The Pedagogy Of The Operating Theatre

This thesis outlines the findings of a large body of research work undertaken during 3 years of full-time study. The findings have already provided the author with helpful anchors for structuring formative feedback to surgical trainees within a simulation program, as well as helpful insights into her own learning. This thesis explores the operating theatre as a teaching and learning environment for postgraduate surgical trainees. The work crosses paradigms and uses contrasting methodologies to provide rich insights into surgical pedagogic practice. The first chapter is an introduction to the subject material, outlining the thesis aims and research questions, making clear why the research is important. The perspectives of the researcher are explained, in the first person, to make explicit her background and epistemological stance. The next chapter presents a narrative review of the literature, providing a background to the subject and a theoretical framework. Chapters three to six constitute empirical work. The third and fourth chapters use a grounded theory method to explore surgeons’ perceptions of the content and process of learning in the operating theatre. Chapter five uses case study methodology to illustrate teaching and learning in the operating theatre with concrete examples of pedagogic practice. The sixth chapter is a quasi-experimental study of learning which makes comparison between different pedagogic styles. The final chapter of the thesis draws together the findings from the empirical investigations. The personal development of the researcher is discussed in the first person and the body of research work is critically examined in view of its contribution to the field and its implications for future educational innovation.Open Acces

Detecting genes for developmental dyslexia on chromosome 6p

Developmental dyslexia (DD) is a complex, cognitive disorder, characterised by an impairment in reading despite adequate educational, motivational and intellectual opportunities and in the absence of any sensory or neurological disability. Family and twin studies have shown that genes make a substantial contribution to individual variation in risk of DD. Genetic linkage and association studies have implicated a number of chromosomal regions that may harbour susceptibility genes for DD, including regions on chromosomes 6p and 15q. The aims of this thesis were to identify novel susceptibility gene(s) for DD on chromosome 6p and to replicate the association reported between DD and EKN1 on chromosome 15q. Eleven genes on chromosome 6p were tested for association with DD using data derived from DNA pooling assays of 168 SNPs. Nineteen associations were observed and a minimum set of 13 SNPs were chosen for individual genotyping in a case-control and family-based sample. Nine SNPs revealed association with DD (p<0.03) located in PRL (1 SNP), MRS2L (1 SNP), KIAA0319 (4 SNPs), THEM2 (2 SNP) and 1 intergenic SNP. A haplotype comprising rs4504469/rs6935076 (KIAA0319) revealed strong evidence for association with DD (p=0.0001). This combined with the results of logistic regression analyses suggests that variation within K1AA0319 increases susceptibility to DD. Component phenotype analysis of the rs4504469/rs6935076 haplotype suggested that variation on the haplotype may influence a number of components of reading. It may also influence single word reading across the normal ability spectrum, but for other component phenotypes, variation on rs4504469/rs6935076 may influence affection status only. Association between DD and EKN1 was tested in a large family-based sample. No association was observed between SNPs previously reported to show association with DD (p>0.20). No significant associations were observed between EKN1 and component phenotypes of DD. This study identifies KIAA0319 as a susceptibility gene for DD and suggests that EKN1 is unlikely to increase vulnerability to DD.EThOS - Electronic Theses Online ServiceGBUnited Kingdo

Detecting genes for developmental dyslexia on chromosome 6p

Developmental dyslexia (DD) is a complex, cognitive disorder, characterised by an impairment in reading despite adequate educational, motivational and intellectual opportunities and in the absence of any sensory or neurological disability. Family and twin studies have shown that genes make a substantial contribution to individual variation in risk of DD. Genetic linkage and association studies have implicated a number of chromosomal regions that may harbour susceptibility genes for DD, including regions on chromosomes 6p and 15q. The aims of this thesis were to identify novel susceptibility gene(s) for DD on chromosome 6p and to replicate the association reported between DD and EKN1 on chromosome 15q. Eleven genes on chromosome 6p were tested for association with DD using data derived from DNA pooling assays of 168 SNPs. Nineteen associations were observed and a minimum set of 13 SNPs were chosen for individual genotyping in a case-control and family-based sample. Nine SNPs revealed association with DD (p0.20). No significant associations were observed between EKN1 and component phenotypes of DD. This study identifies KIAA0319 as a susceptibility gene for DD and suggests that EKN1 is unlikely to increase vulnerability to DD.EThOS - Electronic Theses Online ServiceGBUnited Kingdo

Detecting genes for developmental dyslexia on chromosome 6p.

