eligible patients. Ten (38%) of 26 patients were BAP1 negative and BRCA1 negative, 23 patients (89%) were BAP1 negative, and 13 patients (50%) were BRCA1 negative. Disease control rate at 12 weeks was 58% (95% CI 37-77; 15 of 26 patients), and at 24 weeks was 23% (9-44; six of 26 patients). Rucaparib was well tolerated, with 15 (9%) of 166 adverse events being grade 3 or 4, which were seen in nine (35%) of 26 patients, and there were no deaths. The most common grade 1-2 adverse events were nausea (18 [69%] of 26 patients), fatigue (14 patients [54%]), and decreased appetite (ten patients [38%]). The most common grade 3-4 adverse events were upper respiratory tract infection (three patients [12%]) and anaemia (three patients [12%]). All six cycles of rucaparib were received by eight (31%) of 26 patients. One or more dose reductions occurred in nine patients (35%). Rucaparib in patients with BAP1-negative or BRCA1-negative mesothelioma met the prespecified criteria for success, showing promising activity with manageable toxicity. Further investigation of homologous recombination deficiency mutations is planned to refine the identification of predictive biomarkers for PARP inhibition in mesothelioma. University of Leicester (Leicester, UK), Asthma UK and British Lung Foundation Partnership, and the Victor Dahdaleh Foundation (Toronto, ON, Canada).

Coco‐Cola Foundation partners with Global Water Challenge on water, sanitation and hygiene programs

Coco‐Cola Foundation partners with Global Water Challenge on water, sanitation and hygiene programs

Biblissima

Reviewed by: Biblissima Róisín Astell Biblissima. https://biblissima.fr/Managed by Anne-Marie Turcan-Verkerk, Scientific Director, École Pratique des Hautes Études There are many useful online repositories cataloguing medieval manuscripts and early modern printed books in French collections. While each is important, the multiplication of such catalogues has created a fragmented landscape of digital resources. Every platform has a different interface, many are old-fashioned in design and function, each offers different search capabilities, and the data among them vary. Trying to find information about a manuscript often involves going back and forth among these websites. This is where Biblissima comes in. Biblissima is a French project funded by the Agence Nationale de la Recherche’s “Investissements d’Avenir” and is run by the Campus Condorcet. Its aims are to provide an online data facility for historians focusing on the history of ancient and modern collections and the circulation of books. By sharing information from research communities in France and beyond, Biblissima has created an indispensable online library of medieval manuscripts and early modern books for researchers. Ten founding partners across France participate in the Biblissima project.1In 2013, the Biblissima Consortium was formed from a group of twelve research institutions acting as supervisory authorities to the founding partners. Since then, the project has collaborated with international institutions, including the University of Oxford, the University of Padua, and the University of Mississippi. The main goal of Biblissima is to federate digital libraries that contain digitized medieval manuscripts and early printed books. The project has clustered the data from existing collections and created a digital image repository, bringing information from as many as forty databases from across French institutions. These data have then been linked to the online platform documenting digital editions and a digital image repository. This platform, known as the Biblissima portal, provides unified access to the digital data of medieval manuscripts, incunabula, and early printed books produced by the partners of the Biblissima consortium. [End Page 331] The portal regularly receives updates every three to four months. The ever-growing database contains nearly 124,000 manuscripts, more than 300,000 illuminations and decorations, 7,000 editions, and more than 19,000 early printed books. Its interface is straightforward to use. Via a search bar on the homepage, one can comb through key sections, such as “Manuscripts and Early Printed Books,” “Places,” “Historical Collections,” and the “Iconographic Thesaurus.” These can also be accessed directly below or in the dropdown menu “Explore,” via the tool-bar at the top of the page. The IIIF embedded Mirador viewer is a fantastic workspace for researchers, allowing users to view individual pages as an open book or in a gallery format. The “My Selection” option appears at the top of individual manuscript pages. This organizes your manuscript selections into a basket and allows you to open them in a new Mirador viewer and compare them with one another. You can then save and share these workspaces. Another useful feature is the Iconographic Thesaurus, which uses metadata from the Mandragore (BnF) and Initiale (IRHT-CNRS) databases. Its interface is a vast improvement on the existing Mandragore website. That site was published online in 2003 and remains outdated and difficult to navigate and offers only low-resolution images. In contrast, the Biblissima Thesaurus contains more than 160 thematic categories and about 27,000 descriptors. There are thirteen main categories, which are further divided. They include Arts (divided into Architecture, Textiles, Painting, Illumination, Stained Glass, etc.); Bible and Apocrypha (Old Testament, New Testament, etc.); Geography (Africa, Germany, Asia, Oceans, etc.); and Science (Astronomy, Meteorology, Optics, etc.). Within these secondary divisions are associated descriptors that provide further avenues for searching. For example, in Architecture, one can find descriptors of abbey, architect, non-specific architecture, baptistry, trilobed arches, and flying buttresses. (Note: all of the descriptors are in French, even when you are using the English version. In future updates, it would be helpful to make these available in English and other languages.) Searching by using iconography terms is simple. You can either make your way through the different lists or use the toolbar at the top of the page. When searching for words...