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Introduction: This article describes the impact of a simulation-based learning method on emergency nurses at the Royal Devon Hospital (Exeter, United Kingdom)., Objectives: To determine the training needs of nurses who were recently hired, as well as to evaluate the perception on the acquisition of emergency nurse competencies after the educational intervention., Method: The study was composed of 3 phases., First Phase: The training needs were analysed from the point of view of the participants (through a focus group), and the institution (by consulting experts through an online questionnaire)., Second Phase: Various simulations were implemented and designed by the participants themselves according to their needs, using the Self-Learning Methodology in Simulated Environments (MAES©)., Third Phase: The results of the education program were evaluated., Results: Many categories were obtained that served to determine the training needs of the participants, and to design various self-directed simulation scenarios. Three simulation scenarios were performed and afterwards discussed., Conclusion: The experience was positively evaluated by the participants. The participants believed that the MAES© method was adequate, given that at all times, they were the protagonists of their own learning according to their training needs, and considering their previous knowledge., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

The macrobenthic community was compared at four sites characterized by varying degrees of freshwater input, organic enrichment and confinement in the Cabras lagoon (Sardinia, Italy). Three sites, riverine (C1), confined (C2) and seaward (C3), were studied on two dates of summer 2010 and on two dates of winter 2011. A fourth site (C12), representative of the central sector of the Cabras lagoon, was included in this study using the extensive historical datasets at our disposal from previously published work. We aimed to test the hypothesis that (1) the benthos is distributed according to the recently proposed concept of habitat saprobity for coastal lagoons that unifies the Pearson-Rosenberg (sensu organic enrichment) and Guélorget-Perthuisot (sensu confinement) models, and (2) indicator species of different saprobic levels can be identified among dominant species occurring along the saprobity gradient. Salinity was also considered as an additional agent of selection in brackish environments. Irrespective of significant seasonal changes within each site, our results highlighted major environmental and biotic differences between sites. At the northward riverine site (C1), most affected by freshwater input and with limited organic matter (OM) enrichment, Corophium orientale was the single dominant species. The most confined site (C2) was characterized by the highest levels of sedimentary OM and benthic Chlorophyll-a and by mesohaline conditions; the site was inhabited mainly by the halolimnobic Hediste diversicolor and Hydrobia spp. Site C12, characterized by a high OM load and high residence time, was dominated by the opportunistic detritivorous Alitta succinea and Polydora ciliata. At the southernmost seaward site (C3) the considerable seawater renewal, resulting in high salinity (only in summer) and limited OM load, favored a much more diverse macrobenthic assemblage, essentially composed of both marine species, such as Corophium insidiosum, Gammarus aequicauda, and brackish-water species, such as Lekanesphaera hookeri and Idotea chelipes. We conclude that the biotic and abiotic characteristics of the Cabras lagoon can be represented by a succession of spatial zones along two main gradients determined by salinity and saprobity. The salinity gradient proved to be the main structural feature in the oligohaline pole, while in the range of variable salinity, saprobity appeared to be the main selection factor. To illustrate our findings, we provide a graphical representation summarizing the changes in environmental parameters and indicator species along the salinity and saprobity gradients., (Copyright © 2014 Elsevier Ltd. All rights reserved.)

Macrozoobenthic assemblages and stable carbon (delta(13)C) and nitrogen (delta(15)N) isotope values of various primary producers (macroalgae and angiosperms) and consumers (macroinvertebrate filter/suspension feeders, deposit feeders, detritivores/omnivores and carnivores and fishes) were studied in the Santa Giusta lagoon (Sardinia, Italy) before (spring) and after (autumn) a dystrophic event which occurred in the summer of 2004. A few days after the dystrophy, the physico-chemical characteristics of sediments and macrozoobenthic assemblages were also investigated. In the latter occasion, high total organic carbon (3.9%) and organic matter (15.9%) contents of surface sediments went together with peaks in acid-volatile sulphide concentrations. Certain immediate effects were quite extreme, such as the drastic reduction in macrozoobenthos and the massive fish kill in August 2004. Among the macrozoobenthos, there were few individuals of chironomid larvae and Capitella cf. capitata left. However, by October, chironomid larvae were numerous, indicating a lack of predators (e.g. fish) and competitors. In addition, some bivalve species and polychaetes which were absent, or present in small numbers before the event, became relatively numerous. The results are discussed based on a knowledge of the sulphide tolerance of these species. Stable isotope analysis clearly showed that the basal level of the food web for most consumers consisted mainly of macroalgae and sedimentary organic matter, and that the values before and after the dystrophic event were not significantly different from one another. This indicates that the relations among different trophic levels were quickly restored following the dystrophic event.

