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Establishing point of care ultrasound in undergraduate medical education and postgraduate paediatric critical care medicine
No full textPoint-of-care ultrasound (POCUS) is a rapidly evolving bedside imaging modality that enhances clinical decision-making, facilitates procedural guidance, and improves patient safety. This thesis explores the establishment of POCUS in both undergraduate medical education and postgraduate paediatric critical care, outlining its pedagogical and clinical integration.In the undergraduate medical curriculum, early exposure to POCUS aids students in developing anatomical and physiological understanding, hand-eye coordination, and image interpretation skills. The research presented evaluates the effectiveness of ultrasound as a teaching and assessment tool, comparing it to traditional methods such as cadaveric prosections. The findings highlight the benefits of POCUS in enhancing anatomical comprehension and clinical application.In postgraduate paediatric critical care, the thesis demonstrates the utility of POCUS in acute paediatric medicine, particularly in respiratory and cardiovascular assessment. Evidence is provided on the incorporation of POCUS into paediatric resuscitation guidelines and its role in the management of paediatric shock, respiratory failure, and procedural safety. Additionally, the research details the development of the Children’s Acute Ultrasound (CACTUS) course, a national paediatric POCUS curriculum designed to standardize training, accreditation, and governance. Challenges to implementation, including training barriers, governance issues, and the need for faculty development, are also explored. The research contributes to policy and practice by providing a structured pathway for POCUS integration at multiple levels of medical education.This body of work establishes a foundation for future research in paediatric POCUS, advocating for continued curriculum development, assessment standardisation, and widespread adoption of ultrasound in medical education and paediatric critical care.+++Parts of this work have been published as:-• Griksaitis MJ, Sawdon MA, Finn GM. Ultrasound and Cadaveric Prosections as Methods for Teaching Cardiac Anatomy: A Comparative Study. Anat Sci Educ Jan 2012; 5:20-26• Finn GM, Sawdon MA, Griksaitis MJ. The additive effect of teaching undergraduate cardiac anatomy using cadavers and ultrasound echocardiography. Eur J Anat Sept 2012;16(3):199-205• Griksaitis MJ, Scott MP, Finn GM. Twelve tips for teaching with ultrasound in the undergraduate curriculum. Med Teach Jan 2014;36(1):19-24• Griksaitis MJ, Scott MP, Finn GM. Comment on letter by Nicholls et al.--Ultrasound: a hands-on and kinaesthetic approach to anatomy education. Med Teach. 2014 Jul;36(7):644.• Potter SK, Griksaitis MJ. The role of point of care ultrasound in pediatric acute respiratory distress syndrome: emerging evidence for its use. Ann Transl Med. 2019 Oct;7(19):507• Edelman J, Taylor H, Goss AM, Tisovszky N, Sun KM, O'Toole S, Herriotts K, Inglis E, Johnson C, Penfold S, Bull J, Shires P, Towers A, Griksaitis MJ. Point-of-care ultrasound as a diagnostic tool in respiratory assessment in awake paediatric patients: a comparative study. Arch Dis Child. 2024 Mar 19;109(4):287-291.• Walden A, Smallwood N, Dachsel M, Miller A, Stephens J, Griksaitis M. Thoracic ultrasound: it's not all about the pleura. BMJ Open Respir Res. 2018 Oct 1;5(1):e000354.• Ord HL, Griksaitis MJ. Fifteen-minute consultation: Using point of care ultrasound to assess children with respiratory failure. Arch Dis Child Educ Pract Ed. 2019 Feb;104(1):2-10.• Hardwick JA, Griksaitis MJ. Fifteen-minute consultation: Point of care ultrasound in the management of paediatric shock. Arch Dis Child Educ Pract Ed. 2021 Jun;106(3):136-141.• Job S, Griksaitis MJ, Singh Y (Editors: Singh Y, Tissot C, Fraga MV, Conlon T) Chapter 17: Role of Point of Care Ultrasound in Transport Setting for Evaluating Infants & Children with Shock (within Point of Care Ultrasound for the Neonatal & Pediatric Intensivist: A Practical Guide on the Use of POCUS) Sept 2023; 1st Ed. Springer, ISBN 9783031265372• Griksaitis MJ, Zoica B. (Editor: Stephanie Smith) Appendix I: Point of Care Ultrasound in Paediatric Resuscitation. Within Advanced Paediatric Life Support (APLS) 7th Ed. Aug 2023, Wiley Blackwell Publishers, ISBN 9781119716136• Griksaitis MJ, Zoica B, Raffaj D, Stephens J, Sarfatti A, Rajagopal V, Hargadon-Lowe A, Green J, Shires P, Skevington-Postles L, Davies P; Children’s ACuTe UltraSound (CACTUS) group. Development of the Children's ACuTe UltraSound (CACTUS) point-of-care ultrasound (POCUS)-accredited training in the UK: a descriptive study. Arch Dis Child. 2024 Jun 19;109(7):543-549.• Morea CG, Beaves C, Shires P, Hargadon-Lowe A, Ross O, Griksaitis MJ. Current provision of point of care ultrasound in UK paediatric critical care: an online survey. Arch Dis Child. 2025 Feb [E-pub ahead of print 10.1136/archdischild-2024-327934
“There is no reason for the necessity of the ultimate principles of deduction.” Margaret Macdonald on logical necessity
No full textThis paper aims at contributing to the recent enterprise of rediscovering Margaret Macdonald’s views, by focusing on her reflections on the necessity of logic, a theme that runs through many of her papers and reviews. We will see both Macdonald’s negative views about what the necessity of logic is not (§1), and her positive view about what it is and how it supports her claim that it is in fact irrational to ask for a reason for the necessity of the ultimate principles of deduction, such as the Principle of Contradiction (§2). To show how her view on the necessity of logic is different from others, such as David Lewis’s, we will then consider what she would reply to current rejectors of the Principle of Contradiction (§3)
When confidence in institutions backfires: Power-distance orientation moderates the relationship between institutional trust and civic honesty across eight countries.
