Lockdown labs: Pivoting to remote learning in forensic science higher education.

Forensic Science training and education is reliant on the application of knowledge to casework scenarios and the development of key practical skills that provide a platform for career development in the field. The COVID-19 pandemic introduced a number of challenges to effectively deliver practical content online and remotely, whilst still meeting intended learning outcomes, accreditation requirements, and attaining a high level of student engagement and experience. The MSc Forensic Science programme featured in this study is a one-year degree programme with a strong emphasis on the practical elements of forensic science, and a diverse international student cohort. Therefore, the restrictions associated with the pandemic made it very difficult not only to plan the delivery of material but also to adapt the content itself for effective online and remote learning. By focusing on the intended learning outcomes, a number of innovative teaching practices were developed to successfully transition from face-to-face teaching to online and remote delivery. A range of online and practical resources were developed, including a laboratory home kit, demonstration videos, online practical technique simulations (produced by Learning Science), data analysis tasks, and interactive workshops and activities, all designed to consolidate student learning and build confidence, in preparation for such a time that on campus practical teaching could resume. The initial feedback received from these activities from both staff and students was extremely positive and the transition from classroom to online teaching was a success, as reflected in student attainment and later student feedback. Students reported that they had a better understanding of what was expected of them, including knowledge of protocols and techniques, and felt much more confident moving into the next stage of their learning development. Even though the practical laboratory sessions were the most significantly affected by the restrictions associated with the pandemic, and resulted in reduced interaction for the students, this was counteracted by virtual sessions and workshops, which gave students the opportunity to engage with each other and communicate their thoughts and opinions, ultimately building key presentation and group working skills. This case study will detail the pivot to remote learning, as well as critically evaluating the feedback from students and discussing the changes that are likely to be retained as longer-term teaching practices, versus those that were a necessary temporary addition or adjustment in response to the pandemic.

Primary hyperparathyroidism in adults-(Part II) surgical management and postoperative follow-up: Position statement of the Endocrine Society of Australia, The Australian & New Zealand Endocrine Surgeons, and The Australian & New Zealand Bone and Mineral Society.

OBJECTIVE: To develop evidence-based recommendations to guide the surgical management and postoperative follow-up of adults with primary hyperparathyroidism. METHODS: Representatives from relevant Australian and New Zealand Societies used a systematic approach for adaptation of guidelines (ADAPTE) to derive an evidence-informed position statement addressing eight key questions. RESULTS: Diagnostic imaging does not determine suitability for surgery but can guide the planning of surgery in suitable candidates. First-line imaging includes ultrasound and either parathyroid 4DCT or scintigraphy, depending on local availability and expertise. Minimally invasive parathyroidectomy is appropriate in most patients with concordant imaging. Bilateral neck exploration should be considered in those with discordant/negative imaging findings, multi-gland disease and genetic/familial risk factors. Parathyroid surgery, especially re-operative surgery, has better outcomes in the hands of higher volume surgeons. Neuromonitoring is generally not required for initial surgery but should be considered for re-operative surgery. Following parathyroidectomy, calcium and parathyroid hormone levels should be re-checked in the first 24 h and repeated early if there are risk factors for hypocalcaemia. Eucalcaemia at 6 months is consistent with surgical cure; parathyroid hormone levels do not need to be re-checked in the absence of other clinical indications. Longer-term surveillance of skeletal health is recommended. CONCLUSIONS: This position statement provides up-to-date guidance on evidence-based best practice surgical and postoperative management of adults with primary hyperparathyroidism.

Fetal dural sinus malformation: A case report and discussion of the literature.

INTRODUCTION: Fetal dural sinus malformation is a rare but important finding during pregnancy as it has the potential for significant complications. METHODS: Here we present a case of fetal dural sinus malformation and review the current literature relevant to this condition. RESULTS: We present the case of a 33-year-old woman who had fetal dural sinus malformation containing thrombus diagnosed at morphology ultrasound and confirmed on fetal magnetic resonance imaging (MRI). Serial ultrasounds demonstrated the sinus to reduce significantly in size over the course of the pregnancy. The woman delivered a healthy, term baby and there was no evidence of any neurological compromise in the early neonatal period. DISCUSSION: This case is in keeping with a recent systematic review, which identified 78 previous cases of fetal dural sinus thrombosis and reported good outcomes in most cases. CONCLUSION: It therefore appears reasonable, in most cases of isolated dural sinus malformation, to monitor the progress of the lesion and continue managing the pregnancy as usual.

