The challenges of widening access to the medical profession: how to facilitate medical careers for those at a genuine disadvantage

Widening Participation (WP) for medical school entry has been politically encouraged to ensure access and participation for underrepresented groups rarely able to gain access to this high demand profession. Those who reside in the 20-40% most deprived postcodes in Scotland (SIMD20) are much less likely to apply for medical school entrance, and even less likely to succeed. The National Reach programme in Scotland aims to rectify the existing situation by encouraging and supporting students from working class backgrounds to apply to high demand courses, including medicine, and has achieved great success in helping pupils from target secondary schools to gain a place in Glasgow Medical School. However, some of the Reach students have similar demographics to the rest of the medical school class and arguably do not genuinely belong in the target group. To address this, a second flag based on SIMD20 residence was employed. However, applying more than one WP flag - while substantially improving the targeting of this programme and helping those who truly are multiply deprived - reduces the Reach-eligible applicant pool to the point of undermining the high WP targets imposed on Universities. But using only a single criterion of MD20 residence or school progression rate would unfairly advantage some pupils that are actually not disadvantaged. Ideally, individualised indicators such as eligibility for Free School Meals, possession of an Educational Maintenance Allowance or receipt of a UKCAT bursary, would complement residential data and school progression rates. This paper reflects on the evolution of the admissions practices in our medical school designed to comply with the targets, but also create a medical workforce reflecting the population it serves

Effect of Secretin, Cholecystokinin Octapeptide (CCK-8) and a Somatostatin Analogue on Experimental Pancreatic Carcinogenesis

The incidence of pancreatic cancer has increased throughout the world in the last 60 years such that it is now the fourth leading cause of cancer death in the United Kingdom. The tumour usually presents at an advanced stage and cure is rarely possible. Extensive epidemiological investigations during this century suggest that cigarette smoking is the most consistent aetiological factor in the development of pancreatic cancer. Differences in dietary consumption of meat, fat, fruit and vegetables have also been implicated in altering susceptibility to this tumour; high consumption of fat and protein has been thought to increase risk while consumption of fruit and vegetables has been thought to be protective. It remains unclear how these dietary differences affect the risk of developing pancreatic cancer. One possible mechanism that has been suggested for the effects of protein and fat in this regard has been through their influence on endogenous secretion of gastrointestinal hormones such as secretin and cholecystokinin. The late presentation of pancreatic cancer in man makes investigation of the early stage of the carcinogenic process impossible. Two animal models of pancreatic carcinogenesis have been developed in the last 20 years which have allowed investigators to increase our knowledge of some of the processes which go on in this disease. Azaserine has been shown to induce pancreatic acinar cell tumours in rats whereas the nitrosamine family of chemicals, in particular N- nitrosobis(2-oxopropyl)amine (BOP), induces pancreatic tumours with a ductal or ductular morphology in the Syrian golden hamster. The BOP hamster has generally been accepted as the best model for investigating aspects of pancreatic carcinogenesis. In addition to the fact that the tumour induced in the hamster is morphologically similar to the commonest form of human pancreatic cancer (namely ductal adenocarcinoma), the clinical features in the hamster with advanced disease resemble those seen in man, including a propensity for the tumour to metastasize to the liver and other organs. The BOP hamster model has been used widely to investigate some of the factors which might predispose to the development of pancreatic cancer in man. Given that secretin and cholecystokinin have been implicated in the role of diet in the aetiology of human pancreatic cancer, the effects of these and other gastrointestinal hormones have been investigated in the BOP-hamster model. Cholecystokinin and a number of its analogues and secretin have been reported to increase the incidence and extent of BOP induced pancreatic cancer in hamsters. Somatostatin, a gastrointestinal hormone with numerous, predominantly inhibitory, actions, (and largely because of these inhibitory properties,) has been proposed as a possible treatment for pancreatic cancer in man. The aims of this thesis were to investigate the effects of secretin, an octapeptide analogue of cholecystokinin (CCK-8) and a long-acting somatostatin analogue (SMS 201-995) on BOP induced pancreatic carcinogenesis in the Syrian hamster. The hamster model was successfully established. Intraperitoneal (IP) and subcutaneous (SC) BOP were compared for effect on the pancreas. Lesions seen throughout the 20 weeks study period were as previously reported in the literature for both groups. The degree and extent of pre-malignant and malignant change seemed to be greater after 20 weeks in the SC group compared to the IP group. In the second experiment, CCK-8 and secretin stimulated pancreatic juice output when infused intravenously. Pancreatic juice protein and bicarbonate output were also increased. SMS 201-995 suppressed pancreatic juice output. When infused simultaneously with either secretin or CCK-8, SMS 201-995 was still able to suppress pancreatic juice output. Repeated SC injections of secretin, CCK-8 and SMS 201-995 did not have any effect on pancreatic wet weight or DNA content after one or six weeks of treatment. When administered with the carcinogen BOP, CCK-8 did not seem to influence pancreatic carcinogenesis. Secretin and, surprisingly, SMS 201-995, did seem to promote the development of pre-malignant and malignant pancreatic lesions seen histologically. Given that small doses of SMS 201-995 seem to promote pancreatic carcinogenesis in the hamster model, and given the wide interperson variation seen in man in relation to the pharmacology of many compounds, further investigation into the properties of somatostatin analogues should be undertaken before suggesting that these substances should be used to treat human pancreatic cancer. (Abstract shortened by ProQuest.)