No full textConfidence in institutions is a key predictor of civic honesty, yet evidence shows that this relationship varies across contexts and individuals. This study examined whether power-distance orientation (PDO)—the extent to which individuals accept hierarchical power relations—moderates this association. High-PDO individuals tend to view institutional authorities as entitled to privilege,inclined to engage in patronage relationships and potentially corrupt. We hypothesised that for individuals high in PDO, confidence in institutions could backfire and be linked to the rejection of civic honesty. Using data from 2088 participants across eight countries, we found support for this hypothesis. Specifically, the positive link between institutional confidence and civichonesty was reversed among those who strongly endorse PDO. These findings suggest that individual-level variation in the link between confidence in institutions and civic honesty partly reflects broader beliefs about authorities. We discuss implications of this interaction and outline directions for future research
Zero-truncated modelling in a meta-analysis on suicide data after bariatric surgery
No full textMeta-analysis is a well-established method for integrating results from several independent studies to estimate a common quantity of interest. However, meta-analysis is prone to selection bias, notably when particular studies are systematically excluded. This can lead to bias in estimating the quantity of interest. Motivated by a meta-analysis to estimate the rate of completed-suicide after bariatric surgery, where studies which reported no suicides were excluded, a novel zero-truncated count modeling approach was developed. This approach addresses heterogeneity, both observed and unobserved, through covariate and overdispersion modeling, respectively. Additionally, through the Horvitz-Thompson estimator, an approach is developed to estimate the number of excluded studies, a quantity of potential interest for researchers. Uncertainty quantification for both estimation of suicide rates and number of excluded studies is achieved through a parametric bootstrapping approach
Machine learning methods for exploring beyond standard model parameters
No full textPhysics aims to describe natural phenomena through the construction of theoretical models that capture essential system behaviours, with predictions tested against observations. In particle physics, the Standard Model (SM) has been a monumental success but remains incomplete, leaving unresolved challenges such as explaining neutrino masses, dark matter, the hierarchy problem, and gravity. Moreover, recent experimental anomalies, including results from scalar searches, hint at new physics and motivate the exploration of Beyond the SM (BSM) scenarios.However, performing phenomenological studies in BSM models poses two major challenges. First, the number of possible models is immense. Second, within a single model, the parameter space is characterised by high dimensionality, sparsity of feasible configurations, and the computational cost of numerical evaluations, necessitating advanced parameter scan algorithms.This thesis introduces a new formulation for parameter scan algorithms based on an active search methodology. This approach leverages Machine Learning (ML) modelling and sequential decision-making techniques, borrowing concepts from Bayesian Optimisation. A new, sample-efficient parameter scan algorithm, called b-CASTOR, is proposed. Additionally, a Python library named \hepaid\ is presented, designed for the easy use, integration, and development of parameter scan algorithms in phenomenological studies. Finally, a Reinforcement Learning formulation for parameter space scans is reviewed. While this approach yielded negative results, the insights and limitations derived from the project are discussed.This thesis aims to advance the development of ML-based parameter scan algorithms, addressing computational challenges and laying the foundations for a systematic exploration of BSM models
Entail
No full textEntail (2025) is a composition of spoken word and piano created and performed by Will May (words) and Benjamin Oliver (music). The work pays tribute to Philip Hoare's writing on whales and the ocean, and is comprised of text taken from Hoare’s Leviathan, or The Whale
Operando X-ray studies of gas evolving and consuming catalysts
No full textThe inherent intermittency of renewable energy production is one of the major challenges facing a future powered by renewable sources. Electrolysers are a potential solution to buffer this intermittency through production of green hydrogen. The electrochemical conversion of carbon dioxide (CO2) to useful chemicals and fuels is another a promising route toward the achievement of carbon neutral and carbon negative energy technologies. Fully understanding the catalytic and degradation mechanisms at current densities relevant for industrial application of these processes is therefore paramount for further catalyst improvement.In this work a novel in situ specto-electrochemical X-ray absorption cell is presented as a new setup for collecting XAS data of gas evolving and consuming electrocatalysts at high overpotentials. Utilising a thin, porous PTFE membrane coated in gold to act as a current collector, coupled with efficient gas and electrolyte circulation loops, interference from bubble formation