Primary hyperparathyroidism in adults-(Part I) assessment and medical management: Position statement of the endocrine society of Australia, the Australian & New Zealand endocrine surgeons, and the Australian & New Zealand bone and mineral society.

OBJECTIVE: To formulate clinical consensus recommendations on the presentation, assessment, and management of primary hyperparathyroidism (PHPT) in adults. METHODS: Representatives from relevant Australian and New Zealand Societies used a systematic approach for adaptation of guidelines (ADAPTE) to derive an evidence-informed position statement addressing nine key questions. RESULTS: PHPT is a biochemical diagnosis. Serum calcium should be measured in patients with suggestive symptoms, reduced bone mineral density or minimal trauma fractures, and in those with renal stones. Other indications are detailed in the manuscript. In patients with hypercalcaemia, intact parathyroid hormone, 25-hydroxy vitamin D, phosphate, and renal function should be measured. In established PHPT, assessment of bone mineral density, vertebral fractures, urinary tract calculi/nephrocalcinosis and quantification of urinary calcium excretion is warranted. Parathyroidectomy is the only definitive treatment and is warranted for all symptomatic patients and should be considered for asymptomatic patients without contraindications to surgery and with >10 years life expectancy. In patients who do not undergo surgery, we recommend annual evaluation for disease progression. Where the diagnosis is not clear or the risk-benefit ratio is not obvious, multidisciplinary discussion and formulation of a consensus management plan is appropriate. Genetic testing for familial hyperparathyroidism is recommended in selected patients. CONCLUSIONS: These clinical consensus recommendations were developed to provide clinicians with contemporary guidance on the assessment and management of PHPT in adults. It is anticipated that improved health outcomes for individuals and the population will be achieved at a decreased cost to the community.

Two uterine scars and a vaginal birth.

Uterine scarring increases the risk of uterine rupture during labour, which can result in significant maternal and fetal morbidity and mortality. There is insufficient evidence for a clear recommendation on the safety of vaginal delivery in the context of a patient with both a uterine perforation and a previous lower uterine segment caesarean section. We present the case of a woman with a history of one previous caesarean section and uterine perforation with a uterine manipulator, who subsequently had an uncomplicated normal vaginal delivery.

Sapogenol is a Major Microbial Metabolite in Human Plasma Associated with High Protein Soy-Based Diets: The Relevance for Functional Food Formulations.

Legumes are a source of health-promoting macro- and micronutrients, but also contain numerous phytochemicals with useful biological activities, an example of which are saponins. Epidemiological studies suggest that saponins may play a role in protection from cancer and benefit human health by lowering cholesterol. Therefore, they could represent good candidates for specialised functional foods. Following the consumption of a soya-rich high-protein weight-loss diet (SOYA HP WL), the concentrations of Soyasaponin I (SSI) and soyasapogenol B (SSB) were determined in faecal samples from human volunteers (n = 10) and found to be between 1.4 and 17.5 mg per 100 g fresh faecal sample. SSB was the major metabolite identified in volunteers' plasma (n = 10) after consumption of the soya test meal (SOYA MEAL); the postprandial (3 h after meal) plasma concentration for SSB varied between 48.5 ng/mL to 103.2 ng/mL. The metabolism of SSI by the gut microbiota (in vitro) was also confirmed. This study shows that the main systemic metabolites of soyasaponin are absorbed from the gut and that they are bioavailable in plasma predominantly as conjugates of sapogenol. The metabolism and bioavailability of biologically active molecules represent key information necessary for the efficient development of functional foods.

Four-dimensional computed tomography for parathyroid localization: a new imaging modality.

