Implementing a new style of learning in a taught postgraduate medical ultrasound programme: Reflections on the first year

The successful introduction of an action based learning (ABL) module into the medical ultrasound programme several years ago, has led to further developments using this approach. Conflicting pressures from hospital departments requesting increasing numbers of subject specialty areas to be taught, and university managers requiring modules to be economically viable, resulted in a more creative approach to delivery of the programme. ABL requires students to take responsibility for their own learning, thereby promoting independent learning. This is generally recognised as a more effective method for acquiring knowledge and skills, particularly at postgraduate level. Following completion of the first year of this newly accredited module, the experiences of students and staff were evaluated. Results of the evaluation and feedback demonstrated that students initially struggle to understand the concept of ABL. However, results of student assessments showed that once individuals engage with the process, knowledge and skills can be successfully acquired, demonstrating that this style of learning is a tool which can be potentially used in many aspects of life. © 2009 British Medical Ultrasound Society

Funding and commissioning issues for undergraduate and postgraduate healthcare education

The model of healthcare training whereby the National Health Service (NHS) has responsibility for provision, is disappearing with the future direction being that of education providers needing to respond to commissioners’ requests and being able to evidence the capability to train. The intention is to establish a clear linkage between the educational needs of the future healthcare workforce and improved patient outcomes, along with developing a flexible approach to providing quality patient centred care. Training institutions will have greater accountability for the education of the future healthcare workforce, particularly with regard to quality metrics. There will be a requirement for an innovative approach to be adopted in terms of learning, teaching and assessment pedagogies, and the training provision will have to constantly evolve to meet the changing needs of the healthcare workforce. Individuals being trained now will need to be flexible, willing to continuously learn and develop, and be more comfortable with technology and change than any previous set of graduates. Education providers of the future will need to lead the way in improving the quality of education and developing innovative training. Radical changes to the way the service is commissioned in the past have resulted in similar requirements to adapt educational provision, and providers will need to learn from these experiences. The requirement to move towards a more commercial model, and apply this to the NHS educational setting, will mean that examples from the private sector will need to be reviewed.Providers of education for the Allied Health Professions (AHPs) will be required to recognise the need to support the whole workforce, from assistant to consultant level, mapping against the clinical domains outlined in the NHS Outcomes Framework publication. This will involve clear identification of preceptorship, mentorship and lifelong learning in the form of Continued Professional and Personal Development (CPPD). Importantly, Radiography as a profession will need to model future workforce education and training around the adoption of new technology, research and innovation, and further promote itself within the realms of academic and clinical practice. The introduction of Local Education Training Boards (LETBs) and Academic Health Science Networks (AHSNs) will also have integral roles in the translation, development and provision of new curricula, whilst ensuring involvement and appropriate scrutiny from the relevant regulatory professional bodies

Independent reporting sonographers: Could other countries follow the UK's lead?

IntroductionFor many years, the majority of ultrasound examinations in the United Kingdom (UK), both obstetric and non-obstetric, have been performed by radiographers who have undergone postgraduate training. These sonographers scan, interpret and report their own examinations. Today, sonographer-led ultrasound services are an essential and well established part of diagnostic imaging departments. This model however, appears to be unique, with very little evidence of sonographers in countries outside the UK, appearing to offer a similar level of service.MethodsA literature review was undertaken to investigate the background to the evolution of independent reporting in the UK. An exploration of the variable sonography services in other parts of the world was initiated, to obtain some insight into whether the UK model is practised elsewhere. ResultsIn the UK a successful model for ultrasound services has been practised for almost thirty years, with sonographers performing and reporting on ultrasound examinations. This practice is evidence-based with studies showing that detection rates and accuracy for ultrasound examinations are similar for sonographers and radiologists. The importance of good working relations with radiology colleagues and rigorous education and training was apparent in the development of successful sonography reporting practices in the UK.No other country relies so heavily on sonographers. Throughout mainland Europe, physicians and general practitioners perform a significant proportion of ultrasound examinations. In other countries, sonographers may perform the scans but reporting remains primarily the domain of the overseeing medical staff. ConclusionTraditionally, in the UK sonographers work closely alongside radiologists and it is this team-working, along with escalating demand, which has helped lead to the success of the current model. Rigorous professional guidelines and training programmes for sonographers in the UK, have helped to ensure high standards of practice amongst sonographers.The escalating need for ultrasound services is now causing some physicians from other parts of the world to start focusing their attention on the UK model as a possible solution to meet demand. Looking to the future, it is anticipated that more sonographer-led ultrasound departments will start to emerge and independent reporting will become common practice for sonographers. In order to support this however, it is important that appropriate, rigorous training programmes are established, and those who aspire to be independent reporting sonographers will need to forge good working relationships with medical colleagues

