Developing the multi-professional clinical academic workforce in Australia and New Zealand: a scoping review

In Australia and New Zealand (ANZ), clinical academics are an important part of the workforce needed to deliver social and economic returns from health and medical research investment. This review aims to examine the extent and nature of the empirical evidence base addressing the development of the multi-professional clinical academic workforce in ANZ and to synthesise policy-relevant findings. The review adopts a scoping review design. Literature searches were undertaken in February 2019 in Medline (Ovid), Scopus, and CINAHL, with reference lists and websites also searched for additional literature. Papers eligible for inclusion were those published in English in 2000–2018 that reported results of empirical studies that addressed factors relating to developing the ANZ clinical academic workforce size, composition or role through building, enabling or sustaining its research functions. Results were reported narratively using a labour market policy framework. A total of 43 studies representing a diverse range of health professions and study designs were included in the review, only two of which reported on the New Zealand context. The majority were focused on building, supporting and sustaining research capacity and engagement among groups of clinicians within clinical settings. Use of three labour market policy levers to frame analysis enabled identification of issues relating to rural/urban workforce maldistribution, in addition to more widely reported clinical academic workforce production and retention issues. The literature addressing the development of the clinical academic health workforce in ANZ frames this workforce either as clinicians who routinely engage in research activity, or as a workforce cadre comprised of distinct, formalised research-related clinical roles. As such, developing the clinical academic workforce requires both: i) policy attention to the availability of research training opportunities for health professional students and graduates and of dedicated research-related career pathways; and ii) structures and processes that enable or inhibit research engagement among clinicians at a mid-career level

Towards a critical epidemiology approach for applied sexual health research

Critical approaches may benefit epidemiological studies of sexual health. This article proposes a critical approach, reconcilable with social epidemiological enquiry. Key aims of critical epidemiology for sexual health are identified, from which three criticisms of practice emerge: (1) lack of attention to socio-cultural contexts, (2) construction of 'risk' as residing in the individual and (3) enactment of public health agendas which privilege and pathologise certain behaviours. These reflect and construct an apolitical understanding of population health. This article proposes features of a critical epidemiology that represent a morally driven re-envisioning of the focus, analysis and interpretation of epidemiological studies of sexual health

Online Advertising

This chapter explores what makes online advertising different from traditional advertising channels. We argue that online advertising differs from traditional advertising channels in two important ways: measurability and targetability. Measurability is higher because the digital nature of online advertising means that responses to ads can be tracked relatively easily. Targetability is higher because data can be automatically tracked at an individual level, and it is relatively easy to show different people different ads. We discuss recent advances in search advertising, display advertising, and social media advertising and explore the key issues that arise for firms and consumers from measurability and targetability. We then explore possible public policy consequences, with an in depth discussion of the implications for consumer privacy

From amino acid sequence to bioactivity: the biomedical potential of antitumor peptides

Chemoprevention is the use of natural and/or synthetic substances to block, reverse, or retard the process of carcinogenesis. In this field, the use of antitumor peptides is of interest as, (i) these molecules are small in size, (ii) they show good cell diffusion and permeability, (iii) they affect one or more specific molecular pathways involved in carcinogenesis, and (iv) they are not usually genotoxic. We have checked the Web of Science Database (23/11/2015) in order to collect papers reporting on bioactive peptide (1691 registers), which was further filtered searching terms such as antiproliferative, antitumoral, or apoptosis among others. Works reporting the amino acid sequence of an antiproliferative peptide were kept (60 registers), and this was complemented with the peptides included in CancerPPD, an extensive resource for antiproliferative peptides and proteins. Peptides were grouped according to one of the following mechanism of action: inhibition of cell migration, inhibition of tumor angiogenesis, antioxidative mechanisms, inhibition of gene transcription/cell proliferation, induction of apoptosis, disorganization of tubulin structure, cytotoxicity, or unknown mechanisms. The main mechanisms of action of those antiproliferative peptides with known amino acid sequences are presented and finally, their potential clinical usefulness and future challenges on their application is discussed.Grant sponsor: Spanish Programa Estatal de Investigacion, Desarrollo e Inovacion Orientada a los Retos de la Sociedad; Grant number: AGL2013-44039-R; Grant sponsor: Plan galego de investigacion, innovacion e crecemento 2011-2015; Grant number: EM2014/046; Grant sponsor: University of Vigo; Grant number: 14VI05; Grant sponsor: Spanish Ministerio de Economia y Competividad (Ramon y Cajal postdoctoral contract); Grant number: RYC-2012-10052 (to Borja Sanchez)