INTRODUCTION: Four-dimensional computed tomography (4DCT) is a new parathyroid localization technique not previously reported in Australia. It provides both functional and anatomical imaging in a single test, with superior sensitivity compared with sestamibi scintigraphy (SeS). This study examines the utility of 4DCT in defined clinical situations. METHODS: This is a retrospective cohort study in a tertiary referral hospital setting. One hundred consecutive operative cases of primary hyperparathyroidism (99 patients) undergoing both preoperative 4DCT and SeS. Localization studies were correlated with operative findings, histopathology and clinical outcomes. The utility of 4DCT was analysed in three common clinical settings: primary cases with positive SeS (Group A, n = 68), primary cases with negative SeS (Group B, n = 21) and re-operative cases (Group C, n = 11). RESULTS: The overall sensitivity of 4DCT was 92% compared with 70% for SeS. The sensitivity of 4DCT was superior to SeS in Groups B and C (76% versus 0% and 91% versus 46%, respectively). The overall cure rate was 98%, with 94% of cases completed as minimally invasive procedures. Up to 62% of Group B cases potentially avoided a bilateral neck exploration owing to a positive 4DCT. CONCLUSIONS: 4DCT is an accurate technique providing both functional and anatomical localization of abnormal parathyroid glands. However, the advantage of speed and simplicity in image acquisition needs to be balanced against the small risk of increased radiation exposure in the younger patient group.

High-bolus dose tirofiban compared with abciximab in primary percutaneous coronary intervention: a propensity score-matched outcome study.

AIMS: The objective of this study was to analyse the outcomes of patients treated with high-bolus dose (HBD) tirofiban compared with abciximab at the time of primary PCI (PPCI) for ST-elevation myocardial infarction (STEMI). METHODS AND RESULTS: Data from two large UK tertiary centres, with differing protocols for glycoprotein IIb/IIIa inhibitor use during PPCI, were pooled. Propensity scores were calculated based on important covariates, and HBD tirofiban-treated patients were matched to abciximab-treated controls on a one-to-one basis. This resulted in 942 well matched pairs. Survival analysis demonstrated no significant difference in mortality between HBD tirofiban and abciximab either at 30 days (HBD tirofiban 3.7% vs. abciximab 3.2%; HR 1.01 [95% CI: 0.92-1.10], p=0.96) or at three years (HBD tirofiban 9.4% vs. abciximab 9.3%; HR 1.15 [95% CI: 0.79-1.67], p=0.45). Rates of stent thrombosis at 30 days were also similar (HBD tirofiban 12 [1.3%] vs. abciximab 8 [0.8%], p=0.50) but thrombocytopaenia was more common with abciximab (HBD tirofiban 3 [0.3%] vs. abciximab 17 [1.8%], p=0.001). CONCLUSIONS: In this observational study of adjunctive GP IIb/IIIa inhibitor treatment in PPCI, we found no difference in survival between HBD tirofiban-treated patients compared with propensity score-matched abciximab-treated controls up to three-year follow-up.

A putative serine protease, SpSsp1, from Saprolegnia parasitica is recognised by sera of rainbow trout, Oncorhynchus mykiss.

Saprolegniosis, the disease caused by Saprolegnia sp., results in considerable economic losses in aquaculture. Current control methods are inadequate, as they are either largely ineffective or present environmental and fish health concerns. Vaccination of fish presents an attractive alternative to these control methods. Therefore we set out to identify suitable antigens that could help generate a fish vaccine against Saprolegnia parasitica. Unexpectedly, antibodies against S. parasitica were found in serum from healthy rainbow trout, Oncorhynchus mykiss. The antibodies detected a single band in secreted proteins that were run on a one-dimensional SDS-polyacrylamide gel, which corresponded to two protein spots on a two-dimensional gel. The proteins were analysed by liquid chromatography tandem mass spectrometry. Mascot and bioinformatic analysis resulted in the identification of a single secreted protein, SpSsp1, of 481 amino acid residues, containing a subtilisin domain. Expression analysis demonstrated that SpSsp1 is highly expressed in all tested mycelial stages of S. parasitica. Investigation of other non-infected trout from several fish farms in the United Kingdom showed similar activity in their sera towards SpSsp1. Several fish that had no visible saprolegniosis showed an antibody response towards SpSsp1 suggesting that SpSsp1 might be a useful candidate for future vaccination trial experiments.

Distinctive expansion of potential virulence genes in the genome of the oomycete fish pathogen Saprolegnia parasitica.