Nature-based interventions in institutional and organisational settings:A scoping review

The objective of this review was to scope the literature on nature-based interventions that could be conducted in institutional settings where people reside full-time for care or rehabilitation purposes. Systematic searches were conducted across CINAHL, Medline, Criminal Justice Abstracts, PsycINFO, Scopus, Social Care Online and Cochrane CENTRAL. A total of 85 studies (reported in 86 articles) were included. Four intervention modalities were identified: Gardening/therapeutic horticulture; animal-assisted therapies; care farming and virtual reality-based simulations of natural environments. The interventions were conducted across a range of settings, including inpatient wards, care homes, prisons and women’s shelters. Generally, favourable impacts were seen across intervention types, although the reported effects varied widely. There is a growing body of literature on nature-based interventions that could be applied to a variety of institutional settings. Within most intervention types, there is sufficient research data available to perform full systematic reviews. Recommendations for future systematic reviews are offered.</p

Genetic variation within genes associated with mitochondrial function is significantly associated with later age at onset of Parkinson disease and contributes to disease risk

Mitochondrial dysfunction has been implicated in the aetiology of monogenic Parkinson’s disease (PD). Yet the role that mitochondrial processes play in the most common form of the disease; sporadic PD, is yet to be fully established. Here we comprehensively assessed the role of mitochondrial function associated genes in sporadic PD by leveraging improvements in the scale and analysis of PD GWAS data with recent advances in our understanding of the genetics of mitochondrial disease. First, we identified that a proportion of the “missing heritability” of the PD can be explained by common variation within genes implicated in mitochondrial disease (primary gene list) and mitochondrial function (secondary gene list). Next we calculated a mitochondrial-specific polygenic risk score (PRS) and showed that cumulative small effect variants within both our primary and secondary gene lists are significantly associated with increased PD risk. Most significantly we further report that the PRS of the secondary mitochondrial gene list was significantly associated with later age at onset. Finally, to identify possible functional genomic associations we implemented Mendelian randomisation, which showed that 14 of these mitochondrial function associated genes showed functional consequence associated with PD risk. Further analysis suggested that the 14 identified genes are not only involved in mitophagy but implicate new mitochondrial processes. Our data suggests that therapeutics targeting mitochondrial bioenergetics and proteostasis pathways distinct from mitophagy could be beneficial to treating the early stage of PD

Monitoring the Depth of Anaesthesia

One of the current challenges in medicine is monitoring the patients’ depth of general anaesthesia (DGA). Accurate assessment of the depth of anaesthesia contributes to tailoring drug administration to the individual patient, thus preventing awareness or excessive anaesthetic depth and improving patients’ outcomes. In the past decade, there has been a significant increase in the number of studies on the development, comparison and validation of commercial devices that estimate the DGA by analyzing electrical activity of the brain (i.e., evoked potentials or brain waves). In this paper we review the most frequently used sensors and mathematical methods for monitoring the DGA, their validation in clinical practice and discuss the central question of whether these approaches can, compared to other conventional methods, reduce the risk of patient awareness during surgical procedures

Identification of novel risk loci, causal insights, and heritable risk for Parkinson's disease: a meta-analysis of genome-wide association studies