Developmental dyslexia (DD) is a complex, cognitive disorder, characterised by an impairment in reading despite adequate educational, motivational and intellectual opportunities and in the absence of any sensory or neurological disability. Family and twin studies have shown that genes make a substantial contribution to individual variation in risk of DD. Genetic linkage and association studies have implicated a number of chromosomal regions that may harbour susceptibility genes for DD, including regions on chromosomes 6p and 15q. The aims of this thesis were to identify novel susceptibility gene(s) for DD on chromosome 6p and to replicate the association reported between DD and EKN1 on chromosome 15q. Eleven genes on chromosome 6p were tested for association with DD using data derived from DNA pooling assays of 168 SNPs. Nineteen associations were observed and a minimum set of 13 SNPs were chosen for individual genotyping in a case-control and family-based sample. Nine SNPs revealed association with DD (p0.20). No significant associations were observed between EKN1 and component phenotypes of DD. This study identifies KIAA0319 as a susceptibility gene for DD and suggests that EKN1 is unlikely to increase vulnerability to DD

Ethical dilemmas and reflexivity in qualitative research.

Context: For medical education researchers, a key concern may be the practicalities of gaining ethical approval where this is a national or local requirement. However, in qualitative studies, where the dynamics of human interaction pervade, ethical considerations are an ongoing process which continues long after approval has been granted. Responding to ethical dilemmas arising ‘in the moment’ requires a reflexive approach whereby the researcher questions his/her own motivations, assumptions and interests. Drawing on empirical studies and their experiences in academic and clinical research practice, the authors share their reflections on adhering to ethical principles throughout the research process to illustrate the complexities and nuances involved. Objectives and findings: These reflections offer critical insights into dilemmas arising in view of the ethical principles driving good conduct, and through domains which distinguish between procedural ethics, situational ethics, ethical relationships and ethical issues in exiting the study. The accounts consider integrity and altruism in research, gatekeeping and negotiating access, consent and confidentiality, power dynamics and role conflict, and challenges in dissemination of findings. The experiences are based on a range of examples of research in a UK context from managing difficult conversations in the classroom to video-ethnography in the operating theatre. Discussion and conclusions: These critical reflections make visible the challenges encountered and decisions that must be taken in the moment and on reflection after the event. Through sharing our experiences and debating the decisions we made, we offer insights into reflexivity in qualitative research which will be of value to others

An evaluation of surface meteorology and fluxes over the Iceland and Greenland Seas in ERA5 reanalysis: the impact of sea ice distribution