Oomycetes in the class Saprolegniomycetidae of the Eukaryotic kingdom Stramenopila have evolved as severe pathogens of amphibians, crustaceans, fish and insects, resulting in major losses in aquaculture and damage to aquatic ecosystems. We have sequenced the 63 Mb genome of the fresh water fish pathogen, Saprolegnia parasitica. Approximately 1/3 of the assembled genome exhibits loss of heterozygosity, indicating an efficient mechanism for revealing new variation. Comparison of S. parasitica with plant pathogenic oomycetes suggests that during evolution the host cellular environment has driven distinct patterns of gene expansion and loss in the genomes of plant and animal pathogens. S. parasitica possesses one of the largest repertoires of proteases (270) among eukaryotes that are deployed in waves at different points during infection as determined from RNA-Seq data. In contrast, despite being capable of living saprotrophically, parasitism has led to loss of inorganic nitrogen and sulfur assimilation pathways, strikingly similar to losses in obligate plant pathogenic oomycetes and fungi. The large gene families that are hallmarks of plant pathogenic oomycetes such as Phytophthora appear to be lacking in S. parasitica, including those encoding RXLR effectors, Crinkler's, and Necrosis Inducing-Like Proteins (NLP). S. parasitica also has a very large kinome of 543 kinases, 10% of which is induced upon infection. Moreover, S. parasitica encodes several genes typical of animals or animal-pathogens and lacking from other oomycetes, including disintegrins and galactose-binding lectins, whose expression and evolutionary origins implicate horizontal gene transfer in the evolution of animal pathogenesis in S. parasitica.

Cerebral emboli and cognitive function after intramedullary fracture fixation.

INTRODUCTION: Cerebral emboli have been detected during intramedullary orthopaedic procedures. The quantity of emboli produced and their clinical effects are currently not known. This study aimed to quantify the intra-operative cerebral embolic load using transcranial Doppler ultrasound during the intramedullary stabilisation of femoral and tibial diaphyseal fractures. Clinical cognitive function was also assessed after surgery and any relationship to the cerebral embolic load determined. PATIENTS AND METHODS: Prospective cohort study of 20 patients with femoral or tibial diaphyseal fractures treated with reamed intramedullary nailing. The intra-operative cerebral embolic load was measured using transcranial Doppler ultrasound of the middle meningeal artery. Cognitive function was assessed 3 days after surgery using a range of validated neuropsychological tests. The cognitive results were compared to predicted scores matched for age and intelligence quotient as is the standard method of cognitive assessment after trauma. RESULTS: Four patients had detectable cerebral emboli with counts of only 2, 3, 3, and 9 respectively. A significantly poorer than predicted cognitive score occurred in immediate and delayed memory recall tests. However there was no significant difference in any cognitive function score between those patients who had detectable cerebral emboli and those who did not. DISCUSSION: Small numbers of cerebral emboli were detected during intramedullary stabilisation of lower limb long bone fractures but with no apparent cognitive effect. This poor correlation is similar to recent studies performed on arthroplasty patients and also conforms to the extensive cardiac surgery literature which would indicate that such low levels of systemic embolisation are unlikely to consistently produce cerebral clinical effects.

Are the best available clinical effectiveness data used in economic evaluations of drug therapies?

OBJECTIVES: Use of evidence on clinical effectiveness that is of poor quality or is biased in favour of the therapy under study is a concern in economic evaluations and may contribute to a mistrust of pharmacoeconomic studies. This study aimed to determine whether the authors of economic evaluations use the best available evidence for clinical effectiveness. METHODS: One hundred economic evaluations of drug therapies (published in 2001-2003) were sampled randomly from the National Health Service Economic Evaluation Database, and the source of clinical evidence was identified. For each therapy, alternative, high quality sources of clinical effectiveness data were sought by searching the Database of Abstracts of Reviews of Effects and Health Technology Assessment databases. The magnitude and direction of the effect size in the different sources of evidence were compared. RESULTS: Relevant systematic reviews were found for only 32 of the 100 economic evaluations in the sample. In three cases these reviews had been identified by the authors of the economic evaluations and two of these cases were used in the evaluation. Comparisons were possible in 21 cases. The clinical effects reported in all 21 comparisons were similar in direction but differed in magnitude. Compared to the systematic reviews, the authors of economic evaluations used evidence that was more favourable in five cases, less favourable in four cases, and similar in 12 cases. Six of the economic evaluations and corresponding systematic reviews did not present measures of effectiveness in a manner that allowed comparison. CONCLUSIONS: Authors of economic evaluations have not made sufficient use of the evidence available from systematic reviews of clinical effectiveness. The central role of economic evaluations in health policy makes it essential that improvements in economic methods are accompanied by a structured search for the highest quality information on clinical effectiveness.