Background Genome-wide association studies (GWAS) in Parkinson's disease have increased the scope of biological knowledge about the disease over the past decade. We aimed to use the largest aggregate of GWAS data to identify novel risk loci and gain further insight into the causes of Parkinson's disease. Methods We did a meta-analysis of 17 datasets from Parkinson's disease GWAS available from European ancestry samples to nominate novel loci for disease risk. These datasets incorporated all available data. We then used these data to estimate heritable risk and develop predictive models of this heritability. We also used large gene expression and methylation resources to examine possible functional consequences as well as tissue, cell type, and biological pathway enrichments for the identified risk factors. Additionally, we examined shared genetic risk between Parkinson's disease and other phenotypes of interest via genetic correlations followed by Mendelian randomisation. Findings Between Oct 1, 2017, and Aug 9, 2018, we analysed 7·8 million single nucleotide polymorphisms in 37 688 cases, 18 618 UK Biobank proxy-cases (ie, individuals who do not have Parkinson's disease but have a first degree relative that does), and 1·4 million controls. We identified 90 independent genome-wide significant risk signals across 78 genomic regions, including 38 novel independent risk signals in 37 loci. These 90 variants explained 16–36% of the heritable risk of Parkinson's disease depending on prevalence. Integrating methylation and expression data within a Mendelian randomisation framework identified putatively associated genes at 70 risk signals underlying GWAS loci for follow-up functional studies. Tissue-specific expression enrichment analyses suggested Parkinson's disease loci were heavily brain-enriched, with specific neuronal cell types being implicated from single cell data. We found significant genetic correlations with brain volumes (false discovery rate-adjusted p=0·0035 for intracranial volume, p=0·024 for putamen volume), smoking status (p=0·024), and educational attainment (p=0·038). Mendelian randomisation between cognitive performance and Parkinson's disease risk showed a robust association (p=8·00 × 10−7). Interpretation These data provide the most comprehensive survey of genetic risk within Parkinson's disease to date, to the best of our knowledge, by revealing many additional Parkinson's disease risk loci, providing a biological context for these risk factors, and showing that a considerable genetic component of this disease remains unidentified. These associations derived from European ancestry datasets will need to be followed-up with more diverse data. Funding The National Institute on Aging at the National Institutes of Health (USA), The Michael J Fox Foundation, and The Parkinson's Foundation (see appendix for full list of funding sources)

A framework for human microbiome research

A variety of microbial communities and their genes (the microbiome) exist throughout the human body, with fundamental roles in human health and disease. The National Institutes of Health (NIH)-funded Human Microbiome Project Consortium has established a population-scale framework to develop metagenomic protocols, resulting in a broad range of quality-controlled resources and data including standardized methods for creating, processing and interpreting distinct types of high-throughput metagenomic data available to the scientific community. Here we present resources from a population of 242 healthy adults sampled at 15 or 18 body sites up to three times, which have generated 5,177 microbial taxonomic profiles from 16S ribosomal RNA genes and over 3.5 terabases of metagenomic sequence so far. In parallel, approximately 800 reference strains isolated from the human body have been sequenced. Collectively, these data represent the largest resource describing the abundance and variety of the human microbiome, while providing a framework for current and future studies