Questioning the rise of gelatinous zooplankton in the World's oceans

During the past several decades, high numbers of gelatinous zooplankton species have been reported in many estuarine and coastal ecosystems. Coupled with media-driven public perception, a paradigm has evolved in which the global ocean ecosystems are thought to be heading toward being dominated by “nuisance” jellyfish. We question this current paradigm by presenting a broad overview of gelatinous zooplankton in a historicalcontext to develop the hypothesis that population changes reflect the human-mediated alteration of global ocean ecosystems. To this end, we synthesize information related to the evolutionary context of contemporary gelatinous zooplankton blooms, the human frame of reference forchanges in gelatinous zooplankton populations, and whether sufficient data are available to have established the paradigm. We conclude that the current paradigm in which it is believed that there has been a global increase in gelatinous zooplankton is unsubstantiated, and we develop a strategy for addressing the critical questions about long-term, human-related changes in the sea as they relate to gelatinous zooplankton blooms

Shifts between gelatinous and crustacean plankton in a coastal upwellin region

proyectos RADIALES (IEO) y EURO-BASIN (Ref. 264933, 7FP)Variability in the dominance of copepods vs. gelatinous plankton was analysed using monthly time-series covering the last 55 years and related to changes in climatic, oceanographic, and fishery conditions in the upwelling region of Galicia (NW Spain). Seasonality was generally the main component of variability in all groups, both along the coast and in the nearby ocean, but no common long-term trend was found. Coastal copepods increased since the early 1990s, and gelatinous plankton increased in the ocean during the 1980s. Different trends were found for gelatinous plankton in two coastal sites, characterized by increases in either medusae or tunicates. In all series, multiyear periods of relative dominance of gelatinous vs. copepod plankton were evident. In general, copepod periods were observed in positive phases of the main modes of regional climatic variability. Conversely, gelatinous periods occurred during negative climatic phases. However, the low correlations between gelatinous plankton and climatic, oceanographic, or fishery variables suggest that local factors play a major role in their proliferations.7FP, IEOPreprin

An early Phase II randomised controlled trial testing the effect on persecutory delusions of using CBT to reduce negative cognitions about the self: the potential benefits of enhancing self confidence

Background Research has shown that paranoia may directly build on negative ideas about the self. Feeling inferior can lead to ideas of vulnerability. The clinical prediction is that decreasing negative self cognitions will reduce paranoia. Method Thirty patients with persistent persecutory delusions were randomised to receive brief CBT in addition to standard care or to standard care (ISRCTN06118265). The six session intervention was designed to decrease negative, and increase positive, self cognitions. Assessments at baseline, 8 weeks (posttreatment) and 12 weeks were carried out by a rater blind to allocation. The primary outcomes were posttreatment scores for negative self beliefs and paranoia. Secondary outcomes were psychological well-being, positive beliefs about the self, persecutory delusions, social comparison, self-esteem, anxiety, and depression. Results Trial recruitment and retention were feasible and the intervention highly acceptable to the patients. All patients provided follow-up data. Posttreatment there was a small reduction in negative self beliefs (Cohen's d = 0.24) and a moderate reduction in paranoia (d = 0.59), but these were not statistically significant. There were statistically significant improvements in psychological well-being (d = 1.16), positive beliefs about the self (d = 1.00), negative social comparison (d = 0.88), self-esteem (d = 0.62), and depression (d = 0.68). No improvements were maintained. No adverse events were associated with the intervention. Conclusions The intervention produced short-term gains consistent with the prediction that improving cognitions about the self will reduce persecutory delusions. The improvement in psychological well-being is important in its own right. We recommend that the different elements of the intervention are tested separately and that the treatment is lengthened

A multi-centre, randomised controlled trial of cognitive therapy to prevent harmful compliance with command hallucinations