Economic evaluation databases as an aid to healthcare decision makers and researchers.

Economic evaluation databases have been developed to assist in setting priorities and facilitating research within the healthcare sector. This paper presents an overview of the major databases of economic evaluations currently available (HEED, NHS EED, the CEA Registry, CODECS, PEDE, EURONHEED and JEED). It describes the key features of each database and the main user groups. It also presents evidence of the value of access to economic evaluation databases, particularly for the researchers and decision makers who form their main target audience. The research available shows that both decision makers and researchers find economic evaluation databases helpful as a source of information. However, database producers may also need to better understand the requirements of their users and consider adaptations to their products.

The usefulness of the NHS Economic Evaluation Database to researchers undertaking technology assessment reviews.

OBJECTIVES: Health-care technology reviews now increasingly include outcome costs as well as clinical effects. This study reports the findings and implications of a survey to explore the usefulness of the National Health Service Economic Evaluation Database (NHS EED) within this process. METHODS: Postal survey of lead authors of Technology Assessment Reviews (TARs) commissioned by the United Kingdom's National Institute for Clinical Excellence (NICE). The questionnaire investigated the usefulness of NHS EED in terms of (a) search strategy, (b) data extraction, (c) quality assessment, and (d) determining requirements for new modeling studies. Qualitative data were requested, including opinions regarding NHS EED. RESULTS: NHS EED was used in 90 percent of all identified reviews (n = 46). The questionnaire response rate was 63 percent. The percentage of scores 3 or above (most useful), 2 or below (least useful), or N/A were, respectively, (a) search strategy= 62 percent, 23 percent, 15 percent; (b) data extraction = 23 percent, 27 percent, 50 percent, (c) quality assessment= 38 percent, 19 percent, 42 percent; (d) determining requirements for new modeling studies = 27 percent, 23 percent, 50 percent. The results were expanded further in the qualitative data from the respondents. CONCLUSIONS: NHS EED is a useful tool for a variety of tasks in the NICE/TAR process but not, unsurprisingly, as a replacement for understanding primary studies. There is, however, a need to reduce the impact of time lags between the publication of economic evaluations and the appearance of abstracts relating to them on NHS EED. The results will inform future developments of the NHS EED database, which should increase its usefulness to researchers.

Implanon implant detection with ultrasound and magnetic resonance imaging.

OBJECTIVE: The objective of the present study was to determine the degree of difficulty in locating Implanon (Organon, Sydney, Australia) contraceptive rods which had been inserted suboptimally, using both ultrasound and magnetic resonance imaging (MRI). METHODS: Volunteers with correctly placed Implanon rods were recruited for normal scanning protocols. A phantom was used to display abnormal rod placements. Ultrasound imaging was carried out using a variety of transducers to demonstrate their suitability. An MRI scanning protocol was formulated to achieve required views in the shortest time. RESULTS: All Implanon rods were successfully imaged with both ultrasound and MRI. CONCLUSION: High resolution linear array transducers combined with the correct scanning protocol should enable visualisation of Implanon rods in almost all cases. The MRI imaging requires caution when differentiating blood vessels and fibrous septae from the Implanon rods.

Hip fracture rehabilitation -- a comparison of two centres.

The outcomes for 2005 consecutive patients aged 50 years or over admitted to two orthopaedic centres with a hip fracture were prospectively studied. All the patients were followed up to 1 year from injury. The mean orthopaedic ward stay was shorter in Edinburgh in comparison to Peterborough (20 versus 10 days), but the total hospital stay was shorter in Peterborough (34 versus 22 days). In Peterborough twice as many patients were discharged directly back from the orthopaedic ward to their place or origin (82 versus 41%). At 1 year from injury 34% of the patients had died. Factors associated with an increased mortality were increased age, male sex, pre-fracture place of residence and impaired mobility. For the survivors, the patients from Edinburgh had an increased mortality but were older, more likely to have impaired mobility and to come from more dependent residential accommodation. The different mortality between centres (30 versus 36%) was not statistically significant when adjusted for the possible confounding factors.