Medical student wellbeing - a consensus statement from Australia and New Zealand

Abstract Background Medical student wellbeing – a consensus statement from Australia and New Zealand outlines recommendations for optimising medical student wellbeing within medical schools in our region. Worldwide, medical schools have responsibilities to respond to concerns about student psychological, social and physical wellbeing, but guidance for medical schools is limited. To address this gap, this statement clarifies key concepts and issues related to wellbeing and provides recommendations for educational program design to promote both learning and student wellbeing. The recommendations focus on student selection; learning, teaching and assessment; learning environment; and staff development. Examples of educational initiatives from the evidence-base are provided, emphasising proactive and preventive approaches to student wellbeing. Main recommendations The consensus statement provides specific recommendations for medical schools to consider at all stages of program design and implementation. These are:Design curricula that promote peer support and progressive levels of challenge to students.Employ strategies to promote positive outcomes from stress and to help others in need.Design assessment tasks to foster wellbeing as well as learning.Provide mental health promotion and suicide prevention initiatives.Provide physical health promotion initiatives.Ensure safe and health-promoting cultures for learning in on-campus and clinical settings.Train staff on student wellbeing and how to manage wellbeing concerns. Conclusion A broad integrated approach to improving student wellbeing within medical school programs is recommended. Medical schools should work cooperatively with student and trainee groups, and partner with clinical services and other training bodies to foster safe practices and cultures. Initiatives should aim to assist students to develop adaptive responses to stressful situations so that graduates are prepared for the realities of the workplace. Multi-institutional, longitudinal collaborative research in Australia and New Zealand is needed to close critical gaps in the evidence needed by medical schools in our region

Localisation of RNAs into the germ plasm of vitellogenic xenopus oocytes

We have studied the localisation of mRNAs in full-grown Xenopus laevis oocytes by injecting fluorescent RNAs, followed by confocal microscopy of the oocyte cortex. Concentrating on RNA encoding the Xenopus Nanos homologue, nanos1 (formerly Xcat2), we find that it consistently localised into aggregated germ plasm ribonucleoprotein (RNP) particles, independently of cytoskeletal integrity. This implies that a diffusion/entrapment-mediated mechanism is active, as previously reported for previtellogenic oocytes. Sometimes this was accompanied by localisation into scattered particles of the “late”, Vg1/VegT pathway; occasionally only late pathway localisation was seen. The Xpat RNA behaved in an identical fashion and for neither RNA was the localisation changed by any culture conditions tested. The identity of the labelled RNP aggregates as definitive germ plasm was confirmed by their inclusion of abundant mitochondria and co-localisation with the germ plasm protein Hermes. Further, the nanos1/Hermes RNP particles are interspersed with those containing the germ plasm protein Xpat. These aggregates may be followed into the germ plasm of unfertilized eggs, but with a notable reduction in its quantity, both in terms of injected molecules and endogenous structures. Our results conflict with previous reports that there is no RNA localisation in large oocytes, and that during mid-oogenesis even germ plasm RNAs localise exclusively by the late pathway. We find that in mid oogenesis nanos1 RNA also localises to germ plasm but also by the late pathway. Late pathway RNAs, Vg1 and VegT, also may localise into germ plasm. Our results support the view that mechanistically the two modes of localisation are extremely similar, and that in an injection experiment RNAs might utilise either pathway, the distinction in fates being very subtle and subject to variation. We discuss these results in relation to their biological significance and the results of others

'We used to be somebody': a critical consideration of plans to recapture the UK’s reputation as a world-leader in teaching research and innovation

The UK has recognised itself as a world leading educator, particularly in higher education where ten of the top 100 institutions are based in the UK. And yet, establishments such as the British Academy and the Royal Society are questioning whether the UK will continue to hold this recognition. Ahead of the recommissioning of Doctoral Training Partnerships (DTPs) in 2023, the Economic & Social Research Council (ESRC), one of seven council domains of UKRI (UK Research & Innovation, the largest funder of doctoral research in the UK distributing funding from the UK Government) has sought to understand what the ‘gap’ is and how to close it. The ESRC commissioned three projects (Adams & Neary, 2022; ESRC, 2022; Ferrie et al., 2022; Tazzyman et al., 2021) in preparation for recommissioning and this paper reviews their recommendations and anticipated impact on DTPs, and the education of doctoral researchers. Specifically, the plans to increase exposure of digital data and related skills/toolkits and project management skills including dissemination strategies will be evaluated. The paper critically asks how the new approach will benefit researchers with a focus on those intending to stay in the academy and those who choose to build a career ‘beyond’. To focus this critical work, an ‘alternative’ career pathway, that uses research skills but also dissemination and knowledge exchange skills, will be examined as a critical exemplar: journalism. This paper will close by considering the future for research methods training, at least within UK social sciences, and whether it meets the needs of doctoral researchers, whichever career pathway they intend to follow