Structure, function and diversity of the healthy human microbiome

Author Posting. © The Authors, 2012. This article is posted here by permission of Nature Publishing Group. The definitive version was published in Nature 486 (2012): 207-214, doi:10.1038/nature11234.Studies of the human microbiome have revealed that even healthy individuals differ remarkably in the microbes that occupy habitats such as the gut, skin and vagina. Much of this diversity remains unexplained, although diet, environment, host genetics and early microbial exposure have all been implicated. Accordingly, to characterize the ecology of human-associated microbial communities, the Human Microbiome Project has analysed the largest cohort and set of distinct, clinically relevant body habitats so far. We found the diversity and abundance of each habitat’s signature microbes to vary widely even among healthy subjects, with strong niche specialization both within and among individuals. The project encountered an estimated 81–99% of the genera, enzyme families and community configurations occupied by the healthy Western microbiome. Metagenomic carriage of metabolic pathways was stable among individuals despite variation in community structure, and ethnic/racial background proved to be one of the strongest associations of both pathways and microbes with clinical metadata. These results thus delineate the range of structural and functional configurations normal in the microbial communities of a healthy population, enabling future characterization of the epidemiology, ecology and translational applications of the human microbiome.This research was supported in part by National Institutes of Health grants U54HG004969 to B.W.B.; U54HG003273 to R.A.G.; U54HG004973 to R.A.G., S.K.H. and J.F.P.; U54HG003067 to E.S.Lander; U54AI084844 to K.E.N.; N01AI30071 to R.L.Strausberg; U54HG004968 to G.M.W.; U01HG004866 to O.R.W.; U54HG003079 to R.K.W.; R01HG005969 to C.H.; R01HG004872 to R.K.; R01HG004885 to M.P.; R01HG005975 to P.D.S.; R01HG004908 to Y.Y.; R01HG004900 to M.K.Cho and P. Sankar; R01HG005171 to D.E.H.; R01HG004853 to A.L.M.; R01HG004856 to R.R.; R01HG004877 to R.R.S. and R.F.; R01HG005172 to P. Spicer.; R01HG004857 to M.P.; R01HG004906 to T.M.S.; R21HG005811 to E.A.V.; M.J.B. was supported by UH2AR057506; G.A.B. was supported by UH2AI083263 and UH3AI083263 (G.A.B., C. N. Cornelissen, L. K. Eaves and J. F. Strauss); S.M.H. was supported by UH3DK083993 (V. B. Young, E. B. Chang, F. Meyer, T. M. S., M. L. Sogin, J. M. Tiedje); K.P.R. was supported by UH2DK083990 (J. V.); J.A.S. and H.H.K. were supported by UH2AR057504 and UH3AR057504 (J.A.S.); DP2OD001500 to K.M.A.; N01HG62088 to the Coriell Institute for Medical Research; U01DE016937 to F.E.D.; S.K.H. was supported by RC1DE0202098 and R01DE021574 (S.K.H. and H. Li); J.I. was supported by R21CA139193 (J.I. and D. S. Michaud); K.P.L. was supported by P30DE020751 (D. J. Smith); Army Research Office grant W911NF-11-1-0473 to C.H.; National Science Foundation grants NSF DBI-1053486 to C.H. and NSF IIS-0812111 to M.P.; The Office of Science of the US Department of Energy under Contract No. DE-AC02-05CH11231 for P.S. C.; LANL Laboratory-Directed Research and Development grant 20100034DR and the US Defense Threat Reduction Agency grants B104153I and B084531I to P.S.C.; Research Foundation - Flanders (FWO) grant to K.F. and J.Raes; R.K. is an HHMI Early Career Scientist; Gordon&BettyMoore Foundation funding and institutional funding fromthe J. David Gladstone Institutes to K.S.P.; A.M.S. was supported by fellowships provided by the Rackham Graduate School and the NIH Molecular Mechanisms in Microbial Pathogenesis Training Grant T32AI007528; a Crohn’s and Colitis Foundation of Canada Grant in Aid of Research to E.A.V.; 2010 IBM Faculty Award to K.C.W.; analysis of the HMPdata was performed using National Energy Research Scientific Computing resources, the BluBioU Computational Resource at Rice University

The development of an innovative approach to postgraduate ultrasound education: An evolving process

Increasing economic pressures on higher education institutions to limit the number of modules offered, together with the conflicting pressure from hospital departments requiring an increasingly skilled and flexible workforce, have resulted in the requirement for a more creative approach to delivery of university postgraduate programmes. One approach implemented at the University of the West of England, Bristol was to extend the role of an Action Based Learning (ABL) module within the Medical Ultrasound programme. Following completion of the first year of this newly accredited module, the experiences of students and staff were evaluated. Results of the evaluation and feedback demonstrated both positive and negative features of this style of learning, and the programme team decided to use this feedback to enhance the student experience for future cohorts undertaking the module. The second delivery of this module is now complete, and the module has again been evaluated. The following article discusses the evolutionary process involved in developing this module, and reviews the enhancements introduced over a two-year period. © 2010 The College of Radiographers