<p>Abstract</p> <p>Background</p> <p>Command hallucinations are among the most distressing, high risk and treatment resistant symptoms for people with psychosis; however, currently, there are no evidence-based treatment options available for this group. A cognitive therapy grounded in the principles of the Social Rank Theory, is being evaluated in terms of its effectiveness in reducing harmful compliance with command hallucinations.</p> <p>Methods/Design</p> <p>This is a single blind, intention-to-treat, multi-centre, randomized controlled trial comparing Cognitive Therapy for Command Hallucinations + Treatment as Usual with Treatment as Usual alone. Eligible participants have to fulfil the following inclusion criteria: i) ≥16 years; ii) ICD-10 diagnosis of schizophrenia or related disorder; iii) command hallucinations for at least 6 months leading to risk of harm to self or others. Following the completion of baseline assessments, eligible participants will be randomly allocated to either the Cognitive Therapy for Command Hallucinations + Treatment as Usual group or the Treatment as Usual group. Outcome will be assessed at 9 and 18 months post randomization with assessors blind to treatment allocation. The primary outcome is compliance behaviour and secondary outcomes include beliefs about voices' power, distress, psychotic symptoms together with a health economic evaluation. Qualitative interviews with services users will explore the acceptability of Cognitive Therapy for Command Hallucinations.</p> <p>Discussion</p> <p>Cognitive behaviour therapy is recommended for people with psychosis; however, its focus and evaluation has primarily revolved around the reduction of psychotic symptoms. In this trial, however, the focus of the cognitive behavioural intervention is on individuals' appraisals, behaviour and affect and not necessarily symptoms; this is also reflected in the outcome measures used. If successful, the results will mark a significant breakthrough in the evidence base for service users and clinicians and will provide a treatment option for this group where none currently exist. The trial will open the way for further breakthrough work with the 'high risk' population of individuals with psychosis, which we would intend to pursue.</p> <p>Trial registration</p> <p>ISRCTN: <a href="http://www.controlled-trials.com/ISRCTN62304114">ISRCTN62304114</a></p

The 12 Item Social and Economic Conservatism Scale (SECS)

Recent years have seen a surge in psychological research on the relationship between political ideology (particularly conservatism) and cognition, affect, behaviour, and even biology. Despite this flurry of investigation, however, there is as yet no accepted, validated, and widely used multi-item scale of conservatism that is concise, that is modern in its conceptualisation, and that includes both social and economic conservatism subscales. In this paper the 12-Item Social and Economic Conservatism Scale (SECS) is proposed and validated to help fill this gap. The SECS is suggested to be an important and useful tool for researchers working in political psychology

SlowMo, a digital therapy targeting reasoning in paranoia, versus treatment as usual in the treatment of people who fear harm from others: study protocol for a randomised controlled trial

Background: Paranoia is one of the most common symptoms of schizophrenia-spectrum disorders, and is associated with significant distress and disruption to the person’s life. Developing more effective and accessible psychological interventions for paranoia is a clinical priority. Our research team has approached this challenge in two main ways: firstly, by adopting an interventionist causal approach to increase effectiveness and secondly, by incorporating user-centred inclusive design methods to enhance accessibility and usability. Our resultant new digital intervention, SlowMo, intensively targets a reasoning style associated with paranoia, fast thinking, characterised by jumping to conclusions and belief inflexibility. It consists of an easy-to-use, enjoyable and memorable digital interface. An interactive web-based app facilitates delivery of face-to-face meetings which is then synchronised with an innovative mobile app for use in daily life. Methods/Design: We aim to test the clinical efficacy of SlowMo over 24 weeks to determine the mechanisms through which it reduces paranoia, and to identify participant characteristics that moderate its effectiveness. In a parallel-group randomised controlled trial, with 1:1 allocation, 360 participants with distressing persecutory beliefs will be independently randomised to receive either the SlowMo intervention added to treatment as usual (TAU) or TAU, using randomly varying permuted blocks, stratified by paranoia severity and site. Research workers will be blind to therapy allocation. The primary outcome is paranoia severity over 24 weeks; our hypothesised mechanism of change is reasoning; moderators include negative symptoms and working memory; and secondary outcomes include wellbeing, quality of life, and service use. The accessibility, usability and acceptability of the digital platform will be assessed. Discussion: SlowMo has been developed as the first blended digital therapy to target fears of harm from others through an inclusive design approach. In addition to testing its efficacy, this trial will add to our understanding of psychological mechanisms in paranoia. The study will examine the usability and adherence of a novel digital therapy, including an app for self-management, in a large sample of people affected by severe mental health difficulties