Structural insights into the production of 3-hydroxypropionic acid by aldehyde dehydrogenase from Azospirillum brasilense

3-Hydroxypropionic acid (3-HP) is an important platform chemical to be converted to acrylic acid and acrylamide. Aldehyde dehydrogenase (ALDH), an enzyme that catalyzes the reaction of 3-hydroxypropionaldehyde (3-HPA) to 3-HP, determines 3-HP production rate during the conversion of glycerol to 3-HP. To elucidate molecular mechanism of 3-HP production, we determined the first crystal structure of a 3-HP producing ALDH, alpha-ketoglutarate-semialdehyde dehydrogenase from Azospirillum basilensis (AbKGSADH), in its apo-form and in complex with NAD(+). Although showing an overall structure similar to other ALDHs, the AbKGSADH enzyme had an optimal substrate binding site for accepting 3-HPA as a substrate. Molecular docking simulation of 3-HPA into the AbKGSADH structure revealed that the residues Asn159, Gln160 and Arg163 stabilize the aldehyde-and the hydroxyl-groups of 3-HPA through hydrogen bonds, and several hydrophobic residues, such as Phe156, Val286, Ile288, and Phe450, provide the optimal size and shape for 3-HPA binding. We also compared AbKGSADH with other reported 3-HP producing ALDHs for the crucial amino acid residues for enzyme catalysis and substrate binding, which provides structural implications on how these enzymes utilize 3-HPA as a substrate

Editorial: Teaching research methods better? Or research methods for better teaching?

This special issue invited papers relating either to the pedagogy of research practice, or how we can harness methods, methodologies and research design to better evaluate our teaching. In essence, the paper was derived from personal struggles to find a home for such work within a world-leading research university that was structured around disciplines and the teaching of substantive topics, and around research careers. The editing team for this special edition teach courses which sit alongside this disciplinary structure: teaching either research methods courses spanning a School made up of six disciplines, or across a College made up of five schools and many hundreds of students; or skills-based courses on journalism practice within subject or School-wide media courses. Each of the editors are on learning and teaching contracts despite all being actively involved in research. This is an example of neoliberal management decision-making, a decision that disappears our potential to be recognised as researchers because there is so much teaching for us to do. Within our institution there has been growing investment in research methods teaching teams, just as there has been growing investment and recognition of colleagues on the learning and teaching track. The investment is slow and often concentrated on early career scholars meaning there are leadership vacuums in the ‘middle’ of the institution. Our overarching university structures have created barriers to the building of communities of practice in research methods or learning and teaching. This journal is something of a beacon and its ethos of critical development of scholarship and of scholars attracted our attention. Early conversations with the oSoTL editors Nathalie Tasler, Matthew Barr, and Vicki Dale, helped us consider what a useful contribution could be. We had a strong desire to expose how tough some things are and how welcome the solidarity found within communities of practice is. Teaching students to develop their research practice is tough. The scholarship of learning and teaching (SoTL) in this field is relatively new and has focused predominantly on the teaching of numeric data, an area also sometimes known as ‘quantitative methods’ and ‘computational social sciences.’ The difficulty of teaching in this field is fuelled both by the resistance shown by students: on maths anxiety (Williams, Payne, Hodgkinson, & Poade, 2008); on fear of numbers (Scott Jones & Goldring, 2015); on anxiety and devaluing of courses that receive mixed student feedback (Scott Jones & Goldring, 2014); on the devaluing of high value, rather than enjoyable learning (Ryan, Saunders, Rainsford, & Thompson, 2014); and on managers resisting adequate time to learn methods because they’re perceived as unpopular (MacInnes, 2010). Significant social science investment in Q-Step Centres across the UK (over £20million into 17 centres) demonstrated a different ‘way’ was possible. Significant outputs including writing on embedding methods in substantive learning (Buckley, Brown, Thomson, Olsen, & Carter, 2015; Technopolis, 2022) were produced by Q-Step teams, adding to a growing literature on pedagogy and methods. Most of the literature in the teaching of numeric data is published in journals which examine advances in methodologies rather than in dedicated SoTL journals, and so it can be difficult to find for those coming with pedagogic concerns

In vivo photoacoustic imaging of breast cancer tumor with HER2-targeted nanodiamonds

