The ‘Teaching - Research’ nexus in medical education

Research forms an important part of the academic competencies attained during academic study.For medical students, this includes learning how to critically appraise and interpret medical and widerhealth care research, particularly – but not only – when relevant for one»s own current or future practice.It also includes understanding the core principles of different methods and research ethics and learningto participate in research. The teaching – research nexus: strategies to implement research education in the medical curriculum. In this paper, we offer reflections on how to do this on the basis of professional anecdotal experiences by a general educationalist with a particular interest in medical education; an undergraduate medical student with a research-focussed, stand-alone additional degree, and a medical academic.Our paper initially explores the need for research education; tying in Healey»s theoretical frameworkin student research, and the nature of providing evidence-based patient care. The paper then presents areport on a student research programme at the University of Birmingham, England.Teaching and Teacher Learning (ICLON

Microdosing and other phase 0 clinical trials: facilitating translation in Drug Development

Increasing costs of drug development and ethical concernsabout the risks of exposing humans and animals to novelchemical entities favor limited exposure clinical trials suchas microdosing and other phase 0 trials. An increasing bodyof research supports the validity of extrapolation from thelimited drug exposure of phase 0 approaches to the full,therapeutic exposure. An increasing number of applicationsand design options demonstrate the versatility and exibilitythese approaches offer to drug developers

The effect of distant reiki on pain in women after elective Caesarean section: a double-blinded randomised controlled trial

Introduction: Approximately 25% of all babies in North America are delivered via Caesarean section (C-section). Though a common surgical procedure, C-section recovery can be painful. Opioids, specifically codeine, are commonly used to ease pain; however, its active metabolite, morphine, passes into breast milk, and may produce unwanted side effects in neonates; therefore, alternatives to opioids are being sought. Reiki is an ancient Japanese form of healing where practitioners transfer healing energy through light touch and positive healing intention. Although 1.2 million Americans use reiki to reduce pain or depression, there is a lack of strong evidence supporting its effectiveness. A recent systematic review showed existing studies to be of poor methodological quality, with the common limitation of lack of blinding. To overcome this issue, the authors used distant reiki to assess its effectiveness in reducing pain following an elective C-section. Methods: In this randomised, double-blinded study, women who underwent an elective C-section were allocated to either usual care (control, n=40) or three distant reiki sessions in addition to usual care (n=40). Pain was assessed using a visual analogue scale (VAS). The primary endpoint was the Area Under the VAS-Time Curve (AUC) for days 1-3. Secondary measures included: The proportion of women who required opioid medications and dose consumed, rate of healing and vital signs. Results: AUC for pain was not significantly different in the distant reiki and control groups (mean±SD; 212.16104.7 vs 223.16117.8; p=0.96). There were no significant differences in opioid consumption or rate of healing; however, the distant reiki group had a significantly lower heart rate (74.368.1 bpm vs 79.867.9 bpm, p=0.003) an

The status of paediatric medicines initiatives around the world-what has happened and what has not?

Purpose: This review was conducted to examine the current status of paediatric medicines initiatives across the globe. Methods: The authors made a non-systematic descriptive review of current world situation. Results: Two regions, the United States (US) and the European Union (EU), and the World Health Organization (WHO) have introduced strong paediatric initiatives to improve children's health through improving access to better paediatric medicines. The experience from the US initiative indicates that it is possible to stimulate development and study of paediatric medicines and provide important new information for improvement of paediatric therapy. The early results from the EU initiative are similarly encouraging. In Canada, Japan, Australia and other developed countries, specific paediatric medicines initiatives have been less extensive and weaker, with modest results. Disappointingly, current evidence suggests that results from clinical trials outside the US often do not benefit children in the country in which the trials were largely conducted. Pharmaceutical companies that have derived a financial benefit commensurate with the cost of doing the paediatric trials in one country do not seem to be making the results of these trials available to all countries if there is no financial incentive to the company. The WHO campaign 'make medicines child size' has produced substantive accomplishments in building improved foundations to improve mechanisms that will enhance children's access to critical medicines in resource-limited settings. However, practically all of this work has been performed using an amalgamation of short-term funding from a variety of sources as opposed to a sustained, programmatic commitment. Conclusions: Although much still needs to be done, it's clear that with concerted efforts and appropriate resources, change is possible but slow. Retaining and fostering public and political interest in paediatric medicines is challenging, but pivotal for success.Fil: Hoppu, Kalle. Helsinki University Central Hospital; FinlandiaFil: Anabwani, Gabriel. Botswana-Baylor Children’s Clinical Centre of Excellence; BotsuanaFil: Garcia Bournissen, Facundo. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Gobierno de la Ciudad de Buenos Aires. Hospital General de Niños "Ricardo Gutiérrez"; ArgentinaFil: Gazarian, Madlen. University of New South Wales; Australia. Sydney Children’s Hospital; AustraliaFil: Kearns, Gregory L.. The Children’s Mercy Hospital; Estados Unidos. University of Missouri; Estados UnidosFil: Nakamura, Hidefumi. National Center for Child Health and Development; JapónFil: Peterson, Robert G.. University of British Columbia; CanadáFil: Sri Ranganathan, Shalini. University Of Colombo. Faculty Of Medicine; Sri LankaFil: De Wildt, Saskia N.. Sophia Children’s Hospital; Países Bajo

