Undergraduate medical textbooks do not provide adequate information on intravenous fluid therapy: a systematic survey and suggestions for improvement

<b>Background</b><p></p> Inappropriate prescribing of intravenous (IV) fluid, particularly 0.9% sodium chloride, causes post-operative complications. Fluid prescription is often left to junior medical staff and is frequently poorly managed. One reason for poor intravenous fluid prescribing practices could be inadequate coverage of this topic in the textbooks that are used.<p></p> <b>Methods</b><p></p> We formulated a comprehensive set of topics, related to important common clinical situations involving IV fluid therapy, (routine fluid replacement, fluid loss, fluids overload) to assess the adequacy of textbooks in common use. We assessed 29 medical textbooks widely available to students in the UK, scoring the presence of information provided by each book on each of the topics. The scores indicated how fully the topics were considered: not at all, partly, and adequately. No attempt was made to judge the quality of the information, because there is no consensus on these topics.<p></p> <b>Results</b><p></p> The maximum score that a book could achieve was 52. Three of the topics we chose were not considered by any of the books. Discounting these topics as “too esoteric”, the maximum possible score became 46. One textbook gained a score of 45, but the general score was poor (median 11, quartiles 4, 21). In particular, coverage of routine postoperative management was inadequate.<p></p> <b>Conclusions</b><p></p> Textbooks for undergraduates cover the topic of intravenous therapy badly, which may partly explain the poor knowledge and performance of junior doctors in this important field. Systematic revision of current textbooks might improve knowledge and practice by junior doctors. Careful definition of the remit and content of textbooks should be applied more widely to ensure quality and “fitness for purpose”, and avoid omission of vital knowledge

Relativistic Mean-Field Theory Equation of State of Neutron Star Matter and a Maxwellian Phase Transition to Strange Quark Matter

The equation of state of neutron star matter is examined in terms of the relativistic mean-field theory, including a scalar-isovector $\delta$-meson effective field. The constants of the theory are determined numerically so that the empirically known characteristics of symmetric nuclear matter are reproduced at the saturation density. The thermodynamic characteristics of both asymmetric nucleonic matter and $\beta$-equilibrium hadron-electron $npe$-plasmas are studied. Assuming that the transition to strange quark matter is an ordinary first-order phase transition described by Maxwell's rule, a detailed study is made of the variations in the parameters of the phase transition owing to the presence of a $\delta$-meson field. The quark phase is described using an improved version of the bag model, in which interactions between quarks are accounted for in a one-gluon exchange approximation. The characteristics of the phase transition are determined for various values of the bag parameter within the range $B\in[60,120]$ $MeV/fm^{3}$ and it is shown that including a $\delta$-meson field leads to a reduction in the phase transition pressure $P_{0}$ and in the concentrations $n_{N}$ and $n_{Q}$ at the phase transition point.Comment: 17 pages, 8 figure

Sex-Specific Differences in Shoaling Affect Parasite Transmission in Guppies

Background: Individuals have to trade-off the costs and benefits of group membership during shoaling behaviour. Shoaling can increase the risk of parasite transmission, but this cost has rarely been quantified experimentally. Guppies (Poecilia reticulata) are a model system for behavioural studies, and they are commonly infected by gyrodactylid parasites, notorious fish pathogens that are directly transmitted between guppy hosts. Methodology/Principal Findings:Parasite transmission in single sex shoals of male and female guppies were observed using an experimental infection of Gyrodactylus turnbulli. Parasite transmission was affected by sex-specific differences in host behaviour, and significantly more parasites were transmitted when fish had more frequent and more prolonged contact with each other. Females shoaled significantly more than males and had a four times higher risk to contract an infection. Conclusions/Significance: Intersexual differences in host behaviours such as shoaling are driven by differences in natural and sexual selection experienced by both sexes. Here we show that the potential benefits of an increased shoaling tendency are traded off against increased risks of contracting an infectious parasite in a group-living species

Elementary Forms of the Metaphorical Life : Tropes at Work in Durkheim’s Theory of the Religious

Peer reviewedPostprin

Professional capacity and organizational change as measures of educational effectiveness: assessing the impact of postgraduate education in development policy and management

We tend to measure educational performance by students' attainment in coursework or examinations. In the case of professional education, the impact of the educational programme on the students' own capacities to enhance their work practices, and the wider organizational effects of the students' education and training, are also key 'products' of the educational process. This is particularly important with education for Development Policy and Management (DPAM), which is directly concerned with capacity-building. This article adopts a work-related approach to educational effectiveness and examines four professional programmes in DPAM--three in Southern Africa and one in the UK. Through the analysis of the results of surveys and case studies, the article demonstrates how a positive learning experience is related to the application of learning at work. However the conditions for applying learning also depend strongly on organizational context, as do the wider organizational impacts of learning. The article presents a broad approach to assessing educational effectiveness in professional programmes which incorporate these factors

