Global health competencies in UK postgraduate medical training: a scoping review and curricular content analysis

ObjectiveTo assess global health (GH) training in all postgraduate medical education in the UK.DesignMixed methodology: scoping review and curricular content analysis using two GH competency frameworks.Setting and participantsA scoping review (until December 2017) was used to develop a framework of GH competencies for doctors. National postgraduate medical training curricula were analysed against this and a prior framework for GH competencies. The number of core competencies addressed and/or appearing in each programme was recorded.OutcomesThe scoping review identified eight relevant publications. A 16-competency framework was developed and, with a prior 5-competency framework, used to analyse each of 71 postgraduate medical curricula. Curricula were examined by a team of researchers and relevant learning outcomes were coded as one of the 5 or 16 core competencies. The number of core competencies in each programme was recorded.ResultsUsing the 5-competency and 16-competency frameworks, 23 and 20, respectively, out of 71 programmes contained no global health competencies, most notably the Foundation Programme (equivalent to internship), a compulsory programme for UK medical graduates. Of a possible 16 competencies, the mean number across all 71 programmes was 1.73 (95% CI 1.42 to 2.04) and the highest number were in paediatrics and infectious diseases, each with five competencies. Of the 16 core competencies, global burden of disease and socioeconomic determinants of health were the two most cited with 47 and 35 citations, respectively. 8/16 competencies were not cited in any curriculum.ConclusionsEquity of care and the challenges of practising in an increasingly globalised world necessitate GH competencies for all doctors. Across the whole of postgraduate training, the majority of UK doctors are receiving minimal or no training in GH. Our GH competency framework can be used to map and plan integration across postgraduate programmes.</jats:sec

Health risk assessment of instant noodles commonly consumed in Port Harcourt, Nigeria

The current study investigated the levels of some heavy metals [Lead (Pb), Arsenic (As), Nickel (Ni), Mercury (Hg), Copper (Cu), Cadmium (Cd), Aluminium (Al) and Chromium (Cr)] and Polycyclic Aromatic Hydrocarbons (PAHs) in six brands of instant noodles (CFN, GFC, NGP, GAA, CUN and FCS) commonly consumed in Port Harcourt, Nigeria. Risks of consumption of contaminated noodles were also assessed. Heavy metals content and PAHs were determined using Flame Atomic Absorption Spectrophotometer (AAS) and Gas Chromatography (GC), respectively. Concentration of heavy metals as Pb, Ni, Cu, Al and Cr were detected while As, Hg and Cd were not detected in noodles. High average concentration (mean ± SD mg/kg) of Pb were observed in brands CFN (3.163 ± 0.21) and GFC (1.022 ± 0.08) which were significantly higher (P≤0.05) than in NGP (0.043 ± 0.15) and GAA (0.276 ± 0.18), although all were above WHO permissible limits (0.025 mg/kg). Target Hazard Quotient and Hazard Index for Pb were >1 in brands CFN and GFC indicating unacceptable risk. Results of PAHs showed brands had total PAHs (mg/kg) in the order: CFN >CUN >GAA >NGP >FCS > GFC. Although Carcinogenic Risks associated with these noodles are within permissible range, consumption of CFN and GFC could pose greater health risk to consumers. Long term consumption of brands CUN, CFN and GAA may have higher probability of carcinogenesis among consumers. We therefore recommend more diligent regulatory policies and monitoring by relevant Government agencies (WHO, NAFDAC, CPC and SON) to ensure wholesome noodles get to consumers

