The Mind is Not (Just) a System of Modules Shaped (Just) by Natural Selection

[First paragraph]. 1. Did the Mind Evolve by Natural Selection? Of course our minds and brains evolved by natural selection! They aren’t the result of divine intervention or fabrication by space aliens. Nor are they solely products of drift or any other naturalistic alternative to selection. That natural selection profoundly "shaped" the mind and brain is accepted by both by evolutionary psychologists and virtually all of their most vigorous critics

Female urogenital dysfunction following total mesorectal excision for rectal cancer

BACKGROUND: The effect of Total Mesorectal Excision (TME) on sexual function in the male is well documented. However, there is little literature in female patients. The aim of this study was to review the pelvic autonomic nervous anatomy in the female and to perform a retrospective audit of urinary and sexual function in women following surgery for rectal cancer where TME had been performed. Urogenital dysfunction was assessed through interview and questionnaire. METHOD: Twenty-three questionnaires, eighteen returned, were sent to women with a mean age 65.5 yrs (range 34–86). All had undergone total mesorectal excision for rectal cancer between 1998–2001. Mean follow-up was 18.8 months (range 3–35). RESULTS: Preoperatively 5/18 (28%) were sexually active, 3/18 (17%) of patients described urinary frequency and nocturia and 7/18 (39%) described symptoms of stress incontinence prior to surgery. Postoperatively all sexually active patients remained active although all described some discomfort with penetration. Two of the patients sexually active described reduced libido secondary to the stoma. Postoperative urinary symptoms developed with 59% reporting the development of nocturia, 18% developed stress incontinence and one patient required a permanent catheter. Of those with symptoms, 80% persisted longer than three months from surgery. Symptoms were predominant in those patients with low rectal cancers, particularly those undergoing abdomino-perineal excision and in those who had previously undergone abdominal hysterectomy. CONCLUSION: The treatment of rectal cancer involves surgery to the pelvic floor. Despite nerve preservation this is associated with the development of worsening nocturia and stress incontinence. This is most marked in those patients who had previously undergone a hysterectomy. Further studies are warranted to assess the interaction with previous gynaecological surgery

Developing New Indicators To Describe Digital Technology Infrastructure In Primary And Secondary Education

Provides sets of metrics for describing digital technology provision in primary and secondary education (schools and beyond) based on analysis of the literature and testing against a range of vignettes representing a wide range of settings in 'developing world' contexts

School based professional development in partnership in Zambia

The Open University (UK) and World Vision (Zambia) have developed a model of School-based Continuous Professional Development (SBCPD) for primary teachers. The Zambian Education School-based Training (ZEST) programme supports the implementation of the revised curriculum and policies for SBCPD. Zambia has established structures and roles in place to support SBCPD through Teacher Group Meetings, School and Zonal In-service Coordinators and District and Province support teams. However there is a lack of resources to foster professional discussions around teaching and learning the regular Teacher Group Meetings. Using an iterative co-design process, ZEST has developed online resources, which are being used in over 400 schools in Central Province and are freely available, to support active teaching and learning in Africa. Through collaboration with local province, district and zonal officials as well as school leaders and teachers, ZEST has collected stories of the impact that collaborative planning of teaching activities; peer support and observation; and teacher reflection, have had on learners and education professionals. With contributions from practitioners in the participating schools and districts, this poster offers a representation of how the partnership between the Open University (UK), World Vision (Zambia), education officials and teachers has matured developing each participants’ skills and competences to contribute to successful SBCPD and achieve more learner-centred teaching in schools in Zambia

Effectiveness of self-management interventions for long-term conditions in people experiencing socio-economic deprivation in high-income countries: a systematic review and meta-analysis

BACKGROUND: Long-term conditions (LTCs) are prevalent in socio-economically deprived populations. Self-management interventions can improve health outcomes, but socio-economically deprived groups have lower participation in them, with potentially lower effectiveness. This review explored whether self-management interventions delivered to people experiencing socio-economic deprivation improve outcomes. METHODS: We searched databases up to November 2022 for randomized trials. We screened, extracted data and assessed the quality of these studies using Cochrane Risk of Bias 2 (RoB2). We narratively synthesized all studies and performed a meta-analysis on eligible articles. We assessed the certainty of evidence using GRADE for articles included in the meta-analysis. RESULTS: The 51 studies included in this review had mixed findings. For the diabetes meta-analysis, there was a statistically significant pooled reduction in haemoglobin A1c (-0.29%). We had moderate certainty in the evidence. Thirty-eight of the study interventions had specific tailoring for socio-economically deprived populations, including adaptions for low literacy and financial incentives. Each intervention had an average of four self-management components. CONCLUSIONS: Self-management interventions for socio-economically deprived populations show promise, though more evidence is needed. Our review suggests that the number of self-management components may not be important. With the increasing emphasis on self-management, to avoid exacerbating health inequalities, interventions should include tailoring for socio-economically deprived individuals

Are women with pathogenic variants in PMS2 and MSH6 really at high lifetime risk of breast cancer?

We read with some concern the recent article in Genetics in Medicine reporting a high lifetime risk of breast cancer in pathogenic variant (PV) carriers for PMS2 and MSH6 (ref. 1). Although the reported odds ratios for breast cancer were given as MSH6 (2.11; 95% confidence interval [CI] = 1.56–2.86) and PMS2 (2.92; 95% CI = 2.17–3.92) the cumulative risks to age 60 were given as 31.1% (95% CI, 21.9–40.7) and 37.7% (95% CI, 27.5–47.8) respectively. These are equivalent to UK National Institute for Health and Care Excellence (NICE) defined high lifetime risks. These two analyses are inaccurate given that the risk of breast cancer to the age of 60 years in the UK and United States is 5–6%. Therefore, if the risks from incidence ratios and Kaplan–Meier were equivalent, the odds ratios would be over 6-fold for PMS2 and >5-fold for MSH6