The formation, properties and impact of secondary organic aerosol: current and emerging issues

Secondary organic aerosol (SOA) accounts for a significant fraction of ambient tropospheric aerosol and a detailed knowledge of the formation, properties and transformation of SOA is therefore required to evaluate its impact on atmospheric processes, climate and human health. The chemical and physical processes associated with SOA formation are complex and varied, and, despite considerable progress in recent years, a quantitative and predictive understanding of SOA formation does not exist and therefore represents a major research challenge in atmospheric science. This review begins with an update on the current state of knowledge on the global SOA budget and is followed by an overview of the atmospheric degradation mechanisms for SOA precursors, gas-particle partitioning theory and the analytical techniques used to determine the chemical composition of SOA. A survey of recent laboratory, field and modeling studies is also presented. The following topical and emerging issues are highlighted and discussed in detail: molecular characterization of biogenic SOA constituents, condensed phase reactions and oligomerization, the interaction of atmospheric organic components with sulfuric acid, the chemical and photochemical processing of organics in the atmospheric aqueous phase, aerosol formation from real plant emissions, interaction of atmospheric organic components with water, thermodynamics and mixtures in atmospheric models. Finally, the major challenges ahead in laboratory, field and modeling studies of SOA are discussed and recommendations for future research directions are proposed

Gas phase formation of extremely oxidized pinene reaction products in chamber and ambient air

High molecular weight (300–650 Da) naturally charged negative ions have previously been observed at a boreal forest site in Hyytiälä, Finland. The long-term measurements conducted in this work showed that these ions are observed practically every night between spring and autumn in Hyytiälä. The ambient mass spectral patterns could be reproduced in striking detail during additional measurements of α-pinene (C<sub>10</sub>H<sub>16</sub>) oxidation at low-OH conditions in the Jülich Plant Atmosphere Chamber (JPAC). The ions were identified as clusters of the nitrate ion (NO<sub>3</sub><sup>−</sup>) and α-pinene oxidation products reaching oxygen to carbon ratios of 0.7–1.3, while retaining most of the initial ten carbon atoms. Attributing the ions to clusters instead of single molecules was based on additional observations of the same extremely oxidized organics in clusters with HSO<sub>4</sub><sup>−</sup> (Hyytiälä) and C<sub>3</sub>F<sub>5</sub>O<sub>2</sub><sup>−</sup> (JPAC). The most abundant products in the ion spectra were identified as C<sub>10</sub>H<sub>14</sub>O<sub>7</sub>, C<sub>10</sub>H<sub>14</sub>O<sub>9</sub>, C<sub>10</sub>H<sub>16</sub>O<sub>9</sub>, and C<sub>10</sub>H<sub>14</sub>O<sub>11</sub>. The mechanism responsible for forming these molecules is still not clear, but the initial reaction is most likely ozone attack at the double bond, as the ions are mainly observed under dark conditions. β-pinene also formed highly oxidized products under the same conditions, but less efficiently, and mainly C<sub>9</sub> compounds which were not observed in Hyytiälä, where β-pinene on average is 4–5 times less abundant than α-pinene. Further, to explain the high O/C together with the relatively high H/C, we propose that geminal diols and/or hydroperoxide groups may be important. We estimate that the night-time concentration of the sum of the neutral extremely oxidized products is on the order of 0.1–1 ppt (~10<sup>6</sup>–10<sup>7</sup> molec cm<sup>−3</sup>). This is in a similar range as the amount of gaseous H<sub>2</sub>SO<sub>4</sub> in Hyytiälä during day-time. As these highly oxidized organics are roughly 3 times heavier, likely with extremely low vapor pressures, their role in the initial steps of new aerosol particle formation and growth may be important and needs to be explored in more detail in the future