Effective elastic properties of 3D stochastic bicontinuous composites

We study effective elastic properties of 3D bicontinuous random composites (such as, e.g., nanoporous gold filled with polymer) considering linear and infinitesimal elasticity and using asymptotic homogenization along with the finite element method. For the generation of the microstructures, a leveled-wave model based on the works of J. W. Cahn [J.W. Cahn. Phase separation by spinodal decomposition in isotropic systems. The Journal of Chemical Physics, 42(1):93-99, 1965.] and Soyarslan et al. [C. Soyarslan, S. Bargmann, M. Pradas, and J. Weissmüller. 3D stochastic bicontinuous microstructures: generation, topology and elasticity. Acta Materialia, 149: 326-340, 2018.] is used. The influences of volume element size, phase contrast, relative volume fraction of phases and applied boundary conditions on computed apparent elastic moduli are investigated. The nanocomposite behaves distinctly different than its nanoporous counterpart without any filling as determined by scrutinized macroscopic responses of gold-epoxy nanocomposites of various phase volume fractions. This is due to the fact that, in the space-filling nanocomposite the force transmission is possible in all directions whereas in the nanoporous gold the load is transmitted along ligaments, which hinges upon the phase topology through network connectivity. As a consequence, we observe a distinct elastic scaling law for bicontinuous metal-polymer composites. A comparison of our findings with the Hashin-Shtrikman, the three-point Beran-Molyneux and the Milton-Phan-Tien analytical bounds for the same composites show that computational homogenization using periodic boundary conditions is justified to be the only tool in accurate and efficient determination of the effective properties of 3D bicontinuous random composites with high contrast and volume fraction bias towards the weaker phase

Development and evaluation of a method to estimate the potential of decarbonisation technologies deployment at higher education campuses

peer-reviewedThis paper describes a method for the quantitative estimation of the potential of decarbonisation technologies deployed on Higher Education Campuses (HEC). This was developed to fill the need for a practicable and standardised method to provide preliminary estimations of the deployment potential of building integrated photovoltaics (PV), micro-wind turbines, rainwater harvesting and ground mounted PV at HECs. The method identifies two key variables, namely roof area and open carpark area, to aid estimation of decarbonisation technologies deployment at HECs, using Google Earth imagery coupled with publicly available online HEC maps. The method was trialled for the higher education sector in Ireland identifying major potential for deployment of decarbonisation technologies for the sector. The building decarbonisation aspect of the proposed approach is applicable to sectors outside HEC particularly commercial and industrial sectors due to similarity in building footprint characteristics. The open carpark component of the methodology is also applicable to city-scale analysis due to uniformity in form of open carparks worldwide. This highlights the usefulness of this method through informing city-scale transitions towards decarbonisatio

Fine-mapping of the HNF1B multicancer locus identifies candidate variants that mediate endometrial cancer risk

Martin K. Oehler is a member of The Australian Ovarian Cancer Study GroupCommon variants in the hepatocyte nuclear factor 1 homeobox B (HNF1B) gene are associated with the risk of Type II diabetes and multiple cancers. Evidence to date indicates that cancer risk may be mediated via genetic or epigenetic effects on HNF1B gene expression. We previously found single-nucleotide polymorphisms (SNPs) at the HNF1B locus to be associated with endometrial cancer, and now report extensive fine-mapping and in silico and laboratory analyses of this locus. Analysis of 1184 genotyped and imputed SNPs in 6608 Caucasian cases and 37 925 controls, and 895 Asian cases and 1968 controls, revealed the best signal of association for SNP rs11263763 (P = 8.4 × 10−14, odds ratio = 0.86, 95% confidence interval = 0.82–0.89), located within HNF1B intron 1. Haplotype analysis and conditional analyses provide no evidence of further independent endometrial cancer risk variants at this locus. SNP rs11263763 genotype was associated with HNF1B mRNA expression but not with HNF1B methylation in endometrial tumor samples from The Cancer Genome Atlas. Genetic analyses prioritized rs11263763 and four other SNPs in high-to-moderate linkage disequilibrium as the most likely causal SNPs. Three of these SNPs map to the extended HNF1B promoter based on chromatin marks extending from the minimal promoter region. Reporter assays demonstrated that this extended region reduces activity in combination with the minimal HNF1B promoter, and that the minor alleles of rs11263763 or rs8064454 are associated with decreased HNF1B promoter activity. Our findings provide evidence for a single signal associated with endometrial cancer risk at the HNF1B locus, and that risk is likely mediated via altered HNF1B gene expression.Jodie N. Painter ... National Study of Endometrial Cancer Genetics Group (NSECG), CHIBCHAConsortium ... The Australian National Endometrial Cancer Study Group (ANECS) ... RENDOCAS ... Australian Ovarian Cancer Study (AOCS) ... The GENICA Network ... et al