is minimised. The ability of the cell in characterising gas evolution / consumption reactions is demonstrated in the study of three reactions, the oxygen reduction reaction, oxygen evolution reaction and carbon dioxide reduction reaction. A detailed XAS investigation of highly dispersed platinum during the oxygen reduction reaction is presented, along with comparative data in nitrogen. These measurements show the preservation of oxygen on the surface of the platinum nanoparticles below the platinum oxide reduction peak (0.48 VRHE). A range of highly active iridium oxides were investigated for the oxygen evolution reaction. Hydrated and rutile type iridium oxide XAS spectra were measured potentiodynamically, and it is found that a plateau region occurs in the oxidation states of hydrated iridium oxide at characteristic potentials for each material. This plateau region is attributed to the formation of a low conductivity Ir3+ species, the formation of which is also found in iridium oxides prepared by Adams Fusion method and demonstrates the structural variations in the materials that lead to their high activity. Finally, oxide derived copper is investigated for the CO2 reduction reaction during reduction / re-oxidation cycles and various oxides of copper are formed which are reduced immediately upon CO2 reduction
Scaffolding by teaching assistants in England: exploring the interaction between practice and task structure
No full textInternationally, teaching assistants (TA) support children with special needs and/or disabilities as they complete classroom tasks; meanwhile, teachers manage whole-class instruction. Given the limited training for TAs, Bosanquet et al. (2020) developed an influential framework promoting TA effectiveness. Their ‘scaffolding framework’ encourages TAs to provide minor support, such as prompting, while children complete tasks. Accordingly, children retain independence, maximising thinking and learning. This study examined how different task structures, including open tasks, influence the strategies TAs use. Two focus groups were conducted with four TAs working in an English primary school. Through facilitated discussion, participants reviewed the scaffolding framework, and commented on videos showcasing the practices of another primary-school TA across open and closed tasks. Data were largely coded using the categories of the scaffolding framework. The findings reveal that TA support, such as prompting, is recommendable across tasks. In open-task settings, TAs could also utilise more nuanced assistance, notably ‘what else’ questions. These encourage children to further elaborate on their ideas, leveraging the undetermined nature of open-task responses. Such scaffolding opportunities are more limited in closed tasks, which require precise answers. Moreover, the findings illustrate that effective TA practice stems from open-ended or closed tasks well-suited to children’s capabilities
Influenza-induced microRNA-155 expression is altered in extracellular vesicles derived from the COPD epithelium
No full textBackground: influenza virus particularly affects those with chronic lung conditions such as Chronic Obstructive Pulmonary Disease (COPD). Airway epithelial cells are the first line of defence and primary target of influenza infection and release extracellular vesicles (EVs). EVs can transfer of biological molecules such as microRNAs (miRNAs) that can modulate the immune response to viruses through control of the innate and adaptive immune systems. The aim of this work was to profile the EV miRNAs released from bronchial epithelial cells in response to influenza infection and discover if EV miRNA expression was altered in COPD. Methods: influenza infection of air-liquid interface (ALI) differentiated BCi-NS1.1 epithelial cells were characterised by analysing the expression of antiviral genes, cell barrier permeability and cell death. EVs were isolated by filtration and size exclusion chromatography from the apical surface wash of ALI cultured bronchial epithelial cells. The EV miRNA cargo was sequenced and reads mapped to miRBase. The BCi sequencing results were further investigated by RT-qPCR and by using healthy and COPD primary epithelial cells.Results: infection of ALI cultured BCi cells with IAV at 3.6 x 106 IU/ml for 24 h led to significant upregulation of anti-viral genes without high levels of cell death. EV release from ALI-cultured BCi cells was confirmed using electron microscopy and detection of known tetraspanin EV markers using western blot and the ExoView R100 platform. Differential expression analyses identified 5 miRNA that had a fold change of >0.6: miR-155-5p, miR-122-5p, miR-378a-3p, miR-7-5p and miR-146a-5p (FDR<0.05). Differences between EV, non-EV and cellular levels of these miRNA were detected. Primary epithelial cell release of EV and their miRNA cargo was similar to that observed for BCi. Intriguingly, miR155 expression was decreased in EVs derived from COPD patients compared to EVs from control samples.Conclusion: epithelial EV miRNA release may be a key mechanism in modulating the response to IAV in the lungs. Furthermore, changes in EV miRNA expression may play a dysfunctional role in influenza-induced exacerbations of COPD. However, further work to fully characterise the function of EV miRNA in response to IAV in both health and COPD is required. <br/
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