Background: Smartphones provide a diverse range of functions, including the ability to communicate rapidly, store information and consult online medical applications (apps). Whilst their use by doctors is popular, there is little data on their clinical use and application by surgical trainees. Aims: Here we assess smartphone ownership, usage in clinical environments, medical app download patterns, and knowledge of current app regulation by surgical trainees. Methods: An online questionnaire was distributed to all core and specialty NHS general surgical trainees working in Scotland. Results: Thirty three percent (76/233) of trainees responded. Ninety two percent owned a smartphone. Trainees used smartphones at work for email (96%), calls (85%), SMS/MMS (81%), Internet browsing (76%) and medical app access (55%). Eighty two percent of respondents had downloaded at least one app, including clinical guidelines (70%), medical calculators (59%), anatomy guides (50%) and study aids (32%). There was no statistical difference between demographics and smartphone use or app downloads. Thirty five percent had used apps to help make clinical decisions. Thirteen percent felt they had encountered erroneous outputs, according to their own judgement and/or calculation. Fifty eight percent felt apps should be compulsorily regulated however only one trainee could name a regulatory body. Conclusion: Smartphone possession amongst NHS surgical trainees is high. Knowledge of app regulation is poor, with potential safety concerns regarding inaccurate outputs. Integration of apps, developed and approved by an appropriate authority, may improve confidence when integrating them into training and healthcare delivery.

An inhibitor of procoagulant and fibrinolytic enzymes was derived from cabbage seeds by a procedure using acetone precipitation, ion-exchange chromatography, and gel filtration. The cabbage seed inhibitor was a 10- Kd monomeric protein with intrachain disulfide bonds. This preparation prevented clot formation in whole blood and blocked the ability of thrombin to induce clot formation in plasma and to induce platelet aggregation. A number of proteases were inhibited, as demonstrated by using purified enzymes in amidolytic assays. Tight-binding inhibition was observed for activated Stuart factor (factor Xa) and plasmin. Inhibition of thrombin and activated Hageman factor (factor XIIa) was observed with a molar excess of inhibitor. No inhibition was detected for activated plasma thromboplastin antecedent (factor XIa), plasma kallikrein, or C1 esterase. Reaction progress curves for trypsin indicated slow, tight-binding inhibition, with an apparent inhibition constant in the nanomolar range or less. The electrophoretic mobility of trypsin was altered by the inhibitor in nondenaturing polyacrylamide gel electrophoresis (PAGE) but not in sodium dodecyl sulfate (SDS)- PAGE, indicating noncovalent bonding. Only partial reversal of trypsin inhibition could be demonstrated by washing the inhibitor from enzyme immobilized on solid beads. A dot-blot technique with cabbage seed inhibitor was capable of detecting 10 ng nitrocellulose-bound trypsin. The dot-blot technique also appeared capable of detecting plasmin. These findings demonstrated the potential utility of this inhibitor as a probe for detection of tightly bound proteases. In summary, cabbage seed extracts contain an inhibitor with activity toward a broad range of proteases important to hemostasis. To our knowledge, this agent represents the first inhibitor isolated from a plant source that inhibits thrombin.