Multi-omic features of oesophageal adenocarcinoma in patients treated with preoperative neoadjuvant therapy

Oesophageal adenocarcinoma is a poor prognosis cancer and the molecular features underpinning response to treatment remain unclear. We investigate whole genome, transcriptomic and methylation data from 115 oesophageal adenocarcinoma patients mostly from the DOCTOR phase II clinical trial (Australian New Zealand Clinical Trials Registry-ACTRN12609000665235), with exploratory analysis pre-specified in the study protocol of the trial. We report genomic features associated with poorer overall survival, such as the APOBEC mutational and RS3-like rearrangement signatures. We also show that positron emission tomography non-responders have more sub-clonal genomic copy number alterations. Transcriptomic analysis categorises patients into four immune clusters correlated with survival. The immune suppressed cluster is associated with worse survival, enriched with myeloid-derived cells, and an epithelial-mesenchymal transition signature. The immune hot cluster is associated with better survival, enriched with lymphocytes, myeloid-derived cells, and an immune signature including CCL5, CD8A, and NKG7. The immune clusters highlight patients who may respond to immunotherapy and thus may guide future clinical trials.Marjan M. Naeini, Felicity Newell, LaurenG. Aoude, Vanessa F. Bonazzi, Kalpana Patel, Guy Lampe, Lambros T. Koufariotis, Vanessa Lakis, Venkateswar Addala, Olga Kondrashova, Rebecca L. Johnston, Sowmya Sharma, Sandra Brosda, Oliver Holmes, Conrad Leonard, Scott Wood, Qinying Xu, Janine Thomas, Euan Walpole, G. Tao Mai, Stephen P. Ackland, Jarad Martin, Matthew Burge, Robert Finch, Christos S. Karapetis, Jenny Shannon, Louise Nott, Robert Bohmer, Kate Wilson, Elizabeth Barnes, John R. Zalcberg, B. Mark Smithers, John Simes, Timothy Price, Val Gebski, Katia Nones, David I. Watson, John V. Pearson, Andrew P. Barbour, Nicola Waddel

Exposure assessment of process-related contaminants in food by biomarker monitoring

Exposure assessment is a fundamental part of the risk assessment paradigm, but can often present a number of challenges and uncertainties. This is especially the case for process contaminants formed during the processing, e.g. heating of food, since they are in part highly reactive and/or volatile, thus making exposure assessment by analysing contents in food unreliable. New approaches are therefore required to accurately assess consumer exposure and thus better inform the risk assessment. Such novel approaches may include the use of biomarkers, physiologically based kinetic (PBK) modelling-facilitated reverse dosimetry, and/or duplicate diet studies. This review focuses on the state of the art with respect to the use of biomarkers of exposure for the process contaminants acrylamide, 3-MCPD esters, glycidyl esters, furan and acrolein. From the overview presented, it becomes clear that the field of assessing human exposure to process-related contaminants in food by biomarker monitoring is promising and strongly developing. The current state of the art as well as the existing data gaps and challenges for the future were defined. They include (1) using PBK modelling and duplicate diet studies to establish, preferably in humans, correlations between external exposure and biomarkers; (2) elucidation of the possible endogenous formation of the process-related contaminants and the resulting biomarker levels; (3) the influence of inter-individual variations and how to include that in the biomarker-based exposure predictions; (4) the correction for confounding factors; (5) the value of the different biomarkers in relation to exposure scenario’s and risk assessment, and (6) the possibilities of novel methodologies. In spite of these challenges it can be concluded that biomarker-based exposure assessment provides a unique opportunity to more accurately assess consumer exposure to process-related contaminants in food and thus to better inform risk assessment

Dynamic Load Distribution in MIST

This paper presents an algorithm for scheduling parallel applications in large-scale, multiuser, heterogeneous distributed systems. The approach is primarily targeted at systems that harvest idle cycles in general-purpose workstation networks, but is also applicable to clustered computer systems and massively parallel processors. The algorithm handles unequal processor capacities, multiple architecture types and dynamic variations in the number of processes and available processors. Scheduling decisions are driven by the desire to minimize turnaround time while maintaining fairness among competing applications. For efficiency, the virtual processors (VPs) of each application are gang scheduled on some subset of the available physical processors