© The Author(s), 2020. This article is distributed under the terms of the Creative Commons Attribution License. The definitive version was published in Renfrew, I. A., Barrell, C., Elvidge, A. D., Brooke, J. K., Duscha, C., King, J. C., Kristiansen, J., Cope, T. L., Moore, G. W. K., Pickart, R. S., Reuder, J., Sandu, I., Sergeev, D., Terpstra, A., Vage, K., & Weiss, A. An evaluation of surface meteorology and fluxes over the Iceland and Greenland Seas in ERA5 reanalysis: the impact of sea ice distribution. Quarterly Journal of the Royal Meteorological Society, (2020): 1-22, doi:10.1002/qj.3941.The Iceland and Greenland Seas are a crucial region for the climate system, being the headwaters of the lower limb of the Atlantic Meridional Overturning Circulation. Investigating the atmosphere–ocean–ice processes in this region often necessitates the use of meteorological reanalyses—a representation of the atmospheric state based on the assimilation of observations into a numerical weather prediction system. Knowing the quality of reanalysis products is vital for their proper use. Here we evaluate the surface‐layer meteorology and surface turbulent fluxes in winter and spring for the latest reanalysis from the European Centre for Medium‐Range Weather Forecasts, i.e., ERA5. In situ observations from a meteorological buoy, a research vessel, and a research aircraft during the Iceland–Greenland Seas Project provide unparalleled coverage of this climatically important region. The observations are independent of ERA5. They allow a comprehensive evaluation of the surface meteorology and fluxes of these subpolar seas and, for the first time, a specific focus on the marginal ice zone. Over the ice‐free ocean, ERA5 generally compares well to the observations of surface‐layer meteorology and turbulent fluxes. However, over the marginal ice zone, the correspondence is noticeably less accurate: for example, the root‐mean‐square errors are significantly higher for surface temperature, wind speed, and surface sensible heat flux. The primary reason for the difference in reanalysis quality is an overly smooth sea‐ice distribution in the surface boundary conditions used in ERA5. Particularly over the marginal ice zone, unrepresented variability and uncertainties in how to parameterize surface exchange compromise the quality of the reanalyses. A parallel evaluation of higher‐resolution forecast fields from the Met Office's Unified Model corroborates these findings.This study was part of the Iceland Greenland Seas Project. Funding was from the NERC AFIS grant (NE/N009754/1), the ALERTNESS (Advanced models and weather prediction in the Arctic: enhanced capacity from observations and polar process representations) project (Research Council of Norway project number 280573), the Trond Mohn Foundation (BFS2016REK01), and the National Science Foundation grant OCE‐1558742. The Leosphere WindCube v2 and the Wavescan buoy are part of the OBLO (Offshore Boundary Layer Observatory) infrastructure funded by the Research Council of Norway (project number 227777)

Aircraft-based mass balance estimate of methane emissions from offshore gas facilities in the Southern North Sea

Atmospheric methane (CH4) concentrations have more than doubled since the beginning of the industrial age, making CH4 the second most important anthropogenic greenhouse gas after carbon dioxide (CO2). The oil and gas sector represent one of the major anthropogenic CH4 emitters as it is estimated to account for 22 % of global anthropogenic CH4 emissions. An airborne field campaign was conducted in April&ndash;May 2019 to study CH4 emissions from offshore gas facilities in the Southern North Sea with the aim to derive emission estimates using a top-down (measurement-led) approach. We present CH4 fluxes for six UK and five Dutch offshore platforms/platform complexes using the well-established mass balance flux method. We identify specific gas production emissions and emission processes (venting/fugitive or flaring/combustion) using observations of co-emitted ethane (C2H6) and CO2. We compare our top-down estimated fluxes with a ship-based top-down study in the Dutch sector and with bottom-up estimates from a globally gridded annual inventory, UK national annual point-source inventories, and with operator-based reporting for individual Dutch facilities. In this study, we find that all inventories, except for the operator-based facility-level reporting, underestimate measured emissions, with the largest discrepancy observed with the globally gridded inventory. Individual facility reporting, as available for Dutch sites for the specific survey date, shows better agreement with our measurement-based estimates. For all sampled Dutch installations together, we find that our estimated flux of (122.7 &plusmn; 9.7) kg h-1 deviates by a factor 0.7 (0.35&ndash;12) from reported values (183.1 kg h-1). Comparisons with aircraft observations in two other offshore regions (Norwegian Sea and Gulf of Mexico) show that measured, absolute facility-level emission rates agree with the general distribution found in other offshore basins despite different production types (oil, gas) and gas production rates, which vary by two orders of magnitude. Therefore, mitigation is warranted equally across geographies.</p

The Genomic and Immune Landscapes of Lethal Metastatic Breast Cancer.

The detailed molecular characterization of lethal cancers is a prerequisite to understanding resistance to therapy and escape from cancer immunoediting. We performed extensive multi-platform profiling of multi-regional metastases in autopsies from 10 patients with therapy-resistant breast cancer. The integrated genomic and immune landscapes show that metastases propagate and evolve as communities of clones, reveal their predicted neo-antigen landscapes, and show that they can accumulate HLA loss of heterozygosity (LOH). The data further identify variable tumor microenvironments and reveal, through analyses of T cell receptor repertoires, that adaptive immune responses appear to co-evolve with the metastatic genomes. These findings reveal in fine detail the landscapes of lethal metastatic breast cancer.CRUK