Physiological characteristics of dysphagia following thermal burn injury

The study aim was to document the acute physiological characteristics of swallowing impairment following thermal burn injury. A series of 19 participants admitted to a specialised burn centre with thermal burn injury were identified with suspected aspiration risk by a clinical swallow examination (CSE) conducted by a speech-language pathologist and referred to the study. Once medically stable, each then underwent more detailed assessment using both a CSE and fiberoptic evaluation of swallowing (FEES). FEES confirmed six individuals (32%) had no aspiration risk and were excluded from further analyses. Of the remaining 13, CSE confirmed that two had specific oral-phase deficits due to orofacial scarring and contractures, and all 13 had generalised oromotor weakness. FEES revealed numerous pharyngeal-phase deficits, with the major findings evident in greater than 50% being impaired secretion management, laryngotracheal edema, delayed swallow initiation, impaired sensation, inadequate movement of structures within the hypopharynx and larynx, and diffuse pharyngeal residue. Penetration and/or aspiration occurred in 83% (n = 10/12) of thin fluids trials, with a lack of response to the penetration/aspiration noted in 50% (n = 6/12 penetration aspiration events) of the cases. Most events occurred post swallow. Findings support the fact that individuals with dysphagia post thermal burn present with multiple risk factors for aspiration that appear predominantly related to generalised weakness and inefficiency and further impacted by edema and sensory impairments. Generalised oromotor weakness and orofacial contractures (when present) impact oral-stage swallow function. This study has identified a range of factors that may contribute to both oral- and pharyngeal-stage dysfunction in this clinical population and has highlighted the importance of using a combination of clinical and instrumental assessments to fully understand the influence of burn injury on oral intake and swallowing

Extending Epigenesis: From Phenotypic Plasticity to the Bio-Cultural Feedback

The paper aims at proposing an extended notion of epigenesis acknowledging an actual causal import to the phenotypic dimension for the evolutionary diversification of life forms. Section 1 offers introductory remarks on the issue of epigenesis contrasting it with ancient and modern preformationist views. In Section 2 we propose to intend epigenesis as a process of phenotypic formation and diversification a) dependent on environmental influences, b) independent of changes in the genomic nucleotide sequence, and c) occurring during the whole life span. Then, Section 3 focuses on phenotypic plasticity and offers an overview of basic properties (like robustness, modularity and degeneracy) that allows biological systems to be evolvable – i.e. to have the potentiality of producing phenotypic variation. Successively (Section 4), the emphasis is put on environmentally-induced modification in the regulation of gene expression giving rise to phenotypic variation and diversification. After some brief considerations on the debated issue of epigenetic inheritance (Section 5), the issue of culture (kept in the background of the preceding sections) is considered. The key point is that, in the case of humans and of the evolutionary history of the genus Homo at least, the environment is also, importantly, the cultural environment. Thus, Section 6 argues that a bio-cultural feedback should be acknowledged in the “epigenic” processes leading to phenotypic diversification and innovation in Homo evolution. Finally, Section 7 introduces the notion of “cultural neural reuse”, which refers to phenotypic/neural modifications induced by specific features of the cultural environment that are effective in human cultural evolution without involving genetic changes. Therefore, cultural neural reuse may be regarded as a key instance of the bio-cultural feedback and ultimately of the extended notion of epigenesis proposed in this work