We studied the spatial variability and within-year temporal changes in hydrological features, grain size composition and chemical characteristics of sediments, as well as macrofaunal assemblages, along a heavily modified inlet in the Gulf of Oristano (western Sardinia, Italy). The inlet connects the Cabras lagoon to the gulf through a series of convoluted creeks and man-made structures, including a dam and fish barriers built in the last three decades. Sediments were muddy and mainly composed of the "non-sortable" fraction (i.e., <8 microm particle size) in all four areas investigated: Lagoon, Creeks, Channel and Seaward. Along the inlet, however, the ratio between the <8 microm and the 8-64 microm fractions was highest in Creeks and Channel, between the fish barriers and the dam, suggesting impaired hydrodynamics. Consistently, steep gradients in water salinity, temperature and dissolved oxygen concentrations were found in proximity to the fish barriers. The whole inlet was characterized by a major organic enrichment of sediments, with up to an annual mean of 33.6% of organic matter and 11.7% of total organic carbon in Seaward due to the presence of seagrass leaf litter. Acid-volatile sulphide and chromium-reduced sulphur concentrations were highest throughout the year in Seaward and Lagoon, respectively, with a peak in summer. Consistently, the whole inlet supported low structured macrofaunal assemblages dominated by few opportunist species, with a relatively lower diversity in Lagoon throughout the year and the highest abundances in Seaward in summer. We infer that the presence of artificial structures along the inlet, such as fish barriers and the dam, impair the lagoon-gulf hydrodynamics, sediment exchange and animal recruitment and colonization. We suggest that the removal of these structures would favour water renewal in the Cabras lagoon, but would also increase the outflow of organic C-bonding fine particles into the gulf with serious consequences for Posidonia oceanica and Cymodocea nodosa seagrass meadows. We conclude that all possible consequences of such initiatives should be carefully considered before any action is taken.

It is not clear whether the ophthalmopathy present in Graves' disease is related to autoimmune reactions to common thyroid/orbit components or is due to specific ocular antigens unrelated to the thyroid. In Graves' disease, serum antibodies to the thyrotropin receptor (TSH-R) can stimulate thyroid function, but no link between the TSH-R and ocular tissues has been found. We have shown, by polymerase chain reaction amplification of specific cDNA, that mature TSH-R mRNA is expressed in the retro-orbital tissue of both healthy subjects and patients with Graves' disease. Of other tissues and cells tested (fibroblasts, lymphocytes, muscle, and thyroid), only thyroid tissue expressed the TSH-R mRNA.

FRTL-5 rat thyroid cells were either surface-labeled with 125I or biosynthetically labeled with [3H]N-acetylglucosamine, solubilized by lithium diiodosalicylate and immunoprecipitated after sequential exposure to bovine thyrotropin and anti-bovine thyrotropin. Autoradiography of polyacrylamide gels run under denaturing conditions and in the presence of a reducing agent revealed two prominent bands with approximate molecular weights of 66-70 kDa and 47 kDa. Immunoprecipitation of the same radiolabeled and solubilized membrane preparations with a Graves' disease IgG having thyroid stimulating but no thyrotropin-binding inhibiting activity revealed only one major band, migrating near the 47 kDa component reactive with thyrotropin. No bands were immunoprecipitated in control incubations using normal human IgG or substituting radiolabeled, solubilized membranes from a rat thyroid cell line with no thyrotropin receptor activity. Thin layer chromatography of Folch extracts of the [3H]-N-acetylglucosamine-labeled immunoprecipitates obtained by either procedure indicated that a specific thyroid ganglioside was coprecipitated with the immunoprecipitated proteins in both cases.

The presence of thyroid stimulating antibodies (TSAb) in patients with Graves' disease is well established. Considerable evidence has accumulated that these are antibodies to thyroid plasma membrane components related to the TSH receptor. The question of whether thyroid stimulation is mediated by a direct interaction with the TSH binding site is still debated. Recent data obtained by the use of monoclonal antibodies to the TSH receptor are consistent with the view that Graves' immunoglobulins comprise antibodies to at least two different components of the TSH receptor complex, one of which is more strictly related to the binding of TSH and the other to the transmission of the hormonal effect. The causative role of TSAb in the hyperthyroidism of Graves' disease is widely recognized. The use of human specific stimulation assays has circumvented the objection of the relatively low frequency of LATS-positive patients. Individual variations in the thyroid response may account for the lack of correlation between levels of thyroid stimulating immunoglobulins and most parameters of thyroid function. In this respect, the interference of non-stimulatory thyroid antibody and of other autoimmune mechanisms may be of importance. An important clinical implication of TSAb and TSH-binding inhibiting antibody determinations is their prognostic value in predicting the relapse of hyperthyroidism in treated patients. This clinical application has been so far limited by the technical difficulty of the assays. This emphasizes the need for a simple and reliable test, which can be used for routine measurements of TSAb.