Drug loading capacity of microporous β-pyrophosphate crystals

Periodontitis and peri-implantitis are two characteristic examples where bacterial infections compromise the healing of dental tissues. Drug eluting scaffolds are a potential solution to this problem but their fabrication requires suitable biomaterials with significant drug loading capacity and regenerative potential to support new tissue formation. With this aim, porous β-pyrophosphate crystals having a micro-pore area of 2.59 m2/g and an average pore diameter of 65 nm, have been obtained by the heat treatment of brushite (at 780 °C). To demonstrate the drug loading potential of the mineral, experiments with chloramphenicol have been conducted. After tests with four common bacteria, the drug loaded mineral was shown to have enhanced antibacterial properties, particularly towards E. coli (74% growth inhibition) and S. aureus (48% growth inhibition). Taking into account β-pyrophosphate's significant role in hard tissue mineralisation and the capability to tailor crystal micro-porosity characteristics by controlled heat treatment, the mineral can be considered as an ideal biomaterial for localised drug delivery in dental applications

Reflections and Experiences of a Co-Researcher involved in a Renal Research Study

Background Patient and Public Involvement (PPI) is seen as a prerequisite for health research. However, current Patient and public involvement literature has noted a paucity of recording of patient and public involvement within research studies. There have been calls for more recordings and reflections, specifically on impact. Renal medicine has also had similar criticisms and any reflections on patient and public involvement has usually been from the viewpoint of the researcher. Roles of patient and public involvement can vary greatly from sitting on an Advisory Group to analysing data. Different PPI roles have been described within studies; one being a co-researcher. However, the role of the co-researcher is largely undefined and appears to vary from study to study. Methods The aims of this paper are to share one first time co-researcher's reflections on the impact of PPI within a mixed methods (non-clinical trial) renal research study. A retrospective, reflective approach was taken using data available to the co-researcher as part of the day-to-day research activity. Electronic correspondence and documents such as meeting notes, minutes, interview thematic analysis and comments on documents were re-examined. The co-researcher led on writing this paper. Results This paper offers a broad definition of the role of the co-researcher. The co-researcher reflects on undertaking and leading on the thematic analysis of interview transcripts, something she had not previously done before. The co-researcher identified a number of key themes; the differences in time and responsibility between being a coresearcher and an Advisory Group member; how the role evolved and involvement activities could match the co-researchers strengths (and the need for flexibility); the need for training and support and lastly, the time commitment. It was also noted that it is preferable that a co-researcher needs to be involved from the very beginning of the grant application. Conclusions The reflections, voices and views of those undertaking PPI has been largely underrepresented in the literature. The role of co-researcher was seen to be rewarding but demanding, requiring a large time commitment. It is hoped that the learning from sharing this experience will encourage others to undertake this role, and encourage researchers to reflect on the needs of those involved.Peer reviewedFinal Published versio

Thermodynamic instability of doubly spinning black objects

We investigate the thermodynamic stability of neutral black objects with (at least) two angular momenta. We use the quasilocal formalism to compute the grand canonical potential and show that the doubly spinning black ring is thermodynamically unstable. We consider the thermodynamic instabilities of ultra-spinning black objects and point out a subtle relation between the microcanonical and grand canonical ensembles. We also find the location of the black string/membrane phases of doubly spinning black objects.Comment: 25 pages, 7 figures v2: matches the published versio

Changing gender roles and attitudes and their implications for well-being around the new millennium

<b>Purpose</b><p></p> Given evidence that gender role attitudes (GRAs) and actual gender roles impact on well-being, we examine associations between GRAs, three roles (marital status, household chore division, couple employment) and psychological distress in working-age men and women. We investigate time-trends reflecting broader social and economic changes, by focusing on three age groups at two dates.<p></p> <b>Methods</b><p></p> We used British Household Panel Survey data from 20- to 64-year-olds in heterosexual couple households in 1991 (N = 5,302) and 2007 (N = 6,621). We examined: levels of traditional GRAs according to gender, age, date, household and employment roles; associations which GRAs and roles had with psychological distress (measured via the GHQ-12); whether psychological distress increased when GRAs conflicted with actual roles; and whether any of these associations differed according to gender, age or date.<p></p> <b>Results</b><p></p> Gender traditionalism was lower among women, younger people, those participating in 2007 and in ‘less traditional’ relationships and households. Psychological distress was higher among those with more traditional GRAs and, particularly among men, for those not employed, and there was some evidence of different patterns of association according to age-group. There was limited evidence, among women only, of increased psychological distress when GRAs and actual roles conflicted and/or reductions when GRAs and roles agreed, particularly in respect of household chores and paid employment.<p></p> <b>Conclusions</b><p></p> Although some aspects of gender roles and attitudes (traditionalism and paid employment) are associated with well-being, others (marital status and household chores), and attitude-role consistency, may have little impact on the well-being of contemporary UK adults.<p></p&gt