Radiation-damaged nanodiamonds (NDs) are ideal optical contrast agents for photoacoustic (PA) imaging in biological tissues due to their good biocompatibility and high optical absorbance in the near-infrared (NIR) range. Acid treated NDs are oxidized to form carboxyl groups on the surface, functionalized with polyethylene glycol (PEG) and human epidermal growth factor receptor 2 (HER2) targeting ligand for breast cancer tumor imaging. Because of the specific binding of the ligand conjugated NDs to the HER2-overexpressing murine breast cancer cells (4T1.2 neu), the tumor tissues are significantly delineated from the surrounding normal tissue at wavelength of 820 nm under the PA imaging modality. Moreover, HER2 targeted NDs (HER2-PEG-NDs) result in higher accumulation in HER2 positive breast tumors as compared to non-targeted NDs after intravenous injection (i.v.). Longer retention time of HER-PEG-NDs is observed in HER2 overexpressing tumor model than that in negative tumor model (4T1.2). This demonstrates that targeting moiety conjugated NDs have great potential for the sensitive detection of cancer tumors and provide an attractive delivery strategy for anti-cancer drugs

Staff perspectives of barriers to women accessing birthing services in Nepal: A qualitative study

Background: Nepal has made significant progress with regard to reducing the maternal mortality ratio but a major challenge remains the under-utilisation of skilled birth attendants who are predominantly facility based. Studies have explored women's views of the barriers to facility birth; however the voices of staff who offer services have not been studied in detail. This research explores the views of staff as to the key reasons why pregnant women do not give birth in a maternity-care facility. Methods: This mixed methods study comprised qualitative interviews and non-participant observation. The study was conducted in two small non-governmental hospitals, one semi-rural and one urban, in Kathmandu Valley. Twenty interviews were conducted with health care providers and other staff in these hospitals. The interviews were undertaken with the aid of a Nepali translator, with some interviews being held in English. Twenty-five hours of non-participant observation was conducted in both maternity hospitals . Both observation and interview data were analysed thematically. Ethical approval was granted by the Nepal Research Health Council and Bournemouth University's Ethics Committee. Results: Key themes that emerged from the analysis reflected barriers that women experience in accessing services at different conceptual levels and resembled the three phases of delay model by Thaddeus and Maine. This framework is used to present the barriers. First Phase Delays are: 1) lack of awareness that the facility/services exist; 2) women being too busy to attend; 3) poor services; 4) embarrassment; and 5) financial issues. Themes for the second Phase of Delay are: 1) birthing on the way; and 2) by-passing the facility in favour of one further away. The final Phase involved: 1) absence of an enabling environment; and 2) disrespectful care. Conclusion: This study highlights a multitude of barriers, not all of the same importance or occuring at the same time in the pregnancy journey. It is clear that staff are aware of many of the barriers for women in reaching the facility to give birth, and these fit with previous literature of women's views. However, staff had limited insight into barriers occuring within the facility itself and were more likely to suggest that this was a problem for other institutions and not theirs

Population‐based cohort study of outcomes following cholecystectomy for benign gallbladder diseases

Background The aim was to describe the management of benign gallbladder disease and identify characteristics associated with all‐cause 30‐day readmissions and complications in a prospective population‐based cohort. Methods Data were collected on consecutive patients undergoing cholecystectomy in acute UK and Irish hospitals between 1 March and 1 May 2014. Potential explanatory variables influencing all‐cause 30‐day readmissions and complications were analysed by means of multilevel, multivariable logistic regression modelling using a two‐level hierarchical structure with patients (level 1) nested within hospitals (level 2). Results Data were collected on 8909 patients undergoing cholecystectomy from 167 hospitals. Some 1451 cholecystectomies (16·3 per cent) were performed as an emergency, 4165 (46·8 per cent) as elective operations, and 3293 patients (37·0 per cent) had had at least one previous emergency admission, but had surgery on a delayed basis. The readmission and complication rates at 30 days were 7·1 per cent (633 of 8909) and 10·8 per cent (962 of 8909) respectively. Both readmissions and complications were independently associated with increasing ASA fitness grade, duration of surgery, and increasing numbers of emergency admissions with gallbladder disease before cholecystectomy. No identifiable hospital characteristics were linked to readmissions and complications. Conclusion Readmissions and complications following cholecystectomy are common and associated with patient and disease characteristics

Research Agenda for Antimicrobial Stewardship in the Veterans Health Administration

Antimicrobial stewardship is vital to reducing the spread of antimicrobial resistance. A group of investigators and clinicians within the Veterans Health Administration set forth a research agenda for antimicrobial stewardship, including research targets for inpatient and outpatient stewardship activities, metrics, and antimicrobial dosing and duration